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We systematically compared the effects of prophylactic anticonvulsant drug use in patients with traumatic brain injury. We searched four electronic databases from their inception until July 13, 2021. Two researchers independently screened, appraised, and extracted the included studies. Network meta-analysis using multivariate random effects and a frequentist framework was adopted for data analysis. The risk of bias of each study was assessed using the Cochrane risk of bias tool, and confidence in evidence was assessed through confidence in network meta-analysis (CINeMA). A total of 11 randomized controlled trials involving 2,450 participants and six different treatments (i.e., placebo, carbamazepine, phenytoin, levetiracetam, valproate, and magnesium sulfate) were included. We found that anticonvulsant drugs as a whole significantly reduced early posttraumatic seizures (PTS) but not late PTS compared with placebo (odd ratios [ORs] = 0.42 and 0.82, 95% confidence intervals [CIs] = 0.21–0.82 and 0.47–1.43). For the findings of network meta-analysis, we observed that phenytoin (ORs = 0.43 and 0.71; 95% CIs = 0.18–1.01 and 0.23–2.20), levetiracetam (ORs = 0.56 and 1.58; 95% CIs = 0.12–2.55 and 0.03–84.42), and carbamazepine (ORs = 0.29 and 0.64; 95% CIs = 0.07–1.18 and 0.08–5.28) were more likely to reduce early and late PTS compared with placebo; however, the treatment effects were not significant. Sensitivity analysis, after excluding a study enrolling only children, revealed that phenytoin had a significant effect in preventing early PTS (OR = 0.33; 95% CI = 0.14–0.78). Our findings indicate that no antiepileptic drug had an effect on early or late PTS superior to that of another; however, the sensitivity analysis revealed that phenytoin might prevent early PTS. Additional studies with large sample sizes and a rigorous design are required to obtain high-quality evidence on prophylactic anticonvulsant drug use in patients with traumatic brain injury.

Delirium is a frequent complication of critical illness, affecting 34% of children admitted to pediatric intensive care units. The commonly used tools for detecting delirium in the pediatric intensive care unit include the Pediatric Confusion Assessment Method for the intensive care unit (ICU, pCAM-ICU), Preschool Confusion Assessment Method for the ICU (psCAM-ICU), Pediatric Anesthesia Emergence Delirium and the Cornell Assessment of Pediatric Delirium. We searched four electronic databases for relevant articles from inception to March 1, 2023. All full-text observational studies examining the sensitivity and specificity of the four tools for screening delirium in the pediatric intensive care units were included. Two researchers independently identified articles, extracted data, and retrieved the diagnostic accuracy parameters of the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium relative to standard references. A bivariate diagnostic statistical analysis with a random-effects model was performed. Four, five, three and seven studies on the pediatric CAM-ICU, pre-school CAM-ICU, Pediatric Anesthesia Emergence Delirium, and Cornell Assessment of Pediatric Delirium, respectively, were identified. Due to the limited number of Pediatric Anesthesia Emergence Delirium articles included, no pooled diagnostic accuracy was produced. The pooled sensitivity was 0.73, 0.84, and 0.95 for the pediatric CAM-ICU, pre-school CAM-ICU, and Cornell Assessment of Pediatric Delirium, respectively, whereas the pooled specificity was 0.98, 0.90, and 0.81, respectively. The Cornell Assessment of Pediatric Delirium had greater sensitivity compared to both the pediatric CAM-ICU and pre-school CAM-ICU (both p = 0.04) and lower specificity than the pediatric CAM-ICU did (p < 0.001). Age, sample size, and mechanical ventilation use were significant moderators of the specificity of the pediatric CAM-ICU (p < 0.001, <0.001, and = 0.001, respectively). Our data indicate that the Cornell Assessment of Pediatric Delirium is a more dependable instrument than the pediatric CAM-ICU and pre-school CAM-ICU for detecting pediatric intensive care delirium occurrence. More studies on the Pediatric Anesthesia Emergence Delirium are warranted. Healthcare providers are suggested adopting the Cornell Assessment of Pediatric Delirium into daily routine for the early detection of delirium in pediatric intensive care units.

Background Endometriosis is a prevalent gynecological condition that primarily affects women of reproductive age. When the gastrointestinal system is involved, it can lead to bowel dysfunction and pose diagnostic challenges. Aims To present a rare case of gastrointestinal endometriosis with concurrent uterine adenosarcoma, highlighting the diagnostic complexities and therapeutic considerations. Methods A 42-year-old female presented with refractory bloody diarrhea, abdominal pain, and significant unintentional weight loss for several months. Initial investigations, including stool studies and inflammatory markers, ruled out infectious and common inflammatory causes. Endoscopic evaluation revealed multiple polypoid lesions, prompting further imaging. Magnetic resonance enterography (MRE) identified a uterine mass with suspected extrauterine involvement and a rectal nodule, raising concerns for malignancy or extensive gastrointestinal endometriosis. The patient underwent surgical management, including total hysterectomy, bilateral salpingo-oophorectomy, and lower anterior resection. Results Histopathological analysis confirmed the coexistence of uterine adenosarcoma and rectal endometriosis. The patient fully recovered after surgery without complications. At her 12-month follow-up, she remained asymptomatic, with no evidence of recurrence or residual disease. Conclusions This case underscores the diagnostic and therapeutic challenges of gastrointestinal endometriosis, particularly in the presence of coexisting malignancy. A multidisciplinary approach is essential for early recognition and prompt intervention, which are crucial for improving patient outcomes and quality of life.

Study Objectives: We examined the effects of nurse-led brief behavioral treatment for insomnia (BBTI) on insomnia severity, sleep status, daytime function, quality of life, psychological distress levels, treatment response, and insomnia remission in young and middle-aged Asian adults with insomnia symptoms. Methods: This 2-parallel, randomized controlled trial recruited 42 participants with insomnia symptoms randomly allocated to the nurse-led BBTI group or sleep hygiene group. The outcome measurements included the Insomnia Severity Index, sleep diary, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Brief Fatigue Inventory, RAND-36 Health Status Inventory, and the Depression, Anxiety, and Stress Scale-21. The measurement time points included baseline, the end of each week of the intervention period, and 1-month follow-up. Results: Compared with the sleep hygiene group, participants in the BBTI group had significantly improved insomnia severity, sleep onset latency, sleep efficiency, sleep quality, daytime sleepiness, and the mental components of quality of life after completing nurse-led BBTI immediately and 1 month later ( P < .05). In addition, 52.4% and 71.4% of the participants achieved remission after completing nurse-led BBTI immediately and 1 month later, which was significantly higher than in the sleep hygiene group (14.3%, P = .02; 14.3%, P < .001, respectively). Conclusions: We suggested the relative effects of BBTI on declined insomnia severity and improved sleep status among young and middle-aged Asian adults with insomnia symptoms and confirmed the benefits of nurse-led BBTI in alleviating insomnia. Nurses should incorporate BBTI into insomnia care further to enhance the daytime function and quality of life of the population with insomnia symptoms. Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Effects of Nurse-led Brief Behavioral Treatment for Insomnia: A Feasibility Randomized Controlled Trial; URL: https://clinicaltrials.gov/study/NCT05310136 ; Identifier: NCT05310136. Citation: Chang K-M, Lin C-J, Jan Y-W, et al. Effects of nurse-led brief behavioral treatment for insomnia in adults: a randomized controlled trial. J Clin Sleep Med. 2024;20(11):1763–1772.

Lighting interventions (LIs) have shown positive impact on circadian rhythms and sleep quality in people with dementia. Yet, few studies incorporated daylight with LI. The Smart Ambient Bright Light (SABL) is a newly developed LI that accommodates natural daylight and provides automatic bright light during the day and dim light during the night. The study examined the effect of SABL on sleep in nursing home (NH) residents with dementia. This was a 13-week cluster randomized crossover-controlled trial conducted in two nursing homes in Pennsylvania. The SABL was installed in residents’ bedrooms and common areas for 4 weeks with 2 weeks of washout between control and intervention. The Pittsburgh Sleep Quality Index (PSQI) was used to measure sleep quality. Descriptive analysis and paired t-test was performed to compare difference in sleep quality changes between control and intervention periods. A total of 18 residents enrolled in this study. Participants were 87.3 years old on average and 12 of them (67%) were female. The included residents experienced poor sleep quality at baseline (mean PSQI=6.67, SD± 3.07). A paired t-test showed that comparing to the baseline, the PSQI level decreased in both intervention group (5.28 ± 3.58) and control group (4.28 ± 2.44), without statistical significance (p = 0.29). The results suggest that the SABL did not show significant effect on sleep quality among NH residents with dementia. This is a pilot study with a small sample size. More research is needed to replicate the study on a larger scale.

This study takes National Yang Ming Chiao Tung University Engineering Building II as an example which used temperature control at 24°C, 25°C, 26°C, and 27°C, and used the value of PMV at 0.3 and 0.5 to control the air-conditioning system in August. By the EnergyPlus software simulation, the data in different spaces are compared and analyzed, and the data is used to explain the results of energy-saving between traditional temperature-controlled air-conditioning system and PMV-controlled air-conditioning system.The results show that under the same types of spaces, the spaces on a higher floor have a higher PMV than those on a lower floor under the control of temperature. On the other hand, the spaces on a lower floor have a higher temperature range than those on a higher floor under the control of PMV. When comparing all of the spaces, the fourth floor has the highest energy consumption per area, so the spaces on the top floor are the hottest areas. The energy is saved 8.3% at most by using PMV-controlled than

Cancer stem cells (CSCs) play an important role in cancer treatment resistance and disease progression. Identifying an effective anti‐CSC agent may lead to improved disease control. We used CSC‐associated gene signatures to identify drug candidates that may inhibit CSC growth by reversing the CSC gene signature. Thiostrepton, a natural cyclic oligopeptide antibiotic, was the top‐ranked candidate. In non–small‐cell lung cancer (NSCLC) cells, thiostrepton inhibited CSC growth in vitro and reduced protein expression of cancer stemness markers, including CD133, Nanog and Oct4A. In addition, metastasis‐associated Src tyrosine kinase signalling, cell migration and epithelial‐to‐mesenchymal transition (EMT) were all inhibited by thiostrepton. Mechanistically, thiostrepton treatment led to elevated levels of tumour suppressor miR‐98. Thiostrepton combined with gemcitabine synergistically suppressed NSCLC cell growth and induced apoptosis. The inhibition of NSCLC tumours and CSC growth by thiostrepton was also demonstrated in vivo. Our findings indicate that thiostrepton, an established drug identified in silico, is an inhibitor of CSC growth and a potential enhancer of chemotherapy in NSCLC.

In our previous study, we have demonstrated that curcumin can efficiently kill the anaerobic bacterium Propionibacterium acnes by irradiation with low-dose blue light. The curcuminoids present in natural plant turmeric mainly include curcumin, demethoxycurcumin, and bisdemethoxycurcumin. However, only curcumin is commercially available. Eighteen different curcumin analogs, including demethoxycurcumin and bisdemethoxycurcumin, were synthesized in this study. Their antibacterial activity against Gram-positive aerobic bacteria Staphylococcus aureus and Staphylococcus epidermidis was investigated using the photodynamic inactivation method. Among the three compounds in turmeric, curcumin activity is the weakest, and bisdemethoxycurcumin possesses the strongest activity. However, two synthetic compounds, (1E,6E)-1,7-bis(5-methylthiophen-2-yl)hepta-1,6-diene-3,5-dione and (1E,6E)-1,7-di(thiophen-2-yl)hepta-1,6-diene-3,5-dione, possess the best antibacterial activity among all compounds examined in this study. Their chemical stability is also better than that of bisdemethoxycurcumin, and thus has potential for future clinical applications.