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Background: The SYNCHRONOUS-study investigates simultaneous ASV-ablation with great saphenous vein (GSV) treatment in endovenous laser ablation (EVLA) for preventing varicose vein recurrence. This sub-study examines complication rates associated with prophylactic ASV-ablation., Methods: Among 1173 patients with refluxing GSV, 604 underwent GSV-ablation only, and 569 received additional ASV-ablation. Complication rates were compared over 6 months., Results: Approximately 80% of patients were complication-free with minor bruising and dysesthesia being most common complications. After 6 months, additional prophylactic ASV-ablation did not increase the rate of complications compared to GSV-only treatment., Conclusion: The 6-months follow-up data suggests that prophylactic ASV-closure, alongside GSV-treatment, is safe, with similar complication rates to GSV-only EVLA., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: This study aimed to investigate the impact of post-interventional compression therapy on clinical outcomes after endovenous laser ablation (EVLA) of incompetent saphenous veins., Methods: This prospective, controlled, multicenter study in Germany involved 493 varicose vein patients followed-up for 6 months., Results: Compression therapy significantly reduced symptoms compared to no compression (VCSS: 1.4 ± 1.6 vs 2.2 ± 2.2; p = .007). Post-interventional therapy duration of up to 14 days was found to be most effective for improving patient-reported disease severity ( p < .001) and higher quality of life ( p = .001). Patient compliance was high (82%), and non-compliance was linked to worse disease severity (VCSS 1.4 ± 1.5 vs 2.1 ± 2.3, p = .009)., Conclusion: In conclusion, post-interventional compression therapy is beneficial by reducing symptoms and improving quality of life. High patient compliance with the therapy is observed, and non-compliance is associated with worse disease severity., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study enhances the current limited understanding of the interaction between mercury (Hg) and selenium (Se) species in fish. Rainbow trout (Oncorhynchus mykiss), a model aquaculture fish, was exposed to Hg and Se species through controlled dietary conditions. Over a 6-month feeding trial, the impact of dietary Se on Hg bioaccumulation in fish, including flesh, brain, and liver, was tracked. Twelve dietary conditions were tested, including plant-based diets (0.25 µgSe g -1 ) and tuna byproduct diets (0.25 µgHg g -1 , 8.0 µgSe g -1 ) enriched with methylmercury and/or Se as selenite or selenomethionine. The tuna byproduct diet resulted in lower Hg levels than the plant-based diets, with muscle Hg content below the European Commission's safe threshold. This study highlights the significant impact of specific Se compounds in the diet, particularly from tuna-based aquafeed, on Hg bioaccumulation. These promising results provide a strong recommendation for future use of fisheries byproducts in sustainable aquafeeds., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This S2k guideline on venous leg ulcers was created on the initiative and under the leadership of the German Society of Phlebology and Lymphology (DGPL). The guideline group also consisted of representatives from the German Society for Phlebology and Lymphology, German Dermatological Society, German Society for General Medicine, German Society for Angiology, German Society for Vascular Surgery and Vascular Medicine, German Society for Surgery, German Society for Dermatosurgery, German Society for Wound Healing and Wound Treatment, Professional Association of Phlebologists and Lymphologists and Initiative Chronische Wunden. The aim of this guideline is to combine the different approaches and levels of knowledge of the respective professional groups on the basis of consensus, so that a basic concept for the best possible treatment of patients with venous leg ulcers can be provided. A total of 70 specific recommendations were formulated and agreed upon, divided into the subject areas of diagnostics, therapy, prevention of recurrences, and everyday challenges. The guideline thus reflects the current state of scientific knowledge and is intended to be widely used as the best available document for the treatment of patients with venous leg ulcers in everyday clinical practice., (© 2024 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Background: The aim of this publication is to demonstrate similarities and differences in the association of risk factors with the prevalence of different manifestations of chronic venous disease (CVD), like varicose veins (VV), venous oedema (C3) and severe chronic venous insufficiency (CVI) in the population-based cross-sectional Bonn Vein Study 1 (BVS). Patients and methods: In the BVS 1 between 13.11.2000 and 15.3.2002, 3.072 participants, 1350 men and 1722 women, from a simple random sample of the general population of the city of Bonn and two rural townships aged 18-79 years were included. The overall response proportion was 59%. All participants answered a standardized questionnaire including information about socio-economic data, lifestyle, physical activity, medical history, and quality of life. Venous investigations were performed clinically and by a standardized duplex examination by trained investigators. The CEAP classification in the version of 1996 was used to classify the findings. Logistic regression models were performed for the association of possible risk factors with VV, venous edema (C3) and severe CVI (C4-C6). The predictive risk (PR) describes the association of the diseases and the possible influencing factors. Results: VV, venous oedema (C3) and severe CVI (C4-C6) have common risk factors like higher age, number of pregnancies, family history of VV and overweight or obesity. Female gender is significantly associated with VV and C3 but not with severe CVI (C4-C6). High blood pressure and urban living are only associated with C3 and C4-C6 disease whereas prolonged sitting is associated with C3 and lower social class with C4-C6 exclusively. Discussion: In many epidemiological studies risk factors were associated with chronic venous disorders in general. Our data show that VV, venous edema and severe CVI may have different risk profiles. Venous edema is more often associated with arterial hypertension and sedentary lifestyle whereas lower social class seems to be a risk factor for severe CVI including venous ulcers. Conclusions: The differences in the association of risk factors to VV, venous edema and severe CVI should be considered if prevention and treatment of chronic venous diseases are planned. As examples, compression stockings could be proposed in sitting profession to prevent oedema, VV patients with risk factors like obesity might benefit from early treatment for VV and obesity. More longitudinal evaluation of risk factors is necessary to evaluate the true risk profile of CVD.

Published scientific evidence demonstrate the current spread of healthcare misinformation in the most popular social networks and unofficial communication channels. Up to 40% of the medical websites were identified reporting inappropriate information, moreover being shared more than 450,000 times in a 5-year-time frame. The phenomenon is particularly spread in infective diseases medicine, oncology and cardiovascular medicine. The present document is the result of a scientific and educational endeavor by a worldwide group of top experts who selected and analyzed the major issues and related evidence-based facts on vein and lymphatic management. A section of this work is entirely dedicated to the patients and therefore written in layman terms, with the aim of improving public vein-lymphatic awareness. The part dedicated to the medical professionals includes a revision of the current literature, summing up the statements that are fully evidence-based in venous and lymphatic disease management, and suggesting future lines of research to fulfill the still unmet needs. The document has been written following an intense digital interaction among dedicated working groups, leading to an institutional project presentation during the Universal Expo in Dubai, in the occasion of the v-WINter 2022 meeting.

Background: This single center prospective randomized study was performed to compare the effect of endovenous laser flush ablation (EVLAf) of the great saphenous vein (GSV) close to the sapheno-femoral junction (SFJ) with a standard ablation (EVLAs) up to two cm distally of the SFJ on reflux in the GSV stump. Patients and methods: Between April 2013 and January 2016, 146 legs in 146 consecutive patients, meeting the inclusion/exclusion criteria, were treated by EVLA. All patients were randomized into 2 groups. In group 1 EVLAf started from the SFJ level, and in group 2 EVLAs started two cm below the SFJ. The primary endpoint was reflux in the GSV stump after 900 days. Secondary endpoints were reflux in the anterior accessory saphenous vein (AASV), proximal clinically recurrent varicose veins related to reflux in the stump and/or the AASV. Results: At day 900, 27 patients were lost to follow-up. Reflux in the stump was detected in 3.6% in group 1 and in 22.2% in group 2 (p<0.05). Reflux in the AASV was present in 7.1% in group 1 and in 17.46% in group 2 (p=0.09). Proximal clinically recurrent varicose veins were observed in 8.9% in group 1 and in 19.1% in group 2 (p=0.12). The greatest diameter of the stump was significantly larger in group 2 (group 1: 0.41 cm, group 2: 0.6 cm, p<0.001). Conclusions: EVLAf is associated with a significantly lower incidence of reflux in the GSV stump, with a trend to a lower incidence of reflux in the AASV and with a lower incidence of proximal recurrent varicose veins after 900 days follow-up compared to EVLAs. EVLAf may improve the clinical recurrence rate after EVLA of the GSV.

Radionuclides 129 I (t 1/2  = 15.7 × 10 6 years) and 131 I (t 1/2  = 8.02 days) are both introduced into the environment as a result of nuclear human activities. Environmental transfer pathways and fluxes between and within ecosystems are essential information for risk assessment. In forest ecosystems, humus degradation over time could result in re-mobilization and then downward migration and/or volatilization of intercepted 129 I. In order to estimate the scale of these processes, humus (mull and moder forms) sampled under deciduous and coniferous forests were spiked with 125 I - (t 1/2  = 59.4 days), as a surrogate for 129 I, in order to study the evolution of its water-soluble and organic fractions as well as the volatilization rate during humus degradation at laboratory scale. To our knowledge, this is the first time that interactions between iodine and contrasting forms of forest humus have been investigated. The evolution of native stable iodine ( 127 I) pools in unspiked humus was also studied. The nature of the humus' organic matter appears to be a factor that impacts on the proportions of water-soluble and organic fractions of iodine and on their evolution. Iodine-125 was mainly organically bound (fraction for mulls and moders: ∼54-59 and 41-49%, respectively) and no clear evolution was observed within the 4-month incubation period. A large decrease in 125 I water-solubility occurred, being more marked for mull (from ∼14-32 to 3-7%) than for moder (from ∼21-37 to 7-19%) humus. By contrast, a significant fraction was not extractible (∼38-43%) and varied in inverse proportion to the water-soluble fraction, suggesting a stabilization of iodine in humus after wet deposit. The nature of the humus organic matter also impacted on 125 I volatilization. Although of the same order of magnitude, the total volatilization of 125 I was higher for moders (∼0.039-0.323%) than for mulls (∼0.015-0.023%) within the 4-month incubation period. Volatilization rates for mulls were correlated with the water-soluble fraction, implying that volatilization of 125 I could occur from the humus solution. Our results showed that humus is thus a zone of iodine accumulation by association with organic matter and that potential losses by lixiviation are significantly more important compared to volatilization., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: To date, there are no prospective studies evaluating the prevention of recurrent veins by the simultaneous treatment of a sufficient anterior accessory saphenous vein (AASV) in patients undergoing endovenous laser ablation (EVLA) of an insufficient great saphenous vein (GSV). This study will provide important information about the impact of the AASV on the development of recurrent veins after EVLA of the GSV. Additionally, it will be clarified whether patients benefit from a preventive ablation of a sufficient AASV., Methods and Analysis: This is a multicentre, prospective, controlled, exploratory clinical study in 1150 patients with a medical indication for EVLA of a refluxing great saphenous vein. Patients will be enrolled into two study groups: in half of the patients EVLA will be performed on the insufficient GSV only. In the other half of the patients EVLA will be performed on the insufficient GSV and additionally on the sufficient AASV. Within seven study visits, patients will be followed-up over a time period of 5 years. Primary study endpoint is the recurrence rate; secondary endpoints include inter alia, complication rate, postoperative pain intensity, quality of life and patient satisfaction., Ethics and Dissemination: Before initiation of the study, the protocol was presented and approved by the independent ethics committee of the medical faculty of the University of Heidelberg (Ethics approval number S-596/2018). This study was prospectively registered at the German Clinical Trial Register (https://www.germanctr.de/). Research findings will be disseminated in a peer-reviewed journal and at relevant conferences., Trial Registration Number: German Clinical Trial Registry (DRKS00015486)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Birds are principally exposed to selenium (Se) through their diet. In long-lived and top predator seabirds, such as the giant petrel, extremely high concentrations of Se are found. Selenium speciation in biota has aroused great interest in recent years; however, there is a lack of information about the chemical form of Se in (sea)birds. The majority of publications focus on the growth performance and antioxidant status in broilers in relation to Se dietary supplementation. The present work combines elemental and molecular mass spectrometry for the characterization of Se species in wild (sea)birds. A set of eight giant petrels ( Macronectes sp.) with a broad age range from the Southern Ocean were studied. Selenoneine, a Se-analogue of ergothioneine, was identified for the first time in wild avian species. This novel Se-compound, previously reported in fish, constitutes the major Se species in the water-soluble fraction of all of the internal tissues and blood samples analyzed. The levels of selenoneine found in giant petrels are the highest reported in animal tissues until now, supporting the trophic transfer in the marine food web. The characterization of selenoneine in the brain, representing between 78 and 88% of the total Se, suggests a crucial role in the nervous system. The dramatic decrease of selenoneine (from 68 to 3%) with an increase of Hg concentrations in the liver strongly supports the hypothesis of its key role in Hg detoxification.

Chronic venous disease and diabetes mellitus are highly prevalent and debilitating conditions affecting millions of individuals globally. Although these conditions are typically considered as separate entities, they often co-exist which may be important in both understanding their pathophysiology and determining the best treatment strategy. Diabetes mellitus is twice as common in patients with chronic venous disease compared with the general population. Notably, a large proportion of patients with diabetes mellitus present with venous disorders, although this is often overlooked. The etiology of chronic venous disease is multifactorial, involving hemodynamic, genetic, and environmental factors which result in changes to the venous endothelium and structural wall as well as inflammation. Inflammation, endothelial dysfunction and hyperfiltration or leakage, are commonly observed in diabetes mellitus and cause various diabetic microvascular complications. Both diseases are also influenced by the increased expression of adhesion molecules, chemokines, and cytokines, and are characterized by the presence of vessel hypertension. Consequently, despite differences in etiology, the pathophysiology of both chronic venous disease and diabetic microangiopathy appears to be driven by endothelial dysfunction and inflammation. Treatment strategies should take the co-existence of chronic venous disease and diabetic microangiopathy into account. Compression therapy is recommended in inflammatory conditions that have an edema component as seen in both chronic venous disease and diabetes mellitus. Lifestyle changes like weight loss and exercise, will improve metabolic state and lower inflammation and should be promoted in these patients. Additionally, both patient populations may benefit from venoactive drugs.

The aim of this study was to establish whether PD-L1, PD-1, and markers of the tumor microenvironment (CD4, CD8, FOXP3) could have a prognostic value in squamous cell carcinoma of the lip (LSCC). In patients with histologically proven LSCC, tumor specimens were stained using immunohistochemistry (for PD-1, PD-L1, CD4, CD8, and FOXP3) on paraffin-embedded tissues. Patients with (N+) and without (N-) nodal metastasis were stratified and matched to each other according to prognostically relevant clinicopathological parameters. 58 patients (29 N+ and 29 N-) were included. PD-L1 expression was positive (>1%) in 56.1% (n = 33) of all LSCC cases, but its expression did not differ significantly between metastasis groups (65.5% in N+ versus 48.3% in N-; p = 0.144). Nodal disseminated LSCC showed a tendency for higher PD-L1 expression. None of the analyzed markers showed significant correlation with the risk for nodal disease, or revealed significant prognostic value. Due to their significant expression, PD-L1 and PD-1 are potential targets for checkpoint inhibitor therapy in LSCC. Their expression should be analyzed in advanced and metastasized LSCC cases., Competing Interests: Declaration of competing interest None declared., (Copyright © 2021 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The aim of this study was to demonstrate the effects of compression following the endovenous laser ablation (EVLA) of incompetent great saphenous veins (GSVs) using a 1470 nm diode laser (Ceralas E 1470 nm, biolitec) and a 2ring radial fiber (ELVeS Radial 2ring™, biolitec). In this single-center prospective study, 150 legs of 150 consecutive patients were randomly allocated to one of three groups (A, B, and C). Group A patients did not undergo postoperative compression. Group B patients wore a thigh-length graduated compression stocking (23-32 mmHg) for 7 days, whereas group C patients wore the same stocking for 28 days. No additional phlebectomies or sclerotherapies were performed. Investigations were performed prior to intervention, at the day of intervention (D0), at day 7 (D7), and at day 28 post intervention (D28). The primary endpoint was post-interventional pain measured on a 10-point scale. A significant but small pain decrease was observed in the first week of compression, by comparing group B's mean pain scores to those of group A ( p = 0.009). Wearing a compression stocking after EVLA reduced pain within the first week on a significant, but low level. Taking the very low differences in pain levels into account, the difference may not be clinically relevant and post-treatment compression may not be necessary if no additional phlebectomies or sclerotherapies are performed.

Objectives: The aim of this study was to illustrate how compression is performed worldwide in proximal DVT and if compression management has changed recently., Methods: A global online survey, consisting of 36 questions, was used. The survey was solicited from membership lists of Union Internationale de Phlébologie (UIP) membership societies. For differences between the continents in comparison to Western Europe odds ratios and 95% Confidence Intervals (95%CI) where calculated., Results: We received 626 answers from 41 countries. Compression is routinely used in proximal DVT in all regions (82.8%). 81.4% start compression immediately after diagnosis. In the acute phase of DVT reduction of pain and swelling (91.7%) and PTS prevention (66.2%) are the main reasons for compression. 33.2% recently changed their compression management with 43.5% starting compression earlier and 7.0% later., Conclusions: Compression is still used routinely in proximal DVT in addition to anticoagulation. The changes in international guidelines towards the non-routine use of compression in proximal DVT have not caused significant changes in DVT management.

The spatial distribution and seasonal variations of atmospheric iodine (I), selenium (Se) and caesium (Cs) depositions remain unclear and this precludes adequate inputs for biogeochemical models. We quantified total concentrations and fluxes of these elements in rainfalls from 27 monitoring sites in France with contrasted climatic conditions; monthly measurements were taken over one year (starting in 2016/09). Since speciation of I and Se can impact their behaviour in the environment, analysis of their inorganic compounds was also conducted. Our results showed that annual I concentrations in rainfall were much higher than those of Se and Cs (annual means = 1.56, 0.044 and 0.005 μg L -1 , respectively). The annual iodine concentrations were highly positively correlated with those of marine elements (i.e. Na, Cl and Mg), involving higher I concentrations under oceanic climate than for transition, continental and mountainous ones. Furthermore, common patterns were found between Se concentrations and both marine and terrestrial components consistent with the various sources of Se in atmosphere. The association of Cs with two anthropogenic components (i.e. NH 4 + and NO 3 - ) used in agriculture supports the hypothesis of its terrestrial origin (i.e. from atmospheric dusts) in rainfall. We found higher rainfall concentrations of I during the warmest months for all climates. However, no specific seasonal trend occurred for Se and Cs. On annual average, rainfall contained mostly unidentified selenium compounds (inorganic Se proportions = 25-54%) and equal proportions of inorganic and unidentified I compounds. Concentrations of iodate were higher under oceanic climate consistent with an iodine marine-origin., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Estimation of the canopy influence on atmospheric inputs of iodine (I), selenium (Se) and caesium (Cs) in terrestrial ecosystems is an essential condition for appropriate biogeochemical models. However, the processes involved in rain composition modifications after its passage through forest canopy have been barely studied for these elements. We monitored I, Se and Cs concentrations in both rainfall and throughfall of fourteen French forested sites throughout one year, and estimated dry deposition and canopy exchange fluxes for these elements, as well as speciation of I and Se. Comparison of rainfall and throughfall elemental composition highlighted an important impact of forest canopy on both (i) concentrations and fluxes of I, Se and Cs, and (ii) I and Se species. For the three elements, most of their throughfall concentrations were higher than corresponding rainfall. The increase of throughfall elemental fluxes was mostly due to dry deposition for I and Se although the canopy exchange model revealed some sorption within the canopy in most cases; for Cs, foliage leaching was most influencing. Regarding speciation, iodine species in rainfall were highly modified by forest canopy with an important increase of unidentified I proportion in throughfall (on average 49 and 82% in rainfall and throughfall, respectively), possibly due to washoff of dry deposition and/or to transformation into organic forms. Similarly, while rainfall was composed of 26-54% of inorganic Se, inorganic species were undetectable in throughfall. This dataset represents key information to improve modelling of I, Se and Cs cycling within forest ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Aim: This study assessed the characteristics of individuals with chronic venous disease (CVD) and their treatment pathways. Materials & methods: A web-based survey enrolled representative populations of adults from Brazil, Czech Republic, France, Hungary, Italy, Romania, Russia and Spain, and identified those self-reporting CVD. Results: A total of 22% of respondents had signs/symptoms of CVD. Individuals with CVD were generally older, female and obese, and had more comorbidities than the general population. Common initial symptoms were tiredness, heaviness, pain, swelling in legs and night cramps. Participants waited ∼1 year before seeking treatment but most did not initially consult a physician; those who did tended to have more severe disease. Conclusion: One in five adults had CVD, but most did not seek a physician's help.

Chronic venous diseases belong to the most frequent diseases. They can be asymptomatic, cause subjective symptoms or lead to objectif alterations, such as edema, cutaneous alterations and venous leg ulcers. This ultimately results in chronic venous insufficiency (CVI). Varicose veins are a progressive degenerative disease of the venous walls in the superficial venous system of the legs, which can decisively impair the quality of life of those affected. The classification of chronic venous diseases is carried out with the CEAP classification according to clinical, etiological, anatomical and pathophysiological criteria. Instruments, such as the venous clinical severity score, are used for assessment of the severity. The treatment of chronic venous diseases targets the improvement of the subjective complaints and objectifiable alterations. In addition, complications, such as phlebitis and formation of ulcers should be avoided. Invasive procedures, compression treatment and pharmaceutical treatment are complementary and a combination of these procedures can be meaningful. General physical measures, such as propping up the legs and frequent walking, are part of the basic measures for every patient with venous diseases. Compression therapy with medical compression stockings is the gold standard in the noninvasive treatment of symptomatic venous diseases, possibly supplemented by anti-inflammatory drugs. A varicose vein should be eliminated whenever possible. Stripping operations and the less invasive endovenous thermal ablation show comparable results for saphenous vein varicosis. Foam sclerotherapy and percutaneous phlebectomy are the methods of choice for elimination of side branch varicosis; however, recurrences of varicose veins are frequent.

Chlor-alkali plants (CAP) are recognized as major sources of mercury (Hg) in the environment. In this work, Hg concentration, speciation and isotopic signature were determined in sediments and biota (fish and oyster) from Sagua La Grande River (SG River) and the adjacent coastal zone in the vicinity of a CAP (Cuba). High Hg concentrations in surface sediments (up to 5072 ng g -1 ), mainly occurring as inorganic Hg, decrease with the distance from the CAP along the SG River and seaward. Meanwhile, Hg concentration and speciation in riverine catfish (Claria gariepinus) muscle (1093 ± 319 ng g -1 , ˜70% as MeHg) and coastal oysters (Crassostrea rizophorae) (596 ± 233 ng g -1 , ˜50% as MeHg) indicate a direct impact from CAP. Hg isotopic signature in sediments, following both mass dependent (MDF) and mass independent fractionation (MIF), exhibits a clear binary mixing between CAP pollution (+0.42‰, δ 202 Hg; -0.18‰, Δ 201 Hg) and regional background end-member (˜ -0.49‰, δ 202 Hg; +0.01‰, Δ 201 Hg). The combination of speciation and isotopic information in biota and sediments allows to trace Hg contamination pathways from contaminated sediments to the biota, establishing the importance of both methylation and demethylation extent in both river and coastal sites before Hg species bioaccumulation., (Copyright © 2019. Published by Elsevier B.V.)

Due to its longevity, radioisotope 129 I is a health concern following potential releases in the environment which raises questions about residence and exposure times relevant for risk assessments. We determined 127 I concentrations (as a surrogate for 129 I) in a series of French forest soils (i.e. litters, humus and mineral soils) under different vegetation and climate conditions in order to identify the major processes affecting its accumulation and persistence in the soil column. The input fluxes linked to rainfall, throughfall and litterfall were also characterized. Main results obtained showed that: (i) rainfall iodine concentrations probably influenced those of litterfall through absorption by leaves/needles returning to the ground; (ii) throughfall was the major iodine input to soils (mean = 83%), compared to litterfall (mean = 17%); (iii) humus represented a temporary storage of iodine from atmospheric and biomass deposits; (iv) iodine concentrations in soils depended on both the iodine inputs and the soil's ability to retain iodine due to its organic matter, total iron and aluminium concentrations; (v) these soil properties were the main factors influencing the accumulation of iodine in the soil column, resulting in residence times of 419-1756 years; and (vi) the leaching of iodine-containing organic matter dissolved in soil solution may be an important source of labile organic iodine for groundwater and streams., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Radioiodine is of health concerns in case of nuclear events. Possible pathways and rates of flow are essential information for risk assessment. Forest ecosystems could influence the global cycle of long-lived radioiodine isotope ( 129 I) with transfer processes similar to stable isotope ( 127 I). Understanding iodine cycling in forest involves study of the ecosystem as a whole. In this context, we determined the 127 I contents and distribution in soil, tree compartments and atmospheric inputs during a three years in situ monitoring of a temperate beech forest stand. The iodine cycle was first characterized in terms of stocks by measuring its concentrations in: tree, litterfall, humus, soil, rainfall, throughfall, stemflow and soil solutions. Main annual fluxes (requirement, uptake and internal transfers) and forest input-output budget were also estimated using conceptual model calculations. Our findings show that: (i) soil is the main I reservoir accounting for about 99.9% of ecosystem total stock; (ii) iodine uptake by tree represents a minor fraction of the available pool in soil (<0.2%); (iii) iodine allocation between tree compartments involves low immobilization in wood and restricted location in the roots; (iv) translocation of excess iodine towards senescing foliage appears as an elimination process for trees, and (v) litterfall is a major pathway in the I biological cycling. In our soil conditions, the input - output budget shows that the ecosystem behaves as a potential source of I for groundwater., (Copyright © 2018 Elsevier B.V. All rights reserved.)

The success of biofortification and phytoremediation practices, addressing Se deficiency and Se pollution issues, hinges crucially on the fate of selenium in the plant media in response to uptake, translocation and assimilation processes. We investigate the fate of selenium in root and shoot compartments after 3 and 6 weeks of experiment using a total of 128 plants grown in hydroponic solution supplied with 0.2, 2, 5, 20 and 100 mg L -1 of selenium in the form of selenite, selenate and a mixture of both species. Selenate-treated plants exhibited higher root-to-shoot Se translocation and total Se uptake than selenite-treated plants. Plants took advantage of the selenate mobility and presumably of the storage capacity of leaf vacuoles to circumvent selenium toxicity within the plant. Surprisingly, 28% of selenate was found in shoots of selenite-treated plants, questioning the ability of plants to oxidize selenite into selenate. Selenomethionine and methylated organo-selenium amounted to 30% and 8% respectively in shoots and 35% and 9% in roots of the identified Se, suggesting that selenium metabolization occurred concomitantly in root and shoot plant compartments and demonstrating that non-accumulator plants can synthesize notable quantities of precursor compound for volatilization. The present study demonstrated that non-accumulator plants can develop the same strategies as hyper-accumulator plants to limit selenium toxicity. When both selenate and selenite were supplied together, plants used selenate in a storage pathway and selenite in an assimilation pathway. Plants might thereby benefit from mixed supplies of selenite and selenate by saving enzymes and energy required for selenate reduction., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

A better understanding of selenium fate in soils at both short and long time scales is mandatory to consolidate risk assessment models relevant for managing both contamination and soil fertilization issues. The purpose of this study was thus to investigate Se retention processes and their kinetics by monitoring time-dependent distribution/speciation changes of both ambient and freshly added Se, in the form of stable enriched selenite-77, over a 2-years field experiment. This study clearly illustrates the complex reactivity of selenium in soil considering three methodologically defined fractions (i.e. soluble, exchangeable, organic). Time-dependent redistribution of Se-77 within solid-phases having different reactivity could be described as a combination of chemical and diffusion controlled processes leading to its stronger retention. Experimental data and their kinetic modeling evidenced that transfer towards less labile bearing phases are controlled by slow processes limiting the overall sorption of Se in soils. These results were used to estimate time needed for (77)Se to reach the distribution of naturally present selenium which may extend up to several decades. Ambient Se speciation accounted for 60% to 100% of unidentified species as function of soil type whereas (77)Se(IV) remained the more abundant species after 2-years field experiment. Modeling Se in the long-term without taking account these slow sorption kinetics would thus result in underestimation of Se retention. When using models based on Kd distribution coefficient, they should be at least reliant on ambient Se which is supposed to be at equilibrium., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Selenium is both essential and toxic for mammals; the range between the two roles is narrow and not only dose-dependent but also related to the chemical species present in foodstuff. Unraveling the metabolism of Se in plants as a function of Se source may thus lead to ways to increase efficiency of fertilization procedures in selenium deficient regions. In this study, stable-isotope tracing was applied for the first time in plants to simultaneously monitor the bio-incorporation of two inorganic Se species commonly used as foodstuff enrichment sources. Occurrence and speciation of Se coming from different Se sources were investigated in root and leaf extracts of ryegrass (Lolium perenne L.), which had been co-exposed to two labeled Se species ((77)SeIV and (82)SeVI). Although the plant absorbed similar amounts of Se when supplied in the form of selenite or selenate, the results evidenced marked differences in speciation and tissues allocation. Selenite was converted into organic forms incorporated mostly into high molecular weight compounds with limited translocation to leaves, whereas selenate was highly mobile being little assimilated into organic forms. Double-spike isotopic tracer methodology makes it possible to compare the metabolism of two species-specific Se sources simultaneously in a single experiment and to analyze Se behavior in not-hyperaccumulator plants, the ICP-MS sensitivity being improved by the use of enriched isotopes.

Objectives: The aim was to study the association between venous disorders and leg symptoms in the population based cross sectional Bonn Vein Study 1 (BVS1)., Methods: A total of 1,350 men and 1,722 women aged 18-79 years were enrolled into BVS1. Chronic venous insufficiency (CVI), varicose veins (VVs), and clinical classes (C-classes/CEAP [Clinical, Etiological, Anatomical, and Pathophysiological]) were determined by clinical and duplex investigation. Leg symptoms (heaviness, tightness, swelling, pain after standing or sitting, pain while walking, muscle cramps, itching, and restless legs) were assessed in a standardized interview. For 2,624 subjects (48.7% male) with complete information on venous disorders, relevant characteristics and information on at least one leg symptom, multivariate logistic regression analysis was performed., Results: More women (929/63.0%) reported at least one leg symptom within the last 4 weeks than men (560/48.7%). Prevalence of reported symptoms increased with age (45.4% of the 18-29 year olds, 73.9% of the 70-79 year olds). Leg symptoms were more frequent in obese and underweight subjects. As confirmed by clinical and duplex examination 22.6% had VV and 15.8% had CVI. VV (OR: 1.4; CI: 1.1-1.7) and CVI (OR: 1.8; CI: 1.3-2.3) were significantly associated with reporting at least one leg symptom. In particular, there was a positive association of VV and CVI with itching, feeling of heaviness, tightness, swelling, and pain after standing or sitting. C2-C6 showed a statistically significant association with feeling of heaviness, tightness, swelling, and itching, while for pain on walking and muscle cramps this was shifted towards C classes C3-C6 and C3-C4, respectively., Conclusions: Venous disorders show significant associations with several leg symptoms. Itching, feeling of heaviness, or tightness seem to be more closely related than other symptoms. The associations between C classes and symptoms seem to be restricted to classes C2 or higher., (Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Aim: Endovenous thermal ablation (ETA) procedures are catheter-directed, ultrasound (US)-guided thermal methods for treatment in varicose veins disease. Radiofrequency, laser or steam energy thermally denatures vein wall collagen, leading first to vein wall inflammation, then fibrosis and finally to occlusion. The aim of this guideline is to give evidence-based recommendations for ETA procedures., Methods: These guidelines were drafted during a consensus meeting of a group of experts in the field of ETA in June 2012 (Hvar, Croatia) under the auspices of the International Union of Phlebology (IUP). These guidelines review the present state of knowledge as reflected in peer-reviewed published medical literature. The recommendations of these guidelines are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines., Results: Recommendations on the use of ETA procedures were made based on the quality of evidence for efficacy, safety, tolerability, cosmetic outcome, patient satisfaction/preference and, where appropriate, on the experts' opinion. Health economics were not considered, since differences in national health systems and pricing make it difficult to form general conclusions that are relevant at an international level., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Aim: To consider if it is essential to perform embolization in the treatment of leg varices due to pelvic venous insufficiency., Methods: Review of the current literature concerning treatment options of leg varicose veins of pelvic origin., Results: Pelvic venous insufficiency, vulvar and pudendal varicose veins as well as pelvic congestive syndrome are under diagnosed entities. Embolization of ovarian and pelvic veins is well established in patients with pelvic congestive syndrome. In varicose veins of pelvic origin but without pelvic congestive syndrome, comparative studies comparing the outcome of embolization or treatment of varicose veins by sclerotherapy or phlebectomy alone are missing. Foam sclerotherapy or phlebectomy shows good results in patients with varicose veins of pelvic origin., Conclusions: Embolization is not essential in the treatment of leg varices of pelvic origin without pelvic congestive syndrome. Foam sclerotherapy or phlebectomy shows good results in patients with vulvar or pudendal varicose veins. Randomized comparative studies using embolization of incompetent pelvic veins or sclerotherapy of varicose veins with pelvic origin should be performed., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Aim: To review epidemiologic data on progression of venous pathology in varicose veins and from varicose veins towards chronic venous insufficiency., Methods: We searched Medline and PubMed for epidemiologic studies concerning progression of venous pathology., Results: The data suggest that reflux progression may develop from segmental to multisegmental superficial reflux. In younger age, reflux in tributaries and non-saphenous veins is more frequent. In older age, more saphenous reflux develops and more proximal sites seem to be affected. A high proportion of uncomplicated varicose vein (C2) develops skin changes and chronic venous insufficiency (C3-C6). Significant risk factors for the progression of varicose vein towards venous leg ulcers are skin changes, corona phlebectatica, higher body mass index and popliteal vein reflux. During a 13.4-year follow-up period, 57.8% (4.3%/year) of all chronic venous disease patients showed progression of the disease., Summary: Studies on the progression of venous pathology show a high progression rate of chronic venous disease. More follow-up studies are still needed to get better information about the risk of varicose vein patients for progression to venous leg ulcers and to answer the question which patients may benefit from early varicose vein interventions., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Aim: Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy., Methods: This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7-10 May 2012 in Mainz. The conference was organized by the German Society of Phlebology. These guidelines review the present state of knowledge as reflected in published medical literature. The regulatory situation of sclerosant drugs differs from country to country but this has not been considered in this document. The recommendations of this guideline are graded according to the American College of Chest Physicians Task Force recommendations on Grading Strength of Recommendations and Quality of Evidence in Clinical Guidelines., Results: This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, polidocanol and sodium tetradecyl sulphate. Other sclerosants are not discussed in detail. The guideline gives recommendations concerning indications, contraindications, side-effects, concentrations, volumes, technique and efficacy of liquid and foam sclerotherapy of varicose veins and venous malformations., (© The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

A better understanding of Se fate in soils is required for different environmental issues, such as radioactive waste management or soil fertilization procedures. In these contexts, the mobility and speciation of Se have to be studied at both short and long terms after Se inputs. Here, we present a new methodology to monitor simultaneously the reactivity of added (isotopic enriched tracers) and ambient Se at trace level in soils by high-performance liquid chromatography inductively coupled plasma mass spectrometry (ICP-MS) following specific extractions. To do so, the collision/reaction cell of the ICP-MS instrument and the interference corrections were optimized to measure reliably the four major Se isotopes. To exemplify the method capabilities, the behaviors of added (77)Se(IV) and ambient Se were followed up in two soils submitted to an ageing process during 3 months. The solid/liquid distribution of added Se reached a steady state after 1 month while its speciation and distribution among soil solid phases were still changing after 3 months. The results clearly demonstrate that slow processes are involved in Se retention and transformation in soils. The usual short-term experiments (<1 month) performed after Se addition are thus not suitable for long-term risk assessment. Interestingly, the behavior of added Se tended to that of ambient Se, suggesting that ambient Se would be useful to infer the fate of Se input over long time scales.

Objectives: A variety of studies have suggested that flavonoids are effective for the treatment of CVD. However, many questions remain about their mechanism of action and when, how, and for what signs and symptoms they should be used., Method: A panel of experts in CVD met in Budapest, Hungary in December 2011 to discuss the current state of knowledge of CVD and the role of flavonoids in its treatment. The discussion was based on a literature search in the current databases. The goals of this paper are recommendations for further studies on the use of flavonoids in the treatment of CVD., Results: There is good evidence to recommend the use of flavonoids in the treatment of CVD. However, because of the poor quality of some older clinical trials, inadequate reporting, and insufficient information, much work is still needed to firmly establish their clinical efficacy and to determine when and how they should be employed. In particular, long-term randomized, placebo-controlled, double-blind studies are needed to establish the efficacy and safety of flavonoids. Additional studies are also needed to establish their mechanism of action, pharmacokinetics, toxicity, and cost-effectiveness., Conclusions: Aside from good evidence for the use of flavonoids in CVD further studies are indicated to establish long term treatment in this indication.

Venous malformations are the result of an arrested development of the venous system during the embryogenesis. In the treatment of venous malformations the standard of care is a multidisciplinary approach including the use of traditional surgical therapy if applicable and endovascular treatment. Endovascular techniques include embolization therapy for instance with coils but also sclerotherapy with liquid or foamed sclerosants. The aim of this paper is to give an overview of foam sclerotherapy in venous malformations. Sclerotherapy of venous malformations has been performed in superficial and intramuscular malformations. In many cases ethanol has been used for the treatment. Since more than 10 years, less aggressive sclerosants like polidocanol and sodiumtetradecyl sulphate have been used to treat venous malformations. These substances can be used without anaesthesia and the rate of side-effects is much lower. Yamaki and Cabrera are the first who used foam sclerotherapy for the treatment of symptomatic venous malformations. Compared with liquid sclerotherapy foam sclerotherapy has the advantage of a better and longer lasting contact of the sclerosing agent with the vessel wall which leads to a more effective treatment and to a reduction of concentrations needed. In a recent European Guideline on Sclerotherapy foam sclerotherapy is recommended over liquid therapy for the treatment of venous malformations. Foam sclerotherapy is an effective treatment option for low flow extratruncular and truncular venous malformations. Foam is significantly more effective than liquid sclerotherapy and side-effects with polidocanol or sodiumtetradecyl sulphate foam are less compared with sclerotherapy with ethanol. With foam sclerotherapy a significant reduction of pain and volume of the venous malformations can be reached.

Leg and foot ulcers are symptoms of very different diseases. The aim of this paper is to demonstrate the differential diagnosis of leg ulcers. The majority of leg ulcers occur in the lower leg or foot. In non-venous ulcers the localization in the foot area is more frequent. The most frequent underlying disease is chronic venous disease. In 354 leg ulcers, Koerber found 75.25% venous leg ulcers, 3.66% arterial leg ulcers, 14.66% ulcers of mixed venous and arterial origin and 13.5% vasculitic ulcers. In the Swedish population of Skaraborg, Nelzen found a venous origin in 54% of the ulcer patients. Each leg ulcer needs a clinical and anamnestic evaluation. Duplex ultrasound is the basic diagnostic tool to exclude vascular anomalies especially chronic venous and arterial occlusive disease. Skin biopsies help to find a correct diagnosis in unclear or non-healing cases. In conclusion, chronic venous disease is the most frequent cause of leg ulcerations. Because 25% of the population have varicose veins or other chronic venous disease the coincidence of pathological venous findings and ulceration is very frequent even in non-venous ulcerations. Leg ulcers without the symptoms of chronic venous disease should be considered as non-venous.

Background: Despite the frequent use of medical compression stockings (MCS), reliable data are lacking on the frequency of MCS use and experience of patients with the treatment., Patients and Methods: The Bonn Vein Study included 3,072 participants from the general population aged 18 to 79 years (1,350 men/1,722 women). Between 2007 and 2008 (Bonn Vein Study 2) 1,978 participants from the Bonn Vein Study 1 were reinvestigated. This paper combines the results of both investigations., Results: 14.6% (7.5% men, 20.3% women) reported having previously undergone treatment with compression stockings. A mean of 71.3% reported an improvement in their venous disease as a result of MCS treatment. During the 6.6 years of follow-up (Bonn Vein Study 2), significantly more prescriptions of MCS were given to patients in higher CEAP clinical stages. 12.2% of the population in C2 was treated with MCS as were 19.1% in C3 and 27.0% in C4-C6. Among participants with chronic venous insufficiency (CVI) (skin changes up to venous ulcers), about 60% were not treated by MCS or bandages in the past years., Conclusions: These results show that MCS is the most common treatment of venous disorders in the German population. At the same time, these figures also demonstrate severely lacking treatment with MCS in CVI., (© The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.)

Endoluminal catheter-based procedures enable venous reflex in varicose saphenous veins to be eliminated. The catheter tip is positioned in the sapheno femoral or popliteal junction under ultrasound guidance. The energy necessary to ablate the vein is generated as heat by high-frequency current (radiofrequency) by laser light or by steam. Advantages of this procedure include low invasiveness, subcutaneous infusion anesthesia (SIA), low perioperative morbidity and rapid restoration of mobility of patients.

Chronic venous disease (CVD) is one of the most common diseases in our population. Aside from venous symptoms like heaviness and pain, which are present in about 50% of the general population, signs of CVD include varicose veins (VVs), oedema, eczema, venous eczema, hyperpigmentation, white atrophy, lipodermatosclerosis and venous ulcers. The aim of this paper is to review current literature for the relevance of natural history of VVs in refunded care. Available papers on VVs, progression of the disease and complications were reviewed. Prevalence of VVs is high with more than 20% in the general population. Information on progression of uncomplicated VV to chronic venous insufficiency (CVI) is rare. However, most venous ulcers have a primary venous origin. The progression rate of VV to higher clinical stages reaches 4% per year. Among the risk factors are obesity and higher age. Quality of life (QOL) is also reduced in uncomplicated VV in C2 patients. In conclusion, there is evidence from the literature that a high proportion of patients with uncomplicated VVs in the clinical, aetiological, anatomical and pathophysiological classification (CEAP Clinical Class 2) will progress to CVI if untreated. VVs have a negative impact on QOL and clinical symptoms. VV patients with CVI (C3-C6) as well as those C2 patients with severe clinical symptoms and impaired QOL due to CVD should be treated with ablation of the VVs in a refunded care system.

The first CEAP (clinical, aetiological, anatomical and pathological elements) consensus document was published after a consensus conference of the American Venous Forum, held at the sixth annual meeting of the AVF in February 1994 in Maui, Hawaii. In the following years the CEAP classification was published in many international journals and books which has led to widespread international use of the CEAP classification since 1995. The aim of this paper is to review the benefits and limits of CEAP from the available literature. In an actual Medline analysis with the keywords 'CEAP' and 'venous insufficiency', 266 publications using the CEAP classification in venous diseases are available. The CEAP classification was accepted in the venous community and used in scientific publications, but in most of the cases only the clinical classification was used. Limitations of the first version including a lack of clear definition of clinical signs led to a revised version. The CEAP classification is the gold standard of classification of chronic venous disorders today. Nevertheless for proper use some facts have to be taken into account: the CEAP classification is not a severity classification, C2 summarizes all kinds of varicose veins, in C3 it may be difficult to separate venous and other reasons for oedema, and corona phlebectatica is not included in the classification. Further revisions of the CEAP classification may help to overcome the still-existing deficits.