Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage: a randomised controlled clinical trial.

BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone. METHODS: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone. The primary outcome was a score of 5-6 on the modified Rankin Scale (mRS) at 180 days, analysed in the intention-to-treat population. This trial is registered with ClincalTrials.gov, NCT02258919, and is completed. FINDINGS: SWITCH had to be stopped early due to lack of funding. Between Oct 6, 2014, and April 4, 2023, 201 individuals were randomly assigned and 197 gave delayed informed consent (96 decompressive craniectomy plus best medical treatment, 101 best medical treatment). 63 (32%) were women and 134 (68%) men, the median age was 61 years (IQR 51-68), and the median haematoma volume 57 mL (IQR 44-74). 42 (44%) of 95 participants assigned to decompressive craniectomy plus best medical treatment and 55 (58%) assigned to best medical treatment alone had an mRS of 5-6 at 180 days (adjusted risk ratio [aRR] 0·77, 95% CI 0·59 to 1·01, adjusted risk difference [aRD] -13%, 95% CI -26 to 0, p=0·057). In the per-protocol analysis, 36 (47%) of 77 participants in the decompressive craniectomy plus best medical treatment group and 44 (60%) of 73 in the best medical treatment alone group had an mRS of 5-6 (aRR 0·76, 95% CI 0·58 to 1·00, aRD -15%, 95% CI -28 to 0). Severe adverse events occurred in 42 (41%) of 103 participants receiving decompressive craniectomy plus best medical treatment and 41 (44%) of 94 receiving best medical treatment. INTERPRETATION: SWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups. FUNDING: Swiss National Science Foundation, Swiss Heart Foundation, Inselspital Stiftung, and Boehringer Ingelheim.

Sulfate sensitivity of aquatic organism in soft freshwaters explored by toxicity tests and species sensitivity distribution.

Elevated concentrations of sulfate in waterways are observed due to various anthropogenic activities. Elevated levels of sulfate can have harmful effects on aquatic life in freshwaters: sulfate can cause osmotic stress or specific ion toxicity in aquatic organisms, especially in soft waters where Ca2+ and Mg2+ concentrations are low. Formerly, chronic toxicity test data in soft water have been scarce. The chronic and acute sulfate toxicity tests conducted with aquatic organisms from 10 families across various trophic levels in this study multiplied the number of tests conducted in soft freshwater conditions and enabled derivation of the species sensitivity distribution (SSD) and sulfate hazardous concentrations for soft freshwaters. The cladoceran Daphnia longispina and freshwater snail Lymnaea stagnalis were the most sensitive to sulfate among the studied species. Harmful effects on the reproduction of D. longispina were observed at 49 mg SO4 /L while growth of L. stagnalis was inhibited at 217 mg SO4 /L. Most studied organisms tolerated high sulfate concentrations: the median of chronic effective concentrations (EC10 or LC10) was 1008 mg/L for all the species tested in this study. Based on the species sensitivity distribution of the studied species the hazardous concentration for 5 % of aquatic organism (HC5) in soft waters was 117-194 mg SO4/L. Different data set combinations were used to demonstrate the data variability in SSD-based HC5 estimates. The lowest values were produced from combining biotest results from the present study and earlier literature, while the highest values were calculated from the present study only. The derived chronic no-effect concentrations (PNEC) varied between 39 and 65 mg SO4/L.

Particle balance and return loops for microplastics in a tertiary-level wastewater treatment plant.

Microplastics (MPs) from households, stormwater, and various industries are transported to wastewater treatment plants (WWTPs), where a high proportion of them are captured before discharging their residuals to watersheds. Although recent studies have indicated that the removed MPs are mainly retained in wastewater sludge, sludge treatment processes have gained less attention in MP research than water streams at primary, secondary, and tertiary treatments. In this study, we sampled 12 different process steps in a tertiary-level municipal WWTP in central Finland. Our results showed that, compared to the plant influent load, three times more MPs circulated via reject water from the sludge centrifugation back to the beginning of the treatment process. Fibrous MPs were especially abundant in the dewatered sludge, whereas fragment-like MPs were observed in an aqueous stream. We concluded that, compared to the tertiary effluent, sludge treatment is the major exit route for MPs into the environment, but sludge treatment is also a return loop to the beginning of the process. Our sampling campaign also demonstrated that WWTPs with varying hydraulic conditions (such as the one studied here) benefit from disc filter-based tertiary treatments in MP removal.

Optical Monitoring of Microplastics Filtrated from Wastewater Sludge and Suspended in Ethanol.

The abundance of microplastics (MPs) in the atmosphere, on land, and especially in water bodies is well acknowledged. In this study, we establish an optical method based on three different techniques, namely, specular reflection to probe the medium, transmission spectroscopy measurements for the detection and identification, and a speckle pattern for monitoring the sedimentation of MPs filtrated from wastewater sludge and suspended in ethanol. We used first Raman measurements to estimate the presence and types of different MPs in wastewater sludge samples. We also used microscopy to identify the shapes of the main MPs. This allowed us to create a teaching set of samples to be characterized with our optical method. With the developed method, we clearly show that MPs from common plastics, such as polypropylene (PP), polyethylene terephthalate (PET), polystyrene (PS), and polyethylene (PE), are present in wastewater sludge and can be identified. Additionally, the results also indicate that the density of the plastics, which influences the sedimentation, is an essential parameter to consider in optical detection of microplastics in complex natural environments. All of the methods are in good agreement, thus validating the optics-based solution.

Sulfate toxicity to early life stages of European whitefish (Coregonus lavaretus) in soft freshwater.

Sulfate occurs naturally in the aquatic environment but its elevated levels can be toxic to aquatic life in freshwater environments. We investigated the toxicity of sulfate in humic, soft freshwater to whitefish (Coregonus lavaretus) from fertilization of eggs to hatching i.e. during the critical phases of whitefish early development. Anadromous Kokemäenjoki whitefish eggs and sperm during fertilization, embryos and larvae were exposed in the long-term 175-day incubation to seven different sodium sulfate (Na2SO4) concentrations from 44 to 2 000 mg SO4 L-1. Endpoint variables were the fertilization success, offspring survival and larval growth. Egg fertilization and early embryonic development were the most sensitive developmental stages of whitefish to sulfate, although the fertilization success and survival of embryos decreased only in the highest concentration of 2 000 mg SO4 L-1. The survival during late embryonic period, hatching and the 5-day larval period was high and no difference between the control and sulfate treatments were observed. LC50-values of sulfate for early embryonic period and for the entire embryonic and larval period was 1 413 and 1 161 mg L-1, respectively. The NOEC (No-observed Effect Concentration) of sulfate for the both periods was 1 207 mg L-1. The tolerance of whitefish early stages to sulfate toxicity seems to be on the same level as the tolerance of other salmonids' early stages.

Condition and Sperm Characteristics of Perch Perca fluviatilis inhabiting Boreal Lakes Receiving Metal Mining Effluents.

One of the world's largest, but low-grade, sulfide nickel deposits in northeastern Finland has been exploited by a bioheapleaching technology since 2008. Bioheapleaching is a relatively new, cost-effective technology, but humid climate, e.g., in boreal temperate environments, causes challenges to the management of the water balance in the ore heaps with wide catchment area, and the mining effluents have caused substantial metal and salting contamination of the receiving waterbodies. In our study, the impacts of metal-extracting bioheapleaching mine effluents on muscle and liver element concentrations, body condition, liver and testes mass, and sperm count and motility of male perch Perca fluviatilis were analysed. Liver, testes, and carcass mass of perch in relation to their length were lower in the mining-impacted lakes than in the reference lake, which may be due to the metal contamination, food availability, and energy demand under multistressor conditions. The sperm counts of the males in the mining-impacted lakes were lower, but the endurance of their sperm motility was longer than the endurance of sperm of the reference males. These findings suggested that the condition and sperm characteristics of perch were altered in lakes receiving metal mining effluents. Measured variables seem to be useful indicators for metal mining impacts on freshwater fish but only if high natural variation in these characteristics can be controlled by multiyear monitoring scheme.

Comparison of high versus low frequency cerebral physiology for cerebrovascular reactivity assessment in traumatic brain injury: a multi-center pilot study.

Current accepted cerebrovascular reactivity indices suffer from the need of high frequency data capture and export for post-acquisition processing. The role for minute-by-minute data in cerebrovascular reactivity monitoring remains uncertain. The goal was to explore the statistical time-series relationships between intra-cranial pressure (ICP), mean arterial pressure (MAP) and pressure reactivity index (PRx) using both 10-s and minute data update frequency in TBI. Prospective data from 31 patients from 3 centers with moderate/severe TBI and high-frequency archived physiology were reviewed. Both 10-s by 10-s and minute-by-minute mean values were derived for ICP and MAP for each patient. Similarly, PRx was derived using 30 consecutive 10-s data points, updated every minute. While long-PRx (L-PRx) was derived via similar methodology using minute-by-minute data, with L-PRx derived using various window lengths (5, 10, 20, 30, 40, and 60 min; denoted L-PRx_5, etc.). Time-series autoregressive integrative moving average (ARIMA) and vector autoregressive integrative moving average (VARIMA) models were created to analyze the relationship of these parameters over time. ARIMA modelling, Granger causality testing and VARIMA impulse response function (IRF) plotting demonstrated that similar information is carried in minute mean ICP and MAP data, compared to 10-s mean slow-wave ICP and MAP data. Shorter window L-PRx variants, such as L-PRx_5, appear to have a similar ARIMA structure, have a linear association with PRx and display moderate-to-strong correlations (r ~ 0.700, p < 0.0001 for each patient). Thus, these particular L-PRx variants appear closest in nature to standard PRx. ICP and MAP derived via 10-s or minute based averaging display similar statistical time-series structure and co-variance patterns. PRx and L-PRx based on shorter windows also behave similarly over time. These results imply certain L-PRx variants may carry similar information to PRx in TBI.

Cervical Spine Involvement among Patients with Rheumatoid Arthritis Treated Actively with Treat-to-target Strategy: 10-year Results of the NEO-RACo Study.

OBJECTIVE: To evaluate the development of radiological changes of the cervical spine in patients with rheumatoid arthritis (RA) in the NEO-RACo trial treated with an intensive, remission-targeted combination of conventional synthetic disease-modifying antirheumatic drugs (csDMARD) and additional infliximab (IFX) or placebo (PLA) for the first 6 months. METHODS: Ninety-nine patients with early, DMARD-naive RA were treated with a triple combination of csDMARD and prednisolone, and randomized to double-blindly receive either IFX (FIN-RACo+IFX) or PLA (FIN-RACo+PLA) infusions during the first 6 months. After 2 years the treatment strategies became unrestricted, but the treatment goal was strict NEO-RACo remission. At the 10-year visit, radiographs of the cervical spine were taken of 85 patients (38 in the FIN-RACo+IFX group and 47 in the FIN-RACo+PLA group). The study was registered at ClinicalTrials.gov (NCT00908089). RESULTS: There were 4/85 patients (4.7%) with cervical spine involvement (CSI) by 10 years. Atlantoaxial subluxation was found in 2/85 patients (2.4%), both in the FIN-RACo+IFX group, and none in the FIN-RACo+PLA group. Atlantoaxial impaction was found in 1/85 patients (1.2%) in the FIN-RACo+IFX group. Subaxial subluxation was found in 1/85 patients (1.2%). CONCLUSION: Early and intensive remission-targeted treatment has reduced the incidence of CSI and our results show that intensive treatment also prevents its development in the long run.

Ecotoxicity assessment of boreal lake sediments affected by metal mining: Sediment quality triad approach complemented with metal bioavailability and body residue studies.

There are several methods for studying metal-contaminated freshwater sediments, but more information is needed on which methods to include in ecological risk assessment. In this study, we compliment the traditional Sediment Quality Triad (SQT) approach - including information on chemistry, toxicity and ecological status - with studies on metal bioavailability and metal body residues in local organisms. We studied four mining-affected boreal lakes in Finland by conducting chemical analyses of sediment and water, toxicity tests (L. variegatus, V. fischeri, C. riparius, L. stagnalis), and analysis of benthic organism community structure. In addition, we studied the relationships between metal loading, toxicity, metal bioavailability, and metal body residues in the field-collected biota. Chemistry and benthic organism community structures show adverse effects in those lakes, where the metal concentrations are the highest. However, toxicity was connected to low sediment pH during the experiment, rather than to high metal concentrations. Toxicity was observed in 4 out of 6 toxicity tests including growth test with L. variegatus, bulk sediment test with V. fischeri, and the L. stagnalis toxicity test. The C. riparius test did not show toxicity. Metal body residues in biota were not high enough to induce adverse effects (0.1-4.1 mg Cu/kg fw, 0.01-0.3 mg Ni/kg fw, 2.9-26.7 mg Zn/kg fw and 0.01-0.7 mg As/kg fw). Chemical analyses, metal bioavailability assessment and benthic community structures survey revealed adverse effects in the sediments, where metal concentrations are highest (Lake SJ and Lake KS). Standard toxicity tests were not suitable for studying acid, sulfide-rich sediments and, therefore, benthic structure study and chemical analyses are believed to give more reliable results of the ecological status of these sediments.

Assessment of Fish Embryo Survival and Growth by In Situ Incubation in Acidic Boreal Streams Undergoing Biomining Effluents.

The applicability of an in situ incubation method in monitoring the effects of metal mining on early life stages of fish was evaluated by investigating the impacts of a biomining technology utilizing mine on the mortality, growth, and yolk consumption of brown trout (Salmo trutta) and whitefish (Coregonus lavaretus) embryos. Newly fertilized eggs were incubated from autumn 2014 to spring 2015 in six streams under the influence of the mine located in North-Eastern Finland and in six reference streams. Although the impacted streams clearly had elevated concentrations of several metals and sulfate, the embryonic mortality of the two species did not differ between the impacted and the reference streams. Instead, particle accumulation to some cylinders had a significant impact on the embryonic mortality of both species. In clean cylinders, mortality was higher in streams with lower minimum pH. However, low pH levels were evident in both the reference and the mine-impacted groups. The embryonic growth of neither species was impacted by the mining activities, and the growth and yolk consumption of the embryos was mainly regulated by water temperature. Surprisingly, whitefish embryos incubated in streams with lower minimum pH had larger body size. In general, the applied in situ method is applicable in boreal streams for environmental assessment and monitoring, although in our study, we did not observe a specific mining impact differing from the effects of other environmental factors related to catchment characteristics.

Lumbriculus variegatus (Annelida) biological responses and sediment sequential extractions indicate ecotoxicity of lake sediments contaminated by biomining.

We assessed potential ecotoxicity of lake sediments affected by biomining effluents in northeastern Finland. Growth, reproduction and behavior of the sediment-dwelling oligochaete Lumbriculus variegatus (Müller 1774) were used as ecotoxicity endpoints. Standardized chronic bioassays were used for growth and reproduction, and acute and chronic tests with Multispecies Freshwater Biomonitor (MFB) for behavior assessments. Sequential extractions were used to characterize metal bioavailability and exposure conditions in the sediments, which indicated mining-induced contamination gradients of S, Cu, Ni and U and also bioavailability gradients of S and Ni. Among the ecotoxicity endpoints, growth and reproduction responses of the standard bioassays appeared more sensitive than the behavioral responses at 21 d. In the two most mining-affected test sediments, mean number of worms and dry biomass decreased 35-42% and 46-51% in comparison to the reference sediment, respectively. The behavioral changes of worms, i.e. peristaltic and overall locomotory activity, decreased on average 20-70% and 2-61% at 21 d in the same sediments. However, these behavioral changes were observed at the onset of exposure indicating MFB technique is a suitable and rapid screening level ecotoxicity assessment tool.

Toxicity of biomining effluents to Daphnia magna: Acute toxicity and transcriptomic biomarkers.

Increasing metal consumption is driving the introduction of new techniques such as biomining to exploit low grade ores. The biomining impacts notably aquatic ecosystems, yet, the applicability of ecotoxicological tests to study the complex mixture effects of mining waters is insufficiently understood. The aim of the present work was to test if transcriptomic biomarkers are suitable and sensitive for the ecotoxicity assessment of biomining affected waters. The study site had been affected by a multimetal biomine, and the studied water samples formed a concentration gradient of contamination downstream from the biomining site. Cadmium and nickel were used as positive controls in the toxicity tests. Selected transcriptomic biomarkers, previously shown to be differentially regulated by metals, were used to evaluate the ecotoxicity of the water samples. Parallel samples were used to compare the transcriptomic biomarkers with the conventional acute D. magna toxicity test. In the acute test, one sample was acutely toxic to D. magna, when pH was adjusted according to the standard, whereas, in the native pH, three samples caused total immobility. Monooxygenase was up-regulated by the highest concentration of Cd in control samples and three of the water samples. Vtg-SOD was up-regulated by one of the water samples, and catalase by the second highest concentration of Cd. The results show that transcriptomic biomarkers in D. magna can be used as sensitive bioindicators for metal mixture toxicity assessment in complex environmental water samples.

High burden of adverse events is associated with reduced remission rates in early rheumatoid arthritis.

Adverse events (AEs) are common during disease-modifying antirheumatic drug (DMARD) treatment, but their influence on treatment results is unclear. We studied AEs in relation to disease activity in early rheumatoid arthritis (RA). Ninety-nine patients started intensive treatment with three conventional synthetic DMARDs (csDMARDs) and oral prednisolone, and were randomized to a 6-month induction treatment with infliximab or placebo. All AEs during the first 12 months of treatment were recorded. We scored each AE based on severity (scale 1-4) and defined the burden of AEs as the sum of these scores. Patients were divided into tertiles according to the burden of AEs. As outcomes, we assessed 28-joint disease activity score (DAS28) levels and remission rates at 12 and 24 months. Three hundred thirty-one AEs in 99 patients were reported, and 27 (8%) were categorized as severe or serious. Mean burden of AEs per patient was 5.4 ± 4.3. Seventy-nine AEs (24%) led to temporary (n = 52) or permanent (n = 27) csDMARD discontinuation. Of discontinuations, 1, 21, and 57 were detected in the first, second, and third tertiles, respectively. DAS28 remission rates decreased across tertiles at 12 months (94, 94, and 76%; p for linearity 0.029) and at 24 months (90, 86, and 70%; p for linearity 0.021). Mean DAS28 levels increased across tertiles at 12 months (1.5 ± 1.0, 1.7 ± 0.9, and 1.9 ± 1.2; p for linearity 0.021) and at 24 months (1.4 ± 0.8, 1.6 ± 1.0, and 1.9 ± 1.1; p for linearity 0.007). High burden of AEs is associated with higher disease activity and lower likelihood of remission in early RA.

Cytokine data obtained from synovial stromal cells of patients with rheumatoid arthritis or osteoarthritis.

In this article, we share the raw cytokine data obtained from basal and stimulated synovial stromal cells cultured from patients with rheumatoid arthritis or osteoarthritis. This data article is related to the research article entitled "1,25D3 and calcipotriol, its hypocalcemic analog, exert a long-lasting anti-inflammatory and anti-proliferative effect in synoviocytes cultured from patients with rheumatoid arthritis and osteoarthritis (1). Cytokine levels were analyzed by a magnetic bead-based multiplex assay (a panel of 27 important cytokines) in two separate sets of experiments. The first was conducted with IL-1ß and 1,25(OH)2D3 and the other with TNFα, calcipotriol, i.e. the hypocalcemic analog 1,25(OH)2D3, and dexamethasone. The raw data of this article display the individual variation in basal secretion of cytokines and in their response to different stimuli.

Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach.

Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.

1,25(OH)2D3 and calcipotriol, its hypocalcemic analog, exert a long-lasting anti-inflammatory and anti-proliferative effect in synoviocytes cultured from patients with rheumatoid arthritis and osteoarthritis.

OBJECTIVES: We investigated the effects of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3), i.e. biologically active vitamin D and calcipotriol, a vitamin D analog, on growth and secretion of inflammatory mediators in synovial stromal cells (SSC) of patients with rheumatoid arthritis (RA) or osteoarthritis (OA). METHODS: Synovial stromal cells (SSC) isolated during knee prosthesis surgery from four patients with RA and four with OA were exposed to 1,25(OH)2D3 or calcipotriol with or without stimulation of cells with IL-1ß or TNF-α. The proliferation of cells was studied by MTT assay. Levels of cytokines were analyzed by a magnetic bead-based multiplex assay (a panel of 27 important cytokines and IL-6 alone) and RT-PCR was used to validate the concentrations of the key cytokines secreted by SSC. The vitamin D receptor (VDR) was visualized by immunofluorescence in SSC and by immunohistochemistry in the synovial tissues of three RA and three OA patients. RESULTS: We detected intense staining for VDR in the synovial lining and vascular endothelium in tissue sections from all our RA and OA patients. Both 1,25(OH)2D3 and calcipotriol inhibited SSC proliferation for a prolonged time (up to 23 days with calcipotriol), but dexamethasone tended to increase SSC proliferation in a 4-day culture. 1,25(OH)2D3, calcipotriol and dexamethasone reduced the secretion of most inflammatory factors. Calcipotriol and dexamethasone additively reduced the secretions of IL-6, IFN-γ, basic FGF and VEGF in TNF-α stimulated SSC. The level of IL-6 was still diminished at 10 days after exposure, emphasizing the long-term impact of calcipotriol on SSC. CONCLUSIONS: Exposure for 24-48h to 1,25(OH)2D3 or calcipotriol causes a long-lasting inhibition of cell proliferation and cytokine production in SSC in vitro.

Assessing ecotoxicity of biomining effluents in stream ecosystems by in situ invertebrate bioassays: A case study in Talvivaara, Finland.

Mining of sulfide-rich pyritic ores produces acid mine drainage waters and has induced major ecological problems in aquatic ecosystems worldwide. Biomining utilizes microbes to extract metals from the ore, and it has been suggested as a new sustainable way to produce metals. However, little is known of the potential ecotoxicological effects of biomining. In the present study, biomining impacts were assessed using survival and behavioral responses of aquatic macroinvertebrates at in situ exposures in streams. The authors used an impedance conversion technique to measure quantitatively in situ behavioral responses of larvae of the regionally common mayfly, Heptagenia dalecarlica, to discharges from the Talvivaara mine (Sotkamo, Northern Finland), which uses a biomining technique. Behavioral responses measured in 3 mine-impacted streams were compared with those measured in 3 reference streams. In addition, 3-d survival of the mayfly larvae and the oligochaete Lumbriculus variegatus was measured in the study sites. Biomining impacts on stream water quality included increased concentrations of sulfur, sulfate, and metals, especially manganese, cadmium, zinc, sodium, and calcium. Survival of the invertebrates in the short term was not affected by the mine effluents. In contrast, apparent behavioral changes in mayfly larvae were detected, but these responses were not consistent among sites, which may reflect differing natural water chemistry of the study sites. Environ Toxicol Chem 2017;36:147-155. © 2016 SETAC.

Tolerance of whitefish (Coregonus lavaretus) early life stages to manganese sulfate is affected by the parents.

European whitefish (Coregonus lavaretus) embryos and larvae were exposed to 6 different manganese sulfate (MnSO4 ) concentrations from fertilization to the 3-d-old larvae. The fertilization success, offspring survival, larval growth, yolk consumption, embryonic and larval Mn tissue concentrations, and transcript levels of detoxification-related genes were measured in the long-term incubation. A full factorial breeding design (4 females × 2 males) allowed examination of the significance of both female and male effects, as well as female-male interactions in conjunction with the MnSO4 exposure in terms of the observed endpoints. The MnSO4 exposure reduced the survival of the whitefish early life stages. The offspring MnSO4 tolerance also was affected by the female parent, and the female-specific mean lethal concentrations (LC50s) varied from 42.0 mg MnSO4 /L to 84.6 mg MnSO4 /L. The larval yolk consumption seemed slightly inhibited at the exposure concentration of 41.8 mg MnSO4 /L. The MnSO4 exposure caused a significant induction of metallothionein-A (mt-a) and metallothionein-B (mt-b) in the 3-d-old larvae, and at the exposure concentration of 41.8 mg MnSO4 /L the mean larval mt-a and mt-b expressions were 47.5% and 56.6% higher, respectively, than at the control treatment. These results illustrate that whitefish reproduction can be impaired in waterbodies that receive Mn and SO4 in concentrations substantially above the typical levels in boreal freshwaters, but the offspring tolerance can be significantly affected by the parents and in particular the female parent. Environ Toxicol Chem 2017;36:1343-1353. © 2016 SETAC.

Effectiveness and drug survival of TNF-inhibitors in the treatment of psoriatic arthritis: A prospective cohort study.

BACKGROUND AND OBJECTIVES: Tumor necrosis factor (TNF)-inhibitors are used to treat psoriatic arthritis (PsA), but only a limited number of observational studies on this subject have been published thus far. The aim of this research was to analyze the effectiveness and drug survival of TNF-inhibitors in the treatment of PsA. METHODS: PsA patients identified from the National Register for Biologic Treatment in Finland (ROB-FIN) starting their first, second, or third TNF-inhibitor treatment between 2004 and 2014 were included. Effectiveness was measured using ACR and EULAR response criteria and modeled using ordinal logistic regression. Treatment persistence was analyzed using Kaplan-Meier survival analysis and Cox proportional hazards model. RESULTS: The study comprised 765 patients and 990 TNF-inhibitor treatment courses. EULAR moderate treatment responses at 6 months were achieved by 68% and 37% of the users of the first and the second or the third biologic, respectively. The probabilities of discontinuing the treatment within 12 and 24 months were 20% and 28%, respectively. Adjusted treatment responses to all TNF-inhibitors were similar; however, co-therapy with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) was not associated with better effectiveness. Adalimumab [hazard ratio (HR) = 0.62; 95% confidence interval (CI): 0.44-0.88] was superior to infliximab in drug survival while etanercept (HR = 0.77, 95% CI: 0.55-1.1) and golimumab (HR = 0.75, 95% CI: 0.46-1.2) did not differ from it. Co-medication with csDMARDs did not statistically improve drug survival. CONCLUSION: All available TNF-inhibitors showed similar treatment responses with or without csDMARDs. Adalimumab was associated with better drug survival when compared to infliximab.