Endoscopic sleeve gastroplasty (ESG) for the therapy of morbidly obese patients with clinical challenging situations

Morbidly obese patients with clinical challenging situations like with serious even fatal preoperative comorbidities or with super-obesity, which had emerged as the clinical tough problem for the existing obesity surgeries and had already led to unsatisfactory bariatric outcomes after the conventional obesity surgery. Recently, novel bariatric therapies based on the endoscopic techniques were emerging and considered as potential alternative and useable treatments for the above-mentioned clinical situations. Especially for the endoscopic sleeve gastroplasty (ESG) procedure, which had been successfully performed for patients with morbid obesity and achieved satisfactory bariatric outcomes and favorable safety profile. Hence the clinical application of ESG procedure might potentially provide mighty boosts for the final solution of the above-mentioned challenging conditions. The purpose of our study was to assess the safety profile and potential efficacy of ESG for the treatment of morbidly obese patients with clinical challenging situations. Demographic and clinical data of patients were prospectively recorded, the follow-up data was acquired through the periodical returning visit in outpatient or the telephone interview. The main outcome measures were the success rate of ESG, post-procedure morbidity and ESG-related mortality, and the alteration of BMI and weight. The secondary outcome was remission of obesity associated comorbid diseases. All ESG procedures were performed based on the Apollo OverStitch device (Apollo Endosurgery, Austin, Texas, USA). All eligible twenty-four cases were classified as high-risk cases. The ESG procedure had been performed for all included cases successfully, without any adverse event (AE) during the ESG procedure. Only 1 intermediate post-ESG AE (hemorrhage of the stomach) was reported, while procedure-related mortality had not been observed. On average, percent of total body weight loss (%TBWL) and percent of excess weight loss (%EWL) were 11.3% (± 4.7%) and 25.0% (± 9.1%), and 12.2% (± 8.9%) and 29.1% (± 17.9%) at 6-month and 1-year after ESG, respectively. The obesity associated comorbidities like gastroesophageal reflux, dyslipidemia, type 2 diabetes, and arterial hypertension were improved after the ESG procedure. The ESG procedure can be considered as a novel bariatric therapy for high-risk obese patients with the favorable safety profile and satisfactory bariatric outcomes. The clinical applications of the ESG could potentially be expanded based on this study.Morbid fettleibige Patienten mit klinisch schwierigen Situationen wie schweren, sogar tödlichen präoperativen Komorbiditäten oder mit Superfettleibigkeit, die sich als klinisches Problem für die bestehenden Adipositaschirurgieverfahren erwiesen und bereits zu unbefriedigenden bariatrischen Ergebnissen nach der herkömmlichen Adipositaschirurgie geführt hatten. In jüngster Zeit wurden neuartige bariatrische Therapien, die auf endoskopischen Techniken basieren, entwickelt und als potenzielle alternative und brauchbare Behandlungen für die oben genannten klinischen Situationen angesehen. Dies gilt insbesondere für die endoskopische Sleeve-Gastroplastie (ESG), die bei Patienten mit morbider Adipositas erfolgreich durchgeführt wurde und zufriedenstellende bariatrische Ergebnisse und ein günstiges Sicherheitsprofil aufweist. Daher könnte die klinische Anwendung des ESG-Verfahrens der endgültigen Lösung der oben genannten schwierigen Bedingungen möglicherweise einen großen Schub verleihen. Ziel unserer Studie war es, das Sicherheitsprofil und die potenzielle Wirksamkeit von ESG bei der Behandlung von krankhaft fettleibigen Patienten mit schwierigen klinischen Situationen zu bewerten. Die demografischen und klinischen Daten der Patienten wurden prospektiv erfasst, die Follow-up-Daten wurden durch regelmäßige ambulante Nachuntersuchungen oder telefonische Befragungen erhoben. Die Hauptergebnisse waren die Erfolgsrate der ESG, die Morbidität nach dem Eingriff und die ESG-bedingte Mortalität sowie die Veränderung von BMI und Gewicht. Das sekundäre Ergebnis war die Remission von mit Adipositas verbundenen Begleiterkrankungen. Alle ESG-Verfahren wurden mit dem Apollo OverStitch-Gerät (Apollo Endosurgery, Austin, Texas, USA) durchgeführt. Alle in Frage kommenden vierundzwanzig Fälle wurden als Hochrisikofälle eingestuft. Das ESG-Verfahren wurde bei allen eingeschlossenen Fällen erfolgreich durchgeführt, ohne dass es während des ESG-Verfahrens zu unerwünschten Ereignissen kam. Es wurde nur ein Zwischenereignis nach dem ESG-Verfahren (Magenblutung) gemeldet, während eine verfahrensbedingte Sterblichkeit nicht beobachtet worden war. Im Durchschnitt betrugen der prozentuale Gesamtgewichtsverlust (%TBWL) und der prozentuale Übergewichtsverlust (%EWL) 11,3 % (± 4,7 %) und 25,0 % (± 9,1 %) bzw. 12,2 % (± 8,9 %) und 29,1 % (± 17,9 %) 6 Monate und 1 Jahr nach der ESG. Die mit Adipositas verbundenen Begleiterkrankungen wie gastroösophagealer Reflux, Dyslipidämie, Typ-2-Diabetes und arterielle Hypertonie wurden nach dem ESG-Verfahren verbessert. Das ESG-Verfahren kann als neuartige bariatrische Therapie für fettleibige Hochrisikopatienten betrachtet werden, da es ein günstiges Sicherheitsprofil und zufriedenstellende bariatrische Ergebnisse aufweist. Die klinischen Anwendungen der ESG könnten auf der Grundlage dieser Studie möglicherweise erweitert werden

Recent progress towards in-situ biogas upgrading technologies

Biogas is mainly produced from the anaerobic fermentation of biomass, containing methane with an extensive range between about 50% and 70%. Higher methane content biogas has higher energy and heat value, which needs biogas upgrading. There are mainly two types of biogas upgrading technologies (ex-situ and in-situ). This manuscript presents a review of technologies on in-situ biogas upgrading. These technologies comprise H2 addition technology (e.g., continuous stirring tank reactor (CSTR), hollow fiber membrane (HFM), nano-bubble (NB) technology, upflow anaerobic sludge blanket (UASB)), high-pressure anaerobic digestion (HPAD), bioelectrochemical system (BES), and additives (e.g., ash, biochar, and iron powder). The results confirm the excellence of H2-addition technology, with the highest average CH4 content obtained (HFM: 92.5%) and one of the few full-scale cases reported (Danish GasMix ejector system: 1110 m3). Meanwhile, newly pop-up technology such as HPAD delivers appropriate CH4 content (an average of 87%) and is close to the full-scale application (https://bareau.nl/en/for-professionals/). More importantly, the combo between HPAD and H2-addition technology is prominent as the former improves the low gas-to-liquid obstacle confronted by the latter. Additionally, recently emerging BES can't stand out yet because of limited efficiency on CH4 content or constraint full-scale application behaviors (disability to operate at high current density). However, its combination with H2-addition technology to form the Power to Gas (PtG) concept is promising, and its commercial application is available (http://www.electrochaea.com/). Hydrogenotrophic methanogens are imperative players in all reviewed technologies for the generation of upgraded CH4

Review on Chromobacterium Violaceum for Gold Bioleaching from E-waste

AbstractElectronic waste, such as printed circuit boards, are an important secondary resource if processed with environment-friendly technologies for obtaining precious metal, such as gold. The gold bioleaching from electronic waste was recently getting paid attractive attention because its available deposit is limited. This review was focused on Chromobacterium violaceum (C. Violaceum), which was a mesophilic, gram-negative, and facultative anaerobe. C. violaceum has the ability of producing CN− which can dissolve gold from the metallic particles of crushed waste printed circuit boards. This article also provided an overview of cyanide-generation mechanism and the optimal conditions for C. violaceum to achieve maximum amount of cyanide generation. The past achievements and recently scenario of recovery studies carried out on the use of some other microorganisms were compared with C. violaceum. And recently some researchers proposed that combined C. violaceum with chemical methods or other mechanism such as iodide, Pseudomonas aeruginosa and Pseudomonas fluorescens which can reinforce the cyanide generation and improve gold-leaching efficiency. The factors affected the microorganisms on cyanide generation were summarized and the proper conditions were also discussed in this article. And present researches of C. violaceum in gold bioleaching had made good progress which the reported leaching efficiency of gold was over 70%

Driver-automation indirect shared control of highly automated vehicles with intention-aware authority transition

Shared control is an important approach to avoid the driver-out-of-the-loop problems brought by imperfect autonomous driving. Steer-by-wire technology allows the mechanical decoupling between the steering wheel and the road wheels. On steer-by-wire vehicles, the automation can join the control loop by correcting the driver steering input, which forms a new paradigm of shared control. The new framework, under which the driver indirectly controls the vehicle through the automation’s input transformation, is called indirect shared control. This paper presents an indirect shared control system, which realizes the dynamic control authority allocation with respect to the driver’s authority intention. The simulation results demonstrate the effectiveness and benefits of the proposed control authority adaptation method