In this study we aimed to review and compare the existing guidelines and make recommendations specific to this group of patients. We proposed changes in the diagnostic work-up, follow-up and surveillance, perioperative pathways, and management of metastatic disease, with an emphasis on minimally invasive surgical procedures. We concluded that there is need to modify the existing colorectal cancer guidelines to address the needs of obese patients and recommend that a multidisciplinary approach, with involvement of bariatric principles, should be considered.Obese patients are known to be at higher risk of developing colorectal cancer. Meanwhile, the rate of obesity continues to rise worldwide. Current guidelines by the National Comprehensive Cancer NetworkThe link between obesity and colorectal cancer has been well established. The worldwide rise in obesity rates in the past 40 years means that we are dealing with increasing numbers of obese patients with colorectal cancer. We aimed to review the existing guidelines and make recommendations specific to this group of patients. Upon comparing the current NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ®), the guidelines from the European Society of Medical Oncology (ESMO) and the guidelines of the Japanese Society for Cancer of the Colon and Rectum (JSCCR), we observed that these did not take into consideration the needs of obese patients. We proceeded to make specific recommendations with regards to the diagnostic work-up, surgical pathways, minimally invasive technique, perioperative treatment, post-operative surveillance, and management of metastatic disease in this group of patients. Our review highlights the need for modification of the existing guidelines to account for the needs of this patient cohort. A multidisciplinary approach, including principles used by bariatric surgeons, should be the way forward to reach consensus in the management of this group of patients. Obesity is a continually rising global phenomenon, with worldwide obesity rates having tripled since 1975. According to the World Health Organisation (WHO), 39% of adults measured as overweight and 13% as obese by 2016 [Meanwhile, colorectal cancer remains the fourth most common cancer in the UK, with 42,886 new cases diagnosed each year . There iThe use of elective minimally invasive colorectal cancer procedures (MICCP), such as the laparoscopic or robotic approach, is also well-established and increasingly more popular amongst colorectal surgeons in the developed world. The well-described benefits of this approach,  are undoubtedly key to an uncomplicated post-surgical recovery of the clinically obese patient ,11 and aIn obese patients, there are multiple additional issues that should be taken into consideration when planning their surgical and non-surgical treatment. Obesity has been linked to increased rates of diabetes mellitus, cardiovascular disease, and venous thromboembolism and increased surgical site infections. Understanding the differences in physiology, metabolism, anaesthetic needs, and susceptibility to post-operative complications, as well as the technical challenges associated with MICCP in this group of patients, is therefore of the outmost importance. Surgical lessons can be learned from already-established bariatric surgery pathways and practices and applied to colorectal minimally invasive surgery.®, the European Society of Medical Oncology (ESMO) guidelines, and the Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines for the management of colon and rectal cancer are not adjusted to specifically account for the obese patient. Therefore, the need for modifications of the current guidelines is imperative to establish a baseline and consensus of how to approach this group of patients. We aimed to review and compare the existing NCCN, ESMO, and JSCCR Guidelines to identify areas where modifications could be made to account for the obese patient.The current NCCN GuidelinesThe Websites of NCCN ,14, ESMOData of interest included: year of publication, condition assessed, diagnostic work-up and surgery, pre-operative (neoadjuvant) and postoperative (adjuvant) treatment, post-operative surveillance (follow-up), management of metastatic disease, and current guidelines on minimally invasive surgery. The guidelines were also reviewed for any references to obesity. The guidelines were reviewed by two authors (N.P. and H.R.), who independently identified discrepancies and areas of further research. These were discussed and agreed upon with all the authors. The authors subsequently made recommendations in areas where the current guidelines could be adjusted to account for the obese population.The NCCN Guidelines for colon cancer (2022) and rectal cancer (2022), the JSCCR guidelines for colorectal cancer (2019), and the ESMO guidelines for localised colon cancer (2020), metastatic colorectal cancer (2016), and rectal cancer (2017) were accessed on their respective websites and included in this comparison. Tables 1–9 summarise the findings for each condition. The recommendations are summarised in The management of colonic polyps with invasive cancer depends on whether they have been completely removed endoscopically at the time of the colonoscopy and on the morphological features of the polyp. Low-risk polyps are managed by observation, whereas higher-risk polyps would be considered for colectomy with regional lymphadenectomy . JCSSR recommends polypectomy or snare endoscopic mucosal resection (EMR) for polyps less than 2 cm and endoscopic submucosal dissection (ESD) for polyps 2–5 cm. NCCN recommends transanal local excision for sessile polyps and for those that that have unfavourable histological features or completeness of excision cannot be confirmed. ESMO also recommend transanal local procedures depending on the submucosal (Sm) depth of invasion of the polyp. Guidelines agree that, for higher risk polyps, the approach should be with surgical resection . ESMO recommends chemoradiotherapy or radiotherapy if surgery is contraindicated. The guidelines do not include comments on the obese patient.The recommendations are summarised in The management of non-metastatic colorectal cancer depends on whether the cancer is resectable or unresectable. ESMO recommends local excision for early (Tis/T1 N0) colon cancers. For resectable colon cancers, the standard approach is colectomy with regional lymphadenectomy. NCCN recommends consideration of neoadjuvant chemotherapy or immunotherapy for advanced disease. JSCCR makes recommendations for the extent of the lymphadenectomy depending on cancer staging. NCCN, ESMO, and JSCCR recommend transanal local excision for early rectal cancers (T1 N0). Higher-risk lesions require surgery (TME). Total neoadjuvant therapy, neoadjuvant short-course radiotherapy (SCRT) or chemoradiotherapy (CRT) are recommended for higher-risk lesions . Early low-risk Stage I tumours do not require adjuvant treatment and can be surveyed. The NCCN, ESMO, and JSCCR recommendations on different adjuvant protocols  and their indications according to staging are summarised in For patients that have completed treatment for colorectal cancer and have entered surveillance, NCCN, ESMO, and JSCCR recommend follow-up with physical examination, monitoring of CEA levels, CT chest-abdomen-pelvis, and colonoscopy. For patients who have entered surveillance post-transanal local excision of rectal cancer, NCCN additionally recommends follow up with proctoscopy with EUS or MRI with contrast. The protocol and time intervals for the surveillance schedule as recommended by each guideline are summarised in Synchronous metastatic disease in the liver and lung can be resectable or unresectable. The NCCN, ESMO, and JSCCR recommendations are summarised in In patients with peritoneal disease, NCCN recommends palliative surgery  or stenting in patients with obstructing or imminently obstructing colorectal primary, followed by systemic therapy. NCCN and ESMO recommend that, in appropriate patients, cytoreductive surgery and/or hyperthermic intraperitoneal chemotherapy (HIPEC) can be considered. HIPEC has high morbidity and should be performed in experienced centres with the appropriate set-up. The guidelines do not include comments on the management of peritoneal metastatic disease in the obese patient.The recommendations are summarised in In this review of the available guidelines, we observed that overall, the recommendations of the current NCCN, ESMO, and JSCCR Guidelines do not account for the needs of the obese patients in areas such as diagnostic work-up and management of colorectal polyps with invasive cancer, colorectal cancer, adjuvant therapy, surveillance protocols, management of metastatic disease, and minimally invasive surgery. The challenges in the management of obese patients with colorectal cancer, as well as our proposed recommendations are summarized in In the work-up of patients with colorectal cancer or with colorectal polyps with invasive cancer, modalities such as colonoscopy or ERUS, pelvic MRI, or CT scan may be associated with particular challenges for the obese patient . Colonoscopy itself can be difficult in obese patients due to positioning problems, inability to splint effectively, increased scope looping, and higher risk of sedation complications . We recoAll cross-sectional imaging modalities  have industry standard table weight and aperture limits. In hospitals, the standard table limit of a CT scanner is 205 kg and the limit of an MRI scanner is 159 kg. Specialist bariatric imaging equipment that is currently available includes a weight limit of 308.4 kg for a CT scanner and a weight limit of 249.5 kg for open MRI [It is important to consider the operating room and theatre team set-up for obese patients that are undergoing resectional surgery. We recommend that colorectal surgeons should use a bariatric surgical table or appropriate side table extensions and stirrups for suitable support and comfortable wrapping of the arms at the side. Alternatively, the arm-out position should be used, taking care to avoid over-extension of the shoulders and avoid brachial plexus injuries . The patThe perioperative pathway should involve pre-operative assessment by an experienced anaesthetist and optimisation in a multidisciplinary setting, with input from surgeons, anaesthetists, dieticians, and physiotherapists. Emphasis should be placed in predicting and assessing individual obese patient risks, e.g., obstructive sleep apnoea, cardiovascular disease, venous thromboembolism (VTE), and diabetes mellitus, which are known to be more prevalent in the obese population. At the time of pre-assessment, in addition to risk assessment, emphasis should be placed in addressing existing comorbidities that may require optimisation e.g., by referral to the Cardiology service for cardiovascular optimisation or referral to the Endocrinology service for optimisation of their diabetic control. Aiming for preoperative weight reduction (POWR) would lead to delays in the surgical pathway and therefore we would not recommend POWR as an appropriate strategy in this group of patients. Preoperative risk prediction with scores such as the Obesity Surgery Mortality Risk Score (OS-MRS), which is already validated in bariatric patients, should be calculated and used to anticipate a patient’s postoperative needs, e.g., critical care unit admission.The use of a preoperative liver shrinkage diet  is routinely employed in elective bariatric surgery to reduce liver size and intra-abdominal adiposity. We recommend a preoperative liver shrinkage diet for obese patients planned to undergo MICCP. This would allow for wider intra-abdominal spaces and easier manoeuvrability and therefore improved views and tissue handling for the surgeon. In obese male patients who have a narrow pelvis, use of a robotic minimally invasive approach (by an experienced surgeon) should be considered, as it would allow for better views, access, and pelvic dissection. Obesity is a recognized independent risk factor for SSI . A recenOn the day of the surgery, the patient should be anaesthetised by an anaesthetist with experience in bariatric anaesthesia. Anaesthesia should be induced in the head-up ramped position . If possPost-operatively, due to their pre-existing comorbid profile that puts them at higher risk of complications, we recommend that obese patients would highly benefit from early mobilisation, incentive spirometry or chest physiotherapy, carefully planned and weight-adjusted dosing for venous thromboembolism (VTE) prophylaxis, and antibiotic and analgesia administration.In the neoadjuvant and adjuvant setting, adjustments to oncological treatments may be required, considering the risks of chemotherapy underdosing (if not carefully adjusted for weight) or of possibly reduced effectiveness of radiotherapy treatment in patients with central obesity. A systematic review (2021) noted that obese patients tolerated full body-size-based dosing of chemotherapy as well as non-obese patients . The AmeIn the context of metastatic disease, obesity does not appear to influence the postoperative mortality and morbidity of cytoreductive surgery and/or HIPEC and therefore should not be contraindicated in obese patients that otherwise meet the criteria for this intervention . Obese pIn conclusion, the incidence of colorectal cancer and of obesity continues to increase worldwide. Current guidelines do not make provisions for obese patients undergoing MICCP, and modification of the existing guidelines is needed now more than ever to address the complexities of this group of patients. A perioperative multidisciplinary pathway with a focus on risk prediction and risk reduction is of paramount importance to optimise these patients, and the surgical and non-surgical challenges of treating obese patients with colorectal cancer make it highly desirable for a consensus to be reached between colorectal and bariatric surgeons.


Lung ultrasound (LUS) can be used to diagnose various neonatal lung diseases. It more sensitively diagnoses pulmonary edema, pneumothorax, pulmonary consolidation, and atelectasis than traditional X-ray and quickly determines the cause of dyspnea. As a component of severe ultrasound, LUS enables rapid bedside visualization of lung diseases and plays a major role in guiding the differential diagnosis of disease, ventilator treatment, and lung recruitment. This study introduced the application of LUS in the diagnosis and treatment of critically ill neonates with lung diseases. Respiratory diseases are the leading causes of neonatal death. The common respiratory diseases include meconium aspiration syndrome (MAS), respiratory distress syndrome (RDS), pneumothorax (PTX), pneumonia (PN), and transient tachypnea of the newborn (TTN). Due to the physiological characteristics of the respiratory tract and poor alveolar compensation capacity of the neonates, mechanical ventilation respiratory support is needed in most cases. However, it may develop into critical ill respiratory disease. The treatment of such a disease has always been challenging and the focus of neonatal medicine; thus, the accurate and rapid examination is the key to successful treatment. In the last decade, with the development of technology, lung ultrasound (LUS) has been successfully applied in the clinical diagnosis of various neonatal lung diseases, thereby opening a new era of green diagnosis of lung diseases –3. The a“White lung,” the most critical condition of the respiratory system, refers to the extensive exudation and consolidation of both lungs caused by various reasons. Chest X-ray displayed that cardiac margin and diaphragmatic surface are not clear, and the lung development is white. The most common neonatal lung diseases with white lung on chest X-rays are severe respiratory distress syndrome (RDS) and severe TTN. Clinically, these two lung diseases have similar history and symptoms, but their pathophysiological changes and treatment have some variations. Therefore, it is difficult to identify them based on X-ray findings completely.Lung ultrasound examination is mainly affected by the different proportion of air and fluid distribution in lung tissues; for example, normally inflated lung tissues , pulmonary edema of varying degrees , lung consolidation of varying degrees (air bronchogram), and other ultrasonic images. When LUS presents compact B-lines in each scanning area of both lungs, it indicates a white lung. Different from the “white lung” on X-ray, that on LUS indicates severe pulmonary edema. Ultrasound showed the disappearance of pleural line, A-lines, compact B-lines, and even white lung disappeared on both RDS and TTN. However, the ultrasonic diagnosis of TTN is based on varying degrees of pulmonary edema without lung consolidation see , while tThe pulmonary lesions of critically ill patients are manifested as pulmonary consolidation, pulmonary edema, pleural effusion, and pneumothorax. As a non-invasive, real-time, and repeatable tool, LUS can achieve rapid bedside visualization of pulmonary diseases. Thus, it is a vital application in the field of critical ills . Sudden Atelectasis is a common complication of neonatal lung diseases, usually accompanied by NRDS, MAS, severe pneumonia, and other diseases. It is also the common cause of neonatal dyspnea. Neonates given mechanical ventilation often face man-machine incongruity or disengagement failure caused by atelectasis. Lung recruitment refers to a sustained increase in airway pressure or volume within a limited time to maximize the physiological expansion of the maximum lung units, with the goal to open the collapsed pulmonary alveoli, thus improving gas exchange, oxygenation function, and lung compliance. The ultrasound of neonatal atelectasis was characterized by hepatoid echo consolidation accompanied by lung pulsation and air bronchogram , 10, indLung ultrasound can also be used to guide the precise care of patients with severe pneumonia. Since prolonged supine position leads to severe lung consolidation in gravity-dependent areas and insufficient ventilation due to dorsal alveoli closure, it is necessary to change position or perform prone ventilation to promote deep sputum drainage and reopen the dorsal alveoli.Currently, LUS has been widely studied with respect to mechanical ventilation in critically ill patients to guide weaning. However, only a few studies have reported the use of LUS in predicting the need for mechanical ventilation. The main ultrasound characteristics of pneumonia are abnormal pleural line, lung consolidation, and alveolar interstitial syndrome, and severe lung consolidation can be developed into atelectasis . The morPatients with severe pertussis are prone to pulmonary consolidation and atelectasis –14. WhenSummarizing the above cases, we found that in the treatment of neonatal respiratory critical illness, the application of LUS to monitor pulmonary lesions is more advantageous than X-ray. Both atelectasis and a large amount of pleural effusion show decreased transparency or white lung on X-ray chest film, which is difficult to distinguish, but the ultrasonic manifestations of the two have different signs, which are easy to distinguish. The accuracy and sensitivity of LUS diagnosis of pneumothorax are higher than that of X-ray, especially a small amount of pneumothorax. The X-ray manifestations of TTN and RDS are similar, while ultrasound can distinguish them according to the presence of consolidation and bronchial inflation sign see . In addiChildren’s lung ultrasound technology in our country began in 2010. Professor Liu Jing, an expert in pediatric LUS, propagated its application in mature ways in China . The conLung ultrasound is a rapid, accurate, and non-invasive tool for the diagnosis of neonatal respiratory critical diseases. It avoids radiation exposure, is easy for repetitive bedside operation, and has high sensitivity in the diagnosis of pulmonary edema, pneumothorax, lung consolidation, and atelectasis, making up for the deficiency of X-ray. When LUS examination is difficult in subcutaneous emphysema and deep lesions, X-ray and LUS can complement each other, improving the accuracy of diagnosis . LUS is The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by the Ethics Committee of Dongguan Eighth People’s Hospital. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin. Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin, for the publication of any potentially identifiable images or data included in this article.BD conceptualized the study, collected and analyzed the data, and wrote the manuscript. FX assisted with the study design and reviewed the drafts of the manuscript. JLi, MM, QC, and JLiao assisted with the data collection and analysis. XH and NL conceptualized the study and reviewed the drafts of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The paper is dedicated to the discussion of kinetics of growth, and electronic properties of filled carbon nanotubes investigated by spectroscopy for applications. The paper starts with discussion of growth of carbon nanotubes inside metallocene-filled carbon nanotubes. Nickelocene, cobaltocene are considered for growth of carbon nanotubes. Then, the investigations of filled carbon nanotubes by four spectroscopic techniques are discussed. Among them are Raman spectroscopy, near edge X-ray absorption fine-structure spectroscopy, photoemission spectroscopy, optical absorption spectroscopy. It is discussed that metal halogenides, metal chalcogenides, metals lead to changes in electronic structure of nanotubes with n- or p-doping. The filling of carbon nanotubes with different organic and inorganic substances results in many promising applications. This review adds significant contribution to understanding of the kinetics and electronic properties of filled SWCNTs with considering new results of recent investigations. Challenges in various fields are analyzed and summarized, which shows the author’s viewpoint of progress in the spectroscopy of filled SWCNTs. This is a valuable step toward applications of filled SWCNTs and transfer of existing ideas from lab to industrial scale.  BWF, GLThus, the application of Raman spectroscopy allows for the investigation of the electronic properties of filled SWCNTs. The changes in spectra vary for p- and n-doping. They also vary for different-diameter SWCNTs. π∗-orbitals of introduced compounds and carbon nanotube walls. The local bonding in filled SWCNTs was studied by NEXAFS. The spectrum of the pristine SWCNTs includes the peaks A, a, B, C, D, E, F that correspond to the fine structure of the band edge  27]. Th. Th27]. Thus, NEXAFS allows investigating of bond environment in filled SWCNTs, and reveal the differences in chemical bonds before and after filling with different substances. The electronic properties were also investigated by XPS. Thus, PES allows for investigation of the effects of filler on SWCNTs. This is performed for n- and p-type dopants, and the changes in the spectra are opposite. This also allows revealing modifications in the spectra of different-diameter SWCNTs. The optical absorption spectroscopy was also applied to investigate the electronic properties of pristine and filled SWCNTs. The OAS spectra of the pristine and cobalt-iodide-filled SWCNTs are shown in Thus, OAS allows finding the modification in spectra of filled SWCNTs that are dependent on doping of SWCNTs with n- and p-dopants. The changes can be different, and also depend on the diameter of the SWCNTs.There are several limitations:At the moment, the adoption of applications of filled SWCNTs is bottlenecked by their lab-scale synthesis. The supply situation is even more dramatic for metallicity sorted SWCNT for filling as two different lab-scale techniques have to be combined. Metallicity sorting is currently still challenging in regard to yield, purity, and also the shortened lengths of metallicity sorted or single-chirality SWCNTs. There are different techniques actively developed and improved. However, there are currently none that could sustain commercially viable applications. The demand for raw material dictates the development of controlled scalable low-cost methods for synthesis, purification and separation of SWCNTs. The processes for filling SWCNTs with different substances, have so far only been demonstrated at the lab scale. Applications need to be able to rely on consistent high and uniform yields of filled SWCNT. These quality standards have to be maintained when up-scaling the production to industrial levels. If and how fast these challenges can be overcome will greatly depend on how well the scientific community can built up an understanding of synthesis, purification, sorting, and filling mechanisms of SWCNTs. This does also comprise investigating in detail the process parameters for the best filling method for each substance. While the application potential of SWCNTs and filled SWCNTs has been explored in applied research, still more basic research is likely needed before the ultimate goal of commercial availability can become a reality.There is a number of open challenges for applications of filled SWCNTs, but considering the recent advancements in purification, synthesis and filling of SWCNTs rapid progress, that will overcome many of these challenges, can be expected in the near future ,106. TheFuture perspectives include the following:The unique combination of exceptional material properties of SWCNTs is promising for a wide range of applications. A very specific feature of SWCNTs is that their electronic properties crucially depend on their diameter and twist angle, the chirality. So many potential applications hinge on the effective control of the electronic properties. In the past years, considerable progress has been made in controlling the electronic properties of SWCNTs by filling them with appropriate materials. Further progress is expected in controlled electronic properties of filled SWCNTs, which will, in conjunction with the wide range of demonstrated and envisaged applications, stimulate further advancements towards viable technologies built on them.The synthesis and separation of metallic and semiconducting or even single chiralities of SWCNTs vastly extends the scope of possible applications for filled SWCNT. This is true especially for applications that rely on specific electronic properties. If there is more control on electronic properties of the starting material, then there is also more control on the achievable results if the electronic properties are modified by filling SWCNT. This new level of attainable accuracy in engineering electronic properties by choosing a type or even single chirality of SWCNT as well as an appropriate dopant for filling will greatly benefit most of the applications. The electronic properties of cobalt-iodide- and nickel-filled carbon nanotubes can be applied in various fields, which has been the basis of work for hundreds of years in all countries. It became a trend to start papers by mentioning early Soviet papers; this will continue as more and more immigrant scientists become Noble prize winners. I think that this topic is not interesting as the investigation of metals; however, the study of metal-filled single-walled carbon nanotubes produced by different methods, including treatments of metallocene-filled SWCNTs and the resulting metals, is an appealing topic for future research around the world.


A review of the root causes and mechanisms of damage and failure to wind turbine blades is presented in this paper. In particular, the mechanisms of leading edge erosion, adhesive joint degradation, trailing edge failure, buckling and blade collapse phenomena are considered. Methods of investigation of different damage mechanisms are reviewed, including full scale testing, post-mortem analysis, incident reports, computational simulations and sub-component testing. The most endangered regions of blades include the protruding parts , tapered and transitional areas and bond lines/adhesives. Computational models of different blade damage mechanisms are discussed. The role of manufacturing defects  for the failure mechanisms of wind turbine blades is highlighted. It is concluded that the strength and durability of wind turbine blades is controlled to a large degree by the strength of adhesive joints, interfaces and thin layers  in the blade. Possible solutions to mitigate various blade damage mechanisms are discussed. Wind energy is one of the fastest growing renewable energy technologies. Over the last decades, the global installed wind energy generation capacity has increased drastically from 7.5 GW in 1997 to 564 GW by 2018. In 2019, 60 GW of new capacity was added. In 2020, the wind sector installed 93 GW. In 2020, the global installed offshore wind capacity reached around 5% of the total wind capacity [However, the maintenance of wind turbines remains an important cost factor, influencing the energy price and competitiveness of renewable energy . For insWind turbine blades are subject to complex environmental and mechanical loading during their service time, including cyclic deformation, rain, sand and contaminants causing erosion, icing, high moisture and temperature variations, but also extraordinary events, such as transportation damage, lightning strikes and bird impacts ,10,11,12In this paper, the mechanisms of degradation and failure of wind turbine blades under service conditions are reviewed, with a view also on the role of manufacturing defects and possible solutions.Wind turbine blade damage can be classified as surface damage (microcracks on the surface and coatings), resin and/or interface damage  and structural element damage (with broken or kinked fibers) . The surPost-mortem analysis of failed blades;Full scale testing of blades in laboratories with video-observation and structural health monitoring;Analysis of databases and collections of incident reports;Direct monitoring of blade deformation and degradation during service ;Testing design of subcomponents , reproducing parts or elements of the blades ;Computational modelling of blade deformation and damage.Generally, failure mechanisms of wind turbine blades are analyzed using the following main methods:Post-mortem analysis of failed or damaged blades (either test blades or blades taken from old or damaged wind turbines) is the most obvious approach to explore the blade failure mechanisms. A visual analysis of failed blades, the mechanical testing of used blade parts or their microscopic study allow an analysis of the root causes of failure. Marin et al. [n et al. ,14 studiSpecifically with a view to the surface degradation of blades, Fæster, Mishnaevsky and colleagues ,16 studiThe post-mortem analysis of decommissioned blades can allow a quick identification of the failure mechanisms for specific blades, location and sites. However, it is often difficult to make more general conclusions and observe tendencies due to the limited knowledge of the blade service history in each specific case.analysis of a database of incident reports and failure frequencies analysis. Referring to the WindStats Newsletter, HSE Electrical Incident Database, RenewableUK “lessons learnt” database and US National Renewable Energy Laboratory (NREL) data, Robinson et al. [Another approach is based on an n et al.  providedn et al.  also claBranner and Ghadirian  reviewedCarroll and colleagues  presenteBoopathi, Sumatraa and colleagues  carried This approach has the advantage of a bigger data volume (as compared with difficult and labor consuming post-mortem studies). The single observations are typically limited, but this is partially compensated by larger data volumes.Full scale testing of blades in a laboratory should allow loading conditions to be varied, thus establishing relationships between blade failure mechanisms and loading cases. This can open the possibility of optimizing the blade materials and elements, with a view on specific failure mechanisms. Full scale testing of blades is carried out both under dynamic and static loading, following the requirements in the IEC 61400-23 standard on full-scale testing [ testing . Sørense testing ,22 carriLee and Park  tested 4Chen and colleagues  studied The advantage of full-scale blade testing is that it allows new wind turbines, manufactured from new materials to be tested and also allows the use of newer technologies. However, only very idealized loading conditions can be reproduced in the laboratory full scale tests.Direct monitoring of the deformation and damage in wind turbine blades can be carried out using methods of non-destructive testing and structural health monitoring methods [ methods . Sensors methods .The sub-component testing is used typically for a better understanding of local effects, see computational modelling of the degradation of wind turbine blades is one of the most efficient approaches to the analysis of failure mechanisms, the models typically include some pre-defined and assumed damage mechanisms. For instance, Shokrieh and Raffiee [While the  Raffiee  simulate Raffiee  carried Different methods of investigations allow a better understanding of the various aspects and factors influencing the blade damage mechanisms. The analysis of incident reports leads to a better understanding of the effect of real service conditions, location, weather and manufacturing conditions on the damage mechanisms. However, this analysis has an apparent time gap: the observations made on 10, 15 or even 20 years old wind turbines are not always applicable to wind turbines which are manufactured today. Both materials, quality control, technologies and sizes can be different.Full scale blade testing in laboratories is quite expensive, applicable only to relatively small wind turbines, does not reflect real service conditions and uses laboratory-manufactured materials and structures, which might have fewer or different manufacturing defects than those exploited in the field.Computational models are quite efficient and have a wide application range. However, their application requires a preliminary knowledge of the expected damage mechanisms.Generally, the combination of all or several of the listed approaches can be the best approach to obtain a better understanding of real blade damage mechanisms and the possibilities of their mitigation.Several regions of wind turbine blades are especially susceptible to degradation, among them, regions subject to the most intensive loading , transitional regions , dissimilar and interface-containing regions . According to Refs. ,31,32,33Let us look at the main mechanisms of damage in these regions:Blade tip: Since the speed at the tip is much greater than at the root, erosion with resulting damage to the leading or trailing edges is much more intensive near the tip. Moreover, lightning can initially strike blades near the tip and then can develop into the separation of high-pressure and low-pressure skins near the tip or the separation of the skins from the shear webs [ear webs .Leading edge. The leading edge of a wind turbine blade is commonly subject to rain droplets, hail, sand and successive impacts. If the surface erosion is not repaired quickly, it can lead to the cracking of the laminates or it will allow water penetration into the bond line [ond line .Trailing edge. The trailing edge of wind turbine blades can fail by debonding in the adhesive joint  and/or g stress . Buckling stress . Ataya ag stress  reportedTapered areas, plydrop (thickness transitions), root region: Other potentially damageable regions are the mid spans in the root region of the blade, in the area of transition from cylinder to an aerofoil, due to the sharp transition from thick laminate to fine geometry and large laminate panels near the maximum chord which can be buckling-sensitive [ensitive . Local sensitive .Adhesive joints/bond lines: Joints at the leading and trailing edges, between the shell and main spar, between the spar cap and internal stiffeners can become damaged or debond, and this can lead to the buckling of the structures [ructures ,38. Bladructures , the mosructures .Therefore, the most endangered regions of the blades include the outstanding and high velocity region (tip), the transitional and tapered areas and the interface regions. The general tendency now is to use larger wind turbine blades, often located offshore. Thus, the question of the influence of the size of the blades on their damage mechanism becomes a critical question. Jensen and colleagues ,32 studiThus, the most endangered regions of a wind turbine blade are the protruding parts , the tapered, transitional areas and the bond lines. Strengthening these regions can drastically increase the durability and lifetime of wind turbine blades.In this section, we review the main experimental and computational investigations, seeking to understand the root causes of main failure mechanisms of wind turbine blades.A widely used approach for the erosion testing involves a so-called rain erosion tester, for instance, provided by R & D Test Systems, based on a 3-bladed helicopter principle ,40. ThisSeveral models of rain erosion have been developed, from phenomenological formulas  to compGenerally, the surface erosion of wind turbine blades  is a complex multiphysical process, strongly influenced by random factors . Still, the erosion (as said) is most often observed and is the earliest observed damage mechanism of wind turbine blades , which Tapered areas and plydrops in the blades are necessary in the blades to ensure an optimal, aerodynamic shape. Plydrops are formed by terminating some of composite plies. The tapered structures create local stress concentrations, in particular, interlaminar stresses in the vicinity of the ply drop-off which can lead to the delamination of plies and the failure of these regions . Figure In a number of studies, the effect of the thickness and the amount of dropped plies on the stress concentration, delamination and fatigue behavior were studied. In their study of beam elements representing the blade substructures, Mandell et al.  tested bCairn and colleagues  carried Shim  studied Samborsky et al.  studied In Ref. , the losGenerally, it can be concluded that the risks of delamination, fatigue and failure of the tapered areas of wind turbine blades can be minimized by choosing the optimal design, thickness and number of plies.The structural collapse of a wind turbine blade can occur if the blade is subject to extreme loads, exceeds its designed strength, and/or as a result of degradation and fatigue of the blade elements, which reduce its structural strength, thus making it more susceptible to extreme winds. As noted above, the structural integrity of a blade is ensured by the spar and shear webs, which are still quite strong under normal conditions.testing under flapwise load, supported by computational modelling. Jensen et al. [The often-used approach to study the structural failure of wind turbine blades is the full scale n et al.  carried n et al.  . Given that the buckling process is strongly influenced by the properties of the interface if the composites ,70, the As discussed in sub-component testing. Here, the problem is reduced to the task of designing of a subcomponent (beam) which should reproduce the realistic loading conditions of the joint and testing the subcomponents under different loading conditions. Mandell et al. [A widely used approach to the analysis of adhesive joins in the wind turbine blade is l et al.  studied l et al.  reviewedl et al. , Sayer al et al.  studied Typical joints in the wind blades can be relatively thick , reachinFinite element models of adhesive joints are often realized using the cohesive zone models. Sørensen et al.  studied Hua et al.  studied Raman and Drissi-Habti  carried Jørgensen  studied Adhesive joints in the spar area are critical elements of wind turbine blades, ensuring their high strength. Understanding the mechanisms of their failure and the factors which control the failure is necessary to enhance the blade lifetime and reliability. This understanding requires the development of sub-structure test specimens, which reflect the real loading conditions of the joints and also their real properties . In addition to the design of sub-component samples, reflecting the real service conditions, computational models, reflecting the cracking mechanisms, effect of thickness, plies are required for the analysis of the joints.The trailing edge is another critically important structural part depending on the reliability of adhesive bond. Van Leeuwen et al.  tested aMechanisms of trailing edge fractures were also studied by Eder, Branner, Haselbach and colleagues ,93,94,95Haselbach and Branner  tested 1Lahuerta et al. ,88 preseJørgensen and colleagues  simulateChen and colleagues  sought tAdhesive joints of the leading edges of wind turbine blades are not among the most often observed damage sites. Still, it is an important structural region which can potentially degrade. The degradation of the adhesive joint region has been studied in several works ,96. DrouFailure of the root end of the wind turbine blade is another critical failure mechanism. As a result of root end failure, the blade can be pulled from its hub during the service time. Lee et al.  reportedIn their studies of failure reasons of blades, Marin et al.  observedHosseini-Toudeshky et al.  studied Again, one can see that the root cause of the failure of the root region of wind turbine blades is related to delamination and adhesive debonding, i.e., with interface and thin layer effects.Apart from leading edge erosion , the failure mechanisms of wind turbine blades are caused by interface debonding or thin layer  degradation, which can trigger the buckling of composites under compressive loading. It is known that the buckling of composites is strongly influenced by interface strength, shear modulus of matrix near the interface and the angle between the compressive load and the interface . Given tLeading edge erosion is the most prominent example of microscale processes, which in fact triggers the drastic reduction in the performance of wind turbine blades, and can lead to failure of the full blade. These environmental effects  as well as small, random load variations have an apparently stronger effect on other mechanical failure mechanisms.The influence of even small deviations in the geometry on the failure likelihood is quite strong. In the next section, we consider the available data on the influence of the manufacturing defects on the failure of wind turbine blades.Summarizing the above investigations, one can make the following conclusions:One should note that the damage mechanisms of wind turbine blades are strongly influenced by environmental effects such as humidity, temperature variations and ultraviolet (UV) radiation. In this review, these effects were not discussed, due to very few sources in the literature and very few investigations devoted to the environmental degradation of wind turbine blades.The failure of wind turbine blades is influenced by design peculiarities , high mechanical and environmental loads and material limits. However, there is more and more evidence that manufacturing defects are among the main factors limiting the potential strength and reliability of the blades . This caWind turbine blades are structures built from fiber-reinforced composites, including various elements such as single skins, sandwich structures and adhesive layers . Figure The complexity of the structure leads to a situation where the smallest deviations from the designed geometry of blades can drastically influence the blade life. In particular, internal defects in the elements of the blade can reduce the lifetime of wind turbine blades and trigger various failure mechanisms. Cairns and colleagues  categoriAccording to , the folIn a number of works, the direct connection between the availability of manufacturing defects and the degradation of wind turbine blades has been observed.Generally, manufacturing defects are formed in random locations and their formation is a random event. Riddle and colleagues  proposedLeading edge erosion. The microscale mechanisms and factors controlling the leading-edge erosion have been studied in [udied in ,16,48,49udied in ,16. The udied in ,16. In tSpar caps, shell, parts [l, parts . There cWrinkles can be observed in thick composite parts, e.g., in sandwich panels. They can drastically reduce the compressive strength of composites, with up to 55% strength reduction for sandwiches [ndwiches ,105. Leondwiches  studied ndwiches  presentedelamination defects. Li et al. [Other common defects in laminates are i et al.  studied Ply waviness in the laminate can reduce the compressive strength due to the misalignment effect, increasing the likelihood of buckling [buckling ,70, and buckling . Fiber mbuckling ,70.Avery et al.  investigNelson and colleagues ,110 studvoids or defect-caused softening of matrix leads to a reduction in the compressive strength of composites [Further, the availability of mposites ,101. Nelmposites ,110 studAdhesives bonds. Katnam et al. [m et al. ,112 obsem et al. . In [114Hua et al.  simulateSamborsky et al.  presenteSørensen and colleagues  simulateSayer and colleagues  carried Trailing edge: Trailing edge buckling is very sensitive to local defects [ defects . Local b defects . Chen et defects  carried Eder and Bitche  studied From this (non-exhaustive) overview, one can conclude that the manufacturing defects play critically important roles for the degradation and failure mechanisms of blades. The defects, voids, debondings and misalignments serve as sites of damage initiation, or weaken the strength of blade elements, reducing the critical strength or lifetime.In this section, some technical solutions which seek to prevent various damage mechanisms of wind turbine blades, are discussed.Available solutions for preventing or counteracting the leading-edge erosion of wind turbine blades can been grouped as prevention and avoidance , repairSolutions for the development of new, highly protective coatings for wind turbine blades include multi-layered, highly damping, particle, nanoparticle or fiber-reinforced polymer coatings, ensuring the scattering of rain impact energy and additional toughening and damping mechanisms, but also special metallic coatings . VariatiJohansen et al.  tested aBuckling resistance and spar cap. An approach to improve the buckling resistance of a spar includes using stronger, more resistant flanges, e.g., sandwich, hybrid or carbon plies.Berggreen and colleagues  studied Cox and Echtermeyer  sought tadditional reinforcing elements, which prevent the buckling possibility of caps. To reduce cap failure due to interlaminar failure, Jensen and colleague [Another approach is based on introducing olleague ,32 propoolleague . In the olleague , a thirdolleague  suggestemethods of topology optimization were used to improve the blade design. Lund et al. [In several works, d et al.  applied Blasques and Stolpe  presenteBuckney et al.  investigSjølund, Peters and Lund ,131 usedbend-twist coupling of wind turbine blades [One should also mention here the concept of e blades ,133. Thee blades . Ashwille blades  demonstre blades , the feaTrailing edge: The idea to use the additional reinforcing elements is also applicable to the trailing edge. Jensen and colleagues [lleagues ,32 propolleagues ,136 carrWith view on improving residual strength of trailing edge of blades, Lee and Park  proposedRaman et al.  and RamaTransitional regions. The delamination risk from tapered laminates can be reduced by using gradual, staggered plydrop [ plydrop  placemen plydrop ,139. Cai plydrop  noticed Cairns and colleagues  carried Khan and colleagues  proposedMoreover, with view on root region, Jensen and colleague ,32 propoSummarizing, one can state that different reinforcing elements in wind turbine blades can allow the common damage mechanisms to be mitigated and reduced. They can be realized on structural level , or at material level . Moreover, the topological optimization allows the blade structure to be improved, taking into account several key criteria (such as weight and buckling resistance).Failure mechanisms of wind turbine blades and their root causes have been reviewed in this paper. The methods of analysis of failure mechanisms of blades include a post-mortem analysis of failed blades , full scale testing of blades in laboratories, with video-observation, structural health monitoring, analysis of data bases and collections of incident reports, direct monitoring of blade deformation and degradation during service using attached or embedded sensors and computational modelling of blade deformation and damage, and combinations of all these methods. With view on specific damage mechanisms in specific regions, testing of subcomponent , reproducing parts or elements of blades , or specific physical process testing  are employed.The often-observed damage mechanisms include leading edge erosion, adhesive joint degradation, trailing edge failure, buckling and blade collapse phenomena. Critical areas of wind turbine blades include the outstanding and high velocity region , transitional and tapered areas  and interface regions .Methods of investigation of failure mechanisms of wind turbine blades include the full scale testing of blades in laboratories, a post-mortem analysis of failed blades, analysis of incident reports and computational modelling. The most endangered regions of the blades include the outstanding and high velocity region , transitional and tapered areas , interface and bonded regions .Critical role of interfaces and bonding layers: Apart from leading edge erosion , the failure mechanisms of wind turbine blades are often triggered by interface debonding, delamination and thin layer  degradation, which interact with composite buckling processes. Given that the buckling of composites is strongly influenced by interface effects, the role of strong, tough interfaces in blade composites and structures cannot be overestimated. The critical roles of interfaces mean that the development of new technologies of bonding, surface preparation and bond quality control is an important element for the blade life extension.Manufacturing defects and quality of blade elements: The role of manufacturing defects in the failure mechanisms of wind turbine blades was discussed. The flaws can be classified as “design flaws”  and manufacturing flaws. The manufacturing flaws include porosity, debonding, delaminations, fiber misalignment and waviness, ply wrinkling, bonding defects, foreign inclusions, incompletely cured matrix, thickness variability and voids in adhesive bonds, heterogeneities (resin rich regions and dry spots). The manufacturing defects can be formed due to imperfect curing conditions, air trapping in polymers, misplacement of fibers or layers, not enough adhesives and so on. Under loading, these defects act as notches or microcracks, creating local stress concentrations and serve as initiation points for growing cracks. The critical role of manufacturing defects means that several critical directions for the development of high-quality blades, namely, the automatization of manufacturing and quality control of blades and improved manufacturing technologies are especially important for the future. A number of technical solutions exist to reduce different damage mechanisms, which can be realized on a structural level , split spar caps, transverse cap stiffeners or third shear web), or at the material level .


Pure viable strains of microorganisms identified and characterised as probiotic cultures are used in the fermentation process to prepare functional beverages. The fermented probiotic products can be consumed as a source of nutrition and also for the maintenance of healthy gut microbiota. The functional beverages contain the substrates used for the preparation of product with a specific culture or a mixture of known strains used to perform the fermentation, hence these drinks can be considered as a healthy formulation of synbiotic products. If a beverage is prepared using agriculturally sourced materials, the fermented substrates with their oligosaccharides and fiber content act as prebiotics. Both the components (probiotic strain/s and prebiotic substrate) exist in a synergistic relationship in the product and contribute to several benefits for nutrition and gut health. The preparation of such probiotic beverages has been studied using non-dairy-based materials, including fruits, vegetables, nuts, grains, and cassava, a staple diet source in many regions. The consumption of beverages prepared with the use of probiotics, which contain active microbial cells and their metabolites, contributes to the functional properties of beverages. In addition, the non-dairy probiotic products can be used by consumers of all groups and food cultures, including vegans and vegetarians, and particularly consumers with allergies to dairy-based products. The aim of this article is to present a review of published research highlighting specific probiotic strains, which have the potential to enhance sustainability of healthy GIT microbiota, used in the fermentation process for the preparation of non-dairy beverages. The beverage industry is one of the largest manufacturing sectors in several countries; it contributes to local economies in terms of the provision of value-added products and the large workforce associated with this industry. The topic of fermented products is an essential part of the beverage industry, and it is also a traditional dietary practice in several cultures such as in South-East Asian, Far-East and African countries. In the recent decade, food and drink exports have doubled within European countries, reaching over EUR 90 billion and contributing to a positive balance of almost EUR 30 billion . ScientiThe intake of constituents and nutrients present in fermented products determines the growth of individual microbial strains in the microbiota of the gastrointestinal tract (GIT). Therefore, it is reasonable to consider the availability of functional and bioactive components in beverages for the regulation and determination of the gut microbiota composition . ResearcThere have been several studies on gut microbiota composition and its effect on health. The studies include interventions using fermented foods containing probiotics and prebiotics, with potential in their multidimensional health advantages in various systemic disorders. Beneficial gut microbiota (probiotic cultures) in the host’s GIT system selectively utilise substrates present in food as prebiotics . This prSeveral reports have produced the outcome that the gut microbiota can be targeted and manipulated by suitable dietary means ,10. Resein vivo and in vitro) or external (in vitro) [The definition of probiotics according to the Food and Agriculture Organization/World Health Organization is “Live microorganisms which when administered in adequate amounts confer a health benefit on the host”, mainly through the process of replacing or including beneficial bacteria in the gastrointestinal tract ,16. Recen vitro) ,17,18.Lactobacillus, Bacillus, and Bifidobacterium, Streptococcus, and Enterococcus, although some strains of yeast Saccharomyces genera have also been included in probiotic cultures. According to the International Scientific Association for Probiotics and Prebiotics (ISAPP) consensus panel, the probiotic mechanisms can be delivered by only a few strains of a particular class of bacteria, for example, Lactobacillus casei or Bifidobacterium bifidum [Probiotics usually comprise bacteria, mainly  bifidum . However bifidum ,20.Lactococcus and Lactobacillus have been given a GRAS status, however, the LAB genus Streptococcus and certain other species have been granted a GRAS/QPS status [Bifidobacterium genus [For their beneficial properties, several GRAS strains of lactic acid bacteria have been granted a “Qualified Presumption of Safety” (QPS) status in the E.U. for food applications. Though S status . Due to um genus ,23. ThisThe conventional method for making probiotic microorganisms available in the gut is through the consumption of dairy-based fermented items, normally prepared using milk as the starting raw material. The most popular fermented beverage products sold in the global market include kefir, fermented milk, and natural yogurt smoothies. Probiotic cultures are usually added to dairy products; consumers are used to the presence of microorganisms in milk-based products ,10.Bifidobacterium bifidum probiotic culture in yogurt preparation. Therefore, the customers are keen on the alternative options of non-dairy-based products to meet the benefits of probiotic cultures, possibly through the intake of fermented beverages without the use of milk [However, the consumption of such products is not suitable for groups of the population who are lactose-intolerant, allergic to milk protein, or follow a vegan diet ,25. Othe of milk .As a result, there has been an increasing demand for non-dairy probiotic products which meet the needs of people with dietary restrictions to dairy foods. According to a current report of the market assessed on 20 July 2022, the global dairy alternatives market is estimated to be valued at USD 27.3 billion in 2022 and is projected to reach USD 44.8 billion by 2027, recording a CAGR of 10.4% in terms of value . Dairy aThere are some factors guiding the economic growth of non-dairy products, such as changes in lifestyles with growing awareness for well-being, adopting of natural dietary supplements, and increasing occurrences of allergies to dairy products, and, as a result, the application areas are expanding for such probiotic–synbiotic beverages. The global market for alternatives to non-dairy products is focusing on extracts of soybean, rice, and coconut as the main matrices for the expansion of probiotic fruit and vegetable beverages .Probiotic beverages can be made from various raw materials, such as vegetables, corn, legumes, and fruits ,31. JuicThe advantage of the use of fruits and vegetables in preparation of beverages is that unlike dairy products, there are no such problems associated with the presence of lactose and cholesterol. Such non-dairy based products can be utilised by all groups of the population . Fruit-bThe biomolecules present in fruits and vegetables improve the viability of probiotics during fermentation. The nutrients in the raw materials act as biofactors for the inclusion of microorganisms due to their functional advantages provided by their components, such as vitamins, minerals, antioxidants, and dietary fiber. These nutritional substrates make them ideal natural media for the growth of probiotics in the fermentation process. The viability of probiotics in fruit and vegetable juices depends on some important factors, such as the type of microbial strain used in fermentation, oxygen level, pH of the natural juice, temperature, and the consistence of the culture medium . HoweverBifidobacterium genus [The most common probiotic food products are prepared using bacteria from the Lactobacillaceae family or um genus ,39,40,41um genus ,45,46,47Lactiplantibacillus plantarum with the probiotic yeasts Pichia kluyveri, Pichia guilliermondii and Debaryomyces hansenii CCMA 1761 separately [The potential of probiotic yeast and lactic acid bacteria has been the focus of research in producing fermented beverages using substrates other than fruits and vegetables. The functionality and potential improvements of non-alcoholic fermented cereal beverages have been discussed in detail regarding the achievements and technological development employed to enhance the qualitative and nutritional status of fermented beverages prepared from cereals . Combinaparately .Studies have confirmed that the strains of probiotic microorganisms develop different flavours in media prepared using a variety of plant-based materials. The right combination of strains and substrates could have an advantage of formulating palatable probiotic products. Nine cereal-based probiotic beverages were produced by inoculating oats, barley and malt substrates with single cultures of three different strains of Lactobacillus .Preparation of novel plant-based drinks have been assessed with the use of different mixtures of soy and rice milks and fermenting substrate media with single or multi-culture probiotics with several strains of Lactobacillus and Bifidobacterium . The resIn recent reports, various non dairy substrates with varying matrices have been used to deliver live probiotic microorganisms to the host. However, each substrate matrix has its unique properties and advantages, therefore, plant-based materials may imcause technological barriers . NormallOne of the desired characteristics of probiotic cultures is their survival during their passage through the environment of gastrointestinal tract and exposure to ad-verse conditions of pH in different sections of the gut. The survival of probiotic strains in the required numbers necessary to provide probiotic impact is fundamental and it might be influenced by the non-dairy matrix components present in fermented bev-erage. In addition, the high viability of probiotic cells is also important during the stages of production and storage of probiotic products, in order to obtain the desired probiotic population and provide health benefits to the host at the time of consump-tion, which will be after a lapse of some time after their production. Therefore, some fermented beverages will have a shorter shelf-life compared to others, depending on the matrices of raw materials used in their production, whether fresh fruit and vege-tables  juice fermentation conducted by a probiotic strain Lactobacillus plantarum under different pH conditions. Bilberries used in the fermentation were good fruits for the reason that they are more intensely flavoured, softer and juicier than blueberries, However, the main outcome of this study was very interesting that fermentation alters the composi-tion of substrates used in the preparation of the beverage, and that can significantly change the profile of aromatic compounds in fermented product and as a result the sensory taste qualities of beverage are compromised . Thus, eIn the last few decades, there has been a rise in the number of studies on the effect of probiotic food, beverages, and fermented foods as potential synbiotics on the gut microbiome. The interest of research has moved towards clinical studies to understand how the GIT microbiome can be manipulated for establishing and maintaining a healthy gut . ConsumpInnovation for new products depends on the fact that the matrices of non-dairy substrates sourced from plants have different characteristics that could limit the viability of probiotic strains when compared to milk-based matrices. The selection of suitable fruits or vegetables for beverage production needs to be considered, as some extracts may contain anti-nutritional factors, unfavorable pH, and lower nutrient availability. Future work could investigate and compare the performance of lactic acid bacteria with fermentation by probiotic yeasts and bacteria in co-cultivation. This could offer more options for the use of other non-dairy cheaper agricultural substrates such as seeds, grains, nuts, and cereals for the commercial-scale production of non-dairy fermented beverages for vegan consumers. Further studies on fermentation profile, the viability of probiotic strains during their refrigerated storage, the production of desirable volatile or undesirable non-volatile compounds, and the resultant sensory profile of the beverage will support the use of a variety of agriculturally sourced substrates other than fruits and vegetables.


Bringing together scholars from philosophy, bioethics, law, sociology, and anthropology, this topical collection explores how innovations in the field of biomedicine and the life sciences are challenging and transforming traditional understandings of human temporality and of the temporal duration, extension and structure of human life. The contributions aim to expand the theoretical debate by highlighting the significance of time and human temporality in different discourses and practical contexts, and developing concrete, empirically informed, and culturally sensitive perspectives. The collection is structured around three main foci: the beginning of life, the middle of life, and later life. This structure facilitates an in-depth examination of specific technological and biographical contexts and at the same time allows an overarching comparison of relevant similarities and differences between life phases and fields of application. Recent developments in the fields of medicine, biotechnology, and the life sciences are challenging traditional views of human temporality and seemingly self-evident notions of the temporal extension and structure of life, thus raising novel philosophical, sociological, and bioethical questions and problems. At the same time, new theoretical approaches from existential or hermeneutic philosophy, narrative phenomenology, the social sciences, medical humanities, medical anthropology and science and technology studies (STS) are increasingly acknowledging the significance of time and temporality for understanding contemporary medical practices, biotechnological endeavors, and research paradigms in the life sciences .All in all, these and similar biomedical and technological innovations challenge common understandings of human temporality and thus raise philosophical as well as empirical questions. They fuel controversial ethical debates about appropriate timing and the individually desirable as well as socially acceptable temporal structure of human life: How is the emergence and development of biomedical technologies and life sciences interwoven with particular understandings and practices regarding human temporality? What is the role of medical diagnoses and therapies as well as technological artefacts in generating new temporal perspectives  develops an epistemological understanding of health as temporally extended. The contribution starts from an exploration of evolving images of medical practice and emerging temporal aspects of health. Contrasting this perspective with Boorse’s biostatistical theory of health in terms of “normal species functioning” or “absence of disease”, Schick then develops an alternative conception of health that incorporates temporality across the lifespan. By bringing together biomedicine and epidemiology with philosophy of biology and related views on the nature of living organisms, he outlines a process ontology and further establishes a unified "life course process theory of health". Finally, Schick points out implications of this temporal approach to health for different fields of biomedicine that are discussed in more detail in subsequent contributions to this collection, especially reproductive health, healthy ageing, and end-of-life decision-making.The following contributions focus on specific biomedical and technological issues at the beginning of life. Medical sociologist Limor Meoded Danon (Safed) provides a temporality-sensitive analysis of the treatment of intersex infants, that is, children with variation of sex development (VSD). Based on extensive qualitative social research with medical professionals as well as intersex people and their parents, Meoded Danon identifies three different sociomedical approaches of addressing the uncertainty surrounding intersex/VSD bodies and the related temporal conflicts and complexities: The corrective-concealing approach involves early surgery and hormonal treatments intended to “normalize” patients with intersex bodies/VSD and shape their future soma-sexual development and socialization in order to conceal ambiguity and uncertainty. The preventive approach aims at erasing the past and controlling the future by utilizing selective reproductive technologies to predict, control, and prevent the existence of intersex babies. The wait-and-see approach takes intersex bodies as a natural variant, encourages parents to embrace the social, physical and emotional aspects of uncertainty and live in the present in order to gain time for decision-making. The author finally applies the lenses of biopolitics and phenomenology to conceptualize temporality as a prominent sociopolitical agent in controlling and managing human bodies and related uncertainties.Jozef H. H. M. Dorscheidt’s (Groningen) contribution then turns to a highly sensitive field of biomedicine connecting the beginning and the end of human life: end-of-life decision-making in the context of pediatric care. In his paper, Dorscheidt describes current legal regulations and medical practices in two European countries: the Netherlands and Belgium. Both have adopted regulations that permit physician-assisted suicide and euthanasia in minors who experience hopeless and unbearable suffering under the condition that the minor involved is legally competent and able to express an authentic and lasting wish to die. The contribution represents a highly original legal approach as it highlights temporality and its legal significance for end-of-life decision making in pediatrics and discusses legal lessons to be learned from a time-sensitive perspective. Particular attention is paid to the question of whether incurable and suffering minor patients have, from a legal point of view, a sufficient ability to choose death and to the way temporality affects competency and its assessment. These considerations are further connected to notions of the continuity of personal development. The paper finally discusses whether such notions can be (made) productive for assessing minor patients’ end-of-life requests.The second section of this topical collection focuses on the middle of life. The section presents different aspects and examples of the usage of scientific advancements and medical technologies as a means of controlling and mastering biological and biographical temporality. It opens with a contribution by anthropologist Nolwenn Bühler (Lausanne) that focuses on the connection between reproductive biomedicine, the challenges of reproductive timing, and the age limits of motherhood. The piece draws attention to the transgressive potential of reproductive technologies as they blur the biological landmark of menopause – governing and organizing reproductive lives. Bühler employs the concept of “biotemporality” in order to analyze the ways such technologies challenge the notion of maternal age and its ontological foundations. Relating to relevant literature dealing with reproductive technologies and reproduction, she further discusses the reconfiguration of the ontological boundaries of the facts of life. Based on anthropological research on reproductive biomedicine  and age-related infertility in Switzerland, the piece uncovers the views, attitudes and negotiations of medical experts regarding the age limits of motherhood, elucidating the binaries of the normal/pathological and the biological/social. By that, the author provides a contemporary example of different configurations of moral reasoning, highlighting a change in the understanding of what is natural and reflecting new negotiations of the normative order.Sociologist Nitzan Rimon-Zarfaty (Göttingen and Hof Ashkelon) and bioethicist Silke Schicktanz (Göttingen) combine historical, theoretical, and socio-empirical insights for a temporal analysis of contemporary practices of cryo-fertility. The piece starts with a broad historical overview of cryo-fertility and its developments. It then applies a theoretical framework examining how cryobiology and cryo-technologies in the wider sense open up a new epistemic perspective interconnecting biology and temporality while creating novel forms of “latent” or “suspended” lives. In what follows, the authors focus on social egg freezing (SEF) as a particular field of application of cryo-fertility and present findings from a cross-cultural comparison of the views and experiences of German and Israeli SEF users. The case study reveals three different types of “reproductive temporalities”: postponing motherhood/reproductive decisions (German users); singlehood and “waiting” for a partner (Israeli and German users); and the planning of and hope for multiple children (Israeli users). The authors further discuss these temporalities in terms of the “extended present”, “waiting”, and “reproductive futurism”. Emphasizing the relevance and importance of emerging gendered and cultural imaginaries, they finally draw conclusions for the theoretical framework of cryopolitics.In the final contribution of this section, philosopher and medical ethicist Claudia Bozzaro (Kiel) presents a critical analysis of a variety of emerging medical enhancement technologies aimed at transcending the natural temporal rhythms and limitations of human life. To this end, Bozzaro reflects upon the implications of the finitude and fugacity of individual lifetime for leading a good life. Combining philosophical and sociological perspectives, she first analyses the increasingly negative experience of the “passing of time”, in particular in the context of contemporary individualized, capitalist, and consumerist societies. Against this backdrop, she then critically examines the usage of three biomedical enhancement technologies representing recent developments in the life sciences: social egg freezing, anti-aging medicine, and physical-/neuro-enhancement, as well as their attempts at controlling or halting the passing of time or expanding the lifespan. Embracing an existentialist perspective, Bozzaro arrives at the conclusion that such attempts are doomed to fail because the awareness of time’s passing is a necessary precondition for leading a good life.The final section of this collection turns to temporal aspects in the context of ageing, old age, and the end-of-life. The contribution of sociologist and bioethicist Julia Perry (Göttingen) combines both theoretical and empirical reflections on advance care planning and advance research directives (ARDs) in the context of dementia. The author first outlines the theoretical concept of anticipation and its key dimensions as discussed in the sociology of the future. She then provides an overview of dementia, advance planning in medical and research contexts, and the current practice of research involving people with decreased decisional capacities. This section presents an interpretation of advance planning as a form of anticipation whose epistemic, social, and normative challenges or implications need further examination. Against this backdrop, the contribution offers insights from qualitative empirical research assessing ARDs for people with dementia or cognitive impairment in Germany and devises a framework for anticipatory decision-making taking into account perceptions of time and liminality entangled with notions of uncertainty and changing values, needs, and preferences in the dementia trajectory.In the collection’s closing contribution, philosopher and medical ethicist Mark Schweda (Oldenburg) and bioethicist Karin Jongsma (Utrecht) criticize the cultural metaphor of dementia as a “death while alive”. By implementing a historical perspective, the authors first trace the development and the philosophical premises of this image. Against this backdrop, the piece undertakes a critical inspection of the implications and consequences of this metaphor in terms of scientific understandings as well as social attitudes and behaviors regarding people with dementia. Employing a life course perspective that considers the ethical significance of the temporal extension and structure of human life, the authors problematize the way the “death while alive” metaphor identifies dementia with a deviation from the biographical norm and the normative standards of age-appropriate behavior, and thus as a disruption in an assumed temporal order of existence. They draw conclusions with regard to medical and nursing ethical debates in the context of dementia, e.g., concerning self-determination, surrogate decision making, and advance directives, and stress the theoretical importance of a biography- and culture-sensitive approach to philosophical and ethical reasoning in the context of the life sciences.Overall, this topical collection thus offers an exploratory overview of the manifold interconnections between ongoing developments in medicine, biotechnology, and the life sciences on the one hand, and perspectives of human temporality, the life course, and intergenerational relations on the other. It thus sheds light on the variety of mutual relations and interactions in which medical, biotechnological, or scientific innovations either challenge or transform human temporality – or are themselves perceived, negotiated, and implemented based on social ideas, moral standards, as well as gendered and cultural imaginaries of temporality. In doing so, the collection highlights pertinent temporal concepts and attitudes that deserve closer interdisciplinary examination, including continuity and disruption, letting time pass or halting (“freezing”) it, preceding, postponing, waiting, planning, anticipating, and ending. In addition, the different contributions also offer a useful contextualization with regard to particular medical, biotechnological, and scientific settings, as well as different stages of individual development and generational cycles. The collection thus connects motivations behind the usage of medical and biotechnological innovations, the ways they are embedded in everyday life and different sociocultural contexts, the power relations and biopolitical mechanisms involved, and the relevant ethical concerns and philosophical debates.


Intracranial lipomas are rare benign tumors considered exceptional when localized in the cerebellopontine angle (CPA), with an incidence of 0.1% of the total number of expansive processes located in this area. We present a case of the sudden death of a 26-year-old young woman in which an unencapsulated neoformation of 0.8 cm was documented at the right cerebellopontine angle and was histologically characterized as intracranial lipoma. The cause of death was then identified as a cardiocirculatory failure secondary to supratentorial  herniation caused by the lipoma of the pontocerebellar angle with high-grade diffuse cerebral edema. Her family members reported they had seen her alive a few hours before and that she occasionally suffered from migraine, which was never medically investigated and treated with over-the-counter analgesics. They declined alcohol or drug abuse. The autopsy was ordered by the Judicial Authority. At post-mortem examination, the corpse was in good preservation conditions . It did not present any sign of traumatic-blunt lesion on external examination. At cadaveric dissection, the brain showed smoothed convolutions and shallower grooves than normally and there was evidence of supratentorial herniation  with tonsillar imprint . In the in toto and samples of the lung, liver, kidneys, and spleen for subsequent histopathological study. The latter were conducted using standard post-fixative techniques. The sections obtained were stained using basic H&E and Masson trichrome histochemical staining. Slides were observed with a Leica DMR optical microscope, capturing the most significant images with a Leica DC300F Digital Camera.During the autopsy investigation, fragments of viscera and biological fluids were sampled for the usual chemical-toxicological analyses, as well as the brain and heart Toxicological analyses were negative for determining Blood Alcohol Concentration (BAC), narcotics, and psychotropic substances. On the other hand, histopathological investigations of the viscera and the cerebellopontine neoformation showed a formation composed by mature adipocytes, allowing to define it as an intracranial lipoma .No evidence of malignancy was observed. Areas of acute neuronal hypoxic distress in the bulbar site (olive) and diffuse cerebral edema of a severe degree, mainly in the right hemisphere, were also documented .Histological examinations of all other viscera revealed no pathological findings. In detail, the heart, which was taken entirely, was studied carefully with numerous histological samples, and sudden death from cardiac causes was ruled out.Therefore, based on the concordance and convergence of the data that emerged at autopsy examination and laboratory testing, we attributed the cause of death of the young woman to acute cardiocirculatory failure secondary to supratentorial herniation  from lipoma of the cerebellopontine angle with diffuse cerebral edema of high degree.,11,12-6,Intracranial lipomas (ILs) are benign, slow-growing neoplasms that typically cause progressive neurological symptoms with loss of hearing ability, dizziness, tinnitus, trigeminal neuralgia, and occasionally, involvement of the facial10intravitam, the true nature of the headache pathology suffered by the girl remained unclear. In the literature, the correlation between evolving intracranial lipoma (PCA included) and headache is well known and reported on several occasions.17,A case of sudden death of a young woman with a lipoma of the pontocerebellar angle has been illustrated. The deceased presented episodes of migraine, which were never clinically investigated. The post-mortem examination depicted a single pathological cause responsible for the death, which consisted of an expansive intracranial process characterized by mature adipose tissue in the absence of cellular atypia, dysplasia, and other malignant indices on microscopy. The case was considered of particular interest because of the exceptional rarity leading to sudden death, and the lack of alarming symptoms that could eventually indicate a previous diagnostic workup. In detail, it was reported by relatives that the girl had suffered episodes of migraine. However, since no clinical examination had been carried out