Critical review of technologies for the on-site treatment of hospital wastewater: From conventional to combined advanced processes.

This review aims to assess different technologies for the on-site treatment of hospital wastewater (HWW) to remove pharmaceutical compounds (PhCs) as sustances of emerging concern at a bench, pilot, and full scales from 2014 to 2020. Moreover, a rough characterisation of hospital effluents is presented. The main detected PhCs are antibiotics and psychiatric drugs, with concentrations up to 1.1 mg/L. On the one hand, regarding the presented technologies, membrane bioreactors (MBRs) are a good alternative for treating HWW with PhCs removal values higher than 80% in removing analgesics, anti-inflammatories, cardiovascular drugs, and some antibiotics. Moreover, this system has been scaled up to the pilot plant scale. However, some target compounds are still present in the treated effluent, such as psychiatric and contrast media drugs and recalcitrant antibiotics (erythromycin and sulfamethoxazole). On the other hand, ozonation effectively removes antibiotics found in the HWW (>93%), and some studies are carried out at the pilot plant scale. Even though, some families, such as the X-ray contrast media, are recalcitrant to ozone. Other advanced oxidation processes (AOPs), such as Fenton-like or UV treatments, seem very effective for removing pharmaceuticals, Antibiotic Resistance Bacteria (ARBs) and Antibiotic Resistance Genes (ARGs). However, they are not implanted at pilot plant or full scale as they usually consider extra reactants such as ozone, iron, or UV-light, making the scale-up of the processes a challenging task to treat high-loading wastewater. Thus, several examples of biological wastewater treatment methods combined with AOPs have been proposed as the better strategy to treat HWW with high removal of PhCs (generally over 98%) and ARGs/ARBs (below the detection limit) and lower spending on reactants. However, it still requires further development and optimisation of the integrated processes.

Un nuevo paradigma para el tratamiento de la osteoartritis de rodilla: el papel del ácido hialurónico, el plasma rico en plaquetas (PRP) y el ozono en la modulación de la inflamación: una revisión / A new paradigm for the treatment of knee osteoarthritis: the role of hyaluronic acid, platelet-rich plasma (prp) and ozone in the modulation of inflammation: a review

Introducción: La osteoartritis (OA) es la causa más común de la artritis. Tradicionalmente, la OA se consideraba como una enfermedad de "desgaste". Sin embargo, los factores metabólicos e inflamatorios se están considerando ahora como los factores patogénicos hasta el punto de que algunos autores están redefiniendo la OA como una enfermedad de "inflamación crónica de bajo grado". Evidencia: En la artrosis de rodilla están involucradas muchas vías de señalización y mediadores inflamatorios. El nuevo paradigma de tratamiento se basa en los tratamientos celulares sobre las vías de señalización de la inflamación, basados en componentes celulares y proteicos para combatir el entorno inflamatorio de la articulación artrósica y regenerar el tejido dañado. Resultados: El enfoque de tratar solo una diana terapéutica (inhibidores de óxido nítrico, nutracéuticos, agentes reductores de uratos y fármacos biológicos) que han demostrado su eficacia en el tratamiento de enfermedades inflamatorias como la artritis reumatoide no se ha traducido en un manejo eficaz de la OA. Un enfoque de tratamiento dirigido simultáneamente a varias dianas sería capaz de manejar la OA de manera más eficiente. Las pautas estándar (AAOS, OARSI, ACR, NICE o EULAR) no consideran el ácido hialurónico, el plasma rico en plaquetas ni el ozono, aunque estas opciones de tratamiento han mostrado propiedades inmunomoduladoras y curativas. En ese escenario, planteamos la hipótesis de que el ácido hialurónico, el plasma rico en plaquetas y el ozono son alternativas prometedoras para el manejo de la OA de rodilla, debido a sus propiedades multidiana, como se observará en esta revisión. Conclusión: En el presente estudio se ha revisado la fisiopatología de la OA, centrándose principalmente en el mecanismo inflamatorio, las vías de señalización implicadas y los posibles objetivos del tratamiento...(AU)

Introduction: Osteoarthritis (OA) is the most common cause of arthritis. Traditionally, OA was viewed as a "wear and tear" disease. However, metabolic and inflammatory factors are now being considered as pathogenic factors to the point that some authors are redefining OA as a "chronic low-grade inflammation" disease. Evidence: In knee osteoarthritis, many inflammatory signaling pathways and mediators are involved. The new treatment paradigm is based on cellular treatments on the signaling pathways of inflammation, based on cellular and protein components to combat the inflammatory environment of the arthritic joint and regenerate damaged tissue. Results: The approach of treating only one therapeutic target (nitric oxide inhibitors, nutraceuticals, urate reducing agents, and biologics) that have demonstrated their efficacy in the treatment of inflammatory diseases such as rheumatoid arthritis has not been translated into effective management in OA. A treatment approach aimed simultaneously at multiple targets would be able to manage OA more efficiently. The standard guidelines (AAOS, OARSI, ACR, NICE, or EULAR) do not consider hyaluronic acid, platelet-rich plasma, or ozone, although these treatment options have shown immunomodulatory and healing properties. In this scenario, we hypothesized that hyaluronic acid, platelet-rich plasma, and ozone are promising alternatives for the management of knee OA, due to their multidial properties, as will be seen in this review. Conclusion: In the present study the pathophysiology of OA has been reviewed, focusing mainly on the inflammatory mechanism, the signaling pathways involved and the possible goals of treatment. Hyaluronic acid, platelet-rich plasma and ozone are proposed as multi-target options for the treatment of knee osteoarthritis.

Investigation of the photocatalytic transformation of acesulfame K in the presence of different TiO2-based materials.

The photocatalytic transformation of acesulfame K - an artificial sweetener that has gained popularity over the last decades for being a calorie-free additive in food, beverages and several pharmaceutical products - was studied using three different photocatalysts, the benchmark TiO2-P25 and two other forms of synthetized titanium oxides named TiO2-SG1 and TiO2-SG2. The two latter materials were synthesized by a sol gel process in which the hydrolysis rate of titanium n-butoxide was controlled by the water formed in situ through an esterification reaction between ethanol and acetic acid. The investigation included monitoring the sweetener disappearance, identifying its intermediate compounds, assessing mineralization and evaluating toxicity. The analyses were carried out using high-performance liquid chromatography (HPLC) coupled with a LTQ-Orbitrap analyzer via an electrospray ionization (ESI) in the negative ion mode. This is a powerful tool for the identification, characterization and measurement of the transformation products (TPs); overall 13 species were identified. The use of several semiconductors has pointed out differences in terms of both photocatalytic efficiency and mechanism: the assessment of the evolution kinetics of each species (TPs, total organic carbon and inorganic ions) has brought to the elaboration of a general transformation pathway of acesulfame K. TiO2-SG2 proved to be the most efficient material in degrading the artificial sweetener and leads to the complete mineralization within 6 h of irradiation, while up to 16 h are required for TiO2-P25.

Coupling membrane separation and photocatalytic oxidation processes for the degradation of pharmaceutical pollutants.

The coupling of membrane separation and photocatalytic oxidation has been studied for the removal of pharmaceutical pollutants. The retention properties of two different membranes (nanofiltration and reverse osmosis) were assessed. Comparable selectivity on the separation of pharmaceuticals were observed for both membranes, obtaining a permeate stream with concentrations of each pharmaceutical below 0.5 mg L(-)(1) and a rejected flux highly concentrated (in the range of 16-25 mg L(-)(1) and 18-32 mg L(-)(1) of each pharmaceutical for NF-90 and BW-30 membranes, respectively), when an initial stream of six pharmaceuticals was feeding to the membrane system (10 mg L(-)(1) of each pharmaceutical). The abatement of concentrated pharmaceuticals of the rejected stream was evaluated by means of heterogeneous photocatalytic oxidation using TiO2 and Fe2O3/SBA-15 in presence of hydrogen peroxide as photo-Fenton system. Both photocatalytic treatments showed remarkable removals of pharmaceutical compounds, achieving values between 80 and 100%. The nicotine was the most refractory pollutant of all the studied pharmaceuticals. Photo-Fenton treatment seems to be more effective than TiO2 photocatalysis, as high mineralization degree and increased nicotine removal were attested. This work can be considered an interesting approach of coupling membrane separation and heterogeneous photocatalytic technologies for the successful abatement of pharmaceutical compounds in effluents of wastewater treatment plants.