Effect of Intraoperative Esketamine Infusion on Postoperative Sleep Disturbance After Gynecological Laparoscopy

JAMA Network Open, Journal Year: 2022, Volume and Issue: 5(12), P. e2244514 - e2244514

Published: Dec. 1, 2022

Importance Postoperative sleep disturbance (PSD) is common in patients after surgery. Objective To examine the effect of intraoperative esketamine infusion on incidence PSD who underwent gynecological laparoscopic Design, Setting, and Participants This single-center, double-blind, placebo-controlled randomized clinical trial was conducted from August 2021 to April 2022 First Affiliated Hospital Zhengzhou University China. included aged 18 65 years with an American Society Anesthesiologist Physical Status classification I III (with indicating a healthy patient, II patient mild systemic disease, severe disease) Patients were randomly assigned either group or control group. Data analyzed using per protocol principle. Interventions received continuous esketamine, 0.3 mg/kg/h, intraoperatively. equivalent volume saline. Main Outcomes Measures The primary outcome postoperative days (PODs) 1 3. defined as numeric rating scale score 6 higher Athens Insomnia Scale points higher. secondary outcomes anxiety depression scores Anxiety Depression Scale, pain visual analog scale, hydromorphone consumption, risk factors associated PSD. Results A total 183 female (n = 91; median [IQR] age, 45 [35-49] years) 92; 43 [32-49] years). significantly lower than POD (22.8% vs 44.0%; odds ratio [OR], 0.38 [95% CI, 0.20-0.72]; P .002) 3 (7.6% 19.8%; OR, 0.33 0.13-0.84]; .02). There no differences between 2 groups. consumption first 24 hours (3.0 [range, 2.8-3.3] mg 3.2 2.9-3.4] mg; .04) movement (3 [3-4] 4 [3-5] points; < .001) On multivariable logistic regression, preoperative (OR, 1.31; 95% 1.01-1.70) 1.67; 1.04-1.80) scores, duration anesthesia 1.04; 1.00-1.08), 1.92; 1.24-2.96) identified Conclusions Relevance this showed prophylactic Further studies are needed confirm these results. Trial Registration Chinese Clinical Registry Identifier: ChiCTR2100048587

Language: Английский

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The circadian system, sleep, and the health/disease balance: a conceptual review

Journal of Sleep Research, Journal Year: 2022, Volume and Issue: 31(4)

Published: June 7, 2022

Summary The field of “circadian medicine” is a recent addition to chronobiology and sleep research efforts. It represents logical step arising from the increasing insights into circadian system its interactions with life in urbanised societies; applying these health/disease balance at home medical practice (outpatient) clinic (inpatient). Despite fast expansion proliferating efforts, medicine lacks formal framework categorise many observations describing among system, sleep, balance. A good allows us then assign them one or more components hypothesised interactions. Such assignments can lead experiments that document causal (rather than correlational) relationships move discovering mechanisms. This review details such proposed for will hopefully trigger discussion our colleagues, so be improved expanded. As basis medicine, we define health” how it links general health. We put context literature examples six domains balance: fertility, cancer, immune mental health, cardiovascular, metabolism.

Language: Английский

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Suprachiasmatic nucleus dysfunction induces anxiety- and depression-like behaviors via activating the BDNF-TrkB pathway of the striatum

Translational Psychiatry, Journal Year: 2025, Volume and Issue: 15(1)

Published: March 21, 2025

The circadian rhythm system consists of a master clock located in the suprachiasmatic nucleus (SCN) hypothalamus and peripheral clocks dispersed throughout other brain areas (including striatum, Str) as well various tissues organs. Circadian disturbance is major risk factor common comorbidity for mood disorders, especially anxiety depression. Bmal1 one fundamental protein genes that required to maintain rhythm. Recent research has revealed link between dysfunction depression, but underlying mechanisms remain be fully elucidated. This study aimed investigate how may lead anxiety- depression-like behaviors. Through behavioral tests, virus tracing, molecular biology techniques, we found neural connection from striatum. SCN lesions Bmal1flox/flox + pAAV-hSyn-Cre-GFP (conditional knockout, cKO) mice exhibited disruptions core body temperature rhythm, Importantly, these displayed altered expression patterns an upregulation Brain-Derived Neurotrophic Factor (BDNF) - Tyrosine Kinase receptor B (TrkB) signaling pathway within Microinjection TrkB inhibitor ANA-12 can effectively reverse These findings indicate contribute pathogenesis depression through BDNF-TrkB potentially mediated by projections SCN. gene represent novel therapeutic target disorders.

Language: Английский

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Prefrontal cortex molecular clock modulates development of depression-like phenotype and rapid antidepressant response in mice

Nature Communications, Journal Year: 2024, Volume and Issue: 15(1)

Published: Aug. 23, 2024

Abstract Depression is associated with dysregulated circadian rhythms, but the role of intrinsic clocks in mood-controlling brain regions remains poorly understood. We found increased negative loop and decreased positive clock regulators expression medial prefrontal cortex (mPFC) a mouse model depression, subsequent countermodulation by rapid antidepressant ketamine. Selective Bmal1 KO CaMK2a excitatory neurons revealed that functional mPFC an essential factor for development depression-like phenotype ketamine effects. Per2 silencing produced antidepressant-like effects, while REV-ERB agonism enhanced suppressed action. Pharmacological potentiation modulator ROR elicited upregulating plasticity protein Homer1a, synaptic AMPA receptors plasticity-related slow wave activity specifically mPFC. Our data demonstrate critical molecular regulating behavior therapeutic potential pharmacological manipulations influencing glutamatergic-dependent plasticity.

Language: Английский

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Deciphering Depression: Epigenetic Mechanisms and Treatment Strategies

Biology, Journal Year: 2024, Volume and Issue: 13(8), P. 638 - 638

Published: Aug. 20, 2024

Depression, a significant mental health disorder, is under intense research scrutiny to uncover its molecular foundations. Epigenetics, which focuses on controlling gene expression without altering DNA sequences, offers promising avenues for innovative treatment. This review explores the pivotal role of epigenetics in depression, emphasizing two key aspects: (I) identifying epigenetic targets new antidepressants and (II) using personalized medicine based distinct profiles, highlighting potential focal points such as methylation, histone structure alterations, non-coding RNA molecules miRNAs. Variations methylation individuals with depression provide opportunities target genes that are associated neuroplasticity synaptic activity. Aberrant acetylation may indicate antidepressant strategies involve enzyme modifications. Modulating miRNA levels can reshape depression-linked expression. The second section discusses profiles. Analyzing these patterns could identify biomarkers treatment response susceptibility facilitating tailored treatments proactive care. Addressing ethical concerns regarding information, privacy stigmatization, crucial understanding biological basis depression. Therefore, researchers must consider issues when examining disorders. importance critical aspect modern medical research. These findings hold great novel medications treatments, would significantly improve patient outcomes, transform psychiatry. As progresses, it expected more complex aspects processes enhance our comprehension, increase effectiveness therapies.

Language: Английский

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It’s About Time: The Circadian Network as Time-Keeper for Cognitive Functioning, Locomotor Activity and Mental Health

Frontiers in Physiology, Journal Year: 2022, Volume and Issue: 13

Published: April 25, 2022

A variety of organisms including mammals have evolved a 24h, self-sustained timekeeping machinery known as the circadian clock (biological clock), which enables to anticipate, respond, and adapt environmental influences such daily light dark cycles. Proper functioning plays pivotal role in temporal regulation wide range cellular, physiological, behavioural processes. The disruption rhythms was found be associated with onset progression several pathologies sleep mental disorders, cancer, neurodegeneration. Thus, health disease, its clinical applications, gained increasing attention, but exact mechanisms underlying require further work integration evidence from different research fields. In this review, we address current knowledge regarding molecular circuits generators essential synchrony healthy organism. particular, discuss context behaviour cognitive functioning, delineating how loss tight interplay is linked pathological development focus on disorders We describe emerging new aspects link between physical exercise-induced usage activator positive impact delaying certain neurodegeneration brain-related disorders. Finally, recent epidemiological pointing an important health.

Language: Английский

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Effect of subanesthetic dose of esketamine on postoperative pain in elderly patients undergoing laparoscopic gastrointestinal tumor Surgery:A prospective, double-blind, randomized controlled trial

Heliyon, Journal Year: 2024, Volume and Issue: 10(5), P. e27593 - e27593

Published: March 1, 2024

PurposePostoperative pain is prevalent and severe complication in elderly surgical patients. Multiple studies propose that a small dose of esketamine administered intraoperatively can alleviate postoperative curtail opioid usage. We aimed to evaluate the impact on acute among patients with gastrointestinal tumors.Patients methodsThis prospective, parallel-group, randomized controlled trial. Ninety aged 60 above, undergoing resection tumors, were randomly assigned two groups: group (Group S, single 0.25 mg/kg 0.1 mg/kg/h infusion) control C, saline). Visual Analogue Scale (VAS) scores primary outcome. Remifentanil consumption, instances rescue analgesia, delirium, sleep quality, recovery serum levels inflammatory cytokines, adverse events within 72 h post-surgery secondary outcomes, respectively.ResultsData 87 99 eligible analyzed. VAS at rest Group S lower than those C 6 [1.2 (0.6, 1.6) vs 1.6 (1.0, 2.0), P = 0.003], 12 [1.4 2.0) 2.0 (1.5, < 0.001], 24 [1.8 (1.3, 2.2 (1.6, 2.6), 0.001] postoperatively. At post-surgery, score during coughing was [2.0 (2.0, 2.3) 3.0), 0.009]. The analgesia fewer compared (P 0.007). Furthermore, showed improved quality QoR-15 0.05) postoperatively.ConclusionIntravenous administration as an adjunct general anesthesia decrease intensity for without additional effects after laparoscopic tumor surgery.

Language: Английский

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The trilateral interactions between mammalian target of rapamycin (mTOR) signaling, the circadian clock, and psychiatric disorders: an emerging model

Translational Psychiatry, Journal Year: 2022, Volume and Issue: 12(1)

Published: Aug. 31, 2022

Circadian (~24 h) rhythms in physiology and behavior are evolutionarily conserved found almost all living organisms. The endogenously driven by daily oscillatory activities of so-called "clock genes/proteins", which widely distributed throughout the mammalian brain. Mammalian (mechanistic) target rapamycin (mTOR) signaling is a fundamental intracellular signal transduction cascade that controls important neuronal processes including neurodevelopment, synaptic plasticity, metabolism, aging. Dysregulation mTOR pathway associated with psychiatric disorders autism spectrum (ASD) mood (MD), patients often exhibit disrupted physiological abnormal circadian gene expression Recent work has temporally controlled clock robust oscillations multiple systems. In meantime, regulates properties central peripheral clocks, period length, entrainment, synchronization. Whereas underlying mechanisms remain to be fully elucidated, increasing clinical preclinical evidence support significant crosstalk between signaling, clock, disorders. Here, we review recent progress understanding trilateral interactions propose an "interaction triangle" model (focusing on ASD MD).

Language: Английский

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Fear extinction induced by activation of PKA ameliorates anxiety-like behavior in PTSD mice

Neuropharmacology, Journal Year: 2022, Volume and Issue: 222, P. 109306 - 109306

Published: Oct. 29, 2022

Language: Английский

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L’importance de l’horloge circadienne du cortex préfrontal dans la neurobiologie et le traitement de la dépression

médecine/sciences, Journal Year: 2025, Volume and Issue: 41(1), P. 29 - 32

Published: Jan. 1, 2025

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