Serum pharmacokinetics in patients treated with transarterial chemoembolization (TACE) using two types of epirubicin-loaded microspheres

AIM

The purpose of this study was the pharmacokinetic (PK) profile assessment in the serum of patients affected by hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) with drug-eluting beads.

PATIENTS AND METHODS

This study included 20 patients, 12 treated with DC Bead® and 8 with HepaSphere Microsphere®, preloaded with epirubicin. No patient randomization was used for the inclusion in one group or in the other. Peripheral blood samples were obtained from all patients after the treatment, until 24 hours past the procedure.

RESULTS

The pharmacokinetic study showed low peak serum epirubicin concentrations with greater drug exposure for the DC Bead® group (p<0.05). The highest drug concentration after microsphere injection was observed at 5 minutes in all 20 patients. In the time interval between 1 and 24 hours after TACE, persisting levels of epirubicin were detected in peripheral blood samples.

CONCLUSION

A persistent and sustained drug elution for both types of microparticles was found.

[Work at high altitude: concepts of physiopathology, risk factors, health surveillance and criteria for the development of work capacity evaluation criteria]

Work at high altitude (elevation equal to or greater than 3000 m above sea level) results in a physiological adaptation of the human organism to changing environmental conditions. The main problem related to the altitude is represented by the reduction of partial pressure of oxygen (hypoxia) that occurs in proportion to the reduction of barometric pressure. Our study, starting with an analysis of the human body's physiological response to acute hypoxic conditions and acclimatization for reaching protracted stays, takes into consideration all risk factors related to the performance of work at high altitude. We identified risk factors related to physical environment of high altitude and represented by temperature, humidity, latitude, speed wind, atmospheric pressure and hypoxia, risk factors related to the worker and represented by age, sex, state of health and individual susceptibility, degree of training. With reference to the state of health we analyzed the major pathophysiological conditions that can create situations of susceptibility to high altitude. We then analyzed risk factors related to the characteristics of the job that are represented by the degree of physical effort and energy expenditure required, by the personal protective equipment (PPE) used and by the concomitant exposure to other occupational risk factors of physical and chemical nature. It was finally addressed the decision making process related to the formulation of the judgment of suitability for performance of work activities at high altitude. The health protocol proposed requires an accurate anamnestic investigation aimed at gathering information on pre-existing pathophysiological conditions that need, once identified, clinical and instrumental tests specific and targeted. These clinical protocols are analyzed and proposed for the main pathophysiologic conditions that pose a risk to health at high altitude. For workers, in which clinical investigation and medical history has not shown significant pathophysiological conditions, we propose a basic health protocol, including clinical and instrumental examinations, modulated in relation to age of workers. Among the specific instrumental tests necessary to process a judgment of suitability to work in complex cases, the ergospirometric test performed under conditions of hypoxia was considered. This test is important for the study of the main predictive parameters in assessing the ability to work at high altitude. The test involves measurement of three key parameters (heart rate, oxygen saturation, ventilation) that are then integrated in the construction of variables useful for the interpretation of the test: cardiac response and ventilatory response to hypoxia, desaturation at rest and during exercise, respiratory rate.

Online education in a large scale rehabilitation institution

Large scale multiple venue institutions face problems when delivering educations to their healthcare staff. The present study is aimed at evaluating the feasibility of relying on e-learning for at least part of the training of the Salvatore Maugeri Foundation healthcare staff. The paper reports the results of the delivery of e-learning courses to the personnel during a span of time of 7 months in order to assess the attitude to online courses attendance, the proportion between administered online education and administered traditional education, the economic sustainability of the online education delivery process. 37% of the total healthcare staff have attended online courses and 46% of nurses have proved to be the very active. The ratio between total number of credits and total number of courses for online and traditional education are respectively 18268/5 and 20354/96. These results point out that eLearning is not at all a niche tool used (or usable) by a limited number of people. Economic sustainability, assessed via personnel work hour saving, has been demonstrated. When distance learning is appropriate, online education is an effective, sustainable, well accepted mean to support and promote healthcare staff's education in a large scale institution.

Is it worth investing in online continuous education for healthcare staff?

Educational activities for hospital staff don't easily match with the congestive rhythm of healthcare personnel working life. Online learning could make it easier for healthcare personnel to attend courses, but there is still uncertainty about the feasibility of using distance learning to effectively meet education goals in healthcare institutions. Fondazione Salvatore Maugeri (FSM) started an online educational program, as pilot project, in October 2010. The present study hence is aimed at evaluating the impact of this initiative (in terms of extent and intensity of healthcare staff attendance; objective and subjective effectiveness) in order to take informed decisions for the future. In 15 months, 5 elearning courses have been provided to 2261 potential users of 14 FSM hospitals, in parallel with traditional education. 1099 users from all the hospital have intensively attended the courses (58% of nurses, 50% of therapists, 44%, of technicians, 25% of physicians) for a total of 27459 CME credits. Effectiveness in terms of knowledge gain is satisfactory and subjective evaluation is good (more than 95% of satisfied users). Elearning is not appropriate for all the educational needs and is not a panacea, but the reported results point out that it may be an effective and economically convenient mean to support massive educational interventions reaching results hardly attainable with traditional education. Users should be better educated about how to exploit online education at best.

[microRNAs as biological indicators of environmental and occupational exposure to asbestos]

Malignant mesothelioma is an aggressive cancer refractory to current therapies, the incidence of which is expected to rise in the next decades. Exposure to asbestos is a well known risk factor, as InternationalAgency for Research and Cancer (IARC) classified this compound as group I (carcinogenic to humans). The lack of tumor biomarkers for diagnosis and medical survey plays a fundamental role for the development of a universally accepted therapeutic approach. In this review we evaluated the mechanism of asbestos carcinogenesis by analyzing activated oncogenes, genetic predisposition, and SV40 infection as cofactors. Therefore, interest has focused on microRNAs, 19-25 nucleotide-long single-stranded RNAs that negatively regulate gene expression by modulating translational efficiency of target genes involved in numerous cellular processes including development, differentiation, proliferation, apoptosis, and stress response. The analysis revealed a differential expression of miRNAs between mesothelioma and mesothelial cells, suggesting their potential role as oncogenes or tumor suppressor genes in mesothelioma oncogenesis. We have also investigated the role of polymorphism in the etiology and pathogenesis of mesothelioma, in order to evaluate the association between disease linked to asbestos exposure andgenetic variability. The identification of dysregulated miRNAs or frequent genetic polymorphisms as potential diagnostic biomarkers or as prognostic factors for malignant mesothelioma could facilitate the surveillance procedure of subjects exposed to asbestos.

[The Maugeri Stress Index: a questionnaire to assess work-related psychological stress]

INTRODUCTION

The European directives concerning the evaluation of work-related stress were absorbed into Italian law by means of Legislative Decree No. 81 of 9 April 2008.

AIMS

To develop a new questionnaire to assess the impact of work-related psychological distress and to validate it by testing its factorial structure, its content, its construct and discriminant validity.

METHODS

After critically reviewing the literature, we generated an initial item set to identify the items to be used in a preliminary version of the questionnaire, and then used a focus group to test the comprehensibility of the items. The questionnaire was administered to 329 subjects working in state and private organisation and a small sample of 29 subjects complaining of vexation at work.

RESULTS

The Maugeri Stress Index (MSI) is reliable (Cronbach alpha: 0.93). Factorial analysis indicated five factors: Well-being, Adaptation, Support, Irritability and Avoidance. The total and subscale scores were significantly different when comparing subjects with and without vexation at work.

CONCLUSION

The MSI has a multi-factorial structure, good internal reliability and sufficient discriminant power.

Occupational exposure to antineoplastic drugs in four Italian health care settings

Exposure assessment of health care workers to antineoplastic drugs (ADs) is still an open issue since new, critical, and emerging factors may put pharmacists who prepare hazardous drugs or nurses who administer anti cancer agents to an increased risk of developing adverse health effects. Overall, eight pharmacies and nine patient areas have been surveyed in this study. Wipe and pad samples were experienced during the surveillance program in four Italian health care settings. Urine samples were collected from workers handling ADs. Cyclophosphamide (CP), ifosfamide (IF), and gemcitabine (GEM) were detected in all the work environments by using a LC-MS/MS method-based capable of analysing all the three drugs simultaneously. In total, 54% of wipe samples were positive for at least one drug and 19% of pad samples were shown to be contaminated by cyclophosphamide. Pharmacies were generally more contaminated than patient areas with the exception of one site where a nurse had an acute exposure during the cleaning-up of an hazardous drug solution spill. In total, 22 urine samples collected from pharmacists and 78 urine samples from nurses had no detectable concentrations of any antineoplastic drugs. Despite the adherence to the recommended safety practices residue contamination on surfaces and floors has continued to be assessed in all the investigated sites.

Effect of electrospun fiber diameter and alignment on macrophage activation and secretion of proinflammatory cytokines and chemokines

Macrophage activation can be modulated by biomaterial topography according to the biological scale (micrometric and nanometric range). In this study, we investigated the effect of fiber diameter and fiber alignment of electrospun poly(L-lactic) (PLLA) scaffolds on macrophage RAW 264.7 activation and secretion of proinflammatory cytokines and chemokines at 24 h and 7 days. Macrophages were cultured on four different types of fibrous PLLA scaffold (aligned microfibers, aligned nanofibers, random microfibers, and random nanofibers) and on PLLA film (used as a reference). Substrate topography was found to influence the immune response activated by macrophages, especially in the early inflammation stage. Secretion of proinflammatory molecules by macrophage cells was chiefly dependent on fiber diameter. In particular, nanofibrous PLLA scaffolds minimized the inflammatory response when compared with films and microfibrous scaffolds. The histological evaluation demonstrated a higher number of foreign body giant cells on the PLLA film than on the micro- and nanofibrous scaffolds. In summary, our results indicate that the diameter of electrospun PLLA fibers, rather than fiber alignment, plays a relevant role in influencing in vitro macrophage activation and secretion of proinflammatory molecules.

In vitro calcified matrix deposition by human osteoblasts onto a zinc-containing bioactive glass

Bioactive glasses synthesized by the sol-gel technique possess many of the qualities associated with an ideal scaffold material for a bone graft substitute. In view of the potential clinical applications, we performed a detailed in vitro study of the biological reactivity of synthesized 58S bioactive glass containing-zinc, in terms of osteoblast morphology, proliferation, and deposition of a mineralized extracellular matrix (ECM). Human Sarcoma Osteoblast (SAOS-2) cells were used to i) assess cytotoxicity by lactate dehydrogenase (LDH) release and ii) evaluate the deposition of a calcified extracellular matrix by ELISA assay and quantitative RT-PCR (qRT-PCR). In comparison with pure silica and 58S, the 58S-Zn0.4 bioglass showed a significant increase in cellular proliferation and deposition of ECM components such as decorin, fibronectin, osteocalcin, osteonectin, osteopontin, type-I and -III collagens. Calcium deposition was significantly higher than on pure silica and 58S samples. Also Alkaline phosphatase (ALP) activity and its protein content was higher with respect to pure silica and 58S. qRT-PCR analysis revealed the up-regulation of type-I collagen, bone sialoprotein and osteopontin genes. All together these results demonstrate the cytocompatibility of 58S-Zn0.4 bioglass and its capability to promote osteoblast differentiation.

E-learning for occupational physicians' CME: a study case

The present study reports the results of the evaluation of an e-learning CME course in the field of Occupational Medicine. In particular the following aspects have been investigated: If and how the course contents have met the educational users' needs; The effectiveness of the course in terms of knowledge improvement; Users' behaviour. Attendance data and results of a sample of 1128 attendees have been analyzed via ad hoc developed tools for direct inspection of Moodle CMS database. The results document the effectiveness of the e-learning course, as regards meeting the educational needs of physicians and also the improvement in terms of knowledge and problem solving skill acquisition. Users' behaviour has revealed a certain tendency for passing the tests, more than for pursuing the best possible result. Interaction with the tutor is low.

Applicability of urinary benzene to biological monitoring of occupational and environmental exposure to very low benzene concentrations

OBJECTIVE

To verify whether urinary benzene is an applicable biomarker of occupational exposure to very low concentrations of benzene, considering the influence of cigarette smoke and benzene-toluene co-exposure.

MATERIALS AND METHODS

23 filling station attendants with occupational exposure to benzene and 31 controls were analyzed. Occupational and environmental exposure was monitored and t,t-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), urinary benzene and creatinine in the urine samples were tested.

RESULTS

Occupational exposure to benzene and toluene was significantly higher in the filling station attendants than in the controls, whereas t,t-MA, SPMA and urinary benzene were not different in the two groups. Instead, the smoker group showed significantly higher values for the above biomarkers than the non-smoker group, each of which included both exposed workers and controls. SPMA was dependent on airborne benzene and cigarette smoking, and urinary benzene only on cigarette smoking, while t,t-MA was not dependent on either of these variables.

CONCLUSIONS

At very low concentrations of occupational exposure to benzene, urinary benzene is less valid than SPMA as a biomarker, even if both are strongly influenced by smoking habit. Abstention from smoking should therefore be recommended for at least two hours before urine collection.

Online CME usage patterns

The paper reports the findings of the analysis of a sample of 829 online Continuous Medical Education (CME) enrolments aimed at inspecting users' preferences and behaviours. The contents of the analyzed course are provided as online SCORM (Sharable Content Object Reference Model) resources together with the corresponding Pdf downloadable versions allowing different usage patterns (online only, Pdf only, online AND Pdf, mixed online OR Pdf). The results point out that there is not a specific preference for one of the four patterns and that most of the users access both navigable modules and Pdf documents. Demographic characteristics and initial knowledge level do not influence the choice of a specific usage pattern that probably depends on internal or context factors. From the point of view of knowledge acquisition, the four patterns are equivalent. As regards users' behaviour, the analysis has pointed out two issues: 1) the attitude to conclude the course in a short time and to reach good test scores, but not the excellence; 2) learning activity tracing data were not available for all the enrolments. Cues for discussion are proposed.

Occupational exposure to antineoplastic drugs in seven Italian hospitals: the effect of quality assurance and adherence to guidelines

In health care facilities, dermal contact and inhalation are considered to be the main routes of exposure to cytotoxic antineoplastic drugs (ADs). Hand-to-mouth contamination or accidental needle sticks as well as events due to inadequate disposal may also contribute to exposure. In order to measure the extent of contamination, biological and environmental monitoring are essential tools for routine testing. Moreover, reliable sampling and analytical procedures are required. During the last decade, several methods have been developed and validated. The appropriate analytical techniques were used to quantify even very low levels of some of the more commonly used ADs, such as cyclophosphamide, 5-fluoruracil, taxol, anthracyclines, and platinum-compounds. The main objective of this study is to assess the adherence to existing standards of practice through an effective monitoring program, including environmental and biological measurements. In seven hospitals located in Northern-Central Italy, periodic surveys were scheduled to verify continuing compliance with guidelines over a 5-year period. All biological samples were found to be below detection limits and a progressive, significant decrease in workplace contamination was observed. Our results confirm that a cost-effective monitoring regime, including fast and simple sample pre-treatment procedures, simultaneous determination of the analytes and their metabolites, validated procedures including uncertainty evaluation, and periodic surveys, is the adequate approach for the collection of reliable exposure data and hence for effective intervention.

1,1,1-Trichloroethane (methyl chloroform) in urine as biological index of exposure

Fifteen human volunteers were exposed to 1,1,1-trichloroethane (methyl chloroform) vapor at 72-495 mg/m3 for a period of 2 to 4 hours at rest (ten cases) and during light physical exercise (five cases). Subsequently 60 workers occupationally exposed to 1,1,1-trichloroethane in a refrigerator manufacturing plant were studied (median value: 178 mg/m3; geometrical standard deviation: 2.19 mg/m3). As expected, the relative uptake (R) of 1,1,1-trichloroethane decreased in the course of exposure at rest (R = 0.44 after 20 minutes of exposure; R = 0.26 after 240 minutes of exposure). Both in the experimentally exposed subjects and in the occupationally exposed workers, the urinary concentration of 1,1,1-trichloroethane showed a linear relationship to the corresponding environmental time-weighted average concentration. The correlation coefficients (r) were 0.95 in occupationally exposed subjects and more than 0.90 in experimentally exposed groups. A linear equation also existed between urinary concentration and amount of 1,1,1-trichloroethane absorbed (r = 0.88). The findings indicate that the urinary concentration of 1,1,1-trichloroethane can be used as an appropriate biological exposure indicator. In occupationally exposed subjects performing moderate work, the urinary 1,1,1-trichloroethane concentration corresponding to the time-weighted average of the threshold limit value was found to be 860 micrograms/L and its 95% lower confidence limit (biological threshold) 805 micrograms/L.

Nanostructured biocides for means of rehabilitation

In this work, the description of technology of intercalation of montmorillonite by ions of biometals is submitted. Laboratory techniques of definition of a mass fraction of silver and copper in montmorillonite are resulted The manufacturing regulations of obtaining of nanodispersed powders of intercalated montmorillonite are submitted. Bases of technology of obtaining and manufacturing of cosmetic means on a basis of nanomaterials; technologies of antibacterial processing of textile materials, obtaining of antimicrobic properties by medical polymers are described in the report. Bases of technology of obtaining of biocidal and fungicidal coatings (paints, varnishes) on a basis of nanomaterials are described. The estimation of biocidal and properties of nanomaterials on a basis of intercalated montmorillonite by an integral disk-diffusion method is resulted. High efficiency of application of nanosystems on a basis of intercalated montmorillonite for obtaining of antimicrobic properties in paint and varnish materials is shown.

Earnings in e-learning: knowledge, CME credits or both? Hints from analysis of attendance dynamics and users' behaviour

Many papers report and convey positive opinion about the use of e-learning in the healthcare sector. The issue is how to exploit at best such a powerful instrument. Starting from data regarding the usage of a CME e-learning course, attendance dynamics and users' behaviour have been inspected with the aim of getting some hints about how to improve the development and the delivery of e-learning courses for CME, and to promote knowledge acquisition at best. The different paths followed by 7811 users have been modeled, from enrolment to conclusion/drop-out, then the behaviour in terms of effort, elapsed time, achieved result have been analyzed. The obtained results point out: good acceptance (retention rate 83%) of a not basic educational model and effectiveness (success rate 79%). At the same time the inspection of behaviour has shown that there is a good margin of possible improvement in terms of knowledge acquisition. Conclusions provide a list of issues to keep in mind during system development, in order to provide CME e-learning meeting both credit and knowledge acquisition goals.