Evaluation of Clinical Efficacy of Combined Use of Acupuncture and Medicine in Treating Sleep Disorder in Patients with Anxiety Disorder

[Objectives]To evaluate the clinical efficacy of combined acupuncture and medicine in the treatment of sleep disorders in patients with anxiety disorders.[Methods]A total of 300 anxiety patients with sleep disorders were randomly selected and divided into a research group and a control group,with 150 cases in each group.The control group was administered with western medicine,and the research group was treated with acupuncture and medicine to compare their clinical treatment effects.[Results]The total effective rate of treatment in the research group was significantly higher than that in the control group;after treatment,both the PSQI and SAS scores of the two groups were significantly reduced,and the reduction degree of the research group was higher than that of the control group,the difference was statistically significant(P<0.05).[Conclusions]Combined use of acupuncture and medicine to treat sleep disorders in patients with anxiety disorders has better curative effect and fewer adverse reactions,so it has high clinical application value.

Sleep breathing disorders in female population of Dubai, UAE

PURPOSE: United Arab Emirates (UAE) is part of the GCC countries and ranks 18 on 2007 WHO list of the fattest countries with 68.3% of its citizens with an unhealthy weight. The WHO data in 2008 state that the prevalence of overweight in UAE is 71%, while it is 61% in the UK, 54% in Germany, and 45% in France. The increasing overweight and obesity in the UAE are closely related to high social-economic development. Accordingly, the medical authority has observed that the rates of hypertension and diabetes mellitus type 2 appear to be one of the highest rates worldwide. We presume that the increase prevalence of obesity in the UAE would be linked to the increase in prevalence of obstructive sleep apnea syndrome (OSAS). The purpose of this study is to estimate the prevalence of symptoms and risk of OSAS in women followed up in the primary health care (PHC) setting in Dubai and the relationship between obesity and sleep apnea in females in the UAE. DESIGN: Prospective observational community-based survey. SETTING: 20 primary health centers in Dubai. PARTICI-PANTS: Consecutive female patients who were older than 14 years, regardless of the reason of their visit. METHODS: In this prospective survey, trained medical nurse administered the Berlin Questionnaire (which includes questions about self-reported snoring, witnessed apneas, daytime sleepiness, hypertension, and obesity) to a consecutive random sample of female patients in the age group older than 14 years, attending the PHC center in Dubai Health Authority, Dubai, UAE, from September 2011 to March 2012. Based on the questionnaire, individuals were classified into high-risk and low-risk groups for OSAS. RESULTS: Based on the responses and measurement of the Berlin Questionnaire of 704 female subjects studied, 137 respondents met the criteria for the high-risk scoring. This gives a prevalence rate of 19.5% while the remainders of the participants were classified as low risk. The overall mean age of the high risk for OSAS female respondents was 39.95 ± 11.73 years. The highest prevalence was noticed between age group 51 to 60 years. 70% of the high risk group patients had Body Mass Index (BMI) ≥30 kg/m2 and nearly 75% of the low risk group had BMI 2 and the Mean BMI was 33.59 ± 6.44 kg/m2. CONCLUSIONS: One in five women in Dubai, UAE is at high risk of having OSAS. Awareness by the primary care medical community about this disorder in females should be increased so that the patients would benefit from proper evaluation and treatment of OSAS.

The good,the bad,and the ugly of consumer sleep technologies use among athletes:A call for action

1.Introduction For athletes,the quality and quantity of sleep are essential elements for optimizing recovery and subsequent performance.1 Unfortunately,athletes frequently face challenges getting sufficient,high-quality sleep.2 A recent systematic review and meta-analysis of 81 studies involving 1830 athletes concluded that compared to healthy non-athletes,athletes'sleep duration was shorter with poorer sleep efficiency.

Role of Cannabinoid CB1 Receptor in Object Recognition Memory Impairment in Chronically Rapid Eye Movement Sleep-deprived Rats

Objective We aimed to investigate whether antagonism of the cannabinoid CB1 receptor(CB1R)could affect novel object recognition(NOR)memory in chronically rapid eye movement sleep-deprived(RSD)rats.Methods The animals were examined for recognition memory following a 7-day chronic partial RSD paradigm using the multiple platform technique.The CB1R antagonist rimonabant(1 or 3 mg/kg,i.p.)was administered either at one hour prior to the sample phase for acquisition,or immediately after the sample phase for consolidation,or at one hour before the test phase for retrieval of NOR memory.For the reconsolidation task,rimonabant was administered immediately after the second sample phase.Results The RSD episode impaired acquisition,consolidation,and retrieval,but it did not affect the reconsolidation of NOR memory.Rimonabant administration did not affect acquisition,consolidation,and reconsolidation;however,it attenuated impairment of the retrieval of NOR memory induced by chronic RSD.Conclusions These findings,along with our previous report,would seem to suggest that RSD may affect different phases of recognition memory based on its duration.Importantly,it seems that the CB1R may,at least in part,be involved in the adverse effects of chronic RSD on the retrieval,but not in the acquisition,consolidation,and reconsolidation,of NOR memory.

Effect of Sleep Hygiene Orientation on Social Cognition Impairments Due to Chronic Sleep Restriction in Mexican Medical Residents

Introduction: Sleep is critical to human physiological function, cognitive performance, and emotional regulation. Healthcare personnel, especially physicians, are chronically exposed to long working hours, which are often accompanied by decreased sleep time. Clinical evidence indicates that these conditions affect their cognitive function and professional practice, but researchers in the field have not sufficiently explored the possible effects of reductions in sleep time on social cognition. Objective: The aim of this is to further explore the effects of sleep restriction among medical residents, the specific impairments in social cognition that it produces, and the effects of a sleep hygiene orientation on those impairments. Method: There were 124 medical residents (50 males, 74 females) who completed a daily sleep/work log, a battery of sleep tests/questionnaires, and neuropsychological evaluations. The participants then received a short course (8 hours) on basic concepts of sleep hygiene and sleep psychoeducation. Once the course was completed, participants filled out the questionnaires again. Results: The results indicate that sleep disturbances in medical residents were associated with severe neurocognitive and social cognition impairments. After the sleep hygiene intervention, neuropsychological function and sleep parameters improved, awareness increased, and social cognition performance significantly improved. Conclusion: Using sleep psychoeducation and sleep hygiene intervention in medical residents is a simple strategy to mitigate the effects of sleep restriction.

Obstructive sleep apnea syndrome and cardiovascular disease: The influence of C-reactive protein

Obstructive sleep apnea syndrome(OSAS) is a common medical condition, associated with atherosclerosis and cardiovascular disease(CVD). The underlying pathophysiologic mechanisms of this association have not been completely understood and may be multifactorial in origin. A number of studies suggest that inflammatory processes have emerged critical in the pathogenesis of CVD in OSAS. A range of circulating inflammatory molecules has been identified and measured, with a view to assess inflammation and predict vascular damage risk, such as plasma cytokines, adhesion molecules, and C-reactive protein(CRP). CRP is a relevant marker worthy of further study, because not only is elevated in patients with OSAS, but also is rapidly becoming a risk factor for cardiac disease. Furthermore, in selected OSAS patients, aggressive treatment of the disorder may lead to retarding or even improvement of CVD progression. However, still there is a debate on the true correlation between CRP and OSAS, as well as the clinical effect of any reduction after OSAS treatment. Further research is required to define those OSAS patients who will have a considerable reduction with treatment, as well as to understand the significance of the interaction between cardiovascular risk factor and CRP reduction in patients with OSAS.

Anshen Babu Ointment Improves Sleep Function of Insomnia Mice and Its Mechanism

[Objectives]This study aimed to study the sleep-improving effect of Anshen Babu ointment on insomnia mice and its mechanism of action.[Methods]Mouse models of insomnia were established by p-chlorophenylalanine(PCPA)injection.They were given high,middle and low doses of Anshen Babu ointment,for 7 consecutive days,and then,the spontaneous activity of insomnia mice and the effect on hypnotic time and subthreshold hypnotic dose of pentobarbital sodium were observed,and the levels of 5-HT,IL-6 and TNF-α in the hippocampus of mice were determined.[Results]High and middle-dose Anshen Babu ointment significantly reduced the spontaneous activity of insomnia mice and shorten the hypnotic time of pentobarbital sodium;high and middle-dose Anshen Babu ointment increased the 5-HT content and inhibited the IL-6 and TNF-α expression in the hippocampus of mice.[Conclusions]Anshen Babu ointment has hypnotic and sedative effect on insomnia mice.The mechanism may be achieved by increasing 5-HT and reducing IL-6 and TNF-α levels.

Relationship between metabolic syndrome and hypercapnia among obese patients with sleep apnea Relationship between metabolic syndrome and hypercapnia among obese patients with sleep apnea

BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime hypercapnia,and the condition is called obesity hypoventilation syndrome.However,mechanisms for such daytime hypoventilation remain unclear.AIM To investigate metabolic syndrome and daytime hypercapnia association based on hypercapnia prevalence in obese OSA patients in a nested case-control study.METHODS Consecutive obese patients(body mass index≥30 kg/m2)who underwent polysomnography due to suspected OSA were included.Among them,patients with severe OSA(apnea hypopnea index≥30/h)were divided into two groups according to the presence or absence of hypercapnia during wakefulness(arterial partial pressure of carbon dioxide≥or<45 Torr,respectively).The characteristics and clinical features of these two groups were compared.RESULTS Among 97 eligible patients,25 patients(25.8%)had daytime hypercapnia.There were no significant differences in age,gender,body mass index,apnea-hypopnea index,and Epworth Sleepiness Scale scores between the two groups.However,patients with hypercapnia had a significantly lower arterial partial pressure of oxygen level(75.8±8.2 torr vs 79.9±8.7 torr,P=0.042)and higher arterial partial pressure of carbon dioxide level(46.6±2.5 torr vs 41.0±2.9 torr,P<0.001).Additionally,patients with hypercapnia were more likely to have metabolic syndrome(72.0%vs 48.6%,P=0.043)and a higher metabolic score(the number of satisfied criteria of metabolic syndrome).In multivariate logistic regression analysis,the presence of metabolic syndrome was associated with the presence of hypercapnia(OR=2.85,95%CI:1.04-7.84,P=0.042).CONCLUSION Among obese patients with severe OSA,26%of patients had hypercapnia during wakefulness.The presence of metabolic syndrome was independently correlated with the presence of daytime hypercapnia.

儿童注意缺陷多动障碍夜间遗尿的风险因素研究（英文）

背景:儿童注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的存在对其夜间遗尿(nocturnal enuresis,NE)的治疗不利;然而,较少有研究对ADHD患者的夜间遗尿的危险因素进行研究。目的:本研究旨在探讨儿童ADHD患者夜间遗尿的患病率及其危险因素。方法:研究对象为331名6-10岁的儿童,由儿少精神病学家根据DSM-IV-TR的诊断标准明确诊断ADHD。NE的诊断标准为年龄5岁以上,每周夜尿至少两次,持续3个月或更长时间,夜间不自主排尿,伴有或不伴有日间尿失禁,无任何神经系统症状和体征,无泌尿系统疾病。有关人口数据、围产期病史、既往病史的详细资料均从父母或医疗记录中收集的。结果:注意力缺陷亚型的ADHA患儿有77.5%伴发夜间遗尿症,而在多动/冲动亚型为31.7%、混合亚型为22.5%的(p<0.001, t=42.71)。在有遗尿症的患儿中,家族性尿失禁的发生率明显较高(26%比18%,p<0.001,t=16.9),剖腹产率(47%对33%,p=0.019, t=5.84),新生儿败血症史(16%与7%,p=0.018, t=5.62),高于非NE患儿。此外,有NE的患者的出生体重低于非NE患者(2.93(0.65)和3.09(0.46),p=0.026,t=2.51)。此外,父母低教育程度与NE的高发生率有关。结论:ADHD患儿的NE患病率较高。男性、父母低教育程度、新生儿败血症史、家族性尿失禁史、低出生体重和剖腹产都可能是ADHD患儿的NE患病的危险因素。大多数注意力缺陷亚型的患儿都伴发NE。

Perchance to dream? Primordial motor activity patterns in vertebrates from fish to mammals: their prenatal origin, postnatal persistence during sleep, and pathological reemergence during REM sleep behavior disorder

An overview is presented of the literature dealing with sleep-like motility and concomitant neuronal activity patterns throughout the life cycle in vertebrates, ectothermic as well as endothermic. Spontaneous, periodically modulated, neurogenic bursts of non-purposive movements are a universal feature of larval and prenatal behavior, which in endothermic animals （i.e. birds and mammals） continue to occur periodically throughout life. Since the entire body musculature is involved in ever-shifting combinations, it is proposed that these spontaneously active periods be designated as ＇rapid-BODY-movement＇ （RBM） sleep. The term ＇rapid-EYE- movement （REM） sleep＇, characterized by attenuated muscle contractions and reduced tonus, can then be reserved for sleep at later stages of development. Mature stages of development in which sustained muscle atonia is combined with ＇paradoxical arousal＇ of cortical neuronal firing patterns indisputably represent the evolutionarily most recent aspect of REM sleep, but more research with ectothermic vertebrates, such as fish, amphibians and reptiles, is needed before it can be concluded （as many prematurely have） that RBM is absent in these species. Evidence suggests a link between RBM sleep in early development and the clinical condition known as ＇REM sleep behavior disorder （RBD）＇, which is characterized by the resurgence of periodic bouts of quasi-fetal motility that closely resemble RBM sleep. Early developmental neuromotor risk factors for RBD in humans also point to a relationship between RBM sleep and RBD.

Clinical Observation of Huatanjieyu Granule in the Treatment of Post-stroke Depression

[Objectives]To observe the clinical effect of Huatanjieyu granule on patients with post-stroke depression.[Methods]Total 76 patients with confirmed post-stroke depression were randomly divided into two groups(treatment group and control group)according to the double-blind principle.The treatment group(38 cases)was treated with Huatanjieyu granule combined with escitalopram,and the control group(38 cases)was treated with escitalopram alone.The course of treatment was 6 weeks.Through clinical efficacy,Hamilton Depression Scale(HAMD)and Treatment Emergent Symptom Scale(TESS)scores were compared,and blood,liver function,renal function and electrocardiogram were examined.[Results]The scores of HAMD and TESS in patients with post-stroke depression were significantly decreased by Huatanjieyu granule,and there were no obvious side effects.The total effective rate was 92.1%in the treatment group and 76.3%in the control group.There was significant difference between the two groups(P<0.01).[Conclusions]Huatanjieyu granule was effective in the treatment of post-stroke depression with little side effects and was easy to be accepted by patients.

The Characteristics of the Drug Composition in the Treatment of Insomnia by External Bath Prescription of Traditional Chinese Medicine

[Objectives]The research aimed to carry out a retrospective analysis on the characteristics of the drug composition in the treatment of insomnia by external bath prescription of traditional Chinese medicine,to provide ideas for the research and development of new Chinese medicine for insomnia.[Methods]The external bath prescriptions of traditional Chinese medicine related to insomnia were collected,and the appearance frequency of drug was analyzed,and statistical analysis of drug with high appearance frequency was conducted.[Results]In the external bath prescriptions of traditional Chinese medicine related to insomnia,the top ten herbs with high appearance frequency were as follows:Chaozaoren,Drgonsbones,Margaritifera,Yejiaoteng,Schisandrae Chinensis Fructus,Lilii Bulbus,Platycladi Semen,Poria,Coptidis Rhizoma,and Scutellariae Radix.According to the classification by efficacy,these herbs mostly have the effects of calming,nourishing and heat clearing.[Conclusions]Traditional Chinese medicine is most closely related to heart,kidney,liver and other viscera.Tranquilizing and sedative drugs should be chosen,which corresponds with the understanding on pathogenesis of insomnia in traditional Chinese medical science,and embodies the characteristics of external bath prescription of traditional Chinese medicine in the treatment of insomnia.

Effects of Onion Extract on Male Sexual Dysfunction Induced by SSRI Antidepressants

[Objectives] To investigate the effect of onion extract on male sexual dysfunction caused by SSRI antidepressants.[Methods] 40 male patients with depression and anxiety who took SSRI antidepressants for a long time were randomly divided into observation group and control group. The observation group was treated with onion extract and SSRI drugs, while the control group was treated with SSRL drugs only. After 4 weeks of treatment, the scores of the two groups were evaluated by the International Index of Erectile Function (IIEF) questionnaire and the serum testosterone levels were measured in the two groups.[Results] Onion extract could improve the sexual dysfunction caused by SSRI drugs and significantly increase the level of serum testosterone.[Conclusions] Onion extract could significantly enhance the sexual function of men, and could alleviate the sexual dysfunction caused by SSRI drugs by increasing the level of serum testosterone.

Efficacy of Anshen Jieyu Decoction for Sub-healthy People with Insomnia

[Objectives]To investigate the efficacy of Anshen Jieyu decoction for sub-healthy people with insomnia.[Methods]A total of 80 sub-healthy insomnia patients admitted to Taihe Hospital of Shiyan City from January,2020 to December,2020 were selected as the research objects.All the patients were divided into observation group and control group according to a random number table.The control group was treated with conventional Western medicine,and the observation group was treated with Anshen Jieyu decoction.The clinical treatment effect of the two groups was compared.[Results]Before the intervention,there was no significant difference in Pittsburgh sleep quality index between the two groups.After the intervention,the scores of time required to fall asleep[(1.2±0.3)points],sleep time[(1.2±0.4)points],sleep disorder[(1.2±0.2)points],sleep efficiency[(1.4±0.3 points)],sleep quality[(0.9±0.2)points]and daytime dysfunction[(0.9±0.4)points]of the observation group were significantly lower than those of the control group.There was no significant difference in life quality between the two groups before the intervention.The scores of physical function[(92.3±3.3)points],social function[(91.7±4.1)points],mental health[(92.3±4.1)points]and emotional role[(92.8±5.2)points]after the intervention were significantly higher than those before the intervention.Before the intervention,there was no significant difference in the severity of insomnia between the two groups.After the intervention,the score of insomnia severity index was(10.3±3.0)points in the observation group and was(12.2±2.9)points in the control group.In terms of safety,there were 23 cases of level 1,15 cases of level 2 and 2 cases of level 3 in the observation group,and there were 20 cases of level 1,16 cases of level 2 and 4 cases of level 3 in the control group.No significant difference was observed in treatment safety between the two groups.[Conclusions]Anshen Jieyu decoction is effective in treating sub-healthy insomnia and is worthy of promotion.

Sodium glucose cotransporter 2 inhibitors:New horizon of the heart failure pharmacotherapy

Sodium-glucose cotransporter 2(SGLT2)inhibitors have gained momentum as the latest class of antidiabetic agents for improving glycemic control.Large-scale clinical trials have reported that SGLT2 inhibitors reduced cardiovascular outcomes,especially hospitalization for heart failure in patients with type 2 diabetes mellitus who have high risks of cardiovascular disease.Accumulating evidence has indicated that beneficial effects can be observed regardless of the presence or absence of type 2 diabetes mellitus.Accordingly,the Food and Drug Administration approved these agents specifically for treating patients with heart failure and a reduced ejection fraction.It has been concluded that canagliflozin,dapagliflozin,empagliflozin,or ertugliflozin can be recommended for preventing hospitalization associated with heart failure in patients with type 2 diabetes and established cardiovascular disease or those at high cardiovascular risk.In the present review,we explore the available evidence on SGLT2 inhibitors in terms of the cardioprotective effects,potential mechanisms,and ongoing clinical trials that may further clarify the cardiovascular effects of the agents.

A Nomogram for Predicting the Likelihood of Obstructive Sleep Apnea to Reduce the Unnecessary Polysomnography Examinations

Background：The currently available polysomnography （PSG） equipments and operating personnel are facing increasing pressure,such situation may result in the problem that a large number of obstructive sleep apnea （OSA） patients cannot receive timely diagnosis and treatment,we sought to develop a nomogram quantifying the risk of OSA for a better decision of using PSG,based on the clinical syndromes and the demographic and anthropometric characteristics.Methods：The nomogram was constructed through an ordinal logistic regression procedure.Predictive accuracy and performance characteristics were assessed with the area under the curve （AUC） of the receiver operating characteristics and calibration plots,respectively.Decision curve analyses were applied to assess the net benefit of the nomogram.Results：Among the 401 patients,73 （18.2%） were diagnosed and grouped as the none OSA （apnea-hypopnea index [AHI] 〈5）,67 （16.7%） the mild OSA （5 ≤ AHI 〈 15）,82 （20.4%） the moderate OSA （15 ≤ AHI 〈 30）,and 179 （44.6%） the severe OSA （AHI ≥ 30）.The multivariable analysis suggested the significant factors were duration of disease,smoking status,difficulty of falling asleep,lack of energy,and waist circumference.A nomogram was created for the prediction of OSA using these clinical parameters and was internally validated using bootstrapping method.The discrimination accuracies of the nomogram for any OSA,moderate-severe OSA,and severe OSA were 83.8%,79.9%,and 80.5%,respectively,which indicated good calibration.Decision curve analysis showed that using nomogram could reduce the unnecessary polysomnography （PSG） by 10% without increasing the false negatives.Conclusions：The established clinical nomogram provides high accuracy in predicting the individual risk of OSA.This tool may help physicians better make decisions on PSG arrangement for the patients referred to sleep centers.

Effects of two types of exercise training on psychological well-being,sleep,quality of life and physical fitness in patients with high-grade glioma(WHO III and IV):study protocol for a randomized controlled trial

Background:There is existing evidence on whether and to what degree regular exercise training improves the quality of life(QoL)among cancer survivors.However,in regards to patients with high-grade glioma(HGG;WHO grade III and IV),no conclusive study has been performed so far.The present trial aims to fill this gap by examining whether psychological well-being,sleep,QoL and physical fitness might be improved with two different types of exercise,as compared to an active control condition.Active control condition represent individuals participating at regular meetings to talk about their current life situation,though,the meetings were not intended as that of the psychotherapy group.Regular meetings are of the same frequency,duration,and intensity as the exercise interventions.Methods:A total of 45 patients with HGG after undergoing neurosurgery and adjuvant radiotherapy,chemotherapy,or chemoradiotherapy will be consecutively and randomly assigned to(a)an endurance training,(b)a resistance training or(c)to an active control condition.The intervention will last for 6 consecutive weeks,consisting of 2 weekly sessions(30-45 min per session).Measurements would take place at three time points,namely at the beginning of the study(baseline),3 weeks after the beginning of the study,and 6 weeks after the beginning of the study.The last measurement also represents the end of the study.Aerobic exercise performance will be assessed objectively with a 6-min walking test,and a handgrip test will be used to assess the upper body strength.Further,participants will complete a battery of questionnaires covering sociodemographic information,QoL,sleep quality and sleep patterns,coping with stress,state-and trait-anxiety,depression,and fatigue.In parallel,experts will use the Hamilton Depres-sion Rating Scale to determine and rate participants’symptoms of depression.Significance:The present study will be the first to investigate and compare the impact of two different exercise modalities,namely endurance and resistance training,on physical fitness and dimensions of well-being,and sleep among patients with HGG who underwent neurosurgery followed by adjuvant radiotherapy,chemotherapy,or chemoradiotherapy.Importantly,unlike the majority of previous studies,the control condition consists of an active set-up to detect possible factual beneficial effects of exercise training,irrespective of social interactions.

Global prevalence of drug-resistant tuberculosis: a systematic review and meta-analysis

Background Tuberculosis is a bacterial infectious disease,which affects different parts of a human body,mainly lungs and can lead to the patient’s death.The aim of this study is to investigate the global prevalence of drug-resistant tuberculosis using a systematic review and meta-analysis.Methods In this study,the PubMed,Scopus,Web of Science,Embase,ScienceDirect and Google Scholar repositories were systematically searched to find studies reporting the global prevalence of drug-resistant tuberculosis.The search did not entail a lower time limit,and articles published up until August 2022 were considered.Random effects model was used to perform the analysis.The heterogeneity of the studies was examined with the I^(2) test.Data analysis was conducted within the Comprehensive Meta-Analysis software.Results In the review of 148 studies with a sample size of 318,430 people,the I^(2) index showed high heterogeneity(I^(2)=99.6),and accordingly random effects method was used to analyze the results.Publication bias was also examined using the Begg and Mazumdar correlation test which indicated the existence of publication bias in the studies(P=0.008).According to our meta-analysis,the global pooled prevalence of multi-drug resistant TB is 11.6%(95%CI:9.1–14.5%).Conclusions The global prevalence of drug-resistant tuberculosis was found to be very high,thus health authorities should consider ways to control and manage the disease to prevent a wider spread of tuberculosis and potentially subsequent deaths.