[Cancer risk among shift workers: a review]

INTRODUCTION

According to IARC, shift work resulting in disruption of circadian rhythm is a probable human carcinogen (Group 2A).

METHODS

We examined the scientific literature on the carcinogenic risk among shift workers for risk assessment purposes.

RESULTS

Clock genes polymorphisms might contribute with suppression of melatonin synthesis, immuno-suppression from sleep deprivation, individual habits associated with shift work, and low vitamin D levels, in increasing risk of breast cancer, prostate cancer and lymphoma among shift workers.

CONCLUSION

Although the epidemiological evidence seems scanty, the hypothesis that shift work-related sleep deprivation would contribute to increasing cancer risk seems based on solid ground.

[Hepatitis B vaccination coverage and booster dose: results from a survey on healthcare students]

This study assessed the immunisation status against hepatitis B in healthcare students and residents, before their hospital internship, as suggested by the "National Immunization Prevention Plan 2012-2014". The concentration of antibodies against hepatitis B was measured in 2,491 subjects (70.90% women), born between 1980 and 1993 and visited between January 1st 2000 and July 15th 2012. Personal and serologic data were collected for each subjects. Individuals with antibody less than 10 mIU/mL (327, 13.3%) were given a booster dose and re-tested 2 months later. The multivariate logistic regression evidenced that immunization is influenced by the gender, the age at first vaccination, the time elapsed between first vaccination and antibody measurement. This study confirms the importance of measuring the concentration of antibodies against hepatitis B among healthcare students, even if they have previously been vaccinated, according to the "National Immunization Prevention Plan 2012-2014".

[SENTIERI Project: discussion and conclusions]

SENTIERI Project is the first comprehensive study of the health impact of residence in Italian polluted sites (IPSs). The present Chapter examines the main validity aspects of the present mortality investigation and the evaluation of causality of the observed associations; in addition, some recommendations for public health intervention and research priorities in epidemiological studies on environment and health are given. Exposure ascertainment is a key aspect when an ecological study design is adopted in environmental epidemiology, therefore any exposure potentially affecting the population at study should be described in detail. This is here discussed. SENTIERI is an ecological study, based on a priori hypotheses, in which each IPS's types of exposure were described with specific attention to human exposure. Though, when commenting the results, the problem of concurrent air pollution exposure and/or industrial activities implying occupational risk, if present in the IPSs, was taken into account. Socioeconomic status is a determinant of health and disease, therefore in SENTIERI the Standardized Mortality Ratios were computed both crude and adjusted for an ad hoc deprivation index. About 60% versus an expected 40% of IPSs residents are in the two most deprived quintiles of the index. This hints to a possible problem of environmental justice that should be taken into account when planning remediation intervention. The mortality results here presented are a first step in the epidemiological IPSs' characterization, and some developments have been made or planned. Firstly, a mortality analysis was performed combining mortality data in IPSs presenting similar pollution, i.e. asbestos, or industrial hazardous wastes or dumping sites; secondly, the mortality analysis will be extended beyond 2002, namely the year when ICD X started to be in use in Italy. In addition, disease prevalence will be investigated using hospital discharge records; cancer incidence and congenital anomalies incidence will be studied in IPSs in which a Cancer Register or a Congenital Anomalies Register are active. The above described activities will lead to a more valid estimate of the disease burden of IPSs residents, and allow to identify priorities of remediation activities. The method adopted in SENTIERI, specifically the ecological design and the use of mortality data at municipal level, in general does not grant the evaluation of the causal association between environmental exposure and adverse health effects. However, it allows etiological observations that make unacceptable the delay of remediation intervention.

[Methods for mortality analysis in SENTIERI Project]

The methods of mortality analysis in Italian polluted sites (IPS) are described. The study concerned 44 IPSs; each one included one or more municipalities. Mortality at municipality level was studied in the period 1995-2002, using the following indicators: crude rate, standardized rate, standardized mortality ratio (SMR), and SMR adjusted for an ad hoc deprivation index. Regional populations were used as reference for indirect standardization. The deprivation index was constructed using the 2001 national census variables representing the following socioeconomic domains: education, unemployment, dwelling ownership, overcrowding. Mortality indicators were computed for 63 single or grouped causes. The results for all the 63 analysed causes of death are available for each IPS, and in this Chapter the results for each IPS for causes selected on the basis of a priori evidence of risk from local sources of environmental pollution are presented. The procedures and results of the evidence evaluation have been published in the 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[SENTIERI Project: rationale and objectives]

SENTIERI Project (Mortality study of residents in Italian polluted sites) studied mortality of residents in the sites of national interest for environmental remediation (Italian polluted sites--IPSs). IPSs are in proximity of either active or dismissed industrial areas, near dumping sites of industrial and hazardous waste or incinerators. SENTIERI Project described and evaluated the mortality of the populations residing in IPSs and it specifically focused on causes of death for which environmental exposure is suspected or ascertained to play an etiologic role. The epidemiological evidence of the causal association was classified a priori into one of these three categories: Sufficient (S), Limited (L) and Inadequate (I). The study results will allow the priorities setting in remediation intervention, so as to prevent adverse health effects from environmental exposure. At the time of 2001 Census, about 10%of Italian population resided in the 44 IPSs included in SENTIERI; the mortality analysis was carried out for the years 1995-2002 for 63 causes of death. The study results for the 44 IPSs are here commented and read on the basis the a priori evaluation of the epidemiological evidence in terms of strength of the causal association, and taking into account the limits of a geographic study design and its implied complexities. The procedures and results of the evidence evaluation have been presented in a 2010 Supplement of Epidemiology & Prevention devoted to SENTIERI.

[The use of municipality-level data on mortality in Italy: SENTIERI Project]

In Italy, complete municipality-level data on specific-cause mortality have been available at central level since 1980; Italy's National Institute of Statistics (Istat) collects data from all municipalities using two sources: i) the Office of Vital Statistics; and ii) the Civil Status Office. The Office of Vital Statistics records data on events such as births, deaths and migration for the population with official residence in the municipality, with the aim of describing the resident population's structure and composition. The Civil Status Office records data on the demographic dynamics (not only marital status but also causes of death); the data refer to the population living in the municipality, independently of official residence. Changes in the status of a municipality (e.g., the creation of a new municipality or the unification of diverse municipalities) are often not recorded simultaneously by these two offices, so that the data do not correspond.

[EMG and forces during manoeuvring of ceiling-based and floor-based patient transfer devices]

A laboratory and on-the-field study was conducted to compare Floor-Based (FB) and Ceiling-Based (CB) patients transfer devices. Pushing and pulling forces were measured by means of computer assisted dynamometer. EMG signals were measured. Standardized patient transfers were setup in the room (bed-chair-door-return). FB devices showed pushing and pulling forces higher than CB ones. CB paths were the smoothest and EMG data related to upper arms and trunk muscles showed stable lower loads for CB. The study suggests that CB patient transfer devices reduced the load. CBs seem the best tools for patient handling.

Abstract P2-06-10: Loss of Heterozygosity of an Intron 1 Polymorphic Sequence of Epidermal Growth Factor Receptor in Basal-Like Breast Cancer and Tumor-Adjacent Normal Tissue

Background: Breast cancer (BC) is currently regarded as a heterogeneous disease classified, through gene expression analysis, into various molecular subtypes with different biological characteristics and clinical behaviour. Using a few protein biomarkers as estrogen, progesterone and HER2 receptors, BC subtypes can be divided in four main groups: luminal A, luminal B, HER2 and triple negative (TN). Triple negative BC are a heterogeneous subset of tumors grouped together on the basis of their lack of hormone receptor and HER2 expression. Although they demonstrate similarities in terms of pathological and molecular characteristics, they do not represent a uniform clinical entity since the expression of the basal cytokeratin (CK5) and EGFR may identify a subgroup, called basal-like, of very aggressive tumors encompassing about 10% of BC that display a particularly poor prognosis. Recently, in vitro and in vivo studies reported that the length of a CA Simple Sequence Repeat 1 (CASSRI) dinucleotides in the intron 1 of egfr was associated with the expression of EGFR. In addition, the loss of heterozigosity (LOH) within this region would also lead to altered receptor expression. In this study we aimed to determine the association between LOH and overexpression of EGFR in a series of basal-like BC and their in autologous uninvolved peritumoral tissues (PTT) in comparison to normal tissues (NT).

Material and Methods: 35 TN BC, the correspondent PTT and the autologous NT were analyzed for EGFR, CK5 expression by immunohistochemistry (IHC) and for LOH using a fragment separation performed by capillary electrophoresis (ABI 3130 Applied Biosystem). The assessment of LOH on the three tissue substrates were evaluated comparing the peak area of the two alleles using the following equation: LOH score=T1XN2/T2XN1, where T is BC or PTT, N is normal tissue, 1 is the area under the peak corresponding to the shorter allele, and 2 to the longer allele. The result was significantly different from the ratio of the normal allele peak areas when the LOH score was < 0.79 (loss of the longer allele) or >1.27 (loss of the shorter allele). Results: Of the 35 TN BC, 29 (83%) expressed EGFR and/or CK5 and were defined basal-like BC. The remaining 6 (17%) cases, negative both for EGFR and CK5, were excluded from the study. Of the 16 EGFR positive basal-like BC, 10 (63%) showed LOH whereas of the 13 EGFR negative basal-like BC, only 3 (23%) showed LOH (p=0.03). Although in the majority basal-like BC with LOH (8/10; 80%) PTT displayed a genetic profile similar to NT and did not show LOH, interestingly, in 2 cases (20%) PTT is different from NT presenting LOH and expressing EGFR as the autologous BC.

Conclusions: Our data indicate that LOH of CASSRI in the intron 1 of egfr is related to EGFR expression in basal-like BC. In addition, the evidence of LOH in PTT, denoting the occurrence of early molecular alterations in histologically normal tissues, could represent a potential biomarker with diagnostic/prognostic implications. Supported by AIRC

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-06-10.

The potential for a concerted system for the rapid monitoring of excess mortality throughout Europe

We present the results of a survey conducted in the context of the project European Monitoring of Excess Mortality for Public Health Action (EuroMOMO), which is being conducted to develop a routine public health mortality monitoring system for the timely detection of excess deaths related to public health threats in Europe. The survey was conducted in 32 European countries using two questionnaires on: i) the existing and planned mortality monitoring systems, and ii) the routine collection of mortality data. Nine existing mortality monitoring systems were identified in seven countries (Belgium, Germany, France (two systems), Italy (two systems), Portugal, Spain, and Switzerland), as well as several systems that were in a pilot or planning state. Each system is described in detail. The results will be used for the subsequent phases of EuroMOMO, in particular for identifying the minimum requirements for the planned European system and for selecting countries to be included in the project's pilot phase.

Enterobacteriaceae and pseudomonadaceae on the dorsum of the human tongue

OBJECTIVE

The aim of this study was to correlate the presence of Enterobacteriaceae, Pseudomonadaceae, Moraxellaceae and Xanthomonadaceae on the posterior dorsum of the human tongue with the presence of tongue coating, gender, age, smoking habit and denture use.

MATERIAL AND METHODS

Bacteria were isolated from the posterior tongue dorsum of 100 individuals in MacConkey agar medium and were identified by the API 20E system (Biolab-Mérieux).

RESULTS

43% of the individuals, presented the target microorganisms on the tongue dorsum, with greater prevalence among individuals between 40 and 50 years of age (p = 0.001) and non-smokers (p=0.0485).

CONCLUSIONS

A higher prevalence of Enterobacteriaceae and Pseudomonadaceae was observed on the tongue dorsum of the individuals evaluated. There was no correlation between these species and the presence and thickness of tongue coating, gender and presence of dentures.

Antibodies as crypts of antiinfective and antitumor peptides

Antibodies (Abs), often associated with antimicrobial and antitumor agents, have emerged as an important class of novel drugs for antigen-driven therapeutic purposes in diverse clinical settings, including oncology and infectious diseases. Abs commonly give rise in the treated host to anti-Ab responses, which may induce adverse reactions and limit their therapeutic efficacy. Their modular domain architecture has been exploited to generate alternative reduced formats (Fabs, scFvs, dAbs, minibodies, multibodies), essentially devoid of the Fc region. The presence of complementarity determining regions (CDRs) ensures the maintenance of selective binding to antigens and supports their use for biotechnological and therapeutic applications. Paradigmatic Abs mimicking the wide-spectrum antimicrobial activity of a yeast killer toxin (killer Abs) have revealed the existence of a family of Abs exerting a direct in vitro and/or in vivo microbicidal activity. Based on the variable sequence of an antiidiotypic recombinant killer Ab, CDR-related peptides have been synthesized, engineered by alanine-scanning and selected according to antimicrobial, antiviral and immunomodulatory properties. Irrespective of the native Ab specificity, synthetic CDRs from unrelated murine and human monoclonal Abs, have shown to display differential in vitro, in vivo and/or ex vivo antifungal (Candida albicans), antiviral (HIV-1) and antitumor (melanoma cells) activities. Alanine substitution of single residues of synthetic CDR peptides resulted in further differential increased/unaltered/decreased biological activity. The intriguing potential of Abs as source of antiinfective and antitumor therapeutics will be discussed, in light of recent advances in peptide design, stability and delivery.

[Interregional mobility for total knee arthroplasty]

45.049 primary total knee replacements were performed in Italy in 2005, with large distribution all over the country. However referral to centers of excellence far from the area of residency is still common with massive interregional mobility. Aim of this study is to define this issue both in quantitative and qualitative terms. For the timeframe 2001-2005 the SDO database was used to calculate the number of discharges of both residents and non residents for each Region and for each year and the ability of each region to attract patients from other regions or the tendency of the resident population to migrate. Only 8 Regions present an attraction index better than the escape index. Among those 4 are located in the North of Italy, 2 in the Center and 2 in the South. Migration from the North or Center to the South was never observed. Interregional mobility for knee replacement is noteworthy. Such phenomenon is comparable to migration for other major procedures, especially the steady tendency of a south to north mobility. An accurate analysis of potential causes of migration as well as the empowering of southern and central centers is needed.