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Deng R, Liang G, Chen W, Nie Q, Wen J. Inhibitory Effects of Paclitaxel-Loaded Iron Oxide Nanoparticles on Non-Small Cell Lung Cancer by Enhancing Autophagy-Dependent Ferroptosis and Apoptosis Pathways. Cancer Manag Res 2025; 17:541-555. [PMID: 40098803 PMCID: PMC11911239 DOI: 10.2147/cmar.s497238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2024] [Accepted: 01/17/2025] [Indexed: 03/19/2025] Open
Abstract
Background Iron oxide nanoparticles coated with paclitaxel (IONP@PTX) are frequently applied to various tumor types. However, inhibitory effect and possible mechanism of IONP@ PTX on non-small-cell lung cancer (NSCLC) remain unclear. Objective This work aimed to assess inhibitory effects and potential mechanisms of IONP@PTX on lung cancer A549 cells and further explore the nanomedicine delivery systems for applications in cancer therapies. Methods Morphology features and qualities of IONP@PTX were directly assessed. After treatment of A549 cells with either PTX or IONP@PTX, cell viability and apoptosis were separately detected by CCK‑8 assay and flow cytometry. In addition, intracellular iron ion, lipid peroxidation (LPD) and reactive oxygen species (ROS) were identified by using an iron colorimetric assay kit, DCFH-DA and C11-BODIPY fluorescent probe, respectively. Moreover, the expression levels of autophagy-, ferroptosis-, and apoptosis-related proteins were measured by Western blot. Results The synthesized IONP@PTX had a core particle size of about 10 nm and a hydrated particle size of 31.01±2.47 nm. In comparison with PTX, IONP@PTX had a stronger anti-tumor effect on A549 cells, with considerably higher levels of ROS, LPD, and total iron ion concentration (P<0.05). Likewise, IONP@PTX markedly reduced the expression levels of GPX4, FTH, and SLC7A11 proteins whereas obviously increased the expression levels of LC3II/I and ACSL4 proteins (P<0.05). Furthermore, the inhibitory effects of both PTX and IONP@PTX on A549 cells could be evidently reversed by additional 3-methyladenine (3-MA) or ferrostatin-1. Interestingly, the apoptosis rates of A549 cells, together with the expression level of pro-apoptotic protein Cleaved caspase-3, were significantly higher in the IONP@PTX group than those in the control and PTX groups (P<0.05). Conclusion IONP@PTX inhibits the proliferation of human lung cancer A549 cells by enhancing autophagy-dependent ferroptosis and apoptosis pathways.
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Affiliation(s)
- Rongchu Deng
- Department of Guangxi Clinical Research Center for Neurological Diseases, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China
| | - Guanghong Liang
- Department of Guangxi Clinical Research Center for Neurological Diseases, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China
| | - Wenqing Chen
- Department of Guangxi Clinical Research Center for Neurological Diseases, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China
- College of Pharmacy, Guilin Medical University, Guilin, Guangxi, People’s Republic of China
| | - Qi Nie
- Department of Guangxi Clinical Research Center for Neurological Diseases, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China
| | - Jian Wen
- Department of Guangxi Clinical Research Center for Neurological Diseases, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, People’s Republic of China
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Kulkarni A, Chandralekha SC, Sreedharan SE. Sleep dysfunction in stroke survivors impacts caregiver burden and functional recovery-an observational study. Sleep Breath 2025; 29:99. [PMID: 39934599 DOI: 10.1007/s11325-025-03276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 01/16/2025] [Accepted: 02/05/2025] [Indexed: 02/13/2025]
Abstract
PURPOSE Sleep dysfunction is often reported post-stroke, but its impact on short-term outcomes and caregiver burden remains less studied. Here, we studied the prevalence of sleep dysfunction and its relationship with self-reported depression, caregiver burden, and functional outcome after stroke. METHODS Prospective observational study where consecutive patients with acute ischemic stroke were recruited at 3 months follow-up visit from stroke outpatient clinic from January 2022-March 2023. After informed consent, all the recruited patients were administered 5 questionnaires[Epworth Sleepiness Scale, Insomnia Severity Index, and Pittsburgh Sleep Quality Index for sleep, Patient Health Quality 9 for depression, and Zarit's Caregiver Burden Scale]. 20% of patients underwent overnight ambulatory level 3 polysomnography. Clinical and sleep characteristics were correlated with functional outcome and caregiver burden scores at 3 and 6 months follow-up. RESULTS Of 100 patients, with a mean age of 62.2 ± 11.2 years, 67% had moderate to severe strokes at admission with mean National Institute of Health Stroke Scale [NIHSS] 8.3 ± 6.24.63% reporting one or more sleep disturbances post-stroke. 20% had hypersomnolence,35% had insomnia and 40% had poor sleep quality at 3 months after stroke.45% reported depression and 22% caregivers reported significant burden. Caregiver burden had a strong correlation with patient-reported hypersomnolence and poor sleep quality. Sleep dysfunction showed a significant association with poor functional outcomes at 6 months after stroke. CONCLUSION Sleep dysfunction is present in a significant number of ischemic stroke survivors 3 months after stroke and can contribute to poor functional outcomes and caregiver stress. The impact of early recognition and timely treatment of sleep dysfunction post-stroke needs to be studied in larger populations.
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Affiliation(s)
- Avinash Kulkarni
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - S C Chandralekha
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India
| | - Sapna Erat Sreedharan
- Department of Neurology, Sree Chitra Tirunal Institute of Medical Science and Technology, Thiruvananthapuram, Kerala, India.
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Chen P, Wang W, Ban W, Zhang K, Dai Y, Yang Z, You Y. Deciphering Post-Stroke Sleep Disorders: Unveiling Neurological Mechanisms in the Realm of Brain Science. Brain Sci 2024; 14:307. [PMID: 38671959 PMCID: PMC11047862 DOI: 10.3390/brainsci14040307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 04/28/2024] Open
Abstract
Sleep disorders are the most widespread mental disorders after stroke and hurt survivors' functional prognosis, response to restoration, and quality of life. This review will address an overview of the progress of research on the biological mechanisms associated with stroke-complicating sleep disorders. Extensive research has investigated the negative impact of stroke on sleep. However, a bidirectional association between sleep disorders and stroke exists; while stroke elevates the risk of sleep disorders, these disorders also independently contribute as a risk factor for stroke. This review aims to elucidate the mechanisms of stroke-induced sleep disorders. Possible influences were examined, including functional changes in brain regions, cerebrovascular hemodynamics, neurological deficits, sleep ion regulation, neurotransmitters, and inflammation. The results provide valuable insights into the mechanisms of stroke complicating sleep disorders.
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Affiliation(s)
- Pinqiu Chen
- Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, School of Pharmacy, Yantai University, Yantai 264005, China; (P.C.)
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Wenyan Wang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation, Ministry of Education, Collaborative Innovation Center of Advanced Drug Delivery System and Biotech Drugs in Universities of Shandong, School of Pharmacy, Yantai University, Yantai 264005, China; (P.C.)
| | - Weikang Ban
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Kecan Zhang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Yanan Dai
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Zhihong Yang
- Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100193, China
| | - Yuyang You
- School of Automation, Beijing Institute of Technology, Beijing 100081, China
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Dong Y, Wang M, Li W, Zhao K, Cui X, Yang Y, Geng X, Pu Y, Hu Z, Fang C, Lv G, Liu S, Chen X. Effect of dexmedetomidine infusion on postoperative sleep disturbances in women with breast cancer: A monocentric randomized-controlled double-blind trial. Anaesth Crit Care Pain Med 2024; 43:101358. [PMID: 38365169 DOI: 10.1016/j.accpm.2024.101358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Most women with breast cancer are prone to postoperative sleep disturbances (POSD). Little is known about the differences between sevoflurane and propofol combined with dexmedetomidine on POSD in the same context. We investigated the effect of intra-operative sevoflurane or propofol combined with intravenous dexmedetomidine on the incidence of POSD and postoperative sleep structures. METHODS A monocentric, randomized-controlled, double-blind trial. Female patients undergoing radical surgery for breast cancer were randomly assigned to receive sevoflurane and placebo, sevoflurane and dexmedetomidine, propofol and placebo, or propofol and dexmedetomidine. Dexmedetomidine was administered at 1.0 μg kg-1 infusion 15 min before induction, then infused at 0.4 μg kg-1 h-1 until the surgical drain started to be placed. The primary outcome was the incidence of POSD within the postoperative first three days (defined as an Athens Insomnia Scale score ≥ 6 points on at least one day of postoperative first three days). The secondary outcome was the duration of sleep structures, collected from the Fitbit Charge 2® smart bracelet (Fitbit, Inc., San Francisco, CA, USA). RESULTS There were 188 women analyzed with the modified intention-to-treat method. The incidences of POSD in the dexmedetomidine and placebo groups were similar (p = 0.649). In the sevoflurane sedation strategy, dexmedetomidine decreased nocturnal wakefulness on postoperative first day (p = 0.001). In the propofol sedation strategy, dexmedetomidine increased nocturnal deep sleep on postoperative first (p < 0.001) and third (p < 0.001) days. CONCLUSION Intra-operative infusion of dexmedetomidine had no significant effect on POSD but decreased nocturnal wakefulness in the sevoflurane group and increased nocturnal deep sleep in the propofol group. TRIAL REGISTRATION Registered at www.chictr.org.cn (ChiCTR2300070136).
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Affiliation(s)
- Yushan Dong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Maosan Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Wenzhan Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Kai Zhao
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Xiaojie Cui
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yanming Yang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xingyu Geng
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Yutian Pu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Ziwei Hu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Can Fang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Gaochao Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Su Liu
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Xiuxia Chen
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, China; Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
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Zhong Z, Tao G, Hao S, Ben H, Qu W, Sun F, Huang Z, Qiu M. Alleviating sleep disturbances and modulating neuronal activity after ischemia: Evidence for the benefits of zolpidem in stroke recovery. CNS Neurosci Ther 2024; 30:e14637. [PMID: 38380702 PMCID: PMC10880125 DOI: 10.1111/cns.14637] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 01/01/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
AIMS Sleep disorders are prevalent among stroke survivors and impede stroke recovery, yet they are still insufficiently considered in the management of stroke patients, and the mechanisms by which they occur remain unclear. There is evidence that boosting phasic GABA signaling with zolpidem during the repair phase improves stroke recovery by enhancing neural plasticity; however, as a non-benzodiazepine hypnotic, the effects of zolpidem on post-stroke sleep disorders remain unclear. METHOD Transient ischemic stroke in male rats was induced with a 30-minute middle cerebral artery occlusion. Zolpidem or vehicle was intraperitoneally delivered once daily from 2 to 7 days after the stroke, and the electroencephalogram and electromyogram were recorded simultaneously. At 24 h after ischemia, c-Fos immunostaining was used to assess the effect of transient ischemic stroke and acute zolpidem treatment on neuronal activity. RESULTS In addition to the effects on reducing brain damage and mitigating behavioral deficits, repeated zolpidem treatment during the subacute phase of stroke quickly ameliorated circadian rhythm disruption, alleviated sleep fragmentation, and increased sleep depth in ischemic rats. Immunohistochemical staining showed that in contrast to robust activation in para-infarct and some remote areas by 24 h after the onset of focal ischemia, the activity of the ipsilateral suprachiasmatic nucleus, the biological rhythm center, was strongly suppressed. A single dose of zolpidem significantly upregulated c-Fos expression in the ipsilateral suprachiasmatic nucleus to levels comparable to the contralateral side. CONCLUSION Stroke leads to suprachiasmatic nucleus dysfunction. Zolpidem restores suprachiasmatic nucleus activity and effectively alleviates post-stroke sleep disturbances, indicating its potential to promote stroke recovery.
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Affiliation(s)
- Zhi‐Gang Zhong
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Gui‐Jin Tao
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Shu‐Mei Hao
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Hui Ben
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Wei‐Min Qu
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Feng‐Yan Sun
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
| | - Zhi‐Li Huang
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Mei‐Hong Qiu
- Department of Neurobiology, Institute for Basic Research on Aging and Medicine, School of Basic Medical SciencesFudan UniversityShanghaiChina
- Department of Pharmacology, School of Basic Medical Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
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Sorici A, Băjenaru L, Mocanu IG, Florea AM, Tsakanikas P, Ribigan AC, Pedullà L, Bougea A. Monitoring and Predicting Health Status in Neurological Patients: The ALAMEDA Data Collection Protocol. Healthcare (Basel) 2023; 11:2656. [PMID: 37830693 PMCID: PMC10572511 DOI: 10.3390/healthcare11192656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/12/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
(1) Objective: We explore the predictive power of a novel stream of patient data, combining wearable devices and patient reported outcomes (PROs), using an AI-first approach to classify the health status of Parkinson's disease (PD), multiple sclerosis (MS) and stroke patients (collectively named PMSS). (2) Background: Recent studies acknowledge the burden of neurological disorders on patients and on the healthcare systems managing them. To address this, effort is invested in the digital transformation of health provisioning for PMSS patients. (3) Methods: We introduce the data collection journey within the ALAMEDA project, which continuously collects PRO data for a year through mobile applications and supplements them with data from minimally intrusive wearable devices (accelerometer bracelet, IMU sensor belt, ground force measuring insoles, and sleep mattress) worn for 1-2 weeks at each milestone. We present the data collection schedule and its feasibility, the mapping of medical predictor variables to wearable device capabilities and mobile application functionality. (4) Results: A novel combination of wearable devices and smartphone applications required for the desired analysis of motor, sleep, emotional and quality-of-life outcomes is introduced. AI-first analysis methods are presented that aim to uncover the prediction capability of diverse longitudinal and cross-sectional setups (in terms of standard medical test targets). Mobile application development and usage schedule facilitates the retention of patient engagement and compliance with the study protocol.
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Affiliation(s)
- Alexandru Sorici
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Lidia Băjenaru
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Irina Georgiana Mocanu
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Adina Magda Florea
- AI-MAS Laboratory, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania; (L.B.); (I.G.M.); (A.M.F.)
| | - Panagiotis Tsakanikas
- Institute of Communication and Computer Systems, National Technical University of Athens, 10682 Athens, Greece;
| | - Athena Cristina Ribigan
- Department of Neurology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, 16149 Genoa, Italy;
| | - Anastasia Bougea
- 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece;
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Niu S, Liu X, Wu Q, Ma J, Wu S, Zeng L, Shi Y. Sleep Quality and Cognitive Function after Stroke: The Mediating Roles of Depression and Anxiety Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032410. [PMID: 36767777 PMCID: PMC9915208 DOI: 10.3390/ijerph20032410] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 05/19/2023]
Abstract
This study examined the association between post-stroke cognitive function and sleep status at 30 days post-stroke and evaluated the role of anxiety and depression as potential mediators of that association. The participants in this study were 530 acute ischemic stroke (IS) patients. Sleep disturbance at 30 days post-stroke was assessed by the Pittsburgh Sleep Quality Index. Basic patient information, cognitive function, depression, and anxiety status were assessed before discharge from the hospital. Stratified linear regression analysis models were fit to examine the associations between post-stroke sleep quality and the influencing factors. A structural equation model was developed to evaluate the role of anxiety and depression as potential mediators of sleep quality and cognitive function. At 30 days post-stroke, 58.7% of IS patients had sleep disturbance. Women and older IS patients were more likely to suffer poorer sleep quality (p < 0.05). A stratified linear regression analysis showed that the inclusion of cognitive function variables and indicators of depression and anxiety were statistically significant in predicting improvement in the sleep disturbance of AIS patients. Cognitive function, depression, anxiety, and sleep status were selected to construct a structural equation model. The total effect of cognitive function on sleep status was -0.274, with a direct effect of -0.097 and an indirect effect (through depression) of -0.177. The total effect of anxiety on sleep status was 0.235, with a direct effect of 0.186 and an indirect effect (through depression) of 0.049. IS patients often experience poor sleep quality. Depression in IS patients mediates two pathways: the pathway through which cognitive function affects sleep quality and the pathway through which anxiety affects sleep quality.
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Affiliation(s)
- Shuzhen Niu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Xianliang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane 4000, Australia
| | - Qian Wu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jiajia Ma
- Chest Hospital, Shanghai 200030, China
| | - Songqi Wu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Li Zeng
- Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yan Shi
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
- Correspondence:
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Huang G, Chen J, Zhan L, Long J, Lin Y, Zhu B, He J. Reduced serum vitamin D levels are associated with poor sleep quality in early stroke patients. Front Nutr 2022; 9:937867. [PMID: 35938109 PMCID: PMC9355158 DOI: 10.3389/fnut.2022.937867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPoor sleep quality and vitamin D deficiency are common in stroke patients. Our aim was to evaluate the possible association between vitamin D and sleep quality in acute ischemic stroke (AIS) patients.MethodsA total of 301 AIS patients were screened and completed 1-month follow-up. Serum 25-hydroxyvitamin D [25(OH)D] was used to assess the vitamin D status by a competitive protein-binding assay at baseline. All patients were divided into equal quartile according to the distribution of 25(OH)D. One month after stroke, sleep quality was evaluated by using Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaire; depression status was confirmed by 17-item Hamilton Depression Scale (HAMD).ResultsThere were 89 (29.6%) AIS patients with poor sleep quality 1-month post-event. Within 24 h after admission, serum 25(OH)D levels were significantly lower in patients with poor sleep quality after stroke (P < 0.001). In the results of multivariate-adjusted logistic regression analysis, the odds ratio (OR) of poor sleep quality was 6.199 (95% CI, 2.066–18.600) for the lowest quartile of 25(OH)D compared with the highest quartile. In patients without depression, reduced 25(OH)D were still significantly associated with poor sleep quality (OR = 8.174, 95% CI = 2.432–27.473). Furthermore, 25(OH)D and HAMD score were combined to enhance the diagnostic accuracy of poor sleep quality, with the area under the receiver operating characteristic curve of 0.775.ConclusionReduced serum levels of vitamin D at admission were independently and significantly associated with poor sleep quality at 1 month after stroke. Our findings suggested the combination of vitamin D and depression status could provide important predictive information for post-stroke sleep quality.
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Schmidt MH, Dekkers MPJ, Baillieul S, Jendoubi J, Wulf MA, Wenz E, Fregolente L, Vorster A, Gnarra O, Bassetti CLA. Measuring Sleep, Wakefulness, and Circadian Functions in Neurologic Disorders. Sleep Med Clin 2021; 16:661-671. [PMID: 34711389 DOI: 10.1016/j.jsmc.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Neurologic disorders impact the ability of the brain to regulate sleep, wake, and circadian functions, including state generation, components of state (such as rapid eye movement sleep muscle atonia, state transitions) and electroencephalographic microarchitecture. At its most extreme, extensive brain damage may even prevent differentiation of sleep stages from wakefulness (eg, status dissociatus). Given that comorbid sleep-wake-circadian disorders are common and can adversely impact the occurrence, evolution, and management of underlying neurologic conditions, new technologies for long-term monitoring of neurologic patients may potentially usher in new diagnostic strategies and optimization of clinical management.
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Affiliation(s)
- Markus H Schmidt
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Ohio Sleep Medicine Institute, 4975 Bradenton Avenue, Dublin, OH 43017, USA.
| | - Martijn P J Dekkers
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Sébastien Baillieul
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Univ. Grenoble Alpes, Inserm, U1300, CHU Grenoble Alpes, Service Universitaire de Pneumologie Physiologie, Grenoble 38000, France
| | - Jasmine Jendoubi
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Marie-Angela Wulf
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Elena Wenz
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Livia Fregolente
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Albrecht Vorster
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland
| | - Oriella Gnarra
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Sensory-Motor System Lab, IRIS, ETH Zurich, Switzerland
| | - Claudio L A Bassetti
- Department of Neurology, Bern University Hospital (Inselspital) and University Bern, Switzerland; Department of Neurology, University of Sechenow, Moscow, Russia
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Hao S, Zhong Z, Qu W, Huang Z, Sun F, Qiu M. Melatonin supplementation in the subacute phase after ischemia alleviates postischemic sleep disturbances in rats. Brain Behav 2021; 11:e2366. [PMID: 34520636 PMCID: PMC8553311 DOI: 10.1002/brb3.2366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Sleep disorders are highly prevalent among stroke survivors and impede stroke recovery. It is well established that melatonin has neuroprotective effects in animal models of ischemic stroke. However, as a modulator of endogenous physiological circadian rhythms, the effects of melatonin on poststroke sleep disorders remain unclear. In the present study, we investigated how melatonin delivered intraperitoneally once daily in the subacute phase after stroke onset, influencing neuronal survival, motor recovery, and sleep-wake profiles in rats. METHODS Transient ischemic stroke in male Sprague-Dawley rats was induced with 30 min occlusion of the middle cerebral artery. Melatonin or vehicle was delivered intraperitoneally once daily in the subacute phase, from 2 to 7 days after stroke. Electroencephalogram and electromyogram recordings were obtained simultaneously. RESULTS Compared to the effects observed in the vehicle-treated ischemic group, after 6 daily consecutive treatment of melatonin at 10 mg/kg starting at ischemic/reperfusion day 2, the infarct volume was significantly decreased (from 39.6 to 26.2%), and the degeneration of axons in the ipsilateral striatum and the contralateral corpus callosum were significantly alleviated. Sensorimotor performances were obviously improved as evidenced by significant increases in the latency to falling off the wire and in the use of the impaired forelimb. In addition to those predictable results of reducing brain tissue damage and mitigating behavioral deficits, repeated melatonin treatment during the subacute phase of stroke also alleviated sleep fragmentation through reducing sleep-wake stage transitions and stage bouts, together with increasing stage durations. Furthermore, daily administration of melatonin at 9 a.m. significantly increased the nonrapid eye movement sleep delta power during both the light and dark periods and decreased the degree of reduction of the circadian index. CONCLUSIONS Melatonin promptly reversed ischemia-induced sleep disturbances. The neuroprotective effects of melatonin on ischemic injury may be partially associated with its role in sleep modulation.
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Affiliation(s)
- Shu‐Mei Hao
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
| | - Zhi‐Gang Zhong
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Wei‐Min Qu
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Zhi‐Li Huang
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Feng‐Yan Sun
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
| | - Mei‐Hong Qiu
- Department of NeurobiologyInstitute for Basic Research on Aging and MedicineSchool of Basic Medical ScienceFudan UniversityShanghaiChina
- Department of PharmacologySchool of Basic Medical ScienceState Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
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Zhang Q, Liu Y, Liang Y, Yang D, Zhang W, Zou L, Wan Z. Exercise intervention for sleep disorders after stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e25730. [PMID: 33907166 PMCID: PMC8084092 DOI: 10.1097/md.0000000000025730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sleep disorders after stroke is one of the most common neuropsychiatric complications and is associated with increased risk of death and poor functional outcomes. Some evidence shows that patients with sleep disorders after stroke benefit from exercise intervention. However, this result is still conflicting. This study aims to explore the effects of exercise on sleep disorders after stroke and to establish safe and effective exercise prescriptions. METHODS AND ANALYSIS The databases including Google Scholar, Pubmed, Embase, and Cochrane library will be searched using pre-specified search strategies. Randomized controlled trials and non-randomized prospective controlled cohort studies regarding exercise for sleep disorders after stroke will be included. The primary outcome is the Pittsburgh Sleep Quality Index (PSQI) scale. The secondary outcomes are adverse events associated with exercise and all deaths. The methodological quality of each study will be evaluated by the physiotherapy evidence database scale. The heterogeneity will be evaluated using the I2 test. If I2 > 50%, random effects models will be used in the analysis; otherwise, fixed effects models will be used to pool the data. RESULTS This study will assess the efficacy and safety of exercise for sleep disorders after stroke. CONCLUSIONS Our findings will be helpful for clinicians to examine the clinical decision-making in the treatment of sleep disorders after stroke using exercise intervention. ETHICS AND DISSEMINATION Ethical approval is not required because this study is a secondary analysis. The results of this study will be disseminated through journals and academic exchanges. SYSTEMATIC REVIEW REGISTRATION NUMBER INPLASY202130106.
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Affiliation(s)
- Qin Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Yin Liang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Dan Yang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Zhang
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Liqun Zou
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
- School of Nursing, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi Wan
- Department of Emergency Medicine, Laboratory of Emergency Medicine, Disaster Medical Center
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12
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Gottlieb E, Khlif MS, Bird L, Werden E, Churchward T, Pase MP, Egorova N, Howard ME, Brodtmann A. Sleep architectural dysfunction and undiagnosed obstructive sleep apnea after chronic ischemic stroke. Sleep Med 2021; 83:45-53. [PMID: 33991892 DOI: 10.1016/j.sleep.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep-wake dysfunction is bidirectionally associated with the incidence and evolution of acute stroke. It remains unclear whether sleep disturbances are transient post-stroke or are potentially enduring sequelae in chronic stroke. Here, we characterize sleep architectural dysfunction, sleep-respiratory parameters, and hemispheric sleep in ischemic stroke patients in the chronic recovery phase compared to healthy controls. PATIENTS/METHODS Radiologically confirmed ischemic stroke patients (n = 28) and matched control participants (n = 16) were tested with ambulatory polysomnography, bi-hemispheric sleep EEG, and demographic, stroke-severity, mood, and sleep-circadian questionnaires. RESULTS Twenty-eight stroke patients (22 men; mean age = 69.61 ± 7.4 years) were cross-sectionally evaluated 4.1 ± 0.9 years after mild-moderate ischemic stroke (baseline NIHSS: 3.0 ± 2.0). Fifty-seven percent of stroke patients (n = 16) exhibited undiagnosed moderate-to-severe obstructive sleep apnea (apnea-hypopnea index >15). Despite no difference in total sleep or wake after sleep onset, stroke patients had reduced slow-wave sleep time (66.25 min vs 99.26 min, p = 0.02), increased time in non-rapid-eye-movement (NREM) stages 1-2 (NREM-1: 48.43 vs 28.95, p = 0.03; NREM-2: 142.61 vs 115.87, p = 0.02), and a higher arousal index (21.46 vs 14.43, p = 0.03) when compared to controls. Controlling for sleep apnea severity did not attenuate the magnitude of sleep architectural differences between groups (NREM 1-3=ηp2 >0.07). We observed no differences in ipsilesionally versus contralesionally scored sleep architecture. CONCLUSIONS Fifty-seven percent of chronic stroke patients had undiagnosed moderate-severe obstructive sleep apnea and reduced slow-wave sleep with potentially compensatory increases in NREM 1-2 sleep relative to controls. Formal sleep studies are warranted after stroke, even in the absence of self-reported history of sleep-wake pathology.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia.
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Laura Bird
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
| | - Thomas Churchward
- Institute for Breathing and Sleep, Melbourne, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, VIC, Australia; Harvard T.H. Chan School of Public Health, Harvard University, MA, USA
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Mark E Howard
- University of Melbourne, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; University of Melbourne, Melbourne, VIC, Australia
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Gottlieb E, Egorova N, Khlif MS, Khan W, Werden E, Pase MP, Howard M, Brodtmann A. Regional neurodegeneration correlates with sleep-wake dysfunction after stroke. Sleep 2021; 43:5813630. [PMID: 32249910 DOI: 10.1093/sleep/zsaa054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/19/2020] [Indexed: 12/13/2022] Open
Abstract
Sleep-wake disruption is a key modifiable risk factor and sequela of stroke. The pathogenesis of poststroke sleep dysfunction is unclear. It is not known whether poststroke sleep pathology is due to focal infarction to sleep-wake hubs or to accelerated poststroke neurodegeneration in subcortical structures after stroke. We characterize the first prospective poststroke regional brain volumetric and whole-brain, fiber-specific, white matter markers of objectively measured sleep-wake dysfunction. We hypothesized that excessively long sleep (>8 h) duration and poor sleep efficiency (<80%) measured using the SenseWear Armband 3-months poststroke (n = 112) would be associated with reduced regional brain volumes of a priori-selected sleep-wake regions of interest when compared to healthy controls with optimal sleep characteristics (n = 35). We utilized a novel technique known as a whole-brain fixel-based analysis to investigate the fiber-specific white matter differences in participants with long sleep duration. Stroke participants with long sleep (n = 24) duration exhibited reduced regional volumes of the ipsilesional thalamus and contralesional amygdala when compared with controls. Poor sleep efficiency after stroke (n = 29) was associated with reduced ipsilesional thalamus, contralesional hippocampus, and contralesional amygdala volumes. Whole-brain fixel-based analyses revealed widespread macrostructural degeneration to the corticopontocerebellar tract in stroke participants with long sleep duration, with fiber reductions of up to 40%. Neurodegeneration to subcortical structures, which appear to be vulnerable to accelerated brain volume loss after stroke, may drive sleep-wake deficiencies poststroke, independent of lesion characteristics and confounding comorbidities. We discuss these findings in the context of the clinicopathological implications of sleep-related neurodegeneration and attempt to corroborate previous mechanistic-neuroanatomical findings.
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Affiliation(s)
- Elie Gottlieb
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Natalia Egorova
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mohamed S Khlif
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Wasim Khan
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,Department of Neuroimaging, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College, London, UK
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew P Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.,Harvard T.H. Chan School of Public Health, Harvard University, MA
| | - Mark Howard
- University of Melbourne, Melbourne, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
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14
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Li C, Liu Y, Zhou X, Wang Y. A paper-based SERS assay for sensitive duplex cytokine detection towards the atherosclerosis-associated disease diagnosis. J Mater Chem B 2021; 8:3582-3589. [PMID: 31872850 DOI: 10.1039/c9tb02469g] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Atherosclerosis (AS) is the most common factor causing many cardiovascular and cerebrovascular diseases and has received considerable attention. The occurrence mechanism of AS is uncertain because it is a choronically pathological process that is influenced by multi-aspects, among which cytokines play the key roles in regulating the processes of the immune system. For example, two key cytokines, namely, IL-10 and MCP-1 (chemokine), which are involved in AS progression with varied levels, can be used for AS status monitoring and early diagnosis of AS-associated diseases. Hence, a new paper-based, surface-enhanced Raman spectroscopy (SERS) sensing platform was established for the detection of these two key cytokines. By combining a nanoporous networking membrane as the substrate and SERS nanotags as the probe for signal reading, together with a sandwich design, sensitive and specific identification and quantification of cytokine targets in human serum were achieved with excellent sensing characteristics. The lowest detectable concentration was determined to be 0.1 pg mL-1 for both IL-10 and MCP-1 in human serum. The assay also exhibits high specificity towards target cytokine detection, with low-nonspecific binding and acceptable cross-reactivity in the presence of other structurally similar targets. Finally, the practicability was validated by performing duplex detection in human serum, which further demonstrates the high specificity of the assay for the detection of target cytokines. Taken together, these promising results illustrate that this developed sensing assay is a candidate for clinical multi-target analysis in real environments.
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Affiliation(s)
- Chunxia Li
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
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15
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Hasan F, Gordon C, Wu D, Huang HC, Yuliana LT, Susatia B, Marta OFD, Chiu HY. Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke 2021; 52:655-663. [PMID: 33406871 DOI: 10.1161/strokeaha.120.029847] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The exact prevalence of sleep disorders following stroke or transient ischemic attack (TIA) remains unclear. We aimed to determine the prevalence of sleep-disordered breathing, insomnia, periodic leg movement during sleep, and restless leg syndrome following stroke or TIA in acute, subacute, and chronic phases and examine the moderating effects of patient characteristics (eg, age) and methodological features (eg, study quality) on the prevalence. METHODS We performed a systematic review and meta-analysis. Embase and PubMed were searched from inception to December 18, 2019. We included 64 047 adults in 169 studies (prospective, retrospective, case-control, and cross-sectional study designs) reporting the prevalence of sleep disorders following stroke or TIA. RESULTS In the acute phase, the overall prevalence of mild, moderate, and severe sleep-disordered breathing was 66.8%, 50.3%, and 31.6% (95% CIs, 63.8-69.7, 41.9-58.7, and 24.9-39.1). In the subacute phase, the prevalence of mild, moderate, and severe sleep-disordered breathing was 65.5%, 44.3%, and 36.1% (95% CIs, 58.9-71.5, 36.1-52.8, and 22.2-52.8). In the chronic phase, the summary prevalence of mild, moderate, and severe sleep-disordered breathing was 66.2%, 33.1%, and 25.1% (95% CIs, 58.6-73.1, 24.8-42.6, and 10.9-47.6). The prevalence rates of insomnia in the acute, subacute, and chronic phases were 40.7%, 42.6%, and 35.9% (95% CIs, 31.8-50.3, 31.7-54.1, and 28.6-44.0). The pooled prevalence of periodic leg movement during sleep in the acute, subacute, and chronic phases was 32.0%, 27.3%, and 48.2% (95% CIs, 7.4-73.5, 11.6-51.7, and 33.1-63.5). The summary prevalence of restless leg syndrome in the acute and chronic phases was 10.4% and 13.7% (95 CIs, 6.4-16.4 and 2.3-51.8). Age, sex, comorbidities, smoking history, and study region had significant moderating effects on the prevalence of sleep disorders. CONCLUSIONS Sleep disorders following stroke or TIA are highly prevalent over time. Our findings indicate the importance of early screening and treating sleep disorders following stroke or TIA.
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Affiliation(s)
- Faizul Hasan
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Christopher Gordon
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Australia (C.G.)
| | - Dean Wu
- Department of Neurology, School of Medicine, College of Medicine (D.W.), Taipei Medical University, Taiwan.,Department of Neurology, Shuang-Ho Hospital (D.W.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
| | - Hui-Chuan Huang
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan
| | | | - Budi Susatia
- School of Nursing (F.H., B.S.), Politeknik Kesehatan Kemenkes Malang, Indonesia
| | - Ollyvia Freeska Dwi Marta
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Nursing Department, Faculty of Health Science, University of Muhammadiyah Malang, Indonesia (O.F.D.M.)
| | - Hsiao-Yean Chiu
- School of Nursing, College of Nursing (F.H., H.-C.H., O.F.D.M., H.-Y.C.), Taipei Medical University, Taiwan.,Research Center of Sleep Medicine, College of Medicine (D.W., H.-Y.C.), Taipei Medical University, Taiwan
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16
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Bian Y, Zhang Y, Tian ZB. Effect of hirudin on serum matrix metalloproteinase-9 of acute cerebral infarction: A protocol of systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20533. [PMID: 32629634 PMCID: PMC7337417 DOI: 10.1097/md.0000000000020533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This study aims to check the effect of hirudin on serum matrix metalloproteinase-9 (SMMP9) in patients with acute cerebral infarction (ACI). METHODS For acquisition of obtained data of included studies, we will undertake comprehensive search from the following electronic databases: MEDLINE, Embase, Cochrane Library, CINAHL, WANGFANG database, VIP database, CBM database, and China National Knowledge Infrastructure from their inceptions to the March 31, 2020. No restrictions of language and publication status will be applied to all database sources. Two investigators will independently undertake study selection, data extraction, and study quality. Any different opinions between 2 investigators will be solved by a third investigator through consultation. Study quality will be assessed using Cochrane risk of bias tool, and level of evidence for outcome results will be identified using the Grading of Recommendations Assessment, Development, and Evaluation method. We will use RevMan 5.3 software for statistical analysis. RESULTS From this study, we will evaluate the effect of hirudin on SMMP9 in patients with ACI. CONCLUSION The findings of this study will provide evidence to ensure the effect of hirudin on SMMP9 in patients with ACI.
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Affiliation(s)
| | - Ying Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine
| | - Zhi-bin Tian
- Second Ward of Neurology Department, Xianyang Hospital of Yan’an University, Xianyang, China
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17
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Wei CJ, Zou CY, Wang ZM, Jiang YJ. Association between serum lipoprotein levels and cognitive impairment in acute cerebral infarction: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e20178. [PMID: 32443336 PMCID: PMC7253535 DOI: 10.1097/md.0000000000020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The objective of this study is to examine the association between serum lipoprotein levels (SLL) and cognitive impairment (CI) in patients with acute cerebral infarction (ACI). METHODS All published studies will be searched from the following electronic databases: PubMed, EMBASE, Cochrane Library, PsycINFO, Web of Science, WANGFANG, and China National Knowledge Infrastructure from inauguration of each electronic database up to March 1, 2020. In addition, we will also search other sources, such as dissertations, Google scholar, conference proceedings, and reference lists of relevant reviews. We will not apply any language restrictions to the electronic databases. Two researchers will independently carry out literature selection, data collection, and methodological quality. A third researcher will help to solve any divergences by discussion. The RevMan 5.3 software will be employed to pool the collected data and to analyze the outcome data. RESULTS This study will scrutinize the association between SLL and CI in patients with ACI. CONCLUSIONS The results of this study will present helpful evidence of the association between SLL and CI in patients with ACI.Registration number: INPLASY202040018.
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Affiliation(s)
| | - Chun-Ying Zou
- Fourth Ward of Neurology Department, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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18
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Baylan S, Griffiths S, Grant N, Broomfield NM, Evans JJ, Gardani M. Incidence and prevalence of post-stroke insomnia: A systematic review and meta-analysis. Sleep Med Rev 2020; 49:101222. [DOI: 10.1016/j.smrv.2019.101222] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
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19
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Wang D, Peng X, Yang A, He Y, Dong L, Lu H. Edaravone promotes nerve function recovery after acute cerebral infarction in rats via targeting Keap1-Nrf2/ARE. Panminerva Med 2019; 63:384-385. [PMID: 31355603 DOI: 10.23736/s0031-0808.19.03694-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dong Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Xiaoyan Peng
- Department of Dermatology, Wuhan University, Renmin Hospital, Wuhan, China
| | - Aiguo Yang
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Ying He
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Li Dong
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu, China
| | - Huajie Lu
- Department of Pain Rehabilitation, Hubei Provincial Hospital of Traditional Chinese Medicine, Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China -
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20
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Liu X, Rao S, Wang J. Intravenous thrombolysis in combination with mild hypothermia therapy in the treatment of acute cerebral infarction. Pak J Med Sci 2019; 35:1161-1166. [PMID: 31372161 PMCID: PMC6659097 DOI: 10.12669/pjms.35.4.311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the efficacy of recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis in combination with mild hypothermia therapy in the treatment of acute cerebral infarction. Methods One hundred and thirty-two patients with acute cerebral infarction who were admitted to our hospital were selected and grouped into a control group and an observation group, 66 each group. Patients in the control group were given conventional treatment in combination with local mild hypothermia therapy, and patients in the observation group were given rt-PA intravenous thrombolysis on the basis of conventional treatment and local mild hypothermia therapy. National institute of health stroke scale (NIHSS) score and intracranial pressure (ICP) of the two groups before and after treatment was recorded. The efficacy of the two groups was evaluated. The modified Rankin scale (MRS) score was followed up for three months. The blood samples of the patients were collected before and after thrombolysis. Superoxide dismutase (SOD) and malondialdehyde (MDA) levels in the plasma were detected. Results The NIHSS score of the two groups decreased in the 1st, 3rd and 7th day after treatment compared to before treatment (p<0.05), but the NIHSS score of the two groups had no significant difference at different time points after treatment (p>0.05). The ICP of the two groups decreased in the 1st, 3rd and 7th day after treatment compared to before treatment (p<0.05), and the decrease of ICP of the observation group was more significant than that of the control group at the same time point (1st, 3rd and 7th day after treatment) (p<0.05). The clinical efficacy of the observation group was higher than that of the control group after treatment, and the difference was statistically significant (p<0.05). The MDA concentration of both groups decreased at different time points after treatment (p<0.05), but the SOD concentration increased (p<0.05). The MDA concentration of the observation group was lower than that of the control group at different time points after treatment (p<0.05), and the SOD concentration of the observation group was higher than that of the control group (p<0.05). Conclusion rt-PA intravenous thrombolysis in combination with mild hypothermia therapy has significant efficacy in the treatment of acute cerebral infarction. It can effectively relieve neurological function. Its action mechanism may be realized by relieving oxidative stress response.
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Affiliation(s)
- Xiaoying Liu
- Xiaoying Liu Departments of Neurology, Binzhou People's Hospital, Shandong, 256610, China
| | - Shengli Rao
- Shengli Rao Departments of Emergency, Binzhou People's Hospital, Shandong, 256610, China
| | - Jiajia Wang
- Jiajia Wang Departments of Neurology, Binzhou People's Hospital, Shandong, 256610, China
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21
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Gottlieb E, Landau E, Baxter H, Werden E, Howard ME, Brodtmann A. The bidirectional impact of sleep and circadian rhythm dysfunction in human ischaemic stroke: A systematic review. Sleep Med Rev 2019; 45:54-69. [DOI: 10.1016/j.smrv.2019.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 01/11/2023]
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22
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The prevalence and clinical significance of sleep disorders in acute ischemic stroke patients—a questionnaire study. Sleep Breath 2017; 21:759-765. [DOI: 10.1007/s11325-016-1454-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/24/2016] [Accepted: 12/29/2016] [Indexed: 10/20/2022]
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