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This study critically analyses filtration process modeling in membrane bioreactor (MBR) technology. More specifically, the variety of approaches and assumptions considered within a curated selection of resistance-in-series (RIS) filtration models found in the literature is critically assessed. Aimed to move towards good filtration process modeling practices, the basis for establishing a unified framework rooted in the fundamentals of membrane fouling is defined in this work, considering fouling classifications, process dynamics, and underlying processes used by different authors for elucidating membrane fouling phenomena. Systematically analyzing these factors should be considered as a basic step for efficiently comparing the performance of different models. This involves a detailed examination of the processes applied within each model and their interplay with the involved resistances and fouling types. A lack of homogeneity in RIS-based filtration modeling has been observed. To address this, basic guidelines towards good modeling practices are proposed aimed at balancing model accuracy and complexity. Specifically, seven model processes, six resistances, and three subgroups for types of fouling, further divided into four or five categories are proposed to guide the selection of processes and state variables in the model structure. Hence, this study facilitates the understanding of different approaches to be used during the modeling exercise of membrane filtration processes within the MBR field, not only to enhance the comprehensibility of available filtration models, but also to help the comparison, implementation, and adaptation of available models and the comprehensive development of new ones., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The dripper clogging due to the development of biofilm can reduce the benefits of micro-irrigation technology implementation using reclaimed wastewater. The narrow cross-section and labyrinth geometry of the dripper channel enhance the fouling mechanisms. The aim of this study was to evaluate the water distribution and biofouling of drip irrigation systems at the field scale during irrigation with treated wastewater. Six 100 m lines of commercial pipes with two pressure-compensating dripper types (flow rate, Q, of 0.65 L h -1 and 1.5 L h -1 , respectively) were monitored for four months. Different zones along the pipes were selected to evaluate the influence of hydrodynamical conditions (Reynolds number = 5400 to 0) on biofouling. Destructive methods involving the biofilm extraction by mechanical means, showed little biofilm development without significant differences in dry and organic matter content in function of the sampling location along the pipe or dripper flow rate (Q 0.65 and Q 1.5 ). These results were confirmed by non-destructive methods, such as optical coherence tomography, that nevertheless showed that biofouling concerned 15-20% of the total dripper labyrinth volume. Total organic carbon monitoring and its composition (by three-dimensional excitation and emission matrix fluorescence microscopy) showed that the biofilm did not significantly influence the organic matter nature. Our results indicated that the biological activity and biofilm development in irrigation systems were more affected by the environmental conditions, particularly water temperature, rather than flow conditions. This confirmed that treated wastewater with low organic content can be used in micro-irrigation systems without significant loss of efficiency, even in conditions requiring intensive irrigation, such as the Mediterranean climate., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The optimization of integrated membrane bioreactors (MBRs) models is of paramount importance in view of reducing the costs, greenhouse gas emissions or enhancing the water quality. On this behalf, this paper, produced by the International Water Association (IWA) Task Group on Membrane modelling and control, reviews the current state-of-the-art regarding the control and optimization of integrated MBR models. Whether aerobic or anaerobic, such modelling allows the consideration of specific functioning conditions and optimization problems together with the estimation and monitoring of Performance Index (PIs). This paper reviews the diversity of those problems criteria used in performance assessment. Dividing issues that can be addressed either off-line or online, it is shown that integrated models have attained an important degree of maturity. Several recommendations for mainstreaming the optimization of MBRs using such integrated models. The key findings of this work show that there is room for improving and optimizing the functioning of MBRs using integrated modelling and that this integrated modelling approach is necessary to link functioning conditions together with PI estimation and monitoring., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Inferior vena cava (IVC) compression secondary to mass effect is accompanied by edema, ascites, back and abdominal pain, and central nervous system symptoms. Most IVC syndrome cases described in the literature focus on the focal treatment of IVC lesions, and reports of complete iliocaval reconstructions secondary to malignant IVC syndrome in the palliative context are limited. In this case report, we describe the clinical presentation, technical approach, and symptomatic outcomes of a patient with extensive malignant compression and invasion of the iliofemoral venous system. An 82-year-old male with metastatic lung cancer invading the right upper quadrant of the abdomen presented with scrotal and bilateral lower extremity edema, as well as anasarca. Computed tomography (CT) demonstrated an 11 cm right adrenal metastasis and extensive retroperitoneal lymphadenopathy resulting in the compression of the IVC and iliac veins. Femoral venography demonstrated extensive collateral venous pathway formation with the opacification of the para-lumbar and vertebral veins, in addition to the vertebral/sacral venous plexus. Iliocaval reconstruction was performed using venous-dedicated stents. This case report highlights a technically successful total iliocaval reconstruction in a complex palliative patient with diffuse metastatic disease resulting in IVC compression and syndrome.

The reuse of treated wastewater (TWW) for irrigation appears to be a relevant solution to the challenges of growing water demand and scarcity. However, TWW contains not only micro-pollutants including pharmaceutical residues but also antibiotic resistant bacteria. The reuse of TWW could contribute to the dissemination of antimicrobial resistance in the environment. The purpose of this study was to assess if exogenous bacteria from irrigation waters (TWW or tap water-TP) affect endogenous soil microbial communities (from 2 soils with distinct irrigation history) and key antibiotic resistance gene sul1 and mobile genetic elements intl1 and IS613. Experiments were conducted in microcosms, irrigated in one-shot, and monitored for three months. Results showed that TP or TWW exposure induced a dynamic response of soil microbial communities but with no significant increase of resistance and mobile gene abundances. However, no significant differences were observed between the two water types in the current experimental design. Despite this, the 16S rDNA analysis of the two soils irrigated for two years either with tap water or TWW resulted in soil microbial community differentiation and the identification of biomarkers from Xanthomonadaceae and Planctomycetes families for soils irrigated with TWW. Low-diversity soils were more sensitive to the addition of TWW. Indeed, TWW exposure stimulated the growth of bacterial genera known to be pathogenic, correlating with a sharp increase in the copy number of selected resistance genes (up to 3 logs). These low-diversity soils could thus enable the establishment of exogenous bacteria from TWW which was not observed with native soils. In particular, the emergence of Planctomyces, previously suggested as a biomarker of soil irrigated by TWW, was here demonstrated. Finally, this study showed that water input frequency, initial soil microbial diversity and soil history drive changes within soil endogenous communities and the antibiotic resistance gene pool., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Purpose: Infarct volume and other imaging markers are increasingly used as surrogate measures for clinical outcome in acute ischemic stroke research, but how improvements in these imaging surrogates translate into better clinical outcomes is currently unclear. We investigated how changes in infarct volume at 24 hours alter the probability of achieving good clinical outcome (modified Rankin Scale [mRS] 0-2)., Methods: Data are from endovascular thrombectomy patients from the randomized controlled ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial. Infarct volume at 24 hours was manually segmented on non-contrast computed tomography or diffusion-weighted magnetic resonance imaging. Probabilities of achieving good outcome based on infarct volume were obtained from a multivariable logistic regression model. The probability of good outcome was plotted against infarct volume using linear spline regression., Results: A total of 1,099 patients were included in the analysis (median final infarct volume 24.9 mL [interquartile range: 6.6-92.2]). The relationship between total infarct volume and good outcome probability was nearly linear for infarct volumes between 0 mL and 250 mL. In this range, a 10% increase in the probability of achieving mRS 0-2 required a decrease in infarct volume of approximately 34.0 mL (95% confidence interval: -32.5 to -35.6). At infarct volumes above 250 mL, the probability of achieving mRS 0-2 probability was near zero. The relationships of tissue-specific infarct volumes and parenchymal hemorrhage volume generally showed similar patterns, although variability was high., Conclusion: There seems to be a near-linear association between total infarct volume and probability of achieving good outcome for infarcts up to 250 mL, whereas patients with infarct volumes greater than 250 mL are highly unlikely to have a favorable outcome.

A simple model is developed for membrane fouling, taking into account two main fouling phenomena: cake formation, due to attached solids on the membrane surface, and pore clogging, due to retained compounds inside the pores. The model is coupled with a simple anaerobic digestion model for describing the dynamics of an anaerobic membrane bioreactor (AnMBR). In simulations, we investigate its qualitative behavior: it is shown that the model exhibits satisfying properties in terms of a flux decrease due to membrane fouling. Comparing simulation and experimental data, the model is shown to predict quite well the dynamics of an AnMBR. The simulated flux best fits the experimental flux with a correlation coefficient r2=0.968 for the calibration data set and r2=0.938 for the validation data set. General discussions are given on possible control strategies to limit fouling and optimize the flux production. We show in simulations that these strategies allow one to increase the mean production flux to 33 L/(h·m 2 ),whereas without control, it was 18 L/(h·m 2 ).

The 2022 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Acute Stroke Management , 7 th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by an interdisciplinary team of healthcare providers and system planners caring for persons with an acute stroke or transient ischemic attack. These recommendations are a timely opportunity to reassess current processes to ensure efficient access to acute stroke diagnostics, treatments, and management strategies, proven to reduce mortality and morbidity. The topics covered include prehospital care, emergency department care, intravenous thrombolysis and endovascular thrombectomy (EVT), prevention and management of inhospital complications, vascular risk factor reduction, early rehabilitation, and end-of-life care. These recommendations pertain primarily to an acute ischemic vascular event. Notable changes in the 7 th edition include recommendations pertaining the use of tenecteplase, thrombolysis as a bridging therapy prior to mechanical thrombectomy, dual antiplatelet therapy for stroke prevention, the management of symptomatic intracerebral hemorrhage following thrombolysis, acute stroke imaging, care of patients undergoing EVT, medical assistance in dying, and virtual stroke care. An explicit effort was made to address sex and gender differences wherever possible. The theme of the 7 th edition of the CSBPR is building connections to optimize individual outcomes, recognizing that many people who present with acute stroke often also have multiple comorbid conditions, are medically more complex, and require a coordinated interdisciplinary approach for optimal recovery. Additional materials to support timely implementation and quality monitoring of these recommendations are available at www.strokebestpractices.ca.

To investigate the effect of wastewater (WW) treatment on soil bacterial communities, water of different quality was used to irrigate eight lettuces per tank: raw municipal wastewater (RWW), WW treated with an aerated constructed wetland (CWW) and WW treated with a membrane bioreactor (MBW), and tap water (TW). The physicochemical and microbiological characteristics (quality indicators) of these water types were characterized, and the water and soil bacterial communities were monitored by quantitative PCR (qPCR) and 16S rRNA gene sequencing. Despite marked differences in microbial load and diversity of waters, soil communities remained remarkably stable after irrigation. Microbial biomass was increased only in soils irrigated with RWW. At the end of the irrigation period (day 84), soil and water shared a large fraction of their bacterial communities, from 43 % to 70 %, depending on the water quality, indicating a transfer of bacterial communities from water to soil. Overall, the relative abundance of Proteobacteria and Acidobacteria was increased and that of Actinobacteria was decreased in soils irrigated with MBW, CWW and even more with RWW. Multivariate ordination clearly separated soils in three groups: soils irrigated with the cleanest water (TW), with treated WW (MBW and CWW), and with untreated WW (RWW). Nitrifying, denitrifying, and nitrogen-fixing bacteria were quantified by qPCR targeting amoA, narG, and nifH, respectively. Nitrifying bacteria were the most affected by the water quality, as indicated by amoA copy number increase in RWW-irrigated soil and decrease in CWW-irrigated soil. Overall, the abundance of all three genes was positively influenced by RWW treatment. In conclusion, the 84 days of irrigation influenced the soil microbial communities, and the impact depended on the quality of the used water., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

A mathematical correlation between biomass kinetic and membrane fouling can improve the understanding and spread of Membrane Bioreactor (MBR) technology, especially in solving the membrane fouling issues. On this behalf, this paper, produced by the International Water Association (IWA) Task Group on Membrane modelling and control, reviews the current state-of-the-art regarding the modelling of kinetic processes of biomass, focusing on modelling production and utilization of soluble microbial products (SMP) and extracellular polymeric substances (EPS). The key findings of this work show that the new conceptual approaches focus on the role of different bacterial groups in the formation and degradation of SMP/EPS. Even though several studies have been published regarding SMP modelling, there still needs to be more information due to the highly complicated SMP nature to facilitate the accurate modelling of membrane fouling. The EPS group has seldom been addressed in the literature, probably due to the knowledge deficiency concerning the triggers for production and degradation pathways in MBR systems, which require further efforts. Finally, the successful model applications showed that proper estimation of SMP and EPS by modelling approaches could optimise membrane fouling, which can influence the MBR energy consumption, operating costs, and greenhouse gas emissions., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Giorgio Mannina reports was provided by University of Palermo. Giorgio Mannina reports a relationship with University of Palermo that includes: employment., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Sugarcane industries produce wastewater loaded with various pollutants. For reuse of treated wastewater and valorization of biogas in a Sahelian climatic context, the performance of an anaerobic membrane bioreactor was studied for two solid retention times (40 days and infinity). The pilot was fed with real wastewater from a sugarcane operation with an organic load ranging from 15 to 22 gCOD/L/d for 353 days. The temperature in the reactor was maintained at 35 °C. Acclimatization was the first stage during which suspended solids (SS) and volatile suspended solids (VSS) evolved from 9 to 13 g/L and from 5 to 10 g/L respectively, with a VSS/SS ratio of about 80%. While operating the pilot at a solid retention time (SRT) of 40 days, the chemical oxygen demand (COD) removal efficiency reached 85%, and the (VSS)/(TSS) ratio was 94% in the reactor. At infinity solid retention time, these values were 96% and 80%, respectively. The 40-day solid retention time resulted in a change in transmembrane pressure (TMP) from 0.0812 to 2.18 bar, with a maximum methane production of 0.21 L/gCOD removed. These values are lower than those observed at an infinite solid retention time, at which the maximum methane production of 0.29 L/gCOD was achieved, with a corresponding transmembrane pressure variation of up to 3.1 bar. At a shorter solid retention time, the fouling seemed to decrease with biogas production. However, we note interesting retention rates of over 95% for turbidity.

The worldwide pressure on water resources is aggravated by rapid industrialization, with the food industry, particularly sugar factories, being the foremost contributor. Sugarcane, a primary source of sugar production, requires vast amounts of water, over half of which is discharged as wastewater, often mixed with several byproducts. The discharge of untreated wastewater can have detrimental effects on the environment, making the treatment and reuse of effluents crucial. However, conventional treatment systems may not be adequate for sugarcane industry effluent treatment due to the high organic load and variable chemical and mineral pollution. It is essential to explore pollution-remediating technologies that can achieve a nexus (water, energy, and food) approach and contribute to sustainable development. Based on the extensive literature, membrane technologies such as the membrane bioreactor have shown promising results in treating sugarcane industry wastewater, producing treated water of higher quality, and the possibility of biogas recovery. The byproducts generated from this treatment can also be recovered and used in agriculture for food security. To date, membrane technologies have demonstrated successful results in treating industrial wastewater. This critical review aims to evaluate the performance of traditional and conventional processes in order to propose sustainable perspectives. It also serves to emphasize the need for further research on operating conditions related to membrane bioreactors for valuing sugarcane effluent, to establish it as a sustainable treatment system.

Background: The use of neoadjuvant chemotherapy (NAC) in patients with mismatch repair (MMR) deficient (dMMR) localized gastric and oeso-gastric junction (OGJ) adenocarcinoma is subject of debate. Histological response assessment might help to better evaluate the impact of dMMR on response to NAC., Methods: Patients with localized gastric/OGJ adenocarcinoma resected after NAC were retrospectively identified. MMR protein expression status was assessed by immunohistochemistry. The primary objective was the frequency of histological responders to NAC defined by tumour regression grade (TRG) using Mandard's (TRG1-2) and Becker's (TRG1) classifications, according to the MMR status., Results: In total, 247 patients with 43 dMMR and 204 pMMR gastric/OGJ adenocarcinoma were identified. Among dMMR tumours, 18 (42%) arose from the OGJ. Histological response (Becker TRG1-2) was observed for 28% and 35% of dMMR and pMMR tumours, respectively (p = 0.35). Similar results were observed with Mandard classification. With a median follow-up of 37.5 months, median disease-free and overall survival were not reached for the dMMR group., Conclusion: Histological response after NAC in patients with localized dMMR gastric/OGJ adenocarcinoma is not statistically different to those with pMMR tumours. This study provides additional data for the discussion about avoiding NAC in patients with dMMR gastric/OGJ adenocarcinomas., Competing Interests: Declaration of Competing Interest TA reports consulting/advisory role and/or honoraria from Amgen, Astellas Pharma, Astra-Zeneca, Bristol-Myers Squibb, Chugai, Clovis, Gritstone Oncology, GlaxoSmithKline, Haliodx, Kaleido Biosciences, Merck & Co., Inc., Pierre Fabre, Roche/Ventana, Sanofi, Seagen, Servier and compensation for travel, accommodation, and expenses from Roche/Genentech, MSD & Co., Inc, and Bristol-Myers Squibb. RC reports honoraria from Pierre Fabre and MSD Oncology, and travel fees from Amgen. GP reports honoraria from BMS, Roche,Amgen and Nestlé, and travel fees from Medtronic., (Copyright © 2022. Published by Elsevier Ltd.)

Gastrojejunostomy tubes (GJTs) can be a long-term solution for patients with intragastric feeding intolerance. Our retrospective study of 101 patients correlates the frequency of routine and urgent GJT changes, as well as complications and radiation exposure. Over a 2.75-year median duration, 60%, 33%, and 28% of patients had >1 episodes of a tube dislodgement/malpositioning, blockage, or leakage, respectively. Aspiration pneumonia hospital admission was required for 23% of patients. Patients with <1 routine tube change/year had more urgent changes/year (3.0) compared to patients with 1-2 (1.2) or >2 (0.8) routine yearly change. These patients required more frequent sedation for tube placement (21% vs 4.7%, P = 0.03) and experienced greater annual radiation exposure (9599 vs 304.5 and 69.1 μGym 2 , P = 0.01 and 0.008, respectively). Overall, aiming for a routine tube change at least every 6-12 months is associated with fewer urgent changes and complications as well as reduced radiation exposure and sedation requirements., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Intraparenchymal hemorrhage (IPH) after a traumatic injury has been associated with poor neurological outcomes. Although IPH may result from the initial mechanical trauma, the blood and its breakdown products have potentially deleterious effects. Further, the degree of IPH has been correlated with injury severity and the extent of subsequent recovery. Therefore, accurate evaluation and quantification of IPH following traumatic spinal cord injury (SCI) is important to define treatments' effects on IPH progression and secondary neuronal injury. Imaging modalities, such as magnetic resonance imaging (MRI) and ultrasound (US), have been explored by researchers for the detection and quantification of IPH following SCI. Both quantitative and semiquantitative MRI and US measurements have been applied to objectively assess IPH following SCI, but the optimal methods for doing so are not well established. Studies in animal SCI models (rodent and porcine) have explored US and histological techniques in evaluating SCI and have demonstrated the potential to detect and quantify IPH. Newer techniques using machine learning algorithms (such as convolutional neural networks [CNN]) have also been studied to calculate IPH volume and have yielded promising results. Despite long-standing recognition of the potential pathological significance of IPH within the spinal cord, quantifying IPH with MRI or US is a relatively new area of research. Further studies are warranted to investigate their potential use. Here, we review the different and emerging quantitative MRI, US, and histological approaches used to detect and quantify IPH following SCI.

This research investigated the impact of permeate flux and gas sparging rate on membrane permeability, dissolved and colloidal organic matter (DCOM) rejection and process economics of granular anaerobic membrane bioreactors (AnMBRs). The goal of the study was to understand how membrane fouling control strategies influence granular AnMBR economics. To this end, short- and long-term filtration tests were performed under different permeate flux and specific gas demand (SGD) conditions. The results showed that flux and SGD conditions had a direct impact on membrane fouling. At normalised fluxes (J 20 ) of 4.4 and 8.7 L m -2 h -1 (LMH) the most favourable SGD condition was 0.5 m 3 m -2 h -1 , whereas at J 20 of 13.0 and 16.7 LMH the most favourable SGD condition was 1.0 m 3 m -2 h -1 . The flux and the SGD did not have a direct impact on DCOM rejection, with values ranging between 31 and 44%. The three-dimensional excitation-emission matrix fluorescence (3DEEM) spectra showed that protein-like fluorophores were predominant in mixed liquor and permeate samples (67-79%) and were retained by the membrane (39-50%). This suggests that protein-like fluorophores could be an important foulant for these systems. The economic analysis showed that operating the membranes at moderate fluxes (J 20 = 7.8 LMH) and SGD (0.5 m 3 m -2 h -1 ) could be the most favourable alternative. Finally, a sensitivity analysis illustrated that electricity and membrane cost were the most sensitive economic parameters, which highlights the importance of reducing SGD requirements and improving membrane permeability to reduce costs of granular AnMBRs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

This study deals with the conversion of organic matter into methane at ambient temperature, during anaerobic digestion of domestic wastewater combined with a submerged ultrafiltration membrane with no gas-sparging. A one-stage submerged granular anaerobic membrane bioreactor (G-AnMBR) and a control anaerobic digester (UASB type) were operated during four months, after 500 days of biomass acclimatization to psychrophilic and low loading rate conditions. Membrane barrier led to the retention of biomass, suspended solids and dissolved and colloidal organic matter which greatly enhanced total COD (tCOD) removal (92.3%) and COD to methane conversion (84.7% of tCOD converted into dissolved and gaseous CH4). G-AnMBR overcame the usual long start-up period and led to a higher sludge heterogeneity, without altering the granular biomass activity. The feasibility of the G-AnMBR without gas-sparging was also assessed and the net positive energy balance was estimated around + 0.58 kWh.m -3 ., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Sclerotherapy is frequently employed in treating lymphatic malformations (LMs), and multiple agents, practitioners and strategies exist. This review investigates the reported efficacy and safety of sclerosants in the pediatric population., Methods: Adhering to PRISMA guidelines, multiple databases were queried without linguistic or temporal restriction. Inclusion criteria were patients aged 0-18 exclusively receiving injection sclerotherapy for the treatment of LMs with follow-up data. Data abstracted included agent, dose, anatomic site and key outcome measures including complications (major/minor) and resolution rates (>95% reduction in volume). Critical appraisal was undertaken using the MINORS tool., Results: Forty-eight studies met the inclusion criteria with a mean MINORS score of 0.65 ± 0.08. Included studies yielded 886 patients, across nearly 30 years. The overall observed rate of success was 89%, with variable follow-up across publications (6 weeks - 10 years). Most reported LMs were macrocystic (82%) and had a higher resolution rate than mixed/microcytic variants (89%, 71%, 34%, p<0.01) For head/neck LMs, rates of complete regression for OK-432, bleomycin, and doxycycline were 67% ± 27% (n = 26), 91% ± 53% (n = 34) and 85% ± 16% (n = 52) respectively. Major complications were most commonly reported with OK-432, including airway compromise or subsequent operation., Conclusions: In pediatric patients treated for LM by sclerotherapy, complication rates were low. Macrocystic lesions respond well but success rates were modest at best for microcystic disease. Differences in agent utilization were noted between high and low resourced contexts; despite its lack of federal approval, OK-432 was the most reported agent. Further prospective research is warranted. LOE: 3a., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging. Devices and tools are rapidly evolving. We aimed to gain insight into preferences and global perspectives on the usage of endovascular tools in treating MeVOs. Methods: We conducted an international survey with seven scenarios of patients presenting A3, M2/3, M3, M3/4, or P2/3 occlusions. Respondents were asked for their preferred first-line endovascular approach, and whether they felt that the appropriate endovascular tools were available to them. Answers were analyzed by occlusion location and geographical region of practice, using multinomial/binary logistic regression. Results: A total of 263 neurointerventionists provided 1836 responses. The first-line preferences of physicians were evenly distributed among stent-retrievers, combined approaches, and aspiration only (33.2, 29.8, and 26.8%, respectively). A3 occlusions were more often treated with stent-retrievers (RR 1.21, 95% CI: 1.07-1.36), while intra-arterial thrombolysis was more often preferred in M3 (RR 2.47, 95% CI: 1.53-3.98) and M3/4 occlusions (RR 7.71, 95% CI: 4.16-14.28) compared to M2/3 occlusions. Respondents who thought appropriate tools are currently not available more often chose stent retrievers alone (RR 2.07; 95% CI: 1.01-4.24) or intra-arterial thrombolysis (RR 3.35, 95% CI: 1.26-8.42). Physicians who stated that they do not have access to optimal tools opted more often not to treat at all (RR 3.41, 95% CI: 1.11-10.49). Stent-retrievers alone were chosen more often and contact aspiration alone less often as a first-line approach in Europe (RR 2.12, 95% CI: 1.38-3.24; and RR 0.49, 95% CI 0.34-0.70, respectively) compared to the United States and Canada. Conclusions: In EVT for MeVO strokes, neurointerventionalists choose a targeted vessel specific first-line approach depending on the occlusion location, region of practice, and availability of the appropriate tools., Competing Interests: NK is an informatics consultant for Circle Neurovascular. JF reports grants and personal fees from Stryker, Acandis, Microvention, Medtronic, personal fees from Codman, Ceronovus, Penumbra, Phenox, other (stock ownership) from Tegus, outside the submitted work; and Executive functions with University Medical Center Hamburg-Eppendorf, Eppdata GmbH. MC reports personal fees from Stryker, personal fees from Microvention, Medtronic, Genentech, Ceronovus, Penumbra, outside the submitted work. MG reports personal fees from Stryker, personal fees from Mentice, personal fees from Microvention, personal fees from Medtronic, outside the submitted work; in addition, MG has a patent for Systems of acute stroke diagnosis issued and licensed. The remaining 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., (Copyright © 2021 Kashani, Cimflova, Ospel, Singh, Almekhlafi, Rempel, Fiehler, Chen, Sakai, Agid, Heran, Kappelhof and Goyal.)

The characteristics of foulant in the cake layer and bulk suspended solids of a 10 L submerged anaerobic membrane bioreactor (AnMBR) used for treatment of palm oil mill effluent (POME) were investigated in this study. Three different organic loading rates (OLRs) were applied with prolonged sludge retention time throughout a long operation time (270 days). The organic foulant was characterized by biomass concentration and concentration of extracellular polymeric substances (EPS). The thicknesses of the cake layer and foulant were analyzed by confocal laser scanning microscopy and Fourier transform infrared spectroscopy. The membrane morphology and inorganic elements were analyzed by field emission scanning electron microscope coupled with energy dispersive X-ray spectrometer. Roughness of membrane was analyzed by atomic force microscopy. The results showed that the formation and accumulation of protein EPS in the cake layer was the key contributor to most of the fouling. The transmembrane pressure evolution showed that attachment, adsorption, and entrapment of protein EPS occurred in the membrane pores. In addition, the hydrophilic charge of proteins and polysaccharides influenced the adsorption mechanism. The composition of the feed (including hydroxyl group and fatty acid compounds) and microbial metabolic products (protein) significantly affected membrane fouling in the high-rate operation.

Integrated Membrane Bioreactor (MBR) models, combination of biological and physical models, have been representing powerful tools for the accomplishment of high environmental sustainability. This paper, produced by the International Water Association (IWA) Task Group on Membrane Modelling and Control, reviews the state-of-the-art, identifying gaps for future researches, and proposes a new integrated MBR modelling framework. In particular, the framework aims to guide researchers and managers in pursuing good performances of MBRs in terms of effluent quality, operating costs (such as membrane fouling, energy consumption due to aeration) and mitigation of greenhouse gas emissions., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Microsatellite instability (MSI) is a tumor phenotype related to a deficient DNA mismatch repair system (dMMR). This phenotype, observed in 5% of metastatic mCRC but 10-18% of localized CRC, is associated with high tumor mutational burden with highly immunogenic neoantigens. It has emerged as a major predictive biomarker for the efficacy of ICIs. In this review, we will present a comprehensive overview of the literature concerning the efficacy of ICIs in MSI/dMMR mCRC, with a focus on new developments in first-line metastatic setting. Then, we will present current and future challenges of immuno-oncology for patients with MSI/dMMR metastatic CRC.

As world demand for clean water increases, reverse osmosis (RO) desalination has emerged as an attractive solution. Continuous RO is the most used desalination technology today. However, a new generation of configurations, working in unsteady-state feed concentration and pressure, have gained more attention recently, including the batch RO process. Our work presents a mathematical modeling for batch RO that offers the possibility of monitoring all variables of the process, including specific energy consumption, as a function of time and the recovery ratio. Validation is achieved by comparison with data from the experimental set-up and an existing model in the literature. Energetic comparison with continuous RO processes confirms that batch RO can be more energy efficient than can continuous RO, especially at a higher recovery ratio. It used, at recovery, 31% less energy for seawater and 19% less energy for brackish water. Modeling also proves that the batch RO process does not have to function under constant flux to deliver good energetic performance. In fact, under a linear pressure profile, batch RO can still deliver better energetic performance than can a continuous configuration. The parameters analysis shows that salinity, pump and energy recovery devices efficiencies are directly linked to the energy demand. While increasing feed volume has a limited effect after a certain volume due to dilution, it also shows, interestingly, a recovery ratio interval in which feed volume does not affect specific energy consumption.

Background: Loeys-Dietz syndrome (LDS) is a rare autosomal-dominant connective tissue disorder characterized by arterial aneurysms and vascular friability. Surgical intervention for LDS patients carries significant morbidity and mortality. Currently, the standard management of aortic root pseudoaneurysms is surgical intervention., Case Presentation: A 20 year old male with LDS presented with a progressively enlarging ascending aortic aneurysm. He underwent a Bentall-type aortic root replacement complicated by a 20 mm aortic root anastomotic pseudoaneurysm. Due to the patient's high risk for repeat surgical intervention, he underwent successful transarterial coil embolization of his aortic root pseudoaneurysm without complication., Conclusions: Coil embolization may provide an alternative treatment for patients presenting with aortic root pseudoaneurysm who are high risk for traditional surgical treatment, such as those with connective tissue disease.

In this study, Pb doped ZnO nanoparticles were synthesized by a sol-gel technique for the sorption of Reactive Black 5 (RB5) textile dye in aqueous solution. The ZnO:Pb (2 and 4%) nanoparticles have been characterized by X-ray diffraction (XRD), Fourier transform infrared spectroscopy, scanning electron microscopy, energy dispersive X-ray spectroscopy and cryogenic nitrogen adsorption method. The average size of the synthesized nanoparticles was less than 100 nm and the surface areas were 18.8 and 20.8 m 2 /g, respectively for ZnO:Pb 2% and ZnO:Pb 4%. Batch sorption experiments were performed for color removal of RB5 dye at ambient temperature and 30 mg/L dye concentration. The central composite design with response surface methodology was used to study the effect of sorption condition (pH, nanoparticles dose and contact time). The significance of independent variables and their interactions was tested by analysis of variance. The optimum conditions of color removal were pH = 7, 2 g/L dose of nanoparticles and a contact time of 79 min. The color removal performance was 79.4 and 98.1% for ZnO:Pb 2 and 4% respectively. The pseudo-second-order model described well the removal rates while the Langmuir model fitted well the adsorption isotherms.

Conventional vaccine design has been based on trial-and-error approaches, which have been generally successful. However, there have been some major failures in vaccine development and we still do not have highly effective licensed vaccines for tuberculosis, HIV, respiratory syncytial virus, and other major infections of global significance. Approaches at rational vaccine design have been limited by our understanding of the immune response to vaccination at the molecular level. Tools now exist to undertake in-depth analysis using systems biology approaches, but to be fully realized, studies are required in humans with intensive blood and tissue sampling. Methods that support this intensive sampling need to be developed and validated as feasible. To this end, we describe here a detailed approach that was applied in a study of 15 healthy adults, who were immunized with hepatitis B vaccine. Sampling included ~350 mL of blood, 12 microbiome samples, and lymph node fine needle aspirates obtained over a ~7-month period, enabling comprehensive analysis of the immune response at the molecular level, including single cell and tissue sample analysis. Samples were collected for analysis of immune phenotyping, whole blood and single cell gene expression, proteomics, lipidomics, epigenetics, whole blood response to key immune stimuli, cytokine responses, in vitro T cell responses, antibody repertoire analysis and the microbiome. Data integration was undertaken using different approaches-NetworkAnalyst and DIABLO. Our results demonstrate that such intensive sampling studies are feasible in healthy adults, and data integration tools exist to analyze the vast amount of data generated from a multi-omics systems biology approach. This will provide the basis for a better understanding of vaccine-induced immunity and accelerate future rational vaccine design., (Copyright © 2020 Ben-Othman, Cai, Liu, Varankovich, He, Blimkie, Lee, Gill, Novotny, Aevermann, Drissler, Shannon, McCann, Marty, Bjornson, Edgar, Lin, Gladish, Maclsaac, Amenyogbe, Chan, Llibre, Collin, Landais, Le, Reiss, Koff, Havenar-Daughton, Heran, Sangha, Walt, Krajden, Crotty, Sok, Briney, Burton, Duffy, Foster, Mohn, Kobor, Tebbutt, Brinkman, Scheuermann, Hancock, Kollmann and Sadarangani.)

Background: Preventing errors and complications in neurointervention is crucial, particularly in the treatment of unruptured intracranial aneurysms (UIAs), where the natural history is generally benign, and the margin of treatment benefit small. We aimed to investigate how neurointerventionalists perceive the importance and frequency of errors and the resulting complications in endovascular UIA treatment, and which steps could be taken to prevent them., Methods: An international multidisciplinary survey was conducted among neurointerventionalists. Participants provided their demographic characteristics and neurointerventional treatment volume. They were asked about their perceptions on the importance and frequency of different errors in endovascular UIA treatment, and which solutions they thought to be most effective in preventing these errors., Results: Two-hundred-thirty-three neurointerventionalists from 38 countries participated in the survey. Participants identified errors in technical execution as the most common source of complications in endovascular UIA treatment (40.4% thought these errors constituted a relatively or very large proportion of all complication sources), closely followed by errors in decision-making/indication (32.2%) and errors related to management of unexpected events (28.4%). Simulation training was thought to be most effective in reducing technical errors, while cognitive errors were believed to be best minimized by abandoning challenging procedures, more honest discussion of complications and better standardization of procedure steps., Conclusion: Neurointerventionalists perceived both technical and cognitive errors to be important sources of complications in endovascular UIA treatment. Simulation training, a cultural change, higher acceptance of bail-out strategies and better standardization of procedures were perceived to be most effective in preventing these.

Membrane bioreactor (MBR) models are useful tools for both design and management. The system complexity is high due to the involved number of processes which can be clustered in biological and physical ones. Literature studies are present and need to be harmonized in order to gain insights from the different studies and allow system optimization by applying a control. This position paper aims at defining the current state of the art of the main integrated MBR models reported in the literature. On the basis of a modelling review, a standardized terminology is proposed to facilitate the further development and comparison of integrated membrane fouling models for aerobic MBRs.

Purpose: Multiphase computed tomography angiography (MP-CTA) is an innovative imaging tool that can give those managing acute ischemic stroke temporal information on degree and extent of pial collateral arterial filling in the affected brain. We sought to estimate the incidence of false-positive or -negative evaluation of the carotid bifurcation or intracranial thrombus on single-phase CTA (SP-CTA) compared with MP-CTA., Material and Methods: A single-center, retrospective consecutive review was conducted of imaging and clinical records of 150 patients in two months who presented with neurological symptoms with a National Institutes of Health Stroke Scale score ≥ 2 and who received an MP-CTA as part of their investigative work-up. The cohort consisted of 52.3% male and 47.7% female patients. Median individual age was 68 years (interquartile range 60-79). Extracranial and intracranial vessel images of the initial early arterial phase were evaluated and compared with late arterial and early venous phase images., Results: In the cohort of 150 patients, in three patients (2%) SP-CTA would have led to an incorrect diagnosis and management without MP-CTA-acquired source imaging. The three scenarios represented differentiating a carotid string sign from internal carotid artery occlusion, determining the appearance and extent of thrombus in carotid T-occlusion, and differentiating slow flow and contrast mixing-related artifacts from intraluminal thrombus., Conclusions: In addition to improving assessment of collateral circulation in acute stroke patients, MP-CTA is also useful in assessing specific flow-related scenarios for which SP-CTA may give spurious results.

Water shortage, public health and environmental protection are key motives to treat wastewater. The widespread adoption of wastewater as a resource depends upon development of an energy-efficient technology. Anaerobic membrane bioreactor (AnMBR) technology has gained increasing popularity due to their ability to offset the disadvantages of conventional treatment technologies. However there are several hurdles, yet to climb over, for wider spread and scale-up of the technology. This paper reviews fundamental aspects of anaerobic digestion of wastewater, and identifies the challenges and opportunities to the further development of AnMBRs. Membrane fouling and its implications are discussed, and strategies to control membrane fouling are proposed. Novel AnMBR configurations are discussed as an integrated approach to overcome technology limitations. Energy demand and recovery in AnMBRs is analyzed. Finally key issues that require urgent attention to facilitate global penetration of AnMBR technology are highlighted., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Next generation immunotherapies have limited efficacy in colorectal cancer. Immune checkpoints inhibitors demonstrated their benefit in mismatch repair-deficient tumors, which also exhibit microsatellite instability (MSI). The Consensual Molecular Subtype (CMS) classification has been recently proposed and highlights specific immune escape mechanisms for each subtype. CMS1 "immune" subtype is hypermutated with a favorable immune microenvironment for immune checkpoints inhibitors activity. Importantly, CMS1 is not restricted to MSI tumors and includes also exonucleasic domain POLE mutated tumors which are good candidates for immunotherapy. The scope of this comprehensive review is to described immune anomalies and propose immunomodulating strategies for each CMS subtype in colorectal cancer. Finally, the potential interest of tumor mutation burden and the Immunoscore ® in colorectal cancer is discussed taking into account the molecular classification and obstacles to antitumoral immune activity., (Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider's recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

The use of anaerobic membrane bioreactor technology (AnMBR) is rapidly expanding. However, depending on the application, AnMBR design and operation is not fully mature, and needs further research to optimize process efficiency and enhance applicability. This paper reviews state-of-the-art of AnMBR focusing on modelling and control aspects. Quantitative environmental and economic evaluation has demonstrated substantial advantages in application of AnMBR to domestic wastewater treatment, but detailed modelling is less mature. While anaerobic process modelling is generally mature, more work is needed on integrated models which include coupling between membrane performance (including fouling) and the biological process. This should include microbial factors, which are important to generation of specific foulants such as soluble and particulate inert organics. Mature and well-established control tools, including better feedback control strategies are also required for both the process, and for fouling control., (Copyright © 2018 Elsevier Ltd. All rights reserved.)