Enhancement of biogas production from individually or co-digested green algae Cheatomorpha linum using ultrasound and ozonation treated biochar

This paper proposes the use of modified biochar, derived from Sawdust (SD) biomass using sonication (SSDB) and Ozonation (OSDB) processes, as an additive for biogas production from green algae Cheatomorpha linum (C. linum) either individually or co-digested with natural diet for rotifer culture (S. parkel). Brunauer-Emmett-Teller (BET), Fourier-Transform Infrared (FTIR), thermal-gravimetric (TGA), and X-ray diffraction (XRD) analyses were used to characterize the generated biochar. Ultrasound (US) specific energy, dose, intensity and dissolved ozone (O3) concentration were also calculated. FTIR analyses proved the capability of US and ozonation treatment of biochar to enhance the biogas production process. The kinetic model proposed fits successfully with the data of the experimental work and the modified Gompertz models that had the maximum R2 value of 0.993 for 150 mg/L of OSDB. The results of this work confirmed the significant impact of US and ozonation processes on the use of biochar as an additive in biogas production. The highest biogas outputs 1059 mL/g VS and 1054 mL/g VS) were achieved when 50 mg of SSDB and 150 mg of OSDB were added to C. linum co-digested with S. parkle

Impact of age on outcome after colorectal cancer surgery in the elderly - a developing country perspective

<p>Abstract</p> <p>Background</p> <p>Colorectal cancer (CRC) is a major source of morbidity and mortality in the elderly population and surgery is often the only definitive management option. The suitability of surgical candidates based on age alone has traditionally been a source of controversy. Surgical resection may be considered detrimental in the elderly solely on the basis of advanced age. Based on recent evidence suggesting that age alone is not a predictor of outcomes, Western societies are increasingly performing definitive procedures on the elderly. Such evidence is not available from our region. We aimed to determine whether age has an independent effect on complications after surgery for colorectal cancer in our population.</p> <p>Methods</p> <p>A retrospective review of all patients who underwent surgery for pathologically confirmed colorectal cancer at Aga Khan University Hospital, Karachi between January 1999 and December 2008 was conducted. Using a cut-off of 70 years, patients were divided into two groups. Patient demographics, tumor characteristics and postoperative complications and 30-day mortality were compared. Multivariate logistic regression analysis was performed with clinically relevant variables to determine whether age had an independent and significant association with the outcome.</p> <p>Results</p> <p>A total of 271 files were reviewed, of which 56 belonged to elderly patients (≥ 70 years). The gender ratio was equal in both groups. Elderly patients had a significantly higher comorbidity status, Charlson score and American society of anesthesiologists (ASA) class (all p < 0.001). Upon multivariate analysis, factors associated with more complications were ASA status (95% CI = 1.30-6.25), preoperative perforation (95% CI = 1.94-48.0) and rectal tumors (95% CI = 1.21-5.34). Old age was significantly associated with systemic complications upon univariate analysis (p = 0.05), however, this association vanished upon multivariate analysis (p = 0.36).</p> <p>Conclusion</p> <p>Older patients have more co-morbid conditions and higher ASA scores, but increasing age itself is not independently associated with complications after surgery for CRC. Therefore patient selection should focus on the clinical status and ASA class of the patient rather than age.</p

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Synthesis, characterization, and synergistic effects of modified biochar in combination with alpha-Fe2O3 NPs on biogas production from red algae pterocladia capillacea

This study is the first work that evaluated the effectiveness of unmodified (SD) and modified biochar with ammonium hydroxide (SD-NH2) derived from sawdust waste biomass as an additive for biogas production from red algae Pterocladia capillacea either individually or in combination with hematite α-Fe2O3 NPs. Brunauer, Emmett, and Teller, Fourier transform infrared, thermal gravimetric analysis, X-ray diffraction, transmission electron microscopy, Raman, and a particle size analyzer were used to characterize the generated biochars and the synthesized α-Fe2O3. Fourier transform infrared (FTIR) measurements confirmed the formation of amino groups on the modified biochar surface. The kinetic research demonstrated that both the modified Gompertz and logistic function models fit the experimental data satisfactorily except for 150 SD-NH2 alone or in combination with α-Fe2O3 at a concentration of 10 mg/L. The data suggested that adding unmodified biochar at doses of 50 and 100 mg significantly increased biogas yield compared to untreated algae. The maximum biogas generation (219 mL/g VS) was obtained when 100 mg of unmodified biochar was mixed with 10 mg of α-Fe2O3 in the inoculum