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Holder S, Narula NS. Common Sleep Disorders in Adults: Diagnosis and Management. Am Fam Physician 2022; 105:397-405. [PMID: 35426627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sleep disorders are common in the general adult population and are associated with adverse effects such as motor vehicle collisions, decreased quality of life, and increased mortality. Patients with sleep disorders can be categorized into three groups: people with problems falling asleep, people with behavior and movement disturbances during sleep, and people with excessive daytime sleepiness. Insomnia, the most common sleep disorder, is defined by difficulty initiating sleep, maintaining sleep, or both, resulting in daytime consequences. Insomnia is diagnosed by history and is treated with cognitive behavior therapy, with or without medications. Rapid eye movement sleep behavior disorder is characterized by increased muscle tone during rapid eye movement sleep, resulting in patients acting out their dreams with potentially harmful effects. Rapid eye movement sleep behavior disorder is diagnosed by polysomnography and treated with melatonin or clonazepam. Restless legs syndrome is defined by an urge to move the legs that worsens when at rest. Restless legs syndrome is treated with gabapentin or dopamine agonists, depending on the severity. Narcolepsy is characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and sleep hallucinations. Diagnosis is suggested by the history and can be confirmed with polysomnography and a multiple sleep latency test the following day. Narcolepsy is treated with behavior modifications and medications such as stimulants, selective serotonin reuptake inhibitors, sodium oxybate, and pitolisant. Obstructive sleep apnea may be diagnosed in patients with excessive snoring and witnessed apneas and can be diagnosed using overnight polysomnography. Treatment consists of positive airway pressure therapy while sleeping in conjunction with weight loss.
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Affiliation(s)
- Sarah Holder
- AtlantiCare Regional Medical Center, Atlantic City, NJ, USA
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Jasuja R, Costello JC, Singh R, Gupta V, Spina CS, Toraldo G, Jang H, Li H, Serra C, Guo W, Chauhan P, Narula NS, Guarneri T, Ergun A, Travison TG, Collins JJ, Bhasin S. Combined administration of testosterone plus an ornithine decarboxylase inhibitor as a selective prostate-sparing anabolic therapy. Aging Cell 2014; 13:303-10. [PMID: 24305501 PMCID: PMC4331775 DOI: 10.1111/acel.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/26/2022] Open
Abstract
Because of its anabolic effects on muscle, testosterone is being explored as a function-promoting anabolic therapy for functional limitations associated with aging; however, concerns about testosterone's adverse effects on prostate have inspired efforts to develop strategies that selectively increase muscle mass while sparing the prostate. Testosterone's promyogenic effects are mediated through upregulation of follistatin. We show here that the administration of recombinant follistatin (rFst) increased muscle mass in mice, but had no effect on prostate mass. Consistent with the results of rFst administration, follistatin transgenic mice with constitutively elevated follistatin levels displayed greater muscle mass than controls, but had similar prostate weights. To elucidate signaling pathways regulated differentially by testosterone and rFst in prostate and muscle, we performed microarray analysis of mRNAs from prostate and levator ani of castrated male mice treated with vehicle, testosterone, or rFst. Testosterone and rFst shared the regulation of many transcripts in levator ani; however, in prostate, 593 transcripts in several growth-promoting pathways were differentially expressed after testosterone treatment, while rFst showed a negligible effect with only 9 transcripts differentially expressed. Among pathways that were differentially responsive to testosterone in prostate, we identified ornithine decarboxylase (Odc1), an enzyme in polyamine biosynthesis, as a testosterone-responsive gene that is unresponsive to rFst. Accordingly, we administered testosterone with and without α-difluoromethylornithine (DFMO), an Odc1 inhibitor, to castrated mice. DFMO selectively blocked testosterone's effects on prostate, but did not affect testosterone's anabolic effects on muscle. Co-administration of testosterone and Odc1 inhibitor presents a novel therapeutic strategy for prostate-sparing anabolic therapy.
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Affiliation(s)
- Ravi Jasuja
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - James C. Costello
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Rajan Singh
- Division of Endocrinology and Metabolism Charles Drew University of Medicine and Science David Geffen School of Medicine at UCLA Los Angeles CA 90059 USA
| | - Vandana Gupta
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Catherine S. Spina
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02215 USA
| | - Gianluca Toraldo
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Hyeran Jang
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Hu Li
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Carlo Serra
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Wen Guo
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Pratibha Chauhan
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Navjot S. Narula
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Tyler Guarneri
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - Ayla Ergun
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
| | - Thomas G. Travison
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
| | - James J. Collins
- Howards Hughes Medical Institute Center for BioDynamics Boston University Boston MA 02115 USA
- Wyss Institute for Biologically Inspired Engineering Harvard University Boston MA 02215 USA
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Anabolic Therapies Brigham and Women's Hospital Harvard Medical School 221 Longwood Avenue Boston MA 02115 USA
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Zakharov MN, Ulloor J, Bhasin S, Ross JA, Narula NS, Bakhit M, Pillai BK, Kumar R, Jameson DM, Jasuja R. Guanidinium chloride-induced spectral perturbations of 4,4'-dianilino-1,1'-binaphthyl-5,5'-disulfonic acid confound interpretation of data on molten globule states. Anal Biochem 2011; 416:126-8. [PMID: 21569754 DOI: 10.1016/j.ab.2011.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/09/2011] [Accepted: 04/12/2011] [Indexed: 11/18/2022]
Abstract
We describe limitations in the use of 4,4'-dianilino-1,1'-binaphthyl-5,5'-disulfonic acid (bis-ANS) to examine unfolding intermediates associated with guanidinium chloride (GuHCl)-induced protein denaturation. Several studies have used alterations in fluorescence emission of bis-ANS to quantify the population of "molten globule" states. Our findings indicate that the observed changes in bis-ANS spectroscopic properties could originate from the interactions of bis-ANS and GuHCl and the aggregation of the dye at higher GuHCl concentrations. We posit that in the absence of additional complementary structural or spectroscopic measurements, the use of bis-ANS emission alone to monitor protein conformations can be misleading.
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Affiliation(s)
- M N Zakharov
- Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, MA 02118, USA
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Gupta V, Bhasin S, Guo W, Singh R, Miki R, Chauhan P, Choong K, Tchkonia T, Lebrasseur NK, Flanagan JN, Hamilton JA, Viereck JC, Narula NS, Kirkland JL, Jasuja R. Effects of dihydrotestosterone on differentiation and proliferation of human mesenchymal stem cells and preadipocytes. Mol Cell Endocrinol 2008; 296:32-40. [PMID: 18801408 PMCID: PMC2873614 DOI: 10.1016/j.mce.2008.08.019] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Revised: 07/29/2008] [Accepted: 08/10/2008] [Indexed: 10/21/2022]
Abstract
UNLABELLED The mechanisms by which androgens regulate fat mass are poorly understood. Although testosterone has been reported to increase lipolysis and inhibit lipid uptake, androgen effects on proliferation and differentiation of human mesenchymal stem cells (hMSCs) and preadipocytes have not been studied. Here, we investigated whether dihydrotestosterone (DHT) regulates proliferation, differentiation, or functional maturation of hMSCs and human preadipocytes from different fat depots. DHT (0-30 nM) dose-dependently inhibited lipid accumulation in adipocytes differentiated from hMSCs and downregulated expression of aP2, PPARgamma, leptin, and C/EBPalpha. Bicalutamide attenuated DHT's inhibitory effects on adipogenic differentiation of hMSCs. Adipocytes differentiated in presence of DHT accumulated smaller oil droplets suggesting reduced extent of maturation. DHT decreased the incorporation of labeled fatty acid into triglyceride, and downregulated acetyl CoA carboxylase and DGAT2 expression in adipocytes derived from hMSCs. DHT also inhibited lipid accumulation and downregulated aP2 and C/EBPalpha in human subcutaneous, mesenteric and omental preadipocytes. DHT stimulated forskolin-stimulated lipolysis in subcutaneous and mesenteric preadipocytes and inhibited incorporation of fatty acid into triglyceride in adipocytes differentiated from preadipocytes from all fat depots. CONCLUSIONS DHT inhibits adipogenic differentiation of hMSCs and human preadipocytes through an AR-mediated pathway, but it does not affect the proliferation of either hMSCs or preadipocytes. Androgen effects on fat mass represent the combined effect of decreased differentiation of fat cell precursors, increased lipolysis, and reduced lipid accumulation.
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Affiliation(s)
- Vandana Gupta
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Shalender Bhasin
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Wen Guo
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Rajan Singh
- Charles R. Drew University, Los Angeles, CA 90059, United States
| | - Rika Miki
- Charles R. Drew University, Los Angeles, CA 90059, United States
| | - Pratibha Chauhan
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Karen Choong
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Tamara Tchkonia
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Nathan K. Lebrasseur
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - John N. Flanagan
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - James A. Hamilton
- Department of Biophysics, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Jason C. Viereck
- Department of Biophysics, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Navjot S. Narula
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - James L. Kirkland
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
| | - Ravi Jasuja
- Department of Medicine, Boston University, School of Medicine, Boston Medical Center, Boston, MA 02118, United States
- Charles R. Drew University, Los Angeles, CA 90059, United States
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