Assessment of lettuces grown in urban areas for human consumption and as bioindicators of atmospheric pollution.

This study proposes using the network of urban gardens to grow vegetables and to monitor air quality, and it also evaluates whether food grown on a clean substrate in an urban environment is safe for consumption. For this purpose, lettuces were exposed to different degrees of air pollution in five locations in the city of Copenhagen, plus a reference site. Six specimens were placed at each site and, after the exposure period, half of each sample was washed. Subsamples were then digested by a total extraction method and a bioaccessible extraction method, and the concentration of 23 elements subsequently measured by ICP-MS. The results showed that exposed samples in areas of higher atmospheric pollution accumulated a larger amount of trace elements associated with typical urban sources. They also highlighted the importance of washing food to remove particles that adhere to their surface. However, bioaccessibility testing demonstrated the importance of including bioaccessibility in risk analyses and how this factor varies depending on the type of matrix. In this case, bioaccessibility was higher for plant tissue than for particulate matter. Lastly, metal concentrations in lettuce were compared with legal values and an analysis of daily intake showed that the levels in Copenhagen were within limits for the protection of human health.

Influence of advection on the soil gas radon deficit technique for the quantification of LNAPL.

The Radon (Rn) deficit technique is a rapid, low-cost, and non-invasive method to identify and quantify light non-aqueous phase liquids (LNAPL) in the soil. LNAPL saturation is typically estimated from Rn deficit using Rn partition coefficients, assuming equilibrium conditions. This work examines the applicability of this method in the presence of local advective fluxes that can be generated by groundwater fluctuations or biodegradation processes in the source zone. To this end, a one-dimensional analytical model was developed to simulate the steady-state diffusive-advective transport of soil gas Rn in the presence of LNAPL. The analytical solution was first validated against an existing numerical model adapted to include advection. Then a series of simulations to study the effect of advection on Rn profiles were carried out. It was found that in high-permeability soils (such as sandy soils), advective phenomena can significantly affect Rn deficit curves in the subsurface compared with those expected, assuming either equilibrium conditions or a diffusion-dominated transport. Namely, in the presence of pressure gradients generated by groundwater fluctuations, applying the traditional Rn deficit technique (assuming equilibrium conditions) can lead to an underestimation of LNAPL saturation. Furthermore, in the presence of methanogenesis processes (e.g., in the case of a fresh LNAPL of petroleum hydrocarbons), local advective fluxes can be expected above the source zone. In such cases, Rn concentrations above the source zone can be higher than those above background areas without advective phenomena, resulting in Rn deficits higher than 1 (i.e., Rn excess), and thus leading to a wrong interpretation regarding the presence of LNAPL in the subsurface if advection is not considered. Overall, the results obtained suggest that advection should be considered in the presence of pressure gradients in the subsurface to ensure an effective application of the soil gas Rn-deficit technique for quantitative estimation of LNAPL saturation.

Modelling the Transference of Trace Elements between Environmental Compartments in Abandoned Mining Areas.

An openly accessible cellular automaton has been developed to predict the preferential migration pathways of contaminants by surface runoff in abandoned mining areas. The site where the validation of the results of the Contaminant Mass Transfer Cellular Automaton (CMTCA) has been carried out is situated on the steep flank of a valley in the Spanish northwestern region of Asturias, at the foot of which there is a village with 400 inhabitants, bordered by a stream that flows into a larger river just outside the village. Soil samples were collected from the steep valley flank where the mine adits and spoil heaps are situated, at the foot of the valley, and in the village, including private orchards. Water and sediment samples were also collected from both surface water courses. The concentration of 12 elements, including those associated with the Cu-Co-Ni ore, were analyzed by ICP-OES (Perkin Elmer Optima 3300DV, Waltham, MA, USA) and ICP-MS (Perkin Elmer NexION 2000, Waltham, MA, USA). The spatial representation of the model's results revealed that those areas most likely to be crossed by soil material coming from source zones according to the CMTCA exhibited higher pollution indexes than the rest. The model also predicted where the probabilities of soil mass transfer into the stream were highest. The accuracy of this prediction was corroborated by the results of trace element concentrations in stream sediments, which, for elements associated with the mineral paragenesis (i.e., Cu, Co, Ni, and also As), increased between five- and nine-fold downstream from the predicted main transfer point. Lastly, the river into which the stream discharges is also affected by the mobilization of mined materials, as evidenced by an increase of up to 700% (in the case of Cu), between dissolved concentrations of those same elements upstream and downstream of the confluence of the river and the stream.

Urban Allotment Gardens for the Biomonitoring of Atmospheric Trace Element Pollution.

This study evaluates the results of the characterization of air pollution in urban green areas using edible plants. To this purpose, we examined the effect of location (i.e., three different levels of pollution), substrate (peat moss and vermiculite), and plant species (oilseed rape [ L.] and kale [ L.]) on the accumulation of trace elements on leaves. A total of 36 samples of unwashed leaves were digested with HNO-HO and analyzed for 27 elements by inductively coupled plasma mass spectrometry. Considering the location, plants exposed next to the road showed higher contents of traffic-related elements, and additionally, outdoors samples were enriched in marine aerosol ions. Cadmium and Pb concentrations did not exceed the European legal maximum levels for vegetables, so their consumption would be safe for human health. Results support the hypothesis that edible plants such as kale and rapeseed could be used as bioindicators of atmospheric pollution.

Comunicar para el desarrollo: una propuesta de divulgación radiofónica en la lucha contra el hambre y la malnutrición en Nicaragua / Communicating for development: a proposal for radio broadcasting to deal with hunger and malnutrition in Nicaragua

Nicaragua presenta altos niveles de inseguridad alimentaria y nutricional. Predomina la deficiencia proteico-energética y la carencia de nutrientes específicos y al mismo tiempo presenta la superposición epidemiológica-nutricional y la doble carga de riesgos para la salud. Faltan conocimientos para optimizar los escasos recursos para adquirir productos de mayor valor nutricional. El objetivo fue contribuir a reducir el hambre y la desnutrición y mejorar la alimentación y el estado nutricional de la población del municipio nicaragüense de Somotillo, a través de estrategias educativas difundidas por el medio radiofónico. Se ejecutó el programa "Por una mejor nutrición" en la radio (1 junio al 29 de julio, 2016) y se abordaron cuatro temas: conocimientos sobre alimentación saludable, higiene alimentaria, enfermedades asociadas a la malnutrición y alimentación del escolar y se acompañaron de tres cápsulas informativas cada uno, transmitidas 1v/s y 5v/s (8v/día), respectivamente, más una sesión 1v/s de respuesta a los oyentes (maestros y niños escolares). Además, se hizo una evaluación cualitativa (grupo de discusión con maestros y promotores de salud) y se aplicó un cuestionario de 5 preguntas pre y post intervención a 600 escolares seleccionados al azar en 20 escuelas rurales. Se encontró dominio parcial del tema de higiene pre-intervención y fallas en las acciones para prevenir las enfermedades que afectan el estado nutricional de los escolares (post intervención). El programa benefició a 2.349 estudiantes y familias. Esta experiencia puede mejorar el empoderamiento de las familias y la comunidad frente a los problemas de alimentación y prácticas higiénicas peligrosas existentes, pero requieren por parte de las comunidades garantizar la sostenibilidad y replicabilidad del mismo(AU)

Nicaragua has high levels of food and nutritional insecurity. Protein-energy deficiency and lack of specific nutrients predominate, while epidemiological-nutritional deficiencies and excess overlap and the double burden of health risks. There is a lack of knowledge in order to optimize scarce resources and to acquire products of greater nutritional value. The aim was to contribute to the reduction of hunger and malnutrition and to improve the diet and nutritional status of the population of the Nicaraguan municipality of Somotillo, through educational strategies broadcasted by radio. The program "For better nutrition" was carried out on the radio (1 June to 29 July 2016) and addressed four topics: knowledge of healthy eating, food hygiene, diseases associated with malnutrition and school feeding, and was accompanied by three information capsules, each transmitted 1/s and 5/s (8v/day), respectively, plus a 1/s response session for listeners (teachers and school children). In addition, a qualitative evaluation (discussion group with teachers and health promoters) and a questionnaire of 5 pre and post intervention questions were applied to 600 randomly selected schoolchildren in 20 rural schools. Partial mastery was found of the issue of pre-intervention hygiene and failures in actions to prevent diseases that affect the nutritional status of schoolchildren (post-intervention). The program benefited 2,349 students and families. This experience can improve the empowerment of families and the community in the face of existing food problems and dangerous hygiene practices(AU)

Applicability of radon emanometry in lithologically discontinuous sites contaminated by organic chemicals.

The applicability of radon (222Rn) measurements to delineate non-aqueous phase liquids (NAPL) contamination in subsoil is discussed at a site with lithological discontinuities through a blind test. Three alpha spectroscopy monitors were used to measure radon in soil air in a 25,000-m2 area, following a regular sampling design with a 20-m2 grid. Repeatability and reproducibility of the results were assessed by means of duplicate measurements in six sampling positions. Furthermore, three points not affected by oil spills were sampled to estimate radon background concentration in soil air. Data histograms, Q-Q plots, variograms, and cluster analysis allowed to recognize two data populations, associated with the possible path of a fault and a lithological discontinuity. Even though the concentration of radon in soil air was dominated by this discontinuity, the characterization of the background emanation in each lithological unit allowed to distinguish areas potentially affected by NAPL, thus justifying the application of radon emanometry as a screening technique for the delineation of NAPL plumes in sites with lithological discontinuities.

Prospective Clinical Integration of an Amplicon-Based Next-Generation Sequencing Method to Select Advanced Non-Small-Cell Lung Cancer Patients for Genotype-Tailored Treatments.

INTRODUCTION: A substantial fraction of non-small-cell lung cancers (NSCLCs) harbor targetable genetic alterations. In this study, we analyzed the feasibility and clinical utility of integrating a next-generation sequencing (NGS) panel into our routine lung cancer molecular subtyping algorithm. PATIENTS AND METHODS: After routine pathologic and molecular subtyping, we implemented an amplicon-based gene panel for DNA analysis covering mutational hot spots in 22 cancer genes in consecutive advanced-stage NSCLCs. RESULTS: We analyzed 109 tumors using NGS between December 2014 and January 2016. Fifty-six patients (51%) were treatment-naive and 82 (75%) had lung adenocarcinomas. In 89 cases (82%), we used samples derived from lung cancer diagnostic procedures. We obtained successful sequencing results in 95 cases (87%). As part of our routine lung cancer molecular subtyping protocol, single-gene testing for EGFR, ALK, and ROS1 was attempted in nonsquamous and 3 squamous-cell cancers (n = 92). Sixty-nine of 92 samples (75%) had sufficient tissue to complete ALK and ROS1 immunohistochemistry (IHC) and NGS. With the integration of the gene panel, 40 NSCLCs (37%) in the entire cohort and 30 NSCLCs (40%) fully tested for ALK and ROS1 IHC and NGS had actionable mutations. KRAS (24%) and EGFR (10%) were the most frequently mutated actionable genes. Ten patients (9%) received matched targeted therapies, 6 (5%) in clinical trials. CONCLUSION: The combination of IHC tests for ALK and ROS1 and amplicon-based NGS is applicable in routine clinical practice, enabling patient selection for genotype-tailored treatments.

Risk assessment from exposure to arsenic, antimony, and selenium in urban gardens (Madrid, Spain).

The authors discuss the geochemical behavior of arsenic (As), antimony (Sb), and selenium (Se) in urban gardens and the human health implications associated with urban agriculture. A total of 42 samples from 7 urban gardens in Madrid, Spain, were collected from the top 20 cm of soil. Concentrations of As, Sb, and Se and the main soil properties (i.e., total iron, pH, texture, calcium carbonate, and organic matter) were determined. A significant correlation was found between As and Sb and calcium carbonate, indicating the possibility of surface adsorption or ligand exchange with the carbonate group. Also, Sb seemed to form stable chelates with soil organic matter. On the other hand, Se showed a significant association with clay and iron content. The concentration of Sb in soil exceeded the recommended value for agricultural use in 70% of the urban gardens. A human health risk assessment resulted in acceptable levels of both noncarcinogenic and carcinogenic risks (although with elevated values of the latter), with As as the main risk driver and soil and food ingestion as the main exposure pathways. The numerical results of the risk assessment should be interpreted with caution given the considerable uncertainties in some exposure variables and the lack of quantitative values for the suspected carcinogenicity of Sb and Se. Environ Toxicol Chem 2017;36:544-550. © 2016 SETAC.

Hambre, miseria y enfermedad en latinoamérica y el caribe: el papel de la nutrición en las enfermedades tropicales desatendidas (ETDs) en nicaragua / Hunger, misery and disease in Latin America and the Caribbean: the role of nutrition in neglected tropical diseases (NTDs) in Nicaragua

La alimentación y la nutrición adecuadas son el primer y el más importante de los derechos humanos fundamentales y de los determinantes de la salud de las personas. Con el propósito de ayudar a reducir el impacto del hambre y facilitar el control y la eliminación de las enfermedades tropicales desatendidas (ETDs), contribuyendo al alcance de la seguridad alimentaria en la población escolar del Departamento de Chinandega (Nicaragua), se desarrolló el proyecto piloto “Hambre, miseria y enfermedad: el papel de la nutrición en las enfermedades tropicales desatendidas (ETDs) en Nicaragua”. El presente artículo documenta esta experiencia. Para conseguir los objetivos planteados se organizó una jornada científica con expertos en nutrición y en las ETDs, un panel elaboró las conclusiones que sirvieron para la redacción del documento de consenso, en el cual se fundamentó la elaboración de los materiales a ser utilizados en la intervención educativa: “Alimentación para crecer sano”, manual dirigido a los promotores de salud y “Manual de estrategias educativas: alimentación para crecer sano” dirigido a los escolares. Se realizaron cuatro jornadas de capacitación que inicialmente involucró a 80 maestros de 20 escuelas, y que en la última jornada logró sumar 145 docentes. Seguidamente se desarrolló la fase de multiplicación en las escuelas, con la participación de 2.327 niños de entre 7 y 14 años de edad. En esta experiencia la receptividad de los docentes, la mejora en sus habilidades y conocimientos son una garantía para la replicación en los niños y niñas(AU)

Food and proper nutrition are the first and most important of fundamental human rights and the determinants of health of people. In order to help reduce the impact of hunger and facilitate the control and elimination of neglected tropical diseases (NTDs), contributing to the extent of food safety in the school population of the Department of Chinandega (Nicaragua), the pilot project “Hunger, misery and disease: the role of nutrition in neglected tropical diseases (NTDs) in Nicaragua” was developed. This article documents this experience. To achieve the goals a scientific conference with experts in nutrition and NTDs was organized, a panel drew conclusions that were used for drafting the consensus document in which the development of the materials was based to be used in the intervention education: A “Food to grow healthy” manual aimed at health promoters and a “Manual of educational strategies: healthy food for growth” aimed at schoolchildren. Four days of training initially involved 80 teachers from 20 schools were made, and on the last day managed to reach 145 teachers. Then the multiplication phase in schools was developed with the participation of 2,327 children between 7 and 14 years old. In this experience the receptivity of teachers, improving their skills and knowledge are a guarantee for replication in children(AU)

Determinants of false-negative results in non-small-cell lung cancer staging by endobronchial ultrasound-guided needle aspiration.

OBJECTIVES: False-negative results of endobronchial ultrasound-guided transbronchial needle aspiration in non-small-cell lung cancer staging have shown significant variability in previous studies. The aim of this study was to identify procedure- and tumour-related determinants of endobronchial ultrasound-guided transbronchial needle aspiration false-negative results. METHODS: We conducted a prospective study that included non-small-cell lung cancer patients staged as N0/N1 by endobronchial ultrasound-guided transbronchial needle aspiration and undergoing therapeutic surgery. The frequency of false-negative results in the mediastinum was calculated. Procedure-related, first, and tumour-related, second, determinants of false-negative results in stations reachable and non-reachable by endobronchial ultrasound were determined by multivariate logistic regression. RESULTS: False-negative endobronchial ultrasound-guided transbronchial needle aspiration results were identified in 23 of 165 enrolled patients (13.9%), mainly in stations reachable by endobronchial ultrasound (17 cases, 10.3%). False-negative results were related to the extensiveness of endobronchial ultrasound sampling: their prevalence was low (2.4%) when sampling of three mediastinal stations was satisfactory, but rose above 10% when this requirement was not fulfilled (P = 0.043). In the multivariate analysis, abnormal mediastinum on computer tomography/positron emission tomography [odds ratio (OR) 7.77, 95% confidence interval (CI) 2.19-27.51, P = 0.001] and extensiveness of satisfactory sampling of mediastinal stations (OR 0.37, 95% CI 0.16-0.89, P = 0.026) were statistically significant risk factors for false-negative results in stations reachable by endobronchial ultrasound. False-negative results in non-reachable nodes were associated with a left-sided location of the tumour (OR 10.11, 95% CI 1.17-87.52, P = 0.036). CONCLUSIONS: The presence of false-negative ultrasound-guided transbronchial needle aspiration results were observed in nearly 15% of non-small-cell lung cancer patients but in only 3% when satisfactory samples were obtained from three mediastinal stations. False-negative results in stations reachable by endobronchial ultrasound were associated with the extensiveness of sampling, and in stations out of reach of endobronchial ultrasound with left-sided tumours. These results suggest that satisfactory sampling of at least three mediastinal stations by EBUS-TBNA may be a quality criterion to be recommended for EBUS-TBNA staging.

Probabilistic meta-analysis of risk from the exposure to Hg in artisanal gold mining communities in Colombia.

Colombia is one of the largest per capita mercury polluters in the world as a consequence of its artisanal gold mining activities. The severity of this problem in terms of potential health effects was evaluated by means of a probabilistic risk assessment carried out in the twelve departments (or provinces) in Colombia with the largest gold production. The two exposure pathways included in the risk assessment were inhalation of elemental Hg vapors and ingestion of fish contaminated with methyl mercury. Exposure parameters for the adult population (especially rates of fish consumption) were obtained from nation-wide surveys and concentrations of Hg in air and of methyl-mercury in fish were gathered from previous scientific studies. Fish consumption varied between departments and ranged from 0 to 0.3 kg d(-1). Average concentrations of total mercury in fish (70 data) ranged from 0.026 to 3.3 µg g(-1). A total of 550 individual measurements of Hg in workshop air (ranging from

The relationship between soil geochemistry and the bioaccessibility of trace elements in playground soil.

A total of 32 samples of surficial soil were collected from 16 playground areas in Madrid (Spain), in order to investigate the importance of the geochemistry of the soil on subsequent bioaccessibility of trace elements. The in vitro bioaccessibility of As, Co, Cr, Cu, Ni, Pb and Zn was evaluated by means of two extraction processes that simulate the gastric environment and one that reproduces a gastric + intestinal digestion sequence. The results of the in vitro bioaccessibility were compared against aqua regia extractions ("total" concentration), and it was found that total concentrations of As, Cu, Pb and Zn were double those of bioaccessible values, whilst that of Cr was ten times higher. Whereas the results of the gastric + intestinal extraction were affected by a high uncertainty, both gastric methods offered very similar and consistent results, with bioaccessibilities following the order: As = Cu = Pb = Zn > Co > Ni > Cr, and ranging from 63 to 7 %. Selected soil properties including pH, organic matter, Fe and CaCO(3) content were determined to assess their influence on trace element bioaccessibility, and it was found that Cu, Pb and Zn were predominantly bound to organic matter and, to a lesser extent, Fe oxides. The former fraction was readily accessible in the gastric solution, whereas Fe oxides seemed to recapture negatively charged chloride complexes of these elements in the gastric solution, lowering their bioaccessibility. The homogeneous pH of the playground soils included in the study does not influence trace element bioaccessibility to any significant extent except for Cr, where the very low gastric accessibility seems to be related to the strongly pH-dependent formation of complexes with organic matter. The results for As, which have been previously described and discussed in detail in Mingot et al. (Chemosphere 84: 1386-1391, 2011), indicate a high gastric bioaccessibility for this element as a consequence of its strong association with calcium carbonate and the ease with which these bonds are broken in the gastric solution. The calculation of risk assessments are therefore dependant on the methodology used and the specific environment they address. This has impacts on management strategies formulated to ensure that the most vulnerable of society, children, can live and play without adverse consequences to their health.

Assessment of oral bioaccessibility of arsenic in playground soil in Madrid (Spain): a three-method comparison and implications for risk assessment.

Three methodologies to assess As bioaccessibility were evaluated using playground soil collected from 16 playgrounds in Madrid, Spain: two (Simplified Bioaccessibility Extraction Test: SBET, and hydrochloric acid-extraction: HCl) assess gastric-only bioaccessibility and the third (Physiologically Based Extraction Test: PBET) evaluates mouth-gastric-intestinal bioaccessibility. Aqua regia-extractable (pseudo total) As contents, which are routinely employed in risk assessments, were used as the reference to establish the following percentages of bioaccessibility: SBET-63.1; HCl-51.8; PBET-41.6, the highest values associated with the gastric-only extractions. For Madrid playground soils--characterised by a very uniform, weakly alkaline pH, and low Fe oxide and organic matter contents--the statistical analysis of the results indicates that, in contrast with other studies, the highest percentage of As in the samples was bound to carbonates and/or present as calcium arsenate. As opposed to the As bound to Fe oxides, this As is readily released in the gastric environment as the carbonate matrix is decomposed and calcium arsenate is dissolved, but some of it is subsequently sequestered in unavailable forms as the pH is raised to 5.5 to mimic intestinal conditions. The HCl extraction can be used as a simple and reliable (i.e. low residual standard error) proxy for the more expensive, time consuming, and error-prone PBET methodology. The HCl method would essentially halve the estimate of carcinogenic risk for children playing in Madrid playground soils, providing a more representative value of associated risk than the pseudo-total concentrations used at present.

Apoptosis of hepatic stellate cells mediated by specific protein nitration.

Inflammatory conditions are characterized by continuous overproduction of nitric oxide (NO) that can contribute to cell survival but also to cell demise by affecting apoptosis. These facts are important in regulation of hepatic fibrogenesis during exposure to inflammatory stress, since elevated NO may pose the risk of cells with a pro-fibrogenic phenotype giving rise to a sustained proliferation leading to chronic fibrosis. Since nitration of tyrosine residues occurs in a range of diseases involving inflammation, we tested the hypothesis that nitration of specific proteins could result in apoptosis of hepatic stellate cells (HSC), the primary cellular source of matrix components in liver diseases. We found the peroxynitrite generator SIN-1 to promote apoptosis in human and rat HSC, based on oligonucleosomal DNA fragmentation, caspase-3 and -9 activation, Bcl-2 depletion and accumulation of Bax protein. We also showed that SIN-1-induced apoptosis of HSC was due to protein nitration. Among the tyrosine-nitrated proteins, tyrosine kinase Lyn was identified. SIN-1 triggered a signaling pathway through Src kinase Lyn activation that resulted in increased activity of the tyrosine kinase Syk. The involvement of these signaling molecules in the apoptotic process induced by SIN-1 as well as the mechanism by which they are activated was confirmed by using specific inhibitors. In summary, NO, via protein-nitration, could play an important role in controlling liver fibrosis resolution by regulation of HSC apoptosis.

Sensitivity of linear endobronchial ultrasonography and guided transbronchial needle aspiration for the identification of nodal metastasis in lung cancer staging.

The aim of this study is to determine the sensitivity of real-time endobronchial ultrasonography (EBUS)-guided transbronchial needle aspiration (TBNA) in lung cancer staging. Short- and long-axis node diameters were measured during EBUS in patients referred for lung cancer staging and sensitivities for the identification of nodal malignancy at TBNA determined. Three hundred fifteen real-time EBUS-guided TBNA nodal sampling procedures were performed in 161 patients and in 87 of them, N2/N3 metastasis was confirmed (50.9%), eliminating the need for mediastinoscopy. The median (interquartile range [IQR]) short-axis diameters of the sampled mediastinal and lobar nodes were 11 (8-15) and 8 (7-12) mm, respectively. TBNA provided satisfactory samples from 269 nodes (85.4%) and a sensitivity of 100% for the identification of malignant TBNA samples was reached for a short-axis diameter cut-off of 5 mm and a short- to long-axis ratio of 0.5. The probability of malignancy was over 90% for nodes with a short-axis diameter >20 mm and 55% for round nodes (short- to long-axis ratio of 1). In 18 out of 50 patients with a normal mediastinal computed tomography (CT) scan, the technique identified enlarged nodes in the mediastinum (36%), mainly in the subcarinal region and confirmed mediastinal malignancy in 8 (10%). Real-time EBUS-guided TBNA obtains satisfactory node samples in almost 90% of cases and improves the identification of enlarged nodes in patients with a normal mediastinum at CT. If sampling all nodes with a short-axis diameter of > or =5 mm and a short- to long-axis ratio > or =0.5, a sensitivity of 100% for the cytologic identification of malignant nodes can be expected.

The role of airway stenting in pediatric tracheobronchial obstruction.

OBJECTIVE: Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness. MATERIALS AND METHODS: Twenty-one patients with severe airway stenosing disease in which stent placement was performed between 1993 and 2006. Inclusion criteria according to the clinical status were: failure to wean from ventilation, episode of apnea, frequent respiratory infections (>3 pneumonia/year), and severe respiratory distress. Additional criteria for stent placement were: failure of surgical treatment, bronchomalacia, and tracheomalacia refractory to previous tracheostomy. Selection of the type of stent depended on the site of the lesion, the patient's age, and the stent availability when time of presentation. The following variables were retrospectively evaluated: age, type of obstruction, associated malformations, stent properties, technical and clinical success, complications and related reinterventions, outcome and follow-up period. RESULTS: Thirty-three stents were placed in the trachea (n=18) and/or bronchi (n=15) of 21 patients with a median age of 6 months (range, 9 days-19 years). Etiology of the airway obstruction included severe tracheomalacia and/or bronchomalacia in 19 cases (90%), and postoperative tracheal stenosis in two. Twelve children had a total of 20 balloon-expandable metallic stents placed, and 10 had 13 silicone-type stents (one patient had both). In nine patients (42%) more than one device was placed. Stent positioning was technically successful in all but one patient. Clinical improvement was observed in 18 patients (85%) but complications occurred in five of them (27%). Eight patients died during follow-up but only in one case it was related to airway stenting. Thirteen patients (62%) are alive and in good condition with a mean follow-up of 39 months (1-13.8 years). CONCLUSIONS: Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.

High-frequency jet ventilation in interventional bronchoscopy: factors with predictive value on high-frequency jet ventilation complications.

STUDY OBJECTIVE: To evaluate the incidence and impact on clinical outcome of complications observed during high-frequency jet ventilation (HFJV) at interventional bronchoscopy and to identify the perioperative factors that may be associated to an increased incidence of such complications. DESIGN: Observational retrospective, study with an observational prospective validation of the statistically significant associations. SETTING: University hospital. PATIENTS: The retrospective study involved 276 patients who underwent an interventional rigid bronchoscopy during general anesthesia and HFJV. Forty consecutive patients were accrued for the prospective validation group. INTERVENTIONS/MEASUREMENTS: Information recorded included patient medical history and perioperative complications observed at HFJV-managed bronchoscopic procedures and their impact on clinical outcome until hospital discharge. MAIN RESULTS: At least one complication was detected in 38% of retrospective patients and 55% of prospective patients. Most frequent complications were hypercapnia, hypoxemia, and hemodynamic instability, but just one case of barotrauma in the retrospective group. Despite the high incidence, these complications were transient and did not increase hospital stay, whereas technical failure to widen airway lumen was associated with an adverse prognosis. Several clinical parameters showed a significant association with complications in the univariate analysis. However, the multivariate analysis only evidenced two independent predictive factors: the ASA physical status scale and baseline oxygen saturation. CONCLUSIONS: Classification in ASA physical status IV group and a baseline oxygen saturation of 95% or less independently predicted the development of complications during interventional rigid bronchoscopy with HFJV.

Geochemical fingerprints and controls in the sediments of an urban river: River Manzanares, Madrid (Spain).

The geochemical fingerprint of sediment retrieved from the banks of the River Manzanares as it passes through the City of Madrid is presented here. The river collects the effluent water from several Waste Water Treatment (WWT) plants in and around the city, such that, at low flows, up to 60% of the flow has been treated. A total of 18 bank-sediment cores were collected along the course of the river, down to its confluence with the Jarama river, to the south-east of Madrid. Trace and major elements in each sample were extracted following a double protocol: (a) "Total" digestion with HNO3, HClO4 and HF; (b) "Weak" digestion with sodium acetate buffered to pH=5 with acetic acid, under constant stirring. The digests thus obtained were subsequently analysed by ICP-AES, except for Hg which was extracted with aqua regia and sodium chloride-hydroxylamine sulfate, and analysed by Cold Vapour-AAS. X-ray diffraction was additionally employed to determine the mineralogical composition of the samples. Uni- and multivariate analyses of the chemical data reveal the influence of Madrid on the geochemistry of Manzanares' sediments, clearly manifested by a marked increase in the concentration of typically "urban" elements Ag, Cr, Cu, Pb and Zn, downstream of the intersection of the river with the city's perimeter. The highest concentrations of these elements appear to be associated with illegal or accidental dumping of waste materials, and with the uncontrolled incorporation of untreated urban runoff to the river. The natural matrix of the sediment is characterised by fairly constant concentrations of Ce, La and Y, whereas changes in the lithology intersected by the river cause corresponding variations in Ca-Mg and Al-Na contents. In the final stretch of the river, the presence of carbonate materials seems to exert a strong geochemical control on the amount of Zn and, to a lesser extent, Cu immobilised in the sediments. This fact suggests that a variable but significant proportion of both elements may be susceptible to reincorporation in the aqueous phase under realistic environmental conditions.

Endobronchial hamartoma.

OBJECTIVES: To describe clinical, endoscopic, radiographic, and follow-up characteristics of a series of patients in whom endobronchial hamartoma (EH) had been diagnosed. METHODS: Retrospective study of all cases of hamartoma diagnosed by bronchial biopsy between 1974 and 1997 in a tertiary referral hospital in Madrid, Spain. RESULTS: EH was diagnosed 47 patients during the study period. Four patients were excluded from the study because no clinical history was available. We analyzed the cases of 43 patients (37 men and 6 women), with a mean (+/- SD) age of 62 +/- 12 years. Seven patients had a concurrent lung neoplasm, and the EH was an incidental endoscopic finding. Among the other 36 patients, 31 had a new onset of respiratory symptoms, most commonly, recurrent respiratory infections in 16 patients (44%) and hemoptysis in a further 12 patients (33.4%). Chest radiograph findings were abnormal in 38 of 43 patients. At bronchoscopy, the lesions were equally distributed throughout the right and left lungs with no clear lobar predilection. Endobronchial obstruction was evident in 26 patients (72.2%) without concurrent neoplasm, 17 of whom underwent resection with a rigid bronchoscope and laser, with total resolution in 13 patients. Partial resolution was achieved in four patients, two of whom needed a second endoscopic procedure. Five patients were treated with open lung surgery. Clinical and endoscopic follow-up was performed in 23 patients at 1 to 73 months (mean, 17 months), and recurrence was found in 4 patients. CONCLUSION: EH frequently produces respiratory complaints and radiographic abnormalities. Patients with endobronchial obstructions had satisfactory responses to endoscopic therapy.