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Objective Endoscopist-directed propofol (EDP) sedation is becoming more popular, with a reported safety and efficacy similar to anesthesiologist-administered propofol (AAP). The aim of this study is to compare the efficiency of EDP and AAP in patients of low-intermediate anesthetic risk. Methods A prospective cost-effectiveness comparison study was conducted. The costs of the endoscopic procedures in the EDP and AAP group were calculated using the full cost methodology after breaking down the endoscopic activity into relative value units to allocate costs in an equitable way. To determine the effectiveness, adverse events related to endoscopic sedation and the number of incomplete procedures were registered for the EDP group and compared with those published by anesthesiologists for AAP. Results A total of 1165 and 18 919 endoscopic procedures were, respectively, included in the EDP and AAP groups. The average costs of EDP vs. AAP for gastroscopy, colonoscopy and endoscopic ultrasound were O 182.81 vs. O 332.93, O 297.07 vs. O 459.76, and O 319.92 vs. O 485.12, respectively. No significant differences were detected regarding the rate of overall adverse events (4.43 vs. 4.46%) or serious adverse events (0 vs. 0.17%); the rate of arterial hypotension was significantly lower in the EDP group: 0.34 vs. 1.78% [odds ratio (OR), 0.19; 95% confidence interval (CI), 0.08-0.46] and the desaturation rate was significantly lower in the AAP group: 3.26 vs. 1.29% (OR, 2.58; 95% CI, 1.85-3.60). No significant differences were found in terms of incomplete examinations (0.17 vs. 0.14%). Conclusion In patients with low-intermediate anesthetic risk referred for an endoscopic examination, EDP appears to be more efficient than AAP.

Softwood-derived biochar (5% w/w) was added to two mining soils (S1 and S2) contaminated with Cd (4.8–74 mg kg−1), Pb (318–1899 mg kg−1) and Zn (622–3803 mg kg−1), to evaluate its immobilization capabilities towards such potentially toxic elements (PTEs). Biochar addition (S + B) increased soil pH, organic carbon content, extractable phosphorous and calcium. Sequential extractions showed that biochar reduced the labile pools of PTEs (e.g. −29, 55 and 79% of water-soluble and exchangeable Cd, Zn and Pb respectively in S1 + B compared to S1) and at the same time increased their most stable and less mobile fractions. Leaching experiments revealed a significant decrease of DOC, N-NO3−, P and PTEs in biochar-treated soils, and an increase of leached K. Kinetic equations derived from leaching data showed that PTEs in control soils were quickly mobilized, while those in biochar-treated soils needed longer time to leachate. In vitro tests showed that biochar was effective at reducing the bioaccessibility of Cd and Pb in the gastric phase of S2 and that of Zn and Pb in the intestinal phase of S1. The results obtained showed that biochar could be used as alternative amendment for the recovery of PTEs-contaminated soils.

This study assessed the suitability of Phragmites australis and Arundo donax for the aided phytostabilization of metal(loid)s in polluted soils treated with an iron-rich water treatment residue (Fe-WTR), a municipal solid waste compost (MSW-C) and their combination (Fe-WTR + MSW-C). The three soils under study (S1, S2, S3) showed very high total concentrations of As (from 371 to 22,661 mg·kg− 1 d.w.) and variable amounts of co-occurring trace metals (TMs) (i.e. Pb, 74–2162; Zn, 57-1535 and Cu, 19–412 mg·kg− 1 d.w.). Results showed that P. australis and A. donax biomass was significantly increased in all the amended soils and followed the order: MSW-C > Fe-WTR + MSW-C > Fe-WTR > Control. For both plant species grown in the amended soils, metal(loid)s concentration in below ground organs were higher than those in above ground tissues. In S1 soil (the most polluted and acidic; pH 3.77), the highest As bioaccumulation factors (BAFs) were recorded for plants grown on untreated soil (approx. 45% higher with respect to those recorded for plants in treated soils), where the concentration of labile As was significantly higher with respect to amended soils. By contrast, in S2 and S3 soils, the most effective As bioaccumulator plants were grown on soils treated with compost, even if the addition of this amendment induced a decrease of the soil As extractability. Similar results were detected for TMs in S1 soil, where P. australis and A. donax grown on soil amended with compost showed the highest Pb, Zn and Cu BAFs, while variable results were detected in S2 soil. The lowest As translocation factors (TFs ≪ 1.0) were detected for plants grown on compost-amended soils (25 and 51, 34 and 50, 64 and 55% lower with respect to P. australis and A. donax control plants in S1, S2 and S3 soils respectively), while TMs translocation from roots to shoots was more variable and depending on soil, TMs, amendment and plant species. Overall, our results indicate the suitability of P. australis and A. donax, and of Fe-WTR and MSW-C, for the aided phytostabilization of soils contaminated with arsenic and trace metals.

Abandoned waste piles from ancient mining activities are potential hot spots for the pollution of the surrounding areas. A pot experiment was carried out to check the potential toxicity of the dumping material present in one of these scenarios, and several amendments were tested to attenuate the spread of the contamination events. The waste material had an acid pH and a large total concentration of As and Cu. A dose-response experiment was performed with this material following OCDE 208 test. A proportion 90:10 uncontaminated soil: dumping material (% w/w) was selected for the following experiment, in order to surpass the amount of dumping material that caused 50% reduction in plant growth. Pots were filled with the 90:10 mixture, planted with seeds of Brassica napus and amended with the following materials: three iron oxides of Bayoxide® E33 series, iron (II) sulphate in combination with de-inking paper sludge (Fe+PS), iron oxide-rich rolling mill scale (ROL) and iron oxide-rich cement waste (CEM). Amendment effectiveness evaluation was based on chemical and biological assays: extractable trace element concentration, soil enzymatic activities, inhibition of light emission of V. fischeri and Anabaena sp., B. napus L. fresh weight and screening test for emergence of B. napus L. seedlings. Amendments E33HCF and Fe+PS were the most effective in reducing extractable As and Zn concentration. B. napus weight and dehydrogenase and β-glucosidase activities were positively increased with the two above mentioned treatments but they triggered more toxic effects for V. fischeri luminescence. E33P treatment was the only in which the EC50 was higher than in the control. Anabaena sp. was less sensitive than V. fischeri as its luminescence was not hampered by any treatment. Trace element concentration did not significantly affect the failure in seed emergence. E33HCF and Fe+PS could act as proper amendments as they decreased extractable As and Zn. Further, plant fresh weight, enzymatic activities and some of the bioassays identified the latter treatments as the best ones among those tested here to this type of multi-contaminated soil.

Drylands cover more than 40% of terrestrial surface, and their global extent and socio-ecological importance will increase in the future due to the forecasted increases in aridity driven by climate change. Despite the essential role of metallic micronutrients in life chemistry and ecosystem functioning, it is virtually unknown how their bioavailability changes along aridity gradients at the global scale. Here we analysed soil total and available Cu, Fe, Mn, and Zn in 143 drylands from all continents, except Antarctica, covering a broad range of aridity and soil conditions. We found that total and available micronutrient concentrations in dryland soils were low compared to averages commonly found in soils of natural and agricultural ecosystems globally. Aridity negatively affected the availability of all micronutrients evaluated, mainly indirectly by increasing soil pH and decreasing soil organic matter. Remarkably, the available Fe:Zn ratio decreased exponentially as aridity increased, pointing to stoichiometric alterations. Our findings suggest that increased aridity conditions due to climate change will limit the availability of essential micronutrients for organisms, particularly that of Fe and Zn, which together with other adverse effects (e.g., reduced water availability) may pose serious threats to key ecological processes and services, such as food production, in drylands worldwide.

Soil pollution with trace elements is a concerning issue worldwide. Monitoring of soil pollution and remediation protocols need still from valid complementary analytical approaches able to detect changes in speciation and lability of metals in soils (e.g. stabilization or mobility). In this work, we compare three different analytical approaches to assess potential changes in environmental availability of Cu, As and Zn in a Mediterranean polluted soil that was amended with different combinations of iron sulphate and alkaline paper sludge waste. The studied methods were: (i) a standard large-bore flow-through column system (macrocolumn), (ii) an automatic dynamic flow-through microcolumn extraction system, and (iii) the diffusive gradients in thin gels technique (DGT). The three analytical approaches tested showed immobilization of Zn and Cu in contaminated mine soils after co-application of paper sludge and iron sulphate, but they differ quantitatively in terms of As mobility. Interconversion between oxidation states of inorganic As is observed to occur to a larger extent in macrocolumn. Because this may only occur in very specific Mediterranean scenarios (i.e. organic matter application to intermittently flooded mine soils), macrocolumn extraction procedures might not appropriately mimic the environmental availability of As in soils with organic amendments (e.g., paper sludge waste). Microcolumn leaching is the fastest screening tool to ascertain the efficiency of chemical amendments, but DGT is a good alternative with less technical demands.

Two different amendments, an iron-rich water treatment residue (Fe-WTR), a municipal solid waste compost (MSW-C) and their combination (Fe-WTR + MSW-C) were added at different rates (from 2 to 4% w/w) to three mining soils (S1, S2, S3) mainly polluted with As (from 371 to 22,661 mg·kg− 1 d.w.) and different co-occurring trace metals (i.e. Pb, Zn and Cu) to evaluate their effectiveness as metal(loid)s-immobilizing agents. After four months of soil-amendment contact, sequential extractions revealed that MSW-C and Fe-WTR induced an increase of the residual As (non-extractable) fraction. Compost was the most effective amendment at increasing the residual As in treated soils (e.g. + 16% in S1-MSW-C with respect to untreated S1), although its addition increased at the same time the exchangeable and water-soluble As fraction and the extractability of Pb, Zn and Cu, especially in S1-MSW-C. Leaching experiments highlighted a similar trend, with the highest cumulative fraction of As leached recorded in S1 and S2 soils amended with MSW-C (3.8 and 1.4-fold higher than respective controls), and the lowest recorded in S1 and S2 soils amended with Fe-WTR (1.2 and 1.8-fold lower than respective controls). On the other hand, Fe-WTR and Fe-WTR + MSW-C were the most effective at reducing the total cumulative concentration of metal (Pb, Zn and Cu) in soil leachate. The results of this study show that the amendments considered influenced with a different extent metal(loid)s mobility, and this was depending on soil and amendment characteristics, as well as the type and amount of contamination.

Background and aims there is little scientific evidence on the outcomes of endoscopic retrograde cholangiopancreatography (ERCP) performed in low-volume hospitals; however, in our country, it is growing up its implementation. The objectives of our study were to evaluate the efficacy and safety of this technique performed by two endoscopists with basic training in a center of this nature and analyze the learning curve in the first procedures. Patients and methods single-center retrospective study of the first 200 ERCP performed in our hospital (analyzing the evolution between the first 100 and 100 following procedures), comparing them with the quality standards proposed in the literature. Results from February 2009 to April 2011, we performed 200 ERCP in 169 patients, and the most common indications were: Choledocholithiasis (77 %), tumors (14.5 %) and other conditions (8.5 %). The cannulation rate rose from 85 % in the first 100 ERCPto 89 % in the next 100 procedures, clinical success from 81 % to 87 %, decreasing the post-ERCP acute pancreatitis rate from 11 % to 4 %, upper gastrointestinal bleeding (UGIB) from 3 % to 2 % and acute cholangitis from 4 % to 1 %. There was a death from a massive UGIB in a cirrhotic patient in the first group of patients and a case of biliary perforation resolved by surgery in the second one. Conclusions the results obtained after performing 200 procedures support the ability to practice ERCP in low-volume hospitals obtaining levels of efficacy and safety in accordance with published quality standards.

The final publication is available at Springer via http://dx.doi.org/10.1007/s11368-009-0099-4, Background, aim, and scope The mobility of arsenic in soils and its transfer to other environmental components present significant environmental risks. The management of polluted land is determined by the availability, mobility, and transfer of inorganic pollutants to different ecosystem compartments. In this paper, the fate of arsenic at this mining site has been evaluated to determine future management practises to minimise such risk. Materials and methods In a field study carried out in the area adjacent to a mining site at Bustarviejo (North Madrid, Spain), samples of soils, plants, and water were collected from areas adjacent to the core of the former mining activity. The following parameters were investigated in soil samples: pH, organic matter, pseudo-total As, P, and Fe, and labile As and P, and a sequential extraction procedure was performed to investigate As speciation in soil. Plant materials were analysed for both As and P. Arsenic concentrations in water samples (surface and soil pore water collected in the field) were also measured. Results are considered in tandem with previous data on metal concentrations in soils and plants from this site. Results Despite high As concentrations in soils impacted by former mining activities (spoil accumulation and drainage from spoil heaps resulted in concentrations of up to 3,000 mg kg-1), it was not present in a labile form. Sequential extraction revealed that arsenic was mainly retained by Al- and Fe-(oxihydr)oxides (up to 80%). Therefore, only a small proportion of the total soil pool was potentially available for plant uptake (0.3% and 7% extracted by (NH4)2SO4 and NH4H2PO4, respectively). There was very limited transfer of arsenic from soil to plants, and concentrations of arsenic in shoot tissues were relatively low (, This study was supported by the Spanish Ministry of Education and Science, project CTM 2007-66401-CO2/TECNO, and by Comunidad de Madrid, project S-0505/AMB/0296. The authors are grateful to the Excmo. Ayuntamiento de Bustarviejo, for admittance to the mine zone and the facilities offered and to Dr. R. Gamarra for his assistance with plant identification. Authors are grateful to L. Beesley for his comments and language corrections.

The final publication is available at Springer via http://dx.doi.org/10.1007/s11356-013-2412-4, Several amendments were tested on soils obtained from an arsenopyrite mine, further planted with Arrhenatherum elatius and Festuca curvifolia, in order to assess their ability to improve soil's ecotoxicological characteristics. The properties used to assess the effects were: soil enzymatic activities (dehydrogenase, β-glucosidase, acid phosphatase, urease, protease and cellulase), terrestrial bioassays (Eisenia fetida mortality and avoidance behaviour), and aquatic bioassays using a soil leachate (Daphnia magna immobilisation and Vibrio fischeri bioluminescence inhibition). The treatment with FeSO4 1 % w/w was able to reduce extractable As in soil, but increased the extractable Cu, Mn and Zn concentrations, as a consequence of the decrease in soil pH, in relation to the unamended soil, from 5.0 to 3.4, respectively. As a consequence, this treatment had a detrimental effect in some of the soil enzymatic activities (e.g. dehydrogenase, acid phosphatase, urease and cellulase), did not allow plant growth, induced E. fetida mortality in the highest concentration tested (100 % w/w), and its soil leachate was very toxic towards D. magna and V. fischeri. The combined application of FeSO4 1 % w/w with other treatments (e.g. CaCO3 1 % w/w and paper mill 1 % w/w) allowed a decrease in extractable As and metals, and a soil pH value closer to neutrality. As a consequence, dehydrogenase activity, plant growth and some of the bioassays identified those as better soil treatments to this type of multi-contaminated soil

The final publication is available at Springer via http://dx.doi.org/10.1007/s11270-014-1874-4, Several amendments were tested for their effectiveness in aiding plant growth and immobilising contaminants in pots containing soil from an arsenopyrite mine contaminated with arsenic and heavy metals. Trace element solubility in pore water was monitored using Rhizon samplers for five weeks. Results showed that amendments containing ferrous sulphate and ferrous sulphate combined with paper mill limited arsenic mobilisation and increased metal solubility. However, ferrous sulphate in combination with calcium carbonate was effective in reducing arsenic and metal solubilisation. Plant biomass of both the grass species used during the experiment, Arrhenatherum elatius and Festuca curvifolia, was a sensitive indicator of the comparative efficiency of the amendments, although metal(loid)s concentration in pore water did not correlate with plant uptake, This study was supported by the Spanish Ministry of Science and Innovation, project COMFITES CTM2010-21922-C02-02; and by the Comunidad de Madrid, project EIADES S2009/AMB-1478

Previous studies have demonstrated that rice cultivated under flooded conditions has higher concentrations of arsenic (As) but lower cadmium (Cd) compared to rice grown in unsaturated soils. To validate such effects over long terms under Mediterranean conditions a field experiment, conducted over 7 successive years was established in SW Spain. The impact of water management on rice production and grain arsenic (As) and cadmium (Cd) was measured, and As speciation was determined to inform toxicity evaluation. Sprinkler irrigation was compared to traditional flooding. Both irrigation techniques resulted in similar grain yields (~3000 kg grain ha(-1)). Successive sprinkler irrigation over 7 years decreased grain total As to one-sixth its initial concentration in the flooded system (0.55 to 0.09 mg As kg(-1)), while one cycle of sprinkler irrigation also reduced grain total As by one-third (0.20 mg kg(-1)). Grain inorganic As concentration increased up to 2 folds under flooded conditions compared to sprinkler irrigated fields while organic As was also lower in sprinkler system treatments, but to a lesser extent. This suggests that methylation is favored under water logging. However, sprinkler irrigation increased Cd transfer to grain by a factor of 10, reaching 0.05 mg Cd kg(-1) in 7 years. Sprinkler systems in paddy fields seem particularly suited for Mediterranean climates and are able to mitigate against excessive As accumulation, but our evidence shows that an increased Cd load in rice grain may result.

Inflammatory bowel disease (IBD) is associated with conditions that may predispose to infections, such as the lack of an appropriate innate immune response to infectious agents, malnutrition, surgery, and immunosuppressive and biological drugs. Some of these infections may be preventable by vaccination. Therefore, for this particular patient population, the benefits of implementing a well-established immunization protocol in daily clinical practice are potentially even greater than for the general population. In recent years international consensus guidelines have been published, but in spite of theses recommendations, studies have shown that a significant number of patients with IBD remain inadequately immunized. Another important issue regarding immunization in this population is that vaccine efficacy among patients receiving immunosuppressive therapies has been variable. In a healthy population, a humoral immune response to hepatitis B vaccination (HBV) is expected in > 90%, whereas a much lower rate is achieved in the IBD patients. Immunosuppressive, anti-tumor necrosis factor therapy and disease activity have been implicated in the impaired efficacy of the vaccination. The serological response to HBV should be confirmed and patients with an inadequate response should receive a second full series of vaccine. Modified dosing regimens, including doubling the standard antigen dose, might increase the effectiveness. Response to influenza, pneumococcal and tetanus immunization is still not clear, as there are studies that show a normal response to the vaccination while others demonstrate a lack of efficacy. We pose a series of questions on the efficacy of the different vaccinations recommended for IBD patients and attempt to answer them using scientific evidence.

Cytomegalovirus (CMV) infection is common in humans. The virus then enters a "latency phase" and can reactivate to different stimuli such as immunosuppression. The clinical significance of CMV infection in inflammatory bowel disease is different in Crohn's disease (CD) and ulcerative colitis (UC). CMV does not interfere in the clinical course of CD. However, CMV reactivation is frequent in severe or steroid-resistant UC. It is not known whether the virus exacerbates the disease or simply appears as a bystander of a severe disease. Different methods are used to diagnose CMV colitis. Diagnosis is classically based on histopathological identification of viral-infected cells or CMV antigens in biopsied tissues using haematoxylin-eosin or immunohistochemistry, other tests on blood or tissue samples are currently being investigated. Polymerase chain reaction performed in colonic mucosa has a high sensitivity and a positive result could be associated with a worse prognosis disease; further studies are needed to determine the most appropriate strategy with positive CMV-DNA in colonic mucosa. Specific endoscopic features have not been described in active UC and CMV infection. CMV colitis is usually treated with ganciclovir for several weeks, there are different opinions about whether or not to stop immunosuppressive therapy. Other antiviral drugs may be used. Multicenter controlled studies would needed to determine which subgroup of UC patients would benefit from early antiviral treatment.

The final publication is available at Springer via http://dx.doi.org/10.1007/s11270-012-1363-6, Cytisus scoparius is a native leguminous species which grows at a derelict arsenopyrite mine in NW Madrid, Spain. Among the species found in the area surrounding the mine, this plant has shown one of the highest arsenic bioaccumulation factors. For this reason, alongside with its ability to grow in a contaminated area and its high biomass, it was selected for an arsenate dose-response assay under controlled conditions in order to evaluate its potential resistance to arsenic. C. scoparius accumulated arsenic mainly in roots, and this had a negative effect on root phosphorous concentration. Stress indicators, such as glutathione and synthesis of phytochelatins, and the lack of evidence of an increase in malondialdehyde when arsenate was supplied indicate that C. scoparius has a certain resistance to arsenic. According to our results, C. scoparius would be a good candidate to revegetate arsenic-contaminated sites, This study was supported by the Spanish Ministry of Science and Innovation, project COMFITES CTM2010-21922-C02-02; and by the Comunidad de Madrid, project EIADES S2009/AMB-1478

The present work concerns the distribution and mobility of heavy metals (Fe, Mn, Cu, Zn and Cd) in the surrounding soils of a mine site and their transfer to wild flora. Thus, soils and plants were sampled from a mining valley in NW Madrid (Spain), and total and extractable heavy metals were analysed. Soils affected by mining activities presented total Cd, Cu and Zn concentrations above toxic thresholds. The percentage of extractable element was highest for Cd and lowest for Cu. A highly significant correlation was observed between the total and extractable concentrations of metals in soils, indicating that, among the factors studied, total metals concentration is the most relevant for heavy metals extractability in these soils. (NH 4 ) 2 SO 4 -extractable metal concentrations in soils are correlated better with metal concentrations in several plant species than total metals in soils, and thus can be used as a suitable and robust method for the estimation of the phytoavailable fraction present in soils. Twenty-five vascular plant species (3 ferns and 22 flowering plants) were analysed, in order to identify exceptional characteristics that would be interesting for soil phytoremediation and/or reclamation. High Cd and Zn concentrations have been found in the aerial parts of Hypericum perforatum (Cd), Salix atrocinerea (Cd, Zn) and Digitalis thapsi (Cd, Zn). The present paper is, to the best of our knowledge, the first report of the metal accumulation ability of the two latter plant species. The phytoremediation ability of S. atrocinerea for Cd and Zn was estimated, obtaining intervals of time that could be considered suitable for the phytoextraction of polluted soils.