Electrokinetic transport of CTAB induces multiphasic behavior during capillary adsorption and desorption.

Cationic surfactant coatings (e.g., CTAB) are commonly used in CE to control EOF and thereby improve separation efficiencies. However, our understanding of surfactant adsorption and desorption dynamics under EOF conditions is limited. Here, we apply automated zeta potential analysis to study the adsorption and desorption kinetics of CTAB in a capillary under different transport conditions: diameter, length, voltage alternation pattern and frequency, and applied pressure. In contrast to other studies, we observe slower kinetics at distinct capillary wall zeta potential ranges. Within these ranges, which we call "stagnant regimes," the EOF mobility significantly counteracts the electrophoretic (EP) mobility of CTA+ and hinders the net transport. By constructing a numerical model to compare with our experiments and recasting our experimental data in terms of the net CTA+ transport volume normalized by surface area, we reveal that the EP mobility of CTA+ and the capillary surface-area-to-volume ratio dictate the zeta potential range and the duration of the stagnant regime and thereby govern the overall reaction kinetics. Our results indicate that further transport-oriented studies can significantly aid in the understanding and design of electrokinetic systems utilizing CTAB and other charged surfactants.

Nanofluidic diodes based on asymmetric bio-inspired surface coatings in straight glass nanochannels.

In this study, we present nanofluidic diodes fabricated from straight glass nanochannels and functionalized using bio-inspired polydopamine (PDA) and poly-L-lysine (PLL) coatings. The resulting PDA coatings are shown to be asymmetric due to a combination of transport considerations which can be leveraged to provide a measure of control over the effective channel geometry. By subsequently introducing a layer of amine-bearing PLL chains covalently bound to the PDA, we enhance heterogeneities in the charge and ion distributions within the channel and enable significant current rectification between forward-bias and reverse-bias modes; our PDA-PLL-coated channels yielded a rectification ratio greater than 1000 in a 100 nm channel filled with 0.01× phosphate-buffered saline solution (PBS). We further demonstrated that at higher ionic strength conditions, reducing the solution pH increased the number of protonated amines within the PLL layer, amplifying the charge disparities along the channel and leading to greater rectification. As nanofluidic diodes with bipolar surface charge distributions tend to provide superior performance compared to those with a single wall charge polarity, we imposed a more bipolar charge distribution in our devices by partially coating our PDA-PLL-coated channels with negatively charged polyacrylic acid (PAA). These enhanced bipolar channels exhibited greater current rectification than the PDA-PLL-coated channels, reaching rectification ratios in excess of 100 even in more physiologically-relevant 1× PBS solutions. Our fabrication approach and the results herein provide a promising platform from which the scientific community can build upon in the relentless endeavor for improved sensitivity in biosensors and other analytical devices.

Differentiating Between Sexual Offending and Violent Non-sexual Offending in Men With Schizophrenia Spectrum Disorders Using Machine Learning.

Forensic psychiatric populations commonly contain a subset of persons with schizophrenia spectrum disorders (SSD) who have committed sex offenses. A comprehensive delineation of the features that distinguish persons with SSD who have committed sex offenses from persons with SSD who have committed violent non-sex offenses could be relevant to the development of differentiated risk assessment, risk management and treatment approaches. This analysis included the patient records of 296 men with SSD convicted of at least one sex and/or violent offense who were admitted to the Centre for Inpatient Forensic Therapy at the University Hospital of Psychiatry Zurich between 1982 and 2016. Using supervised machine learning, data on 461 variables retrospectively collected from the records were compared with respect to their relative importance in differentiating between men who had committed sex offenses and men who had committed violent non-sex offenses. The final machine learning model was able to differentiate between the two types of offenders with a balanced accuracy of 71.5% (95% CI = [60.7, 82.1]) and an AUC of .80 (95% CI = [.67, .93]). The main distinguishing features included sexual behaviours and interests, psychopathological symptoms and characteristics of the index offense. Results suggest that when assessing and treating persons with SSD who have committed sex offenses, it appears to be relevant to not only address the core symptoms of the disorder, but to also take into account general risk factors for sexual recidivism, such as atypical sexual interests and sexual preoccupation.

Elevated renal resistive index is independently predicted by older age, but not by the presence of chronic kidney disease: a retrospective cohort study.

BACKGROUND: Renal resistive index (RRI), which reflects intrarenal arterial impedance, is routinely measured when undertaking renal Doppler ultrasonography (RDU). Increased RRI has been suggested to reflect renal parenchymal disease and imply risk of kidney disease progression. But this has been disputed and extra-renal haemodynamic factors rather than intra-renal factors have been proposed to determine RRI. AIMS: To investigate the relationship between elevated RRI and presence of chronic kidney disease (CKD), and examine whether elevated RRI at baseline is associated with decline in estimated glomerular filtration rate (eGFR) on follow up. METHODS: This retrospective observational study examined the association of elevated RRI (>0.7) with the presence of CKD (eGFR < 60 mL/min for >3 months), demographic and clinical factors in multivariable models. We also examined the effect of elevated RRI on eGFR decline on follow up using mixed models. RESULTS: Of the 346 patients undergoing RDU (median age 69.7 years; 46.2% male), 180 had elevated RRI. There was a strong inverse association between RRI and eGFR at baseline, 1 and 2 years (rho = -0.53, -0.51, -0.53, all P < 001). Elevated RRI was independently predicted by older age (odds ratio 3.29; 95% confidence interval 2.25-4.8; P < 0.001) and diabetes (odds ratio 2.65; 95% confidence interval 1.21-5.80; P = 0.015), but not CKD using multivariate logistic regression. Decline of eGFR was not different between RRI categories on follow up. CONCLUSION: Elevated RRI was predicted by older age and diabetes, but not by the presence of CKD. Baseline RRI was not associated with eGFR decline.

Real-Time Zeta Potential Analysis of Microchannel Surfaces during Aminosilane Deposition and Exposure Using Current Monitoring.

Surface coatings are extensively used in capillary electrophoresis to increase separation efficiency and resolution. The stability of these coatings across a wide pH range is desirable to achieve repeatable migration times; therefore, a comprehensive understanding of coating degradation timescales is needed. We present a novel platform for automated zeta potential analysis based upon current monitoring that delivers improved time resolution over the existing methods. Using our platform, we measure the zeta potential continuously during aminosilane coating reactions and infer changes in the surface composition. We found that the change in the zeta potential after coating depended on the monomer type and solvent, while its stability was influenced by the coating solvent and exposure pH. Our versatile platform provides an elegant approach for evaluating the molecular composition, reactivity, and stability of surfaces in real time.

Asymmetric Weights and Retrieval Practice in an Autoassociative Neural Network Model of Paired-Associate Learning.

Rizzuto and Kahana (2001) applied an autoassociative Hopfield network to a paired-associate word learning experiment in which (1) participants studied word pairs (e.g., ABSENCE-HOLLOW), (2) were tested in one direction (ABSENCE-?) on a first test, and (3) were tested in the same direction again or in the reverse direction (?-HOLLOW) on a second test. The model contained a correlation parameter to capture the dependence between forward versus backward learning between the two words of a word pair, revealing correlation values close to 1.0 for all participants, consistent with neural network models that use the same weight for communication in both directions between nodes. We addressed several limitations of the model simulations and proposed two new models incorporating retrieval practice learning (e.g., the effect of the first test on the second) that fit the accuracy data more effectively, revealing substantially lower correlation values (average of .45 across participants, with zero correlation for some participants). In addition, we analyzed recall latencies, finding that second test recall was faster in the same direction after a correct first test. Only a model with stochastic retrieval practice learning predicted this effect. In conclusion, recall accuracy and recall latency suggest asymmetric learning, particularly in light of retrieval practice effects.

Comparison of the double-photoionization processes in triphenylene and corannulene with coronene.

We have studied the production of doubly charged molecular ions by a single photon for the aromatic molecules triphenylene (C18H12) and corannulene (C20H10) using monochromatized synchrotron radiation from 18 eV to 270 eV. We compare our results with previously published data for partially deuterated benzene (C6H3D3), pyrene (C16H10), and coronene (C24H12). The question that we address in this paper is how the different but similar molecular structures of coronene, corannulene, and triphenylene affect the photon-energy dependence of the ratio of doubly to singly charged parent ions. A theoretical analysis of the main features in terms of independent molecular subsystems will be discussed.

Frontal cortex tracks surprise separately for different sensory modalities but engages a common inhibitory control mechanism.

The brain constantly generates predictions about the environment to guide action. Unexpected events lead to surprise and can necessitate the modification of ongoing behavior. Surprise can occur for any sensory domain, but it is not clear how these separate surprise signals are integrated to affect motor output. By applying a trial-to-trial Bayesian surprise model to human electroencephalography data recorded during a cross-modal oddball task, we tested whether there are separate predictive models for different sensory modalities (visual, auditory), or whether expectations are integrated across modalities such that surprise in one modality decreases surprise for a subsequent unexpected event in the other modality. We found that while surprise was represented in a common frontal signature across sensory modalities (the fronto-central P3 event-related potential), the single-trial amplitudes of this signature more closely conformed to a model with separate surprise terms for each sensory domain. We then investigated whether surprise-related fronto-central P3 activity indexes the rapid inhibitory control of ongoing behavior after surprise, as suggested by recent theories. Confirming this prediction, the fronto-central P3 amplitude after both auditory and visual unexpected events was highly correlated with the fronto-central P3 found after stop-signals (measured in a separate stop-signal task). Moreover, surprise-related and stopping-related activity loaded onto the same component in a cross-task independent components analysis. Together, these findings suggest that medial frontal cortex maintains separate predictive models for different sensory domains, but engages a common mechanism for inhibitory control of behavior regardless of the source of surprise.

Stress induced by crude glycerol in a thermophilic digester: microbial community divergence and resilience, but slow process recovery.

Recovery from stress is an important property for anaerobic digestion (AD). Although AD is quite adaptable with regard to waste composition, new substrates added to stable systems may cause process decline. We tested whether crude glycerol would cause stress to a thermophilic AD microbiome previously stabilized long-term on a low C/N ratio feedstock. Three-percent (v/v) crude glycerol was added to the basal substrate (poultry litter) for two hydraulic retention time (HRT) periods. This caused stress where biogas volume and methane percentage dramatically decreased and VFA levels increased. When the basal substrate was resumed, secondary inhibition occurred, resulting in even greater stress (biogas production ceased, methane 3.6%). Unassisted recovery of system processes required eight HRT periods. In contrast, crude glycerol applied at a lower organic loading rate did not cause inhibition. Crude glycerol caused changes in dominance in the microbial community (16S rRNA pyrotags). Although process resilience was slow, the recovery of digester functions occurred in conjunction with the recovery of community structure, particularly putative syntrophic acetate-oxidizing bacteria. KEY POINTS: • Crude glycerol caused stress in thermophilic co-digestion with poultry litter. • Unassisted resilience of digester functions (methane) required 8 HRT. • Syntrophic acetate-oxidizing bacteria implicated for keystone resilience functions. Graphical abstract.

Impact on place of death in cancer patients: a causal exploration in southern Switzerland.

BACKGROUND: Most terminally ill cancer patients prefer to die at home, but a majority die in institutional settings. Research questions about this discrepancy have not been fully answered. This study applies artificial intelligence and machine learning techniques to explore the complex network of factors and the cause-effect relationships affecting the place of death, with the ultimate aim of developing policies favouring home-based end-of-life care. METHODS: A data mining algorithm and a causal probabilistic model for data analysis were developed with information derived from expert knowledge that was merged with data from 116 deceased cancer patients in southern Switzerland. This data set was obtained via a retrospective clinical chart review. RESULTS: Dependencies of disease and treatment-related decisions demonstrate an influence on the place of death of 13%. Anticancer treatment in advanced disease prevents or delays communication about the end of life between oncologists, patients and families. Unknown preferences for the place of death represent a great barrier to a home death. A further barrier is the limited availability of family caregivers for terminal home care. The family's preference for the last place of care has a high impact on the place of death of 51%, while the influence of the patient's preference is low, at 14%. Approximately one-third of family systems can be empowered by health care professionals to provide home care through open end-of-life communication and good symptom management. Such intervention has an influence on the place of death of 17%. If families express a convincing preference for home care, the involvement of a specialist palliative home care service can increase the probability of home deaths by 24%. CONCLUSION: Concerning death at home, open communication about death and dying is essential. Furthermore, for the patient preference for home care to be respected, the family's decision for the last place of care seems to be key. The early initiation of family-centred palliative care and the provision of specialist palliative home care for patients who wish to die at home are suggested.

Testing the primary and convergent retrieval model of recall: Recall practice produces faster recall success but also faster recall failure.

The primary and convergent retrieval (PCR) model assumes that the act of successful recall not only boosts associations between the item and retrieval cues but additionally strengthens associations within the item (i.e., between the features of an item), speeding the rate of information retrieval from memory. The latter effect is termed intra-item learning and is a unique benefit of recall practice (i.e., the "testing effect"). Prior work confirmed the prediction that recall practice produces faster subsequent recall than restudy practice even if accuracy is higher following restudy. The current study replicated this result, but also examined the downside of recall practice: that after a failure to recall during practice, participants will be faster in their failure to recall on a subsequent recall test. This prediction was confirmed in a multisession cued recall experiment that collected accuracy and recall latency measurements for no practice, recall practice, or restudy, with an immediate or delayed final test. The linear ballistic accumulator model was fit to latency distributions, and model comparison determined that these effects reflect differences in drift rates, as predicted by the PCR model.

The elimination of positive priming with increasing prime duration reflects a transition from perceptual fluency to disfluency rather than bias against primed words.

With immediate repetition priming of forced choice perceptual identification, short prime durations produce positive priming (i.e., priming the target leads to higher accuracy, while priming the foil leads to lower accuracy). Many theories explain positive priming following short duration primes as reflecting increased perceptual fluency for the primed target (i.e., decreased identification latency). However, most studies only examine either accuracy or response times, rather than considering the joint constraints of response times and accuracy to properly address the role of decision biases and response caution. This is a critical oversight because several theories propose that the transition to negative priming following a long duration prime reflects a decision strategy to compensate for the effect of increased perceptual fluency. In contrast, the nROUSE model of Huber and O'Reilly (2003) explains this transition as reflecting perceptual habituation, and thus a change to perceptual disfluency. We confirmed this prediction by applying a sequential sampling model (the diffusion race model) to accuracy and response time distributions from a new single item same-different version of the priming task. In this way, we measured strategic biases and perceptual fluency in each condition for each subject. The nROUSE model was only applied to accuracy from the original forced-choice version of the priming task. This application of nROUSE produced separate predictions for each subject regarding the degree of fluency and disfluency in each condition, and these predictions were confirmed by the drift rate parameters (i.e., fluency) from the response time model in contrast to the threshold parameters (i.e., bias).

Comparing different kinds of words and word-word relations to test an habituation model of priming.

Huber and O'Reilly (2003) proposed that neural habituation exists to solve a temporal parsing problem, minimizing blending between one word and the next when words are visually presented in rapid succession. They developed a neural dynamics habituation model, explaining the finding that short duration primes produce positive priming whereas long duration primes produce negative repetition priming. The model contains three layers of processing, including a visual input layer, an orthographic layer, and a lexical-semantic layer. The predicted effect of prime duration depends both on this assumed representational hierarchy and the assumption that synaptic depression underlies habituation. The current study tested these assumptions by comparing different kinds of words (e.g., words versus non-words) and different kinds of word-word relations (e.g., associative versus repetition). For each experiment, the predictions of the original model were compared to an alternative model with different representational assumptions. Experiment 1 confirmed the prediction that non-words and inverted words require longer prime durations to eliminate positive repetition priming (i.e., a slower transition from positive to negative priming). Experiment 2 confirmed the prediction that associative priming increases and then decreases with increasing prime duration, but remains positive even with long duration primes. Experiment 3 replicated the effects of repetition and associative priming using a within-subjects design and combined these effects by examining target words that were expected to repeat (e.g., viewing the target word 'BACK' after the prime phrase 'back to'). These results support the originally assumed representational hierarchy and more generally the role of habituation in temporal parsing and priming.

Maternal exposure to carbamazepine at environmental concentrations can cross intestinal and placental barriers.

Psychoactive pharmaceuticals have been found as teratogens at clinical dosage during pregnancy. These pharmaceuticals have also been detected in minute (ppb) concentrations in drinking water in the US, and are environmental contaminants that may be complicit in triggering neurological disorders in genetically susceptible individuals. Previous studies have determined that psychoactive pharmaceuticals (fluoxetine, venlafaxine and carbamazepine) at environmentally relevant concentrations enriched sets of genes regulating development and function of the nervous system in fathead minnows. Altered gene sets were also associated with potential neurological disorders, including autism spectrum disorders (ASD). Subsequent in vitro studies indicated that psychoactive pharmaceuticals altered ASD-associated synaptic protein expression and gene expression in human neuronal cells. However, it is unknown if environmentally relevant concentrations of these pharmaceuticals are able to cross biological barriers from mother to fetus, thus potentially posing risks to nervous system development. The main objective of this study was to test whether psychoactive pharmaceuticals (fluoxetine, venlafaxine, and carbamazepine) administered through the drinking water at environmental concentrations to pregnant mice could reach the brain of the developing embryo by crossing intestinal and placental barriers. We addressed this question by adding (2)H-isotope labeled pharmaceuticals to the drinking water of female mice for 20 days (10 pre-and 10 post-conception days), and quantifying (2)H-isotope enrichment signals in the dam liver and brain of developing embryos using isotope ratio mass spectrometry. Significant levels of (2)H enrichment was detected in the brain of embryos and livers of carbamazepine-treated mice but not in those of control dams, or for fluoxetine or venlafaxine application. These results provide the first evidence that carbamazepine in drinking water and at typical environmental concentrations is transmitted from mother to embryo. Our results, combined with previous evidence that carbamazepine may be associated with ASD in infants, warrant the closer examination of psychoactive pharmaceuticals in drinking water and their potential association with neurodevelopmental disorders.

Transcriptome Analysis of Invasive Plants in Response to Mineral Toxicity of Reclaimed Coal-Mine Soil in the Appalachian Region.

Efficient postmining reclamation requires successful revegetation. By using RNA sequencing, we evaluated the growth response of two invasive plants, goutweed (Aegopodium podagraria L.) and mugwort (Artemisia vulgaris), grown in two Appalachian acid-mine soils (MS-I and -II, pH ∼ 4.6). Although deficient in macronutrients, both soils contained high levels of plant-available Al, Fe and Mn. Both plant types showed toxicity tolerance, but metal accumulation differed by plant and site. With MS-I, Al accumulation was greater for mugwort than goutweed (385 ± 47 vs 2151 ± 251 µg g-1). Al concentration was similar between mine sites, but its accumulation in mugwort was greater with MS-I than MS-II, with no difference in accumulation by site for goutweed. An in situ approach revealed deregulation of multiple factors such as transporters, transcription factors, and metal chelators for metal uptake or exclusion. The two plant systems showed common gene expression patterns for different pathways. Both plant systems appeared to have few common heavy-metal pathway regulators addressing mineral toxicity/deficiency in both mine sites, which implies adaptability of invasive plants for efficient growth at mine sites with toxic waste. Functional genomics can be used to screen for plant adaptability, especially for reclamation and phytoremediation of contaminated soils and waters.

Using continual flash suppression to investigate cognitive aftereffects.

In a naming task with visually presented words, Prioli and Kahan (2015) reported that negatively valenced words were identified more slowly than neutral words in a condition with continual flash suppression (CFS), which involves showing the dominant eye changing Mondrian patterns, delaying awareness for the word shown to the other eye. However, when these same words were shown to both eyes (i.e., no CFS), negatively valenced words were identified more quickly. The authors hypothesized that the negative word deficit with CFS reflects greater habituation (i.e., a cognitive aftereffect) that accrues for negative words before the observer becomes aware of the word. However, aftereffects typically occur in response to a target stimulus that follows an adapting stimulus, rather than in response to a single stimulus that is initially processed without awareness. Thus, it is not immediately obvious that the explanation provided by Prioli and Kahan is adequate. Here I report a simulation using a model that was previously applied to cognitive aftereffects, demonstrating that their account can explain this crossover interaction. These results suggest that CFS may be a useful technique for studying cognitive aftereffects without concern for conscious decision strategies.

Microbial community structure of a pilot-scale thermophilic anaerobic digester treating poultry litter.

The microbial community structure of a stable pilot-scale thermophilic continuous stirred tank reactor digester stabilized on poultry litter was investigated. This 40-m(3) digester produced biogas with 57% methane, and chemical oxygen demand removal of 54%. Bacterial and archaeal diversity were examined using both cloning and pyrosequencing that targeted 16S rRNA genes. The bacterial community was dominated by phylum Firmicutes, constituting 93% of the clones and 76% of the pyrotags. Of the Firmicutes, class Clostridia (52% pyrotags) was most abundant followed by class Bacilli (13% pyrotags). The bacterial libraries identified 94 operational taxonomic units (OTUs) and pyrosequencing identified 577 OTUs at the 97% minimum similarity level. Fifteen OTUs were dominant (≥2% abundance), and nine of these were novel unclassified Firmicutes. Several of the dominant OTUs could not be classified more specifically than Clostridiales, but were most similar to plant biomass degraders, including Clostridium thermocellum. Of the rare pyrotag OTUs (<0.5% abundance), 75% were Firmicutes. The dominant methanogen was Methanothermobacter which has hydrogenotrophic metabolism, and accounted for >99% of the archaeal clones. Based on the primary methanogen, as well as digester chemistry (high VA and ammonia levels), we propose that bacterial acetate oxidation is the primary pathway in this digester for the control of acetate levels.

The push-pull of serial dependence effects: Attraction to the prior response and repulsion from the prior stimulus.

In the "serial dependence" effect, responses to visual stimuli appear biased toward the last trial's stimulus. However, several kinds of serial dependence exist, with some reflecting prior stimuli and others reflecting prior responses. One-factor analyses consider the prior stimulus alone or the prior response alone and can consider both variables only via separate analyses. We demonstrate that one-factor analyses are potentially misleading and can reach conclusions that are opposite from the truth if both dependencies exist. To address this limitation, we developed two-factor analyses (model comparison with hierarchical Bayesian modeling and an empirical "quadrant analysis"), which consider trial-by-trial combinations of prior response and prior stimulus. Two-factor analyses can tease apart the two dependencies if applied to a sufficiently large dataset. We applied these analyses to a new study and to four previously published studies. When applying a model that included the possibility of both dependencies, there was no evidence of attraction to the prior stimulus in any dataset, but there was evidence of attraction to the prior response in all datasets. Two of the datasets contained sufficient constraint to determine that both dependencies were needed to explain the results. For these datasets, the dependency on the prior stimulus was repulsive rather than attractive. Our results are consistent with the claim that both dependencies exist in most serial dependence studies (the two-dependence model was not ruled out for any dataset) and, furthermore, that the two dependencies work against each other.

"Leap before you look": Conditions that suppress explicit, knowledge-based learning during visuomotor adaptation.

When learning a novel visuomotor mapping (e.g., mirror writing), accuracy can improve quickly through explicit, knowledge-based learning (e.g., aim left to go right), but after practice, implicit or procedural learning takes over, producing fast, natural movements. This procedural learning occurs automatically, whereas it has recently been found that knowledge-based learning can be suppressed by the gradual introduction of the novel mapping when participants must make fast movements and visuomotor perturbations are small (e.g., 30° rotations). We explored the range of task instructions, perturbation parameters, and feedback that preclude or encourage this suppression. Using a reaching task with a rotation between screen position and movement direction, we found that knowledge-based learning could be suppressed even for an extreme 90° rotation, but only if it was introduced gradually and only under instructions to move quickly. If the rotation was introduced abruptly or if instructions emphasized accuracy over speed, knowledge-based learning occurred. A second experiment indicated that knowledge-based learning always occurred in the absence of continuous motion feedback, evidenced by the time course of learning, the aftereffects of learning when the rotation was abruptly removed, and the outcome of formal model comparison between a dual-state (procedural and knowledge-based) versus a single-state (procedural only) learning model of the data. A third experiment replicated the findings and verified that the knowledge-based component of the dual-state model corresponded to explicit aiming, whereas the procedural component was slow to unlearn. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Guidelines for management of actual or suspected inadvertent intra-arterial injection of sclerosants.

BACKGROUND: Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. OBJECTIVES: To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. METHODS: An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. RESULTS: Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. CONCLUSION: Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy.