In predicting palm oil mill effluent (POME) degradation efficiency, previous developed quadratic model quantitatively evaluated the effects of O2 flowrate, TiO2 loadings and initial concentration of POME in labscale photocatalytic system, which however suffered from low generalization due to the overfitting behaviour. Evidently, high RMSE (131.61) and low R2 (-630.49) obtained indicates its insufficiency in describing POME degradation at unseen factor ranges, hence verified the fact of poor generalization. To overcome this issue, several models were developed via machine learning-assisted techniques, namely Gaussian Process Regression (GPR), Linear Regression (LR), Decision Tree (DT), Supported Vector Machine (SVM) and Regression Tree Ensemble (RTE), subsequently being assessed systematically. To achieve high generalization, all models were subjected to 'train-all-test-all' strategy, 5-fold and 10-fold cross validation. Specifically, GPR model was furnished with high accuracy in 'train-all-test-all' strategy, judging from its low RMSE (1.0394) and high R2 (0.9962), which however menaced by the risk of overfitting. In contrast, despite relatively poorer RMSE and R2 (1.7964 and 0.9886) obtained in 5-fold cross validation, GPR model was rendered with highest generalization, while sufficiently preserving its accuracy in development process. Besides, SVM and RTE models were also demonstrated promising R2 (0.9372 and 0.9208), which however shadowed by their high RMSEs (4.2174 and 4.7366). Furthermore, the extraordinary generalization of GPR model was coincidentally verified in 10-fold cross validation. The lowest RMSE (2.1624) and highest R2 (0.9835) obtained with feature number of 36 asserted its sufficiency in both generalization and accuracy prospect. Other models were all rendered with slight lower R2 (> 0.9), plausibly due to the higher RMSE (> 4.0). According to GPR model, optimized POME degradation (52.52%) can be obtained at 70 mL/min of O2, 70.0 g/L of TiO2 and 250 ppm of POME concentration, with only ∼3% error as compared to the actual data.
Since the publication of the Tokyo Guidelines in 2007 and their revision in 2013, appropriate management for acute cholecystitis has been more clearly established. Since the last revision, several manuscripts, especially for alternative endoscopic techniques, have been reported; therefore, additional evaluation and refinement of the 2013 Guidelines is required. We describe a standard drainage method for surgically high-risk patients with acute cholecystitis and the latest developed endoscopic gallbladder drainage techniques described in the updated Tokyo Guidelines 2018 (TG18). Our study confirmed that percutaneous transhepatic gallbladder drainage should be considered the first alternative to surgical intervention in surgically high-risk patients with acute cholecystitis. Also, endoscopic transpapillary gallbladder drainage or endoscopic ultrasound-guided gallbladder drainage can be considered in high-volume institutes by skilled endoscopists. In the endoscopic transpapillary approach, either endoscopic naso-gallbladder drainage or gallbladder stenting can be considered for gallbladder drainage. We also introduce special techniques and the latest outcomes of endoscopic ultrasound-guided gallbladder drainage studies. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.
The initial management of patients with suspected acute biliary infection starts with the measurement of vital signs to assess whether or not the situation is urgent. If the case is judged to be urgent, initial medical treatment should be started immediately including respiratory/circulatory management if required, without waiting for a definitive diagnosis. The patient's medical history is then taken; an abdominal examination is performed; blood tests, urinalysis, and diagnostic imaging are carried out; and a diagnosis is made using the diagnostic criteria for cholangitis/cholecystitis. Once the diagnosis has been confirmed, initial medical treatment should be started immediately, severity should be assessed according to the severity grading criteria for acute cholangitis/cholecystitis, and the patient's general status should be evaluated. For mild acute cholangitis, in most cases initial treatment including antibiotics is sufficient, and most patients do not require biliary drainage. However, biliary drainage should be considered if a patient does not respond to initial treatment. For moderate acute cholangitis, early endoscopic or percutaneous transhepatic biliary drainage is indicated. If the underlying etiology requires treatment, this should be provided after the patient's general condition has improved; endoscopic sphincterotomy and subsequent choledocholithotomy may be performed together with biliary drainage. For severe acute cholangitis, appropriate respiratory/circulatory management is required. Biliary drainage should be performed as soon as possible after the patient's general condition has been improved by initial treatment and respiratory/circulatory management. Free full articles and mobile app of TG18 are available at: http://www.jshbps.jp/modules/en/index.php?content_id=47. Related clinical questions and references are also included.