Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

INTRODUCTION: This systematic review aimed to assess the efficacy and safety of hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in patients with sepsis and septic shock. METHODS: We conducted a database search in MEDLINE, Embase, CENTRAL, Web of Science, and CNKI for randomised controlled trials (RCTs) comparing HAT against placebo/standard of care or against hydrocortisone in sepsis/septic shock patients. Outcomes included mortality, ICU/hospital length of stay (LOS), vasopressor durations, mechanical ventilation durations, change in SOFA at 72 h, and adverse events. RCT results were pooled in random-effects meta-analyses. Quality of evidence was assessed using GRADE. RESULTS: Fifteen RCTs (N = 2,594) were included. At 72 h, HAT reduced SOFA scores from baseline (mean difference [MD] -1.16, 95% confidence interval [CI]: -1.58 to -0.74, I2 = 0%) compared to placebo/SoC, based on moderate quality of evidence. HAT also reduced the duration of vasopressor use (MD -18.80 h, 95% CI: -23.67 to -13.93, I2 = 64%) compared to placebo/SoC, based on moderate quality of evidence. HAT increased hospital LOS (MD 2.05 days, 95% CI: 0.15-3.95, I2 = 57%) compared to placebo/SoC, based on very low quality of evidence. HAT did not increase incidence of adverse events compared to placebo/SoC. CONCLUSIONS: HAT appears beneficial in reducing vasopressor use and improving organ function in sepsis/septic shock patients. However, its advantages over hydrocortisone alone remain unclear. Future research should use hydrocortisone comparators and distinguish between sepsis-specific and comorbidity- or care-withdrawal-related mortality.

The carbon footprint of large- and mid-scale hydropower in China: Synthesis from five China's largest hydro-project.

The past two decades have witnessed growing global concern about excessive greenhouse gas (GHG) emissions by reservoirs and the development of hydropower. Literature review showed that life cycle GHG emissions per energy production of collected global dataset ranged from 0.04 to 237.0 gCO2eq/kW⋅h, with a mean of 25.8 ±â€¯3.0 gCO2eq/kW⋅h. Synthesis from the China's five largest hydro-projects and other publications estimated that the large- and mid-scale hydro-projects in China had a carbon footprint between 6.2 gCO2eq/kWh and 34.6 gCO2eq/kWh, with a mean value of 19.2 ±â€¯6.8 gCO2eq/kWh (mean ±â€¯sd.). Over 80% of the carbon footprint of the hydro-projects could be conservatively allocated to hydroelectricity generation, while the rest could then be allocated to flood control services. In the Three Gorges Dam Project, the allocated life cycle GHG emissions per energy production of its hydroelectricity production was estimated to be 17.8 gCO2eq/kW⋅h. GHG emissions from reservoir sediments and in the phase of operation and maintenance were still uncertain. There is still a need of in-depth research on reservoir carbon cycling to quantify net reservoir GHG emissions.

Greenhouse Gas Emissions from Freshwater Reservoirs: What Does the Atmosphere See?

Freshwater reservoirs are a known source of greenhouse gas (GHG) to the atmosphere, but their quantitative significance is still only loosely con- strained. Although part of this uncertainty can be attributed to the difficulties in measuring highly variable fluxes, it is also the result of a lack of a clear accounting methodology, particularly about what constitutes new emissions and potential new sinks. In this paper, we review the main processes involved in the generation of GHG in reservoir systems and propose a simple approach to quantify the reservoir GHG footprint in terms of the net changes in GHG fluxes to the atmosphere induced by damming, that is, 'what the atmosphere sees.' The approach takes into account the pre-impoundment GHG balance of the landscape, the temporal evolution of reservoir GHG emission profile as well as the natural emissions that are displaced to or away from the reservoir site resulting from hydrological and other changes. It also clarifies the portion of the reservoir carbon burial that can potentially be considered an offset to GHG emissions.