Optimization of a fed-batch fermentation process for production of bleomycin by Streptomyces mobaraensis ATCC 15003

The objective of this work was to optimize inoculum size and pH for rapid production of bleomycin by Streptomyces mobaraensis ATCC 15003 by fed-batch fermentation. In both batch- and fed-batch fermentations, neither production period for bleomycin by S. mobaraensis nor the amount of BLM were affected by increasing the inoculum size from regular 10 to 30% (v/v) level. A fed-batch bioreactor not only shortened the lag phase of BLM production from 114 to 60 h, but also fed-batch fermentationenhanced BLM production when combined with an appropriate pH profile with no effect on the amount produced. Due to the substrate inhibition that takes place at high levels of carbon source, fed-batch fermentation was proposed as a better alternative for BLM production. The combined effects of batch and fed-batch fermentation and various pH profiles on BLM production in a bioreactor were evaluated. The tested pH profiles included; (1) a constant pH profile at 6.8 (profile1); (2) a constant pH profile witha period of auto-acidification for 72 h (profile2) and (3) a step-wise pH profile with pH adjustment every 24 h (profile3). When profile 3 was applied, fed-batch fermentation enhanced BLM production in the bioreactor and yielded about two-fold higher BLM concentration than the irrespective batch fermentation. On the other hand, constant pH profile or that which included one period of autoacidification (profiles 1 and 2) resulted in an insignificantly difference BLM production in fed-batch fermentation. Overall, this study suggested that fed-batch fermentation can be successfully used to enhance BLM production in bioreactor especially with fluctuated pH-profile.Key words: Bleomycin, Streptomyces mobaraensis, rapid production, fed-batch fermentation

Genotypic Characterization of Fungal Species Isolated From Broiler Breeder Chickens, Dead-In-Shell and Hatched Chicks

To investigate the prevalence of fungal agents in local Egyptian broiler breeder chicken’s premises, tracheal and cloacal swabs from chickens, feed, and water samples were collected. The targeted breed's dead-in-shell eggs and newly hatched chick’s samples were also tested. All fungal isolates were morphologically typed and the predominant fungal species were further subjected to molecular typing using PCR-RFLP and gene sequence analysis of the β-tubulin gene. Results revealed a high prevalence of fungal isolates in tracheal and cloacal swabs (39.3 - 48.1%) and feed and water samples (37.5% and 28.6%, respectively). Fungal isolation rates in dead-in-shell eggs of all breeds were high except in Dahaby breed. Aspergillus species including A. niger, A. flavus, and A. terreus were the predominantly isolated fungi from all collected samples. The ß-Tubulin genes PCR-RFLP of selected Aspergillus isolates showed a characteristic restriction pattern for each species; however, the method was unable to distinguish between strains. The β-tubulin gene phylogenetic and sequence analysis of selected A. flavus, and A. terreus from breeder chickens and their hatching chicks indicated their relatedness to isolates from bronchopulmonary Aspergillosis in humans in the Middle East. In conclusion, the Aspergillus species remains the most prevalent fungi in breeder chickens, their incubated eggs and hatched chicks indicating their widespread in hatcheries. The PCR-RFLP is an easy tool to discriminate between Aspergilli species, however, the β-tubulin sequence analysis more descriptive of potential sources of fungal contamination. Further epidemiological studies are needed to monitor avian and human Aspergilli in poultry houses with a special focus on antifungal drug-resistant strains

A Bio-Inspired Heuristic Algorithm for Solving Optimal Power Flow Problem in Hybrid Power System

In recent studies, emphasis has been placed on optimal power flow (OPF) problems in traditional thermal, wind, and solar energy sources-based hybrid power systems. Various metaheuristic algorithms have been proposed to find optimal solutions to the OPF problems in the hybrid power system. The OPF, due to the quadratic nature of its primary objective function, is a nonlinear, nonconvex, and quadratic optimization problem. In this study, we have proposed a bio-inspired bird swarm algorithm (BSA) to find an optimal solution to the OPF problem in the hybrid power system because it performs well in the case of optimizing the well-known Rastrigin quadratic benchmark function. In this study, uncertainty of utility load demand and stochastic electricity output from renewable energy resources (RESs) including wind and solar are incorporated into the hybrid power system for achieving accuracy in operations and planning of the system. We have used a modified IEEE-30 bus test system to verify and measure the performance of BSA and a comparison is made with well-known evolutionary metaheuristic algorithms. The proposed BSA consistently achieves more accurate and stable results than other metaheuristic algorithms. Simulation-based optimization results have shown the superiority of BSA approach to solve the OPF problems by satisfying all constraints and minimum power generation cost 863.121 $\$$ /h is achieved in case study 1. Simulation-based experiment results have indicated that by imposing the carbon tax ( $ton/h$ ) the power generation from RESs was increased. In case study 2, the proposed BSA approach has also outperformed and minimum electricity cost 890.728 $\$$ /h is achieved as compared to other algorithms

A Cost-Effective Optimization for Scheduling of Household Appliances and Energy Resources

In literature, proposed approaches mostly focused on household appliances scheduling for reducing consumers' electricity bills, peak-to-average ratio, electricity usage in peak load hours, and enhancing user comfort level. The scheduling of smart home deployed energy resources recently became a critical issue on demand side due to a higher share of renewable energy sources. In this paper, a new hybrid genetic-based harmony search (HGHS) approach has been proposed for modeling the home energy management system, which contributes to minimizing consumers' electricity bills and electricity usage during peak load hours by scheduling both household appliances and smart home deployed energy resources. We have comparatively evaluated the optimization results obtained from the proposed HGHS and other approaches. The experimental results confirmed the superiority of HGHS over genetic algorithm (GA) and harmony search algorithm (HSA). The proposed HGHS scheduling approach outperformed more efficiently than HSA and GA. The electricity usage cost for completing one-day operation of household appliances was limited to 1305.7 cents, 953.65 cents, and 569.44 cents in the proposed scheduling approach for case I, case II, and case III, respectively and was observed as lower than other approaches. The electricity consumption cost was reduced upto 23.125%, 43.87% and 66.44% in case I, case II, and case III, respectively using proposed scheduling approach as compared to an unscheduled load scenario. Moreover, the electrical peak load was limited to 3.07 kW, 2.9478 kW, and 1.9 kW during the proposed HGHS scheduling approach and was reported as lower than other approaches

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified