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Hydrogen has become an essential element in the pursuit of sustainable and clean energy solutions. Especially with the fast-paced advancement in demand, supply, and policy environment, its impact on hybrid renewable energy (HRE) management is becoming increasingly relevant. Efficient energy consumption, cost reduction, and enhanced user comfort are now critical factors in energy optimization. The production of green hydrogen, which is generated through water electrolysis using renewable energy sources (RES), has shown great potential as a sustainable energy solution. It offers several advantages, such as zero greenhouse gas emissions, high energy density, and versatile applications. This paper presents a detailed study on the power management and control of a hybrid renewable system (HRES) equipped with a diesel generator (DG) as a backup power source. The main objectives of the hybrid system are to satisfy the load power demand, ensure the most efficient use of the HRES, and keep the battery bank charged to prevent blackouts and extend the battery's life. To guarantee the system's reliability, the DG should be sized to meet the peak load demand when the RES generates less electricity than the load demand. This study explores the feasibility of modified versions of the load following and cycle charging control strategies to overcome the limitations of managing generation and storage systems' operations in different operating modes and to enhance the performance of an HRES with a DG that supplies electricity to a small and remote location. The proposed method not only maximizes the use of RES production but also enables multi-energy source management under different power generation and load demand scenarios. The study's outcomes demonstrate the feasibility of this proposed power dispatch strategy in a remote location environment. The paper includes a detailed discussion of overall control, mathematical models, energy storage in the battery model, and energy dispatching based on load following. To design and simulate the hybrid model system, MATLAB-SIMULINK is used, and the results are analyzed to identify the appropriate operation requirements, component selection, and energy management of the hybrid renewable energy system. [ABSTRACT FROM AUTHOR]

To report on the design of a novel 3D-printed retrograde intrarenal surgery (RIRS) benchtop trainer and detail its validation against real-life experiences. Digital Imaging and Communications in Medicine (DICOM) files of 2 patients with normal computed tomography of the kidney and bladder were converted into stereolithography files to create 3D triangular mesh models. These images were further refined using Autodesk Meshmixer. These 3D models were fabricated through additive manufacturing, a process commonly known as 3D printing, and assembled in a polypropylene case. After development, the model was validated by 40 experienced urologists and urology residents in their final year of training. They were asked to rate the components of the simulation using a 9-point questionnaire. The model's value in understanding the principles of RIRS and simulating contextual anatomy had mean scores of 9.43 (standard deviation [SD] = 0.74) and 9.21 (SD = 1.03), respectively. Mean scores for specific steps in RIRS were 8.07 (SD 1.47) for cannulating the ureteric orifice, 8.61 (SD 1.24) for inserting the ureteric access sheath, 9.29 (SD 0.97) for performing a renoscopy and evaluating all the calyces, 9.46 (SD 0.87) for laser lithotripsy, and 9.17 (SD 0.94) for manual stone retrieval. Participants scored the model with a mean score of 9.04 (SD 0.87) regarding realism and a mean score of 9.18 (SD 0.89) when evaluating its ability to enhance a trainee's confidence in RIRS. The model performed well for all components of RIRS. This model allows high fidelity of the simulation and is cost-effective, portable, durable, reusable, and compatible with standard ureteroscopes. [ABSTRACT FROM AUTHOR]

Vancomycin-resistant enterococci (VRE) poses a formidable challenge to public health due to its inherent resistance to multiple antibiotics coupled with the ability to transfer genetic determinants to dangerous pathogens like Methicillin-resistant Staphylococcus aureus (MRSA). The purpose of this study was to investigate the incidence of vancomycin resistance in enterococci among clinical isolates at a tertiary care military hospital in the eastern region of Saudi Arabia and to detect van genes using multiplex-PCR. Overall, 246 isolates of enterococci were collected from various clinical specimens. The isolates were identified, and antimicrobial susceptibility testing was done using the Vitek 2 system. Multiplex PCR was performed on the VRE isolates, thus identified to determine the van genes harbored. A total of 15 VRE were identified, of which 14 (93.3%) were Enterococcus faecium , and 1(6.7%) was Enterococcus casseliflavus with intrinsic vanC resistance. Of the 14 vancomycin-resistant Enterococcus faecium , 8 (57.1%) harbored vanB genes, while 6 (42.8%) harbored vanA genes. All the VRE were susceptible to linezolid and tigecycline. Our study detected a low prevalence (6.1%) of VRE among clinical isolates of enterococci and that the vanB gene predominates in such strains. Susceptibility profiles indicated that linezolid and tigecycline are still effective against these multidrug-resistant pathogens. Pus specimens yielded the highest percentage (53.3%) of isolates from which VRE was obtained, and this finding is novel among studies done in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Objectives: To validate the newly designed ultrasound-guided suprapubic catheter insertion trainer (US-SCIT) model against the real life experience by enrolling participants with prior confidence in the technique of US-guided suprapubic catheter (SPC) insertion.Methods: The US-SCIT was self-constructed from common disposables and equipment found in the emergency department. A validation questionnaire was completed by all participants after SPC insertion on the US-SCIT model.Results: Fifty participants enrolled in the study. Each participant had reported confidence in the SPC insertion technique, prior to participation in this study. There were 13 "super-users" (>65 previous successful real life SPC insertions) in the study. The total material cost per US-SCIT unit was 1.71 USD. The US-SCIT's value in understanding the principals of US-guided SPC insertion had a mean score of 8.86 (standard deviation [SD] 1.03), whereas its value in simulating contextual anatomy had a mean score of 8.26 (SD 1.48). The mean score of the model's ability to provide realistic sensory feedback was 8.12 (SD 1.78), whereas that of realism of initial urine outflow was 9.06 (SD 1.20). Simulation with the model compared well with real life SPC insertion, with a mean score of 8.30 (SD1.48).Conclusions: The US-SCIT model performed well in various spheres developed to assess its ability to simulate real life SPC insertion. We are confident that this low-cost, validated, US compatible SPC trainer, constructed from common material present in the ED, will be a valuable learning asset to trainees across the globe. [ABSTRACT FROM AUTHOR]

Herein, we describe a case of a 14-year-old boy with straddle injury to the base of the penis, sustained during an indoor rock climbing accident, who presented with severe urethraggia. Urethral injury was confirmed with retrograde urethrography. The patient became hemodynamically unstable from persistent blood loss, and corporal arterial injury was diagnosed on computed tomography angiography. The urethraggia was successfully controlled with angioembolization. The unique aspects of this case were the challenges in establishing the diagnosis on the background of the abnormal presentation of vascular injury of blood loss as opposed to painless priapism. [ABSTRACT FROM AUTHOR]

Congenital anterior urethral diverticulum is a rare cause of urethral obstruction in boys. We report on the antenatal diagnosis of this rare phenomenon, making this the sixth prenatally diagnosed case in the English literature (to the best of our knowledge). Our initial prenatal assessment, postnatal endoscopic management, along with the eventual clinical course is outlined. The embryologic theories, differential diagnosis, literature review, imaging, and treatment modalities of this entity are discussed. [ABSTRACT FROM AUTHOR]

A 3-year-old female child presented with a history of recurrent urinary tract infections. On general examination, polydactyly and a pelvic mass were present. An imperforate hymen was also documented on vaginal inspection. Further inquiry revealed a positive history of parental consanguinity. A magnetic resonance imaging study defined a hydrometrocolpos responsible for an obstructive cause of the recurrent urinary tract infections. In view of the above, a diagnosis of McKusick-Kaufman syndrome was made. Formal surgical repair of the imperforate hymen with hydrometrocolpos drainage resulted in complete symptom resolution. McKusick-Kaufman syndrome, its presentation, symptoms, differential diagnosis, and underlying genetics were further expanded. [ABSTRACT FROM AUTHOR]

Summary Introduction The proliferation of medical-type applications or ‘apps’ on smartphones is a typical example of the impact technology has had on medical practice. Maintaining a bladder diary is a recommended part of evaluating the effect of interventions for patients suffering from enuresis. Traditional pen-and-paper bladder diaries have poor completion rates, inconsistent patterns in data entry, and are deficient in validation. Electronic bladder diaries have been proposed to overcome these obstacles. With increasing numbers of smartphone apps available to the general public, it is important to distinguish well-designed apps for childhood enuresis. Purpose To identify, evaluate, and rank all available mobile-phone apps for the management of childhood enuresis. Methods On August 21, 2014, a search was conducted on iTunes, Android Play Store, and BlackBerry World for smartphone apps using the following search terms: bladder , bedwetting , bladder diary , enuresis , incontinence , and wetting . Apps that did not have a bladder diary function and that were unrelated to the investigation, follow-up, and treatment of childhood enuresis were excluded. Apps were rated by a paediatric urology consultant, fellow, registrar, and resident medical officer using standardised criteria including: design; ease of use; languages; quality of instructions; security; accordance with ICCS definition of enuresis; and ability to store histories; record bowel habits; transfer data to other devices; and print data. Results Across all three search platforms, a total of 1041 apps were identified. Only 24 were included and reviewed based on exclusion criteria. Average ratings for apps ranged from 10 to 30.75 out of 50 based on standardised criteria. Discussion Smartphone apps are playing an increasingly significant role in the management of enuresis in place of pen-and-paper bladder diaries. Apps available to the general public vary in quality and it can be difficult for patients to identify one appropriate for use. We found apps with higher ratings consistently had engaging interfaces, were easy to use, and defined the primary purpose clearly. Lower ratings and performance often was caused by poor quality of experience through “freezing”/“crashing.” Conclusion Bladder diary apps can eliminate disadvantages of pen-and-paper diaries in the management of enuresis. Currently, apps available vary in quality. The three best-rated apps currently available are My Dryness Tracker , Bedwetting Tracker , and HapPee Time . There is room for medical associations to collaborate with developers for further app development. Table Summary of results. Platform Apple alone 13 apps Android alone 7 apps Apple and Android 4 apps Price Free 18 Apps (75% of apps) Paid AUD $1.09–6.49 (median $2.49) App size 121 kb–20.7 Mb (median 1.95 Mb) Date of update 16/03/2010–21/08/2014 Average app ratings 10–30.75 (median 22) [ABSTRACT FROM AUTHOR]

Urothelial bladder tumours in childhood are extremely rare, with most cases being low grade, superficial disease of the papillary subtype with favourable outcomes. Urothelial (clear cell variant) carcinoma of bladder (UCCVCB) is an exceptional histological finding in both the adult and paediatric population. Herein we describe the first case of UCCVCB diagnosed in childhood. With this case being only the fourth report of confirmed muscle invasion in childhood, we discuss the entity of UCCVCB, and furthermore review all previously reported confirmed cases of childhood muscle invasive urothelial bladder cancer, in general. [ABSTRACT FROM AUTHOR]

Role of stem cell factor and mast cells in the progression of chronic glomerulonephritides. Background. Mast cells (MCs) have been implicated in the pathogenesis of atherosclerosis and tissue fibrosis. However, the role of MC in the development of renal fibrosis has not been fully elucidated. Stem cell factor (SCF; the ligand for MC c-kit receptor) is thought to attract and activate MCs. Methods. The intensity of MC infiltration and SCF expression in renal biopsies from 56 patients with different forms of primary and secondary glomerulonephritis and five controls were investigated by immunohistochemistry, using a monoclonal anti-human MC tryptase antibody and a polyclonal antihuman SCF antibody. Results. A large number of MCs were detected in the renal interstitium of the diseased kidneys. Immunostainable SCF was detected in tubular as well as interstitial cells. MC infiltration was significantly higher in glomerulonephritis (16.9 ± 10.2 cells/field) compared with controls (2.8 ± 2.1 cells/field, P = 0.03). Similarly, immunostainable SCF was 0.6 ± 0.3% for controls and 3.3 ± 2.1% in the glomerulonephritis group (P = 0.02). MC infiltration was highly correlated with SCF expression in diseased kidneys (r = 0.93, P = 0.0001). Double immunostain showed them to colocalize in some interstitial cells. Analysis of MC proliferation [proliferating cell nuclear antigen (PCNA) positivity] and apoptosis (in situ end labeling of DNA) showed these cells to be terminally differentiated. Both MCs and SCF were correlated with interstitial fibrosis (R = 0.71 for MC and R = 0.62 for SCF, P = 0.0001) and interstitial α-smooth muscle actin (R = 0.69 for MC and R = 0.60 for SCF P = 0.0001). Using regression analysis, the number of MC infiltration was found to be a very powerful determinant of interstitial fibrosis in the glomerulonephritis group (R2 = 91.4%). Conclusion. MCs as an infiltrating hematopoietic cell and its growth factor (SCF) seem to be up-regulated in glomerulonephritis, and may play a role in the development of renal fibrosis. [ABSTRACT FROM AUTHOR]

• Combined exposure to hypoxia and ammonia elicits strong activation of the anaerobic glycolytic pathway. • Combined exposure induce oxidative stress subsequently leading to immunosuppression and apoptosis. • Simultaneous exposure exhibit stronger adverse effects on biological response than exposure to either stressor alone. Hypoxia and ammonia are unavoidable environmental factors in aquaculture, and have been shown cause various adverse effects in fish. In the present study, a two-factor crossover experiment was carried out to evaluate the combined effect of hypoxia and ammonia on oxidative stress and glucose metabolism endpoints in largemouth bass. The fish were divided into four experimental groups: hypoxia and ammonia group, hypoxia group, ammonia group, and control group. The results showed that hypoxia and ammonia exposures both induced antioxidant response and oxidative stress (superoxide dismutase [SOD] and catalase [CAT] activities increased first then decreased, and malondialdehyde accumulated) and anaerobic glycolysis (increase of blood glucose, decrease of liver glycogen, accumulation of lactate, and increased lactate dehydrogenase activity). In addition, hypoxia and ammonia upregulated antioxidant enzyme genes (Cu/ZnSOD, CAT, and GPx), apoptosis genes (caspase 3 , caspase 8 , and caspase 9), as well as inflammatory genes (interleukin [IL]-1β and IL-8) and downregulated an anti-inflammatory gene (IL-10), suggesting that apoptosis and inflammation may be related to oxidative stress. The increased expression of GLUT1 , LDH , and MCT4 were induced by hypoxia and ammonia, suggesting that anaerobic glycolysis was increased. Furthermore, fish suffering from hypoxia or ammonia exposure showed some changes in gill tissues histology, and the most severe lesions of gill tissues appeared in simultaneous exposure. Overall, both hypoxia and ammonia affected homeostasis, and simultaneous exposure led to more deleterious effects on largemouth bass than exposure to the individual stressors. [ABSTRACT FROM AUTHOR]