Landfill leachate treatment by a combination of a multiple plant hybrid constructed wetland system with a solar photoFenton process in a raceway pond reactor.

The sustainable and green treatment of landfill leachate (LL), produced by municipal solid waste, represents one of the most relevant challenges in the integrated waste management systems. Accordingly, in this work a green solution was investigated by coupling an innovative hybrid constructed wetland (HCW) to a solar photo-Fenton (SPF) process. A multiple layers HCW pilot plant including different medium substrates (sand, solid compost and carriers) and plant species (Phragmites australis, Arundo donax and A. plinii) was designed. The HCW was functionalised with compost tea solution to simultaneously provide high nutrient content for plants and increase the microorganism biodiversity. Process efficiency was investigated using different real LLs (young and mature) in terms of chemical oxygen demand (COD), nitrogen compounds, chlorides and metals. Removals in the range 75-95% were observed for all the parameters after ten days of leachate recirculation in the pilot plant. Subsequently, the SPF process was carried out in a raceway pond reactor (RPR) as polishing step, significantly improving COD removal (further 49%). HCW combined with SPF in RPR would allow to meet the corresponding limits according to the final use/fate of the effluent by modulating the main parameters of the process.

Improving organic matter and nutrients removal and minimizing sludge production in landfill leachate pre-treatment by Fenton process through a comprehensive response surface methodology approach.

Landfill leachate (LL) represents a very complex effluent difficult to treat and to manage which usually requires a chemical pre-treatment. In this study, response surface methodology (RSM) was used to identify the optimum operating conditions of the Fenton process as a pre-treatment of LL in order to reduce the high organic content and simultaneously optimize the BOD5:TN:TP ratio. The dosages of Fenton process reagents, namely Fe2+ and H2O2, were used as variables for the implementation of RSM. Chemical oxygen demand (COD), five-days biochemical oxygen demand (BOD5), total nitrogen (TN), total phosphorus (TP) removals (and simultaneously BOD5:TN:TP ratio), sludge-to-iron ratio (SIR) and organic removal-to-sludge ratio (ORSR) were selected as target responses. This approach considered the SIR and ORSR parameters which are a useful tool for assessing sludge formation during the process along with organic matter removal. The variables (H2O2 and Fe2+ concentrations) significantly affected the responses, as the role of oxidation mechanism is dominant with respect to coagulation one. The pH for the process was fixed to 2.8 while the treatment time was set to 2 h. The optimum operational conditions obtained by perturbation and 3D surface plot, were found to be 4262 mg/L and 5104 mg/L for Fe2+ and H2O2, respectively (H2O2/Fe2+ molar ratio = 2) with COD, BOD5, TN and TP removals of 70%, 67%, 84% and 96% respectively, while SIR and ORSR final values were 1.15 L/mol and 33.79 g/L respectively, in accordance with models-predicted values. Moreover, the initial unbalanced BOD5:TN:TP ratio (9:1:1) was significantly improved (100:6:1), making the effluent suitable for a subsequent biological treatment. The investigated approach allowed to optimize the removal of organic load and nutrients as well as to minimize the sludge formation in Fenton process, providing a useful tool for the operation and management of LL pre-treatment.

Factors Affecting the Outcome of Symptomatic Carotid Stenosis Surgical Treatment in a Single Center Series.

BACKGROUND: The aim of this study is to evaluate the role of preoperative ischemic brain lesion (IBL) volume, assessed by Diffusion-weighted magnetic resonance brain imaging (DW-MRI) with RAPID® processing, and surgery timing in predicting post-operative neurological outcomes in symptomatic carotid stenosis (SCS) patients treated with carotid endarterectomy (CEA). MATERIALS AND METHODS: All patients with SCS who underwent CEA between January 2010 and June 2020 were considered. IBLs ipsilateral to the stenosis were identified in the preoperative magnetic resonance brain (MRI). The volume was quantified in mL and correlated with 30-day rates of stroke and stroke/death by χ2 and receiver operating characteristic (ROC) curve. RESULTS: One hundred thirty-four patients were surgically treated for SCS during the entire study period. CEA procedures were defined as emergent, urgent, or elective if performed within 48 hr, between 48 hr and 14 days, or after 14 days from symptoms onset, respectively. Cumulative new ipsilateral stroke rate was 4,5%, with a statistically higher neurological complications in emergent patients compared to urgent and elective patients (10,6%, 1,47% and 0% respectively, P 0,039). ROC curve analysis showed a volume of 10 mL was predictive of postoperative stroke with 100% sensitivity and 80% specificity. An IBL volume >10 mL was an independent risk factor for postoperative stroke. In fact, the perioperative neurological complication rate was significantly different in high-IBL volume patients (>10 mL) compared with low-IBL volume patients (<10 mL) (P 0,003) CONCLUSIONS: The present study suggests that the optimal timing for CEA is between 48 hr and 14 days. Furthermore, the present study suggests that the presence of the IBL, by itself, is not definitively related with an unsatisfactory neurological outcome. However, an IBL higher than 10 mL should be as a reliable threshold value adverse neurological result in SCS patients.

Changes in Antibiotic Resistance Gene Levels in Soil after Irrigation with Treated Wastewater: A Comparison between Heterogeneous Photocatalysis and Chlorination.

Wastewater (WW) reuse is expected to be increasingly indispensable in future water management to mitigate water scarcity. However, this increases the risk of antibiotic resistance (AR) dissemination via irrigation. Herein, a conventional (chlorination) and an advanced oxidation process (heterogeneous photocatalysis (HPC)) were used to disinfect urban WW to the same target of Escherichia coli <10 CFU/100 mL and used to irrigate lettuce plants (Lactuca sativa) set up in four groups, each receiving one of four water types, secondary WW (positive control), fresh water (negative control), chlorinated WW, and HPC WW. Four genes were monitored in water and soil, 16S rRNA as an indicator of total bacterial load, intI1 as a gene commonly associated with anthropogenic activity and AR, and two AR genes blaOXA-10 and qnrS. Irrigation with secondary WW resulted in higher dry soil levels of intI1 (from 1.4 × 104 copies/g before irrigation to 3.3 × 105 copies/g after). HPC-treated wastewater showed higher copy numbers of intI1 in the irrigated soil than chlorination, but the opposite was true for blaOXA-10. The results indicate that the current treatment is insufficient to prevent dissemination of AR markers and that HPC does not offer a clear advantage over chlorination.

Acute Occlusion of Descending Thoracic Aorta.

Acute aortic occlusion is a rare but potentially devastating clinical event, which requires a prompt diagnosis and emergency treatment. Only 5 cases of native thoracic aorta acute occlusion have so far been reported with different pathologic causes. The clinical features depend on the level of occlusion. Sometimes the diagnosis could be misinterpreted as a stroke or other diseases of the central nervous system. This could lead to a delay in the diagnosis and revascularization procedure, followed by a morbidity or mortality increase. Open surgery has been considered the first-line approach. This study is of a female patient suffering from acute descending thoracic aorta occlusion undergoing, for the first time to our knowledge, endovascular surgical treatment.

Different ST2 Serum Concentrations in Asymptomatic and Symptomatic Carotid Artery Stenosis.

BACKGROUND: ST2 represents an interesting biomarker associated with the progression of atherosclerotic disease. METHODS: This study aims to detect different ST2 serum concentrations, and intraplaque ST2 expression, in patients with symptomatic and asymptomatic carotid artery stenosis. RESULTS: The analysis of ST2 expression in the atheromatous plaque did not show any significant difference between symptomatic and asymptomatic patients (39.61 ± 35.97 vs. 38.49 ± 35.26; P = ns). ST2 serum concentrations of asymptomatic and symptomatic patients were statistically different with a concentration of 11.04 ± 8.95 ng/mL and 13.91 ± 8.01 ng/mL, respectively (P = 0.037). We observed statistical difference in serum ST2 levels between asymptomatic and symptomatic patients for cerebrovascular acute disease. No differences have been obtained in intraplaque ST2 expression. CONCLUSIONS: Soluble serum ST2 levels can be a useful biomarker to identify patients at risk for cerebrovascular events.

Simulating the fate of indigenous antibiotic resistant bacteria in a mild slope wastewater polluted stream.

The fate of indigenous surface-water and wastewater antibiotic resistant bacteria in a mild slope stream simulated through a hydraulic channel was investigated in outdoor experiments. The effect of (i) natural (dark) decay, (ii) sunlight, (iii) cloudy cover, (iv) adsorption to the sediment, (v) hydraulic conditions, (vi) discharge of urban wastewater treatment plant (UWTP) effluent and (vii) bacterial species (presumptive Escherichia coli and enterococci) was evaluated. Half-life time (T1/2) of E. coli under sunlight was in the range 6.48-27.7min (initial bacterial concentration of 105CFU/mL) depending on hydraulic and sunlight conditions. E. coli inactivation was quite similar in sunny and cloudy day experiments in the early 2hr, despite of the light intensity gradient was in the range of 15-59W/m2; but subsequently the inactivation rate decreased in the cloudy day experiment (T1/2=23.0min) compared to sunny day (T1/2=17.4min). The adsorption of bacterial cells to the sediment (biofilm) increased in the first hour and then was quite stable for the remaining experimental time. Finally, when the discharge of an UWTP effluent in the stream was simulated, the proportion of indigenous antibiotic resistant E. coli and enterococci was found to increase as the exposure time increased, thus showing a higher resistance to solar inactivation compared to the respective total populations.

The Role of the Profundoplasty in the Modern Management of Patient with Peripheral Vascular Disease.

BACKGROUND: The occlusion of superficial femoris artery (SFA) is a common feature in peripheral vascular disease, so the profunda femoris artery (PFA) is a crucial collateral pathway for the perfusion of the lower limb. The purpose of this study is to discuss the safety, clinical, and hemodynamic efficacy of profundoplasty on the basis of limb salvage, patency, and freedom from reintervention rates. Furthermore, this study aims to identify the risk factors linked to the failure of the procedure. METHODS: The study is based on a retrospective analysis of prospectively collected data of identified patients who underwent profundoplasty from March 2005 to October 2015. All patients showed a hemodynamic stenosis, extended from the posterior wall of the common femoral artery (CFA) into the origin of the PFA and concomitant occlusion of SFA. Endarterectomy with patch angioplasty was performed in all cases. In patients with concomitant iliac occlusive disease, a hybrid treatment was carried out to restore an adequate inflow through an endovascular approach. RESULTS: Seventy-four profundoplasty were performed during the study period. Isolate profundoplasty was performed in 56 cases (75.7%), while in the remaining 18 cases (24.3%), concomitant endovascular treatment of iliac lesions was performed. Hemodynamic success was achieved in 90.5% of the cases. The mean ankle-brachial index significantly improved, rising from 0.36 ± 0.17 preoperatively to 0.57 ± 0.20 postoperatively (P < 0.001). The median follow-up period was 33 months. Primary patency rate was 98.5% at 12, 36, and 60 months. Freedom from reintervention rate was 97% at 1 year and 95.3% at 3 and 5 years. Limb salvage rate was 96.9% at 1 year and 92.7% at 3 and 5 years. Survival rates were 86%, 60%, and 47.4% at 1, 3, and 5 years, respectively. Multivariate analysis identified Rutherford class 5 or 6 lesions as the strongest predictors of major amputation or reintervention (odds ratio, 9.37; confidence interval: 0.98-89.27; P = 0.05). CONCLUSIONS: Profundoplasty is a durable, safe, and effective procedure in terms of clinical and hemodynamic results for patients characterized by occlusion of SFA and stenosis of CFA extended to profunda ostium. For patients with Rutherford category 5 and 6 ischemia, the only profundoplasty does not seem to be adequate, and concomitant distal bypass should be necessary to improve limb salvage and decrease reintervention rate.

High Throughput Analysis of Integron Gene Cassettes in Wastewater Environments.

Integrons are extensively targeted as a proxy for anthropogenic impact in the environment. We developed a novel high-throughput amplicon sequencing pipeline that enables characterization of thousands of integron gene cassette-associated reads, and applied it to acquire a comprehensive overview of gene cassette composition in effluents from wastewater treatment facilities across Europe. Between 38 100 and 172 995 reads per-sample were generated and functionally characterized by screening against nr, SEED, ARDB and ß-lactamase databases. Over 75% of the reads were characterized as hypothetical, but thousands were associated with toxin-antitoxin systems, DNA repair, cell membrane function, detoxification and aminoglycoside and ß-lactam resistance. Among the reads characterized as ß-lactamases, the carbapenemase blaOXA was dominant in most of the effluents, except for Cyprus and Israel where blaGES was also abundant. Quantitative PCR assessment of blaOXA and blaGES genes in the European effluents revealed similar trends to those displayed in the integron amplicon sequencing pipeline described above, corroborating the robustness of this method and suggesting that these integron-associated genes may be excellent targets for source tracking of effluents in downstream environments. Further application of the above analyses revealed several order-of-magnitude reductions in effluent-associated ß-lactamase genes in effluent-saturated soils, suggesting marginal persistence in the soil microbiome.

Carotid Endarterectomy or Stenting in Octogenarians in a Monocentric Experience.

BACKGROUND: Carotid artery stenting (CAS) has emerged as an alternative to carotid endarterectomy (CEA) in patients at high risk for complications from surgery. The very elderly (≥80-year-old) are 1 subgroup of patients identified as being at increased risk for carotid surgery. However, there is concern that the very elderly are also at increased risk for complications of CAS. A stroke and death rate of 12% were reported in very elderly patients during the roll-in phase of Carotid Revascularization Endarterectomy versus Stent Trial. We are reporting on a clinical series of CAS and CEA with independent neurologic assessment in the very elderly. The aim of this article is to evaluate early and mild-term results obtained in the treatment of the carotid artery stenosis in symptomatic and asymptomatic octogenarians, comparing the data of CEA and CAS in academic hospital. METHODS: Between 2002 and 2013, a consecutive series of 129 CAS and 45 CEA patients (≥80-year-old) were treated in our academic hospital, a center with extensive carotid revascularization experience. Independent neurologic assessment was performed before and after procedures. Exclusion criteria were cerebral hemorrhage diagnosed within 6 months, cerebral tumors and dementia. Hostile aortic arches were nevertheless treated with alternative approaches like cervical or radial access. All the procedures have been performed by the senior authors. RESULTS: The average age was 86.9 years. Most patients were male (56%), and the target lesion carotid stenosis was asymptomatic in 80% of patients. No significant differences were obtained regarding gender, symptoms, risk factors or comorbidities, and evident CT lesions among the 2 groups of different treatments. Embolic protection devices were used in all cases with the CAS procedure. The overall 30-day incidence of stroke and death was 2.3% (3 of 129) in CAS group and 4.4% (2 of 45) in CEA group. CONCLUSIONS: Exclusion of high-risk patients from CAS, based on age alone, seems to be unjustified. Octogenarians are not at increased risk of periprocedural adverse events after CAS compared with younger patients. The key to obtain satisfactory results is CAS to be performed by an experienced team able to use not only standard filter protected CAS but also familiar with all the other types of access and protection techniques.

Cross-Contamination of Residual Emerging Contaminants and Antibiotic Resistant Bacteria in Lettuce Crops and Soil Irrigated with Wastewater Treated by Sunlight/H2O2.

The sunlight/H2O2 process has recently been considered as a sustainable alternative option compared to other solar driven advanced oxidation processes (AOPs) in advanced treatment of municipal wastewater (WW) to be reused for crop irrigation. Accordingly, in this study sunlight/H2O2 was used as disinfection/oxidation treatment for urban WW treatment plant effluent in a compound parabolic collector photoreactor to assess subsequent cross-contamination of lettuce and soil by contaminants of emerging concern (CECs) (determined by QuEChERS extraction and LC-QqLIT-MS/MS analysis) and antibiotic resistant (AR) bacteria after irrigation with treated WW. Three CECs (carbamazepine (CBZ), flumequine (FLU), and thiabendazole (TBZ) at 100 µg L(-1)) and two AR bacterial strains (E. coli and E. faecalis, at 10(5) CFU mL(-1)) were spiked in real WW. A detection limit (DL) of 2 CFU mL(-1) was reached after 120 min of solar exposure for AR E. coli, while AR E. faecalis was more resistant to the disinfection process (240 min to reach DL). CBZ and TBZ were poorly removed after 90 min (12% and 50%, respectively) compared to FLU (94%). Lettuce was irrigated with treated WW for 5 weeks. CBZ and TBZ were accumulated in soil up to 472 ng g(-1) and 256 ng g(-1) and up-taken by lettuce up to 109 and 18 ng g(-1), respectively, when 90 min treated WW was used for irrigation; whereas no bacteria contamination was observed when the bacterial density in treated WW was below the DL. A proper treatment time (>90 min) should be guaranteed in order to avoid the transfer of pathogens from disinfected WW to irrigated crops and soil.

Hybrid treatment for thoracoabdominal aortic aneurysms in patients with Marfan syndrome.

Marfan syndrome is a heritable disorder of connective tissue leading to aortic aneurysms and other cardiovascular complications associated with reduced life expectancy. Although contemporary management of ascending aortic disease requires open surgical reconstruction, the combined retrograde visceral revascularization and endovascular exclusion (hybrid procedure) of entire thoracoabdominal aorta has been introduced for the management of descending thoracic and abdominal aortic pathology. The present experience reports 2 cases of thoracoabdominal aortic aneurysms, in Marfan patients, previously submitted to major cardiovascular surgical procedures, through a hybrid approach.

Effect of microplastics on urban wastewater disinfection and impact on effluent reuse: Sunlight/H2O2 vs solar photo-Fenton at neutral pH.

The interference of three types of microplastics (MPs) on the inactivation of Escherichia coli (E. coli) by advanced oxidation processes (AOPs) (namely, sunlight/H2O2 and solar photo-Fenton (SPF) with Ethylenediamine-N,N'-disuccinic acid (EDDS)), in real secondary treated urban wastewater was investigated for the first time. Inactivation by sunlight/H2O2 treatment decreased as MPs concentration and H2O2 dose were increased. Noteworthy, an opposite behaviour was observed for SPF process where inactivation increased as MPs concentration was increased. Biofilm formation and microbial attachment on surfaces of post-treated MPs were observed on polyethylene (PE) and polyvinyl chloride (PVC) MPs by field emission scanning electron microscopy. In presence of PE MPs, a complete inactivation of E. Coli was achieved by SPF with EDDS (Fe:EDDS = 1:2) after 90 min treatment unlike of sunlight/H2O2 treatment (∼4.0 log reduction, 40 mg/L H2O2 dose, 90 min treatment). The lower efficiency of sunlight/H2O2 process could be attributed to the blocking/scattering effect of MPs on sunlight, which finally reduced the intracellular photo Fenton effect. A reduced E. coli regrowth was observed in presence of MPs. SPF (Fe:EDDS = 1:1) with PE MPs was less effective in controlling bacterial regrowth (∼120 CFU/100 mL) than sunlight/H2O2 (∼10 CFU/100 mL) after 48 h of post-treatment. These results provide useful information about possible interference of MPs on urban wastewater disinfection by solar driven AOPs and possible implications for effluent reuse.

Urban wastewater disinfection by iron chelates mediated solar photo-Fenton: Effects on seven pathogens and antibiotic resistance transfer potential.

The effects of solar photo-Fenton (SPF) process mediated by the iron chelate Fe3+ imminodisuccinic acid (Fe:IDS) on both the inactivation of seven relevant pathogens and the potential for antibiotic resistance transfer (degradation of antibiotic resistance genes (ARGs) and after treatment regrowth), in real secondary treated urban wastewater, were investigated for the first time. A comparison with results obtained by sunlight/H2O2 process and Fe3+ ethylenediaminedisuccinic acid (Fe:EDDS) SPF was also carried out. ARGs were quantified by polymerase chain reaction (PCR) in samples before and after (3 h) the treatment. The persistence of the selected pathogens and ARGs was also evaluated in regrowth tests (72 h) under environmentally mimicking conditions. Fe:IDS SPF resulted to be more effective (from 1.4 log removal for Staphylococcus spp. to 4.3 log removal for Escherichia coli) than Fe:EDDS SPF (from 0.8 log removal for Pseudomonas aeruginosa to 2.0 log removal for Total coliphages) and sunlight/H2O2 (from 1.2 log removal for Clostridium perfringens to 3.3 log removal for E. coli) processes for the seven pathogens investigated. Potential pathogens regrowth was also severely affected, as no substantial regrowth was observed, both in presence and absence of catalase. A similar trend was observed for ARGs removal too (until 0.001 fold change expression for qnrS after 3 h). However, a poor effect and a slight increase in fold change was observed after treatment especially for gyrA, mefA and intl1. Overall, the effect of the investigated processes on ARGs was found to be ARG dependent. Noteworthy, coliphages can regrow after sunlight/H2O2 treatment unlike SPF processes, increasing the risk of antibiotic resistance transfer by transduction mechanism. In conclusion, Fe:IDS SPF is an attractive solution for tertiary treatment of urban wastewater in small wastewater treatment plants as it can provide effective disinfection and a higher protection against antibiotic resistance transfer than the other investigated processes.

Making waves: The NORMAN antibiotic resistant bacteria and resistance genes database (NORMAN ARB&ARG)-An invitation for collaboration to tackle antibiotic resistance.

With the global concerns on antibiotic resistance (AR) as a public health issue, it is pivotal to have data exchange platforms for studies on antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) in the environment. For this purpose, the NORMAN Association is hosting the NORMAN ARB&ARG database, which was developed within the European project ANSWER. The present article provides an overview on the database functionalities, the extraction and the contribution of data to the database. In this study, AR data from three studies from China and Nepal were extracted and imported into the NORMAN ARB&ARG in addition to the existing AR data from 11 studies (mainly European studies) on the database. This feasibility study demonstrates how the scientific community can share their data on AR to generate an international evidence base to inform AR mitigation strategies. The open and FAIR data are of high potential relevance for regulatory applications, including the development of emission limit values / environmental quality standards in relation to AR. The growth in sharing of data and analytical methods will foster collaboration on risk management of AR worldwide, and facilitate the harmonization in the effort for identification and surveillance of critical hotspots of AR. The NORMAN ARB&ARG database is publicly available at: https://www.norman-network.com/nds/bacteria/.

Stent-assisted coil embolization of a complex wide-neck splenic artery aneurysm.

We describe the endovascular treatment of a wide-neck splenic artery aneurysm (SAA) using a stent-assisted coil embolization technique. A 55-year-old woman who was admitted for intermittent epigastric pain was diagnosed with a wide-neck aneurysm of the intermediate splenic artery. The SAA had a maximum diameter of 2.2 cm and originated from a tortuous vessel. After percutaneous access through the left brachial artery, a self-expandable stent was initially deployed across the origin of the aneurysm using a 4-French platform. The aneurysm sac was subsequently filled with coils through a microcatheter. The procedure was successful with no postoperative clinical complications. Patency of splenic artery and complete exclusion of the aneurysm were confirmed by follow-up computed tomographic angiography 1 year after treatment. In challenging anatomic situations, stent-assisted coil embolization may represent a first-choice endovascular treatment option for the exclusion of SAAs.

Overcoming the IOTLB wall for multi-100-Gbps Linux-based networking.

This article explores opportunities to mitigate the performance impact of IOMMU on high-speed network traffic, as used in the Linux kernel. We first characterize IOTLB behavior and its effects on recent Intel Xeon Scalable & AMD EPYC processors at 200 Gbps, by analyzing the impact of different factors contributing to IOTLB misses and causing throughput drop (up to 20% compared to the no-IOMMU case in our experiments). Secondly, we discuss and analyze possible mitigations, including proposals and evaluation of a practical hugepage-aware memory allocator for the network device drivers to employ hugepage IOTLB entries in the Linux kernel. Our evaluation shows that using hugepage-backed buffers can completely recover the throughput drop introduced by IOMMU. Moreover, we formulate a set of guidelines that enable network developers to tune their systems to avoid the "IOTLB wall", i.e., the point where excessive IOTLB misses cause throughput drop. Our takeaways signify the importance of having a call to arms to rethink Linux-based I/O management at higher data rates.

Co-treatment of landfill leachate with urban wastewater by chemical, physical and biological processes: Fenton oxidation preserves autochthonous bacterial community in the activated sludge process.

The impact of Fenton oxidation (FO) and Air stripping (AS) pre-treatments on the bacterial community of a biological activated sludge (B-AS) process for the co-treatment of mature landfill leachate (MLL) and urban wastewater (UWW) was assessed. In this work high-throughput sequencing was used to identify changes in the composition of the bacterial communities when exposed to different landfill leachate's pre-treatments. The combination of FO and AS to increase biodegradability (BOD5/COD) and reduce ammonia concentration (NH3) respectively, allowed to successfully operate the B-AS and effectively treat MLL. In particular, BOD5/COD resulted to be the key factor for bacterial community shifting. The microbiological community of the B-AS, mainly composed by the phylum Bacteroidota (Saprospiraceae, PHOS-HE51, Chitinophagaceae) after FO pre-treatment, shifted to Pseudomonadota (Caulobacteraceae and Hyphomicrobiaceae) when FO was not used. At the same time a drastic reduction in BOD5 removal was observed (90%-58%). On the other hand, high NH3 concentration affected the abundance of the family Saprospiraceae, known to play a key role in the degradation of complex organic compounds in B-AS. The results obtained suggest that a suitable combination of pre-treatments can reduce the negative effect of MLL on the B-AS process, reducing the pressure on autochthonous bacteria and therefore the acclimatization time of the biological process.

The Ability to Look Beyond: The Treatment of Peripheral Arterial Disease.

This paper offers a practical overview of the contemporary management of patients with peripheral arterial disease presenting intermittent claudication (IC), including clinical and instrumental diagnosis, risk factors modification, medical management, and evidence-based revascularization indications and techniques. Decision making represents a crucial element in the management of the patient with IC; for this, we think a review of this type could be very useful, especially for non-vascular specialists.

Chelating agents supported solar photo-Fenton and sunlight/H2O2 processes for pharmaceuticals removal and resistant pathogens inactivation in quaternary treatment for urban wastewater reuse.

In this work, Fe3+-iminodisuccinic acid (Fe:IDS) based solar photo Fenton (SPF), an Italian patented method, was investigated in quaternary treatment of real urban wastewater and compared to Fe3+-ethylenediamine-N,N'-disuccinic acid (Fe:EDDS) for the first time. Three pharmaceuticals (PCs) (sulfamethoxazole, carbamazepine and trimethoprim) and four pathogens (Escherichia coli, somatic and F-plus coliphages, Clostridium perfringens, consistently with the new EU regulation for wastewater reuse (2020/741)), were chosen as target pollutants. SPF with Fe:EDDS was more effective in PCs removal (80%, 10 kJ L-1) than the SPF with Fe:IDS (58%), possibly due to the higher capability of generating hydroxyl radicals. On the contrary, Fe:IDS was more effective (4.3 log inactivation for E. coli) than Fe:EDDS (1.9 log) in pathogens inactivation, possibly due to a lower iron precipitation and turbidity which finally promoted an improved intracellular photo-Fenton mechanism. Fe:L based SPF was subsequently coupled to sunlight/H2O2. Interestingly, while its combination with Fe:EDDS based SPF slightly increased disinfectant efficacy (2.3 vs 1.9 log inactivation for E. coli), the combination with Fe:IDS decreased inactivation efficiency (3.4 vs 4.3 log reduction). In conclusion, due to the good compromise between PCs removal and disinfection efficiency, Fe:IDS SPF alone is an attractive option for quaternary treatment for urban wastewater reuse.