Rectal prolapse is a common condition in children in the underdeveloped nations, albeit with unclear etiology. The commonest predisposing factors are the diseases leading to malnutrition (e.g. amebiasis, giardiasis, worms) leading to disappearance of the ischio-rectal fat and causing lack of rectal support. A persistently increased intra -abdominal pressure e.g. due to constipation, frequent cough, has also been implicated. Among the anatomical factors that had to the development of rectal prolapse in children are the vertical course of rectum, a low-position of rectum in relation to other pelvic organs and lack of levator support [1, 2]. There are other authors who believe that the rectal prolapse in children mainly involves the mucosa; and the muscle coats are either not involved or are involved at a later stage [3]. This reason is forwarded to explain the noted higher frequency of rectal prolapse in infants [4]. It is, therefore, on this ground that the prolapse in children is supposedly different from the adults (as in adults the weakness of the pelvic floor is the predominant etiological factor) [5].
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We performed a prospective, double-center, open-label, randomized controlled trial. Eligible patients were aged over 65 years, had end-stage renal disease, and underwent maintenance HD. The primary endpoint was muscle power, and the secondary endpoints included changes in dialysis efficiency, serum phosphorus, and inflammatory markers. Thirty HD outpatients were randomly assigned to the following groups: exercise (EX), ES, or control (SED). In EX and ES groups, patients were instructed to exercise twice a week for 12 weeks, depending on their physical capabilities. The safety and efficacy of aerobic training and ES during HD were confirmed when a sudden decrease in blood pressure or any other side effects did not occur. A repeated measures analysis of variance was performed as the principal method to evaluate time (baseline vs. 12 weeks) and group (EX vs. ES vs. SED) comparisons for the experimental outcomes.
Chronic kidney disease (CKD) is a major contemporary health problem. The number of patients with CKD continues to increase globally, with a current estimate of 2.6 million CKD patients worldwide [1]. Patients with CKD are at a higher risk of various complications, such as high blood pressure and heart disease, in addition to the frequent occurrence of chronic inflammation, renal anemia, and sarcopenia [2]. While exercise is reported to improve chronic inflammation [3], recent reports have noted that electrical stimulation (ES) is effective not only in patients with moderate to severe heart failure [4], but also in hemodialysis (HD) patients [5]. ES and voluntary muscular contractions during cycle ergometer training are different ways of activating muscle fibers that influence a number of acute changes in the neuromuscular system [5]. ES activates type I muscle fibers, while anaerobic exercise activates type II muscle fibers. In addition, conventional training using cycle ergometers is a whole-body exercise, whereas ES is a static and localized body exercise. Therefore, ES might be effective for elderly patients undergoing HD who have disease complications.
Furthermore, subjects in both the EX and ES groups were able to safely undergo the intervention without shunt trouble, sudden drop in blood pressure, or the need for fluid replacement. Previous studies also reported that intra-dialytic exercise prolongs vital prognosis without adverse events [23]. Likewise, ES has also been safely conducted in previous studies without causing skin problems or new-onset heart failure [4, 24]. Therefore, ES of the lower limbs has beneficial effects on muscle power, systemic inflammation, and the prevention of falls in elderly patients undergoing HD.
The captured CO2 is most often stored underground in a process called geological sequestration [74], which involves pumping CO2 into geological formations. The CO2 is stored under pressure, enough to keep it as a supercritical fluid. Alternatively, the captured CO2 is sunk under pressure deep below the ocean. In order to reduce our reliance on geological sequestration, and also the continuous extraction of more fossil fuels, it is of utmost importance to look for technologies that can convert the captured CO2 to added-value fuels and products. Such technologies can either use CO2 in a circular way, or can sequestrate the CO2 in long duration materials, replacing chemicals and materials currently derived from fossil sources. CO2 conversion processes have been exhaustively discussed in literature [7, 16, 19]. To achieve an optimum conversion while being cost effective and competitive with fossil-fuel production routes, process intensification is essential. In this section, the intensification aspects of photochemical, electrochemical, biochemical and thermochemical routes that have been developed in recent years have been reviewed. Table 3 summarizes some intensification techniques being used in photocatalytic, electrochemical and thermochemical CO2 reduction.
Process intensification in photocatalytic reactors can be achieved through maximisation of the radiation intensity reaching all catalyst surfaces. It is possible to achieve this by intensification of the surface to volume ratio in the reactor while designing adequately illuminated surfaces to illuminate all exposed surfaces. Alternatively, mixing enhancement can play two intensification roles. On the one hand, mixing intensification increases the exposure of the catalyst to regions with high-light intensity, helping to overcome the effects of non-uniform light distribution present in most common light sources, and hence increasing the light usage by all catalyst particles [109]. On the other hand, mixing intensification leads to a reduction in mass and heat transfer resistances [110], especially in aqueous slurry system where catalyst particles tend to settle down and CO2 solubility is low. The most common photoreactor types for CO2 reduction are slurry, fixed bed, annular and surface coated reactors [111]. Slurry reactor types have low light penetration due to light scattering and absorption effect in particle suspended medium [112] and bear additional cost of separating catalyst particles [111]. In fixed bed reactors high photoactivity is achieved for plug flow regime, less pressure drop [112] that enable it to operate under reduced cost. However, this reactor type is mass and photon transfer limited as transfer of molecules within the coated catalyst is diffusion-limited. Alternative intensified reactors that can overcome some of these limitations are discussed below.
In a system involving gas-liquid, liquid-liquid and gas-liquid-solid where usually mass transfer resistances are high, a membrane contactor can be used to maximise the mass transfer rate without dispersion of one phase into the other [155]. Most membrane processes are driven by pressure difference that require less energy compared to thermal processes, making the overall processes high energy efficient. The membrane is characterised by high level of compactness, ability to address thermodynamic limitations [156], high contact area [157] owing to drastic reduction in the size of the unit [158] at the expense however of generally high membrane cost. This technology has been employed for carbon capture [159], in photochemical [160, 161], electrochemical [162], and thermochemical [82] CO2 conversion processes aiming to overcome mass transfer resistance and enhance energy efficiency. With multifunctional units such as these membrane-integrated reactors, combining two functions into one unit should reduce the capital cost of the single unit compared to the individual reactor and membrane separation unit [163]. However, this technology suffers from limitations which include operating under high pressure [58], high membrane cost, cathode flooding, fuel crossover, membrane degradation in electrochemical systems [141]. 2ff7e9595c
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