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Background: Dexmedetomidine, a highly selective alpha-2 adrenoceptor agonist with sedative and analgesic effects, has been suggested in recent studies to possess renoprotective properties. Dexmedetomidine may reduce the incidence of delayed graft function and contribute to effective pain control post-renal transplantation. The primary objective of this systematic review was to assess whether dexmedetomidine decreases the occurrence of delayed graft function in renal transplant patients. Methods: Databases including MEDLINE, EMBASE, and CENTRAL were comprehensively searched from their inception until March 2023. The inclusion criteria covered all Randomized Clinical Trials (RCTs) and observational studies comparing dexmedetomidine to control in adult patients undergoing renal transplant surgery. Exclusions comprised case series and case reports. Results: Ten RCTs involving a total of 1358 patients met the eligibility criteria for data synthesis. Compared to the control group, the dexmedetomidine group demonstrated a significantly lower incidence of delayed graft function (OR = 0.71, 95% CI 0.52–0.97, p = 0.03, GRADE: Very low, I2 = 0%). Dexmedetomidine also significantly prolonged time to initiation of rescue analgesia (MD = 6.73, 95% CI 2.32–11.14, p = 0.003, GRADE: Very low, I2 = 93%) and reduced overall morphine consumption after renal transplant (MD = -5.43, 95% CI -7.95 to -2.91, p < 0.0001, GRADE: Very low, I2 = 0%). The dexmedetomidine group exhibited a significant decrease in heart rate (MD = -8.15, 95% CI -11.45 to -4.86, p < 0.00001, GRADE: Very low, I2 = 84%) and mean arterial pressure compared to the control group (MD = -6.66, 95% CI -11.27 to -2.04, p = 0.005, GRADE: Very low, I2 = 87%). Conclusions: This meta-analysis suggests that dexmedetomidine may potentially reduce the incidence of delayed graft function and offers a superior analgesia profile as compared to control in adults undergoing renal transplants. However, the high degree of heterogeneity and inadequate sample size underscore the need for future adequately powered trials to confirm these findings.

Background: Emergence delirium remains a major postoperative concern for children undergoing surgery. Nalbuphine is a synthetic mixed agonist-antagonist opioid, which is believed to reduce the incidence of emergence delirium in children. The primary objective was to examine the effect of nalbuphine on emergence delirium in children undergoing surgery. Methods: Databases of MEDLINE, EMBASE, and CENTRAL were searched from their starting dates until April 2023. Randomized Clinical Trials (RCT) and observational studies comparing nalbuphine and control in children undergoing surgery were included. Results: Eight studies (n = 1466 patients) were eligible for inclusion of data analysis. Compared to the control, our pooled data showed that the nalbuphine group was associated with lower incidence of emergence delirium (RR = 0.38, 95% CI [0.30, 0.47], p < 0.001) and reduced postoperative pain scores (MD = -0.98, 95% CI [-1.92, -0.04], p = 0.04). Conclusions: This review showed the administration of nalbuphine is associated with significant decrease in the incidence of emergence delirium and postoperative pain scores among children undergoing surgery. However, due to limited sample size, high degree of heterogeneity and low level of evidence, future adequately powered trials are warranted to explore the efficacy of nalbuphine on emergence delirium among the pediatric population.

Abstract In classical and single-particle settings, non-trivial band topology always gives rise to robust boundary modes. For quantum many-body systems, however, multiple topological fermions are not always able to coexist, since Pauli exclusion prevents additional fermions from occupying the limited number of available topological modes. In this work, we show, through IBM quantum computers, how one can robustly stabilize more fermions than the number of topological modes through specially designed 2-fermion interactions. Our demonstration hinges on the realization of BDI- and D-class topological Hamiltonians on transmon-based quantum hardware, and relied on a tensor network-aided circuit recompilation approach. We also achieved the full reconstruction of multiple-fermion topological band structures through iterative quantum phase estimation (IQPE). All in all, our work showcases how advances in quantum algorithm implementation enable noisy intermediate-scale quantum (NISQ) devices to be exploited for topological stabilization beyond the context of single-particle topological invariants.

ObjectiveWe examined the association between cardiorespiratory fitness (CRF), body mass index (BMI), incidence of major acute cardiovascular events (MACE), and all-cause mortality (ACM).MethodsWe conducted a retrospective cohort study involving 212,631 healthy young men aged 16 to 25 years who had undergone medical examination and fitness testing (2.4 km run) from 1995 to 2015. Information on the outcomes of major acute cardiovascular events (MACE) and all-cause mortality (ACM) were obtained from the national registry data.ResultsDuring 2,043,278 person-years of follow-up, 371 first MACE and 243 ACM events were recorded. Compared against the first run-time quintile, adjusted hazard ratios (HR) for MACE in the second to fifth quintiles were 1.26 (95% CI 0.84–1.91), 1.60 (95% CI 1.09–2.35), 1.60 (95% CI 1.10–2.33), and 1.58 (95% CI 1.09–2.30). Compared against the “acceptable risk” BMI category, the adjusted HRs for MACE in the “underweight,” “increased risk,” and “high-risk” categories were 0.97 (95% CI 0.69–1.37), 1.71 (95% CI 1.33–2.21), and 3.51 (95% CI 2.61–4.72), respectively. The adjusted HRs for ACM were increased in participants from the fifth run-time quintile in the “underweight” and “high-risk” BMI categories. The combined associations of CRF and BMI with MACE showed elevated hazard in the “BMI≥23-fit” category, which was more pronounced in the “BMI≥23-unfit” category. The hazards for ACM were elevated across the “BMI

Clean electricity is generated by the anaerobic digestion of biomass waste. The environmental impacts of various biomass waste feedstocks vary, while co-digestion has been reported to improve anaerobic digestion performance. A consequential life-cycle assessment (LCA) and techno-economic analysis (TEA) are carried out for cow manure waste management for a cow farm. Three scenarios are considered in this study: (S1) mono-digestion of cow manure, (S2) co-digestion of cow manure and maize silage, and (S3) co-digestion of cow manure with cow feed waste, sewage sludge, and returned dairy products. The LCA aims to quantify the environmental impact of each MWh of electricity generated, assuming the plant is located in Malaysia, using OpenLCA software. The TEA economic parameters are quantified and compared between the three scenarios. Net present value (NPV), Internal Return Rate (IRR), and Return of Investment (ROI) are examined. Among the three scenarios, S2 with maize cultivation has a higher environmental impact due to its higher energy requirements. With the integration of closed digestate storage and renewable energy-powered electricity, S3 has the best environmental performance in global warming, eutrophication and acidification. S3 is found to be most economically viable, with MYR 1.28 million NPV, 14% IRR, and 15% ROI, and a Payback Period of 6.56 years with an OPEX of MYR 3491.82/MWh.

Waste-to-energy conversion such as anaerobic digestion has been widely promoted under the subsidies to decouple from fossil fuel dependence system and its inherent two-fold benefits. It could diversify the renewable energy matrix and divert the waste from the landfill. Co-digestion of two and more feedstocks could enhance bioenergy production and maximise waste recovery. However, the anticipated benefits are not absolute for all circumstances, varying across the type of co-substrate, pretreatment and other settings. The present study aims to overview the life cycle assessment (LCA) and the techno-economic assessment (TEA) of the anaerobic co-digestion processes. The results could provide an insight into the several critical parameters for sustainable co-digestion. Co-digestion of two or more feedstock is favourable since higher anaerobic digestion performances and higher profitability in TEA is shown. Cultivation of energy crops, transportation, pretreatment of feedstock and storage stage each contributes some shares to eutrophication potential (EP), acidification potential (AP), global warming potential (GWP), ozone depletion and fossil depletion. Generally, high anaerobic digestion performances and biogas upgrading can offset the negative environmental impact. Positive net present value is also observed from the co-digestion of feedstock.