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Pneumonia is one of the top ten causes of death. Early diagnosis of pneumonia is essential for subsequent effective treatment. Judging from the current development situation, many effective artificial intelligence (AI) algorithms are concentrated on diseases with a large amount of standardized data. After all, to achieve high-quality AI diagnosis, a large number of high-quality annotated images are required for pre-algorithm training.This research uses semi-supervised learning with Tensorflow and keras two frameworks to construct a disease location system. We use VGG16 and establish a deep convolutional generation confrontation network (DCGAN) [1], synthesize chest X-ray data, and amplify the data set. With an improved visualization effect, a heat map is used to display the lesions to assist clinical medical care personnel to fully grasp the patient's condition. We show examples of CAMs on the pneumonia detection task with no augmentation and DCGAN. It can be concluded that DCGAN performs the best results, the accuracy rate was increased by 11%.

As the population increases, energy demands continue to rise rapidly. In order to satisfy this increasing energy demand, biogas offers a potential alternative. Biogas is economically viable to be produced through anaerobic digestion (AD) from various biomass feedstocks that are readily available in Malaysia, such as food waste (FW), palm oil mill effluent (POME), garden waste (GW), landfill, sewage sludge (SS) and animal manure. This paper aims to determine the potential feedstocks for biogas production via AD based on their characteristics, methane yield, kinetic studies and economic analysis. POME and FW show the highest methane yield with biogas yields up to 0.50 L/g VS while the lowest is 0.12 L/g VS by landfill leachate. Kinetic study shows that modified Gompertz model fits most of the feedstock with R 2 up to 1 indicating that this model can be used for estimating treatment efficiencies of full-scale reactors and performing scale-up analysis. The economic analysis shows that POME has the shortest payback period (PBP), highest internal rate of return (IRR) and net present value (NPV). However, it has already been well explored, with 93% of biogas plants in Malaysia using POME as feedstock. The FW generation rate in Malaysia is approximately 15,000 tonnes per day, at the same time FW as the second place shows potential to have a PBP of 5.4 years and 13.3% IRR, which is close to the results achieved with POME. This makes FW suitable to be used as the feedstock for biogas production.

This chapter identifies the potential of using an efficient biogas prototype known as integrated anaerobic-aerobic bioreactor (IAAB) system for the treatment of palm oil mill effluent (POME). Additionally, design procedures and design considerations of the IAAB will be discussed in detail as well. The IAAB system implicates a small footprint, shorter hydraulic retention time (HRT), and ability to treat liquid effluent at high loading rates as compared to the conventional biogas technologies. The positive results obtained by the laboratory-scale IAAB (COD removal and total suspended solid [TSS] removal more than 99%) results in upscaling the volume of the IAAB from 55 L to 1.8 m3. It will act as a commercialization prototype for the palm oil industry to accept such a new approach to combat the massive volumes of POME produced daily and unstable characteristics of POME obtained during low- and high-crop seasons of fresh fruit bunch (FFB). Positive results were obtained whereby the IAAB was successfully operated at an organic loading rate (OLR) of 30.0 gCOD/L.day with overall removal efficiency of >99%. Additionally, the final treated effluent produced abides the discharge limit with biochemical oxygen demand (BOD) less than 20 mg/L. This integrated system follows the concept of zero liquid discharge, whereby all liquid biomasses in the palm oil mill are converted into valuable products, and thus transforming the palm oil industry into a “green industry.”

BackgroundEmergency departments (ED) are important providers of asthma care, particularly after-hours. We identified gaps for quality improvement such as suboptimal adherence rates to three key recommendations from the Global Initiative for Asthma (GINA) guidelines for discharge management asthma guidelines. These were: the prescription of oral and inhaled corticosteroids (OCS and ICS) and issuance of outpatient follow-up for patients discharged from the ED.AimTo achieve an adherence rate of 80% to GINA guidelines for ED discharge management by providing after-hours asthma counselling services.MethodsWe implemented Asthma-COPD Afterhours Respiratory Nurse at Emergency (A-CARE) according to the Plan-Do-Study-Act (PDSA) framework to provide after-hours asthma counselling and clinical decision support to ED physicians three nights a week. Data on adherence rates to the GINA guidelines were collected and analysed on a run chart.ResultsAfter 17 months’ follow-up, a sustained improvement was observed in patients reviewed by A-CARE in the median adherence rates to OCS prescription (58% vs 86%), ICS initiation (27% vs 67%) and issuance of follow-up (69% vs 92%), respectively. The overall impact was, however, limited by a suboptimal referral rate to A-CARE (16%) in a clinical audit of all ED patients with asthma. Nonetheless, in this audit, attendance rates for patients referred to our respiratory department for follow-up were higher in those receiving asthma counselling compared with those who did not (41.7% vs 15.9%, p=0.0388).ConclusionSustained improvements in the adherence rates to guidelines were achieved for patients reviewed by A-CARE but were limited in overall impact due to suboptimal referral rate. We plan to improve the quality of asthma care by implementing further PDSA cycles to increase the referral rates to A-CARE.

Anaerobic digestion has been widely employed in waste treatment for its ability to capture methane gas released as a product during the digestion. Certain wastes, however, cannot be easily digested due to their low nutrient level insufficient for anaerobic digestion, thus co-digestion is a viable option. Numerous studies have shown that using co-substrates in anaerobic digestion systems improve methane yields as positive synergisms are established in the digestion medium, and the supply of missing nutrients are introduced by the co-substrates. Nevertheless, large-scale implementation of co-digestion technology is limited by inherent process limitations and operational concerns. This review summarizes the results from numerous laboratory, pilot, and full-scale anaerobic co-digestion (ACD) studies of wastewater sludge with the co-substrates of organic fraction of municipal solid waste, food waste, crude glycerol, agricultural waste, and fat, oil and grease. The critical factors that influence the ACD operation are also discussed. The ultimate aim of this review is to identify the best potential co-substrate for wastewater sludge anaerobic co-digestion and provide a recommendation for future reference. By adding co-substrates, a gain ranging from 13 to 176% in the methane yield was accomplished compared to the mono-digestions.

Endothelial progenitor cells (EPCs) have been pursued as a potential cellular therapy for stroke and central nervous system injury. However, their underlying mechanisms remain to be fully defined. Recent experimental studies suggest that mitochondria may be released and transferred between cells. In this proof-of-concept study, we asked whether beneficial effects of EPCs may partly involve a mitochondrial phenomenon as well. First, EPC-derived conditioned medium was collected and divided into supernatant and particle fractions after centrifugation. Electron microscopy, Western blots, and flow cytometry showed that EPCs were able to release mitochondria. ATP and oxygen consumption assays suggested that these extracellular mitochondria may still be functionally viable. Confocal microscopy confirmed that EPC-derived extracellular mitochondria can be incorporated into normal brain endothelial cells. Adding EPC particles to brain endothelial cells promoted angiogenesis and decreased the permeability of brain endothelial cells. Next, we asked whether EPC-derived mitochondria may be protective. As expected, oxygen–glucose deprivation (OGD) increased brain endothelial permeability. Adding EPC-derived mitochondria particles to the damaged brain endothelium increased levels of mitochondrial protein TOM40, mitochondrial DNA copy number, and intracellular ATP. Along with these indirect markers of mitochondrial transfer, endothelial tightness was also restored after OGD. Taken together, these findings suggest that EPCs may support brain endothelial energetics, barrier integrity, and angiogenic function partly through extracellular mitochondrial transfer.

Modulator of apoptosis 1 (MOAP-1) is a Bcl-2-associated X Protein (BAX)-associating protein that plays an important role in regulating apoptosis. It is highly enriched in the brain but its function in this organ remains unknown. Studies on BAX−/− mice suggested that disruption of programmed cell death may lead to abnormal emotional states. We thus hypothesize that MOAP-1−/− mice may also display stress-related behavioral differences and perhaps involved in stress responses in the brain and investigated if a depression-like trait exists in MOAP-1−/− mice, and if so, whether it is age related, and how it relates to central serotonergic stress response in the dorsal raphe nucleus. Young MOAP-1−/− mice exhibit depression-like behavior, in the form of increased immobility time when compared to age-matched wild-type mice in the forced swimming test, which is abolished by acute treatment of fluoxetine. This is supported by data from the tail suspension and sucrose preference tests. Repeated forced swimming stress causes an up-regulation of tryptophan hydroxylase 2 (TPH2) and a down-regulation of brain-derived neurotrophic factor (BDNF) in the dorsal raphe nucleus (DRN) in young wild-type (WT) control mice. In contrast, TPH2 up-regulation was not observed in aged WT mice. Interestingly, such a stress response appears absent in both young and aged MOAP-1−/− mice. Aged MOAP-1−/− and WT mice also have similar immobility times on the forced swimming test. These data suggest that MOAP-1 is required in the regulation of stress response in the DRN. Crosstalk between BDNF and 5-HT appears to play an important role in this stress response. Electronic supplementary material The online version of this article (10.1007/s12035-018-1205-7) contains supplementary material, which is available to authorized users.

Ischemic postconditioning is increasingly being investigated as a therapeutic approach for cerebral ischemia. However, the majority of studies are focused on the acute protection of neurons per se. Whether and how postconditioning affects multiple cells in the recovering neurovascular unit remains to be fully elucidated. Here, we asked whether postconditioning may modulate help-me signaling between injured neurons and reactive microglia. Rats were subjected to 100 min of focal cerebral ischemia, then randomized into a control versus postconditioning group. After 3 days of reperfusion, infarct volumes were significantly reduced in animals treated with postconditioning, along with better neurologic outcomes. Immunostaining revealed that ischemic postconditioning increased expression of vascular endothelial growth factor (VEGF) in neurons within peri-infarct regions. Correspondingly, we confirmed that VEGFR2 was expressed on Iba1-positive microglia/macrophages, and confocal microscopy showed that in postconditioned rats, these cells were polarized to a ramified morphology with higher expression of M2-like markers. Treating rats with a VEGF receptor 2 kinase inhibitor negated these effects of postconditioning on microglia/macrophage polarization. In vitro, postconditoning after oxygen-glucose deprivation up-regulated VEGF release in primary neuron cultures, and adding VEGF to microglial cultures partly shifted their M2-like markers. Altogether, our findings support the idea that after postconditioning, injured neurons may release VEGF as a 'help-me' signal that promotes microglia/macrophage polarization into potentially beneficial phenotypes.

Introduction: Retroperitoneal necrotizing fasciitis is an uncommon, rapidly fatal condition which often mimics other diseases. Case presentation: We report a case of an elderly woman who was referred to our Emergency Department for suspected acute appendicitis. Computed tomography scan showed an iliopsoas abscess with necrotizing fasciitis on computed tomography scan. Despite aggressive surgical treatment and early antibiotics, she passed away 3 weeks later. Conclusion: Such a case has rarely been reported in an immunocompetent patient who has had no instrumentation, surgeries, or trauma. It serves to highlight the difficulty in diagnosing retroperitoneal necrotizing fasciitis, especially in the elderly patient, as well as the need to recognize it early in the Emergency Department.

Food waste (FW) utilized as substrate for anaerobic digestion (AD) to produce biogas is promising. Simultaneously, waste is handled and value-added products such as biogas and fertilizer are produced. Palm oil mill effluent (POME) is used as the co-substrate. This study aims to simulate the complete process flow of anaerobic co-digestion (AcoD), consisting of pre-treatment of feedstock, biogas upgrading, wastewater treatment and sludge dying using SuperPro Designer. Parameters, namely hydraulic retention time (HRT), recycle ratio of sludge, water to FW ratio (kg/kg) and co-substrate to FW ratio (kg/kg), would affect the performance of digester. The optimization of these parameters is performed using Design-Expert software, involving response surface methodology (RSM). The effects on responses such as methane flow, chemical oxygen demand (COD) and volatile solid (VS) removal efficiencies are analyzed. In treating 25,000 kg/h of feed, the optimized values for HRT, recycle ratio, water to feedstock ratio, POME to FW ratio are 37.2 days, 0.381, 0.027 and 0.004, respectively. The methane yield is 0.30 L CH4/g of COD removed, with COD and VS removal efficiencies of 81.5% and 68.9%, respectively. The project is profitable, with a payback period of 6.14 years and net present value (NPV) of $5,680,000. A comprehensive understanding of AD matures it for commercialization purposes.

Malaysia is experiencing rapid urbanisation leading to an increase in the demand of energy. The use of renewable energy can satisfy energy demands and mitigate environmental issues such as greenhouse gas (GHG) emission. Biogas produced from anaerobic digestion from different feedstock such as food waste (FW), palm oil mill effluent (POME), garden waste (GW), landfill, sewage sludge (SS) and animal manure can be utilised to reduce the need of fossil fuel. This review paper will focus on the current biogas technologies, their scalability and socio-economic analysis on biowastes to energy in Malaysia. If all FW generated in Malaysia (approximately 15,000 tonnes per day) could be converted to energy, it has a potential to replace fossil fuel totally, as it produces 10 times more than the annual requirement of energy. Consequently, there is a significant advantage obtained from offsetting huge amounts of GHG emissions that would otherwise be contributing to the global warming effect. Several issues and challenges have been identified for the scale-up of laboratory scale to industrial scale where parameters including pH, temperature, organic loading rate (OLR), hydraulic retention time (HRT) and mixing rate must be treated carefully. The socio-economic survey conducted as part of this study has revealed the strong acceptability of this technology and the readiness of the population in Malaysia to contribute and be part of this effort. However, the survey has also identified the limitations of the sorting and preparation facilities of food waste segregation for potential biogas generation.

The characteristics of Palm Oil Mill effluent (POME) have captivated attention in harnessing its high organic contents to generate biogas via anaerobic digestion. However, biogas production is unstable during low crop season. Therefore, this research focuses on improving the biogas generation by adopting the co-digestion method which treats POME and Decanter cake (DC) simultaneously. Results show that DC:POME ratio of 0.8:1 (in term of volatile solids (VS)) with organic loading of 11 g VS/L and HRT of 28 days generated the highest methane yield of 0.515 L CH4/g VS, which is a 186% improvement as compared to mono-digestion of POME. The co-digestion of substrates has shown good biodegradability of organic contents where up to 99.42% chemical oxygen demand (COD) and VS removal efficiencies were attained. Logistic Function Model (LFM) is the most suitable model to predict the performance of co-digestion with the highest R2 of 0.9810.

Microbial fuel cell (MFC) technology has attracted a great amount of attention due to its potential for organic and inorganic waste treatment concomitant with power generation. It is thus seen as a clean energy alternative. Modifications and innovations have been conducted on standalone and hybrid/coupled MFC systems to improve the power output to meet the end goal, namely, commercialization and implementation into existing wastewater treatment plants. As the energy generated is inversely proportional to the size of the reactor, the stacking method has been proven to boost the power output from MFC. In recent years, stacked or scale-up MFCs have also been used as a power source to provide off-grid energy, as well as for in situ assessments. These scale-up studies, however, encountered various challenges, such as cell voltage reversal. This review paper explores recent scale-up studies, identifies trends and challenges, and provides a framework for current and future research.

Hydrogen sulfide is believed to be a signalling molecule in the central nervous system. It is known to increase rapidly following an ischemic insult in experimental stroke. Is it protective or deleterious? This review surveys the relevant information available in the literature. It appears that there is no definitive answer to this question at present. Current evidence seems to suggest that the presence of H2S in the ischemic brain may either be deleterious or protective depending on its concentration, deleterious when high and protective when low. Therefore, it can be inferred that either an enhancement or a reduction of its concentration may be of potential use in future stroke therapy.

Despite the efforts in developing therapeutics for stroke, recombinant tissue plasminogen activator (rtPA) remains the only FDA approved drug for ischemic stroke. Regenerative medicine targeting endogenous growth factors has drawn much interest in the clinical field as it provides potential restoration for the damaged brain tissue without being limited by a narrow therapeutic window. To date, most of the translational studies using regenerative medicines have encountered problems and failures. In this review, we discuss the effects of some trophic factors which include of erythropoietin (EPO), brain derived neurotrophic factor (BDNF), granulocyte-colony stimulating factor (G-CSF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), epidermal growth factor (EGF) and heparin binding epidermal growth factor (HB-EGF) in experimental ischemic stroke models and elaborate the lost in translation of the candidate growth factors from bench to bedside. Several new methodologies have been developed to overcome the caveats in translational studies. This review highlights the latest bioengineering approaches including the controlled release and delivery of growth factors by hydrogel-based scaffolds and the enhancement of half-life and selectivity of growth factors by a novel approach facilitated by glycosaminoglycans.

Hydrogen sulfide is believed to be a signalling molecule in the central nervous system. It is known to increase rapidly following an ischemic insult in experimental stroke. Is it protective or deleterious? This review surveys the relevant information available in the literature. It appears that there is no definitive answer to this question at present. Current evidence seems to suggest that the presence of H2S in the ischemic brain may either be deleterious or protective depending on its concentration, deleterious when high and protective when low. Therefore, it can be inferred that either an enhancement or a reduction of its concentration may be of potential use in future stroke therapy.

In the present study, amorphous mesoporous silicon oxycarbide materials (SiOC) were successfully synthesized via a low-cost facile method by using potassium hydroxide activation, high temperature carbonization, and acid treatment. The precursors were obtained from floating plants (floating moss, water cabbage, and water caltrops). X-ray diffraction (XRD) results confirmed the amorphous Si&ndash, O&ndash, C structure and Raman spectra revealed the graphitized carbon phase. Floating moss sample resulted in a rather rough surface with irregular patches and water caltrops sample resulted in a highly porous network structure. The rough surface of the floating moss sample with greater particle size is caused by the high carbon/oxygen ratio (1: 0.29) and low amount of hydroxyl group compared to the other two samples. The pore volumes of these floating moss, water cabbage, and water caltrops samples were 0.4, 0.49, and 0.63 cm3 g&minus, 1, respectively, resulting in thermal conductivities of 6.55, 2.46, and 1.14 Wm&minus, 1 K&minus, 1, respectively. Floating plants, or more specifically, floating moss, are thus a potential material for SiOC production.

Leukotriene B4 (LTB4) has been implicated in ischemic stroke pathology. We examined the prognostic significance of LTB4 levels in patients with acute middle cerebral artery (MCA) infarction and their mechanisms in rat stroke models. In ischemic stroke patients with middle cerebral artery infarction, plasma LTB4 levels were found to increase rapidly, roughly doubling within 24 h when compared to initial post-stroke levels. Further analyses indicate that poor functional recovery is associated with early and more sustained increase in LTB4 rather than the peak levels. Results from studies using a rat embolic stroke model showed increased 5-lipoxygenase (5-LOX) expression in the ipsilateral infarcted cortex compared with sham control or respective contralateral regions at 24 h post-stroke with a concomitant increase in LTB4 levels. In addition, neutrophil influx was also observed in the infarcted cortex. Double immunostaining indicated that neutrophils express 5-LOX and leukotriene A4 hydrolase (LTA4H), highlighting the pivotal contributions of neutrophils as a source of LTB4. Importantly, rise in plasma LTB4 levels corresponded with an increase in LTB4 amount in the infarcted cortex, thereby supporting the use of plasma as a surrogate for brain LTB4 levels. Pre-stroke LTB4 loading increased brain infarct volume in tMCAO rats. Conversely, administration of the 5-LOX-activating protein (FLAP) inhibitor BAY-X1005 or B-leukotriene receptor (BLTR) antagonist LY255283 decreased the infarct volume by a similar extent. To conclude, targeted interruption of the LTB4 pathway might be a viable treatment strategy for acute ischemic stroke. Electronic supplementary material The online version of this article (10.1007/s13311-019-00787-4) contains supplementary material, which is available to authorized users.

Ecological floating bed (EFB) has become the preferred technology due to its reputation of green economy, convenience, and efficiency in treating eutrophic landscape water. Based on the statistical analysis of abundant literatures, this paper systematically summarizes the component elements, design parameters, purification mechanism, purification ability, strengthening methods and the correlations among various parameters of EFB, and points out some issues existing in the current research and applications. The results show that the coverage of 5% ~ 38% and water depth of 60 ~ 110 cm should be recommended for EFB design. The microbial transformation-sedimentation contributes mostly to the removal of pollutant, leading to the contribution rate of 51.9% ± 26.4% to nitrogen (N) removal and 50.8% ± 20.4% to phosphorus (P) removal in water respectively. Meanwhile, the average purification abilities of EFB for carbon (C), N and P in water are 4.59 ± 3.82, 0.43 ± 0.35 and 0.04 ± 0.04 g m−2 d-1 respectively. The purification effect is relatively superior when the initial concentration of C, N and P in water is close to C: N: P = 115: 11: 1. In order to enhance the EFB purification efficiency, the methods of artificial aeration, biological chain extension, functional filler introduction, and composite EFB construction can be used. Furthermore, the purification ability of EFB per unit area is correlated positively with water temperature and initial pollutant concentration (r ≥ 0.577, p

Introduction Pulmonary emphysema is a major component of chronic obstructive pulmonary disease (COPD). Emphysema progression attributed not only to alveolar structure loss and pulmonary regeneration impairment, but also to excessive inflammatory response, proteolytic and anti-proteolytic activity imbalance, lung epithelial cells apoptosis, and abnormal lung remodeling. To ameliorate lung damage with higher efficiency in lung tissue engineering and cell therapy, pre-differentiating graft cells into more restricted cell types before transplantation could enhance their ability to anatomically and functionally integrate into damaged lung. In this study, we aimed to evaluate the regenerative and repair ability of lung alveolar epithelium in emphysema model by using lung epithelial progenitors which pre-differentiated from amniotic fluid mesenchymal stem cells (AFMSCs). Methods Pre-differentiation of eGFP-expressing AFMSCs to lung epithelial progenitor-like cells (LEPLCs) was established under a modified small airway growth media (mSAGM) for 7-day induction. Pre-differentiated AFMSCs were intratracheally injected into porcine pancreatic elastase (PPE)-induced emphysema mice at day 14, and then inflammatory-, fibrotic-, and emphysema-related indices and pathological changes were assessed at 6 weeks after PPE administration. Results An optimal LEPLCs pre-differentiation condition has been achieved, which resulted in a yield of approximately 20% lung epithelial progenitors-like cells from AFMSCs in a 7-day period. In PPE-induced emphysema mice, transplantation of LEPLCs significantly improved regeneration of lung tissues through integrating into the lung alveolar structure, relieved airway inflammation, increased expression of growth factors such as vascular endothelial growth factor (VEGF), and reduced matrix metalloproteinases and lung remodeling factors when compared with mice injected with AFMSCs. Histopathologic examination observed a significant amelioration in DNA damage in alveolar cells, detected by terminal deoxynucleotidyltransferase-mediated dUTP nick end labeling (TUNEL), the mean linear intercept, and the collagen deposition in the LEPLC-transplanted groups. Conclusion Transplantation of predifferentiated AFMSCs through intratracheal injection showed better alveolar regeneration and reverse elastase-induced pulmonary emphysema in PPE-induced pulmonary emphysema mice. Electronic supplementary material The online version of this article (10.1186/s13287-019-1282-1) contains supplementary material, which is available to authorized users.

Biomaterials provide novel platforms to deliver stem cell and growth factor therapies for central nervous system (CNS) repair. The majority of these approaches have focused on the promotion of neural progenitor cells and neurogenesis. However, it is now increasingly recognized that glial responses are critical for recovery in the entire neurovascular unit. In this study, we investigated the cellular effects of epidermal growth factor (EGF) containing hydrogels on primary astrocyte cultures. Both EGF alone and EGF‐hydrogel equally promoted astrocyte proliferation, but EGF‐hydrogels further enhanced astrocyte activation, as evidenced by a significantly elevated Glial fibrillary acidic protein (GFAP) gene expression. Thereafter, conditioned media from astrocytes activated by EGF‐hydrogel protected neurons against injury and promoted synaptic plasticity after oxygen–glucose deprivation. Taken together, these findings suggest that EGF‐hydrogels can shift astrocytes into neuro‐supportive phenotypes. Consistent with this idea, quantitative‐polymerase chain reaction (qPCR) demonstrated that EGF‐hydrogels shifted astrocytes in part by downregulating potentially negative A1‐like genes (Fbln5 and Rt1‐S3) and upregulating potentially beneficial A2‐like genes (Clcf1, Tgm1, and Ptgs2). Further studies are warranted to explore the idea of using biomaterials to modify astrocyte behavior and thus indirectly augment neuroprotection and neuroplasticity in the context of stem cell and growth factor therapies for the CNS. stem cells translational medicine 2019;8:1242&1248, Biomaterials provide novel platforms to deliver stem cell and growth factor therapies for central nervous system repair. Our data suggest that epidermal growth factor‐containing hydrogels can shift astrocytes into potentially beneficial A2‐like phenotypes that may augment neuroprotection and neuroplasticity during the recovery phase after brain injury.

This paper studied the inhibitory effect of pomegranate peel (PP) extract on the growth of Microcystis aeruginosa, the model of harmful algal blooms in aquatic environment. The allelochemicals were identified by HPLC–MS/MS from PP and tested by batch experiment through measurement of algal density, chlorophyll a (Chl-a) concentration, maximum quantum yield of photosystem II (Fv/Fm), superoxide dismutase (SOD), and malondialdehyde (MDA) contents. Results showed that both PP powder and PP extract had obvious inhibitory effect on M. aeruginosa growth. Quercetin and luteolin were identified as the allelochemicals to M. aeruginosa growth. However, the inhibitory capacity of luteolin was stronger than that of quercetin. The growth inhibition ratio of luteolin can reach up to 98.7 and 99.1% of the control on day 7 at the dosages of 7 and 10 mg/L, respectively. Moreover, the changes of Chl-a, Fv/Fm, SOD, and MDA in M. aeruginosa confirmed jointly that the allelochemicals cause inhibition of photosystem and oxidative damage to M. aeruginosa cells with the antioxidant defense system being activated, which leads to the aggravation of membrane lipid peroxidation. Thus, luteolin could be used as a promising algaecide for emergency handling of M. aeruginosa blooms. This study might provide a new direction in the management of eutrophication in the future.

Three main parameters of palm oil mill effluent (POME) i.e. biological oxygen demand (BOD), total suspended solids (TSS) and oil and grease (O&G), at high concentrations, have hindered efficient anaerobic digestion (AD) due to sludge flotation and scum formation. In this study, Moringa Oleifera extract was co-digested with POME to allow TSS and O&G to be coagulated and settled, and hence, an immobilisation media formed for better digestibility. Mono-digestion (POME, T1 and M. oleifera extract, T2, separately) served as control while co-digestion involved dosing 50 mL of M. oleifera extract (500 mg/L) into a fixed volume of POME (450 mL) at two feeding modes: daily, day 1 to day 30 (T3) and one-time, day 1 (T4). Treatments T1-T4 were conducted in an enclosed AD system for 30 days and the undesirable organic materials removal efficiencies i.e. BODremoval, TSSremoval and O&Gremoval were compared. POME co-digestion, T4, showed an improved 92% TSSremoval, 94% BODremoval and methane yield of 24.3 mL CH4/g COD removed. The results suggested that the nitrogen-fixing capabilities of anoxic microbial cells enhanced proliferation and growth encapsulated within the immobilisation media. Methanogen bacterial DNAs isolated from POME, granular sludge and anaerobically-treated POME were identified as Methanoculleus spp., Methanolinea spp. and Methanoculleus spp., respectively. Two-step complementary DNA (cDNA) and quantitative polymerase chain reaction (qPCR) confirmed the highest methanogen DNA concentration in T4. Therefore, the naturally occurring underutilised M. oleifera can be an organic coagulant for efficient POME co-digestion with an overall 69% and 59.5% higher methane yield and TSSremoval than mono-digestion.

Palm oil mill effluent (POME) is the primary source of water pollution in the oil palm industry. Most palm oil mills are employing a series of anaerobic and aerobic ponds for POME treatment, in order to comply with environmental regulation. In recent years, some mills are installed with biogas capture facilities in order to reduce the emission of greenhouse gas, as well as to raise some profits. In this work, a covered lagoon process for POME treatment, coupled with biogas production was modelled using commercial process simulation software SuperPro Designer v9.0. The simulation results revealed that 29 m3 of biogas can be produced per tonne of treated POME, with a removal efficiency of 92 % for its chemical oxygen demand (COD). Cost analysis has proven that the process is economically viable, with a net present values of $ 2,830,000, IRR of 14.3 %, and payback time of 4.66 years. Process optimisation revealed that the optimal recycle ratio of sludge should be set to 30 %, where the minimum net expenditure ($11,812/y) is achieved, with final effluent COD content of 18 ppm. Note that this takes into consideration of the trade-off between capital and operating costs.

Stem-cell based therapy is an emerging therapeutic approach for ischemic stroke treatment. Bone marrow stromal cells (BMSCs) are in common use as a cell source for stem cell therapy and show promising therapeutic outcomes for stroke treatment. One challenge is to develop a reliable tracking strategy to monitor the fate of BMSCs and assess their therapeutic effects in order to improve the success rate of such treatment. Herein, TPEEP, a fluorogen with aggregation-induced emission characteristics and near-infrared emission are designed and synthesized and further fabricated into organic nanoparticles (NPs). The obtained NPs show high fluorescence quantum yield, low cytotoxicity with good physical and photostability, which display excellent tracking performance of BMSCs in vitro and in vivo. Using a rat photothrombotic ischemia model as an example, the NP-labeled BMSCs are able to migrate to the stroke lesion site to yield bright red fluorescence. Immunofluorescence staining shows that the NP labeling does not affect the normal function of BMSCs, proving their good biocompatibility in vivo. These merits make TPEEP NP a potential cell tracker to evaluate the fate of BMSCs in cell therapy.

The gaseous neuromodulator H2S is associated with neuronal cell death pursuant to cerebral ischemia. As cystathionine β-synthase (CBS) is the primary mediator of H2S biogenesis in the brain, it has emerged as a potential target for the treatment of stroke. Herein, a "zipped" approach by alkene cross-metathesis into CBS inhibitor candidate synthesis is demonstrated. The inhibitors are modeled after the pseudo-C 2-symmetric CBS product (l,l)-cystathionine. The "zipped" concept means only half of the inhibitor needs be constructed; the two halves are then fused by olefin cross-metathesis. Inhibitor design is also mechanism-based, exploiting the favorable kinetics associated with hydrazine-imine interchange as opposed to the usual imine-imine interchange. It is demonstrated that the most potent "zipped" inhibitor 6S reduces H2S production in SH-SY5Y cells overexpressing CBS, thereby reducing cell death. Most importantly, CBS inhibitor 6S dramatically reduces infarct volume (1 h post-stroke treatment; ∼70% reduction) in a rat transient middle cerebral artery occlusion model for ischemia.

A feasible approach was studied for utilizing the harvested Lemna minor to treat Ni-Electroplating Waste Water (NEWW). The Lemna minor was pyrolyzed under oxygen-limited condition at various temperatures to produce biochar firstly and the optimal biochar was selected according to the yield of biochars and the adsorption capacity of biochars to treat the simulated Ni-containing wastewater. A combination method of pre-precipitation and biochar adsorption was proposed and validated by treatment of an actual NEWW. Results indicated that the biochar fabricated from Lemna minor at 400 °C (LM400) was the optimal biochar for Ni2+ adsorption and the adsorption capacity of LM400 was 41.68 mg/g. Precipitation with 5.0 g/L Ca(OH)2 succeeded by two-step adsorption with LM400 could yield qualified treatment streams when the actual NEWW was treated. Moreover, the adsorption mechanism of biochars to Ni2+ could mainly be ascribed to the complexation and ion-exchange reactions of Ni2+ in wastewater with the oxygen-containing functional groups and K+ ions of the biochar according to the results of FTIR and XRD. This study shows that Lemna minor is a viable raw material to produce strong adsorption biochar, which could be used as excellent adsorbents for heavy metals, such as Ni, Cu and Zn. Meanwhile, the actual NEWW treated with the combined process of two steps could meet discharge requirements.

Palm oil mill effluent has been extensively researched via three different technologies, namely chemical, physicochemical and biological treatment methods. Biological treatment by anaerobic and aerobic means is currently the most commonly used method for palm oil mill effluent. However, the greatest challenge posed by them is the inconsistent biological oxygen demand of 20 mg/L for the final treated effluent. Large amount of investment for additional polishing plant prior to the final discharge has been utilised intentionally to further reduce the biochemical oxygen demand values, but the problem remains unresolved. The performance of current palm oil mill effluent treatment system deployed by the industry was evaluated by comparing two different types of anaerobic treatments: open ponding and covered lagoon systems (with hydraulic and gas mixing). The covered lagoon with hydraulic mixing achieved the highest chemical oxygen demand, total suspended solids, total volatile solids and lignin removal efficiencies of >80% compared to other systems which showed

Oil and grease, carbohydrate, protein, and lignin are the main constituents of high strength wastewaters such as dairy wastewater, cheese whey wastewater, distillery wastewater, pulp and paper mill wastewater, and slaughterhouse wastewaters. These constituents have contributed to various operational problems faced by the high-rate anaerobic bioreactor (HRAB). During the hydrolysis stage of anaerobic digestion (AD), these constituents can be hydrolyzed. Since hydrolysis is known to be the rate-limiting step of AD, the overall AD can be enhanced by improving the hydrolysis stage. This can be done by introducing pretreatment that targets the degradation of these constituents. This review mainly focuses on the biological pretreatment on various high-strength wastewaters by using different types of enzymes namely lipase, amylase, protease, and ligninolytic enzymes which are responsible for catalyzing the degradation of oil and grease, carbohydrate, protein, and lignin respectively. This review provides a summary of enzymatic systems involved in enhancing the hydrolysis stage and consequently improve biogas production. The results show that the use of enzymes improves the biogas production in the range of 7 to 76%. Though these improvements are highly dependent on the operating conditions of pretreatment and the types of substrates. Therefore, the critical parameters that would affect the effectiveness of pretreatment are also discussed. This review paper will serve as a useful piece of information to those industries that face difficulties in treating their high-strength wastewaters for the appropriate process, equipment selection, and design of an anaerobic enzymatic system. However, more intensive studies on the optimum operating conditions of pretreatment in a larger-scale and synergistic effects between enzymes are necessary to make the enzymatic pretreatment economically feasible.

Recently, worldwide researchers have been focusing on exploiting of black soldier fly larval (BSFL) biomass to serve as the feed mediums for farmed animals, including aquaculture farming, in order to assuage the rising demands for protein sources. In this study, yeast was introduced into coconut endosperm waste (CEW) whilst serving as the feeding medium to rear BSFL in simultaneously performed in situ fermentation. It was found that at a 2.5 wt% yeast concentration, the total biomass gained, growth rate and rearing time were improved to 1.145 g, 0.085 g/day and 13.5 days, respectively. In terms of solid waste reduction, the inoculation of yeast over 0.5 wt% in CEW was able to achieve more than 50% overall degradation, with the waste reduction indexes (WRIs) ranging from 0.038 to 0.040 g/day. Disregarding the concentration of yeast introduced, the protein productivity from 20 BSFL was enhanced from only 0.018 g/day (the control) to 0.025 g/day with the presence of yeast at arbitrary concentrations. On the other hand, the larval protein yield was fortified from the control (28%) to a highest value of 35% with the presence of a mere 0.02 wt% yeast concentration. To summarize, the inclusion of a minimal amount of yeast into CEW for in situ fermentation ultimately enhanced the growth of BSFL, as well as its protein yield and productivity.

With the growing volume of palm oil production, palm oil mill effluent (POME) is an inevitable by-product that causes serious environmental hazards if discharged directly to the environment. This is mainly due to its high concentrations of chemical oxygen demand (COD) and biochemical oxygen demand (BOD). Note however that, with its high organic content, POME is a great source for biogas production. Therefore, POME pollution abatement coupled with biogas capture and utilisation are vital in order to promote sustainable development goal for the palm oil industry. Conventionally, POME is treated by employing open ponding system without capturing biogas released from the anaerobic process. This treatment system is inefficient, requires large footprint, long hydraulic retention time (HRT) and is unable to consistently comply with the proposed stringent BOD regulatory limit of 20 mg/L to be imposed by Department of Environment (DOE). Hence, the current POME treatment trend is gearing towards biogas capture technology and integrated POME treatment system with the ultimate aim of achieving zero discharge concept in the palm oil mill. This can be achieved by integrating several bioprocesses, with the aim to transform POME into value-added products. This chapter will discuss the current POME treatment and biogas capture technologies, as well as to identify issues and challenges faced by the palm oil miller which deters the development of biogas plants in the mill. Development of biogas from POME will no doubt contribute substantially in Malaysia’s renewable energy sector in the near future.

Introduction: Patients who visit ED after-office hours (AOH) often get discharged from ED and do not benefit from asthma counselling and treatment, resulting in repeated attendances. By providing an AOH trained nurse at ED, the A-CARE program aims to address this gap in the patient journey and address the problem of “frequent attenders” (FA) facing most EDs. We present the findings from our pilot asthma program. Methods: Data of all patients presenting to the Singapore General Hospital ED for asthma exacerbation between 11th Sep 2017 and 31st Jan 2018 when the A-CARE nurse was on duty was collected. Information collected included demographic data, asthma history and medications. Asthma AOH nurse provided counselling, checked inhaler techniques and gave written asthma action plans in addition to usual medical care provided at ED. Results: 98 asthma patients presented to ED with mean age of 47.8 ± 17.6, 48% were male. 45 patients were admitted and 47 patients (48%) were discharged from ED. Amongst those who were discharged, 36% (17/47) had at least 1 other ED visit in the last year for asthma exacerbation, 47% (22/47) were naive to inhaled corticosteroids (ICS) and only 36% (8/22) were prescribed ICS on discharge. 23% (5/22) of patients were not given systemic corticosteroids and 30% (14/47) of patients were discharged without any outpatient medical follow-up. Conclusion: Frequent AOH attendances to ED for asthma are common. Disconcordance to guidelines in our ED included suboptimal prescription of steroid burst and ICS as well as outpatient follow-up. Quality improvement initiatives are being planned to improve asthma care in the ED.

This study investigated how efficiently CaO2 could treat black-odor landscape water caused by low dissolved oxygen (DO) in a field experiment of 600 m2. The study demonstrated that CaO2 could significantly elevate the DO concentration in waters and the oxidation–reduction potential (ORP) level in sediments (p = 0.003 and p = 0), which is conducive to improving the anoxic environment of landscape water. The concentrations of total chemical oxygen demand (TCOD) and S2− in overlying and interstitial waters were considerably decreased. The average concentrations of TCOD in the overlying and interstitial waters of the test zone (TZ) were 52.98% and 66.05% of those of the control zone (CZ), and the average concentrations of S2− in the overlying and interstitial waters of TZ were 29.63% and 39.79% of those of CZ. Meanwhile, CaO2 could obviously reduce turbidity but increase the transparency in the overlying water. The mean value of turbidity in the overlying water of TZ was 39.46% of that of CZ, whereas the transparency in the overlying water of TZ was 2.07 times that of CZ. Furthermore, CaO2 changed the microbial community structure in the sediments, where the relative abundance of anaerobic bacteria was decreased but that of the aerobic bacteria was increased with some functional bacteria. In summary, CaO2 could significantly increase the DO and ORP in black-odor landscape water, obviously inhibit the release of pollutants from sediment, and increase the diversity of microbial strains. Consequently, the black-odor phenomenon of landscape water could be alleviated effectively by adding CaO2.

BACKGROUND: Despite the existence of guidelines for treating acute asthma patients in the emergency department (ED), compliance is often poor. We aimed to examine the compliance to treatment guidelines for asthma at our tertiary care teaching hospital’s ED and association with re-attendance rates. METHODS: We performed a retrospective analysis of electronic patient records of patients above 16 years old who presented to our ED with a primary diagnosis of asthma over a 6 month period in 2012. Patient demographics such as age, gender, history of previous intubations and hospitalisations were reviewed, as were the treatment administered during the ED visit and on discharge. Concordance of treatment was compared with the National Asthma Education and Prevention Program’s Expert Panel Report 3 (NAEPP EPR3) guidelines. Re-attendance rates to our ED within one year were then analysed. RESULTS: A total of 552 patients were included in the study. We found that 151 (27.4%) of patients reattended within the year, 35 (6.3%) returned more than twice. Low compliance to the EPR3 guidelines (p = 0.005), age of between 41 and 60 (p = 0.049), previous hospitalisations for asthma (p < 0.001) and non-use of recommended systemic corticosteroids (p = 0.020) in the ED predicted a higher re-attendance rate. Follow up care and medications on discharge were not signifi cant factors. CONCLUSION: Low compliance to recommended treatment by established guidelines is associated with higher re-attendance, as are middle age and previous hospitalisations. Besides managing pressures of time and resource limitations in the ED, an increased awareness of guidelines amongst doctors will improve asthma care.

Modulator of apoptosis 1 (MOAP-1) is a Bax-associating protein highly enriched in the brain. In this study, we examined the role of MOAP-1 in promoting ischemic injuries following a stroke by investigating the consequences of MOAP-1 overexpression or deficiency in in vitro and in vivo models of ischemic stroke. MOAP-1 overexpressing SH-SY5Y cells showed significantly lower cell viability following oxygen and glucose deprivation (OGD) treatment when compared to control cells. Consistently, MOAP-1−/− primary cortical neurons were observed to be more resistant against OGD treatment than the MOAP-1+/+ primary neurons. In the mouse transient middle cerebral artery occlusion (tMCAO) model, ischemia triggered MOAP-1/Bax association, suggested activation of the MOAP-1-dependent apoptotic cascade. MOAP-1−/− mice were found to exhibit reduced neuronal loss and smaller infarct volume 24 h after tMCAO when compared to MOAP-1+/+ mice. Correspondingly, MOAP-1−/− mice also showed better integrity of neurological functions as demonstrated by their performance in the rotarod test. Therefore, both in vitro and in vivo data presented strongly support the conclusion that MOAP-1 is an important apoptotic modulator in ischemic injury. These results may suggest that a reduction of MOAP-1 function in the brain could be a potential therapeutic approach in the treatment of acute stroke.

In consideration of severe eutrophication of scenic water caused by pollutants released from sediments in summer, calcium peroxide (CaO2) was adopted as the slow release peroxide to improve the water quality in a field experiment of 600 m2. The effect of CaO2 on the overlying water, interstitial water, sediment, and sediment microorganisms of scenic water was studied. Results for two months indicated that the dissolved oxygen (DO) concentration of the overlying water in the test zone was 3.78 times that in the control zone; the oxidation–reduction potential (ORP) in the overlying water and sediment increased significantly (p = 0.002 and p = 0). Meanwhile, CaO2 could effectively inhibit the release of nitrogen (N) and phosphorus (P) from the sediment and could obviously reduce the concentrations of N and P in the overlying water by enhancing the microbiological action. Moreover, the average concentrations of total nitrogen and total phosphorus in the overlying water of the test zone were 46.27% and 50.51% of those in control zone, respectively, and the concentrations of N and P in the interstitial water decreased during the entire experiment. In addition, CaO2 decreased the relative abundance of anaerobic bacteria in the sediment, whereas it increased that of aerobic bacteria and promoted the appearance of the functional bacteria, such as Nitrospirae and Thermodesulfoba. In conclusion, CaO2 can improve the DO and ORP in the eutrophic water effectively and change the microbial community in the sediment to a certain extent, thereby controlling the pollutants released from the sediment and reducing the N and P concentrations in the overlying water. Thus, CaO2 can effectively realize the purification and restoration of the severely eutrophic scenic water.

An optimization study on the mesophilic anaerobic treatment of palm oil mill effluent (POME) in an up-flow anaerobic sludge blanket–hollow centered packed bed (UASB–HCPB) reactor was conducted for the first time by using kinetics modeling. Monod model was opted for the optimization due to its capability of describing the anaerobic digestion and the involvement of adequate amount of parameters in the kinetics model. The best-fit kinetic constants obtained from previous work were incorporated in the optimization model. Fuzzy optimization was adopted and it yielded the optimized chemical oxygen demand (COD) removal of 86.7% and volumetric methane production rate of 0.448 LCH 4 /L.day at hydraulic retention time (HRT) of 4.33 days, organic loading rate (OLR) of 14.75 gCOD/L.day and mixed liquor volatile suspended solid (MLVSS) concentration of 19,130 mg/L. A confirmative experiment was conducted and the results validate the legitimacy of the fuzzy optimization model. Further studies are required to improve the reliability of this newly introduced optimization technique in the wastewater treatment industry.

With the growth of aging population, elder care service has become an important part of the service industry of Internet of Things. Activity monitoring is one of the most important services in the field of the elderly care service. In this paper, we proposed a wearable solution to provide an activity monitoring service on elders for caregivers. The system uses wireless signals to estimate calorie burned by the walking and localization. In addition, it also uses wireless motion sensors to recognize physical activity, such as drinking and restroom activity. Overall, the system can be divided into four parts: wearable device, gateway, cloud server, and caregiver's android application. The algorithms we proposed for drinking activity are Decision Tree (J48) and Random Forest (RF). While for restroom activity, we proposed supervised Reduced Error Pruning (REP) Tree and Variable Order Hidden Markov Model (VOHMM). We developed a prototype service Android app to provide a life log for the recording of the activity sequence which would be useful for the caregiver to monitor elder activity and its calorie consumption.

A floating bed (FB) system vegetated with calamus, iris, lythrum, and Hydrocotyle vulgaris, and a strengthened FB (SFB) system with zeolite and sponge iron as fillers were simultaneously applied to purify urban landscape water in different zones. The urban landscape water, an artificial lake of approximately 326m2, was supplied with reclaimed water during a six-month experiment. Results indicated that the concentrations of nitrogen (N) and phosphorus (P) in the SFB zone (SFBZ) were significantly lower than those in the control zone (CZ) and the FB zone (FBZ) after six months of operation. The average removal efficiencies (AREs) in the SFBZ, FBZ and CZ were 89.98%, 77.39% and 56.37%, respectively, for ammonia nitrogen (NH4+-N); 92.49%, 79.55% and 47.85%, respectively, for phosphate (PO43--P). Meanwhile, the average concentration of Chlorophyll a and the algae density in SFBZ during the experiment were 12.54μg/L and 1.31×104cells/mL, which were lower, obviously, than those in the FBZ and CZ. Moreover, the contribution rates analysis of nutrient removal exhibited that the plant absorption in the removal of N and P occupied 27.85% and 26.36%, whereas the filler adsorption occupied 7.93% and 11.93%, respectively, in the SFB. Thus, the water quality of the artificial lake was improved greatly by the SFB which hybridized fillers and FB together. Finally, it was found that the AREs of NH4+-N and PO43--P in the SFBZ could reach 73.93% and 84.56%, approximately 1.39 and 1.41 times that of the FBZ during the winter. Therefore, the application of an SFB can keep a stable water quality in urban landscape water and avoid the lower removal rate of an FB at low-temperature. In summary, the SFB could effectively improve the water quality of urban landscape water supplied with reclaimed water even in winter.

The advance of thrombolytic therapy has been hampered by the lack of optimization of the therapy during the hyperacute phase of focal ischemia. Here, we investigate neurovascular dynamics using a custom-designed hybrid electrocorticography (ECoG)-functional photoacoustic microscopy (fPAM) imaging system during the hyperacute phase (first 6 h) of photothrombotic ischemia (PTI) in male Wistar rats following recombinant tissue plasminogen activator (rtPA)-mediated thrombolysis. We reported, for the first time, the changes in neural activity and cerebral hemodynamic responses following rtPA infusion at different time points post PTI. Interestingly, very early administration of rtPA (< 1 h post PTI) resulted in only partial recovery of neurovascular dynamics (specifically , neural activity recovered to 71 ± 3.5% of baseline and hemodynamics to only 52 ± 2.6% of baseline) and late administration of rtPA (> 4 h post PTI) resulted in the deterioration of neurovascular function. A therapeutic window between 1 and 3 h post PTI was found to improve recovery of neurovascular function (i.e. significant restoration of neural activity to 93 ± 4.2% of baseline and hemodynamics to 81 ± 2.1% of baseline, respectively). The novel combination of fPAM and ECoG enables direct mapping of neurovascular dynamics and serves as a platform to evaluate potential interventions for stroke.

Bmi1 is overexpressed in gastrointestinal cancers, including colorectal cancer (CRC); however, its role as a non-invasive biomarker in CRC has not been established. The aim of this study was to compare the plasma Bmi1 mRNA levels prior to and following curative resection of the primary tumor in CRC patients and to determine their association with the clinicopathological parameters. The plasma Bmi1 mRNA level was measured by quantitative polymerase chain reaction and expressed as cycle threshold value. There was no significant difference between the overall pre- and postoperative plasma Bmi1 mRNA level (31.73±2.63 vs. 31.93±2.88, respectively; P=0.614) in 45 CRC patients. However, when grouped into non-metastatic and metastatic CRC patients, the postoperative Bmi1 transcript level was found to be significantly lower compared to the preoperative level in patients with non-metastatic CRC (32.13±2.677 31.44±2.764, respectively; P=0.041), whereas there was a trend towards a higher postoperative Bmi1 transcript level compared to the preoperative level in the metastatic counterpart (30.85±3.916 vs. 33.27±0.718, respectively; P=0.164). Furthermore, when the patients were categorized into two groups according to their plasma Bmi1 postoperative vs. preoperative level status, we observed that patients without a reduction in the postoperative plasma Bmi1 mRNA levels exhibited a significantly higher rate of distant metastasis following primary resection (P=0.017) and a significantly worse prognosis regarding disease-free survival (P=0.016) when compared to the reduced postoperative plasma Bmi1 level counterparts. In conclusion, plasma Bmi1 mRNA levels may serve as a non-invasive biomarker for monitoring occult metastasis and predicting the development of distant metastasis.

Optimization of an integrated anaerobic-aerobic bioreactor (IAAB) treatment system for the reduction of organic matter (Chemical Oxygen Demand (COD), Biochemical Oxygen Demand (BOD) and Total Suspended Solids (TSS) concentrations) in Palm Oil Mill Effluent (POME) to legal standards with high methane yield was performed for the first time under thermophilic condition (50°C–55°C) by using response surface methodology (RSM). The experiments were conducted based on a central composite rotatable design (CCRD) with three independent operating variables, organic loading rates in anaerobic compartment (OLRan) and mixed liquor volatile suspended solids (MLVSS) concentration in anaerobic (MLVSSan) and aerobic compartments (MLVSSa). The optimum conditions for the POME treatment were determined as OLRan of 15.6 g COD·L−1·d−1, MLVSSan of 43100 mg·L−1, and MLVSSa of 18600 mg·L−1, where high aerobic COD, BOD and TSS removal efficiencies of 96.3%, 97.9%, and 98.5% were achieved with treated BOD of 56 mg·L−1 and TSS of 28 mg·L−1 meeting the discharge standard. This optimization study successfully achieved a reduction of 42% in the BOD concentrations of the final treated effluent at a 48% higher OLRan as compared to the previous works. Besides, thermophilic IAAB system scores better feasibility and higher effectiveness as compared to the optimized mesophilic system. This is due to its higher ability to handle high OLR with higher overall treatment efficiencies (more than 99.6%), methane yield (0.31 L CH4·g−1 CODremoved) and purity of methane (67.5%). Hence, these advantages ascertain the applicability of thermophilic IAAB in the POME treatment or even in other high-strength wastewaters treatment.