2016年 · 第96卷第41期

One third of a person's life is spent in sleep. There is a close connection between the brain and sleep in neurological diseases. All types of sleep disorders can occur in Parkinson's disease (PD), Alzheimer's disease (AD), cerebrovascular disease, etc., including sleep breathing disorder, daytime drowsiness, insomnia, restless leg syndrome (RLS) /periodic leg movements (PMLS), rapid eye movement sleep behavior disorder (RBD), etc. Some are risk factors and precursors of these diseases, and a variety of sleep problems can occur after the disease, and affect the patient's short-term and long-term prognosis. In recent years, domestic clinicians have also noticed this problem, and there are special reports on sleep disorders at the annual academic meetings of Chinese Medical Association, Chinese Medical Doctors Association and other societies. This article takes cerebrovascular disease as an example to talk about the necessity of paying attention to sleep disorders.

Parkinson's disease (Parkinson's disease) is a neurodegenerative disease common in middle-aged and elderly people. It is mainly characterized by progressive degeneration of dopaminergic neurons in substantia nigra and pathological changes of Lewy body formation, biochemical changes such as reduction of dopamine transmitters in the striatum area and imbalance of dopamine and acetylcholine transmitters. Clinically, it is characterized by motor symptoms such as quiescent tremor, bradykinesia and myotonia, and non-motor symptoms such as anosmia, constipation, abnormal sleep behavior and depression. The overall prevalence rate of people over 65 years of age in China is 1700/100,000, and it increases with age, which brings a heavy burden to families and society^[1]。 Up to now, levodopa (LD) is still the gold standard drug for the treatment of Parkinson's disease. However, with the development of the disease, long-term levodopa administration will cause motor complications, such as symptom fluctuation, dyskinesia and other non-motor complications. Among them, levodopa-induced dyskinesia (LID) is one of the common long-term motor complications.

mesenchymal stem cells (MSCs) refer to adult stem cells derived from mesoderm. They are widely present in various tissues, and are relatively abundant in bone marrow and cord blood. They can be differentiated into osteoblasts, chondrocytes, adipocytes, cardiomyocytes, etc^[1]。 MSCs have the characteristics of high self-renewal ability, weak immunogenicity, easy isolation, culture, expansion in vitro, and easy introduction of foreign genes. MSCs also have the ability to chemotaxis to the site of inflammatory damage, so MSCs have shown broad application prospects in cell therapy and gene therapy. The microenvironment of solid tumors is very similar to that of damaged tissues, and both contain a large number of inflammatory cells and inflammatory factors, such as tumor necrosis factor (TNF) -α, interferon (IFN) -γ, interleukin (IL) -6, IL-8, macrophages, mast cells, etc^[2,3,4,5,6]。 MSCs can chemotaxis to small tumor foci and proliferate and differentiate into important components of tumor stroma^[7]。 Taking advantage of the characteristics that MSCs can specifically migrate to tumor sites, MSCs can be used as vectors for tumor therapy, and various genes that have inhibitory effect on tumor can be transfected into MSCs through viral vectors to inhibit or even kill tumors.

As a pure opioid receptor antagonist, naloxone can reverse all the effects mediated by opioid M, β and κ receptors. It is often used clinically to rescue acute alcoholism, reverse overdose of opioid receptor agonist or its related adverse reactions, and counter the adverse reactions mediated by endogenous opioid peptide release under stress conditions. Naloxone is mostly used in conventional doses in these aspects, but it is worth noting in clinical practice that when it is used to antagonize opioid-related adverse reactions, the analgesic effect of the latter will also be partially or completely reversed, thus causing hyperalgesia. Especially for patients who have been treating chronic pain with opioid receptor agonists for a long time, due to the phenomenon of opioid tolerance and dependence, they even have opioid withdrawal symptoms (autonomic nervous system hyperactivity and psychomotor anxiety, etc.) when using naloxone to treat opioid adverse reactions. In this case, it is particularly important to seek effective solutions to alleviate the adverse reactions without reducing the analgesic efficacy of opioid receptor agonists.