Preventive treatment of unruptured intracranial aneurysms in adult patients with sickle cell anemia: A cohort study

BACKGROUND AND PURPOSE

Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines on treatment of unruptured intracranial aneurysms in this population are still missing. We aimed to assess the safety and efficacy of the treatment of unruptured intracranial aneurysm in patients with sickle cell anemia, using an adapted hematological preparation regimen.

PATIENTS AND METHODS

Adult patients with sickle cell anemia and treated unruptured aneurysms by endovascular therapy or neurosurgery were included in this retrospective cohort study. Treatment decision was reached after multi-disciplinary assessment. A pre-operative blood transfusion protocol was undertaken targeting a HbS below 30%. Demographic data, hematological preparation parameters and clinical and radiological outcomes were documented.

RESULTS AND CONCLUSIONS

Twenty-five procedures were performed in 18 patients encompassing 19 aneurysms treated by embolization and 6 by surgery. Median age at treatment was 34 years-old and median aneurysm dome size was 4.4 mm. Immediate aneurysm exclusion rate was 85.7% after endovascular therapy and 100% after neurosurgery. Median follow-up was 6 months, with all patients being asymptomatic at last follow-up. Two transitory ischemic neurological deficits, as well as four cases of iodine-induced encephalopathy were identified after embolization. No complication occurred after surgery. Endovascular therapy by coiling and neurosurgical treatment of unruptured intracranial aneurysms appears to be safe in patients with sickle cell anemia and should be considered given the specific hemorrhagic risk observed in this population. A rigorous hematological preparation, associated with a dedicated peri‑operative protocol and an adequate therapeutic strategy are essential prerequisites.

Comparison of aerobic processes for olive mill wastewater treatment

Membrane bioreactor (MBR) has been proven to be an efficient technology capable of treating various industrial effluents. However, the evaluation of its performances in the case of olive mill wastewater (OMW) over a conventional activated sludge (CAS) have not been determined yet. The present study aims to compare OMW treatment in two laboratory scale pilots: an external ceramic MBR and CAS starting with an acclimation step in both reactors by raising OMW concentration progressively. After the acclimation step, the reactors received OMW at 2 g_COD/L with respect to an organic loading rate of 0.2 and 0.3 kg_COD/kg_MLVSS/d for MBR and CAS, respectively. Biomass acclimation occurred successfully in both systems; however, the MBR tolerated more OMW toxicity than CAS as the MBR always maintained an effluent with a better quality. At a stable state, a higher reduction of 95% chemical oxygen demand (COD) was obtained with MBR compared to CAS (86%), but both succeeded in polyphenols removal (80%). Moreover, a higher MLSS elimination from the MBR treated water (97%) was measured against 88% for CAS. Therefore, CAS was suitable for OMW treatment and MBR could be proposed as an alternative to CAS when a better quality of treated water is required.

Key process parameters involved in the treatment of olive mill wastewater by membrane bioreactor

The Olive Mill Wastewater (OMWW) biodegradation in an external ceramic membrane bioreactor (MBR) was investigated with a starting acclimation step with a Ultrafiltration (UF) membrane (150 kDa) and no sludge discharge in order to develop a specific biomass adapted to OMWW biodegradation. After acclimation step, UF was replaced by an Microfiltration (MF) membrane (0.1 µm). Sludge Retention Time (SRT) was set around 25 days and Food to Microorganisms ratio (F/M) was fixed at 0.2 kg_COD kg_MLVSS^-1 d^-1. At stable state, removal of the main phenolic compounds (hydroxytyrosol and tyrosol) and Chemical Oxygen Demand (COD) were successfully reached (95% both). Considered as a predominant fouling factor, but never quantified in MBR treated OMWW, Soluble Microbial Products (SMP) proteins, polysaccharides and humic substances concentrations were determined (80, 110 and 360 mg L^-1 respectively). At the same time, fouling was easily managed due to favourable hydraulic conditions of external ceramic MBR. Therefore, OMWW could be efficiently and durably treated by an MF MBR process under adapted operating parameters.

Performance of a biomass adapted to oncological ward wastewater vs. biomass from municipal WWTP on the removal of pharmaceutical molecules

The performance of a biomass adapted to Oncological Ward Wastewater (OWW) in a membrane bioreactor (MBR) was compared with that of a municipal WWTP, on the removal of pharmaceutical molecules and more specifically on their overall resistance and purifying ability in the presence of pharmaceutical cocktails. Sorption and biotransformation mechanisms on two antineoplastics, one antibiotic and a painkiller were evaluated. Sludge acclimated to OWW allowed for a 34% increase in the removal rate and in the minimum inhibition concentration. The percentage of the amounts of specific pharmaceutical compounds removed by biotransformation or by sorption were measured. These results are positive, as they show that the observed removal of pharmaceutical molecules by biomass acclimated to OWW can mostly be attributed to developed biotransformation, unlike the biomass from the municipal WWTP for which sorption is sometimes the only removal mechanism. The biotransformation kinetic and the solid-water distribution coefficients in this study show good agreement with literature data, even for much higher pharmaceutical concentrations in OWW.

Kinetic study of compost liquor nitrification

This study is a first kinetic approach about the compost liquor treatment by activated sludge. This industrial wastewater is highly loaded in organic and nitrogen compounds (COD≈12,000 mg L(-1) and NH(4)(+)-N≈4,000 mg L(-1)). The possibility of its treatment in an urban WWTP is studied measuring ammonia oxidation rate with non-acclimated sludge to the industrial effluent. Compost liquor appears as an inhibitor substrate. The ammonia oxidation rate can be modelled by the Haldane model: U(MAX)=0.180 d(-1), K(S)=12.0 mgN.L(-1) and K(I)=26.0 mgN.L(-1). The ammonia oxidation rate also follows for a synthetic substrate which has the same pollutant load as the real substrate. In this case, the ammonia oxidation rate can be modelled by the Monod model: U(MAX)=0.073 d(-1) and K(S)=4.3 mgN.L(-1). This result confirms that the ammonia oxidising bacteria are inhibited by the real wastewater. The following-up of nitrate production shows also the inhibition of nitrite oxidising bacteria. The compost liquor treatment seems not possible in an urban WWTP (<50,000 p.e.). That's why a specific WWTP is recommended and an acclimation step of activated sludge is essential.

Effect of membrane bioreactor configurations on sludge structure and microbial activity

The aim of this paper was to determine the effect of two different membrane bioreactor (MBR) configurations (external/immersed) on sludge structure and microbial activity. Sludge structure was deduced from rheological measurements. The high shear stress induced by the recirculation pump in the external MBR was shown to result in decreasing viscosity due to activated sludge (AS) deflocculation. Besides, soluble microbial products (SMP) release was higher in the external MBR (5 mgCOD gMLVSS(-1)) than in the immersed configuration (2 mgCOD gMLVSS(-1)). Microbial activity was followed from respirometry tests by focusing on the distinction between heterotrophs and autotrophs. An easier autotrophic microbe development was then observed in the immersed MBR compared to the external one. However, the external MBR was shown to allow better heterotrophic microbe development.

Kinetic parameters for 17alpha-ethinylestradiol removal by nitrifying activated sludge developed in a membrane bioreactor

The synthetic hormone 17alpha-ethinylestradiol (EE2) is primarily removed in wastewater treatment plants (WWTPs) by sorption, and nitrifying biomass has been shown to be responsible for EE2 biodegradation. Membrane bioreactor (MBR) technology was chosen to develop a community of autotrophic, nitrifying micro-organisms and determine kinetic parameters for EE2 biodegradation. Biological inhibition by azide was applied to differentiate sorption from biodegradation. Activated sludge (AS) was acclimated in the MBR to a substrate specific to autotrophic biomass and resulted in an increase in nitrifying activity. Acclimated AS was used to successfully biodegrade EE2 (11% increase in EE2 removal), and the overall removal of EE2 was determined to be 99% (sorption+biodegradation). AS used directly from a WWTP without acclimation removed EE2 only through sorption (88% removal of EE2). Therefore, higher nitrifying activity developed by acclimating AS allowed almost complete removal of EE2.

Olive mill wastewater treatment in a membrane bioreactor: process stability and fouling aspects

An external ceramic membrane bioreactor was used to carry out an experimental study of process stability and fouling aspects for olive mill wastewater (OMW) treatment. Three diluted OMW solutions were used to continuously feed the reactor. An acclimated biomass was employed and the process stability was followed on the basis of the permeate quality and some operating parameters (pressure, temperature, mass flow and dissolved oxygen). Several backpulse combinations were tested to determine the best filtration and backwash time. It appeared that a short backpulse duration was sufficient and that the behaviour, in terms of the permeate flux versus time, stabilized. In terms of increased permeate flux, the effect of the backpulsing depended on the nature of the solution. This improvement was limited, but, in the long-term, backpulsing makes it possible to maintain a constant permeate flux over a period of several days.