The complexities of decision-making in food waste valorization: A critical review.

The efficient utilization of food waste (FW) resources through Food Waste Valorization (FWV) has received increasing attention in recent years. Various decision-making studies have been undertaken to facilitate FWV implementation, such as the studies on decision-making framework and FWV technology assessment. Food waste hierarchy is a widely discussed framework in FW management, but it was found too simplified and does not always contribute positively to environmental sustainability. Moreover, decision-making studies in FWV often focus on specific aspects of the food system and employ distinctive decision-making approaches, making it difficult to compare the results from different studies. Therefore, our literature review is conducted to provide a comprehensive understanding of FWV decision-making. This study identifies what decisions are needed, and three levels of decisions are revealed: system-level, FW stream-level, and FWV option-level. The assessment approaches and criteria used to support decision-making in FWV are also collected and analyzed. Building upon these findings, an hourglass model is synthesized to provide a holistic illustration of decision-making in FWV. This study untangles the complexities of FWV decision-making and sheds light on the limitations of current studies. We anticipate this study will make more people realize that FWV is a multidisciplinary issue and requires the collective participation of researchers, practitioners, policymakers, and consumers. Such collective engagement is essential to effectively address practical challenges and propel the transition of the current food system toward a more resource-efficient paradigm.

Integrated life cycle assessment of biotreatment and agricultural use of domestic organic residues: Environmental benefits, trade-offs, and impacts on soil application.

Extensive agricultural activities have been shown to degrade soils, promoting research into improving soil quality. One such method is to increase the amount of organic matter in the soil, and domestic organic residues (DOR) are commonly used for this purpose. The environmental impact of DOR-derived products, from production to agricultural application, remains unclear in current research. With the aim to have a more comprehensive understanding of the challenges and opportunities in DOR management and reuse, this study extended the boundaries of Life Cycle Assessment (LCA) to include the transport, treatment, and application of treated DOR on a national level while also quantifying soil carbon sequestration that has been less addressed in relevant LCA studies. This study focuses on The Netherlands, where incineration predominates, as a representative case to explore the benefits and trade-offs of moving towards more biotreatment for DOR. Two main biotreatments were considered, composting and anaerobic digestion. The results indicate that biotreatment of kitchen and yard residues generally has higher environmental impacts than incineration, including increased global warming and fine particulate matter formation. However, biotreatment of sewage sludge has lower environmental impacts than incineration. Substitution of nitrogen and phosphorus fertilisers with compost reduces mineral and fossil resource scarcity. In fossil-based energy systems like The Netherlands, replacing incineration with anaerobic digestion yields the highest benefit for fossil resource scarcity (61.93 %) due to energy recovery from biogas and the predominant use of fossil resources in the Dutch energy system. These findings indicate that replacing incineration with biotreatment of DOR may not benefit all impact categories in LCA. The environmental performance of substituted products can significantly influence the environmental benefits of increased biotreatment. Future studies or implementation of increased biotreatment should consider trade-offs and local context.

Potential reuse of domestic organic residues as soil organic amendment in the current waste management system in Australia, China, and The Netherlands.

Soil organic carbon (SOC) is essential for most soil functions. Changes in land use from natural land to cropland disrupt long-established SOC balances and reduce SOC levels. The intensive use of chemical fertilisers in modern agriculture accelerates the rate of SOC depletion. Domestic organic residues (DOR) are a valuable source of SOC replenishment with high carbon content. However, there is still a lack of knowledge and data regarding whether and to what extent DOR can contribute to replenishing SOC. This paper aims to unpack the potential of DOR as a SOC source. Total SOC demand and annual SOC loss are defined and calculated. The carbon flow within different DOR management systems is investigated in three countries (China, Australia, and The Netherlands). The results show that the total SOC demand is too large to be fulfilled by DOR in a short time. However, DOR still has a high potential as a source of SOC as it can mitigate the annual SOC loss by up to 100%. Achieving this 100% mitigation requires a shift to more circular management of DOR, in particular, more composting, and direct land application instead of landfilling and incineration (Australia and China), or a higher rate of source separation of DOR (The Netherlands). These findings form the basis for future research on DOR recycling as a SOC source.

Use of ion chromatographic pulsed amperometric method (IC-PAD) for measuring aqueous sulfide in synthetic and real domestic wastewater.

Sulfide detection in domestic wastewater is widely demanded, as sulfide induces odour nuisance and wastewater assets corrosion. However, traditional sulfide detection methods are usually plagued by the limited detection range or interference from impurities. To address these constraints, this study improved the ion chromatographic pulsed amperometric method (IC-PAD) and tested its validity for use in domestic wastewater. Prior to sulfide detection, sulfide-containing sample collection usually requires the use of sulfide antioxidant buffers (SAOB) to minimize sulfide loss. Different sample matrixes require different SAOB recipes, which increases complexity and uncertainty when measuring different environmental samples. Therefore, this study also developed a more convenient and generic sample collection method without the addition of SAOB. The results indicated that the proposed SAOB-free sample collection method could minimize the sulfide loss during sample collection. The IC-PAD method showed a wide linear detection range up to 10 mg-S/L. The detection limit was 3 µg-S/L. Matrix effect studies showed that 1 g/L glucose, formate, acetate, methanol, ethanol, propionate, butyrate, lactate, or sulfate had no evident interference on sulfide measurement. However, 5 mM phosphate buffer led to interference, but reducing the KOH eluent concentration from 62 to 30 mM avoid this interference. Wolfe's vitamin mixture and Wolfe's modified mineral mixture could cause diminutive interference equivalent to 2.53 ± 1.32 µg-S/L sulfide. Moreover, the interference caused by chloride indicated that the IC-PAD method is more applicable for measuring sulfide in low-chloride wastewater. To this end, the IC-PAD method showed high accuracy and precision in the real domestic wastewater samples with chloride concentration of 68 mg/L. The recovery was higher than 97% and the relative standard deviation (RSD) was lower than 1.2%. This study demonstrated the potential use of IC-PAD method for measuring sulfide in real domestic wastewater and possible interference from the solution matrix to be considered.

A comparative study of PSPVP and PSIBG in the treatment of stage II-III Kummell's disease.

BACKGROUND: Percutaneous kyphoplasty (PKP) or percutaneous vertebroplasty (PVP) are commonly employed for Kummell's disease in stages II-III; however, these techniques produce some complications. OBJECTIVE: To compare the clinical efficacy and imaging results of percutaneous vertebroplasty + bone cement-augmented short-segment pedicle screw fixation (PSPVP) versus transpedicular intracorporeal bone grafting + pedicle screw fixation (PSIBG) in the treatment of stage II-III Kummell's disease. METHODS: A total of 69 patients admitted between November 2017 and March 2021 were included in this study; 36 of these were treated with PSPVP, and 33 were treated with PSIBG. Patients in the two groups were compared in terms of perioperative, follow-up, and imaging data. RESULTS: No statistically significant differences were found between the two groups in terms of operation duration (P > 0.05). However, the PSPVP group was superior to the PSIBG group in terms of incision length, intraoperative blood loss, and length of stay (P < 0.05). All patients were followed up for more than 12 months. The VAS score, height of anterior vertebral margin, kyphosis Cobb angle, wedge angle of the affected vertebra at seven days after surgery and last follow-up, and the ODI index at the last follow-up of the two groups were significantly improved compared with figures before surgery (P < 0.05). Compared with values before surgery, no statistically significant differences were found in the height of the posterior vertebral margin in the PSPVP group at seven days after surgery and at the last follow-up (P > 0.05). There were also no statistically significant differences in the VAS score, ODI index, kyphosis Cobb angle, and wedge angle of the affected vertebra between the two groups at corresponding time points (P > 0.05). The heights of the anterior and posterior vertebral margins in the PSIBG group were better than those in the PSPVP group after surgery and at the last follow-up (P < 0.05). In the PSPVP group, a pedicle screw fracture occurred in one patient two months after surgery, while an upper adjacent vertebral fracture occurred in one patient eight months after surgery. CONCLUSION: Both PSPVP and PSIBG can achieve good early clinical efficacy in the treatment of stage II-III Kummell's disease, with PSPVP being relatively less invasive while producing a poorer orthopedic effect and more complications than PSIBG.

Health Risk Assessment of Inhalation Exposure to Airborne Particle-Bound Nitrated Polycyclic Aromatic Hydrocarbons in Urban and Suburban Areas of South China.

Airborne particulates (PM2.5 and TSP) were collected from outdoor and indoor areas at urban (Haizhu District) and suburban (Huadu District) sites from 2019 to 2020 in Guangzhou. Three nitro-polycyclic aromatic hydrocarbons (nitro-PAHs) in the airborne particulates were identified by a gas chromatograph equipped with a triple-quadrupole mass spectrometer. In the Haizhu District and Huadu District, the nitro-PAH concentrations in PM2.5 and TSP did not show a significant decrease from winter to summer. From 2019 to 2020, the difference in the average concentration of nitro-PAHs in PM2.5 and TSP in Guangzhou was relatively low and had no statistical significance. The diagnostic ratios of 2-nitrofluorene (2-NF)/1-nitropyrene (1-NP) in TSP are less than five, while for 2-NF/1-NP in outdoor PM2.5 in the summer of 2019 and 2020 are more than five, which indicates that nitro-PAHs in the atmospheric PM2.5 in Guangzhou during summer mainly originated from the secondary formation of atmospheric photochemical reactions between parent PAHs and oxidants (·OH, NO3, and O3). 9-Nitroanthracene (9-NT) made the most significant contribution to the total nitro-PAH concentration. The incremental lifetime cancer risks (ILCRs) of nitro-PAHs in PM2.5 and TSP by inhalation exposure indicated low potential health risks in the urban-suburban of Guangzhou.

The effect of anode potential on electrogenesis, methanogenesis and sulfidogenesis in a simulated sewer condition.

Methane emissions from the sewer system are considered to be a non-negligible source of aggravating the greenhouse effect. Meanwhile, the sewer system has long been plagued by sulfide-induced corrosion problems. This study explored the possibility of using a bioelectrochemical system to intensify the competition between electroactive bacteria, methanogens and sulfate-reducing bacteria, thereby reducing the production of methane and sulfide. Dual-chamber bioelectrochemical reactors were constructed and operated in fed-batch mode with the coexistence of Electroactive bacteria, Methanogenic archaea and Sulfate-reducing bacteria. Acetate was supplied as the sole carbon source. The results indicated that electrogenesis induced by the anode potentials of -0.42 V and -0.2 V (vs. Ag/AgCl) had advantages over methanogenesis and sulfidogenesis in consuming acetate. The stimulated electrogenesis by anode potentials resulted in a decrease in pH. Methane production was suppressed in the reactors with anode potentials of -0.42 and -0.2 V compared to open circuit controls. In contrast to methane, the capacity for sulfide production was facilitated in the reactors with the anode potentials of -0.42 V and -0.2 V compared to open circuit controls. 16s rRNA gene analysis showed that Geobacter was the most abundant genus on the anode biofilm in the anode potential-controlled reactor, while acetoclastic methanogens dominated in open circuit controls. Methanosaeta and Methanosarcina were the most abundant methanogens in open circuit controls. Collectively, our study demonstrates that the use of electrodes with anode potential control can help to control methane emissions, but could not yet prevent sulfide production, which requires further research.

Circular RNA circ_0006089 promotes the progression of gastric cancer by regulating the miR-143-3p/PTBP3 axis and PI3K/AKT signaling pathway.

OBJECTIVES: Circular RNAs (circRNAs) play pivotal roles in malignancies including gastric cancer (GC). We aimed to investigate the biological function and regulatory mechanism of circ_0006089 in GC. METHODS: Circ_0006089, microRNA (miR)-143-3p, and polypyrimidine tract-binding protein 3 (PTBP3) expressions were measured via quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in GC cell lines. Cell proliferative capacity was determined by colony formation and CCK-8 assays. Flow cytometry was employed for measuring cell apoptosis. Cell invasion and migration were measured via transwell and wound-healing assays. Western blot analysis was utilized for detecting protein expressions of E-cadherin, N-cadherin, vimentin, PTBP3, PI3K, p-PI3K, AKT, and p-AKT. Dual-reporter luciferase analysis was conducted to confirm the association between miR-143-3p and circ_0006089 or PTBP3. The role of circ_0006089 in vivo was detected via establishing a mice xenograft model. RESULTS: Circ_0006089 expression was increased in GC. Circ_0006089 downregulation suppressed the proliferation and metastasis and induced apoptosis of GC cells, which was counteracted by miR-143-3p inhibition or PTBP3 overexpression. In addition, circ_0006089 overexpression could promote GC progression. MiR-143-3p specially bound to circ_0006089 and PTBP3 was targeted by miR-143-3p. Moreover, circ_0006089 could regulate PTBP3 expression and the PI3K/AKT pathway by sponging miR-143-3p. Circ_0006089 knockdown also suppressed tumor growth. CONCLUSION: Circ_0006089 regulated miR-143-3p/PTBP3/PI3K/AKT pathway to facilitate GC progression.

Direct Oral Anticoagulants Are Associated with Superior Survival Outcomes than Warfarin in Patients with Head and Neck Cancers.

Increasing clinical evidence supports the use of direct oral anticoagulants (DOACs) as a potential new therapeutic option for patients suffering from cancer-associated thromboembolism. However, the clinical impact of DOACs compared with traditional anticoagulants on the survival of patients with head and neck cancer has not been well studied. A total of 1025 patients diagnosed as having head and neck cancer, including 92 DOAC users, 113 warfarin users, and 820 nonusers of anticoagulants, were selected from the Chang Gung Research Database between January 2001 and December 2019. The patients were matched using the propensity-score method. The survival rates were estimated among the three groups using the Kaplan-Meier method. The protective effects and side effects of the two anticoagulants were compared using the chi-square test. The death rate (18 patients, 19.57%) in patients using DOACs was significantly lower than that in patients using warfarin (68 patients, 60.18%) and those not using any anticoagulant (403 patients, 49.15%). DOAC users had significantly better disease-specific survival (DSS) than warfarin users (p = 0.019) and those who did not use any anticoagulant (p = 0.03). Further, DOAC users had significantly higher overall survival (OS) rates than warfarin users and those who did not use any anticoagulant (p = 0.003). Patients with oropharyngeal and laryngeal cancer and DOAC users had a significantly lower hazard ratio for survival, whereas patients with American Joint Committee on Cancer stage IV disease and those receiving multidisciplinary treatment (e.g., surgery with radiotherapy or concurrent radiochemotherapy) had a significantly higher hazard ratio for survival. Among them, patients with laryngeal cancer (HR = 0.47, 95% CI = 0.26-0.86, p = 0.0134) and DOAC users (HR = 0.53, 95% CI = 0.29-0.98, p = 0.042) had the lowest hazard ratio from DSS analysis. Similarly, patients with laryngeal cancer (HR = 0.48, 95% CI = 0.30-0.76, p = 0.0018) and DOAC users (HR = 0.58, 95% CI = 0.36-0.93, p = 0.0251) had the lowest hazard ratio from OS analysis. As for the protective effects or side effects of anticoagulants, there were no significant differences in the occurrence rate of bleeding or ischemic events between DOAC and warfarin users. In our study, DOACs were found to be better than warfarin in terms of survival in patients with head and neck cancer. As regards thromboembolism prevention and side effects, DOACs were comparable to warfarin in our patients. DOACs can be a treatment choice or prophylaxis for tumor emboli in head and neck cancer patients and they might be a better choice than traditional anticoagulants according to the results of our study.

Anterior Selective Lumbar Fusion Saving More Distal Fusion Segments Compared with Posterior Approach in the Treatment of Adolescent Idiopathic Scoliosis with Lenke Type 5: A Cohort Study with More Than 8-Year Follow-up.

OBJECTIVE: To investigate whether anterior selective fusion (ASF) could save more distal fusion segments compared with posterior approach in the treatment of Lenke type 5 adolescent idiopathic scoliosis with long term follow-up. METHODS: A retrospective cohort study. From 2008 to 2011, 22 AIS girls with Lenke type 5 who underwent ASF or posterior selective fusion (PSF) with more than 8-year follow-up, were extracted from the database. 13 girls in the ASF group had an average age of 14.3 ± 1.3 years and Risser sign of 3.3 ± 1.1; 9 PSF girls had an average age of 16.2 ± 3.6 years and Risser sign of 3.8 ± 1.5. The radiographic outcome was compared between groups preoperatively, 6-month postoperatively, 8-year postoperatively and at last follow-up (>8 years). RESULTS: The average follow-up duration was 8.7 ± 0.4 (ASF) and 8.8 ± 0.5 (PSF) years, respectively. There was no significant difference at baseline in age, Risser sign and preoperative curve pattern in the coronal and sagittal plane between the groups (P > 0.05). The ASF group had significantly shorter fusion segments (5.1 ± 0.6 vs. 7.0 ± 1.3) and decreased upper instrumented vertebra (UIV) (T11 ± 0.8 vs. T10 ± 0.8) than the PSF (P < 0.05); while no significant difference was found in the lower instrumented vertebra (LIV) and distal reserved segments (P > 0.05), which suggested that ASF could shorten the fusion segments by lowering UIV. The distal compensatory curve in the ASF group (9.0° ± 3.9°) was significantly larger than in the PSF group (3.3° ± 2.4°, P = 0.003), despite of no significant difference in the incidence of coronal imbalance (P > 0.05), indicating that both two approaches could obtain satisfactory correction in the coronal plane. In the sagittal plane, PSF patients had significantly larger lumbar lordosis (LL, 59.1° ± 10.5°), thoracic kyphosis (TK, 37.2° ± 13.3°) and proximal junctional angle (PJA, 13.3° ± 6.1°) at the last follow-up than the ASF (LL: 43.4° ± 9.4°; TK: 20.7° ± 8.4°; PJA: 4.7° ± 3.4°; P < 0.05), but without significant difference in proximal junctional kyphosis (PJK) and sagittal vertical axis (SVA) (P > 0.05). After controlling for age, Risser sign, and radiographic parameters related to the primary curve pattern, shorter fusion segments and more distal reserved segments still remained significant in the ASF group with greater Risser sign (P < 0.05). No major intra- or post-operative complications occurred. CONCLUSIONS: Both ASF and PSF could obtain satisfactory coronal and sagittal correction for Lenke 5 AIS; compared with PSF, ASF could shorten the fusion segments by lowering UIV, and save more distal fusion segments only in patients with greater skeletal maturity.

Ribophorin II Overexpression Is Associated with Poor Response to Induction Chemotherapy with Docetaxel, Cisplatin, and Fluorouracil in P16-Negative Locally Advanced Head and Neck Squamous Cell Carcinoma.

This study aims to evaluate the relationship between human ribophorin II (RPN2) and the effect of treatment using induction therapy with docetaxel, cisplatin, and fluorouracil (TPF) for p-16 negative locally advanced head and neck squamous cell carcinoma (HNSCC). A total of 203 patients with locally advanced p-16 negative HNSCC who received induction chemotherapy with TPF at the Kaohsiung Chang Gung Memorial Hospital between 2009 and 2014 were enrolled. Immunohistochemistry (IHC) for RPN2 was examined and correlated with treatment outcome. Our study showed that RPN2 overexpression was significantly correlated with a poor response to induction chemotherapy with TPF. Both RPN2 overexpression and clinical N1 to N3 stages represented adverse prognostic factors for progression-free survival (PFS) and overall survival (OS). RPN2 might be a predictive marker for treatment response to induction chemotherapy. Further clinical trials are needed to determine the therapeutic significance of RPN2 in patients with HNSCC.

A conceptual framework for a multi-criteria decision support tool to select technologies for resource recovery from urban wastewater.

In the context of circular economy, wastewater can be used to address some of the 21st century's challenges regarding the transition to renewable resources for water, energy, and nutrients. Despite all the research, development, and experience with resource recovery from urban wastewater, its implementation is still limited. The transition from treatment to resource recovery is complex due to the difficulty of selecting unit processes from a large number of candidate processes considering the operational limitations of each process, and sustainability objectives. Presently, a multi-criteria decision support tool that deals with the difficulty of unit process selection for resource recovery from wastewater has not been developed. Therefore, this paper presents the conceptual framework of a decision support tool to find the optimum treatment train consisting of compatible unit processes which can recover water, energy and/or nutrients from a specified influent composition. The framework presents the relationship between the user input, the knowledge library of technologies and a weighted multi-objective nonlinear programming model to aid process selection. The model presented here shows, not only how the processes are selected, but also the four-dimensional sustainability impact of the generated treatment train while considering the weight provided by the user. Thus, this study presents a reproducible framework which can support private and public decision-makers in transparent evidence-based decision making and eventually the systematic implementation of resource recovery from urban wastewater.

Clinical cure and liver fibrosis reversal after postoperative antiviral combination therapy in hepatitis B-associated non-cirrhotic hepatocellular carcinoma: A case report.

BACKGROUND: The incidence of hepatocellular carcinoma (HCC) is high in China, and approximately 15%-20% of HCC cases occur in the absence of cirrhosis. Compared with patients with cirrhotic HCC, those with non-cirrhotic HCC have longer postoperative tumor-free survival. However, the overall survival time is not significantly increased, and the risk of postoperative recurrence remains. Strategies to improve the postoperative survival rate in these patients are currently required. CASE SUMMARY: A 47-year-old man with a family history of HCC was found to have hepatitis B virus (HBV) infection 25 years ago. In 2000, he was administered lamivudine for 2 years, and entecavir (ETV 0.5 mg) was administered in 2006. In October 2016, magnetic resonance imaging revealed a tumor in the liver (5.3 cm × 5 cm × 5 cm); no intraoperative hepatic and portal vein and bile duct tumor thrombi were found; and postoperative pathological examination confirmed a grade II HCC with no nodular cirrhosis (G1S3). ETV was continued, and no significant changes were observed on imaging. After receiving pegylated interferon alfa-2b (PEG IFNα-2b) (180 µg) + ETV in February 2019, the HBsAg titer decreased significantly within 12 wk. After receiving hepatitis B vaccine (60 µg) in 12 wk, HBsAg serological conversion was realized at 48 wk. During the treatment, no obvious adverse reactions were observed, except for early alanine aminotransferase flares. The reexamination results of liver pathology were G2S1, and reversal of liver fibrosis was achieved. CONCLUSION: The therapeutic regimen of ETV+ PEG IFNα-2b + hepatitis B vaccine for patients with HBV-associated non-cirrhotic HCC following hepatectomy can achieve an HBV clinical cure and prolong the recurrence-free survival.

Mathematically formulated key performance indicators for design and evaluation of treatment trains for resource recovery from urban wastewater.

While urban wastewater infrastructure is aging and no longer adequate, climate change and sustainability are urging the transition from pollution management to resource recovery. Lacking evidence-based quantitative evaluation of the potential benefits and consequences of resource recovery from wastewater hinders the negotiation amongst stakeholders and slows down the transition. This study proposes mathematical formulations for technical, environmental, economic, and social key performance indicators (KPIs) that can be used to quantify the benefits and the risks of resource recovery. The proposed formulations are derived from the literature and validated with stakeholders. Each KPI is mathematically formulated at treatment train level by considering: (1) the characteristics of individual unit processes (UPs) in the treatment train (TT), (2) the context in which the TT is installed, and (3) the resources to be recovered. The mathematical formulations of the KPIs proposed in this study enable a transparent, consistent and informative evaluation of existing treatment trains, as well as support the (computer aided) design of new ones. This could aid the transition from urban wastewater treatment to resource recovery from urban wastewater.

Adverse respiratory events with sevoflurane compared with desflurane in ambulatory surgery: A systematic review and meta-analysis.

BACKGROUND: An increasing number of studies have concluded that the number of adverse events in the upper airway caused by desflurane does not differ significantly from the number of adverse events caused by sevoflurane. The advantages of desflurane in ambulatory surgery should be reassessed. OBJECTIVES: The aim of this study was to compare adverse respiratory events and recovery outcomes in patients undergoing desflurane or sevoflurane-based anaesthesia in ambulatory surgery. DESIGN: A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES: A systematic search for eligible RCTs in PubMed, Medline, Cochrane Central Register of Controlled Trials, ScienceDirect and Embase published up to June 2019. ELIGIBILITY CRITERIA: RCTs investigating the occurrence of adverse respiratory events, including airway irritation, stridor, coughing, respiratory distress and laryngospasm, emergence agitation, postoperative nausea and vomiting (PONV), time to eye opening and time to discharge from the operation room after desflurane or sevoflurane-based anaesthesia. RESULTS: Thirteen trials were included and analysed. A total of 634 patients were included in the desflurane group, and 633 patients in the sevoflurane group. The occurrence of respiratory complications was significantly higher with desflurane-based anaesthesia than with sevoflurane-based anaesthesia (Total n = 673, 20.0 vs. 12.8%, relative risk (RR) 1.59 (95% CI 1.15 to 2.20)) with low heterogeneity (I = 20%). There was no difference in the occurrence of emergence agitation (Total n = 626, 29.1 vs. 27.2%, RR 1.05 (95% CI 0.84 to 1.30)) or the incidence of PONV between the desflurane and sevoflurane groups (Total n = 989, 19.0 vs. 21.0%, RR 0.95 (95% CI 0.71 to 1.26)). Time to eye opening was significantly faster with desflurane than that with sevoflurane (Total n = 1072, mean difference = -3.32 min (95% CI -4.02 to -2.61)) with a substantial heterogeneity (I = 72.6%). There was no significant difference in the time to discharge from the operation room between the two groups (Total n = 1056, mean difference = -0.45 min (95% CI -5.89 to 4.99)). CONCLUSION: Despite recent reports that there is no significant difference in adverse respiratory events between desflurane and sevoflurane, a pooled analysis revealed that desflurane resulted in a higher rate than sevoflurane. Therefore, the consequences of desflurane should not be neglected and its airway irritant properties should be taken into account. TRIAL REGISTRATION: PROSPERO (CRD42019147939).

Cervical Flexion Osteotomy through One-Stage Posterior-Anterior-Posterior Approach for Cervical Extension Deformity in Ankylosing Spondylitis: A Novel Surgical Technique.

The present study was to introduce a new surgical technique of cervical flexionosteotomy, with an emphasis on the clinical and radiographic outcomes. Two male patients aged 45 and 21 years presented with cervical extension deformity in ankylosing spondylitis (AS). Both patients exhibited upward deviation of the forward gaze. The chin brow vertical angle (CBVA) were 15° upward and 5° downward, respectively; and the sagittal vertical axis (SVA) were-13.2mm and 195.7mm, respectively. Aposterior transverse release was performed at C7 -T1 , exposing the theca and C8 nerve roots to facilitate closure of theosteotomy site. Then, an anterior closing-wedgeosteotomy of C7 -T1 was performed followed with anterior internal fixation with a locking plate to prevent any translation. After closure and anterior fixation, patients were returned to the proneposition, and posterior screw-rod instrumentation was used for further stabilization. The follow-up periods were 20 and 10 months, respectively. At the last follow-up, CBVA and SVA of Patient 1 were 14° downwardand -12.6mm; and CBVA and SVA of Patient 2 were 1° downward and 75.6mm respectively, indicating the visual angle and sagittal balance were significantly improved. No intraoperative or postoperative complications were encountered. Full-spine radiographs of each patient at the last visit confirmed successfulbony union. The present study was the first report introducing a novel flexion osteotomy for cervical extension deformity in AS through a posterior-anterior-posterior approach inone-stage. The improved forward gaze and no complications demonstrated the effectiveness and safety of the novel technique, suggesting that it might provide a more feasible method for the correction of cervical extension deformity.

Monascin ameliorate inflammation in the lipopolysaccharide-induced BV-2 microglial cells via suppressing the NF-κB/p65 pathway.

OBJECTIVES: The pathophysiology of neurodegenerative diseases is complicated, in which inflammatory reactions play a vital role. Microglia cells activation, an essential process of neuroinflammation, can produce neurotoxic molecules and neurotrophic factors, which aggravate inflammation and neuronal injury. Monascin, a major component of red yeast rice, is an azaphilonoid pigment with potential anti-inflammatory effects; however, the effects in central nervous system have not been evaluated. Our goal in this project was to explore the therapeutic effect and the underlying mechanism of Monascin, which may be via anti-inflammatory action. MATERIALS AND METHODS: We used lipopolysaccharide to induce BV-2 microglial cells in order to form an inflammation model in vitro. The anti-inflammatory effects of Monascin were measured by enzyme-linked immunosorbent assay (ELISA), real time-polymerase chain reaction (RT-PCR), Western Blot and Immunofluorescent staining. RESULTS: Our data indicated that inflammatory cytokines including interleukin-1ß (IL-1ß), IL-6, tumor necrosis factor-alpha (TNF-α) and nitric oxide were suppressed by Monascin treatment. Furthermore, the related pro-inflammatory genes were inhibited consistent with the results of ELISA assay. Western blotting results showed that the phosphorylation of nuclear factor kappa B (NF-κB/p65) was reduced by Monascin treatment may be through suppressing the activation of IκB. Furthermore, immunofluorescence staining showed that the translocation of NF-κB/p65 to the cellular nuclear was blockaded after Monascin treatment. CONCLUSION: Taken together, Monascin exerts anti-inflammatory effect and suppressed microglia activation, which suggested its potential therapeutic effect for inflammation-related diseases.

Risk of carpal tunnel syndrome after parathyroidectomy in patients with end-stage renal disease: A population-based cohort study in Taiwan.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy in clinical practice. Some patients with end-stage renal disease (ESRD) often associate with tertiary hyperparathyroidism, and ultimately need parathyroidectomy (PTX). However, no studies have definitively demonstrated an effect of PTX on ESRD patients' quality of life. We selected 1686 patients who underwent PTX and 1686 patients who did not receive PTX between 2000 and 2010. These patients were propensity-matched with others by age, sex, and comorbidities at a ratio of 1:1. We used single and multivariable cox proportional hazard models to estimate hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). In this study, 116 ESRD patients developed CTS, and the CTS incidences were 7.33 and 12.5 per 1000 person-years for the non-PTX and PTX group. The results reveal that the incidence curve for the PTX group was significantly higher than that for the non-PTX group (log-rank test, P = .004). After adjustments were made for sex, age, and baseline comorbidities, the PTX group had a 1.70-fold higher risk of CTS (hazard ratio (HR) = 1.70, 95% confidence intervals (CI) = 1.17-2.47) than the non-PTX group. The results also demonstrated that female patients (HR = 1.60, 95% CI = 1.06-2.42) and patients with one or more comorbidities (HR = 1.79, 95% CI = 1.23-2.60) might have an increased risk of CTS. The subhazard ratio for CTS risk was 1.62 (95% CI = 1.12-2.36) for the PTX group compared with the non-PTX group in the competing risk of death. In conclusion, we revealed that ESRD patients who had undergone PTX may have an increased risk of CTS.

Effect of nitrogen, phosphorus and pH on biological wood oxidation at 42 °C.

Biological wood oxidation (BWO) is proposed as a cleaner alternative to wood combustion for heat production and wood waste management. Currently, BWO is not extensively studied and little is known about it. Nevertheless, given the composition of wood residues, which is dominated by carbon, nutrient availability may become a limiting factor during BWO. Our objective was to study the nutrition requirements for sustaining the BWO. For this purpose, three different factors including nitrogen addition, phosphorus addition and pH, were studied. Oxygen consumption and mass loss were monitored and used to evaluate the impact of nutrition on BWO and to calculate the theoretical heat production. The result showed that nitrogen addition at a relatively low level (2.5-10 mg/g) enhanced the cumulative oxygen consumption by 60-124% and mass loss by 28-95%, when compared with the BWO without nitrogen addition. The highest nitrogen addition examined in this research (20 mg/g), on the other hand, did not enhance BWO. Different phosphorus addition (0.5-5 mg/g) and pH (4-6) had little impacts on BWO. The highest theoretical heat production rate (0.63 W/kg dry wood biomass) was achieved using 2.5 mg/g nitrogen addition with a 95-day incubation. This suggests that nitrogen addition is required and able to sustain BWO. Besides, the cumulative oxygen consumption showed a good linear relationship with mass loss. This study provides the first indication on the effective quantify of nitrogen addition for enhancing BWO, which contributes to the selection of nutrient source for BWO in future studies.

Concurrent use of methanol and ethanol for chain-elongating short chain fatty acids into caproate and isobutyrate.

Microbial chain elongation (MCE) is a bioprocess that could utilise a mixed-culture fermentation to valorise organic waste. MCE converting ethanol and short chain fatty acids (SCFA; derived from organic waste) to caproate has been studied extensively and implemented. Recent studies demonstrated the conversion of SCFAs and methanol or ethanol into isomerised fatty acids as novel products, which may expand the MCE application and market. Integrating caproate and isomerised fatty acid production in one reactor system is theoretically feasible given the employment of a mixed culture and may increase the economic competence of MCE; however, the feasibility of such has never been demonstrated. This study investigated the feasibility of using two electron donors, i.e. methanol and ethanol, for upgrading SCFAs into isobutyrate and caproate concurrently in MCE Results show that supplying methanol and ethanol in MCE simultaneously converted acetate and/or butyrate into caproate and isobutyrate, by a mixed-culture microbiome. The butyrate supplement stimulated the caproate production rate from 1.5 to 2.6 g/L.day and induced isobutyrate production (1.5 g/L.day). Further increasing ethanol feeding rate from 140 to 280 mmol carbon per litre per day enhanced the direct use of butyrate for caproate production, which improved the caproate production rate to 5.9 g/L.day. Overall, the integration of two electron donors, i.e. ethanol and methanol, in one chain-elongation reactor system for upgrading SCFAs was demonstrated. As such, MCE could be applied to valorise organic waste (water) streams into a wider variety of value-added biochemical.