Divergent responses of phosphorus solubilizing bacteria with P-laden biochar for enhancing nutrient recovery, growth, and yield of canola (Brassica napus L.).

The growing global population has led to a heightened need for food production, and this rise in agricultural activity is closely tied to the application of phosphorus-based fertilizers, which contributes to the depletion of rock phosphate (RP) reserves. Considering the limited P reserves, different approaches were conducted previously for P removal from waste streams, while the adsorption of ions is a novel strategy with more applicability. In this study, a comprehensive method was employed to recover phosphorus from wastewater by utilizing biochar engineered with minerals such as calcium, magnesium, and iron. Elemental analysis of the wastewater following a batch experiment indicated the efficiency of the engineered biochar as an adsorbent. Subsequently, the phosphorus-enriched biochar, hereinafter (PL-BCsb), obtained from the wastewater, underwent further analysis through FTIR, XRD, and nutritional assessments. The results revealed that the PL-BCsb contained four times higher (1.82%) P contents which further reused as a fertilizer supplementation for Brassica napus L growth. PL-BCsb showed citric acid (34.03%), Olsen solution (10.99%), and water soluble (1.74%) P desorption. Additionally, phosphorous solubilizing bacteria (PSB) were incorporated with PL-BCsb along two P fertilizer levels P45 (45 kg ha-1) and P90 (90 kg ha-1) for evaluation of phosphorus reuse efficiency. Integrated application of PL-BCsb with half of the suggested amount of P45 (45 kg ha-1) and PSB increased growth, production, physiological, biochemical, and nutritional qualities of canola by almost two folds when compared to control. Similarly, it also improved soil microbial biomass carbon up to four times, alkaline and acid phosphatases activities both by one and half times respectively as compared to control P (0). Furthermore, this investigation demonstrated that waste-to-fertilizer technology enhanced the phosphorus fertilizer use efficiency by 55-60% while reducing phosphorus losses into water streams by 90%. These results have significant implications for reducing eutrophication, making it a promising approach for mitigating environmental pollution and addressing climate change.

The Use of Noninvasive Scores in Predicting NAFLD Progression After Bariatric Surgery.

BACKGROUND: Bariatric surgery has been postulated to impact liver function resulting in favorable effects on nonalcoholic fatty liver disease (NAFLD). We aimed to analyze the long-term impact of bariatric surgery on noninvasive scores predicting the progression of liver fibrosis in a bariatric population. METHODS: We retrospectively reviewed the records of patients without pre-existing liver disease who underwent sleeve gastrectomy or Roux-en-Y gastric bypass (RYGB) at our center between 2010 and 2018. Four predictive scores for liver fibrosis (AST/ALT, APRI, Fib-4, and BARD) were calculated preoperatively, 6 months post-operatively, and annually up to 5 years. Correlations were analyzed with Pearson R. Subgroup and sensitivity analyses were performed to identify populations at increased risk. RESULTS: A total of 2769 patients were included. The mean age was 40 years, and the majority was females (88.5%) and of Hispanic ethnicity (59.2%). There was a steady post-operative increase in the percentage of patients at increased risk of progression of liver fibrosis. The Fib-4 score showed the largest increase in the population at risk for liver fibrosis (11.3% preoperatively to 28.9% at 5 years). Patients with diabetes and those who underwent a sleeve gastrectomy continued to display a higher risk for liver fibrosis than did patients without diabetes and those who underwent RYGB, respectively. CONCLUSION: There was an overall trend to increased liver fibrosis scores over the 5-year post-operative follow-up, but this increase remained lower than that reported in previous literature. Bariatric surgery offers NAFLD risk reduction in a high-risk population.

An optimized multi-attribute decision-making approach to construction supply chain management by using complex picture fuzzy soft set.

Supplier selection is a critical decision-making process for any organization, as it directly impacts the quality, cost, and reliability of its products and services. However, the supplier selection problem can become highly complex due to the uncertainties and vagueness associated with it. To overcome these complexities, multi-criteria decision analysis, and fuzzy logic have been used to incorporate uncertainties and vagueness into the supplier selection process. These techniques can help organizations make informed decisions and mitigate the risks associated with supplier selection. In this article, a complex picture fuzzy soft set (cpFSS), a generalized fuzzy set-like structure, is developed to deal with information-based uncertainties involved in the supplier selection process. It can maintain the expected information-based periodicity by introducing amplitude and phase terms. The amplitude term is meant for fuzzy membership, and the phase term is for managing its periodicity within the complex plane. The cpFSS also facilitates the decision-makers by allowing them the opportunity to provide their neutral grade-based opinions for objects under observation. Firstly, the essential notions and set-theoretic operations of cpFSS are investigated and illustrated with examples. Secondly, a MADM-based algorithm is proposed by describing new matrix-based aggregations of cpFSS like the core matrix, maximum and minimum decision value matrices, and score. Lastly, the proposed algorithm is implemented in real-world applications with the aim of selecting a suitable supplier for the provision of required materials for construction projects. With the sensitivity analysis of score values through Pythagorean means, it can be concluded that the results and rankings of the suppliers are consistent. Moreover, through structural comparison, the proposed structure is proven to be more flexible and reliable as compared to existing fuzzy set-like structures.

Bio-Organically Acidified Product-Mediated Improvements in Phosphorus Fertilizer Utilization, Uptake and Yielding of Zea mays in Calcareous Soil.

The demand for a better agricultural productivity and the available phosphorus (P) limitation in plants are prevailing worldwide. Poor P availability due to the high pH and calcareous nature of soils leads to a lower P fertilizer use efficiency of 10-25% in Pakistan. Among different technologies, the use of biologically acidified amendments could be a potential strategy to promote soil P availability and fertilizer use efficiency (FUE) in alkaline calcareous soils. However, this study hypothesized that an acidified amendment could lower soil pH and solubilize the insoluble soil P that plants can potentially uptake and use to improve their growth and development. For this purpose, the test plant Zea mays was planted in greenhouse pots with a recommended dose rate of 168 kg ha-1 of P for selected phosphatic fertilizers, viz., DAP (diammonium phosphate), SSP (single superphosphate), and RP (rock phosphate) with or without 2% of the acidified product and a phosphorus solubilizing Bacillus sp. MN54. The results showed that the integration of acidified amendments and PSB strain MN54 with P fertilizers improved P fertilizer use efficiency (FUE), growth, yield, and P uptake of Zea mays as compared to sole application of P fertilizers. Overall, organic material along with DAP significantly improved plant physiological-, biochemical-, and nutrition-related attributes over the sole application of DAP. Interestingly, the co-application of RP with the acidified product and MN54 showed a higher response than the sole application of DAP and SSP. However, based on our study findings, we concluded that using RP with organic amendments was a more economically and environmentally friendly approach compared to the most expensive DAP fertilizer. Taken together, the current study suggests that the use of this innovative new strategy could have the potential to improve FUE and soil P availability via pH manipulation, resulting in an improved crop productivity and quality/food security.

Unrevealing the potential of microbes in decomposition of organic matter and release of carbon in the ecosystem.

Organic matter decomposition is a biochemical process with consequences affecting climate change and ecosystem productivity. Once decomposition begins, C is lost as CO2 or sequestered into more recalcitrant carbon difficult to further degradation. As microbial respiration releases carbon dioxide into the atmosphere, microbes act as gatekeepers in the whole process. Microbial activities were found to be the second largest CO2 emission source in the environment after human activities (industrialization), and research investigations suggest that this may have affected climate change over the past few decades. It is crucial to note that microbes are major contributors in the whole C cycle (decomposition, transformation, and stabilization). Therefore, imbalances in the C cycle might be causing changes in the entire carbon content of the ecosystem. The significance of microbes, especially soil bacteria in the terrestrial carbon cycle requires more attention. This review focuses on the factors that affect microorganism behavior during the breakdown of organic materials. The key factors affecting the microbial degradation processes are the quality of the input material, nitrogen, temperature, and moisture content. In this review, we suggest that to address global climate change and its effects on agricultural systems and vice versa, there is a need to double-up on efforts and conduct new research studies to further evaluate the potential of microbial communities to reduce their contribution to terrestrial carbon emission.

Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study.

BACKGROUND: Research has shown that 20-30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. AIMS: To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. METHOD: We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16-25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. RESULTS: In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI -2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. CONCLUSIONS: ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.

Breeding Practice Improves the Mycorrhizal Responsiveness of Cotton (Gossypium spp. L.).

Maximizing the function of indigenous arbuscular mycorrhizal (AM) fungi by choosing specific crop genotypes offers one of the few untapped opportunities to improve the sustainability of agriculture. In this study, the differences in mycorrhizal responsiveness (MR) in plant growth and shoot phosphorus (P) content among cotton (Gossypium spp. L.) genotypes from different release dates were compared and then the relationships between MR and P uptake-related traits were determined. The experimental design in a greenhouse included 24 genotypes released from 1950 to present in Xinjiang Province, inoculation with or without AM fungi, and P levels (15 and 150 mg P kg-1 added as KH2PO4). Results showed that the modern cotton genotypes exhibited a higher degree of mycorrhizal colonization, the hyphal length density (HLD), and mycorrhizae-induced changes in shoot growth than the old genotypes when inoculated with indigenous AM fungi at both the P levels. Moreover, MR was highly correlated with the HLD at low P levels and the HLD may provide useful insights for future cotton breeding aimed at delivering crop genotypes that can benefit more from AM fungi.

Synchronous presentation of acute cholecystitis and acute appendicitis successful treatment in one step laparoscopic procedure. A case series and literature review.

INTRODUCTION: Hundreds of thousands of cholecystectomies and appendectomies are performed in the United States annually. Due to the prevalence of cholecystitis and appendicitis, a subset of patients will require both operations. The limited literature describing these patients supports a laparoscopic approach over open surgery; consistent with the advantages of laparotomy over open surgery in the treatment of each condition individually. CASE PRESENTATION: We report two cases where a patient presented with cholecystitis and appendicitis simultaneously. An abdominal computer tomography (CT) scan revealed the presence of the two diagnoses, which was then confirmed by an abdominal ultrasound. A four-access port was utilized for simultaneous appendectomy and cholecystectomy. DISCUSSION: A review of the literature indicates that simultaneous infection with appendicitis and cholecystitis is rare, and thus clinical presentation, lab work, and imaging studies are all needed to support such a diagnosis. Potential findings on imaging in these patients may include distended gallbladder with thickened wall and fluid-filled dilated appendix with mural enhancement. In the event that both clinical presentation and further work-up indicate both pathologies, laparoscopic intervention is suitable. A four-access port is deemed the conservative approach to dealing with such cases. CONCLUSION: Finding a single diagnosis responsible for a patient's illness is a high priority in an acute care setting, a concept known as diagnostic parsimony. However, it is inevitable that very common illnesses will be comorbid in a subset of patients, and physicians should be prepared to consider contemporaneous illness in the isolated circumstances it is warranted.

Weight Loss Outcomes following Roux-en-Y Gastric Bypass and Sleeve Gastrectomy in an Ethnically Diverse Bariatric Population: Which Is More Effective?

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) have comparable weight loss outcomes in a general bariatric population. OBJECTIVES: This study aimed to investigate whether similar outcomes can be observed in Hispanic and African American population. Settings. Community Hospital in New York, New York, United States. METHODS: The 5-year prospective data of patients who underwent LRYGB and LSG at a single center were retrospectively reviewed. The long-term weight loss outcomes between patients who had LRYGB and LSG were compared after adjusting for age, sex, race, diabetes mellitus, and hypertension with the linear mixed-effects or logistic regression model. RESULTS: Most patients were Hispanic (59.2%) and African American (22.7%). The mean% total weight loss (%TWL) values of patients with BMI <45 kg/m2 who underwent LRYGB and LSG were 73% and 62% after 1 year, 69% and 56% after 2 years, and 71% and 54% after 5 years, respectively. In patients with a BMI of 45-50 kg/m2 who underwent LRYGB and LSG, the mean %TWL values were 69% and 56% after 1 year, 75% and 58% after 2 years, and 57% and 45% after 5 years, respectively. Meanwhile, the %TWL values of patients with BMI >50 kg/m2 who had LRYGB and LSG were 53% and 42% after 1 year, 53% and 45% after 2 years, and 49% and 36% after 5 years, respectively. All results were statistically significant (p < 0.0001) and remained valid after adjusting for cofactors. CONCLUSION: Thus, LRYGB had consistent and sustained long-term weight loss outcomes compared with LSG in a predominantly ethnically diverse patient population with different BMI. Our study had several limitations in that it is retrospective in nature and some patients were lost to follow-up during the study period.

Bariatric Surgery Improves Renal Function: a Large Inner-City Population Outcome Study.

BACKGROUND: Bariatric surgery is associated with improved renal dysfunction in general population studies. The study examined the effects of bariatric surgery on renal function in a predominantly Hispanic and African American population at a community hospital in New York, USA. METHODS: This retrospective study analyzed prospectively collected bariatric surgical data from 2247 patients (89% female) who underwent bariatric surgery at a single center. Changes in glomerular filtration rate (eGFR), urine albumin-creatinine ratio (UACR), micro- and macroalbuminuria, and hyperfiltration, which were measured preoperatively and then yearly for 3 years postoperatively, were evaluated with t tests and logistic regression analysis, after adjusting for confounding variables. The mean age of the patients at surgery was 37.1 years; the mean preoperative body mass index was 45 ± 7 kg/m2. RESULTS: The results obtained 3 years postoperatively showed the following significant improvements compared with the preoperative values: mean UACR decreased from 40.3 to 11.1 mg/g, mean eGFR improved from 79.4 to 87.3 mL/min, the prevalence of microalbuminuria decreased from 13.7 to 6.2%, the prevalence of macroalbuminuria decreased from 2.5 to 0%, and the prevalence of hyperfiltration decreased from 4.4 to 2.7% (all P < .0001). In adjusted multivariate regression analysis, these results remained significant after adjusting for age, sex, race, type of surgery, and presence of diabetes mellitus or hypertension. CONCLUSION: In this large study at an inner-city hospital, bariatric surgery was associated with significant improvements in renal dysfunction parameters. These results could assist with informed decisions regarding indications for bariatric surgery.

Successful Laparoscopic Repair of Posttraumatic Diaphragmatic Injury.

Diaphragmatic injuries can be a direct result of penetrating thoracoabdominal trauma such as gunshot or stab wounds. Diaphragmatic rupture can lead to herniation of intra-abdominal organs into the thoracic cavity. Diagnosis can be difficult as the results of a physical exam can be unremarkable. A CT scan of the chest is diagnostic for diaphragmatic injuries. In most emergency cases, diaphragmatic injuries are managed with laparotomy where CT was diagnostic. We report a rare case of a 25-year-old man with right diaphragmatic injury sustained after a stab wound to the right liver managed successfully with laparoscopy.

Improvement in glycated hemoglobin A1C after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an ethnically diverse population with diabetes.

BACKGROUND: Obesity is a well-known risk factor for the development of type 2 diabetes. The efficacy of bariatric surgery in reducing weight with resulting improvement in type 2 diabetes has been reliably demonstrated. OBJECTIVES: We investigated and compared the effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG) on glycated hemoglobin (HbA1C) levels in a predominantly Hispanic and black population. SETTINGS: Community Hospital in New York, New York, United States. METHODS: This is a retrospective review of a 5-year data from a single center where patients with diabetes who underwent LRYGB or LSG were included. HbA1C levels and body mass index were analyzed preoperatively and then annually postoperatively for up to 5 years. Improvements in HbA1C were compared between the 2 groups after adjusting for age, sex, race, and hypertension with linear mixed-effects or logistic regression models. RESULTS: Of the 676 included patients, 84.8% were females and the mean age was 47 years. HbA1C levels decreased significantly (P < .05) in the entire group at 1 (21%), 2 (20%), 3 (20%), 4 (18%), and 5 (14%) years. Compared with LSG, LRYGB patients displayed greater improvement in HbA1C levels at 1 year (25% versus 17%, P = .001). The differences in the reduction of HbA1C between LRYGB and LSG for the other time intervals were not significant (P > .05), 24% versus 17% (2 yr), 22% versus 16% (3 yr), 22% versus 13% (4 yr), and 17% versus 10% (5 yr). Changes in body mass index were not correlated to changes in HbA1C at various study points. CONCLUSION: Both LRYGB and LSG resulted in significant decreases in HbA1C levels and are correlated with changes in body mass index. LRYGB had the greatest effect at 1 year postoperatively. There was no significant difference in HbA1C reduction for LRYGB and LSG after 1 year postoperatively in this predominantly Hispanic and black cohort.

A Rare Forehead Mass: The Chondroid Syringoma.

The chondroid syringoma is an extremely rare skin tumor most commonly found in the area of the head and neck region. Its rarity, potential for malignancy, and frequent misdiagnosis for other more common tumors can impart unique challenges in diagnosis and management. Diagnosis is usually revealed by excision followed by histologic examination. We report a case of a 42-year-old male with no prior medical history diagnosed with chondroid syringoma of the forehead and review the relevant literature.

Benzocaine-Induced Methemoglobinemia in a Postoperative Bariatric Patient following Esophagogastroduodenoscopy.

Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%. Paradoxically, these patients demonstrate normal to supranormal oxygen levels in the blood on blood gas analysis. We report a case of 34-year-old female postoperative Roux-en-Y gastric bypass patient who developed hypoxia and cyanosis after a routine EGD procedure to relieve a food impaction. Differentials of aspiration and pulmonary embolism were plausible; stat blood gas analysis clinched the diagnosis and managed with intravenous methylene blue.

Vanishing spleen syndrome post right partial nephrectomy in a sicklemic patient.

Splenic infarction after contralateral laparoscopic renal surgery has not, to our knowledge, been reported. The spleen is the most affected organ in sickle cell disease and the mechanism of auto infarction is thought to result from the crystallization of abnormal hemoglobin during periods of hypoxia or acidosis resulting in parenchymal ischemia and ultimately tissue necrosis. We report a case of 45 year old female with sickle cell disease who had an unremarkable spleen at the time of a laparoscopic right partial nephrectomy and was subsequently found to have marked diminution in her splenic volume.

Warfarin induced mesenteric and intestinal hematoma requiring surgical resection to relieve small bowel obstruction: A case report.

INTRODUCTION: Mesenteric and Intramural Hematoma leading to small bowel obstruction is a rare, but a fatal complication of anticoagulant therapy. PRESENTATION OF CASE: We present this unique case of 61 year old male with non traumatic mesenteric and intramural hematoma secondary to warfarin leading to small bowel obstruction requiring surgical resection. DISCUSSION: Although there have been few cases reported in literature about intramural small bowel hematoma, however, associated with small bowel obstruction secondary to warfarin therapy are less frequently seen. Diagnosis of intramural hematoma can be made with Computed Tomography (CT) of abdomen. The most effective treatment approach is conservative management after excluding any signs of small bowel obstructions, peritonitis and bowel necrosis. CONCLUSION: Therefore, early diagnosis is vitally essential to avoid morbidity in patients with these symptoms. Physician should have a higher index of suspicion to recognize and diagnose this complication is essential for early treatment intervention to prevent morbidity.

A Case series of candy cane limb syndrome after laparoscopic Roux-en-Y gastric bypass.

Candy cane syndrome is a rare complication reported in bariatric patients following Roux-en-Y gastric bypass. It occurs when there is an excessive length of roux limb proximal to gastrojejunostomy, creating the possibility for food particles to lodge and remain in the blind redundant limb. Patients present with non-specific symptoms such as abdominal pain associated with nausea and vomiting. Most remain undiagnosed as the disease process is poorly described. We report three cases of candy cane syndrome treated successfully at our institution.

Duodenal Diverticular Perforation after Small Bowel Obstruction: A Case Report.

INTRODUCTION: Duodenal diverticulum is a rare disease that can be easily missed. The incidence of duodenal diverticulum diagnosed by upper GI study is approximately 5%. Autopsy results show that 22% of the population have duodenum diverticulum. Most patients with duodenal diverticulum are asymptomatic. However, complications like inflammation, perforation with retroperitoneal abscess, sepsis, pancreatitis, bile duct obstruction, and bleeding can occur. Approximately 162 cases of perforated duodenal diverticulum have been reported in the literature. CASE PRESENTATION: We present a rare case of an 82-year-old female with perforation of a duodenal diverticulum caused by small bowel obstruction; in addition to this, there was a synchronous colonic tumor. CONCLUSION: Diagnosis and management of this rare disorder are controversial. Nonoperative management is advocated in some cases. Some of the cases require early aggressive surgical intervention. The mortality rate remains approximately 45% in all these patients.

Blunt Laryngeal Fracture Status Post Fall on a Paintball Gun.

Laryngeal fracture is a rare but potentially lethal injury. A high degree of suspicion along with an expeditious investigation is warranted to prevent airway complications. The initial assessment of the airway is vital as the patient can suffer a severe anoxic brain injury. If the patient is stable, a computed tomography (CT) scan of the neck should be obtained; this was done urgently for our patient and was managed without any extraneous intervention. We report a case of a 38-year-old man that presented to the emergency room with anterior neck pain after falling onto the back of a paintball gun. The patient was managed conservatively and favorable outcomes were obtained.