慢性紧张型头痛与睡眠障碍的相关性研究

目的 探讨慢性紧张型头痛（chronic tension type headache,CTTH）与睡眠障碍的关系,评价睡眠障碍对慢性紧张型头痛的发生、发展及头痛病理生理的影响.方法 依据国际头痛学会2004 ISH-Ⅱ头痛性疾病的分类和诊断标准,选取2012年4月至2013年8月我院神经内科门诊及住院符合慢性紧张型头痛诊断的患者141例,根据头痛程度分为轻度头痛、中度头痛、重度头痛三组,对纳入研究患者性别、年龄、失眠情况、疼痛程度、医后随访、健康指导等指标进行研究,分析睡眠障碍与慢性紧张型头痛发病原因、头痛严重程度等因素的关系.结果 慢性紧张型头痛患者睡眠障碍的发生率为49.6％,与于守臣等调查的正常人群睡眠障碍发生率9.4％有明显的统计学差异（x2=153.63,P＜0.001）,中、重度头痛患者睡眠障碍的发生率明显高于轻度头痛患者（x2=11.017,P＜0.05）,慢性紧张型头痛患者睡眠障碍与性别及家族史无明显相关性（P＞0.05）.结论 慢性紧张型头痛与睡眠障碍存在明显相关性,睡眠障碍可能是慢性紧张型头痛最重要的病因,临床医生应重视慢性紧张型头痛患者睡眠质量,治疗睡眠障碍可能对慢性紧张型头痛的预防及治疗有积极作用.     

睡眠呼吸暂停综合征护理查房报告

护士长：今天要与各位一起讨论的主题是睡眠呼吸暂停综合征(SAS)，系在睡眠时出现严重打鼾，阵发性吸气后呼吸暂停，以及伴有白昼嗜睡、晨起头痛、逆行性健忘、性格改变、肥胖等症状为特征的一种综合征。目前，国内外对此研究较深入，认为睡眠呼吸暂停可引起多系统器官损害。今结合我科病例，组织护理个案查房，请责任护士报告病历。     

褪黑激素治疗偏头痛的作用机制和临床应用的研究进展

偏头痛是一种临床常见的原发性头痛疾病,其发病率、致残率逐年升高,给患者、家庭和社会带来沉重负担.目前偏头痛发病机制尚不明确.有研究表明压力、睡眠障碍等与偏头痛周期性发作有密切联系.褪黑激素在临床上广泛应用,尤其在其节律性减少或失调有关的疾病中,如昼夜节律性睡眠障碍、阿尔茨海默病等.偏头痛患者被证明存在时间生物学功能障碍...     

玉树地震灾后重建工人中高原头痛及与高原睡眠关系的研究

目的对在玉树海拔4520m灾后重建人员中最常见的"高原头痛"及与高原睡眠的关系进行了系统研究。方法高原头痛按国际头痛协会标准结合高原发病特点加以判定,高原睡眠按国际统一的睡眠检测及判定方法。同时测定动脉血氧饱和度。结果在调查的1680名工人中,806名符合高原头痛诊断,发生率为48%。头痛程度与动脉血氧饱和度呈负相关,脑脊髓液压力增高,睡眠监测1期及2期非快眼动睡眠明显延长,而3+4期非快眼动睡眠则明显缩短,处于浅睡眠并有明显的睡眠低氧血症。结论高原头痛与低氧血症及颅内压增高有关,与高原睡眠障碍关系密切,故防治应从提高机体高原整体习服能力及改善高原睡眠同时着手。     

治疗阻塞性睡眠呼吸暂停和发作性睡病的新药：solriamfetol

solriamfetol是选择性多巴胺-去甲肾上腺素再摄取抑制剂,于2019年3月被美国食品和药物管理局批准用于治疗阻塞性睡眠呼吸暂停和发作性睡病成年患者的白天过度睡眠。solriamfetol最常见的不良反应包括头痛、恶心、食欲下降、焦虑和失眠。     

鸡尾酒疗法改善慢性每日头痛患者的头痛症状和睡眠质量

慢性每日头痛是神经科常见病、多发病,且呈日益增多趋势。近年来研究表明心理因素,特别是焦虑、抑郁及睡眠改变是其发病主要原因,影响头痛发生、发展及转归。慢性头痛患者往往病情迁延反复,单纯药物治疗常不能达到满意治疗效果。本研究应用理化治疗结合心理治疗的鸡尾酒疗法改善患者头痛及睡眠质量,为临床推广应用心理疗法提供参考。     

发作性睡病23例病例分析

目的 探讨发作性睡病的临床表现、辅助检查、诊断、治疗及预后.方法 对23例明确诊断的发作性睡病患者进行多导睡眠脑电图分析,采用苯丙胺、哌醋甲酯、丙咪嗪、阿米替林治疗,并进行随访3年.结果 23例患者均有日间不能克制的短暂睡眠发作,睡眠潜伏期缩短.结论 发作性睡病是慢性神经系统疾病,结合其临床表现及睡眠脑电图可以早期诊断,尽早给予患者规范药物治疗、心理疏导,以提高患者的生活质量.     

睡眠呼吸暂停低通气综合征72例临床分析

目的探讨睡眠呼吸暂停低通气综合征（SAHS）患者的临床特征及相关因素。方法回顾性分析我科确诊的睡眠呼吸暂停低通气综合征72例临床资料。结果阻塞性睡眠呼吸暂停低通气综合征（OSAHS）69例,混合性睡眠呼吸暂停低通气综合征（MSAHS）3例;男∶女=11∶1;多有体质肥胖、咽腔结构异常;以夜间打鼾、晨起头痛头晕、白天困倦乏力为主要临床表现。结论以阻塞性睡眠呼吸暂停低通气最常见,男性多于女性,肥胖是主要易患因素,多导睡眠监测是诊断金标准。     

发作性睡病的研究进展

发作性睡病是一种慢性神经系统疾病。常于青春期前起病，并持续终生。本病以发作性不可抗拒入睡、猝倒症、睡眠瘫痪、幻觉及提前出现的快速动眼(REM)睡眠为特征．部分病例可伴有自动症，以及头痛、耳鸣、忧郁、焦虑、记忆力减退等其它神经、精神症状。易与其它疾病相混淆．本文介绍其病理生理改变及其发生的可能因素、诊断、鉴别诊断及治疗。     

老年人失眠的原因及治疗方法

失眠是老年人的常见睡眠障碍。老年人失眠的原因可以归纳为生理性、躯体疾病性、药源性、精神障碍性、睡眠卫生问题和环境因素6个方面。针对老年人的失眠,治疗目标是维护和促进他们的睡眠觉醒节律功能,具体处理对策主要有治疗原发疾病/驱除诱因、合理应用镇静催眠药、心理行为治疗和睡眠卫生教育等。     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

In vitro studies on sterically stabilized liposomes (SL) as enzyme carriers in organophosphorus (OP) antagonism

This study describes a new approach for organophosphorous (OP) antidotal treatment by encapsulating an OP hydrolyzing enzyme, OPA anhydrolase (OPAA), within sterically stabilized liposomes. The recombinant OPAA enzyme was derived from Alteromonas strain JD6. It has broad substrate specificity to a wide range of OP compounds: DFP and the nerve agents, soman and sarin. Liposomes encapsulating OPAA (SL)* were made by mechanical dispersion method. Hydrolysis of DFP by (SL)* was measured by following an increase of fluoride ion concentration using a fluoride ion selective electrode. OPAA entrapped in the carrier liposomes rapidly hydrolyze DFP, with the rate of DFP hydrolysis directly proportional to the amount of (SL)* added to the solution. Liposomal carriers containing no enzyme did not hydrolyze DFP. The reaction was linear and the rate of hydrolysis was first order in the substrate. This enzyme carrier system serves as a biodegradable protective environment for the recombinant OP-metabolizing enzyme, OPAA, resulting in prolongation of enzymatic concentration in the body. These studies suggest that the protection of OP intoxication can be strikingly enhanced by adding OPAA encapsulated within (SL)* to pralidoxime and atropine.     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Pharmacological treatment of COVID-19: an opinion paper

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.     

Steroidal sapogenin contents in some domestic plants

In order to find out the values of the steroid resources for the future use. the compositions and contents of steroidal sapogenins from 13 domestic plants have been investigated. As a result,Dioscorea nipponica, D. quinqueloba andSmilax china were found to have large amount of diosgenin. And pennogenin inTrillium kamtschaticum andParis verticillata, yuccagenin inAllium fistulosum, hecogenin inAgave americana and neochlorogenin inSolanum nigum were appeared to be major steroidal sapogenins.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.