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Since disagreement has been found between an objective sleep propensity measured by sleep onset latency (SOL) and subjective sleepiness assessment measured by the Epworth sleepiness scale (ESS) score, distinct underlying causes and consequences were suggested for these two sleepiness measures. We addressed the issue of validation of the ESS against objective sleepiness and sleep indexes by examining the hypothesis that these two sleepiness measures are disconnected due to their differential relationship with the antagonistic drives for sleep and wake. The polysomnographic records of 50-min napping attempts were collected from 27 university students on three occasions. Scores on the first and second principal components of the electroencephalographic (EEG) spectrum were calculated to measure the sleep and wake drives, respectively. Self-assessments of subjective sleepiness and sleep were additionally collected in online survey of 633 students at the same university. An ESS score was disconnected with the polysomnographic and self-assessed SOL in the nap study and online survey, respectively. An ESS score but not SOL was significantly linked to the spectral EEG measure of the sleep drive, while SOL but not ESS showed a significant association with the spectral EEG measure of the opposing wake drive. Each of two sleepiness measures was validated against objective indicators of the opposing sleep-wake regulating processes, but different underlying causes were identified for two distinct aspects of sleepiness. A stronger sleep drive and a weaker opposing drive for wake seem to contribute to a higher ESS score and to a shorter SOL, respectively.

The conventional staging classification reduces all patterns of sleep polysomnogram signals to a small number of yes-or-no variables labeled wake or a stage of sleep (e.g., W, N1, N2, N3, and R for wake, the first, second, and third stages of non-rapid eye movement sleep and rapid eye movement sleep, respectively). However, the neurobiological underpinnings of such stages remained to be elucidated. We tried to evaluate their link to scores on the first and second principal components of the EEG spectrum (1PCS and 2PCS), the markers of two major groups of promoters/inhibitors of sleep/wakefulness delineated as the drives for sleep and wake, respectively. On two occasions, polysomnographic records were obtained from 69 university students during 50-min afternoon naps and 30-s stage epochs were assigned to 1PCS and 2PCS. Results suggested two dimensionality of the structure of individual differences in amounts of stages. Amount of N1 loaded exclusively on one of two dimensions associated with 1PCS, amounts of W and N2 loaded exclusively on another dimension associated with 2PCS, and amount of N3 was equally loaded on both dimensions. Scores demonstrated stability within each stage, but a drastic change in just one of two scores occurred during transitions from one stage to another on the way from wakefulness to deeper sleep (e.g., 2PCS changed from0 to0 during transition W→N1, 1PCS changed from0 to0 during transition N1→N2). Therefore, the transitions between stages observed during short naps might be linked to rapid changes in the reciprocal interactions between the promoters/inhibitors of sleep/wakefulness.

To test the hypothesis that weak electromagnetic fields of low frequencies (0.5-26 Hz) could affect daytime sleep features and structure.Parameters of daytime sleep continuity were compared in the study with counterbalanced control/exposition (40 min exposure to electromagnetic field at 1 Hz/0.004 μT) scheme in 22 healthy volunteers. Nonlinear regression model was used to assess daytime sleep continuity.Exposure to a weak electromagnetic field of ultra-low frequency significantly improved the quality of sleep, assessed by the indicator of sleep continuity, namely, there were fewer transitions from the second and deeper stages of sleep to the first stage and to the state of wakefulness (The results can be used to develop non-pharmacological methods of sleep correction, as well as to improve the quality of short-term sleep and its positive effect on well-being, cognitive function and working capacity.Исследование влияния экспозиции слабых электромагнитных полей сверхнизкой частоты на структуру дневного сна.У 22 здоровых добровольцев сравнивали по контрбалансированной схеме показатели непрерывности (консолидированности) дневного сна при 40-минутной экспозиции электромагнитного поля (1 Гц/0,004 мкТл) и без воздействия (контроль). Для оценки непрерывности сна использовалась нелинейная регрессионная модель.Показано, что экспозиция слабого электромагнитного поля сверхнизкой частоты достоверно улучшала качество сна, оцениваемое по показателю непрерывности сна, а именно: наблюдалось меньше переходов от второй и более глубоких стадий сна к первой стадии и к состоянию бодрствования (

High-frequency ultrasound has been shown to accelerate enzymatic fibrinolysis. One of the supposed mechanisms of this effect is the enhancement of mass transport by acoustic streaming, i.e., ultrasound-induced macroscopic flow around the clot. In this study, which is aimed at further elucidating the mechanisms of the acceleration of fibrinolysis by ultrasound, we investigated whether ultrasound would accelerate fibrinolysis if the flow around the thrombus is already present, as may occur in vivo. The effect of the ultrasound-induced temperature rise was also studied. In a model of a plasma clot submerged in plasma, containing tissue-type plasminogen activator, mild stirring of the outer plasma producing a shear rate of 40 seconds-1 at the surface of the clot resulted in a two-fold acceleration of lysis. A similar effect was obtained with ultrasound (1 MHz, 2 W/cm2). Furthermore, if ultrasound was applied together with stirring, only 30% acceleration by ultrasound was documented, fully attributable to the concomitant temperature rise. In a model with tissue-type plasminogen activator incorporated throughout a plasma clot, the effect of ultrasound (two-fold shortening of lysis time) was fully attributable to the concomitant temperature rise of a few degrees. We concluded that the acceleration of enzymatic plasma clot lysis by high-frequency ultrasound in the models we used can be largely explained by a combination of the effects of heating and acoustic streaming, equivalent to mild stirring. The thermal effects can hardly be utilized in vivo due to the danger of tissue overheat. The therapeutic advantage of transcutaneous high-frequency ultrasound as an adjunct to thrombolytic therapy may appear limited to the situations where there is no flow in the direct environment of the thrombus. Copyright (C) 2000 Elsevier Science Ltd. Chemicals/CAS: Tissue Plasminogen Activator, EC 3.4.21.68

SummaryFibrinolysis initially generates channels in an occluding thombus which results in blood flow through the thrombus. Since the impact of flow along the surface of a thrombus on thrombolysis has not been investigated in detail, we studied in vitro how such a flow affects lysis. Compacted and noncompacted plasma clots were used as model thrombi. With compacted clots, fibrin-specific lysis induced by alteplase in the outer plasma was accelerated about 2-fold by strong flow (arterial shear rate). Non-fibrin-specific lysis induced either by a high concentration of alteplase or by streptokinase was slow, was accompanied by rapid depletion of plasminogen in the outer plasma, and was only slightly accelerated by flow. With noncompacted clots, similar acceleration factors were documented, when mild flow (venous shear rate) was applied. Strong flow further accelerated fibrin-specific lysis, up to 10-fold as compared to lysis without flow, but paradoxically retarded non-fibrin-specific lysis. The data suggest that flow accelerates lysis by enhancing transport of plasminogen from the outer plasma to the surface of the clot. Both opposite effects of the strong flow were mediated by forceful intrusion of the outer plasma into the noncompacted clot due to flow irregularities. In the case of non-fibrin-specific lysis this resulted in the replacement of the plasminogen-containing milieu by plasminogen-depleted outer plasma in certain areas of the clot turning them into virtually unlysable fragments. This flow-enforced “plasminogen steal” may contribute to the relatively high percentage of incomplete thrombolysis (TIMI-2 grade flow) documented in a number of trials for non-fibrin-specific thrombolytic agents. In the case of fibrin-specific lysis, the effect of flow on the speed of fibrinolysis is always beneficial.

SummaryIn a number of cases, thrombolytic therapy fails to re-open occluded blood vessels, possibly due to the occurrence of thrombi resistant to lysis. We investigated in vitro how the lysis of hardly lysable model thrombi depends on the choice of the plasminogen activator (PA) and is accelerated by ultrasonic irradiation. Lysis of compacted crosslinked human plasma clots was measured after addition of nine different PAs to the surrounding plasma and the effect of 3 MHz ultrasound on the speed of lysis was assessed.Fibrin-specific PAs showed bell-shaped dose-response curves of varying width and height. PAs with improved fibrin-specificity (staphylokinase, the TNK variant of tissue-type PA [tPA], and the PA from the saliva of the Desmodus rotundus bat) induced rapid lysis in concentration ranges (80-, 260-, and 3,500-fold ranges, respectively) much wider than that for tPA (a 35-fold range). However, in terms of speed of lysis, these three PAs exceeded tPA only slightly. Reteplase and single-chain urokinase were comparable to tPA, whereas two-chain urokinase, anistreplase, and streptokinase were inferior to tPA. In the case of fibrin-specific PAs, ultrasonic treatment accelerated lysis about 1.5-fold. For streptokinase no acceleration was observed. The effect of ultrasound correlated with the presence of plasminogen in the outer plasma, suggesting that it was mediated by facilitating the transport of plasminogen to the surface of the clot.In conclusion, PAs with improved fibrin-specificity induce rapid lysis of plasminogen-poor compacted plasma clots in much wider concentration ranges than tPA. This offers a possibility of using single-or double-bolus administration regimens for such PAs. However, it is not likely that administration of these PAs will directly cause a dramatic increase in the rate of re-opening of the occluded arteries since they are only moderately superior to tPA in terms of maximal speed of lysis. Application of high-frequency ultrasound as an adjunct to thrombolytic therapy may increase the treatment efficiency, particularly in conjunction with fibrin-specific PAs.

Background Binding of plasminogen to partially degraded fibrin is an important step in fibrinolysis, influencing its rate and fibrin specificity. Little is known about the spatial distribution of plasminogen and of plasminogen-binding sites inside thrombi during lysis. In the present study, we investigated this problem, which is important for a better understanding of the local regulation of fibrinolysis and the rate-limiting factors of therapeutic thrombolysis. Methods and Results An experimental system was used that allowed continuous visualization and quantification by fluorescence microscopy of the spatial distribution of fluorescein-labeled plasminogen inside and outside model thrombi. Strong superficial accumulation of plasminogen was observed during lysis of a plasma clot induced by tissue-type or urokinase-type plasminogen activators in the surrounding plasma. A distinctly visible plasminogen-accumulating shell moved continuously with the reducing surface of the clot. The accumulation decreased in conditions of exhaustive activation of plasminogen in the outer plasma. It was found in a purified system that a thin superficial layer (≈50 μm wide) of a plasmin-treated fibrin clot exposes about 2.5 plasminogen-binding sites per fibrin monomer with a K d of 2.2 μmol/L. At a physiological concentration of plasminogen (1.5 μmol/L) in the outer medium, plasminogen was concentrated about 10-fold in this layer. The binding was dose-dependently inhibited by ε-aminocaproic acid. Conclusions We conclude that the generation of potent surface-associated plasminogen-binding sites during thrombolysis results in a strikingly high plasminogen concentration at the dynamically changing surface of a lysing clot. The necessity of a continuous plasminogen supply from the plasma supports the use of fibrin-specific and plasminogen-sparing agents for thrombolytic therapy.