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Copyright © 2004 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Wastewater treatment plant (WWTP) discharges are major contributors to the release of microplastics (MPs) into the environment. This research work aimed to assess the performance of the novel living membrane bioreactor (LMBR), which utilizes a biological layer as a membrane filter for the removal of polyethylene (PE) MPs from wastewater. The impact of an intermittently applied low current density (0.5 mA/cm 2 ) on the reduction of MPs in the electrochemically enhanced LMBR (e-LMBR) has also been examined. The reactors were also compared to a conventional membrane bioreactor (MBR) and an electro-MBR (e-MBR). 1 H nuclear magnetic resonance spectroscopy ( 1 H NMR) was implemented for the MPs detection and quantification in terms of mass per volume of sample. The LMBR and MBR achieved comparable mean PE MPs reduction at 95% and 96%, respectively. The MPs mass reduction in the e-LMBR slightly decreased by 2% compared to that achieved in the LMBR. This potentially indicated the partial breakdown of the MPs due to electrochemical processes. Decreasing and inconsistent NH 4 -N and PO 4 -P removal efficiencies were observed over time due to the addition of PE MPs in the MBR and LMBR. In contrast, the integration of electric field in the e-MBR and e-LMBR resulted in consistently high values of conventional contaminant removals of COD (99.72-99.77 %), NH 4 -N (97.96-98.67%), and PO 4 -P (98.44-100.00%), despite the MPs accumulation. Integrating electrochemical processes in the e-LMBR led to the development of a stable living membrane (LM) layer, as manifested in the consistently low effluent turbidity 0.49 ± 0.33 NTU. Despite the increasing MPs concentration in the mixed liquor, applying electrochemical processes reduced the fouling rates in the e-LMBR. The e-LMBR achieved comparable efficiencies in contaminant reductions as those observed in the e-MBR, while using a low-cost membrane material., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Nontargeted screening (NTS) utilizing liquid chromatography electrospray ionization high-resolution mass spectrometry (LC/ESI/HRMS) is increasingly used to identify environmental contaminants. Major differences in the ionization efficiency of compounds in ESI/HRMS result in widely varying responses and complicate quantitative analysis. Despite an increasing number of methods for quantification without authentic standards in NTS, the approaches are evaluated on limited and diverse data sets with varying chemical coverage collected on different instruments, complicating an unbiased comparison. In this interlaboratory comparison, organized by the NORMAN Network, we evaluated the accuracy and performance variability of five quantification approaches across 41 NTS methods from 37 laboratories. Three approaches are based on surrogate standard quantification (parent-transformation product, structurally similar or close eluting) and two on predicted ionization efficiencies (RandFor- IE and MLR- IE ). Shortly, HPLC grade water, tap water, and surface water spiked with 45 compounds at 2 concentration levels were analyzed together with 41 calibrants at 6 known concentrations by the laboratories using in-house NTS workflows. The accuracy of the approaches was evaluated by comparing the estimated and spiked concentrations across quantification approaches, instrumentation, and laboratories. The RandFor- IE approach performed best with a reported mean prediction error of 15× and over 83% of compounds quantified within 10× error. Despite different instrumentation and workflows, the performance was stable across laboratories and did not depend on the complexity of water matrices.

Water scarcity in the Mediterranean area has increased the number of intermittent rivers, whose flow ceases either occasionally or totally. Key elements to characterize their dynamics are water quality, hydrological, and ecological status, when wastewater effluents dominate flow. Regarding water quality, pharmaceuticals are major pollutants, and serve as indicators of wastewater presence. Intermittent rivers are biodiversity hotspots where their hydrological regime may suffer alterations associated with wastewater effluents, making them harder to characterize than perennial streams. This study aimed to integratively characterize intermittent rivers through chemical, ecological and hydrological status calculating respective indices in twenty Mediterranean intermittent wastewater-impacted rivers located in Spain, France, Italy, Algeria and Tunisia. Pharmaceuticals were used as indicators assessing their frequency of PNEC exceedance and detection; while two ecological indicators and one hydrological indicator were used to evaluate wastewater stress on catchments. All indicators displayed a noticeable decline from upper to lower parts of the rivers, proving the effect of anthropogenic stressors on the aquatic environment. The Tunisian catchment displayed the most compromised conditions across all indicators, and the Algerian site even though low concentrations were detected, five compounds exceeded PNEC thresholds. This highlights the need for increased dedication and the adoption of water pollution solutions., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Wastewater treatment plants (WWTPs) provide optimal conditions for the environmental spread of Legionella . As part of the Evaluation of Sanitary Risk Related to the Discharge of Wastewater to the Ground (SCA.Re.S) project, this study was conducted to evaluate the presence of Legionella in WWTP effluent and in groundwater samples collected from two wells located downstream from the plant. The samples were analyzed to determine the concentrations of Legionella spp using the standard culture-based method and molecular techniques, followed by genomic sequencing analysis. Legionella was detected only with the molecular methods (except in one sample of effluent positive for L. pneumophila serogroup 6), which showed viable Legionella pneumophila and L. non- pneumophila through the use of free DNA removal solution in both the effluent and groundwater, with concentrations that progressively decreased downstream from the plant. Viable L. pneumophila appeared to be slightly more concentrated in warm months. However, no significant differences ( p ≥ 0.05) in concentrations between cold and warm months were observed. A genotypic analysis characterized the species present in the samples and found that uncultured Legionella spp, as yet undefined, constituted the prevalent species in all the samples (range 77.15-83.17%). WWTPs play an important role in the hygienic and sanitary quality of groundwater for different uses. The application of Legionella control systems during the purification of effluents is warranted to prevent possible outbreaks of legionellosis.

Objective: To conduct an economic cost analysis and budget impact assessment (BIA) of implementing the Frailty Care Bundle (FCB) intervention nationally over five-years for hip fracture patients. The FCB was designed to reduce hospital associated decline in older hospitalised patients., Methods: The FCB was delivered in two Irish hospitals on two wards per hospital. A micro level cost analysis, from the Irish health service perspective was undertaken. Direct costs of the FCB were considered (personnel, training, resources), expressed in Euros (2020). For the BIA national population estimates for hip fracture and costs avoided were based on 18% difference in patients returning to their baseline capability in the post compared to pre-intervention group, valued using cost estimates of functional decline., Results: We estimated total intervention costs at €53,619 (89% for personnel) and the average cost per patient was €156.03. The expected costs of implementing the FCB nationally over 12-months was €57,274 per hospital (€72.92 per patient). The BIA for an expected targeted population (16,000 over 5 years), estimated that the cost of implementing the FCB (€1.2m) was less than the expected value of functional decline avoided owing to the intervention (€3.6m), suggesting a positive net effect (€2.4m)., Conclusion: Investment in the FCB can be offset with more rapid patient return to baseline functional capability, reducing health care costs. Trial and Protocol Registration (retrospective): BMC ISRCTN 15145850, (https://doi.org/10.1186/ISRCTN15145850)., (Copyright: © 2024 Hylonome Publications.)

Competing Interests: Competing interests: AC is a consultant for ERBE. RM is a consultant for ERBE, Fujifilm, 3DMatrix and Boston Scientific. CH is a consultant for Alpha-Sigma, Fujifilm, Medtronic, Norgine, Olympus and Pentax. AR is a consultant for Medtronic, ERBE, Fujifilm and Olympus. Others authors have nothing to declare.

Pathogenic microorganisms released onto the soil from point or diffuse sources represent a public health concern. They can be transported by rainwater that infiltrates into subsoil and reach the groundwater where they can survive for a long time and contaminate drinking water sources. As part of the SCA.Re.S. (Evaluation of Health Risk Related to the Discharge of Wastewater on the Soil) project, we reviewed a selection of field-scale studies that investigated the factors that influenced the fate of microorganisms that were transported from the ground surface to the groundwater. A total of 24 studies published between 2003 and 2022 were included in the review. These studies were selected from the PubMed and Web of Science databases. Microbial contamination of groundwater depends on complex interactions between human activities responsible for the release of contaminants onto the soil, and a range of environmental and biological factors, including the geological, hydraulic, and moisture characteristics of the media traversed by the water, and the characteristics and the viability of the microorganisms, which in turn depend on the environmental conditions and presence of predatory species. Enterococci appeared to be more resistant in the underground environment than thermotolerant coliforms and were suggested as a better indicator for detecting microbial contamination of groundwater.

Endoluminal biliary radiofrequency ablation (RFA) has been proposed as a palliative treatment for patients with malignant biliary obstruction (MBO) in order to improve stent patency and survival. However, the existing data on patients with inoperable extrahepatic cholangiocarcinoma (eCCA) are conflicting. We performed a meta-analysis of randomized trials comparing RFA plus stenting versus stenting alone in patients with inoperable eCCA. We searched for trials published in the PubMed/MEDLINE, Scopus, and Cochrane databases up to November 2023. Data extraction was conducted from published studies, and a quality assessment was carried out in accordance with the guidelines recommended by the Cochrane Collaboration. Hazard ratios (HRs) with 95% CI were estimated from the trials. The primary endpoints of interest were overall survival and stent patency. Out of 275 results, 5 randomized trials and 370 patients were included. While overall survival was not different between the groups (HR 0.62; 95% CI 0.36-1.07; p = 0.09; I 2 = 80%;), the subgroup analysis of studies employing plastic stents showed a trend toward better survival in the RFA-treated group (HR 0.42; 95% CI 0.22-0.80; p = 0.009; I 2 = 72%). Stent patency was improved in patients receiving RFA (HR 0.64; 95% CI 0.45-0.90; p = 0.01; I 2 = 23%). Adverse events were not different between the groups (OR 1.21; 95% CI 0.69-2.12; p = 0.50; I 2 = 0%). Despite the promising results, high heterogeneity and potential biases in the included studies suggest the need for further high-quality randomized trials to explore the potential cumulative effects of RFA on CCA treatment outcomes.

Two advanced oxidation processes (AOPs), namely ozone/H 2 O 2 and UV/H 2 O 2 , were tested at pilot scale as zero-liquid-discharge alternative treatments for the removal of microbiological (bacteria and viruses), chemical (compounds of emerging concern (CECs)) and genotoxic responses from tertiary municipal wastewater for indirect potable reuse (IPR). The AOP treated effluents were further subjected to granular activated carbon (GAC) adsorption and UV disinfection, following the concept of multiple treatment barriers. As a reference, a consolidated advanced wastewater treatment train consisting of ultrafiltration, UV disinfection, and reverse osmosis (RO) was also employed. The results showed that, for the same electrical energy applied, the ozone/H 2 O 2 treatment was more effective than the UV/H 2 O 2 treatment in removing CECs. Specifically, the ozone/H 2 O 2 treatment, intensified by high pressure and high mixing, achieved an average CECs removal efficiency higher than UV/H 2 O 2 (66.8% with respect to 18.4%). The subsequent GAC adsorption step, applied downstream the AOPs, further improved the removal efficiency of the whole treatment trains, achieving rates of 98.5% and 96.8% for the ozone/H 2 O 2 and UV/H 2 O 2 treatments, respectively. In contrast, the ultrafiltration step of the reference treatment train only achieved a removal percentage of 22.5%, which increased to 99% when reverse osmosis was used as the final step. Microbiological investigations showed that all three wastewater treatment lines displayed good performance in the complete removal of regulated and optional parameters according to both national and the European Directive 2020/2184. Only P. aeruginosa resulted resistant to all treatments with a higher removal by UV/H 2 O 2 when higher UV dose was applied. In addition, E. coli STEC/VTEC and enteric viruses, were found to be completely removed in all tested treatments and no genotoxic activity was detected even after a 1000-fold concentration. The obtained results suggest that the investigated treatments are suitable for groundwater recharge to be used as a potable water source being such a procedure an IPR. The intensified ozone/H 2 O 2 or UV/H 2 O 2 treatments can be conveniently incorporated into a multi-barrier zero-liquid-discharge scheme, thus avoiding the management issues associated with the retentate of the conventional scheme that uses reverse osmosis. By including the chemical cost associated with using 11-12 mg/L of H 2 O 2 in the cost calculations, the overall operational cost (energy plus chemical) required to achieve 50% average CECs removal in tertiary effluent for an hypothetical full-scale plant of 250 m 3 /h (or 25,000 inhabitants) was 0.183 €/m 3 and 0.425 €/m 3 for ozone/H 2 O 2 and UV/H 2 O 2 treatment train, respectively., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

The characterization of organic contaminants in sewage sludge is a fundamental step to address the relevant most appropriate management practice. In this perspective, C10-C40 hydrocarbon content was considered in Italy a crucial parameter to be considered, in spite of its irrelevance in the literature. The very complex mixture of organic substances of both biogenic and anthropogenic origin the sludge is made up of makes sewage sludge a matrix of uniqueness nature, and the analytic determination of hydrocarbon content through conventional procedures may be subjected to overestimation. In this work, optimization of two conventional protocols for the determination of mineral oil (EN14039 and IRSA CNR gravimetric method) were run with attention to anthropogenic compounds potentially affecting the C10-C40 mineral hydrocarbons determination. Effects from the first manipulations of sewage sludge samples to extraction procedure and clean-up operations were investigated. A new simple procedure was set up and tested on 30 samples from different wastewater treatment plants (WWTPs). Through a simple extraction with hexane (12 mL per 2 g of dried sludge, acidified with HCl conc.) at room temperature for 2 h, followed by a clean-up on Florisil column (10 mL-2 g) a confident determination of C10-C40 were obtained with respect to conventional optimized procedures. Variability within the range 0.06-9.49% was calculated with respect to the average value determined using three different methods, with an average value of 2.48 ± 2.37%, demonstrating the robustness of the determination. Up to 3% of the total hydrocarbons were identified as naturally occurring, namely terpenes, squalenes and deoxygenized sterols, passed through the clean-up Florisil column. A significant incidence (up to 75%) of the final overall C10-C40 content was found to be related to the C10-C20 component, originally present in the commercial polyelectrolytes in emulsion, widely used for conditioning before mechanical dewatering., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Dithiocarbamates (DTCs) are a group of chemicals used primarily as fungicides, although they are exploited for various other applications. DTCs represent one of the oldest classes of broad-spectrum fungicides employed worldwide to control fungal diseases on many crops. Due to their ease of synthesis, low production costs (cheap and readily available starting materials) and a fungicidal activity with a multi-site mode of action, they are still among modern agriculture's most extensively used pesticides. Although the environmental degradation in air, water, and soil is relatively rapid due to photolysis and/or hydrolysis, they are among the most frequently detected pesticides in the European Union (EU), also with a high frequency of maximum residue level (MRL) exceedances. The current review aims to comprehensively survey all aspects of DTCs, including the environmental fate, toxicity and analytical methods for determining parental compounds and degradation products in environmental and food samples. Furthermore, the accumulation of carbamate and dithiocarbamate pesticides in vegetables, fruits, bioindicator organisms and human biological samples, as well as their health effects on humans, are also considered in this study.

The concept of environmental flows (E-Flows) describes the streamflow that is necessary to maintain river ecosystems. Although a large number of methods have been developed, a delay was recorded in implementing E-Flows in non-perennial rivers. The general aim of the paper was to analyse the criticalities and the current state of implementation of the E-Flows in non-perennial rivers of southern Europe. The specific objectives were to analyse (i) the European Union (EU) and national legislation on E-Flows, and (ii) the methodologies currently adopted for setting E-Flows in non-perennial rivers in the EU Member States (MSs) of the Mediterranean Region (Spain, Greece, Italy, Portugal, France, Cyprus, and Malta). From the analysis of national legislations, it is possible to acknowledge a step forward toward regulatory unification at the European level, on the subject of E-Flows and more generally toward the protection of aquatic ecosystems. The definition of E-Flows, for most countries, has abandoned the idea of a regime of constant and minimal flow, but it recognizes the importance of the biological, and chemical-physical aspects connected to it. From the analysis of the E-Flows implementation through the review of the case studies, one can surmise that in non-perennial rivers the E-Flows science is still an emerging discipline. The limited availability of hydrological, hydraulic, and biological data as well as the restricted economic resources allocated for managing non-perennial rivers are the main causes of the delay in the E-Flows implementation in MSs. The results of the present study may contribute in setting an E-Flow regime in non-perennial rivers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

This study presents a novel approach for obtaining reliable models and coefficients to estimate the probability of infection caused by common human enteric viruses. The aim is to provide guidance for public health policies in disease prevention and control, by reducing uncertainty and management costs in health risk assessments. Conventional dose-response (DR) models, based on the theory elaborated by Furumoto and Mickey [1] , exhibit limitations stemming from the heterogeneity of individual host susceptibilities to infection resulting from ingesting aggregate viruses. Moreover, the scarcity of well-designed viral challenge experiments contributes to significant uncertainty in these DR models. To address these issues, we conducted a review of infection models used in health risk analysis, focusing on Norovirus (NoV) GI.1, pooled Enterovirus group (EV ), Poliovirus 1/SM , and Echo-12 virus via contaminated water or food. Using a mechanistic approach, we reevaluated the known DR models and coefficients for the probability of individual host infection in the mentioned viruses based on dose-infection challenge experiments. Specifically, we sought to establish a relationship between the minimum infectious dose (ID) and the ID having a 50% probability of initiating host infection in the same challenge experiment. Furthermore, we developed a new formula to estimate the degree of aggregation of GI.1 NoV at the mean infectious dose. The proposed models, based on "exact" beta-Poisson DR models, effectively predicted infection probabilities from ingestion of both disaggregated and aggregate NoV GI.1. Through a numerical evaluation, we compared the results with the maximum likelihood estimation (MLE) probability obtained from a controlled challenge trial with the NoV GI.1 virus described in the literature, demonstrating the accuracy of our approach. By addressing the indetermination of the unmeasured degree of NoV aggregation in each single infectious dose, our models reduce overestimations and uncertainties in microbial risk assessments. This improvement enhances the management of health risks associated with enteric virus infections.

Sludge production in the wastewater treatment sector is consistently increasing and represents a critical environmental and economic issue. This study evaluated an unconventional approach for treating wastewater generated from the cleaning of non-hazardous plastic solid waste during the plastic recycling process. The proposed scheme was based on sequencing batch biofilter granular reactor (SBBGR) technology, which was compared with the activated sludge-based treatment currently in operation. These treatment technologies were compared regarding sludge quality, specific sludge production, and effluent quality to highlight whether the reduced sludge production shown by SBBGR corresponded to an increase in the concentration of hazardous compounds in the sludge. The SBBGR technology showed remarkable removal efficiencies (TSS, VSS, and NH 3  > 99 %; COD >90 %; TN and TP > 80 %) and a sludge production six-fold lower than the conventional plant (in terms of kgTSS/kg COD removed ). Biomass from the SBBGR did not show a significant accumulation of organic micropollutants (i.e., long-chain hydrocarbons, chlorinated pesticides and chlorobenzenes, PCB, PCDD/F, PAH, chlorinated and brominated aliphatic compounds, and aromatic solvents), whereas a certain accumulation of heavy metals was observed. Furthermore, an initial attempt to compare the operating costs of the two treatment approaches revealed that the SBBGR technology would provide 38 % savings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Liver cancer is very frequent, and hepatocellular carcinoma (HCC) accounts for the majority of liver cancer cases. Its growing incidence has been greatly affected by the increasing prevalence of metabolic-associated fatty liver disease (MAFLD). The latter is a new epidemic in our era. In fact, HCC is often generated from noncirrhotic liver and its treatment benefits from surgical and nonsurgical approaches, potentially bridged by transjugular intrahepatic portosystemic shunt (TIPS) use. TIPS use is an effective treatment for portal hypertension complications, but its application in patients with HCC and clinically significant portal hypertension (CSPH) remains controversial due to concerns about tumor rupture, dissemination, and increased toxicity. The technical feasibility and safety of TIPS use in HCC patients have been evaluated in several studies. Despite concerns about intraprocedural complications, retrospective studies have shown high success rates and low complication rates in TIPS placement for HCC patients. TIPS use in combination with locoregional treatments, such as transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), has been explored as a treatment option for HCC patients with portal hypertension. These studies have shown improved survival rates in patients undergoing TIPS in combination with locoregional treatments. However, the efficacy and toxicity of TACE in combination with TIPS use require careful evaluation, as changes in venous and arterial flow can affect treatment outcomes and complications. The results from studies evaluating the impact of TIPS on systemic therapy and surgical options are also promising. In conclusion, the TIPS is a sufficiently safe, useful item available for physicians treating complications of portal hypertension. Moreover, a TIPS can be used in combination with locoregional therapy in HCC patients. Systemic chemotherapy can also benefit of the use of TIPS placement. A complex interplay affects TIPS use with surgery. The latter needs further data. The TIPS is a useful and safe add-on treatment, changing the natural course of HCC progression. Its use is regulated by a sophisticated physiologic and pathophysiologic flow of evidence.

Phase angle (PhA) represents a raw variable measured with bioelectrical impedance analysis (BIA) that is used to assess malnutrition in many diseases, including respiratory diseases, mainly chronic obstructive pulmonary disease (COPD). COPD patients with reduced PhA are older, more hypoxic and hypercapnic; patients with more severe COPD have reduced cell mass, evident skeletal muscle depletion, and worsening gas exchange. Malnourished patients with stable COPD in long-term oxygen therapy (LTOT) have more intense dyspnea at rest, greater weight loss over the past 12 months, and more exacerbations per year. Multiple regression analysis highlighted the significance of PhA° in the estimation of muscle strength: hand grip strength (HGS) and in that of respiratory muscles: maximal inspiratory pressure / max. expiratory pressure ratio (MIP/MEP). Furthermore, the relationship between PhA° and all-cause mortality in COPD patients was confirmed with the Cox regression model, Kaplan-Meier test, and log-rank tests. The role of malnutrition in idiopathic pulmonary fibrosis (IPF) is confirmed by the PhA° measurements which, regardless of body weight, is associated with the reduction in muscle mass of these patients, reduces their strength and exercise capacity, and greatly influences the prognosis. In conclusion PhA is a novel biomarker of morbidity and mortality in patients with severe respiratory diseases., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Inflammatory bowel disease (IBD) patients on biological therapy are receiving vaccines against severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2). However, it is unclear if IBD therapy could influence the response to this vaccine. In a case-control study, we assessed the antibody profiling after anti-SARS-CoV-2 BNT162b2 vaccine in IBD patients on biological therapy., Methods: We analyzed seroprevalence and antibody titer, after 14 weeks from the first BNT162b2 vaccine dose, in IBD patients on biological therapy and health care workers (HCWs). In IBD patients, medical history and disease data were recorded., Results: Eighty-two subjects were enrolled in this study. Among them, 40 were IBD patients on biological therapy and 42 were HCWs. All subjects developed an IgG anti-Spike antibody titer above the cut-off. IBD patients on biological therapy developed a lower antibody titer than HCWs (P<0.00001). No differences were reported in patients who received at least one dose of the vaccine within a period of 7 days from the last biological drug administration, compared to all other IBD patients. A difference was found between patients who were on concomitant immunosuppressive therapy and patients on sole biological therapy (P=0.0287). Patients with presence of any sign of disease activity (clinical, endoscopic or laboratory) showed a higher development of antibody titer compared to those in complete disease remission (P=0.0468)., Conclusions: Our data indicate that in IBD patients, treatment with biological therapies do not affect the seroprevalence but leads to a lower antibody titer development after anti-SARS-CoV-2 BNT162b2 vaccine.