The dissolution of total suspended solids and treatment strategy of tailwater in a Litopenaeus vannamei recirculating aquaculture system

In recirculating aquaculture systems(RASs),the effective treatment of aquaculture tailwater is essential to maintain the health of the RAS.This study investigated the optimal time and method for tailwater treatment during three periods of the aquaculture of the Litopenaeus vannamei:nursery(0–26 d),middle(27–57 d),and later(57–104 d).The variation of several water parameters during the dissolution of total suspended solid(TSS)in tailwater,applied with the effects of ozone on the microorganism and water quality parameters were investigated.Results showed that the TSS concentrations in tailwater decreased with time,although not significantly(P>0.05),whereas total ammonia nitrogen(TAN),nitrite(NO-2-N),and nitrate(NO_(3)^(-)-N)increased significantly(P<0.05).Therefore,TSS should be removed from the tailwater as early as possible,being most optimal within 4 h.Ozone removed 38.24%–48.95%of TSS,17.78%–90.14%of TAN,and 87.50%–98.90%of NO-2-N after 4 h of treatment.However,it resulted in the significant accumulation of NO_(3)^(-)-N.Moreover,the total number of Vibrio and bacterial counts in aquaculture tailwater was reduced completely by ozone within 4 h.Thus,these results provided technical details and data support for the effective treatment of tailwater from shrimp RAS.

Application of CFD Modeling to Hydrodynamics of CycloBio Fluidized Sand Bed in Recirculating Aquaculture Systems

To improve the efficiency of a CycloBio fluidized sand bed(CB FSB) in removal of dissolved wastes in recirculating aquaculture systems, the hydrodynamics of solid-liquid flow was investigated using computational fluid dynamics(CFD) modeling tools. The dynamic characteristics of silica sand within the CB FSB were determined using three-dimensional, unsteady-state simulations with the granular Eulerian multiphase approach and the RNG k-ε turbulence model, and the simulation results were validated using available lab-scale measurements. The bed expansion of CB FSB increased with the increase in water inflow rate in numerical simulations. Upon validation, the simulation involving 0.55 mm particles, the Gidaspow correlation for drag coefficient model and the Syamlal-O'Brien correlation for kinetic granular viscosity showed the closest match to the experimental results. The volume fraction of numerical simulations peaked as the wall was approached. The hydrodynamics of a pilot-scale CB FSB was simulated in order to predict the range of water flow to avoid the silica sand overflowing. The numerical simulations were in agreement with the experimental results qualitatively and quantitatively, and thus can be used to study the hydrodynamics of solid-liquid multiphase flow in CB FSB, which is of importance to the design, optimization, and amplification of CB FSBs.

Numerical simulation of the hydrodynamics within octagonal tanks in recirculating aquaculture systems

A three-dimensional numerical model was established to simulate the hydrodynamics within an octagonal tank of a recirculating aquaculture system. The realizable k-e turbulence model was applied to describe the flow, the discrete phase model （DPM） was applied to generate particle trajectories, and the governing equations are solved using the finite volume method. To validate this model, the numerical results were compared with data obtained from a full-scale physical model. The results show that： （1） the realizable k-e model applied for turbulence modeling describes well the flow pattern in octagonal tanks, giving an average relative error of velocities between simulated and measured values of 18% from contour maps of velocity magnitudes; （2） the DPM was applied to obtain particle trajectories and to simulate the rate of particle removal from the tank. The average relative error of the removal rates between simulated and measured values was 11%. The DPM can be used to assess the self-cleaning capability of an octagonal tank; （3） a comprehensive account of the hydrodynamics within an octagonal tank can be assessed from simulations. The velocity distribution was uniform with an average velocity of 15 cm/s; the velocity reached 0.8 m/s near the inlet pipe, which can result in energy losses and cause wall abrasion; the velocity in tank corners was more than 15 cm/s, which suggests good water mixing, and there was no particle sedimentation. The percentage of particle removal for octagonal tanks was 90% with the exception of a little accumulation of 〈5 mm particle in the area between the inlet pipe and the wall. This study demonstrated a consistent numerical model of the hydrodynamics within octagonal tanks that can be further used in their design and optimization as well as promote the wide use of computational fluid dynamics in aquaculture engineering.

Effect of copper on the growth of shrimps Litopenaeus vannamei : water parameters and copper budget in a recirculating system

Shrimps( Litopenaeus vannamei) were intensively cultured in a recirculating aquaculture system for 98 days to investigate effects of 0.3 mg/L Cu on its performance, Cu budget, and Cu distribution. Shrimps in Cu-treated systems had greater mean final weight(11.10 vs 10.50 g), body length(107.23 vs 106.42 mm), survival rate(67.80% vs 66.40%), and yield(6.42 vs 5.99 kg/m 3), and lower feed conversion ratio(1.20 vs 1.29) than those in control systems but the differences were not significant. Vibrio numbers remained stable(10 4 –10 6 colony forming units/mL) in the rearing tanks of both control and treated systems. Total ammonium-N, nitrite-N, nitrate-N, pH, chemical oxygen demand, 5-day carbonaceous biochemical oxygen demand, and total suspended solids were similar in controls and treatments. Dissolved Cu concentration in the treated systems decreased from 0.284 to 0.089 mg/L while in the control systems it increased from 0.006 2 to 0.018 mg/L. The main sources of Cu in the treated systems were the artificially added component(75.7% of total input), shrimp feed(21.0%), water(2.06%), and shrimp biomass(1.22%). The major outputs of Cu occurred via the mechanical filter(41.7%), water renewal(15.6%), and draining of the sediment trap(15.1%). The foam fractionator removed only 0.69% of total Cu input. Harvested shrimp biomass accounted for 11.68% of Cu input. The Cu concentration of shrimps in the Cu-treated systems(30.70 mg/kg wet weight) was significantly higher than that in control systems(22.02 mg/kg). Both were below the maximum permissible concentration(50 mg/kg) for Cu in seafood for human consumption in China. Therefore, recirculating systems can be used for commercial on-growing of Litopenaeus vannamei without loss of shrimp quality, even in water polluted by 0.30 mg/L Cu. The mechanical filter is the main route for Cu removal.

Intestinal microbiota of healthy and unhealthy Atlantic salmon Salmo salar L. in a recirculating aquaculture system

The present study sampled the intestinal content of healthy and unhealthy Atlantic salmon （Salmo salar L.）, the ambient water of unhealthy fish, and the biofilter material in the recirculating aquaculture system （RAS） to understand differences in the intestinal microbiota. The V4--V5 regions of the prokaryotic 16S rRNA genes in the samples were analyzed by MiSeq high-throughput sequencing. The fish were adults with no differences in body length or weight. Representative members of the intestinal microbiota were identified. The intestinal microbiota of the healthy fish included Proteobacteria （44.33%）, Actinobacteria （17.89%）, Baeteroidetes （15.25%）, and Firmicutes （9.11%）, among which the families Mierococcaceae and Oxalobacteraceae and genera Sphingomonas, Streptomyces, Pedobacter, Janthinobacterium, Burkholderia, and Balneimonas were most abundant. Proteobacteria （70.46%）, Bacteroidetes （7.59%）, and Firmicutes （7.55%） dominated the microbiota of unhealthy fish, and Chloroflexi （2.71%）, and Aliivibrio and Vibrio as well as genera in the family Aeromonadaceae were most strongly represented. Overall, the intestinal hindgut microbiota differed between healthy and unhealthy fish. This study offers a useful tool for monitoring the health status of fish and for screening the utility of probiotics by studying the intestinal microbiota.

Effect of Hydraulic Loading Rate on the Efficiency of Effluent Treatment in a Recirculating Puffer Aquaculture System Coupled with Constructed Wetlands

Constructed wetlands(CWs) were integrated into an indoor recirculating aquaculture system of obscure puffer(Takifugu obscurus) for effluent treatment. The effect of hydraulic loading rate(HLR) on the efficiency of effluent treatment by CWs was examined for over a month. The CWs were operated under brackish conditions(salinity 7.4–7.6) at 3 different HLRs(0.762, 0.633, and 0.458 m d–1) 3 times, 10 days each. Overall, the CWs exhibited high efficiency in removal of total ammonium nitrogen(by 81.03–92.81%) and nitrite nitrogen(by 99.40%–99.68%). The efficiency of CWs in removal of total ammonium nitrogen, nitrate nitrogen, total Kjeldahl nitrogen, total phosphorous, and total suspended solids(TSS) increased with the decrease of HLR. The CWs operated at the 3 HLRs in a decreasing trend proves to be effective, providing a useful method for effluent treatment in commercial puffer aquaculture systems.

Commercial Production of Tiger Puffer(Takifugu rubripes)in Winter Using a Recirculating Aquaculture System

Tiger puffer(Takifugu rubripes) is a promising species for aquaculture production because of its high value and limited supply. However, in the north of China, using sea cages to culture this species in winter is hampered by the fact that the seawater temperature is extremely low. Here, a large scale commercial production of tiger puffer has been successfully realized using a recirculating aquaculture system(RAS) from 3 October 2012 to 31 May 2013. The RAS was comprised of nine culture tanks(total water volume 200 m3) and stocked with approximately a total of 14400 fish(initial mean weight 160 g). The tiger puffer was hand-fed at a rate of 0.7% of total body weight per day, and the feed conversion rate was(1.21 ± 0.3) kg kg-1. The recycle water in RAS was treated by a sieve bend screen, a foam fractionator, a submerged biofilter, an UV sterilizer and a submersible aerator. During the whole culture period, an excellent water quality control was achieved in RAS. At the end of this experiment, the survival rate of tiger puffer was more than 98%. The final tank densities averaged 31.2 kg m-3, and the final individual mean weight was 440 g.

Effects of spectral composition,photoperiod and light intensity on the gonadal development of Atlantic salmon Salmo salar in recirculating aquaculture systems(RAS)

Artificial lighting regimes have been successfully used to inhibit sexual maturity of Atlantic salmon in confinement.However,when these operations are applied in commercial recirculating aquaculture systems(RAS) using standard lighting technology,sexual maturation is not suppressed.In this study,an L_9(3~3) orthogonal design was used to determine the effects of three factors(spectral composition,photoperiod,and light intensity) on the gonadal development of Atlantic salmon in RAS.We demonstrated that the photoperiod at the tested levels had a much greater effect on the gonadosomatic index and female Fulton condition factor than spectral composition and light intensity.The photoperiod had a significant effect on the secretion of sex steroids and melatonin(P<0.05),and a short photoperiod delayed sex steroid and melatonin level increases.The three test factors had no significant effects on the survival rate,specific growth rate,relative weight gain,and male Fulton condition factor(P>0.05).The optimum lighting levels in female and male Atlantic salmon were LD 8:16,455 nm(or 625 nm),8.60 W/m^2;and LD 8:16,8.60 W/m^2,455 nm respectively.These conditions not only delayed gonadal development,but also had no negative effects on Atlantic salmon growth in RAS.These results demonstrate that a combination of spectral composition,photoperiod and light intensity is effective at delaying the gonadal development of both male and female salmon in RAS.

Total Replacement of Fish Oil with Vegetable Oils in the Diet of Juvenile Jade Perch Scortum barcoo Reared in Recirculating Aquaculture Systems

To determine the replacement of fish oil with vegetable oils in the diet of juvenile Jade perch Scortum barcoo, four feeds with each a different oil （fish, sunflower, linseed and a mixture of 75% canola and 25% linseed oil）, were fed to Jade perch reared in recirculating aquaculture systems （RAS）. The trial lasted for 10 weeks and the fatty acid （FA） profile of both feed and fish muscle tissue were examined. There was no difference in growth, feed conversion rate （FCR） and mortality. The fish grew from 10 g to 110 g with a FCR of 1.25 and 0 mortality. The FA profile of the fish muscle tissue reflected the FA profile of the feed. The flesh of the fish that were fed the linseed oil diet, were extremely high in omega-3 （n-3） polyunsaturated FA （n-3 PUFA） with 3.75% of wet weight. This is one of the highest concentrations of n-3 PUFA ever recorded in fish flesh. In a finishing feeding test, the remaining vegetable oil fed fish were fed the fish oil diet for another two weeks immediately after the 10 weeks trial, to check for a possible recovery of n-3 highly unsaturated fatty acids （HUFA）. The wash out rate of FA towards n-3 HUFA in the muscle tissue was about 25% over this two weeks period.

Survival predictors in patients treated with a molecular adsorbent recirculating system

AIM:To identify prognostic factors for survival in patients with liver failure treated with a molecular adsorbent recirculating system(MARS). METHODS:MARS is a liver-assisting device that has been used in the treatment of liver failure to enable native liver recovery,and as a bridge to liver transplantation(LTX).We analyzed the 1-year outcomes of 188 patients treated with MARS,from 2001 to 2007, in an intensive care unit specializing in liver disease. Demographic,clinical and laboratory parameters were recorded before and after each treatment.One-year survival and the number of LTXs were recorded.Logistic regression analysis was performed to determine factors predicting survival. RESULTS:The study included 113 patients with acute liver failure(ALF),62 with acute-on-chronic liver failure(AOCLF),11 with graft failure(GF),and six with miscellaneous liver failure.LTX was performed for 29% of patients with ALF,18% with AOCLF and 55%with GF.The overall 1-year survival rate was 74% for ALF,27% for AOCLF,and 73% for GF.The poorest survival rate,6%,was noted in non-transplanted patients with alcohol-related AOCLF and cirrhosis,whereas,patients with enlarged and steatotic liver had 55% survival.The etiology of liver failure was the most important predictor of survival(P<0.0001).Other prognostic factors were encephalopathy(P=0.001)in paracetamol-related ALF, coagulation factors(P=0.049)and encephalopathy(P=0.064)in non-paracetamol-related toxic ALF,and alanine aminotransferase(P=0.013)and factor V levels(P =0.022)in ALF of unknown etiology. CONCLUSION:The etiology of liver disease was the most important prognostic factor.MARS treatment appears to be ineffective in AOCLF with end-stage cirrhosis without an LTX option.

Effects of Nutrients on Biofouling Formation and Preponderant Bacteria Diversity in Recirculating Cooling Water System

A series of orthogonal array experiments were conducted using carbon source, ammonia nitrogen and total phosphorus （TP） as major influencing factors to investigate the effects of nutrients on biofouling formation and preponderant bacteria diversity in the recirculatiug cooling water system. Carbon source was demonstrated to be the most significant determinant affecting the biofouling formation. A minimum biofouling outcome was obtained when BOD2, NHa＋-N and TP were 25, 10, and 1 mg/L, respectively. Then the preponderant bacteria strains in biofouling mass under two typical culture conditions （negative and favorable） were identified applying both traditional biochemical methods and further molecular biology technology with phylogenetic affiliation analysis, which indicated that Enterobacteriaceae Enterobacter, Micrococcaceae Staphylococcus, Bacillaceae Bacillus, Enterobacteriaceae Proteus, Neisseriaceae Neisseria and Pseudomonadaceae Pseudomonas were dominant under negative condition, while Enterobacteriaceae Klebsiella, Enterobacteriaceae Enterobacter and Microbacterium - under favorable one.

Experiment and simulation on the pyrite removal from the recirculating load of pulverizer with a dilute phase gas-solid fluidized bed

In order to reduce the energy consumption and subsequent air pollution of coal-fired power station, based on the analysis to size and density distribution of particles from the recirculating load of the classifier of pulverizer, the separation experiment on sampling material from power plant with a dilute phase fluidized bed to remove pyrite and other minerals and numerical simulation on the separation process were done. The results show that the minimum fluidization velocity is 1.62 cm/s. Pyrite and other minerals in the material are separated. Ash of the upper and bottom layer material account for 33.34% and 73.42% respectively and sulfur content occupy 1.12% and 8.96% respectively. Scanning electron microscopy and spectroscopy tests show that sulfur in the bottom material exist in the form of pyrite. Numerical simulation on the flow field form of the dilute phase separation bed with gas-solid two phase and particle motion verifies the experimental results.

EXPERIMENTAL STUDIES ON SWIRLING AND RECIRCULATING TWO-PHASE FLOW FIELD IN A COLD MODEL OF DUAL-INLET SUDDEN-EXPANSION COMBUSTOR

The axial and tangential velocities of gas and particle phases and particle concentration for turbulent swirling and recirculating gas-particle (simulating gas-droplet) flows in a cold model of a dual-inlet sudden-expansion combustor with partially tangential central tubes, proposed by the present authors, were measured by using a 2-D LDV system and a laser optic fiber system combined with a sampling probe. The results show that there are both gas and particle strongly reverse flows and swirling flows in the head part of the combustor. The velocity slip between gas and particle phases is remarkable. The particle concentration is higher near the wall and lower near the axis. There are two peaks in the concentration profiles near the inlet tubes. The above-obtained flow characteristics are favorable to ignition, flame stabilization and combustion. The results can also be used to validate the numerical modeling.

Characterization of Bacterial Community,Ammonia-Oxidizing Bacteria,and Nitrospira During the Operation of a Commercial-Scale Recirculating Aquaculture System for Culturing Pufferfish Takifugu rubripes

We investigated the changes in communities of bacteria,ammonia-oxidizing bacteria,and Nitrospira during the operation of a pufferfish Takifugu rubripes recirculating aquaculture system by using high-throughput DNA sequencing.Differences in bacterial communities were observed at days 1-32,47-62 and 78-93 of biofilm development by using 16S rRNA gene pyrosequencing.The relative abundance of Proteobacteria(Gammaproteobacteria)increased,while that of Bacteroidetes(Flavobacteria)decreased.The proportions of Nitrosomonas and Nitrospina ranged from 0.02%to 0.30%and from 0.02%to 0.83%,respectively.Ammonia monooxygenase gene pyrosequencing revealed that the top three operational taxonomic units were related to Nitrosomonas aestuarii(17.5%-61.1%),uncultured beta proteobacterium clone B67S-54(1.9%-45.2%),and uncultured bacterium clone AZPa8(3.6%-24.7%).Nitrite oxidoreductase gene pyrosequencing revealed that the relative abundance of the dominant strain Nitrospira sp.Ecomares 2.1 increased,but that of the abundant species Nitrospira marina decreased.Our results demonstrated that the communities of bacteria,ammonia-oxidizing bacteria,and Nitrospira were changing during the operation of the pufferfish recirculating aquaculture system.

Characterization of the bacterial communities associated with biofilters in two full-scale recirculating aquaculture systems

Bacteria play a major role in metabolizing ammonia and other metabolites in recirculating aquaculture systems(RASs).To characterize and compare the bacterial communities in the biofilters of two full-scale RASs for the culture of puffer fish,Takifugu rubripes,at different ages and densities were studied.In overall,47807 optimized reads of the 16 S rRNA gene with V4-V5 region were obtained from four biofilm samples collected after biofilm maturation.At 97%cut-off level,these sequences were clustered into 500 operational taxonomic units,and were classified into 19 bacterial phyla and 138 genera.At the phylum level,Proteobacteria and Bacteroidetes were the most abundant,followed by Nitrospirae and Planctomycetes.At the genus level,Colwellia,Marinifilum,Oceanospirillum,Lutibacter,Winogradskyella,Pseudoalteromonas,Arcobacter,and Phaeobacter were the top members.Nitrosomonas and Nitrospira were main ammonia-and nitrite-oxidizing bacteria.Differences in bacterial communities at different sampling dates and similarities of both biofilters were revealed in the Venn diagram and cluster analysis.Maintaining a good water quality and health offarmed fish in RASs depended on the correct management of the bacterial communities.This study provides more accurate information on the bacterial communities associated with the bifilters of both RASs.

Design and Dynamic Analysis of the Recirculating Planetary Roller Screw Mechanism

The recirculating planetary roller screw mechanism(RPRSM)is a transmission mechanism that engages the screw and nut threaded by multiple grooved rollers.In this paper,frstly,the design method of RPRSM nut threadless area is proposed,and the equations related to the structural parameters of nut threadless area are derived.On this basis,the cross-section design method of roller,screw and nut is constructed according to the actual situation of engagements between the screw/nut and the roller.By adjusting the gap between the two beveled edges and that between the arc and the beveled edge,the accuracy of the thread engagements between the screw/nut and the roller can be improved.Secondly,to ensure the engagements of the screw/nut and the roller,the distance equation from the center surface of the diferent rollers to the end surface of cam ring is given.Thirdly,combined with the working principle and structural composition of RPRSM,the component model is established according to its relevant structural parameters,and the virtual assembly is completed.Finally,the 3D model is imported into the ADAMS simulation software for multi-rigid body dynamics.The dynamic characteristic is analyzed,and the simulated values are compared with the theoretical values.The results show that the contact forces between the screw/nut and the roller are sinusoidal,mainly due to the existence of a small gap between the roller and the carrier.The maximum collision forces between the roller and cam ring are independent from load magnitude.Normally,the collision force between the roller and the carrier increases as the load increases.When RPRSM is in the transmission process,the roller angular speed in nut threadless area begins to appear abruptly,and the position of the maximum change is at the contact between the roller and the convex platform of cam ring.The design of the nut threadless area and the proposed virtual assembly method can provide a theoretical guidance for RPRSM research,as well as a reference for overall performance optimization.

Artificial liver support molecular adsorbents recirculating system therapy as a bridge to re-transplantation in two cases of long anhepatic duration

BACKGROUND: Molecular adsorbents recirculating sys- tem (MARS) liver support therapy is the development of albumin dialysis. This study was to assess the successful ap- plication of MARS artificial liver support therapy as a bridge to re-transplantation in two cases of long anhepatic duration. METHODS: MARS therapy was given after failure plasma- exchange ( PE) treatment, which resulted in circulatory de- rangement and acute renal dysfunction in a 36-year-old male patient. Finally his uncontrolled anhepatic condition led to a successful re-transplantation. In another 48-year- old man who was diagnosed as having primary nonfunction (PNF) during the liver transplantation, 10-hour MARS treatment contributed to smooth bridging of his anhepatic phase. RESULTS: The two anhepatic patients were bridged for 26 and 17 hours respectively to re-transplantation with MARS therapy. CONCLUSION: Our experience proves that MARS artifi- cial liver can be an effective support for long time bridging PNF until re-transplantation is available.

Stocking density effects on growth and stress response of juvenile turbot(Scophthalmus maximus) reared in land-based recirculating aquaculture system

Stocking density is widely recognized as a critical factor in aquaculture and a potential source of long-term stress.The influence of stocking density on growth and stress response of juvenile turbot（Scophthalmus maximus, ~3–75g, initial to final weight） was examined in fish held under low（LD, ~0.21–5.31 kg/m^2, initial to final density）,medium（MD, ~0.42–10.81 kg/m^2） and high stocking density（HD, ~0.63–14.27 kg/m^2） for 120 days in a recirculating aquaculture system（RAS）. In this trial, the growth curve for weight of juvenile turbot in RAS, all fitted by the Schnute model. No significant difference was found in growth performance among the three densities until at the final sampling（Day 120）. The final weight and body weight increase（BWI） in the HD group were significantly lower than in other groups（P〈0.05, weight：（75.83±2.49） g,（75.39±2.08） g,（65.72±2.86） g and BWI：（2 436.12±28.10）%,（2 421.29±4.64）%,（2 097.88±20.99）% in LD, MD and HD groups, respectively）. Similarly, the specific growth rate（SGR）, feed conversion ratio（FCR） and coefficient of variation for weight（CV_w） were adversely affected by high stocking density（P〈0.05）. However, there was no difference in survival and Fulton＇s condition factor（K） of turbot among the different groups. Physiological analyses demonstrated a clear increase in the plasma cortisol level and an obvious decrease in growth hormone（GH） concentration in the HD group on Day120（P〈0.05）. There was no significant effect of stocking density on plasma glucose, Cl– and protein levels. All these findings would provide a reference for selecting the optimal stocking density of juvenile turbot in RAS.

Molecular adsorbent recirculating system therapy in a rare case of fulminant hepatitis

Background: Acute hepatitis C virus infection leading to fulminant hepatitis is very rare whereas Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. The repertoire of substances that accumulate in the blood in fulminant hepatic failure cause neurological abnormalities, aggravate injury to the liver and other organs, suppress the ability of residual hepatocytes to perform organ-specific functions (sick cell syndrome), and inhibit the hepatic regenerative response especially in fulminant hepatitis Virus C which has subacute clinical evolution and takes time to manifest. Liver support technology is evolving as different techniques become available that assist the remaining functional cell mass by providing specific liver functions. Case Presentation: We report a case of Fulminant C virus Hepatitis, successfully treated with albumin dialysis Molecular Adsorbent Recirculating System (MARS). At time of admittance the patient presented: Model End-stage Liver Disease (MELD)-36;Child Turcotte Pugh (CTP)-C(13);Sequential Organ Failure Assestment (SOFA)-12, Glasgow Coma Score (GCS)-11. The patient underwent six sessions of MARS in Intensive Care Unit (ICU) in association with standard medical therapy (SMT). The patient survived and was discharged from the hospital in good condition after 40 days without liver transplantation (LT).