Endocrine disrupting activity in fruits and vegetables evaluated with the E-screen assay in relation to pesticide residues

Food is likely to be one of the most important routes of human exposure to endocrine disrupting compounds (EDCs). In the present study, we evaluated the total estrogenic activity of fruits and vegetables, which was calculated using the human breast cancer cell line (MCF-7 BUS) proliferation assay (E-screen), in relation to pesticide residues. We analysed 44 food samples, 30 fruits and 14 vegetables. Of these samples, 10 did not contain any pesticide residues. The other 34 samples contained from 1 to 7 pesticide residues in concentrations ranging from 0.03 to 1.91 ppm. Estrogenic activity was detected in the 59% of samples tested. The positive controls used were 17-β-estradiol (E2), the phytoestrogen genistein and the pesticide endosulfan. The average value of estradiol equivalency quantity (EEQ) for all positive samples was 0.15±0.32 μg/100g. A low correlation was found between the concentration of pesticide residues and the EEQ values (Spearman correlation r=0.376 and p=0.012). Using values obtained from the literature, we compared the estrogenic activity of food samples with the intrinsic content of phytoestrogens, but we found no correlations. Our results also suggested that the calculated intake of dietary EDCs might represent a concentration comparable to the normal endogenous estrogen concentration in human blood.

Conceptual issues related to the construction of prescriptive standards for the evaluation of postnatal growth of preterm infants

Monitoring and interpreting the growth of preterm infants is a major clinical task for neonatologists. The effectiveness of this process depends upon the robustness of the standard selected. Concerns have been raised regarding the nature of the charts currently being used, as well as their appropriateness for present-day neonatal care. To overcome these problems, there is a need for new prescriptive standards based on a population of preterm infants without evidence of impaired fetal growth and born to low-risk women followed up since early pregnancy for precise gestational age dating. Preterm infants contributing to the new standards should be free of congenital malformations and major clinical conditions associated with impaired postnatal growth. These infants should receive standardised, evidence-based clinical care and should follow current feeding recommendations based on exclusive/predominant breastfeeding. This strategy should provide a population that is conceptually as close as possible to the prescriptive approach used for the construction of the WHO infant and child growth standards. New international standards constructed in this way should contribute to the evidence-based care of these preterm infants.

Postnatal growth of preterm infants: which reference charts?

Preterm Infants' survival has greatly increased in the last few decades thanks to the improvement in obstetrical and neonatal care. These neonates constitute the large majority of the population in neonatal intensive care units. The correct evaluation of postnatal growth of these babies is nowadays of primary concern, although the definition of their optimal postnatal growth pattern is still controversial. Concerns have also been raised about the strategies to monitor their growth,specifically in relation to the charts used. At present the available charts in clinical practice are fetal growth charts, neonatal anthropometric charts and postnatal growth charts for term infants. None of these, for different reasons, is suitable to correctly evaluate preterm infant growth. An international multicentric project has recently started a study aiming at building a prescriptive standard for the evaluation of postnatal growth of preterm infants and it will be available in the next years. At present, while an international longitudinal standard for evaluating preterm infant postnatal growth is lacking, in Italy the best compromise in clinical practice is likely to be as follows: new Italian INeS (Italian Neonatal Study) charts up to term; International longitudinal charts WHO 2006 or CDC 2002 from term to two years; finally, the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP) 2006 growth charts could be suitable for monitoring the growth of these infants from two years up to 20 years of age.

Meteo-climatic conditions influence the contribution of endotoxins to PM10 in an urban polluted environment

A decrease in inhalable particulate matter (PM10) pollution is a top priority in urban areas of northern Italy. The sources of PM10 are both anthropogenic and natural. The former have been broadly investigated while the latter are less well known. Endotoxins are natural compounds of PM10 and are potentially toxic. Endotoxins are part of the outer membrane of Gram-negative bacteria. Their health effects are linked to environmental exposure. The effects mainly consist of respiratory symptoms, including pulmonary function decline. The occurrence of endotoxins has been proven in several occupational environments where organic materials supply an optimal substrate for bacteria growth. Knowledge about the presence of these contaminants in the environment is limited. The aim of this work is to evaluate the endotoxin levels of PM10 in the urban air of Turin, and to investigate the influence of seasonal and meteo-climatic factors. The sampling was conducted from January to December 2007. Endotoxin determination was performed by an LAL assay after extraction optimization. The PM10 levels ranged from 11.90 to 104.74 microg/m(3) (48.28 +/- 23.09) while the endotoxin levels ranged between 0.09 and 0.94 EU/m(3) (0.42 +/- 0.23). The seasonal trends of PM10 and endotoxin are inversely proportional. There is a statistically significant correlation between endotoxin and temperature (r = 0.532 p < 0.01), as well as between endotoxin and relative humidity (r = -0.457 p < 0.01). However, temperature has a predominant role. We observed that urban endotoxin concentrations are narrow in range and that the contribution of endotoxins to the total PM10 is only two millionths.

Application of semipermeable membrane device (SPMD) to assess air genotoxicity in an occupational environment

Semipermeable membrane device (SPMD) is a passive sampler that sequesters lipophilic contaminants, mimicking the bioconcentration in the fatty tissue of organisms. This study was designed to assess the use of SPMD and biological tests (Comet assay and Ames test) for air monitoring. For this purpose an occupational environment with expected polycyclic aromatic hydrocarbons (PAHs) contamination (coke plant) was selected for a case study. The SPMDs were deployed in five occupational contaminated sites and in a control site. The SPMD dialysates were chemically analysed and examined for in vitro DNA-damaging activity in human cells (Jurkat) by Comet assay and for mutagenicity with the Ames test (TA98 strain, w/o S9). Total suspended particulates were also collected and analysed (GC-MS). No biological effect of SPMD extract was revealed in the control site. On the other hand, air samples collected with SPMDs within the coke plant showed variable degrees of genotoxic and mutagenic activity. The highest effects were associated with the highest PAH level recovered in the SPMDs extracts and in particulate samples. Results obtained support the sensitivity of biological tests associated to SPMD sampling for evaluating the health risk of potentially contaminated work environments highlighting the usefulness of SPMDs for environmental air quality monitoring.

Validation of SAPS 3 Admission Score and comparison with SAPS II

BACKGROUND

The objective of this study was to validate the Simplified Acute Physiology Score SAPS 3 Admission Score (SAPS 3) and to compare its fit with that of SAPS II in an independent sample of patients admitted to a single-centre intensive care unit (ICU).

METHODS

The data for all adult patients consecutively admitted to an eight-bed ICU of a 700-bed university hospital between 1 January 2006 and 2 September 2007 were collected. SAPS II and SAPS 3 were computed, as well as the predicted hospital mortality. The calibration of SAPS II and SAPS 3, according to the general equation (GE), and equations for Southern Europe and Mediterranean countries (SE&MC), and Central and Western Europe (C&WE), were assessed by the goodness-of-fit Hosmer-Lemeshow H and C statistics. Standardized mortality ratios (SMR) with 95% confidence interval (95% CI) were computed for SAPS II and SAPS 3 equations.

RESULTS

Six hundred and eighty-four patients were studied (males 63%). The median age was 73 (quartiles 65-80) years. The fit of SAPS 3 using the C&WE equation (H 13.49, P=0.095; C 12.73, P=0.121) as well as that of SAPS II was acceptable (H 6.02, P=0.644; C12.08, P=0.147), while SAPS 3 GE (H 23.36, P=0.002; C 22.37, P=0.004) and S&MC (H 25.73, P=0.001; C 26.19, P=0.001) did not fit well. SAPS 3 GE, SAPS 3 SE&M Countries and the SAPS II significantly over estimated the mortality. Only 95% CI of SMR for SAPS 3 C&WE included 1 (SMR 0.97; 95% CI 0.89-1.05).

CONCLUSION

Each ICU should identify the SAPS 3 equation most suitable for its case mix. The SAPS II model tended to overestimate the mortality.

Analysis of environmental endocrine disrupting chemicals using the E-screen method and stir bar sorptive extraction in wastewater treatment plant effluents

Endocrine disrupting chemicals (EDCs) have become a major issue in the field of environmental science due to their ability to interfere with the endocrine system. Recent studies show that surface water is contaminated with EDCs, many released from wastewater treatment plants (WWTP). This pilot study used biological (E-screen assay) and chemical (stir bar sorptive extraction-GC-MS) analyses to quantify estrogenic activity in effluent water samples from a municipal WWTP and in water samples of the recipient river, upstream and downstream of the plant. The E-screen assay was performed on samples after solid phase extraction (SPE) to determine total estrogenic activity; the presence of estrogenic substances can be evaluated by measuring the 17-beta-estradiol equivalency quantity (EEQ). Untreated samples were also assayed with an acute toxicity test (Vibrio fischeri) to study the correlation between toxicity and estrogenic disruption activity. Mean EEQs were 4.7 ng/L (+/-2.7 ng/L) upstream and 4.4 ng/L (+/-3.7 ng/L) downstream of the plant, and 11.1 ng/L (+/-11.7 ng/L) in the effluent. In general the WWTP effluent had little impact on estrogenicity nor on the concentration of EDCs in the river water. The samples upstream and downstream of the plant were non-toxic or weakly toxic (0<TU<0.9) while the effluent was weakly toxic or toxic (0.4<TU<7.6). Toxicity and estrogenic activity were not correlated. At most sites, industrial mimics, such as the alkylphenols and phthalates, were present in higher concentrations than natural hormones. Although the concentrations of the detected xenoestrogens were generally higher than those of the steroids, they accounted for only a small fraction of the EEQ because of their low estrogenic potency. The EEQs resulting from the E-screen assay and those calculated from the results of chemical analyses using estradiol equivalency factors were comparable for all samples and closely correlated.

Chemical characteristics and mutagenic activity of PM10 in Torino, a northern Italian city

Epidemiological studies of particulate matter (PM) have associated PM mass, as well as certain individual components of PM such as secondary particulate with adverse human health effects. For example genotoxic effects attributed to PM may relate to the content of organic compounds but also to the oxidative DNA damage generated by transition metals like iron. However the exact physiochemical mechanism by which PM produces adverse effects is not clear. The aims of this study were to evaluate (1) concentrations of PM10, (2) amounts of bioavailable iron associated with PM10, (3) amounts of secondary particulate expressed as SO4(=) and NO3(-) and (4) the mutagenic activities of PM10 organic extracts. Sampling was carried out in a meteochemical station located in Torino, a northern Italian city with high levels of PM10. The mean PM10 concentration in the considered period was 46.1+/-28.8 microg/m3, the iron mean concentration was 0.83 microg/m3 (+/-0.65 microg/m3) and the bioavailable Fe was 5.7% (+/-4.4%). The data showed that secondary particulate matter (as sum of sulfates and nitrates) constituted about 47% of PM10 total mass. Both iron and secondary species concentrations were positively associated with PM10 levels. Seasonal variations of PM10 concentration, iron level and secondary species amount were significant. Samples were tested for mutagenicity with Salmonella typhimurium strains TA98 and TA100, with and without metabolic activation and a positive response was observed especially for TA98. There were positive statistical associations between mutagenicity and PM10, bioavailable iron, sulfates and nitrates concentrations. Therefore, these results showed the usefulness of this biological approach for monitoring PM10.

Urban air quality and carboxyhemoglobin levels in a group of traffic policemen

Toxicological potential of carbon monoxide (CO) on humans is well known. Nevertheless, CO is still considered as a useful marker to detect some environmental and occupational human risk factors typical of cities. The role played by traffic pollution, indoor air quality in offices and tobacco smoke on the expression of carboxyhemoglobin (COHb%) levels was investigated in a large group of traffic policemen in Torino city (North-Western Italy). At the end of the working shift, 228 policemen responded to a questionnaire, weight and height recorded, urine spot samples collected to measure cotinine as biomarker of tobacco smoke exposure, and an arterial blood sample was taken to measure COHb levels. Data of outdoor urban air-CO were collected and to each subject a "CO outdoor air measurement" was related to his/her COHb level. Considering the annual trend of air-CO pollution from 2002 to 2004, one can assume that a general improvement of air quality in Torino was evident. Taking into account the environments where policemen work (urban outdoor and indoor), and analyzing their COHb% content, the traffic-congested areas, and, in general, the outdoor urban environment were equally risky as offices. Furthermore, if compared to CO arising from traffic-congested areas or other outdoor environments, the traffic policemen in Torino city demonstrate COHb% levels largely due to smoking habits.

The mutagenic hazards of environmental PM2.5 in Turin

Owing to the large number of natural and anthropogenic sources, particulate matter (PM) may present several physical and chemical patterns in different areas. The finer PM2.5 fraction, which is now widely but not routinely measured in Europe, is considered to be the alveolar fraction of the ambient particles. Annual and winter mean concentrations of PM2.5 substantially vary in Europe, with higher concentrations in the South. The aims of this work were to (a) measure the PM2.5 levels in Turin over a long period, (b) evaluate mutagenic activities of organic extracts containing this collected complex mixture using the Ames test and (c) determine the level of polycyclic aromatic hydrocarbons (PAHs) in order to identify important mutagens in ambient air. Sampling was carried out from November 2001 to December 2004. The monthly mean of PM2.5 was 48.76+/-24.12 microg/m3. From the beginning to the end of the sample period there was a decrease in gravimetric levels, with annual means of 54.10+/-29.77 microg/m3 in 2002; 42.48+/-15.73 microg/m3 in 2003 and 45.89+/-24.92 microg/m3 in 2004. Samples were tested for mutagenicity using Salmonella typhimurium strains TA98 and TA100, with and without S9 mix metabolic activation. A positive genotoxic response was observed for TA98, with and without metabolic activation. The measured PAHs monthly mean level was 8.24+/-6.30 ng/m3, with values ranging from 0.20 to 21.38 ng/m3 Seasonal variation of gravimetric, mutagenic and PAH values was significant. The Salmonella assay results statistically correlated to PM2.5 and PAHs levels, but sometimes the mutagenic potencies were rather different despite an equal concentration of pollutant. The results confirm the usefulness of this biological approach to detect genotoxic properties of sampled PM2.5 and they show the variability of the mutagenic properties of the airborne mixture over time.

Airborne particulate matter: Ionic species role in different Italian sites

Epidemiological studies have provided evidences for an association between exposure to elevated levels of ambient particulate matter (PM) and increased mortality and morbidity. However, the exact physiochemical nature of the responsible component is not clear. Secondary airborne PM formed from gas-phase pollutants contributes significantly to the most severe particulate air quality events. Although chemical formation for ionic species of aerosol have been observed, they have not been well reported for local variation. This work evaluates the amount of secondary particulate ionic species: sulfates (SO(4)(2-)) and nitrates (NO(3)(-)), chlorides (Cl(-)) and the mutagenic activities of PM10 extracts in different Italian sites (one Southern, one Central and three Northern; in one of the latter also PM2.5 has been evaluated). In general, mean secondary species concentration constitutes about 35-45% of PM10 mass in the North sites, 15% in the center site and 20% in the South site and it is positively associated with PM10 levels. There are significant local differences in the mean levels of PM10 ionic constituents: NO(3)(-) are predominant in northern cities, SO(4)(2-) are more equally distributed and coastal southern city is abundant in Cl(-). Samples were also tested for mutagenicity with Salmonella typhimurium strains TA98 and TA100, with and without metabolic activation; mutagenicity did not correlate with PM10 concentrations. The results showed the important roles and the geographical variability of PM secondary species in the total mass PM10 concentrations and the usefulness of this biological approach for monitoring PM to understand hazards from PM.

Application of semipermeable membrane device for assessing toxicity in drinking water

Semipermeable membrane devices (SPMDs) mimic passive diffusive transport of bioavailable hydrophobic organic compounds through biological membranes and their partitioning between lipids and environmental levels. Our study was developed on a surface water treatment plant based in Turin, Northern Italy. The investigated plant treats Po River surface water and it supplies about 20% of the drinking water required by Turin city (about one million inhabitants). Surface water (input) and drinking water (output) were monitored with SPMDs from October 2001 to January 2004, over a period of 30 days. The contaminant residues, monthly extracted from SPMDs by dialysis in organic solvent, were tested with the Microtox acute toxic test and with the Ames mutagenicity test. Same extracts were also analyzed with gas chromatography--mass spectrometry technique in order to characterise the organic pollutants sampled, especially Polycyclic Aromatic Hydrocarbons (PAHs). Although the PAHs mean concentration is about one hundred times lower in the output samples, the mean toxic units are similar in drinking and surface water. Our data indicate that the SPMD is a suitable tool to assess the possible toxicity in drinking water.

Effect of different sterile barrier precautions and central venous catheter dressing on the skin colonization around the insertion site

AIM

The purpose of this prospective, randomized, controlled study was the comparison of maximal sterile barrier (consisting of mask, cap, sterile gloves, gown, large drape) vs control precautions (mask, cap, sterile gloves, small drape) and of transparent polyurethan film vs gauze dressing for use on central venous (CVC) nontunneled catheters, inserted via the jugular vein. Skin colonization at the insertion site (defined by quantitative skin cultures performed at the time of insertion and in days 2 and 5) was used as a primary endpoint. Catheter tip colonization was also assessed through qualitative culture and CVC related sepsis was defined by the isolation of the same organism from the catheter tip and the blood, with clinical sepsis of no other apparent source.

METHODS

Eighty-two consecutive patients were enrolled, admitted to a mixed medical-surgical ICU, aged 72+/-12 years, 58% male, SAPS II 42+/-13. One-hundred and seven CVCs were studied (presenting 750 catheter in situ days); CVCs were in place for a mean period of 6.9+/-4.7 days and 5 episodes of central catheter-related bloodstream infection were detected (6.6 per 1000 catheter days).

RESULTS

A multiple logistic regression detected an increased risk of skin colonization in male gender (OR=2.5) and control precautions (OR=3.4) and no difference with regard to age, dressing and diagnostic group.

CONCLUSIONS

Maximal sterile barrier proved to be an effective and recommended practice. However surveillance skin cultures revealed the common and changing nature of colonization of skin at the insertion site.

Toxicity and estrogenic activity of a wastewater treatment plant in Northern Italy

Many xenobiotics, widely diffused in the environment, have the potential to disrupt the delicate endocrine system balance of wildlife and humans. Substances showing hormone-like actions in living organisms are defined endocrine-disruptor chemicals and they may mimic, block, or interfere with the synthesis, release, transport, elimination, and binding of natural hormones. Different ecotoxicologic studies were applied to screen for the discharge of estrogenic and toxic substances into the aquatic environment from a small industrial wastewater treatment plant based in Northern Italy. Samples of wastewater (3 L) were taken at three different periods during the year from different points of the plant's process: three phases of treatment, and effluent. Untreated samples (1 L) were assayed with two toxicity tests: Microtox and Daphnia magna. A simplified proliferation test using human estrogen receptor-positive MCF-7 breast cancer cells (E-screen assay) was performed on 2-L samples after solid-phase extraction for the determination of total estrogenic activity; the presence of estrogenic substances was evaluated by measuring the proliferation rate in cells exposed to samples. The results of the Microtox assay employing the marine bacterium Vibrio fischeri were compared with data obtained from whole-effluent toxicity testing methods employing D. magna. Toxicity was found only for the influent point. The proliferative effect of the five points, relative to the positive control 17beta-estradiol (relative proliferation effect), was between 2.4% and 39%, and the 17beta-estradiol equivalent concentrations were between 0.06 and 3.94 ng/L. A first comparison between results from toxicity load and estrogenic activity was performed. At all process points, the effluent samples were considered acceptable (taking only toxicity into account), but we demonstrated that they had estrogenic activity in the river water indicating an input of estrogenic substances by way of the treatment plant.

[Strategic significance of water sources and risk management]

Water quality and its availability is a current and urgent issue. In fact, water is a unique natural resource, but its availability is limited. The paper presents data on its availability and usage. Its quality is of particular concern for safeguarding public health.

Treatment of the cancer anorexia-cachexia syndrome: a critical reappraisal

Cancer anorexia-cachexia syndrome (CACS) is a combination of anorexia, tissue wasting, weight loss and poor performance status. Some CACS symptoms are due to a macrophage production of TNF and IL-1, while the metabolic effects are mainly explained by the release of IL-6 from tumor cells. Clinical treatment of CACS involves progestational agents (medroxyprogesterone acetate, MPA, megestrol acetate, MA) for long term treatment. The use of prokinetic agents (like metoclopramide) is recommended, especially if patients need concomitant opioid treatment for pain; if otherwise indicated, corticosteroids are useful for short periods. The administration of artificial nutrition should be individualized following the clinical condition of the patient and possibly taking into account the wishes of the patient. The practical evaluation criteria of the drugs employed for CACS are based on weight increase and appetite stimulation. Hence, a new approach to the mechanism of action of MPA, MA and of other agents is urgently needed.

Quality of life and length of survival in advanced cancer patients on home parenteral nutrition

BACKGROUND

The use of home parenteral nutrition (HPN) in patients with advanced cancer is controversial because survival is usually short and there are no data regarding the quality of life (QoL).

METHODS

Sixty-nine advanced cancer patients enrolled in a program of HPN in six different Italian centers were prospectively studied as regards nutritional status (body weight, serum albumin, serum transferrin and total lymphocyte count), length of survival and QoL through the Rotterdam Symptom Checklist questionnaire. These variables were collected at the start of HPN and then at monthly intervals. All these patients were severely malnourished, almost aphagic and beyond any possibility of cure.

RESULTS

Nutritional indices maintained stable until death. Median survival was 4 months (range 1-14) and about one-third of patients survived more than 7 months. QoL parameters remained stable till 2-3 months before death.

CONCLUSIONS

HPN may benefit a limited percentage of patients who may survive longer than the time allowed by a condition of starvation and depletion. Provided that these patients survive longer than 3 months, there is some evidence that QoL remains stable for some months and acceptable for the patients.