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The heat treatment of nutshells, followed by the densification of its biochar particles, can be used as a process to improve its quality for use as a solid fuel. In this study, Taguchi method, gray relational analysis (GRA), and analysis of variance (ANOVA) were used to elucidate the effect of compressive force, particle size, and binder content on physical properties of biochar briquettes produced from nutshells, they were also used to determine the optimum conditions of compressing the fuel briquettes. The percentage contribution of each controllable factor was also determined. The solid fuel briquettes were produced by compacting the mixture of the ground biochar and the binder (molasses) at ambient temperature, using a piston and mold process. The results showed that the obtained biochar has a good fuel quality; the amount of binder is the most influent parameter; and that the energy briquettes obtained under the optimal conditions (compressive force of 112 MPa; binder amount of 40%; particle size <200 µm) present a high density, high calorific value, and a good compressive strength. [ABSTRACT FROM AUTHOR]

Producing electricity at an affordable price while taking into account environmental concerns has become a major challenge in Morocco. Moreover, the technical and financial issues related to renewable electricity plants are still hindering their efficient integration in the country. In fact, the energy sector (both electricity and heat) accounted for more than half of all Greenhouse Gases (GHG) emissions in the kingdom due to the major reliance on fossil fuels for answering the growing local demand. The key strategies to alleviate this critical situation include the integration of more renewable energies in the total energy mix and the enhancement of energy efficiency measures in different sectors. This paper strives to (1) evaluate the potential of carbon dioxide mitigation in Moroccan electricity sector following the actual and projected strategies and (2) highlight the policy schemes to be taken in order to achieve the ambitious carbon dioxide mitigation targets in the mid-term. A system dynamics model was built in order to simulate different scenarios of carbon dioxide mitigation policies up to 2030. The results shows that the achievement of renewable energies projects by 2030 could save 228.143 MtCO2 between 2020 and 2030 and an additional 18.127 MtCO2 could be avoided in the same period by enhancing energy efficiency measures.

Renewable energies have been considered as alternative, clean, available, and ecological sources of energy. The production of biochar from biomass by thermochemical means is considered an efficient method of converting biomass for energy production. In this study, the biochars were produced from the biomasses of peanut shells and sugar cane bagasse at different pyrolysis temperatures (400°C, 450°C, and 500°C). The biomass samples and their produced biochars were characterized using calorific value, Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy and energy dispersive X-ray spectrometry (SEM and EDX), compressibility index, and combustion behavior in order to analyze their potential. Experimental results showed that biochar has better fuel qualities compared to raw biomass. We also found that increasing the pyrolysis temperature clearly improved the calorific value, the morphology, the porosity of the biochars as well as the compressibility index of the biochars. The interest of this study was to produce renewable biochar from peanut shell waste and sugar cane bagasse for use as solid fuel., Competing Interests: On behalf of all authors, the corresponding author states that there are no conflicts of interest., (Copyright © 2022 Chaimaa Hadey et al.)

Energy security is a multi-dimensional concept that is gaining a growing interest worldwide for studying the sustainability of a given energy sector. The level of energy security has been always quantified and evaluated by focusing on economic and technical dimensions, and modest importance was attributed to social and environmental aspects. Moreover, countries of the Middle East and North Africa (MENA) region were always under-reported in the literature pertaining to energy security issues. This study strives to evaluate energy security in this region through the establishment of an original Environmental Energy Security Index (EESI) in order to cover different dimensions of security of energy supply within these counties. A total of nine sub-indicators were selected based on the current policies and orientations in the region. These indicators were normalized, weighted, and aggregated for each country of the MENA region between 2008 and 2017. According to the assessment objectives, results showed that on average Yemen holds the highest EESI score of 5.319 followed by Morocco 4.304 and Algeria 4.087. On the other hands, Bahrain is ranked last 1.610 preceded by UAE 2.249 and Qatar 2.461. Some key proposals were suggested including investment in local resources, diversification of the energy mix, reduction of energy imports, and use of energy-efficient technologies., (© The Author(s), under exclusive licence to Springer Nature B.V. 2021.)

In recent years, conversational agents (CAs) have become ubiquitous and are a presence in our daily routines. It seems that the technology has finally ripened to advance the use of CAs in various domains, including commercial, healthcare, educational, political, industrial, and personal domains. In this study, the main areas in which CAs are successful are described along with the main technologies that enable the creation of CAs. Capable of conducting ongoing communication with humans, CAs are encountered in natural-language processing, deep learning, and technologies that integrate emotional aspects. The technologies used for the evaluation of CAs and publicly available datasets are outlined. In addition, several areas for future research are identified to address moral and security issues, given the current state of CA-related technological developments. The uniqueness of our review is that an overview of the concepts and building blocks of CAs is provided, and CAs are categorized according to their abilities and main application domains. In addition, the primary tools and datasets that may be useful for the development and evaluation of CAs of different categories are described. Finally, some thoughts and directions for future research are provided, and domains that may benefit from conversational agents are introduced.

Introduction: Internal hernias are uncommon and are defined by the protrusion of a viscus through intraperitoneal defects. Left paraduodenal hernias (LPDH) are the most common type of congenital internal hernia (CIH). We report a clinical case of a patient with a small bowel obstruction (SBO) due to a LPDH., Case Presentation: An elderly patient, with negative surgical history, presented to the emergency room with abdominal pain and vomiting. Clinical and radiologic investigations were consistent with SBO due to an internal hernia. During laparotomy, a large LPDH containing dilated small bowel loops was identified. The hernia contents were reduced and the opening was closed with non-absorbable sutures. The post-operative course was uneventful without signs of recurrence at follow up., Discussion: LPDH result from absence of retroperitoneal fixation of the descending colon mesentery. Usually, patients are asymptomatic and LPDH are incidental findings detected on imaging and/or during laparotomy. However, LPDH may lead to acute SBO therefore a high index of clinical suspicion and preoperative imaging is crucial to make an early diagnosis., Conclusion: CIH is a rare condition due to embryologic developmental abnormalities. Their diagnosis is based on pathognomonic findings on computed tomography scanner (CTscan). Surgical treatment is the mainstay treatment. Delay diagnosis of strangulated CIH is associated with significant morbidity andmortality., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Ectopic pancreas is most commonly found in the jejunum and stomach. Most patients remain asymptomatic, and the diagnosis is usually made at autopsy or incidentally. We report here 2 cases of intestinal occlusion, secondary to an ectopic pancreatic tissue. Both cases were managed successfully by laparoscopy and laparotomy with subsequent segmental intestinal resection., Case Presentations: Case 1 - An elderly patient presented to the ER because of intestinal occlusion. Paraclinical investigations were consistent with occlusion, with ileal suffering signs on CT-scan. After laparotomy and segmental intestinal resection were done, histopathalogy showed evidence of ectopic pancreas obstructing the intestinal lumen. Case 2 - A young man presented to the ER with acute onset of epigastric pain. signs of peritoneal irritation. Ct-scan showed evidence of small bowel intussusception. Exploratory laparoscopy was done, and confirmed the diagnosis. The intussusceptum was at the level of the proximal jejunum. The suffering intestinal part was exteriorized and then resected. Histopathology was consistent with an ectopic pancreas., Discussion: Symptomatic ectopic pancreas is extremely rare. Symptoms may include, bleeding, intestinal occlusion and intussusception. Few similar cases have been reported in the literature, and the current ones are to be added., Conclusion: As mentioned above, ectopic pancreatic tissue rarely causes symptoms. We presented 2 cases that presented 2 possible complications secondary to this pathology. Both cases were managed successfully., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Cholecystectomy is one of the most frequently done procedures in general surgery. There are few reports of amputation neuromas following this procedure. This presentation describes a case of obstructive jaundice due to amputation neuroma in a patient with a history of cholecystectomy., Case Presentation: We report about a 53 y o lady who presented with obstructive jaundice, 8 years following open cholecystectomy. Paraclinical investigations were in favor of cholangicarcinoma, however the final pathology revealed an amputation neuroma of the CBD., Discussion: Amputation neuromas are rarely seen in the era of laparoscopic cholecystectomy. They are benign reparative lesions of the CBD following surgery or manipulation of the extra hepatic biliary tree. It is very difficult to diagnose them pre-operatively. Surgical resection is the first choice of treatment., Conclusion: Traumatic neuromas should always be among the differential diagnosis, when assessing a CBD mass in patients with a previous history of open cholecystectomy or surgery to the gastrointestinal tract., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Pre-existing renal lesions (PERL) may interfere with the patho-physiology of trauma, alter the radiographic imaging and influence the therapeutic approach. The aims of this study were to record the PERL found incidentally during blunt renal trauma, to specify the place for effective conservative management and to determin the estimated partial permanent disability (PPD)., Patients and Methods: The medical records of 14 patients with PERL and blunt renal trauma were reviewed. In each patient, pre-existing renal abnormalities, clinical symptoms, CT scan study findings, associated injuries, therapeutic approach, the accountability criteria and the estimated PPD were recorded., Results: There were 11 men and 3 women with a mean age of 35,6 years (range 19-66 years). Renal trauma was due to a traffic accident in 8 patients. Renal damage appeared to be disproportionate to the severity of the trauma (minor trauma). They had a lower rate of associated trauma to other abdominal organs (four patients only). Urinary stones were present in 5 patients, pelvi-ureteric junction obstruction in 3, horseshoe kidny in 3, ectopic kidney in 2 and upper urinary tract carcinoma in one case. Early nephrectomy was required in three cases for hemodynamic instability. Ureteral stenting was indicated in 3 cases. Six patients were operated later because of their underlying renal pathology. A conservative treatment was possible only in 7 of cases. The PPD related to renal trauma varide from 0 to 13% in all cases., Conclusion: PERL may complicate a negligible renal trauma while in some cases they may be of vital importance for the patient's final outcome. The imaging findings are crucial but may be confusing. The therapeutic approach is, to a large extent, dependent on the type of PERL and the severity of damage, and is often conservative in the hemo-dynamically stable patient. Accountability link may be difficult to establish and the PPD depends on the PERL and the renal injuries severity., Funding: We have no involvement with funding in this case. Ethical approval: Not required Conflicts of interest: None.

Ilio-caval fistula is a rare complication of lumbar disk surgery that may pose a real diagnostic challenge. We report a case of a 50-year-old woman with overlooked massive right ilio-caval fistula complicating lumbar surgery 6 years previously, and who presented with refractory right heart failure misdiagnosed as chronic pericarditis. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. < Learning objective: Ilio-caval fistula is a rare vascular complication of low lumbar disk surgery often overlooked, which explains the frequency of late discovery cases due to the semiological polymorphism of the presentation. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. The treatment could be based on surgery or endovascular intervention; the prognosis remains good in treated patients.>.

Cardiac diverticulum is an infrequent congenital malformation, it's even more rare in adulthood. It's often associated with other thoraco-abdominal diverticulums, and rarely isolated. The diagnosis relies on echocardiography. By the way, the magnetic resonance imagery (MRI) allows a finer analysis of the diverticulum, its topography and its situation contributed to vascular and cardiac structures, it has largely replaced the ventriculography. We report in this article the case of a patient of 36 years whose diagnosis of the diverticulum was made by transthoracic echocardiography (TTE) at the time of an assessment of dyspnea, this exam also objectified a mitral insufficiency by deformation and dilatation of the mitral annulus. Radiological assessment was completed by a transoesophageal echocardiography (TOE) and magnetic resonance imagery (MRI). Surgical treatment consisted of surgical closing of the diverticulum and mitral annuloplasty., (Copyright © 2012. Published by Elsevier SAS.)

Objectives: To determine the predictive factors of prostate-specific antigen (PSA) recurrence after salvage radiotherapy (RT) for biochemical recurrence following radical prostatectomy (RP) to identify patients who may benefit from this treatment., Methods: From June 1992 to January 2002, 62 patients experiencing PSA recurrence after RP were treated with RT at a dose of 65 Gy. No patient received hormonal therapy. PSA recurrence after RT was defined as three consecutive increased PSA measurements. The risk of experiencing PSA recurrence after RT was analyzed according to 10 factors: patient age, pre-RP PSA level, pathologic stage, Gleason score, surgical margin status, PSA nadir after RP, time to PSA recurrence after RP, pre-RT PSA level, PSA nadir after RT, and length of follow-up after RT., Results: With a mean follow-up of 44 months (range 3 to 110), 23 patients (37.1%) experienced PSA recurrence after RT. Using univariate analysis, six factors were found to be predictive of PSA recurrence after RT: the length of follow-up after RT (P <0.0001), PSA nadir after RP (P = 0.0004), time to PSA recurrence after RP (P = 0.003), pre-RP PSA level (P = 0.008), Gleason score (P = 0.011), and pre-RT PSA level (P = 0.028). Using multivariate analysis, only the Gleason score (P = 0.015) and length of follow-up after RT (P = 0.02) were found to be predictive of PSA recurrence after RT. A Gleason score greater than 7 was a significant predictor of PSA recurrence after salvage RT (P = 0.04)., Conclusions: In our experience, the Gleason score and length of follow-up were the sole independent predictors of PSA recurrence after salvage RT. Our findings suggest that patients with a Gleason score of 7 or less are more likely to benefit from salvage RT after RP and that the durability of the PSA response may be only transient.

Massive hemorrhagic necrosis (MHN) of the liver following orthotopic liver transplantation (OLT) occurs infrequently during an otherwise uneventful recovery 1 week after OLT. It is characterized by fever and sudden deterioration of allograft function leading to failure in the absence of vascular thrombosis. The etiology is unknown, although it is usually preceded by some degree of allograft rejection. Between 6 and 8 days after OLT, four patients (out of 150) became febrile, hypotensive, and experienced a rapid rise in transaminases within 48 hr. Two patients had evidence of mild rejection; the other two had moderate to severe acute cellular rejection. All patients were ABO identical, crossmatch negative. Bolus steroids were given followed by OKT3 in the two patients with severe rejection. Although sepsis was suspected, antibiotic therapy did not ameliorate the clinical course. Each patient progressed to MHN with severe centrilobular necrosis and variable portal infiltrate. High levels of interferon-gamma and tumor necrosis factor-alpha occurred prior to the rise in transaminases in each MHN patient (155 +/- 39 pg/ml and 414 +/- 201 pg/ml, respectively) compared with levels in OLT patients with severe rejection (14 +/- 4 pg/ml and 26 +/- 5 pg/ml, respectively, P < 0.05). These data support the concept of a cytokine-mediated inflammatory response leading to a univisceral Shwartzman reaction in the transplanted liver. Early recognition of this syndrome and retransplantation are critical for survival.

Purpose: To determine the advantages of using transcatheter sclerotherapy to treat renal allograft-related lymphoceles., Materials and Methods: Eighteen patients first seen with symptomatic lymphoceles secondary to renal transplantation were treated with povidone-iodine percutaneous sclerotherapy. Percutaneous catheters were place by means of sonographic, computed tomographic, or combined fluoroscopic and sonographic guidance. Sclerotherapy was initiated while patients were in the hospital, and the patients then instilled povidone-iodine twice a day at home., Results: One patient had an inadequate trial period of therapy and was not included in the analysis. Seventeen lymphoceles were adequately sclerosed. Average length of treatment was 35 days. Three lymphoceles recurred and were effectively treated percutaneously. Follow-up studies showed no recurrence 1 month to 2 years after completion of therapy. No patient needed surgery for lymphocele repair., Conclusion: Because of its safety and efficacy, percutaneous transcatheter sclerotherapy with povidone-iodine should be the treatment of choice in patients with lymphoceles that develop after renal transplantation.

We report a patient who at the time of kidney transplantation for polycystic kidney disease was found to have an enlarged inguinal lymph node which later demonstrated evidence of extra medullary granulopoiesis. During the first two weeks following kidney transplantation, a striking leukemoid pattern developed and 2 months after transplant the patient was diagnosed with acute myelogenous leukemia (AML). Retrospective analysis of peripheral blood cytokines over this time revealed elevated levels of GMCSF and gamma IFN at the time of peak peripheral blood WBC with subsequent peaks in IL-4, IL-6 and IL-2 as the peripheral blood WBC fell. A rise in levels of TNF alpha also preceded the peripheral blood WBC rise (although these concentrations were at or below those following uncomplicated kidney transplants). The clinical course of AML in this patient was marked by relentless relapse despite chemotherapy. The possibility of cytokine facilitated tumor growth is discussed.

A small number of kidney transplant recipients abruptly lose function secondary to acute renal artery or vein thrombosis or more rarely a form of necrotizing vasculitis. We report a group of four kidney transplant recipients who lost renal function and share the following features: (1) diabetes (type I, insulin-dependent diabetes mellitus, type II or steroid-induced); (2) abrupt change/loss of renal function; (3) a concomitant clinical event (fever, viral symptoms, menometrorrhagia, viremia, bacteremia); (4) severe necrotizing vasculitis with hemorrhagic necrosis on histopathology; (5) patent renal artery and vein at time of transplant nephrectomy (i.e., no vascular thrombosis); and (6) high levels of peripheral serum gamma-IFN 1-5 days before transplant nephrectomy (467 +/- 175 pg/ml) compared with that of patients experiencing severe rejection (8.4 +/- 3.7 pg/ml) (P < 0.002). These data support the concept of a cytokine (IFN-gamma)-mediated accelerated inflammatory response resulting in graft loss from necrotizing vasculitis--the clinical equivalent of an organ-specific Shwartzman reaction.