Novel uses of ensiled biomasses as feedstocks for green biorefineries

Perennial forage plants are efficient utilizers of solar radiation and nutrients so that there is a lot of scope to increase the production of green biomass in many areas.Currently,grasses are mainly used as feeds for ruminants and equines,but there could be higher added value use for several components of the green biomass.Interest in green biorefin-ing has risen recently motivated by the increased sustainability pressures and need to break the reliance on fossil fuels.Novel products derived from grass,such as paper and packaging,nanofibers,animal bedding,novel protein feeds,extracted proteins,biochemicals,nutraceuticals,bioactive compounds,biogas and biochar could create new sustainable business opportunities in rural areas.Most green biorefinery concepts focus on using fresh green biomass as the feedstock,but preservation of it by ensiling would provide several benefits such as all-year-around avail-ability of the feedstock and increased stability of the press juice and press cake.The major difference between fresh and ensiled grass is the conversion of water soluble carbohydrates into fermentation end products,mainly lactic and acetic acids,that lower the pH of the silage so that it becomes stable in anaerobic conditions.This has some important consequences on the processability and quality of products,which are partly positive and partly negative,e.g.,degradation of protein into peptides,amino acids and ammonia.These aspects are discussed in this review.

Optimal interval for delayed retrieval surgery with reciprocating morcellators after enucleation of giant prostatic hyperplasia in holmium laser enucleation of the prostate

Objective:The aim of this research was to evaluate the efficiency of reciprocating morcellation for removing giant benign prostatic hyperplasia during holmium laser enucleation of the prostate,investigate whether performing morcellation as a two-stage procedure improves tissue retrieval efficiency,and seek to determine the optimal interval between the two surgeries.Methods:This study included nine cases of holmium laser enucleation of the prostate with an enucleated prostate weight exceeding 200 g,indicative of substantial prostate enlargement.Morcellation was performed on Day 0(n=4),Day 4(n=1),Day 6(n=1),and Day 7(n=3).The intervals were compared regarding the morcellation efficiency,beach ball presence,and pathology.Results:The mean estimated prostate volume was 383(range 330e528)mL;the median enucleation weight was 252(interquartile range[IQR]222,342)g;and the median enucleation time was 83(IQR 62,100)min.The mean morcellation efficiency was 1.44(SD 0.55)g/min on Day 0 and 13.69(SD 2.46)g/min on day 7.The morcellation efficiency was 4.15 g/min and 10.50 g/min on Day 4 and Day 6,respectively,with significantly higher in the two-stage group compared to one-stage group(11.0 g/min vs.1.5 g/min;p=0.014).Efficiency was strongly correlated with intervals(p<0.001);the incidences of beach balls were 100%(4/4)and 60%(3/5)in the immediate and two-stage surgery groups,respectively.Conclusion:The efficiency of two-stage morcellation with reciprocating morcellators was highly related to the postoperative interval,with the maximum efficiency reached on Day 7.

Preoperative gastric retention in endoscopic retrograde cholangiopancreatography

We comment on the article by Jia et al,in the World Journal of Gastrointestinal Surgery.We focus mainly on the factors that impair gastric motility and cause gastric retention in the pre-operative setting of endoscopic retrograde cholan-giopancreatography(ERCP).ERCP is a complex endoscopic therapeutic proce-dure,which demands great skill from the endoscopist but also has recognized complications.Gastric retention impairs the endoscopist’s visibility but also increases the risk of complications,such as aspiration pneumonia.Therefore,identifying the factors that predispose to gastric retention alerts the endoscopists of the possible risks and enables them to take evasive action.The authors in the current study by Jia et al developed and validated a predictive model,which in-corporates five different factors,i.e.,gender,primary disease,jaundice,opioid use,and gastrointestinal obstruction,which were found to influence gastric retention.This model was shown to have a high predictive value to accurately identify pa-tients at risk for gastric retention before a therapeutic ERCP.

Prostaglandin E1 administration post liver transplantation and renal outcomes:A retrospective single center experience

BACKGROUND Prostaglandin E1(PGE1),or alprostadil,is a potent vasodilator that improves hepatic blood flow and reduces ischemia-reperfusion injury post-liver transplantation(LT).However,the benefits of PGE1 on renal function after LT have not yet been well described.AIM To assess the impact of PGE1 administration on renal function in patients who underwent liver or liver-kidney transplant.METHODS This retrospective study included all patients who underwent liver or liverkidney transplant at our institution from January,2011 to December,2021.Patients were classified based on whether they received PGE1.PGE1 was administered post-LT to those with transaminases>1000 U/L in the immediate postoperative period.Demographics,post-LT treatments and/or complications,renal function,and survival were analyzed.Multivariable logistic regression analysis was performed,and a two-tailed P value<0.05 was considered statistically significant.RESULTS A total of 145 patients underwent LT,with 44(30%)receiving PGE1.Baseline patient characteristics were comparable,except the PGE1 group had significantly higher aspartate aminotransferase(AST)(1961.9 U/L±1862.3 U/L vs 878 U/L±741.4 U/L,P=0.000),alanine aminotransferase(1070.6 U/L±895 U/L vs 547.7 U/L±410 U/L,P=0.000),international normalized ratio on post-LT day 1(2±0.74 vs 1.8±0.4,P=0.03),a longer intensive care unit stay(8.1 days±11.8 days vs 3.8 days±4.6 days,P=0.003),more vasopressor use(55.53 hours±111 hours vs 16.33 hours±26.3 hours,P=0.002),and higher immediate postoperative complications(18.6%vs 4.9%,P=0.04).The PGE1 group also had a significantly higher 90-day readmission rate(29.6%vs 13.1%,P=0.02)and lower 1-year liver graft survival(87.5%vs 98.9%,P=0.005).However,30-day readmission(31.6%vs 27.4%,P=0.64),LT complications(hepatic artery thrombosis,biliary complications,rejection of liver graft,cardiomyopathy),1-year patient survival(96.9%vs 97.8%,P=0.77),overall liver graft survival,and overall patient survival were similar between the two groups(95.4%vs 93.9%,P=0.74 and 88.4%vs 86.9%,P=0.81 respectively).Although the PGE1 group had a significantly lower glomerular filtration rate(eGFR)on post-LT day 7(46.3 mL/minute±26.7 mL/minute vs 62.5 mL/minute±34 mL/minute,P=0.009),the eventual need for renal replacement therapy(13.6%vs 5.9%,P=0.09),the number of dialysis sessions(0.91 vs 0.27,P=0.13),and eGFR at 1-month(37.2 mL/minute±35.9 mL/minute vs 42 mL/minute±36.9 mL/minute,P=0.49),6-months(54.8 mL/minute±21.6 mL/minute vs 62 mL/minute±21.4 mL/minute,P=0.09),and 12-months(63.7 mL/minute±20.7 mL/minute vs 62.8 mL/minute±20.3 mL/minute,P=0.85)post-LT were similar to those in the non-PGE1 group.CONCLUSION In patients who received PGE1 for ischemia-reperfusion injury,despite immediate acute renal injury post-LT,the renal function at 1-month,6-months,and 12-months post-LT was similar compared to those without ischemiareperfusion injury.Prospective clinical trials are needed to further elucidate the benefits of PGE1 use in renal function.

Isolated Third Nerve Cranial Palsy: Complication of Brain Aneurysm

This case report highlights a critical and emergent condition, isolated third nerve cranial palsy due to a brain aneurysm. It emphasizes the importance of differential diagnosis and attentiveness to the physical exam in an emergency setting. The detailed progression from initial symptoms and misinterpretation to final diagnosis offers valuable insight into the dangers of overlooking critical diagnoses. A bilobed intracranial aneurysm arising from the internal carotid artery (ICA) caused symptoms in this patient that could have been attributed to a less malignant etiology, such as a complex migraine. Overlooking the urgency of the situation and missing the diagnosis could have had a grave and irreversible outcome.

基于模块化的智能短程医疗废物处理车设计

为应对医院短程医疗废物处理中遇到的复杂挑战,设计一款安全、高效的智能短程医疗废物处理车。通过对医院内短程医废处理现状进行分析,归纳医废处理过程中的关键问题;基于模块化的设计理念,提出了模块化短程医废处理流程设计、模块单元设计、模块评价与调整思路,并开展智能短程医疗废物处理车设计实践。基于模块化理念的短程医疗废物处理车设计方案,不仅满足了智慧医院场景下的医废处理需求,还为医疗废物处理装备的研发和创新提供了新思路。

Disentangling the effects of management and climate change on habitat suitability for saproxylic species in boreal forests

Forest degradation induced by intensive forest management and temperature increase by climate change are resulting in biodiversity decline in boreal forests.Intensive forest management and high-end climate emission scenarios can further reduce the amount and diversity of deadwood,the limiting factor for habitats for saproxylic species in European boreal forests.The magnitude of their combined effects and how changes in forest management can affect deadwood diversity under a range of climate change scenarios are poorly understood.We used forest growth simulations to evaluate how forest management and climate change will individually and jointly affect habitats of red-listed saproxylic species in Finland.We simulated seven forest management regimes and three climate scenarios(reference,RCP4.5 and RCP8.5)over 100 years.Management regimes included set aside,continuous cover forestry,business-as-usual(BAU)and four modifications of BAU.Habitat suitability was assessed using a speciesspecific habitat suitability index,including 21 fungal and invertebrate species groups.“Winner”and“loser”species were identified based on the modelled impacts of forest management and climate change on their habitat suitability.We found that forest management had a major impact on habitat suitability of saproxylic species compared to climate change.Habitat suitability index varied by over 250%among management regimes,while overall change in habitat suitability index caused by climate change was on average only 2%.More species groups were identified as winners than losers from impacts of climate change(52%–95%were winners,depending on the climate change scenario and management regime).The largest increase in habitat suitability index was achieved under set aside(254%)and the climate scenario RCP8.5(>2%),while continuous cover forestry was the most suitable regime to increase habitat suitability of saproxylic species(up to+11%)across all climate change scenarios.Our results show that close-to-nature management regimes(e.g.,continuous cover forestry and set aside)can increase the habitat suitability of many saproxylic boreal species more than the basic business-as-usual regime.This suggests that biodiversity loss of many saproxylic species in boreal forests can be mitigated through improved forest management practices,even as climate change progresses.

Education Programs for Invasive Procedures Involving Nurses: A Scoping Review

Background: Implementing invasive procedures is an important part of patient management by clinical nurses;however, there are gaps between nurses’ actual knowledge and skills and expected professional care capacity. Purpose: This scoping review aimed to map the existing literature related to recent institution-provided educational programs for invasive procedures involving clinical nurses. This study seeks to understand the contents of educational programs and the methods for assessing educational effects. Methods: This scoping review was completed using the following four databases: PubMed (MEDLINE), Embase, Cochrane Library, and Emcare for the period 2000-2022. We included studies that used all forms of educational approaches (e.g., didactic lectures, hands-on training, or on-the-job training). This scoping review considered peer-reviewed publications published in English using quantitative, qualitative, or mixed approaches. A total of 83 studies underwent in the final analysis. Results and Conclusion: A combination of didactic lectures and hands-on training was provided as an educational program in most studies. Contrary to our prediction, educational interventions with advanced technologies such as VR are extremely rare, suggesting that the effectiveness of advanced technologies in learning invasive procedures should be examined to facilitate and retain educational effects more efficiently in future studies. Regarding the assessment of educational effects, nurses’ cognitive (i.e., theoretical knowledge about procedures), psychomotor (i.e., implementing procedures), and psychological aspects (e.g., confidence and self-efficacy in procedures) were evaluated using questionnaires and observational methods. While most studies used a one-group pretest-posttest design, the ratio of randomized controlled trials (RCT) was relatively low. Thus, an RCT design should be introduced in future studies to test the validity of the developed educational program more accurately.

交流电磁场检测技术现场应用的影响因素

对交流电磁场检测技术现场应用的部分影响因素进行了探究。利用仿真技术分析了电导率、磁导率、缺陷长度、缺陷深度、提离高度以及缺陷埋藏深度等因素对交流电磁场检测结果的影响规律,并进行公式拟合。通过试验验证了仿真结果及拟合公式的可靠性,为交流电磁场检测现场应用提供了一定参考。

基于本征图像分解的焊缝提取算法

基于被动式视觉传感器的焊缝提取算法受自然光照等条件的制约,发展较为缓慢。针对这一问题,提出了一种基于本征图像分解的焊缝提取算法。首先,通过预处理抑制原始焊缝图像中的噪声;其次,基于梯度稀疏先验,将预处理图像分解为前景图层和背景图层,其中,前景图层仅包含图像边缘等结构信息,背景图层中则包含光照等平滑信息;最后,对前景图层进行Gamma变换,增强焊缝区域特征,削弱光照条件对算法的影响。试验结果表明,该算法满足检测的准确度和实时性要求,达到了辅助爬壁机器人定位焊缝位置的目的。

BK viral infection: A review of management and treatment

BK viral infection remains to be a challenging post-transplant infection,which can result in kidney dysfunction.The mainstay approach to BK infection is reduction of immunosuppression.Alterations in immunosuppressive regimen with minimization of calcineurin inhibitors,use of mechanistic target of rapamycin inhibitors,and leflunomide have been attempted with variable outcomes.Over the past few years,investigators have explored potential therapeutic options for BK infection.Fluoroquinolone prophylaxis and treatment was found to have no benefit in kidney transplant recipients.The utility of cidofovir is limited by its nephrotoxicity.Intravenous immunoglobulin is becoming a popular option for treatment and prophylaxis for BK infection,as it increases the neutralizing antibody titers against the most common BK virus serotypes.Virus-specific T cell therapy is an emerging treatment option for BK viremia.In this review,we will explore management and therapeutic options for BK infection and recent evidence available in literature.

Hospitalizations for alcoholic liver disease during the COVID-19 pandemic increased more for women,especially young women,compared to men

BACKGROUND Alcoholic liver disease(ALD)remains one of the major indications for liver transplantation in the United States and continues to place a burden on the national healthcare system.There is evidence of increased alcohol consumption during the coronavirus disease 2019(COVID-19)pandemic,and the effect of this on the already burdened health systems remains unknown.AIM To assess the trends for ALD admissions during the COVID-19 pandemic,and compare it to a similar pre-pandemic period.METHODS This retrospective study analyzed all admissions at a tertiary health care system,which includes four regional hospitals.ALD admissions were identified by querying a multi-hospital health system’s electronic database using ICD-10 codes.ALD admissions were compared for two one-year periods;pre-COVID-19 from April 2019 to March 2020,and during-COVID-19 from April 2020 to March 2021.Data were analyzed using a Poisson regression model and admission rates were compared using the annual quarterly average for the two time periods,with stratification by age and gender.Percent increase or decrease in admissions from the Poisson regression model were reported as incident rate ratios.RESULTS One thousand three hundred and seventy-eight admissions for ALD were included.80.7%were Caucasian,and 34.3%were female.An increase in the number of admissions for ALD during the COVID-19 pandemic was detected.Among women,a sharp rise(33%)was noted in those below the age of 50 years,and an increase of 22%in those above 50 years.Among men,an increase of 24%was seen for those below 50 years,and a 24%decrease in those above 50 years.CONCLUSION The COVID-19 pandemic has had widespread implications,and an increase in ALD admissions is just one of them.However,given that women are often prone to rapid progression of ALD,this finding has important preventive health implications.

Locked Posterior Shoulder Dislocation with Impression Fracture Treated All Arthroscopically with the Use of an Allograft Bone Block: A Case Report

Background: Locked posterior shoulder dislocations are uncommon and possess many difficulties in diagnosis. They are often overlooked during the initial examination and delayed diagnosis adversely affects healing process. Apart from many open treatment options, there are reports of single attempts to treat such cases arthroscopically. Purpose: We present an original case of a posterior locked dislocation of the shoulder joint with a fracture of the lesser tuberosity followed by reverse Hill-Sachs fracture, treated in a novel fashion all-arthroscopically with the use of allogenic bone graft. Method: According to Constant Shoulder Score that tries to assess functional and subjective performance of the shoulder joint before the operation and after 12 months, we achieved a leap from 11 to 84. Results: The patient restored almost full range of motion and painless movement in activities of daily life as well as during sports. Conclusion: The use of an arthroscope reduces the invasiveness of the procedure, improves visualization of the joint and allows augmentation of the bone loss without performing an open approach. We believe that this is a promising method of treatment for selected cases of locked posterior shoulder dislocation.

Extensive Spinal Epidural Abscess: Cord Compression with Permanent Neurological Defects

Spinal epidural abscesses (SEA) are considerably rare and tend to present over two to five vertebral segments. Occasionally, there will be two or more noncontiguous areas of pyogenic collections [1]. Minimal cases have been reported to span the entire vertebral column;a meta-analysis estimates that 1% of all SEA are holospinal [2]. The triad of presenting symptoms includes fever, back pain (often midline), and neurologic defects [1] [2] [3]. Early detection is identified as a critical aspect of improved outcomes. Cases that do not present in this manner or with other masking symptoms can lead to delayed diagnosis, thus delaying treatment. In the event of cord compression, the occurrence of neurologic defects increases. Time from the onset of clinical manifestations to the operating room is crucial in reversing symptoms [2]. This article seeks to review a case of a 65-year-old male that presented to the emergency department (ED) due to a falling second to weakness and thigh pain. On presentation, he was also noted to have rhabdomyolysis causing acute kidney injury (AKI) with tubular necrosis. The patient was admitted to the hospital with a complex history of progressive leg weakness, pain in the lower back, incontinence, and elevated white blood cell count. Days into the admission, a magnetic resonance imaging (MRI) study was performed, which revealed a continuous posterior SEA from C4 to S2 with anterior mass effect causing spinal cord compression. Emergency neurosurgery was scheduled for laminectomies in the cervical, thoracic and lumbar spine to drain the abscess. Evaluation of this complex medical course, surgical approach to drainage of an incessant spinal column abscess, and sustained neurologic defects will be discussed.

A New Technique to Remove Accurately Osteoid Osteomas Using Gamma Probe

Study design: Description of a technique through a case-series. Objective: To promote a technique by using a gamma probe that asses intraoperatively the adequacy of the lesion curettage through a minimal invasive procedure. Methods: Reviewing the technique steps through 4 cases of osteoid osteoma surgical removal. Results: Four patients diagnosed with osteoid osteoma and moved to surgical removal. During the operation, excision of the tumour was assessed by a gamma probe, avoiding leaving residual lesion in the field. Operating time was not prolonged, so as the cost of the operation was not increased. Conclusions: Surgical excision of osteoid osteoma in spine region is still the gold standard method. Avoiding recurrence of the lesion is important. The use of gamma probe is an effective and economic solution.

磁轭夹角可变的旋转磁场探伤仪

将旋转磁场探伤仪的底部关节活动距离转换为磁轭夹角变化,设计了一种磁轭夹角可变的旋转磁场探伤仪并进行验证试验。首先通过理论计算获得旋转磁场的磁场分布及其变化规律,并通过仿真确定磁场变化轨迹以及磁场强度变化程度,以确认理论计算是否正确。然后制作灵敏度试块,测试仪器提升力、有效磁化范围以及缺陷检出灵敏度,确定调节电流相位方法的有效性。试验结果表明,该方法对长度不小于9 mm的自然缺陷可以做到100%检出。

Outcomes of gout in patients with cirrhosis:A national inpatient sample-based study

BACKGROUND Hyperuricemia is a prerequisite for the development of gout.Elevated serum uric acid(UA)levels result from either overproduction or decreased excretion.A positive correlation between serum UA levels,cirrhosis-related complications and the incidence of nonalcoholic fatty liver disease has been established,but it is unknown whether hyperuricemia results in worsening cirrhosis outcomes.We hypothesize that patients with cirrhosis will have poorer gout outcomes.AIM To explore the link between cirrhosis and the incidence of gout-related complications.METHODS This was a cross-sectional study.The national inpatient sample was used to identify patients hospitalized with gout,stratified based on a history of cirrhosis,from 2001 to 2013 via the International Classification of Diseases,Ninth Revision,Clinical Modification codes.Primary outcomes were mortality,gout complications and joint interventions.Theχ^(2)test and independent t-test were performed to assess categorical and continuous data,respectively.Multiple logistic regression was used to control for confounding variables.RESULTS Patients without cirrhosis were older(70.37±13.53 years vs 66.21±12.325 years;P<0.05).Most patients were male(74.63%in the cirrhosis group vs 66.83%;adjusted P<0.05).Patients with cirrhosis had greater rates of mortality(5.49%vs 2.03%;adjusted P<0.05),gout flare(2.89%vs 2.77%;adjusted P<0.05)and tophi(0.97%vs 0.75%;adjusted P=0.677).Patients without cirrhosis had higher rates of arthrocentesis(2.45%vs 2.21%;adjusted P<0.05)and joint injections(0.72%vs 0.52%;adjusted P<0.05).CONCLUSION Gout complications were more common in cirrhosis.Those without cirrhosis had higher rates of interventions,possibly due to hesitancy with performing these interventions given the higher complication risk in cirrhosis.

Factor Structure and Measurement Invariance of the Japanese Version of the Mother-to-Infant Bonding Scale

Background: Bonding disorders affect the growth and development of infants. In Japan, the Japanese version of the Mother-to-Infant Bonding Scale (MIBS-J) is widely used for early detection of bonding disorders. Repeated use of a questionnaire has problems of reduced validity. In order to correctly detect bonding disorders at multiple time points, it is necessary to confirm the measurement invariance of the scale. Baba et al. reported that invariance of the MIBS-J factor structure could only be obtained by abridging the scale into three items. Purpose: The aim of this study was to 1) confirm the factor structure and measurement invariance of the MIBS-J between two measurement times and 2) to examine factors that can be used without being affected by measurement time in order to identify item that contribute to measure met invariance. Methods: We analysed the data of 1049 and 878 mothers with a neonate collected in two waves: 5 days (Wave 1) and 1 month postpartum (Wave 2). Exploratory and confirmatory factor analyses were conducted on the data randomly divided into two groups in each wave. Results: The three-item model (MIBS-J items 1, 6, and 8) was most accepted. Measurement invariance and structural invariance were confirmed in the model. This was consistent with Baba et al.’s model. Conclusion: The three MIBS-J items showed measurement invariance and structural invariance in Japanese mothers during 1 month postpartum.

东太湖全新世水下河道沉积特征及环境演变

在详细研究东太湖Ｅ２孔全新世沉积基础上，总结和归纳了水下河道的沉积特征和相组合规律。识别出高湖面型和低湖面型两种沉积层序。划分了东太湖晚更新世末以来环境演变阶段：１）１５８８５—６５７５ａＢ．Ｐ．冲积黄土基础上发育而成的古河道；２）６５７５—５８００ａＢ．Ｐ．高湖面时期水下河道沉积环境；３）５８００ａＢ．Ｐ．后，演化为低湖面型水下河道，并逐渐淤积形成开敞湖缘环境。结合西太湖Ｗ１孔沉积特征和层位对比分析，进而讨论了环境演变的阶段性与中国东部全新世海面升降变化的关系。

太湖16000年来沉积环境的演变

通过对太湖钻孔岩芯岩性、结构、构造的剖析及粒度、磁化率的测试，发现冰后期东太湖形成于距今６５００年前。在距今６５００—５８００年，为一水深约２—３ｍ的、经常受到流水作用影响的浅水湖泊。距今约５８００—５７００年，东太湖曾一度干枯或接近于干枯。距今５７００年以来湖泊变浅，平均水深只有１ｍ左右。由于湖泊变浅，湖底经常遭受波浪的扰动，形成波状层理或透镜状层理。西太湖局部洼地集水成湖的时间比东太湖早，并且水深比东太湖大。在５０００ａＢ．Ｐ，东、西太湖并未连通。东、西太湖的连通及太湖统一水体的形成开始于４０００—３５００ａＢ．Ｐ．。东太湖的成湖及东、西太湖的连通，湖面的扩大与水深的变浅，与冰期后海面上升引起的河谷与洼地沉积充填、淤塞有关。