Impact of Frailty on Survival and Neurological Outcomes After Cardiac Arrest: A Systematic Review and Meta-Analysis.

To synthesize the evidence on the associations of frailty with the risk of mortality and neurological outcomes in patients with cardiac arrest undergoing cardiopulmonary resuscitation. We conducted a literature search on PubMed, EMBASE, and Scopus. We included observational studies on adult participants (18 years or older) with cardiac arrest. The eligible studies reported frailty assessments using standard tools, and the comparator group comprised nonfrail participants. We used random-effects models for all analyses and expressed pooled effect sizes as odds ratios (ORs) with 95% confidence intervals (CIs). We included data from 12 studies in our analysis. Individuals with frailty exhibited a significantly higher risk of in-hospital mortality (OR, 2.18; 95% CI, 1.62-2.94), and increased 30-day mortality (OR, 1.43; 95% CI, 1.12-1.84) and 12-month mortality (OR, 4.16; 95% CI, 2.32-7.47) than the nonfrail individuals. Frail individuals also displayed lower odds of achieving favorable neurological outcomes upon hospital discharge (OR, 0.32; 95% CI, 0.20-0.50) and at the 30-day follow-up (OR, 0.42; 95% CI, 0.23-0.78). Additionally, they had lower odds of return of successful spontaneous circulation (OR, 0.49; 95% CI, 0.34-0.72). The observed associations between frailty and a higher risk of mortality reduced odds of favorable neurological outcomes, and lower odds of return of successful spontaneous circulation underscore the value of identifying frailty in individuals to achieve more accurate prognoses. Our findings highlight the importance of including frailty assessments as a component of the management plan for patients experiencing cardiac arrest.

The effect of urgent-start peritoneal dialysis and urgent-start hemodialysis on clinical outcomes in patients with chronic kidney disease: an updated systematic review and meta-analysis.

OBJECTIVE: Recently, urgent-start peritoneal dialysis (PD) has been suggested in place of urgent-start hemodialysis (HD) in cases of chronic kidney disease (CKD). However, the comparative effectiveness of these methods is still unclear. This study compared the outcomes of urgent-start PD and urgent-start HD in CKD patients. METHODS: Electronic searches were conducted in PubMed, EMbase, Google Scholar databases, and Cochrane Library, up to 30th July 2023 for studies reporting data on all-cause mortality. Secondary outcomes included dialysis-related infectious and mechanical complications. Risk ratios (RRs) with 95% confidence interval (CI) were calculated. RESULTS: Nine eligible studies involving 941 PD and 779 HD patients were analyzed. Pooled analysis demonstrated elevated risk of all-cause mortality (RR: 1.06, 95% CI: 1.02 to 1.09), dialysis-related infectious complications (RR: 1.05, 95% CI: 1.02 to 1.07), and mechanical complications (RR: 1.08, 95% CI: 1.04 to 1.13) in patients undergoing urgent-start HD than in patients on urgent-start PD. CONCLUSION: Our findings indicate that CKD patients that received urgent-start HD are at increased risk of all-cause mortality and infectious, and mechanical complications that are associated with the dialysis than patients that received urgent-start PD. These findings have to be considered when making treatment decisions for patients with acute kidney injury. Better understanding of the mechanism of these differences may help to create guidelines for more informed clinical practices.

Insight into the effect of hydrogenation on efficiency of hydrothermal liquefaction and physico-chemical properties of biocrude oil.

Hydrothermal liquefaction of Nannochloropsis salina (N. salina) and larvae-vermicompost were conducted under both non-hydrogenating and hydrogenating subcritical conditions using H2 and Ni-Mo/Al2O3. Hydrogenation raised biocrude yields from 33.2% to 43.5% (vermicompost) and 55.6% to 78.5% (N. salina), whereas high heat values increased from 32.89 to 34.24 MJ/kg (vermicompost) and 36.30 to 37.53 MJ/kg (N. salina). Compared with the non-hydrogenated HTL process, the contents of acids, amides, phenols, and alcohols decreased, whereas hydrocarbons content increased. More branched cyclic nitrogenous compounds were detected in the hydrogenated biocrudes, whereas the aromatic/hetero-aromatic functionality was somewhat decreased. Smaller molecular weights and polydispersity index of the hydrogenated biocrudes were also detected. Results show that hydrogenation enhanced the removal of hydrophilic functional groups and the stabilization of radicals, thereby leading to the inhibition of loss of mass toward liquid and gaseous products and the upgrading of oil quality.