Clinical experience suggests higher occurrence of carbapenem‐associated seizures in the elderly than what is reported in the available literature (range between 0.2% and 0.7%). An audit of 1345 ...patients with age 60 years or older, who received imipenem, ertapenem or meropenem during their acute hospitalisation found 32 (2.4%) subjects developed seizures. Subjects with more than one central nervous system disorders were 11.6 times more likely to develop seizures (odds ratio 11.61, P < 0.001) and subjects with prior history of seizures is associated with four times greater risks (odds ratio 4.02, P = 0.005). Physicians should exercise caution when prescribing carbapenems in elderly, especially those with known epilepsy and a high number of intracranial pathologies.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Background: While sarcopenia and frailty independently contribute to functional impairment and disability, the combined impact resulting from their interplay is unclear. We investigated if ...functional, physical, cognitive, and nutritional measures were more adversely affected in community-dwelling older adults who were screened positive for both frailty and sarcopenia.Methods: Using the FRAIL (≥1) and SARC-F (Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls) (≥1) scales for screening, we categorized 200 participants (age, 67.9±7.9 years) as combined (both positive, 12.5%), intermediate (either positive, 25.5%), or robust (both negative, 62%). Results: Comparisons of the three groups showed that the combined group had significantly worse functional ability (Frenchay Activities Index and Modified Barthel Index), physical performance (knee extension, gait speed, and Short Physical Performance Battery score), cognition/mood (Chinese Mini-Mental State Examination CMMSE score and Geriatric Depression Scale), and nutrition (Mini Nutritional Assessment MNA score) (p<0.05, one-way analysis of variance). Post-hoc comparisons revealed similar findings between the combined and robust groups, except for knee extension and CMMSE scores. Only MNA scores were significantly lower between the intermediate and robust groups. Conclusion: Functional ability, physical performance, and nutrition were more adversely affected in our study population of community-dwelling older adults who screened positive for both frailty and sarcopenia than in those who screened positive for either or neither, supporting the use of community screening for early detection and intervention for both frailty and sarcopenia as opposed to either alone.
Ketamine in Severe Leptomeningeal Pain Tam, Yong Seng; Chen, Elizabeth; Poh, ZhiSheng Edmund ...
Journal of palliative medicine,
04/2023, Volume:
26, Issue:
4
Journal Article
Peer reviewed
Carcinomatosis meningitis is a rare but deadly complication of medulloblastoma. Surgical and systemic treatment options are often limited in advanced stages of the cancer. Meningeal irritation from ...raised intracranial pressure causes leptomeningeal pain that may respond poorly to opioids and common adjuvant analgesics. We present the case of a terminally ill patient with severe leptomeningeal pain that responded to a trial of ketamine as an adjunct to opioids.
This study employed a portable emissions measurement system to investigate the effects of vehicle attributes, driving behavior, and road grade on real-world emissions of particulate matter (PM), ...regulated gaseous pollutants, and particle-bound polycyclic aromatic hydrocarbons (PAHs) for old-model diesel trucks (model year 1995–2006, 6.7–35.0 metric ton) with little to no tailpipe emission control. The rated power of engines was a major determinant of the distance-specific emission factors of PM, particle-bound PAHs, and most gaseous pollutants. However, the engine size was unrelated to the total hydrocarbon emission factor and the benzoapyrene equivalent (BaPeq) emission factor of PAHs. Aggressive (AG) and normal (NR) driving behaviors were quantitatively defined with a relative positive acceleration. The emission factors of PM, CO2, and THC were significantly different (p < 0.05) between the AG and NR driving modes. AG driving caused an average increase in emissions of PM, CO2, NOx, and particle-bound PAHs by 122%, 56%, 15%, and 128%, respectively, compared to the respective emissions under the NR mode. The BaPeq emission factor of PAHs in the AG mode was more than 10 times that in the NR mode. The road gradient (ranging from −9.3% to 9.0% over the test route) had significant impacts on the emissions of PM, CO2, and NOx. PM, CO2, and NOx emission factors increased by 109%, 168%, and 160%, respectively, in the >6% grade bin and decreased by 95%, 91%, and 90%, respectively, in the equivalent negative-grade bin, implying that the decrease in emissions on negative road slopes may not compensate for the increase in emissions on the equivalent positive road slopes despite the road slope being compensated. The findings of this study will be valuable for developing air quality management strategies and furthering scientific knowledge on the complex interplay of different variables that affect real-world emissions of on-road vehicles.
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•Relative positive acceleration can contrast aggressive and normal driving behaviors.•PM and CO2 emissions increased significantly under aggressive driving conditions.•Rated power had significant correlations (r > 0.961) with NOx and CO2 emissions.•Road grade had significant correlations (r > 0.764) with PM, CO2, and NOx emissions.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The widespread application of deep learning has changed the landscape of computation in data centers. In particular, personalized recommendation for content ranking is now largely accomplished using ...deep neural networks. However, despite their importance and the amount of compute cycles they consume, relatively little research attention has been devoted to recommendation systems. To facilitate research and advance the understanding of these workloads, this paper presents a set of real-world, production-scale DNNs for personalized recommendation coupled with relevant performance metrics for evaluation. In addition to releasing a set of open-source workloads, we conduct in-depth analysis that underpins future system design and optimization for at-scale recommendation: Inference latency varies by 60% across three Intel server generations, batching and co-location of inference jobs can drastically improve latency-bounded throughput, and diversity across recommendation models leads to different optimization strategies.
PURPOSE Intractable ascites (IA) is an uncommon but challenging complication after liver transplantation. Splenic artery embolization (SAE) modulates the splenic artery and regulates portal flow. ...This study aimed to evaluate the efficacy and safety of SAE using the Amplatzer vascular plug (AVP) versus coil embolization for post-living-donor liver transplantation (LDLT) IA. METHODS This retrospective study evaluated consecutive patients from 1 center who received LDLT (n =1410) between March 2006 and August 2019. The inclusion criteria for SAE were splenomegaly with IA after LDLT. RESULTS Totally 15 patients underwent SAE for post-LDLT IA. Eleven patients who received AVP embolization (age, 51.2 + or - 15.1 years; range, 8-63 years; 5 men and 6 women) were compared with 4 patients receiving coil embolization (age, 30.8 + or - 30.8 years; range, 1.5-63 years; 2 men and 2 women). AVP and coil embolization both significantly reduced portal vein hyperflow (plug/coil; P <.001/.006) and decreased ascites volume (plug/coil; P <.003/.042). The benefits of AVP embolization included shorter procedure time (P = .029), significantly reduced splenic volume (P = .012), increased liver volume (P = .012), decreased spleen/liver ratio (P = .012), and improvement of pancytopenia (P = .008) due to secondary hypersplenism. No significant differences were found between the two groups in the length of hospital stay or complications such as splenic infarction, pancreatitis, or sepsis. CONCLUSION SAE using AVP and coil embolization provide effective and safe methods for managing patients with IA after LDLT. AVP embolization may be more efficient than coil embolization, providing more effective reduction of ascites volume and the advantages of shortened procedure time and improvement of hypersplenism.
To evaluate the significance of portosystemic shunts and associated long-term outcomes in living donor liver transplant (LDLT) among pediatric patients.
Retrospective review of 121 pediatric patients ...who underwent LDLT between May 1994 and December 2015 at Taiwan Kaohsiung Chang Gung Memorial Hospital. Pre- and postoperative computed tomography images of the liver were reviewed, and portal vein complications were assessed.
Ninety-seven pediatric patients were included in the study, and 70 had portosystemic shunts before transplant. Thirty-three patients have portal systemic shunt (PSS) 6 months after transplant (mean SD shunt size, 4.59 1.98 mm). Thirty-seven patients’ portosystemic shunts closed spontaneously (mean SD shunt size, 3.14 1.06 mm). Smaller PSSs tend to close spontaneously with a cutoff point of 3.35 mm by receiver operating characteristic curve (P = .01). Patients with PSS have more portal vein complications than those without PSS (44.3% vs 11.1%, P = .02). Among PSS recipients, patients with portal vein complications tend to have larger PSS size (mean SD, 4.14 1.96 mm vs 3.59 1.48 mm), although the difference is not statistically significant (P = .19).
In pediatric patients, preoperative portosystemic shunts are significantly correlated with portal venous complications, some of which require minimal interventions after LDLT with good outcomes. Shunts larger than 3.35 mm tend to persist after transplant with increased portal venous complications.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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