Sidestream characteristics in water resource recovery facilities: A critical review.

This review compiles information on sidestream characteristics that result from anaerobic digestion dewatering (conventional and preceded by a thermal hydrolysis process), biological and primary sludge thickening. The objective is to define a range of concentrations for the different characteristics found in literature and to confront them with the optimal operating conditions of sidestream processes for nutrient treatment or recovery. Each characteristic of sidestream (TSS, VSS, COD, N, P, Al3+, Ca2+, Cl-, Fe2+/3+, Mg2+, K+, Na+, SO42-, heavy metals, micro-pollutants and pathogens) is discussed according to the water resource recovery facility configuration, wastewater characteristics and implications for the recovery of nitrogen and phosphorus based on current published knowledge on the processes implemented at full-scale. The thorough analysis of sidestream characteristics shows that anaerobic digestion sidestreams have the highest ammonium content compared to biological and primary sludge sidestreams. Phosphate content in anaerobic digestion sidestreams depends on the type of applied phosphorus treatment but is also highly dependent on precipitation reactions within the digester. Thermal Hydrolysis Process (THP) mainly impacts COD, N and alkalinity content in anaerobic digestion sidestreams. Surprisingly, the concentration of phosphate is not higher compared to conventional anaerobic digestion, thus offering more attractive recovery possibilities upstream of the digester rather than in sidestreams. All sidestream processes investigated in the present study (struvite, partial nitrification/anammox, ammonia stripping, membranes, bioelectrochemical system, electrodialysis, ion exchange system and algae production) suffer from residual TSS in sidestreams. Above a certain threshold, residual COD and ions can also deteriorate the performance of the process or the purity of the final nutrient-based product. This article also provides a list of characteristics to measure to help in the choice of a specific process.

Abatacept/Ruxolitinib and Screening for Concomitant Respiratory Muscle Failure to Mitigate Fatality of Immune-Checkpoint Inhibitor Myocarditis.

Immune-checkpoint-inhibitor (ICI)-associated myotoxicity involves the heart (myocarditis) and skeletal muscles (myositis), which frequently occur concurrently and are highly fatal. We report the results of a strategy that included identification of individuals with severe ICI myocarditis by also screening for and managing concomitant respiratory muscle involvement with mechanical ventilation, as well as treatment with the CTLA4 fusion protein abatacept and the JAK inhibitor ruxolitinib. Forty cases with definite ICI myocarditis were included with pathologic confirmation of concomitant myositis in the majority of patients. In the first 10 patients, using recommended guidelines, myotoxicity-related fatality occurred in 60%, consistent with historical controls. In the subsequent 30 cases, we instituted systematic screening for respiratory muscle involvement coupled with active ventilation and treatment using ruxolitinib and abatacept. The abatacept dose was adjusted using CD86 receptor occupancy on circulating monocytes. The myotoxicity-related fatality rate was 3.4% (1/30) in these 30 patients versus 60% in the first quartile (P < 0.0001). These clinical results are hypothesis-generating and need further evaluation. SIGNIFICANCE: Early management of respiratory muscle failure using mechanical ventilation and high-dose abatacept with CD86 receptor occupancy monitoring combined with ruxolitinib may be promising to mitigate high fatality rates in severe ICI myocarditis. See related commentary by Dougan, p. 1040. This article is highlighted in the In This Issue feature, p. 1027.

Patent Foramen Ovale Percutaneous Closure: Evolution and Ongoing Challenges.

Patent foramen ovale (PFO) concerns nearly a quarter of the general population and incidence may reach up to 50% in patients with cryptogenic stroke. Recent randomized clinical trials confirmed that percutaneous closure of PFO-related stroke reduces the risk of embolic event recurrence. PFO also comes into play in other pathogenic conditions, such as migraine, decompression sickness or platypnea-orthodeoxia syndrome, where the heterogeneity of patients is high and evidence for closure is less well-documented. In this review, we describe the current indications for PFO percutaneous closure and the remaining challenges, and try to provide future directions regarding the technique and its indications.

From cardio-oncology to cardio-onco-pharmacology: Towards a multidisciplinary approach in the understanding and management of cardiotoxicity.

Cardio-oncology is an emerging field that transformed the medical management of patients with cancer. It encompasses the prevention and treatment of cardiovascular toxicities related to cancer treatments, aiming to reduce cardiac adverse events among cancer survivors. Cardiovascular toxicities related to cancer treatments are described through data collected during phase I to phase III therapeutic trials, and post-marketing surveillance (phase IV). Pharmacovigilance analyses, based on datamining from these extensive databases, allowed to understanding and identifying new adverse drug reactions, some recently made available, such as immunotherapy or inhibitor of Bruton tyrosine kinase (IBTK).