Diagnostic validity of ultrasound including extra-cranial arteries in giant cell arteritis.

OBJECTIVES: Color Doppler ultrasound (CDUS) of the temporal arteries (TA) is becoming the first test to be performed for suspected giant cell arteritis (GCA). Our aim was to assess the added value of including CDUS of large vessels (LV) in the diagnosis of GCA. METHODS: We performed an observational and retrospective study of consecutive patients with suspected GCA. Baseline CDUS of the TA and LV (axillary, subclavian, and carotid) were conducted. We defined the CDUS finding as positive if the halo sign was present. RESULTS: Of 198 patients with suspected GCA, 87 were eventually diagnosed with GCA: 45 (51.7%) had a cranial pattern exclusively, 31 (35.6%) had both a cranial and an LV pattern, and 11 (12.6%) had an isolated LV pattern. CDUS of the TA had a sensitivity of 83.9%, specificity of 97.3%, and positive and negative predictive values (PPV, NPV) of 96.1% and 88.5%, respectively. When LV was added, sensitivity increased to 96.6% and NPV to 98.2%. Specificity was 97.3% and PPV was 96.6%. As for LVs, the axillary, subclavian, and carotid arteries were involved in 87.8%, 77.4%, and 34.4%, respectively. Isolated axillary examination resulted in a loss of 12.2% of patients with LV involvement; however, inclusion of the axillary and subclavian arteries retained 100% of patients with LV involvement. CONCLUSIONS: Detection of GCA by ultrasound should routinely include examinations of the TA and LV (at least the axillary and subclavian arteries) to improve diagnostic accuracy. More than 12% of patients in our cohort had isolated LV involvement. Key Points • Extracranial involvement in GCA is very common: half of patients have extracranial vasculitis and more than 12% isolated LV involvement that can be demonstrated with CDUS. • Adding a CDUS examination of LV to TA increased sensitivity (from 83.9 to 96.6%) and the negative predictive value (from 88.5 to 98.2%) for diagnosis of GCA. • In our cohort, if we only examined the axillary arteries, 12.2% of the CGA with LV involvement would not have been diagnosed. • We propose a CDUS protocol that includes examination of the TA and LV (at least the axillary and subclavian arteries) routinely in cases of suspected GCA.

Magnetic resonance imaging characteristics in patients with spondyloarthritis and clinical diagnosis of heel enthesitis: post hoc analysis from the phase 3 ACHILLES trial.

OBJECTIVE: To investigate the imaging characteristics and clinically assess heel enthesitis in spondyloarthritis (SpA) by applying in a post hoc analysis the Heel Enthesitis Magnetic Resonance Imaging Scoring system (HEMRIS) in blinded and centrally-read MRI data from the ACHILLES trial (NCT02771210). METHODS: ACHILLES included patients (≥18 years) with active psoriatic arthritis or axial SpA with clinical and MRI-positive heel enthesitis refractory to standard treatment. Patients were randomized to receive subcutaneous secukinumab 150/300 mg or placebo. At week 24, patients on placebo were switched to secukinumab treatment. MRI-positive heel enthesitis was confirmed in all patients by local investigators. MRIs were performed at 3 timepoints: screening and weeks 24 and 52. In the present analysis, all MRIs were re-evaluated by 2 blinded central readers in a consensus read fashion for a priori defined MRI parameters based on HEMRIS. RESULTS: At screening, 171/204 (83.8%) of patients presented with entheseal inflammation and/or structural damage, considering both the Achilles tendon and plantar fascia. Pathologies were more evident in the Achilles tendon area compared to the plantar aponeurosis. The most frequent pathologies were intra-tendon hypersignal and retrocalcaneal bursitis. The mean total entheseal inflammation score at screening in the Achilles tendon area was 2.99 (N=204) and the mean change (standard deviation [SD]) from screening to weeks 24 and 52 was - 0.91 (1.99) and - 0.83 (2.12) in the secukinumab group vs - 0.48 (1.86) and - 0.80 (1.98) in the placebo-secukinumab group, respectively. The mean total structural damage score at screening was 1.36 (N=204) and the mean change (SD) from screening to weeks 24 and 52 was 0.00 (0.65) and - 0.06 (0.56) in the secukinumab group vs 0.08 (0.48) and 0.04 (0.75) in the placebo-secukinumab group, respectively. CONCLUSIONS: Based on the newly developed HEMRIS, entheseal inflammation and/or structural damage was confirmed in 83.3% of ACHILLES patients. Pathologies were more evident in the Achilles tendon area compared to plantar fascia, with the inflammatory parameters being more responsive with secukinumab treatment compared to placebo. The present analysis, with detailed information on individual MRI parameters, contributes to the scientific debate on heel enthesitis. TRIAL REGISTRATION: ClinicalTrials.gov NCT02771210 .

Quantification of bone marrow edema by MRI of the sacroiliac joints in patients diagnosed with axial spondyloarthritis: results from the ESPeranza cohort.

OBJECTIVE: To evaluate whether the quantification of bone marrow edema (BMO) of the sacroiliac (SI) joints by magnetic resonance imaging (MRI) improves capacity for axial spondyloarthritis (axSpA) classification in comparison with the assessment of sacroiliitis by Assessment of SpondyloArthritis international Society (ASAS) classification criteria. METHOD: This prospective study from the ESPeranza cohort involved 66 subjects with an available MRI of the SI joints at baseline. This subgroup includes patients with axSpA (n = 28), peripheral spondyloarthritis (n = 10), and other diagnoses that were not spondyloarthritis (n = 28). Measures of diagnostic usefulness [area under the curve (AUC), sensitivity, specificity, Youden's J statistic, positive and negative likelihood ratios (LR+ and LR-)] were calculated for MRI of the SI joints according to ASAS criteria and for MRI quantified by means of SCAISS (Spanish tool for semi-automatic quantification of sacroiliac inflammation by MRI in spondyloarthritis). This analysis was stratified in patients who were human leucocyte antigen (HLA)-B27 positive and negative. RESULTS: The AUC value with BMO quantification was 0.919 [95% confidence interval (CI) 0.799-1] for HLA-B27-positive patients and 0.884 (95% CI 0.764-1) for HLA-B27-negative patients. A SCAISS cut-off point of 80 units obtained a specificity of 94.4% and LR+ 7.5, while assessment by ASAS criteria showed a specificity value of 90% and LR+ 6.4. CONCLUSION: For patients with suspected axSpA, quantification of BMO improves the predictive capacity of MRI of the SI joints, for both HLA-B27-positive and HLA-B27-negative patients. Axial spondyloarthritis (axSpA) has a dramatic impact on physical function and quality of life (1). Despite its significant impact, patients with axSpA are normally diagnosed several years after presenting symptoms (2). In this respect, magnetic resonance imaging (MRI) of the sacroiliac (SI) joints has gained significance over the past decade, particularly in the early stages of the disease. Nowadays, imaging tests and human leucocyte antigen (HLA)-B27 testing are among the most important diagnostic procedures for patients with suspected axSpA.

Ultrasound Doppler enthesitis shows sensitivity to change after biological therapy in spondyloarthritis and psoriatic arthritis patients.

OBJECTIVE: To explore the sensitivity to change in power Doppler (PD) enthesitis in active spondyloarthritis (SpA) and psoriatic arthritis (PsA) patients. METHOD: This was a longitudinal study in patients with SpA and PsA with active disease [patients starting or switching to biological disease-modifying anti-rheumatic drugs (bDMARDs)]. The MAdrid Sonographic Enthesitis Index (MASEI) was performed at baseline and at 3 and 6 month visits. The MASEI and Outcome Measures in Rheumatology (OMERACT) PD enthesitis definitions were checked. Reliability analysis among three readers was performed with ultrasound (US)-recorded videos. RESULTS: US examinations of 25 patients were included; 16 (64%) had SpA and nine (36%) PsA. The median (interquartile range, IQR) age was 49 (41-61) years, and 13 patients (52%) were female. The median (IQR) 28-joint Disease Activity Score of 3.6 (2.3-4.2), Bath Ankylosing Spondylitis Disease Activity Index of 6.7 (6.1-7.4), and C-reactive protein value of 8.2 (1.6-20) reflected moderate to high disease activity at baseline. Both MASEI and OMERACT PD enthesitis improved significantly at 3 and 6 month follow-up (p < 0.05) and showed sensitivity to change (standard error of measurement = 0.47 and 0.61, respectively). Improvement in clinical activity outcomes was significantly associated with decreases in MASEI and OMERACT PD enthesitis counts (p < 0.05). The MASEI and OMERACT PD definitions had excellent reliability (kappa = 0.918 and 0.865, respectively). CONCLUSION: PD enthesitis significantly improved at 3 and 6 month follow-up in patients undergoing bDMARD therapy. Both MASEI and OMERACT PD US enthesitis reflect response to treatment.

1D_RnDPM: A freely available 222Rn production, diffusion, and partition model to evaluate confounding factors in the radon-deficit technique.

The radon-deficit technique is a powerful tool to detect and delineate sub-surface accumulations of organic contaminants. Field measurements of 222Rn in soil air, however, are affected by several confounding factors that can lead to the misinterpretation of results. Among the most influential are: vertical and lateral changes of lithology, fluctuating contaminant saturations with depth, varying water saturation ratios along the soil profile and atmospheric (and, therefore, soil) thermal oscillations. To evaluate and minimize the effect of these confounding factors on the interpretation of the results of the Rn deficit technique, a Matlab® based multi-layer model of 222Rn production-partition-diffusion in unsaturated porous media (1D_RnDPM: One-Dimensional 222Rn Diffusion and Partition Model) has been developed and is freely available as Supplementary Material in this work. A laboratory protocol has also been proposed to obtain site-specific input parameters for the model, i.e., 222Rn equilibrium concentration (as determined by the accumulation chamber method), soil bulk density and soil solid-phase density. The model predictions have been contrasted with field information obtained from successive sampling campaigns in which 222Rn in soil air was measured at a site where the vadose zone, consisting of an anthropogenic backfill underlain by a silt layer, is affected by a complex mixture of benzene, phenol, (poly) chlorobenzenes, (poly) chlorophenols and hexachlorocyclohexane isomers, among other compounds. The model has successfully predicted the vertical profile of 222Rn concentrations in soil air, including the effect of the oscillations of the water table and of ground-level temperature. The results also underline that 222Rn measurements in subsoil air are representative only of local conditions around the sampling point, an expected result given that 222Rn maximum effective diffusion length is very limited. As a consequence, the influence of a highly fluctuating water table at the site goes undetected at the sampling depths used in the field campaigns. MAIN FINDINGS: The combination of a numerical model and a laboratory protocol allows to predict the activity of 222Rn along the soil profile and to assess the influence of site-specific confounding factors.

Usefulness of intestinal ultrasound in inflammatory bowel disease. / Utilidad de la ecografía intestinal en la enfermedad inflamatoria intestinal.

Imaging techniques play a fundamental role in the initial diagnosis and follow-up of inflammatory bowel disease. Intestinal ultrasound has high sensitivity and specificity in patients with suspected Crohn's disease and in the detection of inflammatory activity. This technique enables the early diagnosis of intra-abdominal complications such as stenosis, fistulas, and abscesses. It has also proven useful in monitoring the response to treatment and in detecting postsurgical recurrence. Technical improvements in ultrasound scanners, technological advances such as ultrasound contrast agents and elastography, and above all increased experience have increased the role of ultrasound in the evaluation of the gastrointestinal tract. The features that make ultrasound especially attractive include its wide availability, its noninvasiveness and lack of ionizing radiation, its low cost, and its good reproducibility, which is important because it is easy to repeat the study and the study is well tolerated during follow-up. This review summarizes the role of intestinal ultrasound in the detection and follow-up of inflammatory bowel disease.

Field performance of the radon-deficit technique to detect and delineate a complex DNAPL accumulation in a multi-layer soil profile.

The performance of the radon (222Rn)-deficit technique has been evaluated at a site in which a complex DNAPL mixture (mostly hexachlorocyclohexanes and chlorobenzenes) has contaminated all four layers (from top to bottom: anthropic backfill, silt, gravel and marl) of the soil profile. Soil gas samples were collected at two depths (0.8 m and 1.7 m) in seven field campaigns and a total of 186 222Rn measurements were performed with a pulse ionization detector. A statistical assessment of the influence of field parameters on the results revealed that sampling depth and atmospheric pressure did not significantly affect the measurements, while the location of the sampling point and ground-level atmospheric temperature did. In order to remove the bias introduced by varying field temperatures and hence to be able to jointly interpret 222Rn measurements from different campaigns, 222Rn concentrations were rescaled by dividing each individual datum by the mean 222Rn concentration of its corresponding field campaign. Rescaled 222Rn maps showed a high spatial correlation between 222Rn minima and maximum contaminant concentrations in the top two layers of the soil profile, successfully delineating the surface trace of DNAPL accumulation in the anthropic backfill and silt layers. However, no correlation could be established between 222Rn concentrations in superficial soil gas and contaminant concentration in the deeper two layers of the soil profile. These results indicate that the 222Rn-deficit technique is unable to describe the vertical variation of contamination processes with depth but can be an effective tool for the preliminary characterization of sites in which the distance between the inlet point of the sampling probe and the contaminant accumulation falls within the effective diffusion length of 222Rn in the affected soil profile.

Applicability and limitations of the radon-deficit technique for the preliminary assessment of sites contaminated with complex mixtures of organic chemicals: A blind field-test.

A blind field test with 136 independent measurements of radon (222Rn) in soil air retrieved from a depth of 0.8 m in a decommissioned lindane (γ-hexachlorocyclohexane) production plant was undertaken to evaluate the performance of the 222Rn-deficit technique as a screening methodology for the location and delineation of subsurface accumulations of complex mixtures of organic contaminants. Maps of 222Rn iso-concentrations were drawn and interpreted before direct analytical information regarding concentrations of hexachlorocyclohexanes, chlorobenzenes and BTEX compounds in soil, groundwater and soil air were disclosed to the authors. The location and extension of pollution hot spots inferred from the 222Rn campaigns agrees remarkably well with the analytical data obtained from the intrusive sampling campaigns and with the location of contaminant source zones (chemical reactor and waste-storage area) and geological sinks of those contaminants (paleochannel). Two main limitations to the applicability of the 222Rn-deficit technique were identified and assessed: The statistically significant variation of 222Rn concentrations with diurnal changes of ground-level air temperature and the maximum depth of investigation in the absence of significant advective and co-advective transport of radon. If the influence of those two factors is accounted for and/or minimized (by averaging replicated measurements during the workday and in different days), the 222Rn-deficit technique has the potential to be an efficient technique which delivers information in quasi-real time, with a much higher spatial density than that of intrusive techniques, at a much faster rate and at a significantly lower cost. MAIN FINDINGS: The 222Rn-deficit technique is an effective tool for real-time site characterization only limited by diffusion length of radon and diurnal temperature variations.

Ultrasonography of enthesis in psoriatic arthritis: a descriptive and reliability analysis of elemental lesions and power Doppler subtypes.

Objective: To evaluate the reliability and prevalence of enthesis ultrasound (US) elemental lesions in patients with psoriatic arthritis (PsA), using the Madrid Sonographic Enthesis Index (MASEI) and Outcome Measures in Rheumatology (OMERACT) definitions.Methods: The study included 27 PsA patients with metacarpophalangeal joint swelling. An US rheumatologist performed the MASEI examination. Prevalence and reliability of the included elemental lesions [structure, thickness, erosion, enthesophytes, power Doppler (PD), and bursae] were evaluated. In addition, three other PD definitions were checked: PD OMERACT (≤ 2 mm to the bone profile), PD enthesis-tendon (> 2 mm from the bone profile), and PD bursa. Short (3-5 s) videos of US examinations were recorded for reliability assessment.Results: MASEI and all PD definitions showed good to excellent reliability. The best reliability values were found in erosions, bursae, and PD. When present, the PD signal always appeared in more than one location of the evaluated areas. Enthesis Doppler was present in 81.5% of patients. Abnormal tendon structure and enthesophytes were the most prevalent lesions.Conclusion: MASEI demonstrates to be a reliable tool in PsA. All enthesis US Doppler definitions demonstrate to be reliable for its use in PsA with minimal differences, being PD MASEI the most sensitive in active patients.

Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática / Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review

INTRODUCCIÓN: El síndrome del túnel carpiano (STC) es la neuropatía periférica más común. Consiste en la compresión del nervio mediano a nivel de túnel carpiano. Tiene una alta prevalencia y genera una situación muy discapacitante desde las primeras fases. En los casos graves el tratamiento suele ser quirúrgico, mientras que en los leves y moderados el tratamiento es conservador. El objetivo de esta revisión es conocer los tratamientos conservadores, así como su efectividad, en pacientes con STC leve y moderado, en los 15 últimos años. DESARROLLO: Se realizó una revisión sistemática según los criterios de PRISMA. Se emplearon las bases de datos Medline, PEDro y Cochrane. Se seleccionaron aquellos ensayos clínicos controlados y aleatorizados que analizasen los efectos del tratamiento conservador sobre los síntomas y la función en pacientes con STC leve o moderado. Se incluyeron 32 ensayos clínicos. Existe evidencia sobre la efectividad de los fármacos orales aunque las infiltraciones parecen ser más efectivas. El uso de férulas ha mostrado ser efectivo y asociado a otras técnicas no farmacológicas también. Las técnicas de electroterapia no han mostrado resultados concluyentes sobre la efectividad de forma aislada. Otras técnicas de tejido blando también han mostrado buenos resultados pero es escasa la evidencia en este campo. También se han propuesto varias combinaciones de tratamiento farmacológico con no farmacológico sin resultados concluyentes. CONCLUSIONES: Existen varios tratamientos conservadores capaces de mejorar los síntomas y la función de los pacientes con STC leve y moderado. Estos incluyen el uso de férulas, fármacos orales, infiltraciones, técnicas de electroterapia, técnicas manuales específicas y ejercicios de deslizamiento neural, así como la combinación de varias de ellas. No ha sido posible describir la mejor técnica o combinación de técnicas debido a las limitaciones de los estudios, por lo que es necesario realizar más estudios con una calidad metodológica adecuada

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed

Aerosol sources in subway environments.

Millions of people use rail subway public transport around the world, despite the relatively high particulate matter (PM) concentrations in these underground environments, requiring the identification and quantification of the aerosol source contributions to improve the air quality. An extensive aerosol monitoring campaign was carried out in eleven subway stations in the Barcelona metro system, belonging to seven subway lines. PM2.5 samples were collected during the metro operating hours and chemically analysed to determine major and trace elements, inorganic ions, and total carbon. The chemical compositions of subway components such as brake pads, rail tracks and pantographs were also determined. The mean PM2.5 concentrations varied widely among stations, ranging from 26 µg m-3 to 86 µg m-3. Subway PM2.5 was mainly constituted by Fe2O3 (30-66%), followed by carbonaceous matter (18-37%) for the old stations, while for new stations equipped with Platform Screen Doors (PSD) these percentages go down to 21-44% and 15-30%, respectively. Both the absolute concentrations and the relative abundance of key species differed for each subway station, although with common patterns within a given subway line. This is a result of the different emission chemical profiles in different subway lines (using diverse types of brakes and/or pantographs). The co-emission of different sources poses a problem for their separation by receptor models. Nevertheless, receptor modelling (Positive Matrix Factorization) was applied resulting in ten sources, five of them subway-specific: RailWheel, RailWheel+Brake, Brake_A, Brake_B, Pb. The sum of their contributions accounted for 43-91% of bulk PM2.5 for the old stations and 21-52% for the stations with PSD. The decrease of the activity during the weekends resulted in a decrease (up to 56%) in the subway-specific sources contribution to the -already lower- bulk PM2.5 concentrations compared to weekdays. The health-related elements are mainly apportioned (> 60%) by subway sources.

Conservative treatment in patients with mild to moderate carpal tunnel syndrome: A systematic review. / Tratamiento conservador en pacientes con síndrome del túnel carpiano con intensidad leve o moderada. Revisión sistemática.

BACKGROUND: Carpal tunnel syndrome (CTS) is the most common peripheral neuropathy. It is characterised by the compression of the median nerve in the carpal tunnel. CTS presents a high prevalence and it is a disabling condition from the earliest stages. Severe cases are usually treated surgically, while conservative treatment is recommended in mild to moderate cases. The aim of this systematic review is to present the conservative treatments and determine their effectiveness in mild-to-moderate cases of CTS over the last 15 years. METHODS: A systematic review was performed according to PRISMA criteria. We used the Medline, PEDro, and Cochrane databases to find and select randomised controlled clinical trials evaluating the effects of conservative treatment on the symptoms and functional ability of patients with mild to moderate CTS; 32 clinical trials were included. There is evidence supporting the effectiveness of oral drugs, although injections appear to be more effective. Splinting has been shown to be effective, and it is also associated with use of other non-pharmacological techniques. Assessments of the use of electrotherapy techniques alone have shown no conclusive results about their effectiveness. Other soft tissue techniques have also shown good results but evidence on this topic is limited. Various treatment combinations (drug and non-pharmacological treatments) have been proposed without conclusive results. CONCLUSIONS: Several conservative treatments are able to relieve symptoms and improve functional ability of patients with mild-to-moderate CTS. These include splinting, oral drugs, injections, electrotherapy, specific manual techniques, and neural gliding exercises as well as different combinations of the above. We have been unable to describe the best technique or combination of techniques due to the limitations of the studies; therefore, further studies of better methodological quality are needed.

Remediation of aged diesel contaminated soil by alkaline activated persulfate.

The present work studies the efficiency of alkaline activated persulfate (PS) to remediate an aged diesel fuel contaminated soil from a train maintenance facility. The Total Petroleum Hydrocarbon (TPH) concentration in soil was approximately 5000mgkg-1 with a ratio of aliphatic:aromatic compounds of 70:30. Aromatic compounds were mainly naphtalenes and phenanthrenes. The experiments were performed in batch mode where different initial concentrations of persulfate (105mM, 210mM and 420mM) and activator:persulfate ratios (2 and 4) were evaluated, with NaOH used as activator. Runs were carried out during 56days. Complete TPH conversion was obtained with the highest concentration of PS and activator, whereas in the other runs the elimination of fuel ranged between 60 and 77%. Besides, the abatement of napthalenes and phenantrenes was faster than aliphatic reduction (i. e. after 4days of treatment, the conversions of the aromatic compounds were around 0.8 meanwhile the aliphatic abatements were 0.55) and no aromatic oxidation intermediates from naphtalenes or phenantrenes were detected. These results show that this technology is effective for the remediation of aged diesel in soil with alkaline pH.

Environmental risk assessment of cobalt and manganese from industrial sources in an estuarine system.

A total of 74 samples of soil, sediment, industrial sludge, and surface water were collected in a Mediterranean estuarine system in order to assess the potential ecological impact of elevated concentrations of Co and Mn associated with a Terephthalic (PTA) and Isophthalic (PIPA) acids production plant. Samples were analyzed for elemental composition (37 elements), pH, redox potential, organic carbon, and CaCO3 content, and a group of 16 selected samples were additionally subjected to a Tessier sequential extraction. Co and Mn soil concentrations were significantly higher inside the industrial facility and around its perimeter than in background samples, and maximum dissolved Co and Mn concentrations were found in a creek near the plant's discharge point, reaching values 17,700 and 156 times higher than their respective background concentrations. The ecological risk was evaluated as a function of Co and Mn fractionation and bioavailability which were controlled by the environmental conditions generated by the advance of seawater into the estuarine system during high tide. Co appeared to precipitate near the river mouth due to the pH increase produced by the influence of seawater intrusion, reaching hazardous concentrations in sediments. In terms of their bioavailability and the corresponding risk assessment code, both Co and Mn present sediment concentrations that result in medium to high ecological risk whereas water concentrations of both elements reach values that more than double their corresponding Secondary Acute Values.

Bioaerosols in the Barcelona subway system.

Subway systems worldwide transport more than 100 million people daily; therefore, air quality on station platforms and inside trains is an important urban air pollution issue. We examined the microbiological composition and abundance in space and time of bioaerosols collected in the Barcelona subway system during a cold period. Quantitative PCR was used to quantify total bacteria, Aspergillus fumigatus, influenza A and B, and rhinoviruses. Multitag 454 pyrosequencing of the 16S rRNA gene was used to assess bacterial community composition and biodiversity. The results showed low bioaerosol concentrations regarding the targeted microorganisms, although the bacterial bioburden was rather high (104 bacteria/m3 ). Airborne bacterial communities presented a high degree of overlap among the different subway environments sampled (inside trains, platforms, and lobbies) and were dominated by a few widespread taxa, with Methylobacterium being the most abundant genus. Human-related microbiota in sequence dataset and ascribed to potentially pathogenic bacteria were found in low proportion (maximum values below 2% of sequence readings) and evenly detected. Hence, no important biological exposure marker was detected in any of the sampled environments. Overall, we found that commuters are not the main source of bioaerosols in the Barcelona subway system.

Formation and alteration of airborne particles in the subway environment.

Most particles in the rail subway environment are sub-micron sized ferruginous flakes and splinters generated mechanically by frictional wear of brake pads, wheels and rails. To better understand the mechanisms of formation and the alteration processes affecting inhalable particles in subways, PM samples (1-2.5 µm and 2.5-10 µm) were collected in the Barcelona Metro and then studied under a scanning electron microscope. Most particles in these samples are hematitic (up to 88%), with relatively minor amounts of mineral matter (up to 9%) and sulphates (up to 5%). Detailed microscopy (using back scattered and TEM-DRX imaging) reveals how many of the metallic particles comprise the metallic Fe nucleus surrounded by hematite (Fe2O3) and a coating of sulphate and chloride salts mixed with mineral matter (including Ca-carbonates, clay minerals and quartz). These observations record the emission of fine to ultrafine FePM by frictional wear at elevated temperatures that promote rapid partial (or complete) oxidation of the native metal. Water condensing on the PM surface during cooling leads to the adsorption of inorganic mineral particles that coat the iron oxide. The distinctively layered polymineralic structure that results from these processes is peculiar to particles generated in the subway environment and very different from PM typically inhaled outdoors.

Prediction of the flooding of a mining reservoir in NW Spain.

Abandoned and flooded mines constitute underground reservoirs which must be managed. When pumping is stopped in a closed mine, the process of flooding should be anticipated in order to avoid environmentally undesirable or unexpected mine water discharges at the surface, particularly in populated areas. The Candín-Fondón mining reservoir in Asturias (NW Spain) has an estimated void volume of 8 million m3 and some urban areas are susceptible to be flooded if the water is freely released from the lowest mine adit/pithead. A conceptual model of this reservoir was undertaken and the flooding process was numerically modelled in order to estimate the time that the flooding would take. Additionally, the maximum safe height for the filling of the reservoir is discussed.

Atlas-based knee osteophyte assessment with ultrasonography and radiography: relationship to arthroscopic degeneration of articular cartilage.

OBJECTIVES: To investigate intra- and inter-reader agreement of ultrasonography (US) and conventional radiography (CR) for the evaluation of osteophyte presence and size within the tibiofemoral joint. In addition, to correlate these findings with arthroscopic degeneration of the articular cartilage. METHOD: Forty adult patients with knee pain were enrolled in this study. Knee CR and US scanning of the medial and lateral bone margins were performed on all patients. A novel atlas for the US grading of knee osteophytes was used in the evaluation. The number and size of the osteophytes were evaluated semi-quantitatively in two rounds from both the CR images (four readers) and the US images (14 readers). The Noyes grading system was used for the evaluation of arthroscopic degeneration of the articular cartilage in 26 patients. RESULTS: On average, intra- and inter-reader US and CR agreement was substantial and comparable to each other (κ = 0.60-0.72). US detected more osteophytes than CR at both the medial (65% vs. 48%) and lateral (70% vs. 60%) compartments. A statistically significant correlation between CR- or US-based osteophyte and arthroscopy grades was observed only for US at the medial compartment (rs = 0.747, p < 0.001). CONCLUSIONS: The detection of knee osteophytes using the novel US atlas is as reproducible as reading conventional radiographs. US is more sensitive to detect knee osteophytes than CR. Furthermore, osteophytes detected with US correlate significantly with arthroscopic cartilage changes at the medial knee compartment whereas those detected by CR do not.

Is entheses ultrasound reliable? A reading Latin American exercise.

The objective of this study is to evaluate inter-reader entheses ultrasound (US) reliability and the influence of the type of image or degree of sonographer experience on US reliability in patients with spondyloarthritis (SpA). Eighteen Latin American ultrasonographers with different experience took part in an US reading exercise evaluating 60 entheseal images (50 % static images and 50 % videos) from healthy controls and SpA patients. The following sonographic lesions were assessed: structure, thickness, bone proliferation/tendon calcification, erosions, bursitis, and Doppler signal. Another group of three experts with significant experience in entheses US read all images too. Inter-reader reliability among participants and experts was calculated by the Cohen's kappa coefficient. Thresholds for kappa values were <0.2 poor, 0.21-0.4 fair, 0.41-0.6 moderate, 0.61-0.8 good, and 0.81-1 excellent. Furthermore, the results for the expert group were stratified based on the type of image. Kappa correlation coefficients among participants, showed variability depending on the type of lesion, being fair for structure and thickness, moderate for calcifications, erosions, and bursitis, and excellent for Doppler signal. Inter-reader reliability among experts was higher, being moderate for structure and thickness, good for calcifications and bursitis, and excellent for erosions and Doppler. Inter-reader reliability for assessing calcification and structure using static images was significantly higher than for videos. Overall inter-reader reliability for assessing entheses by US in SpA is moderate to excellent for most of the lesions. However, special training seems fundamental to achieve better inter-reader reliability. Moreover, the type of image influenced these results, where evaluation of entheses by videos was more difficult than by static images.