BackgroundParkinson's disease (PD) pathological changes begin before motor symptoms appear. Rapid eye movement sleep behavior disorder (RBD) has the highest specificity and predictive value of any marker of prodromal PD. Tumor necrosis factor α (TNF-α) plays a part in the pathology of PD and disease conversion in isolated RBD (iRBD). TNF can also directly impair the hypocretin system in mice in vivo. As a result, we intend to investigate the effect of TNF-α on orexin levels in PD patients with RBD.MethodParticipants were recruited from the Department of Neurology of Xuanwu Hospital, Capital Medical University to engage in assessments on motor symptoms, sleep, cognition, etc. Then we collected blood and cerebrospinal fluid of all patients and 10 controls' cerebrospinal fluid. The levels of TNF-α in the serum and cerebrospinal fluid, as well as the level of orexin in the cerebrospinal fluid, were measured in the patients.ResultsThe difference in TNF- levels in cerebrospinal fluid and serum between the three groups were not statistically significant. The levels of orexin in the three groups were not significantly lower than in the control group. UPDRS-III scores were significantly higher in the PD+RBD and PD-RBD groups than in the iRBD group. There was no statistically significant difference in H-Y stages, PSQI, or ESS scores between the PD+RBD and PD-RBD groups.ConclusionOur findings suggest that TNF-α may not have a significant effect on the orexinergic system in patients with Parkinson's disease and iRBD. As a result, it is necessary to investigate the changes in TNF-α and orexin levels in different disease stages and to enlarge the sample size to determine whether TNF-α affects the function of the orexin system, which may be related to the occurrence of RBD and disease progression in Parkinson's disease.

Homesickness, which refers to feelings of distress caused by separation from home, is prevalent among university-aged students. Chronic homesickness can exacerbate mood problems, erode academic performance and lead to dropout from school. The present research examines how students use digital technologies to resolve the experience of missing home. Qualitative interviews and diaries with 50 students at major Australian universities revealed that technologies play a significant role in alleviating homesickness. Specifically, students use technologies to acquire social contact, find help and support, build co-presence to recreate their home, connect with culture, experience distant places, and regulate emotions. However, the use of technology sometimes led to increased emotional labour, frequent exposure to homesickness triggers, and heightened perceptions of distance. We conclude by discussing possible design implications for new technologies that allow students to alleviate homesickness by experiencing their home from afar.

Purpose Narcolepsy is a rare debilitating disorder for which multiple novel pharmacological options have been approved as treatment for the past few years. The current study systematically updates the comparative efficacy and detailed safety analysis of approved wake-promoting agents in narcolepsy. Methods Randomized controlled trials (RCTs) were searched for diagnosed narcolepsy with approved interventions. Efficacy outcomes included the Maintenance of Wakefulness Test (MWT), Epworth Sleepiness Scale (ESS), Clinical Global Impression of Change (CGI-C), and Patient Global Impression of Change (PGI-C). Safety outcomes including overall adverse event (AE) risk were measured. The study was registered at PROSPERO (CRD 42022334915). Results The final analysis included 17 RCTs with five drug treatments: modafinil/armodafinil, sodium oxybate, pitolisant, solriamfetol, and lower-sodium oxybate (LXB). For efficacy measures, interventions included in each outcome were effective compared with placebo. Furthermore, the magnitude of solriamfetol effect on MWT (9.11 minutes; 95% CI=7.05–11.16), ESS (−4.79; 95% CI=−6.56 to −3.01), and PGI-C (9.39; 95% CI= 2.37–37.19), and LXB effect on CGI-C (9.67; 95% CI=2.73–34.26) was greater than that of other treatments included in each outcome compared with placebo. For safety measures, all interventions had an acceptable safety profile with LXB having least risk for overall AEs (0.56; 95% CI=0.20–1.53), serious AEs (0.33; 95% CI=0.09–1.20), AEs leading to treatment discontinuation (0.11; 95% CI=0.01–2.04), and all-cause discontinuation (0.04; 95% CI=0.00–0.67) compared to placebo. Placebo had the lowest risk for exploratory AEs. Conclusion All approved interventions were effective in controlling the symptoms of narcolepsy at varying degrees with an acceptable safety profile.

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