Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: Results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study

Objectives To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population. Methods In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas). Results In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses. Conclusions This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA

Morfología Fluvial.-Una paradoja en la restauración de canteras de caliza en el área mediterránea: características físicas del sustrato como condicionante de la dinámica del sistema creado

ABSTRACT The restoration of opencast mining land looks for the quick integration in the landscape and the erosion control of derelict areas. The characteristics of substrate can determinate the behaviour of novel system. The stony substrates used have a great Ks and a very low water storage capacity. This paper presents the results of an experiment performed on stony mineral substrates amended with sewage sludge under Mediterranean climatic conditions in a limestone quarry in the SW of Barcelona (NE of Spain). The experiment was carried out at container scale and the aim was to evaluate the vegetation response in two substrates with different stoniness and with irrigation during dry period. Water content in the mineral substrate was monitored using vertical TDR probes during the experiment. The growth of introduced plants was monitored monthly. Throughout the experiment, populations of sown plants fluctuated according to the available water in the substrate. The irrigation applied was not sufficient to maintain the vegetation in summer (period of higher evaporative demand at that time of year). The volume of leachate was high and nitrates, sulfates and chlorides were washedRESUMEN La restauración de zonas afectadas por minería a cielo abierto busca una rápida integración en el paisaje y el control de la erosión de las zonas degradadas. Las características del sustrato pueden determinar el funcionamiento del nuevo sistema. Los substratos pedregosos que se usan tienen una elevada conductividad hidráulica y una baja reserva hídrica. En este documento se presentan los resultados de un experimento con substratos pedregosos corregidos con lodos de EDAR bajo condiciones mediterráneas en una cantera de caliza del SW de Barcelona (NE España). La experiencia se realizó en contenedores y el objetivo era evaluar la respuesta de la vegetación en 2 substratos de distinta pedregosidad y con riegos de soporte durante los periodos secos. El contenido de agua del substrato se controló en primavera-verano mediante sondas TDR verticales. El crecimiento de las ESPEcies introducidas se medía mensualmente. Se observa que las poblaciones de las especies sembradas fluctúan en función del agua disponible en el substrato. Los riegos aplicados fueron insuficientes para mantener la vegetación en verano (periodo con mayor demanda evaporativa). El volumen de lixiviados fue elevado y se lavaron nitratos, sulfatos y cloruros

External validation of IOTA simple descriptors and simple rules for classifying adnexal masses

Objective: To assess the diagnostic performance of a three-step strategy proposed by the International Ovarian Tumor Analysis (IOTA) Group for discriminating between benign and malignant adnexal masses. Methods: This was a prospective observational study, performed at two tertiary-care university hospitals, of women diagnosed with an adnexal mass on transvaginal or transabdominal ultrasound between December 2012 and December 2014. Women were scheduled for an ultrasound evaluation, which was initially performed by non-expert examiners. The examiner had to classify the mass using ‘simple descriptors’ (first step) and, if not possible, using ‘simple rules’ (second step). For inconclusive masses, an expert examiner classified the mass according to their subjective impression (third step). Masses were managed expectantly, with serial follow-up examinations, or surgically, according to ultrasound findings and clinical symptoms. Histology was used as the reference standard. Masses that were managed expectantly with at least 1 year of follow-up were considered as benign for analytical purposes. Women with less than 1 year of follow-up were not included in the study. Results: Six hundred and sixty-six women were included (median age, 41 (range, 18–81) years) of whom 514 were premenopausal and 152 were postmenopausal. Based on the three-step strategy, 362 women had surgical removal of the mass (53 malignant and 309 benign), 71 masses resolved spontaneously and 233 persisted. Four hundred and forty-eight (67.3%) of 666 masses could be classified using simple descriptors and, of the 218 that could not, 147 (67.4%) were classified using simple rules. Of the remaining 71 masses, the expert examiner classified 45 as benign, 12 as malignant and 14 as uncertain. Overall sensitivity, specificity, positive likelihood ratio and negative likelihood ratio of the three-step strategy were 94.3%, 94.9%, 18.6 and 0.06, respectively. Conclusion: The IOTA three-step strategy, based on the sequential use of simple descriptors, simple rules and expert evaluation, performs well for classifying adnexal masses as benign or malignant

La restauración ecológica aplicada a la minería a cielo abierto en Cataluña

En la minería a cielo abierto, la revegetación es el objetivo principal de las tareas de restauración ecológica y puede evaluarse desde diferentes enfoques. El aspecto paisajístico ha sido hasta la fecha el más ampliamente valorado y frecuentemente suele asimilarse a la presencia de vegetación que disminuye el impacto visual de estas zonas.La frase 'está verde' simboliza y resume todo un conjunto de prioridades y una primera etapa de implementación de la ley 12/1981 de la legislación catalana.De hecho, naturalizar los taludes resultantes del cese de la extracción de recursos minerales no es una tarea fácil. El tipo de vegetación obtenido difiere en muchos casos de la vegetación de los sistemas natural es del entorno y genera una disfunción en el contexto paisajístico y ecológico [...]

Sonographic features of uterine sarcomas: a multicentre retrospective study

Objectives: To describe the sonographic features in a series of uterine sarcomas. Methods: Retrospective cohort study. Clinical (age, menopausal status); sonographic (lesion size, contour, echogenicity, presence of acoustic shadowing, vascularisation as assessed by colour Doppler) and histological (histological type) data from 60 women with histological diagnosis of uterine sarcoma evaluated and treated at three university hospitals were reviewed. Results: Mean patients’ age was 53.7 years (range: 26 to 81 years). 40% of women were premenopausal. 22% of patients were asymptomatic. 59% had vaginal bleeding. Histologically, there were 25 leiomyosarcomas, 25 endometrial stromal sarcomas and 10 carcinosarcomas. In 11 cases (18.3%) no distinct mass was identifiable. Mean uterine volume was 511.5 mL (range: 23.0 to 4804.2 mL). In those 49 cases were a mass was identifiable, t he sonographic features were as follows: Mean tumour volume: 7.9 cm (SD: 45.9, range: 1.5 to 21.8 cm). Mass contour: well-defined (n = 34, 69%); ill-defined (n = 15, 31%). Echogenicity: homogeneous (n = 12, 25%); heterogeneous (n = 29, 59%); cystic areas (n = 8, 16%). Acoustic shadowing: yes (n = 3, 8%); no (n = 32, 65%), not described (n = 13, 37%). Shape: rounded (n = 35, 72%), lobulated (n = 10, 20%), Ovoid (n = 4, 8%). Colour score: No flow (n = 3, 7%); scanty (n = 19, 44%); moderate (n = 9, 21%); abundant (n = 12, 28%). Most lesions had intramural (n = 22, 44.8%) or submucosal/intracavitary (n = 17, 34.6%) location. Only in 45% of cases there was sonographic suspicion of sarcoma prior to surgery. Conclusions: The sonographic spectrum of sarcomas is wide. Many cases do not present suspicious findings. These data show the limitations of ultrasonography for the diagnosis of these lesions

Clinical and ultrasound features of benign, borderline, and malignant invasive mucinous ovarian tumors

Objective: To compare clinical and sonographic features of benign, borderline, and malignant invasive mucinous ovarian tumors (MOTs). Materials and Methods: Retrospective observational multicenter study comprising 365 women (mean age: 46.1 years) with a histologically confirmed benign, borderline or malignant invasive MOT. Clinical data (patient's age, patient's complaints), tumor markers (CA-125 and CA-19.9), and sonographic data (tumor size, bilaterality, morphology -unilocular, multilocular, unilocular-solid, multilocular- solid and solid-, and IOTA color score) were reviewed and compared among these three groups. Women with ultrasound evidence on intra-abdominal disease spread were excluded. Results: Three hundred seventy-eight MOTs (14 women had bilateral lesions) were analyzed. Histologically, 287 tumors were benign, 51 were borderline, and 40 were malignant. No difference in patient's mean age was observed. Women with borderline or invasive tumors were less frequently asymptomatic. Tumors were larger in case of invasive lesions. Borderline and invasive tumors showed solid components and exhibited IOTA color score 3 or 4, more frequently than benign lesions (p < 0.001). However, the authors discovered that 16 out of 51 (31.4%) of borderline tumors and six out of 40 (15.0%) of invasive cancers had no solid components and a color score 1 or 2, and were considered as a benign lesion by the sonologist. On the other hand, 96 out of 287 (33.4%) benign mucinous cystadenoma exhibited solid components and/or a color score of 3 or 4. Conclusions: In spite of statistical differences, the authors observed significant overlapping in ultrasound features among benign, borderline, and invasive ovarian mucinous tumors that renders a difficult accurate preoperative discrimination among these lesions