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Musculoskeletal ultrasound has become a practical and accessible diagnostic tool for musculoskeletal diseases. It is used to examine joints, tendons, vessels, and nerves due to its wide availability in rheumatology practice. Ultrasound has also been applied for years in other areas such as muscular injuries in sports activities and rheumatic diseases with inflammation such as myositis. The knowledge among rheumatologists about muscle ultrasound is increasingly growing taking into account it is not the main target of their ultrasound activity but mainly based on the evaluation of joint, synovitis, tenosynovitis, vasculitis in giant cell arteritis, and parotid gland evaluation in Sjögren´s syndrome. Thus, the present review describes anatomical and ultrasound findings including all muscles of the thigh (anterior, posterior, medial aspects) and leg (anterior, lateral, posterior superficial, deep posterior compartments) of lower limb structures to ease a comprehensive clinical and sonographic evaluation.

Abstract Introduction Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. Methods Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (> 12 weeks to

Key points Certain radiological findings of acute muscle injury on MRI performed shortly prior to return to play may be considered risk factors of reinjury. There is a high risk of reinjury when two of these five radiological findings are present (connective tissue gap, loss of tendon tension, intermuscular oedema, callus gap and interstitial feather oedema). Despite appropriate progression during rehabilitation, MRI studies appear necessary in the decision to return to competition.

Abstract The physiological effects of physical exercise are ubiquitously reported as beneficial to the cardiovascular and musculoskeletal systems. Exercise is widely promoted by medical professionals to aid both physical and emotional wellbeing; however, mechanisms through which this is achieved are less well understood. Despite numerous beneficial attributes, certain types of exercise can inflict significant significant physiological stress. Several studies document a key relationship between exercise and immune activation. Activation of the innate immune system occurs in response to exercise and it is proposed this is largely mediated by cytokine signalling. Cytokines are typically classified according to their inflammatory properties and evidence has shown that cytokines expressed in response to exercise are diverse and may act to propagate, modulate or mitigate inflammation in musculoskeletal health. The review summarizes the existing literature on the relationship between exercise and the immune system with emphasis on how exercise-induced cytokine expression modulates inflammation and the immune response.

Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes’ well-being and performance.

Tendinopathy describes a spectrum of changes that occur in damaged tendons, leading to pain and reduced function that remains extremely challenging for all clinicians. There is an increasing awareness of the influence that psychological and psychosocial components, such as self-efficacy and fear-avoidance, have on rehabilitation outcomes in musculoskeletal medicine. Although it is widely accepted that psychological/psychosocial factors exist in tendinopathy, there is currently a distinct lack of trials measuring how these factors affect clinical outcomes. Biopsychosocial treatments acknowledge and address the biological, psychological and social contributions to pain and disability are currently seen as the most efficacious approach to chronic pain. Addressing and modulating these factors are crucial in the pathway of personalised treatments in tendinopathy and offer a real opportunity to drive positive outcomes in patients. In this education review, we also provide the current evidence-based guidance on psychological and psychosocial developments in musculoskeletal medicine and how these may be translated to treating tendinopathy using a biopsychosocial model.

Hamstring injuries (HSI) are the most frequent muscle injuries in active individuals and professional athletes. Early and accurate diagnosis is key for planning a correct and individualised return to play (RTP). For that diagnosis imaging tests such as Magnetic Resonance Imaging (MRI) and ultrasound (US) are the most useful tests in the initial stages.

Objectives We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT).Methods Several databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools.Results A total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence).Conclusions Promising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy.

Resumen: Este trabajo constituye la segunda parte de una revisión de la problemática del control de estaciones depuradoras de aguas residuales (EDAR) para el tratamiento de agua residual urbana. Después de haber presentado en la primera parte las perspectivas correspondientes al modelado y simulación, en esta segunda parte nos centramos en el control de las mismas. Esta depuración se realiza, mayoritariamente, mediante procesos biológicos, concretamente, mediante el denominado proceso de fangos activados. El hecho de tratar con un proceso biológico conlleva una elevada complejidad tanto desde el punto de vista de modelado como, por supuesto, de control. Se revisa el control de EDAR desde su perspectiva histórica, como de los lazos de control más usuales, problemáticas que presentan y algunas de las soluciones propuestas. Se realiza también una revisión de la aplicación de las diferentes técnicas de control catalogándolas de acuerdo a su filosofía. Para terminar se ofrece una visión de las tendencia actuales y perspectivas de desarrollos futuros. Abstract: This tutorial is the second part of a review of the problems arising with the control and operation of wastewater treatment plants (WWTP) for urban wastewater. Having presented in the first part the modelling and simulation steps, in this second part we cover the control and operation issues. This treatment is carried out, mainly, by biological processes, specifically, by the so-called activated sludge process. Dealing with a biological process entails a high complexity both from the viewpoint of modelling and, of course, from what matters to control and operation. The control of WWTP is reviewed from an historical perspective, as well as the most common control loops, the problems that present and some of the proposed solutions. A review of the applications of different control techniques is also cataloged according to the philosophy of the control approach. Finally, it offers an overview of the current trends and future development prospects. Palabras clave: Estaciones depuradoras de aguas residuales, benchmarking, control y operación, Keywords: wastewater treatment plants benchmarking control and operation

Resumen: Este trabajo constituye la primera parte de una revisión de la problemática del control y operación de estaciones depuradoras de aguas residuales (EDAR) para el tratamiento de agua residual urbana. En esta primera parte nos centramos en el modelado y simulación mientras que la segunda parte se dedica en exclusiva al control y operación. Esta depuración se realiza, mayoritariamente, mediante procesos biológicos, concretamente, mediante el denominado proceso de fangos activados. El hecho de tratar con un proceso biológico conlleva una elevada complejidad tanto desde el punto de vista de modelado como, por supuesto, de control y operación. Para poder ubicar convenientemente el problema, se presenta una caracterización de las aguas residuales urbanas y las necesidades de depuración asociadas. El control y operación descansan en gran medida en la disponibilidad de modelos apropiados y, ya hoy en día, de una elevada fiabilidad. Se presentan los modelos de la familia ASM; poniendo especial énfasis en el ASM1 que se describe en más detalle; así como las características de otras unidades de proceso como el decantador y su interconexión. En estos modelos destacan los entornos BSM de benchmarking, que han sido esenciales para todo el posterior desarrollo en la actividad de control y operación. Abstract: This tutorial is the first part of a review of the problems arising with the control and operation of wastewater treatment plants (WWTP) for urban wastewater. This first part will concentrate in the modelling and simulation steps whereas the second part will cover the control and operation issues. This treatment is carried out, mainly, by biological processes. Specifically, by the so-called activated sludge process. Dealing with a biological process entails a high complexity both from the viewpoint of modelling and, of course, from what matters to control and operation. In order to properly locate the problem, a characterisation of the urban wastewater and the associated treatment needs are presented. Control and operation rely heavily on the availability of appropriate models and, today, of proved reliability. The models of the ASM family are presented; placing special emphasis on the ASM1 that is described in more detail; as well as the characteristics of other process units like the settler and its interconnection. These models highlight the BSM benchmarking environments, which have been essential for all subsequent development in the control and operation activity. Palabras clave: Estaciones depuradoras de aguas residuales, proceso de fangos activados, benchmarking, Keywords: wastewater treatment plants, activated sludge process, benchmarking

Background: Tendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive. Objectives: This study was designed to evaluate the efficacy of 3 different interventions in patients with Achilles tendinopathy. The interventions include the combination of 2 physical therapy programs (eccentric training [EC] or passive stretching [PS]) with a supplement containing mucopolisaccharides. The efficacy of the interventions was evaluated depending on the stage of the disease. Methods: Fifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified according to the disease stage: reactive versus degenerative tendinopathy. Treatment groups were EC; EC + a dietary supplement containing mucopolisaccharides, type I collagen, and vitamin C (MCVC); and a passive stretching program + MCVC. Patients were evaluated at baseline, 6 weeks, and 12 weeks with the Victorian Institute of Sports Assessment-Achilles questionnaire for function, a visual analog scale for pain, and ultrasound characterization for the evolution of tendon structure. Results: A significant improvement in Victorian Institute of Sports Assessment-Achilles questionnaire score, pain at rest, and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks’ follow-up when compared with baseline. In patients with reactive tendinopathy, the reduction in pain at rest was greater in the groups who took the supplemental MCVC than in the EC alone group (P < 0.05). Conclusions: MCVC seems to be therapeutically useful for management of tendinopathies, providing some additional benefit to physical therapy. This is especially evident in early stages of the disease, when the tendon does not present severe matrix and vascular changes. ClinicalTrials.gov identifier: NCT01691716.