Esmoriz-Paramos lagoon is an ecosystem of great ecological importance that is located on the northwest coast of Portugal and has been degraded as a result of industrial and anthropogenic activities. Concentrations of heavy metals (Cr, Cu, Pb and Zn) were measured in water, sediment and in tissues (liver and muscle) of Liza saliens, which is the dominant fish from the lagoon. Comparisons between metal concentrations in water and sediments were made with those in tissues of fish caught at the lagoon. Metals in water were quantified predominantly bound to particulate and equalled or exceeded the limit of chronic reference values. Metal concentrations in sediments varied among sampled sites. The relative order of concentrations was "Zn > Cu approximately Pb > Cr" the same pattern observed for metals in water. Metals in fish tissues showed higher concentrations in liver (262 mg CuxKg(-1) and 89 mg ZnxKg(-1)) than in muscle (<3 mg CuxKg(-1) and 26 mg ZnxKg(-1)), while Pb and Cr were not detected. These results suggest that Cu and Zn are the metals of major concern in the lagoon. Mullet detritivorous feeding habits, bioaccumulation pattern and the high sediment metals concentrations relative to the water suggest that sediments can be the most important source of contamination in this ecosystem. The positive relationship found between Cu in liver and fish length demonstrates that time of exposure is a crucial factor in bioaccumulation. Condition indices (K and HSI) in mullets from the lagoon were higher compared to mullets from sea, suggesting abnormal condition in the lagoon population. We conclude that metals chronic exposure in the lagoon can impose considerable fish stress. The results also show that the lagoon is an area of environmental concern.

Background Standardised assessment of disease damage is one of the main components of the OMERACT core set of outcome measures in adult ANCA-associated vasculitis. There is no validated tool to assess disease damage in children with vasculitis. While paediatric vasculitis shares many features with adult disease scoring tools validated for use in adults may miss some childhood specific damage. The Paediatric Vasculitis Outcome working group gathers physicians interested in childhood vasculitis from the PReS Vasculitis Working Group and the North American CARRA Vasculitis Committee. In collaboration with EUVAS, adaptation of adult vasculitis assessment tools was considered appropriate for paediatric disease. Vasculitis damage tool development followed our publication of the Paediatric Vasculitis Activity Score (PVAS).1 Objectives To develop a paediatric modification of the Vasculitis Damage Index (VDI).2 Methods Invited paediatric specialists and the group members reviewed existing items of the VDI and some additional items. Using nominal group technique consensus was obtained on damage items and their definitions for use in a paediatric modification of VDI (PVDI). Feasibility, face and content validity were assessed by paper case evaluations. Results Vasculitis damage is defined as the presence of irreversible features present for at least 3 months since the onset of vasculitis. While the VDI is an inventory of 64 items grouped into 11 organ systems, PVDI contains 72 items in 10 systems: musculoskeletal, skin/mucous membranes, ocular, ENT, chest, cardiovascular, abdominal, renal, nervous and “other”. A detailed PVDI glossary was produced. A separate assessment of school absence was added to the one-page form. Each item can be scored as “present” or “no longer present”(NLP), in order to address the potential reversibility of items that fulfil the definition of damage by duration and psychosocial impact but may completely resolve (e.g. growth delay). Every scored item always receives only one point, whether scored “present” or “NLP”, in order to retain compatibility with the VDI. Conclusions PVDI development is an important step towards better disease assessment in children which together with the PVAS allows paediatric vasculitis clinical trials and collaborative studies to gather reliable data on these rare diseases. The PVDI has yet to complete the validation process by its prospective use in real patients, which is currently underway. We aim to ensure that it remains a dynamic data-driven tool reflecting ongoing developments in the field of adult vasculitis damage assessment. References Dolezalova P, Price-Kuehne FE, Özen S et al. Disease activity assessment in childhood vasculitis: development and preliminary validation of the Paediatric Vasculitis Activity Score (PVAS). Ann Rheum Dis 2013 Oct;72(10):1628-33. Exley AR, Bacon PA, Luqmani RA, et al. Development and initial validation of the Vasculitis Damage Index (VDI) for the standardised clinical assessment of damage in the systemic vasculitid...

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for the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Antineutrophil Cytoplasmic Antibody-Associated Vasculitis WorkgroupObjective. There is no standardized approach to the treatment of pediatric antineutrophil cytoplasmic antibodyassociated vasculitis (AAV). Because of the rarity of pediatric AAV, randomized trials have not been feasible. The present study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) was undertaken to establish consensus treatment plans (CTPs) for severe pediatric AAV to enable the future study of comparative effectiveness and safety.Methods. A workgroup of CARRA members (rheumatologists and nephrologists) formed the AAV Workgroup. This group performed a literature review on existing evidence-based treatments and guidelines for the management of AAV. They determined that the target population for CTP development was patients <18 years of age with new-onset granulomatosis with polyangiitis (GPA), microscopic polyangiitis, or renal-limited AAV (eosinophilic GPA was excluded), with presentation confined to those with severe disease (i.e., organ-or life-threatening). Face-to-face consensus conferences employed nominal group techniques to identify treatment strategies for remission induction and remission maintenance, data elements to be systematically collected, and outcomes to be measured over time.Results. The pediatric AAV Workgroup developed 2 CTPs for each of the remission induction and remission maintenance of severe AAV. A glucocorticoid-weaning regimen for induction and maintenance, a core data set, and outcome measures were also defined. A random sample of CARRA membership voted acceptance of the CTPs for remission induction and remission maintenance, with a 94% (75 of 80) and 98% (78 of 80) approval rate, respectively.Conclusion. Consensus methodology established standardized CTPs for treating severe pediatric AAV. These CTPs were in principle accepted by CARRA-wide membership for the evaluation of pragmatic comparative effectiveness in a long-term registry.