Sleep, insomnia, and depression Riemann, Dieter; Krone, Lukas B; Wulff, Katharina ...
Neuropsychopharmacology (New York, N.Y.),
01/2020, Letnik:
45, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Since ancient times it is known that melancholia and sleep disturbances co-occur. The introduction of polysomnography into psychiatric research confirmed a disturbance of sleep continuity in patients ...with depression, revealing not only a decrease in Slow Wave Sleep, but also a disinhibition of REM (rapid eye movement) sleep, demonstrated as a shortening of REM latency, an increase of REM density, as well as total REM sleep time. Initial hopes that these abnormalities of REM sleep may serve as differential-diagnostic markers for subtypes of depression were not fulfilled. Almost all antidepressant agents suppress REM sleep and a time-and-dose-response relationship between total REM sleep suppression and therapeutic response to treatment seemed apparent. The so-called Cholinergic REM Induction Test revealed that REM sleep abnormalities can be mimicked by administration of cholinomimetic agents. Another important research avenue is the study of chrono-medical timing of sleep deprivation and light exposure for their positive effects on mood in depression. Present day research takes the view on insomnia, i.e., prolonged sleep latency, problems to maintain sleep, and early morning awakening, as a transdiagnostic symptom for many mental disorders, being most closely related to depression. Studying insomnia from different angles as a transdiagnostic phenotype has opened many new perspectives for research into mechanisms but also for clinical practice. Thus, the question is: can the early and adequate treatment of insomnia prevent depression? This article will link current understanding about sleep regulatory mechanisms with knowledge about changes in physiology due to depression. The review aims to draw the attention to current and future strategies in research and clinical practice to the benefits of sleep and depression therapeutics.
Purpose
The currently used system to classify the lower limb alignment (neutral, varus, valgus) does not consider the orientation of the joint line or its relationship to the overall lower limb ...alignment. Similarly, current total knee arthroplasty (TKA) alignment concepts do not sufficiently consider the variability of the native coronal alignment. Therefore, the purpose of this study was (1) to introduce a new classification system for the lower limb alignment, based on phenotypes, and (2) to compare the alignment targets of different TKA alignment concepts with the native alignment of non-osteoarthritic patients.
Methods
Two recent articles phenotyped the lower limb, the femur and tibia of 308 non-osteoarthritic knees of 160 patients male to female ratio = 102:58, mean age ± standard deviation 30 ± 7 years (16–44 years). The present study introduces functional knee phenotypes, which are a combination of all previously introduced phenotypes. The functional knee phenotypes therefore enable an evaluation of all parameters in relation to each other and thus a comprehensive analysis of the coronal alignment. The existing functional knee phenotypes in the female and male population were investigated. In addition, how many non-osteoarthritic knees had an alignment within the range of current TKA alignment targets (mechanical, anatomical and restricted kinematic alignment) was investigated. Therefore, it was defined which functional knee phenotypes represented a target of the TKA alignment concepts and which percentage of the population had such a phenotype.
Results
Out of 125 possible functional knee phenotypes, 43 were found (35 male, 26 and 18 mutual). The most common functional knee phenotype in males was NEU
HKA
0° + NEU
FMA
0° + NEU
TMA
0° (19%), followed by VAR
HKA
3° + NEU
FMA
0° + VAR
TMA
0° (8.2%). The most common functional knee phenotype in females was NEU
HKA
0° + NEU
FMA
0° + NEU
TMA
0° (17.7%), closely followed by NEU
HKA
0° + NEU
FMA
0° + VAL
TMA
0° (16.6%). The functional knee phenotype representing a mechanical alignment target was found in 5.6% of the males and 3.6% of the females. The phenotype representing an anatomical alignment target was found in 18% of the males and 17% in females. Five of the nine phenotypes representing a restricted kinematic alignment target were found in this population (male 5, female 4, mutual 4). They represented 31.3% of all males and 45.1% of all females.
Conclusion
A more individualized approach to TKA alignment is needed. The functional knee phenotypes enable a simple, but detailed assessment of a patient’s individual anatomy and thereby could be a helpful tool to individualize the approach to TKA.
Level of clinical evidence
III, retrospective cohort study.
•Propose a tractable capitalist-worker New Keynesian model to study the interaction of household heterogeneity and fiscal policy.•Modeling limited asset market participation through portfolio ...adjustment costs generates a realistic pattern of intertemporal marginal propensities to consume.•The capitalist-worker structures ensures that the transmission of demand shocks under sticky prices does not rely on income effects on labor supply induced by countercyclical markups.•Relative to the predictions of the traditional two-agent model, fiscal multipliers are smaller; and the sensitivity of the output path to public deficits is dampened.•Overall, the model matches the implications of richer Heterogeneous-Agent New Keynesian (HANK) models in key respects, while remaining analytically tractable.
We propose a novel two-agent New Keynesian model to study the interaction of fiscal policy and household heterogeneity in a tractable environment. Workers can save in bonds subject to portfolio adjustment costs; firm ownership is concentrated among capitalists who do not supply labor. The model is consistent with micro data on empirical intertemporal marginal propensities to consume, and it avoids implausible profit income effects on labor supply. Relative to the traditional two-agent model, these features imply, respectively, a lower sensitivity of consumption to the composition of public financing; and smaller fiscal multipliers alongside pronounced redistributive effects.
Purpose
There is a lack of knowledge about the joint line orientation of the femur and tibia in non-osteoarthritic knees. The primary purpose of the present study was to evaluate the orientation of ...the joint lines in native non-osteoarthritic knees using 3D-reconstructed CT scans. The secondary purpose was to identify knee phenotypes to combine the information of the femoral and tibial alignment.
Methods
A total of 308 non-osteoarthritic knees of 160 patients (male to female ratio = 102:58, mean age ± standard deviation 30 ± 7 years (16–44 years) were retrospectively included from our registry. All patients received CT of the knee according to the Imperial Knee Protocol. The orientation of the femoral and tibial joint line was measured in relation to their mechanical axis (femoral mechanical angle, FMA, and tibial mechanical angle, TMA) using a commercially planning software (KneePLAN 3D, Symbios, Yverdon les Bains, Switzerland). The values of FMA and TMA were compared between males and females. Descriptive statistics, such as means, ranges, and measures of variance (e.g. standard deviations), were presented. Based on these results, phenotypes were introduced for the femur and tibia. These phenotypes, based on FMA and TMA values, consist of a mean value and cover a range of ± 1.5° from this mean (3° increments). The distribution of femoral and tibial phenotypes, and their combinations (knee phenotypes) were calculated for the total group and for both genders.
Results
The overall mean FMA ± standard deviation (SD) was 93.4° ± 2.0° and values ranged from 87.9° varus to 100° valgus. The overall mean TMA ± SD was 87.2° ± 2.4° with a range of 81.3° varus to 94.6° valgus. FMA and TMA showed significant gender differences (
p
< 0.01). Females showed more valgus alignment than males. The most common femoral phenotype was neutral in both genders. The most common tibial phenotype was neutral in the male knees (62.8%) and valgus (41.6%) in the female knees. In males, the most frequent combination (knee phenotype) was a neutral phenotype in the femur and a neutral phenotype in the tibia (25.6%). In females, it was a neutral femoral phenotype and a valgus tibial phenotype (28.3%).
Conclusion
3D-reconstructed CT scans confirmed the great variability of the joint line orientation in non-osteoarthritic knees. The introduced femoral and tibial phenotypes enable the evaluation of the femoral and tibial alignment together (knee phenotypes). The variability of knee phenotypes found in this young non-osteoarthritic population clearly shows the need for a more individualized approach in TKA.
Level of evidence
III.
Lipid transfer between cell membrane bilayers at contacts between the endoplasmic reticulum (ER) and other membranes help to maintain membrane lipid homeostasis. We found that two similar ER integral ...membrane proteins, oxysterol-binding protein (OSBP)–related protein 5 (ORP5) and ORP8, tethered the ER to the plasma membrane (PM) via the interaction of their pleckstrin homology domains with phosphatidylinositol 4-phosphate (PI4P) in this membrane. Their OSBP-related domains (ORDs) harbored either PI4P or phosphatidylserine (PS) and exchanged these lipids between bilayers. Gain- and loss-of-function experiments showed that ORP5 and ORP8 could mediate PI4P/PS countertransport between the ER and the PM, thus delivering PI4P to the ER-localized PI4P phosphatase Sac1 for degradation and PS from the ER to the PM. This exchange helps to control plasma membrane PI4P levels and selectively enrich PS in the PM.
Amphiphilic Janus particles feature the combination of two different functional materials in one single colloid, as well as the possibility of self‐assembly at interfaces into complex ...superstructures. In this article, the self‐assembly of dual temperature responsive amphiphilic Janus particles at liquid–liquid interfaces and their subsequent conversion into an actuating layer‐shaped surface are presented. These microparticles are produced in a capillaries based continuous flow microfluidic device by photoinitiated radical polymerization. The hydrophobic part of the Janus particles contains a liquid crystalline elastomer (LCE), which performs a strong actuation up to 95% during the nematic–isotropic phase transition. The other side consists of a p(NIPAAm) hydrogel, which features volumetric expansions up to 280% below the lower critical solution temperature. A multistep molding process is developed to uniformly align the Janus particles at a toluene/water boundary surface and to embed the particles into a hydrogel matrix. A particle covered hydrogel layer is obtained, which features a collective actuation of the rod‐like LCE parts on the surface and a bundling of the resulting forces during the phase transition.
The self‐assembly of microfluidically produced dual temperature responsive Janus particles at a liquid–liquid interface is demonstrated. The hydrophobic liquid crystalline elastomer of the particles offers shape changes up to 95% during the nematic–isotropic phase transition, whereas the hydrogel part features volumetric expansions up to 280%. A multistep molding process is developed to form an actuating layer shaped superstructure from these Janus particles.
Disorders of the lungs such as chronic obstructive pulmonary disease (COPD) are a major cause of chronic morbidity and mortality and the third leading cause of death in the world. The absence of ...sensitive diagnostic tests for early disease stages of COPD results in under-diagnosis of this treatable disease in an estimated 60-85% of the patients. In recent years a grating-based approach to X-ray dark-field contrast imaging has shown to be very sensitive for the detection and quantification of pulmonary emphysema in small animal models. However, translation of this technique to imaging systems suitable for humans remains challenging and has not yet been reported. In this manuscript, we present the first X-ray dark-field images of in-situ human lungs in a deceased body, demonstrating the feasibility of X-ray dark-field chest radiography on a human scale. Results were correlated with findings of computed tomography imaging and autopsy. The performance of the experimental radiography setup allows acquisition of multi-contrast chest X-ray images within clinical boundary conditions, including radiation dose. Upcoming clinical studies will have to demonstrate that this technology has the potential to improve early diagnosis of COPD and pulmonary diseases in general.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
There is a lack of knowledge about the native coronal knee alignment in 3D. The currently used classification system (neutral, valgus and varus) oversimplifies the coronal knee alignment. The ...purpose of this study was therefore (1) to investigate the coronal knee alignment in non-osteoarthritic knees using 3D-reconstructed CT images and (2) to introduce a classification system for the overall knee alignment based on phenotypes.
Methods
The hospital registry was searched for patients younger than 45 years and older than 16, who received a CT according to the Imperial Knee Protocol. Patients with prosthesis, osteoarthritis, fractures or injury of the collateral ligaments were excluded. Finally, 308 non-osteoarthritic knees of 160 patients remained (102 males and 58 females, mean age ± standard deviation (SD) 30 ± 7 years). The overall lower limb alignment was defined as the hip–knee–ankle angle (HKA), which is formed by lines connecting the centers of the femoral head, the knee and the talus. The angle was measured using a commercially planning software (KneePLAN 3D, Symbios, Yverdon les Bains, Switzerland). Descriptive statistics, such as means, ranges, and measures of variance (e.g., standard deviations) are presented. Based on these results, the currently used classification system was evaluated and a new system, based on phenotypes, was introduced. These phenotypes consist of a phenotype-specific mean value (a HKA value) and cover a range of ± 1.5° from this mean (e.g., 183° ± 1.5°). The mean values represent 3° increments of the angle starting from the overall mean value (mean HKA = 180°; 3° increments = 183° and 177°, 186° and 174°). The distribution of these limb phenotypes was assessed.
Results
The overall mean HKA was 179.7° ± 2.9° varus and values ranged from 172.6° varus to 187.1° valgus. The mean HKA values for male and female were 179.2° ± 2.8° and 180.5° ± 2.8°, respectively, which implied a significant gender difference (
r
2
= 0.23). The most common limb phenotype in males was NEU
HKA
0° (36.4%), followed by VAR
HKA
3° (29.2%) and VAL
HKA
3° (23.1%). The most common limb phenotype in females was NEU
HKA
0° (36.4%), followed by VAL
HKA
3° (22.1%) and VAR
HKA
3° (15.0%).
Conclusion
The measurements using 3D-reconstructed CT images confirmed the great variability of the overall lower limb alignment in non-osteoarthritic knees. However, the currently used classification system (neutral, varus, valgus) oversimplifies the coronal alignment and therefore the introduced classification system, based on limb phenotypes, should be used. This will help to better understand individual coronal knee alignment.
Level of evidence
Level III, retrospective cohort study.
Purpose
There is a lack of knowledge about coronal alignment variability in osteoarthritic knees. Therefore, the purpose of this article was to systematically review the literature and collect data ...about the lower limb alignment including hip–knee–ankle angle (HKA), femoral mechanical angle (FMA), tibial mechanical angle (TMA) and the joint line convergence angle (JLCA) in osteoarthritic knees.
Methods
A systematic review was performed using the electronic databases MEDLINE (PubMed), EMBASE and Google Scholar. The following keywords were used: (morphology OR geometr* OR anatomy OR alignment OR phenotypes), (coronal OR neutral OR varus OR valgus), (knee OR lower limb OR femur OR tibia) and (osteoarthritis OR arthritis). Out of 110 full-text articles retrieved, 15 studies were included. Demographic information included author’s names, year of publication, imaging modality, sample size and patient demographics (i.e. sex, age, etc.). Descriptive statistics, such as means, ranges, and measures of variance e.g. standard deviations, 95% confidence intervals (CI) for all angles (HKA, FMA, TMA, JLCA) are presented.
Results
Thirteen studies reported mean overall HKA angles ranging from 163.5° ± 2.3° to 179.9° ± 4.8°. The mean HKA angles in females were between 164.1° ± 7.2° and 178.8° ± 4.8°, and in males between 163.4° ± 5.5° and 177.4° ± 3.9°. The lowest and highest reported HKA angles were − 27.7° and + 22.0°, respectively. Seven studies reported mean FMA angles. Mean values ranged from 92.7° ± 2.7° valgus to 88.6° ± 2° varus. The reported mean FMAs for male were 87.9° ± 0.5° to 90.7° ± 3° and for female 89.91° ± 2.8° to 92.9° ± 3.1°. Six studies reported mean TMA values. TMA ranged from 81.7° ± 3.9° varus to 87.7° ± 4.1° varus. Only three studies reported mean JLCA angles, which ranged from − 4.3° to − 6.4° ± 3.8°.
Conclusion
Osteoarthritic knees showed a huge variation in overall coronal limb alignment as well as in femoral and tibial coronal alignment. Current total knee arthroplasty (TKA) alignment philosophies and preoperative planning do not sufficiently consider these variation, which might be one reason for unhappy knees after TKA.
Level of evidence
IV, systematic review.
Purpose
Recently introduced total knee arthroplasty (TKA) alignment strategies aim to restore the pre-arthritic alignment of an individual patient. The native alignment of a patient can only be ...restored with detailed knowledge about the native and osteoarthritic alignment as well as differences between them. The first aim of this study was to assess the alignment of a large series of osteoarthritic (OA) knees and investigate whether femoral and tibial joint lines vary within patients with the same overall lower limb alignment. The secondary aim was to compare the alignment of OA patients to the previously published data of non-OA patients. This information could be useful for surgeons considering implementing one of the new alignment concepts.
Material
Coronal alignment parameters of 2692 knee OA patients were measured based on 3D reconstructed CT data using a validated planning software (Knee-PLAN
®
, Symbios, Yverdon les Bains, Switzerland). Based on these measurements, patients' coronal alignment was phenotyped according to the functional knee phenotype concept. These phenotypes represent an alignment variation of either the overall alignment, the femoral joint line orientation or the tibial joint line orientation. Each phenotype is defined by a specific mean and covers a range of ± 1.5° from this mean. Mean values and distribution among the phenotypes are presented and compared between two populations (OA patients of this study and non-OA patients of a previously published study) as well as between HKA subgroups (varus, valgus and neutral) using
t
tests and Chi-square tests (
p
< 0.05).
Results
Femoral and tibial joint lines varied within patients with the same overall lower limb alignment. A total of 162 functional knee phenotypes were found (119 males, 136 females and 94 mutual phenotypes). Mean values differed between the OA and non-OA population, but differences were small (< 2°) except for the overall alignment (e.g. HKA). The distribution of OA and non-OA patients among the phenotypes differed significantly, especially among the limb phenotypes.
Conclusion
Differences between OA and non-OA knees are small regarding coronal femoral and tibial joint line orientation. Femoral and tibial joint line orientation of osteoarthritic patients can, therefore, be used to estimate their native coronal alignment and plan an individualized knee alignment.
Level of clinical evidence
III.
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