The past,present, and future of sleep measurement in mild cognitive impairment and early dementia—towards a core outcome set: a scoping review

Study ObjectivesSleep abnormalities emerge early in dementia and may accelerate cognitive decline. Their accurate characterization may facilitate earlier clinical identification of dementia and allow for assessment of sleep intervention efficacy. This scoping review determines how sleep is currently measured and reported in Mild Cognitive Impairment (MCI) and early dementia, as a basis for future core outcome alignment.MethodsThis review follows the PRISMA Guidelines for Scoping Reviews. CINAHL, Embase, Medline, Psychinfo, and British Nursing Index databases were searched from inception—March 12, 2021. Included studies had participants diagnosed with MCI and early dementia and reported on sleep as a key objective/ outcome measure.ResultsNineteen thousand five hundred and ninety-six titles were returned following duplicate removal with 188 studies [N] included in final analysis. Sleep data was reported on 17 139 unique, diagnostically diverse participants (n). “Unspecified MCI” was the most common diagnosis amongst patients with MCI (n = 5003, 60.6%). Despite technological advances, sleep was measured most commonly by validated questionnaires (n = 12 586, N = 131). Fewer participants underwent polysomnography (PSG) (n = 3492, N = 88) and actigraphy (n = 3359, N = 38) with little adoption of non-PSG electroencephalograms (EEG) (n = 74, N = 3). Sleep outcome parameters were reported heterogeneously. 62/165 (37.6%) were described only once in the literature (33/60 (60%) in interventional studies). There was underrepresentation of circadian (n = 725, N = 25) and micro-architectural (n = 360, N = 12) sleep parameters.ConclusionsAlongside under-researched areas, there is a need for more detailed diagnostic characterization. Due to outcome heterogeneity, we advocate for international consensus on core sleep outcome parameters to support causal inference and comparison of therapeutic sleep interventions.     

地黄饮子对双转基因痴呆小鼠学习记忆及抗氧化能力的影响

目的研究地黄饮子对APP/PS1双转基因痴呆模型小鼠学习记忆、脑组织病理形态改变及抗氧化能力的影响。方法将40只APP/PS1双转基因痴呆小鼠分为模型组、西对组、中高组、中中组、中低组,每组8只;另以8只同背景同月龄的阴性小鼠为空白组。西对组给予盐酸多奈哌齐(0.66μg·g-1·d-1)灌胃,中高组、中中组、中低组给予地黄饮子相当于生药67.30 g·kg-1·d-1、33.65 g·kg-1·d-1、16.83 g·kg-1·d-1灌胃,模型组给予0.9%NaCl溶液灌胃。灌胃共4周后通过Morris水迷宫实验检测小鼠的学习和记忆能力;HE、尼氏染色检测小鼠脑组织的病理形态改变;采用比色法测定小鼠血清中超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽过氧化物酶(GSH-Px)水平。结果与模型组比较,中药各剂量组及西对组能缩短小鼠定位潜航实验的逃避潜伏期,差异有统计学意义(P0.05,P0.01);第2、4天西对组优于中低组(P0.05,P0.01),第5天西对组优于中中组、中低组(P0.05)。与模型组比较,中药各剂量组及西对组能提高小鼠穿越平台次数,差异有统计学意义(P0.05,P0.01)。与模型组比较,西对组、中药各剂量组SOD、GSH-Px含量增加,MDA含量下降,差异均有统计学意义(P0.05,P0.01)。与西对组比较,中低组、中中组SOD含量降低,差异有统计学意义(P0.05,P0.01)。结论地黄饮子可通过提高学习记忆能力、减轻脑组织神经元变性及脱失、提高抗氧化能力等途径起到防治老年性痴呆的作用。     

Microtubule-stabilizing peptides and small molecules protecting axonal transport and brain function: Focus on davunetide (NAP)

This review focuses on the therapeutic effects and mechanisms of action of NAP (davunetide), an eight amino acid snippet derived from activity-dependent neuroprotective protein (ADNP) which was discovered in our laboratory. We have recently described the effects of NAP in neurodegenerative disorders, and we now review the beneficial effects of NAP and other microtubule-stabilizing agents on impairments in axonal transport. Experiments in animal models of microtubule-deficiency including tauopathy (spanning from drosophila to mammals) showed protection of axonal transport by microtubule-stabilizers and NAP, which was coupled to motor and cognitive protection. Clinical trials with NAP (davunetide) are reviewed paving the path to future developments.     

静脉注射不同剂量氯胺酮对学龄前小儿心率变异功率谱的影响

目的通过观察不同剂量氯胺酮对学龄前小儿心率变异功率谱的影响,总结出能直观反映小儿氯胺酮麻醉深度的量化指标。方法选择5～6岁小儿54例,随机分为A、B两组,分别静脉注射氯胺酮(Ketamine,KTM)1mg.kg-1、2mg.kg-1,比较组内不同时点、组间同时点心率变异功率谱中各指标的变化。结果静脉注射氯胺酮后,A、B两组心率变异功率谱中,除了心率(HR)外,其余成分值较基础值均下降(P<0.05)。组间比较:B组低频(LF)、高频(HF)、心率变异指数(HRVI)比A组小(P<0.05)。结论静脉注射氯胺酮后心率变异功率谱中除HR外,其他成分值下降且幅度与剂量有关,其中HRVI变化最为直观敏感,可作为麻醉深度的监测指标。     

IL-33对特应性皮炎患者ST2-ILC2s轴及皮肤屏障影响的研究进展

特应性皮炎(AD)是目前最常见、反复发作、对生活质量影响较大的免疫性皮肤病之一.IL-33是IL-1家族成员之一,上皮细胞会因机械创伤、细菌和外源性蛋白酶等触发因素释放IL-33,IL-33通过长型血清刺激因子-2(ST2)和多种细胞上的IL-1受体附件结合,并激活第2组固有淋巴细胞(ILC2s)、Th2细胞、肥大细胞...     

鞘内注射芬太尼对硬膜外麻醉下剖宫产术中恶心、呕吐的抑制作用

目的观察鞘内注射芬太尼对硬膜外麻醉下剖宫产术中恶心、呕吐发生的抑制作用。方法将硬膜外麻醉下行剖宫术产者30例(ASA分级Ⅰ~Ⅱ级)随机均分为对照组和芬太尼组,比较两组产妇术中出现恶心、呕吐的情况,并对娩出婴儿行Apgar评分。结果对照组与芬太尼组术中发生恶心者分别为5例(33.3%)和1例(6.7%);对照组呕吐或干呕发生率则显著高于芬太尼组(P<0.05);两组娩出婴儿的Apgar评分无显著差异(P>0.05)。结论鞘内注射芬太尼能减少产妇硬膜外麻醉下剖宫产术中恶心、呕吐的发生。     

高龄患者麻醉中瑞芬太尼和芬太尼的比较分析

目的 探讨瑞芬太尼和芬太尼在高龄手术患者麻醉中的应用效果.方法 选择56例高龄手术患者,随机分为对照组和实验组,每组28例.记录术中不同时间点的心率、血压,记录术后拔管、意识恢复、自主呼吸恢复时间.所获数据采用方差分析t检验.结果 麻醉后两组患者的血压、心率较诱导前明显下降（P＜0.05）;插管和切皮时实验组血压、心率明显低于对照组,（P＜0.05）具有统计学意义;术后拔管、意识恢复、自主呼吸恢复时间均明显低于对照组,（P＜0.05）具有显著性差异.结论 瑞芬太尼比芬太尼更适合高龄患者的麻醉要求.     

Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review

Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.