Man-made natural and regenerated cellulosic fibres greatly outnumber microplastic fibres in the atmosphere.

Atmospheric microplastics have been widely reported in studies around the world. Microfibres are often the dominant morphology found by researchers, although synthetic (i.e., plastic) microfibres are typically just a fraction of the total number of microfibres, with other, non-synthetic, cellulosic microfibres frequently being reported. This study set out to review existing literature to determine the relative proportion of cellulosic and synthetic atmospheric anthropogenic (man-made) microfibres, discuss trends in the microfibre abundances, and outline proposed best-practices for future studies. We conducted a systematic review of the existing literature and identified 33 peer-reviewed articles from Scopus and Google Scholar searches that examined cellulosic microfibres and synthetic microfibres in the atmosphere. Multiple analyses indicate that cellulosic microfibres are considerably more common than synthetic microfibres. FT-IR and Raman spectroscopy data obtained from 24 studies, showed that 57% of microfibres were cellulosic and 23% were synthetic. The remaining were either inorganic, or not determined. In total, 20 studies identified more cellulosic microfibres, compared to 11 studies which identified more synthetic microfibres. The data show that cellulosic microfibres are 2.5 times more abundant between 2016 and 2022, however, the proportion of cellulosic microfibres appear to be decreasing, while synthetic microfibres are increasing. We expect a crossover to happen by 2030, where synthetic microfibres will be dominant in the atmosphere. We propose that future studies on atmospheric anthropogenic microfibres should include information on natural and regenerated cellulosic microfibres, and design studies which are inclusive of cellulosic microfibres during analysis and reporting. This will allow researchers to monitor trends in the composition of atmospheric microfibers and will help address the frequent underestimation of cellulosic microfibre abundance in the atmosphere.

First comparison of sampler surface areas for atmospheric microfibre deposition.

Recent studies have reported on the widespread abundance of atmospheric microplastics (At-MPs) and atmospheric anthropogenic microfibres (At-AMFs) in urban and remote locations. This study sought to test whether there were differences in the quantity of deposited At-AMFs collected when comparing three different surface sampler areas (small: 0.0113 m2 (Φ = 120 mm), medium: 0.0254 m2 (Φ = 180 mm) and large: 0.0346 m2 (Φ = 210 mm)). The analysis revealed no statistically significant variation in the number of At-AMFs recorded, when data was presented in At-AMFs per m2 day-1. However, our findings indicate that for any given individual sampling event, the amount of deposition can range by ∼ 150 to 200 At-AMFs m2 d-1 even if samplers are kept relatively close together. To account for this, we would recommend that future studies collect data in duplicate or triplicate. Our results suggest that data can be compared across different sites and geographical regions-at least if comparing the overall mean and standard deviation of all samples collected. These findings are important because currently there is no standard sampler size for passive collection of At-AMFs and At-MPs.

Projected plastic waste loss scenarios between 2000 and 2030 into the largest freshwater-lake system in Southeast Asia.

Freshwater plastic pollution is critically understudied in Southeast Asia (SEA). Recent modelling studies indicate that SEA rivers contribute vast quantities of plastic to the world's oceans, however, these fail to capture the complexity of individual systems. We determine the volume of mismanaged plastic waste (MPW) entering Tonle Sap Basin (TSB)-the largest freshwater lake-river system in SEA, between 2000 and 2030. Using economic, population and waste data at provincial and national levels, coupled with high resolution population and flood datasets, we estimate that ca. 221,700 tons of plastic entered between 2000 and 2020, and 282,300 ± 8700 tons will enter between 2021 and 2030. We demonstrate that policy interventions can reduce MPW up to 76% between 2021 and 2030. The most-stringent scenario would prevent 99% of annual MPW losses by 2030, despite substantially higher waste volumes and population. If successfully implemented, Cambodia will prevent significant losses in natural capital, material value and degradation in TSB worth at least US$4.8 billion, with additional benefits for the Mekong River and South China Sea.

Relationship of clinical presentation and angiographic findings in patients with indirect cavernous carotid fistulae.

INTRODUCTION: Indirect cavernous carotid fistulae (ICCFs) can present with insidious, non-specific symptoms and prove difficult to diagnose. This study evaluates associations among ICCF symptoms and angiographic findings. METHODS: A retrospective analysis was performed of prospectively maintained records at four medical centers to identify patients with ICCFs evaluated with angiography. Patient demographics, symptoms, and angiographic findings were tabulated. Univariate and multivariate analyses were conducted to identify associations among these variables. RESULTS: Records sufficient for review existed for 267 patients evaluated with angiography. Patients were most commonly women, in the sixth or seventh decade of life, and had symptoms for months before a definitive diagnosis. The most common symptoms included proptosis, diplopia, cranial nerve palsy, and chemosis. Cortical venous reflux was most common in patients with chemosis, orbital pain, or bruit. Intracranial hemorrhage was associated with cortical reflux and bilateral inferior petrosal sinus occlusion. Patients with loss of symptoms demonstrated higher rates of inferior petrosal sinus occlusion and a trend towards rupture. CONCLUSION: A high index of suspicion is needed to promptly diagnose patients with ICCFs. High risk features are more common in the setting of chemosis, orbital pain, bruit, or spontaneous loss of symptoms. Patients with such symptoms warrant expedited angiographic evaluation.

Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm.

A man aged 61 years with a history of a ruptured basilar fenestration aneurysm underwent unassisted coiling in 1997 and repeat intervention for a recurrence at the aneurysm mouth in 2011. At repeat intervention, the decision was made to intentionally leave some filling at the base to preserve the parent vessels. Stent-assisted coil embolization, although technically feasible, was not pursued given the relative risks of the procedure. In 2017, the patient returned for repeat surveillance and further coil compaction was found at the aneurysm base. With the advent of more compliant woven stents deliverable through 0.017 microcatheters, stent-assisted coiling was possible. This case demonstrates hereto unseen agility afforded by novel low-profile stents allowing a circumferential approach to a basilar artery fenestration aneurysm and resultant limb-to-limb stent-assisted coiling. Techniques described here may be extended to more common anatomic variants that require stent-assisted coiling.

Flanking the fenestration: circumferential limb-to-limb stent-assisted coiling of a basilar artery fenestration aneurysm.

A man aged 61 years with a history of a ruptured basilar fenestration aneurysm underwent unassisted coiling in 1997 and repeat intervention for a recurrence at the aneurysm mouth in 2011. At repeat intervention, the decision was made to intentionally leave some filling at the base to preserve the parent vessels. Stent-assisted coil embolization, although technically feasible, was not pursued given the relative risks of the procedure. In 2017, the patient returned for repeat surveillance and further coil compaction was found at the aneurysm base. With the advent of more compliant woven stents deliverable through 0.017 microcatheters, stent-assisted coiling was possible. This case demonstrates hereto unseen agility afforded by novel low-profile stents allowing a circumferential approach to a basilar artery fenestration aneurysm and resultant limb-to-limb stent-assisted coiling. Techniques described here may be extended to more common anatomic variants that require stent-assisted coiling.

Revisiting Current Golden Rules in Managing Acute Ischemic Stroke: Evaluation of New Strategies to Further Improve Treatment Selection and Outcome.

OBJECTIVE: Advanced stroke imaging has generated much excitement for the early diagnosis of acute ischemic stroke (AIS) and facilitation of intervention. However, its therapeutic impact has not matched its diagnostic utility; most notably, lacking significant contributions to recent major AIS clinical trials. It is time to reexamine the fundamental hypotheses from the enormous body of imaging research on which clinical practices are based and reassess the current standard clinical and imaging strategies, or golden rules, established over decades for AIS. In this article, we will investigate a possible new window of opportunity in managing AIS through a better understanding of the following: first, the potential limitations of the golden rules; second, the significance of imaging-based parenchymal hypoperfusion (i.e., lower-than-normal relative cerebral blood flow [rCBF] may not be indicative of ischemia); third, the other critical factors (e.g., rCBF, collateral circulation, variable therapeutic window, chronicity of occlusion) that reflect more individual ischemic injury for optimal treatment selection; and, fourth, the need for penumbra validation in successfully reperfused patients (not in untreated patients). CONCLUSION: Individual variations in the therapeutic window, ischemic injury (rCBF), and chronicity of vascular lesion development have not been comprehensively incorporated in the standard algorithms used to manage AIS. The current established imaging parameters have not been consistently validated with successfully reperfused patients and rCBF to quantitatively distinguish between oligemia and ischemia and between penumbra and infarct core within ischemic tissue. A novel paradigm incorporating rCBF values or indirectly incorporating relative rCBF values with higher statistically powered imaging studies to more reliably assess the severity of ischemic injury and differentiate reversibility from viability within the area of imaging-based parenchymal hypoperfusion may provide a more personalized approach to treatment, including no treatment of infarction core, to further enhance outcomes.

Transvenous ethanol sclerotherapy of feeding arteries for treatment of a dural arteriovenous fistula.

Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with multiple techniques. This report describes a unique case in which a DAVF was treated with arterial sclerotherapy using ethanol from a transvenous approach.

Transvenous ethanol sclerotherapy of feeding arteries for treatment of a dural arteriovenous fistula.

Dural arteriovenous fistulas (DAVFs) can be complex lesions that require a well trained eye for proper characterization and management decisions. With numerous possible arteries to supply and veins to drain them, DAVFs are often complex lesions. To best treat these complex lesions, the neurointerventionalist should be adept at treating them with multiple techniques. This report describes a unique case in which a DAVF was treated with arterial sclerotherapy using ethanol from a transvenous approach.

Percutaneous sclerotherapy with ethanolamine oleate for venous malformations of the head and neck.

INTRODUCTION: Venous malformations frequently occur in the head and neck, and they can require treatment for a variety of reasons. Among multiple therapeutic approaches employed, percutaneous sclerotherapy has become one of the most commonly used treatments, with numerous sclerosants successfully utilized. Ethanolamine oleate has approval from the Food and Drug Administration for sclerosis of esophageal varices, and is used by some practitioners for the treatment of venous malformations. This study reports single center results of percutaneous sclerotherapy with ethanolamine oleate to treat venous malformations of the head and neck. MATERIALS AND METHODS: Prospectively maintained procedural records were retrospectively reviewed to identify all patients with venous malformations who underwent percutaneous sclerotherapy. The Mulliken and Glowacki classification was used to diagnose venous malformations. Medical records and images were reviewed to record demographic information, lesion characteristics, treatment sessions, and clinical and imaging response. Quantitative volumetric analysis was conducted to augment commonly used poorly reproducible subjective outcome measures. Response was assessed after each session and completion of all percutaneous treatment. A χ(2) analysis was performed to evaluate the effects of the above described characteristics on outcomes. RESULTS: 52 interventions were performed for lesions in 26 patients. No complications occurred following any procedures. Response to individual sessions was categorized as excellent following two (3.8%) sessions, good following 45 (86.5%), and fair following four (7.7%) session. No sessions resulted in poor responses. Final results were excellent in two patients (7.7%), good in 22 (84.6%), and fair in two (7.7%). Average lesion volume reduction was 39% following each session, and 61% after treatment completion. Periorbital lesions were significantly less likely than lesions located elsewhere to have good or excellent outcomes. No other lesion or demographic features affected outcomes. CONCLUSIONS: Percutaneous sclerotherapy with ethanolamine oleate appears to be safe and effective for the treatment of venous malformations and should be considered when treating these complex lesions. The efficacy of this agent appears to match or exceed that of other sclerosants used for such treatment, and further investigation in prospective controlled research is warranted.

Occipital artery anastomosis to vertebral artery causing pulsatile tinnitus.

Pulsatile tinnitus can result from various vascular etiologies that cause transmission of pulsatile turbulent flow into the inner ear. Less commonly, non-vascular sources cause increased blood flow and transmission of sound perceived as tinnitus. Thorough clinical examination leads to appropriate imaging evaluation and therapeutic planning. Most pulsatile tinnitus results from expected mechanisms, such as dural arteriovenous fistula, jugular bulb dehiscence, or paraganglioma; however, the literature contains reports of numerous rare causes, particularly variant anatomic morphologies. We present the case of a novel cause of pulsatile tinnitus in which collateral vascular flow compensated for decreased normal intracranial cerebral arterial supply and might have caused catastrophic consequences if intervened upon after assumptions based on an incomplete evaluation.

Percutaneous sclerotherapy with ethanolamine oleate for lymphatic malformations of the head and neck.

INTRODUCTION: Lymphatic malformations are low flow congenital lesions that frequently occur in the head and neck, and often require treatment. Multiple therapeutic modalities exist, including percutaneous sclerotherapy, which has been performed successfully with numerous sclerosants. Few data exist on use of ethanolamine oleate to treat lymphatic malformations. This study reports single center results using this agent to treat lymphatic malformations of the head and neck. MATERIALS AND METHODS: Prospectively maintained procedural records were retrospectively reviewed to identify all patients with lymphatic malformations who underwent percutaneous sclerotherapy. The Mulliken and Glowacki classification was used to diagnose lymphatic malformations. Medical records and images were reviewed to record demographic information, lesion characteristics, treatment sessions, and clinical and imaging response. Lesions and outcomes were evaluated with both qualitative and quantitative volumetric analysis. Response was assessed after each session and after all sessions in those patients undergoing more than one intervention, and χ(2) analysis was performed to evaluate the effects of lesion and demographic characteristics on outcomes. RESULTS: 12 interventions were performed for lesions in 10 patients. No procedural complications occurred following any procedures. Four (40.0%) patients had an excellent result after treatment, which was accomplished in one session for each of these lesions. Four (40.0%) had good results. One (10.0%) had a fair result after three sessions. One (10.0%) patient with an indeterminate syndrome with multiple congenital anomalies had a poor response following treatment. The family decided to withdraw care, and the airway was compromised. Average lesion volume reduction was 28% for all lesions and 42% when excluding the lesion for which future treatments were declined. Purely macrocystic lesions were more likely to have an excellent response to treatment than lesions with both macrocystic and microcystic components. CONCLUSIONS: Percutaneous sclerotherapy using ethanolamine oleate to treat lymphatic malformations of the head and neck appears safe and efficacious. This agent should be considered when treating these complex lesions, particularly those that are exclusively macrocystic. Further investigation of such treatments should evaluate this agent alongside the many others currently utilized.

Occipital artery anastomosis to vertebral artery causing pulsatile tinnitus.

Pulsatile tinnitus can result from various vascular etiologies that cause transmission of pulsatile turbulent flow into the inner ear. Less commonly, non-vascular sources cause increased blood flow and transmission of sound perceived as tinnitus. Thorough clinical examination leads to appropriate imaging evaluation and therapeutic planning. Most pulsatile tinnitus results from expected mechanisms, such as dural arteriovenous fistula, jugular bulb dehiscence, or paraganglioma; however, the literature contains reports of numerous rare causes, particularly variant anatomic morphologies. We present the case of a novel cause of pulsatile tinnitus in which collateral vascular flow compensated for decreased normal intracranial cerebral arterial supply and might have caused catastrophic consequences if intervened upon after assumptions based on an incomplete evaluation.