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المغامرون الصغار : ملحمة عالمية : استكشاف الطاقة النفط
ليث ولين وزياد. المغامرون الصغار بانتظار المغامرات دوما لكن سرعان ما يجدون أنفسهم أمام قضية غامضة وشائقة بسبب اختفاء البروفيسور أديب. المتهم الرئيسي في قضية انفجار مصنع شركة إنيرجيز وسيسعون معا إلى كشف الحقيقة بالبحث عنه وإثبات براءته.
Book
Risk of postoperative urinary retention after sugammadex use in laparoscopic hernia repair: A matched cohort study of 23,444 cases
This study aimed to determine whether sugammadex use is associated with lower postoperative urinary retention (POUR) incidence than neostigmine-glycopyrrolate reversal in patients undergoing laparoscopic hernia repair.
This retrospective cohort study used the TriNetX research network database to analyze adult patients who underwent laparoscopic hernia repair. Patients receiving rocuronium/vecuronium were divided into sugammadex (n = 92,543) or neostigmine-glycopyrrolate (n = 11,723) reversal groups. After 1:1 propensity score matching, 11,722 matched pairs were analyzed. The primary outcome was POUR within 30 days. The secondary outcomes included pneumonia, hospital readmission, and emergency department (ED) visits. Subgroup analyses were used to examine the effects of age and sex.
In the matched cohort (n = 23,444), sugammadex was associated with a significantly lower risk of POUR (OR 0.23, 95% CI 0.18-0.31; p < 0.001) and ED visits (OR 0.76, 95% CI 0.66-0.87; p < 0.001). No significant differences were found in pneumonia or readmission rates. The POUR reduction was consistent across sexes (males: OR 0.32; females: OR 0.33) but more pronounced in patients aged >50 years (OR 0.35) than in younger patients (OR 0.50, p = 0.067). Among male patients receiving sugammadex, older age (OR, 1.01), history of urinary retention (OR, 9.94), and benign prostatic hyperplasia (OR, 4.04) were significant independent risk factors for POUR.
Sugammadex use is associated with a 77% reduction in POUR and 24% fewer ED visits than neostigmine following hernia repair, suggesting that it may be the preferred reversal agent, particularly for older adults who gain the most benefit.
Journal Article
Perioperative administration of sub-anesthetic ketamine/esketamine for preventing postpartum depression symptoms: A trial sequential meta-analysis
Postpartum depression (PPD) is a major mental health issue affecting 10%-15% of women globally. This meta-analysis synthesized updated evidence on sub-anesthetic ketamine/esketamine's efficacy in preventing PPD.
Randomized controlled trials (RCTs) comparing ketamine/esketamine to a placebo for PPD prevention were searched without language restriction. Primary outcomes were PPD risk at 1- and 4-6-week postpartum. Secondary outcomes included the difference in depression scores and risk of adverse events. Trial sequential analysis (TSA) was conducted to validate the reliability.
A meta-analysis of 22 RCTs (n = 3,463) showed that ketamine/esketamine significantly decreased PPD risk at 1- (risk ratio [RR], 0.41; 95% confidence interval [CI], 0.3-0.57) and 4-6-week (RR, 0.47; 95%CI, 0.35-0.63) follow-ups. Consistently, participants receiving ketamine/esketamine had lower depression-related scores at 1- (standardized mean difference [SMD], -0.94; 95%CI, -1.26 to -0.62) and 4-6-week (SMD, -0.89; 95%CI, -1.25 to -0.53) follow-ups. Despite potential publication bias, TSA confirmed the evidence's reliability. Subgroup analysis showed that ketamine/esketamine's preventive effect on 1-week PPD was consistent, regardless of administration timing, type of agents, or total dosage (<0.5 vs. ≥0.5 mg/kg). For the 4-6-week period, PPD risk was favorably reduced only with postoperative administration or the use of esketamine, with the total dosage having no observed influence. Participants on ketamine/esketamine experienced more frequency of hallucinations (RR, 4.77; 95%CI, 1.39-16.44) and dizziness (RR, 1.36; 95%CI, 1.02-1.81).
Our findings advocate for the postoperative administration of low-dose ketamine/esketamine to avert PPD, which needed additional research for confirmation.
Journal Article
Anakinra usage in febrile infection related epilepsy syndrome: an international cohort
Febrile‐infection related epilepsy syndrome (FIRES) is a devastating neurological condition characterized by a febrile illness preceding new onset refractory status epilepticus (NORSE). Increasing evidence suggests innate immune dysfunction as a potential pathological mechanism. We report an international retrospective cohort of 25 children treated with anakinra, a recombinant interleukin‐1 receptor antagonist, as an immunomodulator for FIRES. Anakinra was potentially safe with only one child discontinuing therapy due to infection. Earlier anakinra initiation was associated with shorter duration of mechanical ventilation, ICU and hospital length of stay. Our retrospective data lay the groundwork for prospective consensus‐driven cohort studies of anakinra in FIRES.
Journal Article
Effective Teaching and Activities of Excellent Teachers for the Sustainable Development of Higher Design Education
Education for sustainable development (ESD) is regarded as a key element of high-quality education. Hence, the United Nations proposed the Sustainable Development Goals (SDGs) in 2015, in an attempt to achieve the harmony and shared prosperity between humans and the Earth, and advocate for fair and high-quality education. With the aim of exploring “high-quality sustainable teaching”, this study intends to probe into the idea and meaning of the high-quality design education for sustainable development and elaborate on the teaching effectiveness and sustainable teaching activities by the teachers of higher design education. According to the research results, the effectiveness of high-quality teaching is introduced in seven categories, as follows: (1) Faith in sustainability in teaching, (2) the trend of talent demand, (3) the teaching value of sustainability, (4) curriculum mapping, (5) teaching approach, (6) teaching evaluation, (7) the sustainable management of teaching development. The factors of high-quality teaching include: The teacher has passion for teaching, the teacher pays attention to the student’s independent learning ability, the teacher intrigues student’s interest in learning, the teacher places emphasis on furnishing the student with professionalism and confidence, the teacher highlights learning through doing to increase the student’s competitiveness in the job fair, the teacher reviews teaching effectiveness and makes progress in pursuing the value of high-quality ESD.
Journal Article
Association between systemic sclerosis and risk of cerebrovascular and cardiovascular disease: a meta-analysis
We aimed to evaluate the association between systemic sclerosis (SSc) and major cerebrovascular/cardiovascular risks through a systematic approach. Databases were systematically searched from their inception to October 10, 2023 for studies comparing cerebrovascular/cardiovascular event rates between patients with SSc and controls. The primary outcome was the stroke risk in patients with SSc. Secondary outcomes included risk of myocardial infarction (MI), cardiovascular disease (CVD), peripheral vascular disease (PVD), and venous thromboembolism (VTE). Seventeen studies with 6,642,297 participants were included. SSc was associated with a significantly increased risk of stroke (HR, 1.64; 95% confidence interval [CI], 1.35–2.01), CVD (HR, 2.12; 95% CI, 1.36–3.3), MI (HR, 2.15; 95% CI, 1.23–3.77), VTE (HR, 2.75; 95% CI, 1.77–4.28), and PVD (HR, 5.23; 95% CI, 4.25–6.45). Subgroup analysis revealed a significantly increased stroke risk in the non-Asian group (HR, 1.55; 95% CI, 1.26–1.9), while the Asian group displayed a higher but not statistically significant risk (HR, 1.86; 95% CI, 0.97–3.55). The study found that SSc is associated with a significantly increased risk of cerebrovascular/cardiovascular events. These findings highlight the importance of vasculopathy in SSc and suggest the need for enhanced clinical monitoring and preventive measures in this high-risk population.
Journal Article
Male Sex and Ageing are Independent Risk Factors for Sarcopenia Stage in Patients With Chronic Kidney Disease Not Yet on Dialysis
ABSTRACT
Background
The risk of sarcopenia in older adults with chronic kidney disease (CKD) not yet on dialysis is controversial. The aims of this study were to investigate the association among sarcopenia, diabetes and predialysis CKD and evaluate the impact of gender and ageing on the risk of sarcopenia statuses in older patients with predialysis CKD.
Methods
The participants aged ≥60 years old were recruited from the community of New Taipei City, Taiwan. Handgrip strength, appendicular skeletal muscle mass and the 6‐m walk were measured. The diagnosis of sarcopenia was established based on the consensus of Asian Sarcopenia Working Group 2019. These older adults were categorised into G1, G2 and G3–5 according to the guidelines of Kidney Disease Improving Global Outcomes (KDIGO) after calculating the estimated glomerular filtration rate by the Modification of Diet in Renal Disease equation. The Chi‐square test and ANOVA were used to estimate the difference of categorical and continuous variables, respectively. Polytomous logistic regression was employed to assess the odds ratio (OR) and 95% confidence intervals (CIs) of the sarcopenia status and sarcopenia‐associated risk factors in the predialysis CKD patients. All tests were two‐sided, and p < 0.05 was defined as statistical significance.
Results
Among the 3648 older adults (mean age: 71.9 ± 6.07 years), including 1701 males and 1947 females, 870 (23.9%), 94 (2.58%) and 48 (1.32%) had possible sarcopenia, sarcopenia and severe sarcopenia, respectively. After adjustment, the risk for possible sarcopenia, sarcopenia and severe sarcopenia significantly increased with ageing (OR = 1.11, 1.10 and 1.23; 95% CI = 1.10–1.13, 1.07–1.15 and 1.18–1.30, respectively) and male gender (OR = 2.26, 20.3 and 25.4; 95% CI = 1.87–2.73, 11.5–36.0 and 11.3–57.2, respectively). Compared with KDIGO G1, no significant association between KDIGO G3–5 and the statuses of sarcopenia was observed (OR = 0.97, 0.88 and 0.91; 95% CI = 0.75–1.26, 0.43–1.78 and 0.37–2.27, p = 0.821, 0.718, 0.838, for possible sarcopenia, sarcopenia and severe sarcopenia, respectively). Ageing and male gender indicated a significant risk for higher sarcopenia status in older patients with predialysis CKD (0.027‐fold/year and 0.284‐fold, respectively) (p < 0.0001).
Conclusions
This study illuminated the importance of the male sex and the ageing process on the risk of sarcopenia progression in patients with predialysis CKD. Early clinical screening and aggressive treatment for the prevention of higher sarcopenia status in advanced older male adults with predialysis CKD are recommended.
Journal Article
Time to treatment in pediatric patients with repeated episodes of status epilepticus
Objective
To compare pediatric patients who presented with repeated status epilepticus episodes to patients with a single episode of status epilepticus and identify distinguishing clinical factors.
Methods
Retrospective analysis of a multicenter, prospective observational cohort of pediatric patients with status epilepticus between 2011 and 2019.
Results
Out of 504 status epilepticus episodes in 420 patients, 50 patients (10.3%) had repeated episodes of status epilepticus. The only predictor of repeated status epilepticus was a prior diagnosis of epilepsy. There was no difference in time to treatment with the first benzodiazepine in patients presenting with their first status epilepticus episode compared to their second status epilepticus episode [median 10 (interquartile range 5–30) vs. 14 (4.5–52.5) minutes; (
p
= 0.24)] or in time to treatment with the first non- benzodiazepine anti-seizure medication (ASM) [61 (37–125) vs. 71 (34.5-117.5) minutes;
p
= 0.61]. In patients with repeated status epilepticus episodes with onset outside the hospital, the percentage of patients treated by caregivers did not improve between the first and second status epilepticus episode (61% vs. 60%,
p
= 0.56). However, the time to first benzodiazepine was shorter in patients treated by caregivers compared to those who were not [5 (0–25) vs. 55 (41–120) minutes;
p
< 0.001].
Conclusions
Time to treatment with benzodiazepine and non-benzodiazepine ASM in patients with repeated episodes of status epilepticus does not improve for a second episode of status epilepticus, suggesting additional opportunities for intervention and teaching.
Journal Article
Combined Systemic Immunotherapy and Intrathecal Dexamethasone in Febrile Infection Related Epilepsy Syndrome
ABSTRACT
Febrile infection related epilepsy syndrome (FIRES) is a rare presentation of refractory status epilepticus with immune dysregulation as a potential pathologic mechanism. Despite promising results from second‐line immunomodulators, approximately 30% remain refractory to treatment. We describe two children with FIRES who were unable to wean from anesthetic infusions with immunomodulatory treatment and subsequently received concurrent intrathecal dexamethasone and anakinra/tocilizumab as escalation of therapy. Following the initiation of this combined regimen, anesthetic infusions were decreased while maintaining seizure freedom. These cases demonstrate proof of principle that a multi‐modal approach may be beneficial and should be considered in the treatment of FIRES.
Journal Article
Systemic inflammatory markers and EEG features of children with FIRES receiving anakinra
In a retrospective case series of 10 children with cryptogenic FIRES, we sought to describe the early clinical course and potential biomarkers following anakinra initiation. Six children achieved anesthetic withdrawal within 3 weeks of therapy and one in week four. Of the available cEEG (six children), CRP (10 children), and serum cytokine (six children) studies, there were temporal changes in highly epileptiform bursts (observed in three children), CRP, IL‐6, and IL‐10 levels that might parallel clinical progression. These observations may represent candidate biomarkers for monitoring clinical progression and therapeutic interventions including anakinra, which merits further investigation in future studies.
Journal Article