A scoping review of the evidence on pharmacological and non-pharmacological interventions for idiopathic hypersomnia.

STUDY OBJECTIVES: Idiopathic hypersomnia (IH) is characterized by excessive sleepiness during the day, prolonged sleep at night, and difficulty waking up. The true prevalence of IH is uncertain. ICSD provides criteria for diagnosing IH; however, the definition has evolved. Managing IH involves using pharmacologic and non-pharmacologic approaches, although the most effective strategies are still unclear. The objective of this scoping review was to identify the extent, range, and nature of the available evidence, identify research gaps, and discuss the implications for clinical practice and policy. METHODS: To conduct this review, a comprehensive search was conducted across scientific databases, without any restrictions on the date or study type. Eligible studies examined the effectiveness of pharmacologic and non-pharmacologic treatments for IH and reported the outcomes of these interventions. Data from the studies were screened, analyzed, and synthesized to provide an overview of the available literature landscape. RESULTS: 51 studies were included in this review, which used various methods and interventions. Pharmacological treatments, particularly modafinil, have been frequently studied and have yielded positive results. There is also emerging evidence for alternative medications such as low-sodium oxybate and pitolisant. Non-pharmacological approaches, such as CBT-H and tDCS have also shown promise in managing IH. CONCLUSIONS: This review highlights the complexity of managing IH management and emphasizes the need for personalized multidisciplinary approaches. Pharmacological interventions are important in managing IH and can be complemented by non-medication strategies. Larger-scale studies are necessary to advance our understanding of IH and to improve treatment outcomes.

Proteomic and metabolomic insights into seed germination of Ferula assa-foetida.

Cold stratification is known to affect the speed of seed germination; however, its regulation at the molecular level in Ferula assa-foetida remains ambiguous. Here, we used cold stratification (4 °C in the dark) to induce germination in F. assa-foetida and adopted a proteomic and metabolomic approach to understand the molecular mechanism of germination. Compared to the control, we identified 209 non-redundant proteins and 96 metabolites in germinated F. assa-foetida seed. Results highlight the common and unique regulatory mechanisms like signaling cascade, reactivation of energy metabolism, activation of ROS scavenging system, DNA repair, gene expression cascade, cytoskeleton, and cell wall modulation in F. assa-foetida germination. A protein-protein interaction network identifies 18 hub protein species central to the interactome and could be a key player in F. assa-foetida germination. Further, the predominant metabolic pathways like glucosinolate biosynthesis, arginine and proline metabolism, cysteine and methionine metabolism, aminoacyl-tRNA biosynthesis, and carotenoid biosynthesis in germinating seed may indicate the regulation of carbon and nitrogen metabolism is prime essential to maintain the physiology of germinating seedlings. The findings of this study provide a better understanding of cold stratification-induced seed germination, which might be utilized for genetic modification and traditional breeding of Ferula assa-foetida. SIGNIFICANCE: Seed germination is the fundamental checkpoint for plant growth and development, which has ecological significance. Ferula assa-foetida L., commonly known as "asafoetida," is a medicinal and food crop with huge therapeutic potential. To date, our understanding of F. assa-foetida seed germination is rudimentary. Therefore, studying the molecular mechanism that governs dormancy decay and the onset of germination in F. assa-foetida is essential for understanding the basic principle of seed germination, which could offer to improve genetic modification and traditional breeding.

Single Patient Multiple Explosions: A Case Report on Exploding Head Syndrome.

Exploding head syndrome (EHS) is an uncommon sleeping disorder that is described by patients as a loud noise occurring while transitioning into and out of sleep. It is not accompanied by a headache but causes a sense of fright. We describe the case of a 58-year-old female patient, presenting with a total of 11 events of EHS occurring at bedtime. Events shared some features but also had unique characteristics. The workup was negative, making a diagnosis of EHS more likely. CPAP was recommended for a newly diagnosed obstructive sleep apnea, but despite non-compliance with the treatment plan, the patient had a complete resolution of her symptoms. Exploding head syndrome is an underreported parasomnia reported in the literature. Our case report demonstrates that a single patient could exhibit different features in displaying EHS, which was shown by changes in the noise description, pattern, and accompanying jerk movement. It also hints at patient education and reassurance as a possible treatment plan.

Blood-Based Biomarkers for Neuroprognostication in Acute Brain Injury.

Acute brain injury causes loss of functionality in patients that often is devastating. Predicting the degree of functional loss and overall prognosis requires a multifaceted approach to help patients, and more so their families, make important decisions regarding plans and goals of care. A variety of blood-based markers have been studied as one aspect of this determination. In this review, we discuss CNS-derived and systemic markers that have been studied for neuroprognostication purposes. We discuss the foundation of each protein, the conditions in which it has been studied, and how the literature has used these markers for interpretation. We also discuss challenges to using each marker in each section as well.

SARS-CoV-2 Causing Transient Central Sleep Apnea in Patients Treated for Obstructive Sleep Apnea with Continuous Positive Airway Pressure.

BACKGROUND SARS-CoV-2 has globally affected humanity and devastated many families. Here, we attempt to identify which diseases are independent risk factors for severe SARS-CoV-2. There have been multiple studies that have evaluated the impact of obstructive sleep apnea (OSA) on SARS-CoV-2 outcomes, suggesting that OSA is an independent risk factor. SARS-CoV-2 has also been suggested to invade the central nervous system and be responsible for neurological signs and decreasing central respiratory drive. Central sleep apnea (CSA) is defined when apneas and hypopneas are associated with absent or reduced ventilatory effort, respectively, due to diminished central respiratory drive. CASE REPORT Here, we describe 2 cases involving patients with OSA that developed transient central sleep apnea after being diagnosed with SARS-CoV-2 by polymerase chain reaction. They had similar past medical histories and presentation of illness. The differences included compliance of continuous positive airway pressure (CPAP), recovery, and severity of central sleep index. We review and address alternate causes for the development of CSA. We hypothesize that continuous and compliant use of CPAP machines may be beneficial in reducing recovery and severity of SARS-CoV-2. CONCLUSIONS Our case report calls attention to the acquired central respiratory drive neurological complication associated with SARS-CoV-2. Our case report highlights the plausible existence of a relationship between development of central respiratory drive leading to CSA and SARS-CoV-2 infection. Further studies are needed to explore this relationship, including evaluating whether CSA occurs in SARS-CoV-2 patients with no history of OSA.

AIE material for photodynamic therapy.

Photodynamic therapy (PDT) is emerging as an excellent strategy to treat different types of cancers. The advantages of using PDT over other cancer treatment modalities are owing to its non-invasive nature, spatiotemporal precession, controllable photoactivity, and least side effects. The photosensitization ability of traditional photosensitizers (PSs) are severely curtailed by aggregation-induced quenching (ACQ). On the contrary, aggregation induced emission (AIE) molecules/fluorogens (AIEgens) show enhanced fluorescence emission and high reactive oxygen species (ROS)/singlet oxygen (1O2) production capability in the aggregated state. These unique characteristics of AIEgens make them potential AIE-PSs for fluorescence/luminescence image-guided combination PDT. In this chapter, we discussed the strategies that are developed to synthesize small molecule-based AIE-PSs, metal complex-based AIE-PSs, and AIE-PSs with two-photon absorbance (TPA) properties, polymer-based AIE-PSs, and nanoparticles based AIE-PSs for PDT. We have also discussed the rational design of targeting peptide conjugated AIE-PSs to selective target cancer cells over normal cells. Furthermore, recent findings on nanoparticle-based combination AIE-PSs are also discussed, where the combination AIE-PSs show synergistically improved anticancer activity and overcome the drug resistance. Finally, we shed light on the recent development, ongoing challenges, and future directions for designing better AIE-PS for PDT.