Fetal neurosonography at 31-35 weeks reveals altered cortical development in pre-eclampsia with and without small-for-gestational-age fetus

OBJECTIVE

To explore the pattern of fetal cortical development in pregnancies complicated by pre-eclampsia (PE), with and without a small-for-gestational-age (SGA) fetus, compared to uncomplicated pregnancies.

METHODS

This was a prospective observational study including singleton pregnancies complicated by normotensive SGA (birth weight < 10^th centile) (n = 77), PE with an appropriate-for-gestational-age (AGA) fetus (n = 76) or PE with a SGA fetus (n = 67), and 128 uncomplicated pregnancies (normotensive AGA) matched by gestational age at ultrasound. All pregnancies underwent detailed neurosonography, using a transabdominal and transvaginal approach, at 31-35 weeks' gestation to assess the depth of the insula, Sylvian fissure, parieto-occipital sulcus, cingulate sulcus and calcarine sulcus. All measurements were adjusted for biparietal diameter (BPD). In addition, a grading score of cortical development was assigned to each brain structure, ranging from Grade 0 (no development) to Grade 5 (maximum development). Univariate and multiple regression analyses were conducted.

RESULTS

Similar to findings in previous studies, normotensive pregnancies with a SGA fetus showed significant differences in cortical development compared with controls, with reduced Sylvian fissure depth adjusted for BPD (14.5 ± 2.4 vs 16.6 ± 2.3; P < 0.001) and increased insula depth adjusted for BPD (33.2 ± 2.0 vs 31.8 ± 2.0; P < 0.001). Interestingly, a similar cortical development pattern was observed in PE pregnancies with a SGA fetus and in PE pregnancies with an AGA fetus, manifested by reduced Sylvian fissure depth adjusted for BPD (14.2 ± 2.3 and 14.3 ± 2.3 vs 16.6 ± 2.3; P < 0.001 for both) and greater insula depth adjusted for BPD (33.2 ± 2.1 and 32.8 ± 1.7 vs 31.8 ± 2.0; P < 0.001 for both) compared with controls. No significant differences were observed in parieto-occipital, cingulate sulcus or calcarine sulcus depth across the study groups. The Sylvian fissure was scored as Grade 4 in significantly more (93.2% vs 59.5%) and as Grade 5 in significantly fewer (2.7% vs 37.3%) PE pregnancies with an AGA fetus compared with controls (P < 0.05 for both). These differences remained significant even after statistical adjustment for potential confounders, including ethnicity, low socioeconomic status, nulliparity, chronic hypertension, pregestational diabetes, assisted reproductive technologies, smoking and fetal gender, with the application of Benjamini-Hochberg procedure for multiple comparisons.

CONCLUSIONS

PE with or without SGA is associated with a differential fetal cortical development pattern which is similar to that described previously in small fetuses. Future research is warranted to elucidate better the mechanism(s) underlying these changes. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

P151 RIGHT VENTRICULAR MECHANICS IN PATIENTS AFFECTED BY PULMONARY VALVE STENOSIS, BEFORE AND AFTER PERCUTANEOUS PULMONARY VALVULOPLASTY

Aim of the Study

To evaluate the mechanical changes of the right ventricle in patients undergoing balloon pulmonary valvuloplasty using transthstandard transthoracic echocardiography (TTE) and speckle–tracking echocardiography (STE) and to investigate the correlation between haemodynamic and echocardiographic parameters before and after treatment.

Materials and Methods

43 pediatric patients (19 males), mean age 3,2±4,9 years with severe pulmonary valve stenosis and indication for percutaneous balloon valvuloplasty were recruited. All patients underwent TTE and STE with analysis of right ventricle global longitudinal strain (RVGLS) one day before and after the procedure. For each patient were collected invasive parameters during balloon valvulopasty.

Results

After the procedure, there was an immediate reduction of both peak–to–peak transpulmonary gradient (Dp post) and ratio between the systolic pressure of right and left ventricle (RV/LV ratio) with a drop of 29,3±14,67mmHg and 0,43±0,03, respectively. Post–procedural echocardiography showed peak and mean transvalvar pressure gradient drop (50±32,23 and 31±17,97, respectively). The degree of pulmonary valve regurgitation was mild in 8% of patients before the procedure, following the intervention it reached 29% with a statistically significant increase (p = 0,007). However, moderate and severe regurgitation remained stable after the procedure. There was a significant improvement of Fractional Area Change (FAC) after the procedure (40,11% vs 44,42%, p = 0,01). TAPSE (p = 0,60) and longitudinal strain (p = 0,31), did not improve significantly after intervention. Finally, pre–procedural invasive RV/LV ratio showed good correlation to echocardiographic transvalvular peak and mean pressure gradient (R = 0,375, p = 0,019 and R = 0,40, p = 0,012, respectively), as well as with FAC (R = 0,31 p = 0,05), TAPSE (R = 0,62 p &lt; 0,001)and RVGLS (R = 0,46 p = 0,01)

Conclusions

Percutaneous balloon pulmonary valvuloplasty represents an efficient and safe procedure. Right ventricular global systolic function improved following afterload reduction, while longitudinal systolic function did not show improvement immediately after intervention. Finally, invasive preprocedural RV/LV ratio demonstrated better correlation with echocardiographic evaluation of stenosis degree and right ventricular function compared to invasive peak–to–peak pressure gradient. Therefore, RV/LV ratio should be preferred for the assessment of pulmonary valve stenosis.

P154 EVOLUTION OF ECHOCARDIOGRAPHIC AND CARDIAC MRI ABNORMALITIES DURING FOLLOW–UP IN PATIENTS WITH PREVIOUS MIS–C DIAGNOSIS

Background

Cardiovascular manifestations in the acute phase of MIS–C are frequent. However, there is lacking evidence regarding late cardiological follow–up of this cohort of patients. The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS–C, assessed by standard echocardiography (TTE), speckle tracking echocardiography (STE), and cardiac MRI (CMR).

Materials and Methods

32 consecutive patients with confirmed MIS–C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected for all patients. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis.

Results

Mean age was 8.25±4years (range 1.3–17.7). Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease–like symptoms, and 5 (15.6%) needed ICU admission. All patients showed an hyperinflammatory state. Tn–I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Median time to STE evaluation was 7 days and to CMR 18 days since fever onset. Mean LVEF at baseline was 58.8±10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (–17.4±4%). Coronary dilation was observed in 9 (28,1%) patients. On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Median time to T1 and T2 evaluation was respectively 48.5 and 207 days. Follow–up data showed statistically significant improvement in left ventricular systolic function compared to acute phase. LVEF improved rapidly at T1 (62.5 ± 7.5 vs. 58.8±10.6%, p value 0.044) with only three patients (10%) below ≤ 55% at T1 and one patient (4%) at T2. LV GLS remained impaired at T1 (–17.2 ± 2.7 vs.–17.4 ± 4, p value 0.71), and significantly improved at T2 (–19±2.6% vs. –17.4±4%, p value 0.009). LV GLS was impaired (&gt;–18%) in 53% of patients at baseline and T1, while only 13% showed LV GLS reduction at T2. CMR, performed 6 months after diagnosis, showed LGE persistence in 33.4% of cases.

Conclusions

Even though, early cardiac involvement significantly improves during follow–up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS–C patients.

Validation of a new intuitive software for automatic heart function analysis. An intraobserver variability study

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua

Background/Introduction: In recent years there has been a growing interest in artificial intelligence (AI) applications in the echocardiography field. This is in order to simplify, reduce time and amplify the use of advanced analyses in the echo lab.

Purpose

to compare results of the fully automated analysis and manual tracing analysis using a new intuitive software.

Methods

28 consecutive previously healthy patients less than 18 years old who were screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection were enrolled. All they were in sinus rhythm. Standard transthoracic echocardiography (TTE) was performed for each patient using Canon Aplio i900, software 2D Wall Motion Tracking. Optimized apical 4-, 3- and 2- chamber views, mitral valve inflow pattern and LVOT Doppler interrogation were collected. Off-line data analysis of each examination was performed by both fully automated analysis (AI) and pediatric cardiologists with experience in echocardiography i.e. by manual tracing, evaluation and adjustment of the track by the operator (Echocardiographers). Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients datasets were performed twice by both operators and AI.

Results

Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.

The time taken for off-line analysis by AI and echocardiographers was 4-5 and 13-20 minutes, respectively.

Reproducibility of echocardiographers’ analysis was found to be excellent for left ventricle assessment (IC from 0,88 to 0,98); moderate for LVOT mean gradient (IC 0,73), RV end diastolic area (IC 0,69) and right atrial strain (IC 0,59); poor for deceleration time (IC 0,5), left ventricle strain (IC 0,49), RV FAC and strain (IC from 0,27 to 0,45).

Conversely, reproducibility of the AI analysis was found to be excellent for any parameter (ICC from 0,87 to 0,99) (Table 1).

About the mitralic valve inflow pattern assessment, despite the excellent reproducibility of AI analysis, the margin of error was found to be high. Particularly, a systematic error was observed with a tendency of the AI to overestimate deceleration time (DT-AI 176,6 ± 63,8 vs DT-Ecocardiographers 150,4 ± 24,3).

Conclusion(s): Fully automated analysis is technically simple, less time consuming and highly reproducible. AI analysis of the mitralic inflow pattern should be optimized, having found a systematic error in the calculation of deceleration time. Reproducibility is the strong point of AI. This reduces the variability of manual measurements between different sonographers and at different times. Abstract Table 1. Echocardiographic measurements

AI do it better. Reproducibility of fully automated versus manual analysis of left ventricle function using a new software

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua

Background/Introduction: Ejection fraction (EF) is a parameter widely used in Echolab to evaluate left ventricular function. Recently, in parallel with the growing interest in artificial intelligence (AI), attemps have been made to create automated systems for EF assessment, in order to reduce time and improve the accuracy of the analysis.

Purpose

to compare results of different methods of EF assessment: visual estimation (visual EF), manual and fully automated analysis.

Methods

28 consecutive pediatric patients were enrolled. This cohort of previously healthy patients was screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection. All they were in sinus rhythm. Optimized apical 4- and 2- chamber views were collected for each patient using Canon Aplio i900. Off-line EF assessment was first evaluated visually by pediatric cardiologists with experience in echocardiography, then performed by both fully automated analysis (AI) using two different methods (Automatic Simpson -AI Simpson- and Wall Motion Tracking -AI WMT-) and pediatric cardiologists through manual tracing of endocardial border (Manual Simpson and Manual WMT respectively).

Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients’ datasets were performed twice by both operators and AI.

Results

Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.

The time taken for off-line analysis was 0.3-0.7 minutes, 1-1.5 minutes, 1-3 minutes and 3-4 minutes, respectively for AI WMT, AI Simpson, Manual WMT and Manual Simpson.

As expected, visual EF showed high intraobserver variability and a poor reproducibility (ICC 43%). AI analysis revealed a good to excellent reproducibility (ICC from 80% to 99%, depending on the method used). WMT methods had the best reproducibility both for manual tracing of endocardial border and fully automated analysis (Table 1).

The comparison between different methods (Table 2) showed a good agreement between AI Simpson and AI WMT (mean bias 2,9, from -3,2 to 9,0, ICC 86%). A moderate correlation was found between different methods of AI analysis while only poor correlation was found between manual Simpson and manual WMT (Table 2).

Conclusion(s): Automatic Simpson and Wall Motion Tracking are two different fully automated methods which can be used for left ventricular function assessment. AI reproducibility is high for both methods, higher for WMT. WMT method is also less time consuming and improves reproducibility of manual tracing of endocardial borderd analysis. Abstract Table 1. Echocardiographic measurements  Abstract Table 2. Comparison between different me

OUP accepted manuscript

Aims

Methods and results

Conclusion

Degradation of estriol (E3) and transformation pathways after applying photochemical removal processes in natural surface water

Steroidal hormones such as estriol (E3), are resistant to biodegradation; hence their removal by conventional treatment systems (aerobic and anaerobic) facilities is limited. These substances are detected in surface water, and present risks to the aquatic ecosystem and humans via potential biological activity. Photochemical treatments can be used to remove E3; however, just a few studies have analyzed the kinetics, intermediates, and E3 degradation pathways in natural surface water. In this study, the behavior of E3 under ultraviolet irradiation associated with H₂O₂, O₃ or TiO₂ was investigated to determine the degradation potential and the transformation pathways in reactions performed with a natural surface water sample. E3 degradation kinetics (200 ppb) fitted well to the pseudo-first-order kinetics model, with kinetic constant k in the following order: k_UV/O3 > k_UV/TiO2 > k_UV/H2O2 > k_UV. The mechanism of degradation using different advanced oxidative processes seemed to be similar and 12 transformation byproducts were identified, with 11 of them being reported here for the first time. The byproducts could be formed by the opening of the aromatic ring and addition of a hydroxyl radical. A possible route of E3 degradation was proposed based on the byproducts identified, and some of the byproducts presented chronic toxicity to aquatic organisms, demonstrating the risks of exposure.

Transcranial Doppler as a useful tool in the detection of cervical steno-occlusive arteriopathy in infants

OBJECTIVE

The early detection of cervical steno-occlusive arteriopathy is essential to rapidly initiate appropriate treatment and to potentially improve neurological outcome. To accurately confirm the diagnosis, cerebral imaging is the gold standard, but it cannot be performed if the patient is unstable or if the facility is unavailable.

CASES

Here we report our experience of using transcranial Doppler (TCD) ultrasound as a readily available, easy-to-use bedside tool to guide the rapid screening and management of cervical steno-occlusive arteriopathy in infants.

DISCUSSION AND CONCLUSION

Children with traumatic cervical steno-occlusive arteriopathy, TCD is a potentially useful tool for early diagnosis.

Intrapartum prediction of emergency delivery due to non-reassuring fetal status at 40 weeks' gestation in low-risk pregnancies: contribution of Doppler parameters, maternal history, and intrapartum clinical characteristics

OBJECTIVE

To assess the added value of Doppler parameters, maternal history, and intrapartum clinical characteristics for the prediction of emergency delivery due to non-reassuring fetal status in low-risk pregnancies.

METHODS

This was a prospective cohort of low-risk pregnancies undergoing ultrasound assessment at 40 weeks' gestation within 7 days of delivery. The main outcome was emergency cesarean section due to non-reassuring fetal status. The association between Doppler parameters, intrapartum clinical characteristics, and maternal history was performed by logistic regression. The predictive performance of the constructed models was assessed by receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC).

RESULTS

From 403 included pregnancies, 18.6% (n = 75) underwent an emergency delivery due to non-reassuring fetal status. The mean gestational age at birth was 40.5 (SD 5) days. Middle cerebral artery pulsatility index (MCA) and cerebroplacental ratio (CPR) were lower in the emergency cesarean section group (1.16 versus 1.30; p < .001, and 1.61 versus 1.78; p = .001, respectively). There was a higher incidence of small-for-gestational-age neonates (20 versus 10.1%; p = .017), lower Apgar scores at the 5th minute (9.7 versus 9.9; p = .006), and NICU admissions (9 versus 3%; p = .016) in the emergency cesarean section group. The base model comprised nulliparity, and the finding of meconium-stained amniotic fluid during labor, achieving an AUC of 66%, while the addition of the MCA Z-score significantly improved the previous model (AUC: 73%; DeLong: p = .008).

CONCLUSIONS

In low-risk pregnant woman at term, the addition of MCA Z-score to a previous model comprising maternal history and intrapartum clinical findings, significantly improves the prediction of emergency delivery due to non-reassuring fetal status.

Acetylcholinesterase inhibitors in Alzheimer's disease influence Zinc and Copper homeostasis

BACKGROUND

Alzheimer's disease (AD) is the most common age-related neurodegenerative disease. An altered homeostasis of Zinc (Zn) and Copper (Cu), as well as a dysregulated expression of Zn-regulatory proteins have been previously described in AD. Acetylcholinesterase inhibitors (AChEI) are commonly used as AD treatment to improve cognitive function, but their effect on Zn homeostasis is still unexplored.

OBJECTIVES

The aims of this study were to define the metal dyshomeostasis in AD patients, to investigate AChEI influence on Zn homeostasis and inflammation, and to analyze the relationship between cognitive impairment at two-year follow-up and metal concentrations, considering AChEI use.

METHODS AND RESULTS

84 Healthy Elderly (HE) and 95 AD patients were enrolled (62 AchEI user and 33 AchEI naïve). HE showed similar plasma Zn and Cu concentrations and Cu/Zn ratio in comparison to AChEI users, but significantly higher Zn level, as well as lower Cu amount and Cu/Zn ratio than AChEI naïve patients. Moreover, AChEI users had increased Zn plasma level, reduced Cu amount, Cu/Zn ratio, and IL1β concentration and lower Zip2 lymphocytic expression vs. naïve patients. A multiple linear regression analysis showed that the MMSE score decline after two-year follow-up was reduced by AChEI therapy and was positively associated with plasma Zn decrease over time.

CONCLUSION

Our data revealed that AChEI use may affect peripheral Zn and Cu homeostasis in AD patients, decrease Cu/Zn ratio demonstrating a general reduction of inflammatory status in patients under AChEI treatment. Finally, AChEI influence on circulating Zn could be implicated in the drug-related slowdown of cognitive decline.

ZnT8 Arg325Trp polymorphism influences zinc transporter expression and cytokine production in PBMCs from patients with diabetes

AIMS

ZnT8 Arg325Trp polymorphism has been associated with type 2 diabetes (T2DM) susceptibility. The Arg-325 risk variant shows accelerated zinc (Zn) transport kinetic and reduced glucose-stimulated insulin secretion in pancreatic cells. However, it remains unexplored the role of Znt8 polymorphism in the regulation of Zn homeostasis and inflammatory response in peripheral blood mononuclear cells (PBMCs) from T2DM patients.

METHODS AND RESULTS

A total of 556 healthy controls and 413 T2DM patients were genotyped for ZnT8 Arg325Trp polymorphism confirming the association of Arg-325 variant with an increased T2DM risk (OR = 1.35 95% C.I: 1.10-1.66; p = 0.0044). Moreover, PBMCs from Arg/Arg T2DM subjects showed increased intracellular free Zn, higher gene expression of Metallothioneins, Znt1, Znt8, Zip2 genes, and reduced Znt4 and Znt7. Higher release of IL-1α, IL-1β, IFN-γ, IL-12p70 and TNF-α and a reduced IL-10 secretion after lipopolysaccharide (LPS) stimulation were observed in PBMCs from Arg/Arg T2DM carriers as compared to subjects with the Trp variant.

CONCLUSIONS

Our data provide evidence of a substantial different Zn homeostasis regulation between Znt8 Arg-325 and Trp-325 carriers in PBMCs from T2DM patients. Moreover, Znt8 Arg-325 risk variant shows an enhanced inflammatory response upon LPS stimulation that might aggravate insulin resistance and the progression of diabetes cardiovascular complications.

The Role of Medical Counseling in Secondary Prevention of Cancer in the Elderly

In western countries the elderly are those who experience the major impact of cancer, as epidemiologic data clearly show. Thus, secondary prevention of cancer (SPC) in older persons deserves more attention than it has received until now. Target subjects, however, are often reluctant to enter SPC plans. The reasons range from the lack of knowledge about the importance of SPC to the underevaluation of the risk of cancer, or, even more often, to the anxiety and fear that may stem from such a clinical investigation. In this context, the intervention known as couseling finds its natural and essential role. In the paper some general considerations on the significance of medical counseling is given, with particular emphasis on its role in SPC in the elderly. The analysis herein reported points out the specific skills and methods that physicians can adopt to cope with the eventually adverse influences that may affect the participation of the elderly in SPC initiatives. However, such action should avoid any paternalistic approach and respect the patient's will and autonomy.

Epirubicin in Combination Chemotherapy in the Treatment of Advanced Stage Non-Hodgkin's Lymphomas

From April 1981 to May 1984, 23 patients with advanced non-Hodgkin's lymphomas were treated with CEOP (cyclophosphamide, epirubicin, vincristine, and prednisone) or OEPP (vincristine, epirubicin, procarbazine, and prednisone) combination chemotherapy. CR was achieved in 58 % and PR in 31 % of the patients, giving an overall response rate of 89 %. Nine of 15 (60 %) previously untreated patients with unfavorable histology obtained a CR and 5 a PR. Median relapse-free survival was 33 months; median overall survival has not yet been reached, and the probability of survival for CRs was 91 % after 54 months of follow-up. Acute toxicity was quite acceptable, and chronic cardiac toxicity was detected in 6 patients only. In conclusion, epirubicin used in combination chemotherapies induced durable remissions and prolonged survivals in advanced non-Hodgkin's lymphomas.

Lavandula angustifolia Mill. Essential Oil Exerts Antibacterial and Anti-Inflammatory Effect in Macrophage Mediated Immune Response to Staphylococcus aureus

Different studies described the antibacterial properties of Lavandula angustifolia (Mill.) essential oil and its anti-inflammatory effects. Besides, no data exist on its ability to activate human macrophages during the innate response against Staphylococcus aureus. The discovery of promising regulators of macrophage-mediated inflammatory response, without side effects, could be useful for the prevention of, or as therapeutic remedy for, various inflammation-mediated diseases. This study investigated, by transcriptional analysis, how a L. angustifolia essential oil treatment influences the macrophage response to Staphylococcus aureus infection. The results showed that the treatment increases the phagocytic rate and stimulates the containment of intracellular bacterial replication by macrophages. Our data showed that this stimulation is coupled with expression of genes involved in reactive oxygen species production (i.e., CYBB and NCF4). Moreover, the essential oil treatment balanced the inflammatory signaling induced by S. aureus by repressing the principal pro-inflammatory cytokines and their receptors and inducing the heme oxygenase-1 gene transcription. These data showed that the L. angustifolia essential oil can stimulate the human innate macrophage response to a bacterium which is responsible for one of the most important nosocomial infection and might suggest the potential development of this plant extract as an anti-inflammatory and immune regulatory coadjutant drug.

Nonhormonal management of postmenopausal women: effects of a red clover based isoflavones supplementation on climacteric syndrome and cardiovascular risk serum profile

PURPOSE OF INVESTIGATION

The aim of this prospective randomized study was to evaluate a red clover based isoflavones supplementation in the treatment of climacteric syndrome and its effects on cardiovascular risk serum profile.

MATERIALS AND METHODS

The study included 150 healthy postmenopausal women that were randomly assigned to receive phytoestrogens tablets, amounting in a total daily intake of 60.8 mg red clover isoflavones plus 19.2 mg soy isoflavones (n = 75), or placebo (n = 75). The authors evaluated teh following: daily number of hot flushes and Kupperman Index at baseline and after one and three months; serum total, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, triglycerides, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, and antithrombin III (ATIII) at baseline and after three and six months.

RESULTS

One hundred twenty-eight patients completed the study: 67 in the active group and 61 in the placebo group. The treatment led to a progressive significant reduction (p < 0.05) of the number of hot flushes in the active group compared to placebo already after one month, while Kupperman Index was statistically reduced after three months. No significant variation in total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, PT, PTT, fibrinogen, and ATIII were found.

CONCLUSION

The present findings suggest that a red clover based isoflavones supplementation in healthy postmenopausal women is promptly effective on climacteric syndrome, improves neurovegetative symptoms, safe on cardiovascular risk serum profile, and does not modify lipids and coagulation.

Immune Effects and Polychlorinated Biphenyls, Smoking and Alcohol

Polychlorinated biphenyls (PCB) have been shown to exert some immune effects. Here we analysed their effects also on immune parameters not previously studied such as TCR α-β, TCR γ-δ and regulatory T cells (Treg), taking into account the specific and cumulative interference of smoking and alcohol. The study subjects consisted of 26 male workers in a steelworks factory, employed in the electrical maintenance sector, with previous exposure to a mixture of PCB (exposed subjects), and 30 male workers with no occupational exposure to PCB (controls). All subjects were given a questionnaire and peripheral venous blood samples were taken to determine serum PCB (33 congeners), total cholesterol and triglycerides, leukocytes, total lymphocytes and the T lymphocyte subpopulations (TCR α-β, TCRγ-δ, CD4+ and Treg lymphocytes). PCB, even though at a very low concentration, were significantly higher in exposed subjects than controls, and were significantly correlated with age. Monocytes% and CD4+ were significantly reduced in the exposed subjects as compared to the controls. The serum concentration of PCB positively correlated with TCR α-β, and negatively with TCRγ-δ. Treg lymphocytes showed a positive dependence on tobacco smoking, while the monocytes% and CD4+ showed a negative and positive dependence, respectively, on alcohol intake. Our results seem to show some effects of slight exposure to PCB in particular reducing the relative concentration of TCRγ-δ. This effect can favour indirectly the increase in Treg induced by smoking, the anti-inflammatory or proinflammatory/fibrogenetic/angiogenetic effect of which, exerted by produced cytokines, particularly TGF-β, deserves further clarification.

Toxicity of the fungicide trifloxystrobin on tadpoles and its effect on fish-tadpole interaction

Contamination of aquatic systems is a major environmental stress that can interfere with predator-prey interactions, altering prey or predator behavior differentially. We determined toxicity parameters of the fungicide trifloxystrobin (TFS) and examined its effects on predation rate, using a fish predator (Synbranchus marmoratus) and four anuran tadpole species as prey (Rhinella arenarum, Physalaemus santafecinus, Leptodactylus latrans, and Elachistocleis bicolor). TFS was not equally toxic to the four tadpole species, E. bicolor being the most sensitive species, followed by P. santafecinus, R. arenarum, and L. latrans. Predation rates were evaluated using different treatments that combined predator and prey exposed or not to this fungicide. TFS would alter the outcome of eel-tadpole interaction by reducing prey movements; thus, prey detection would decrease and therefore tadpole survival would increase. In addition, eels preyed selectively upon non-exposed tadpoles avoiding the exposed ones almost all throughout the period evaluated. Predation rate differed among prey species; such differences were not due to TFS exposure, but to interspecific differences in behavior. The mechanism that would explain TFS-induced reduction in predation rates remains unclear; however, what is clear is that sublethal TFS concentrations have the potential to alter prey behavior, thereby indirectly altering predator-prey interactions. In addition, we consider that predator-prey relationships are measurable responses of toxicant exposure and provide ecological insight into how contaminants modify predator-prey interactions.

[Lesser validity of urinary benzene than S-phenylmercapturic acid for measuring occupational and environmental exposure to very low concentrations of benzene]

AIM

To study the validity of urinary benzene as a biomarker of low and very low exposure to this toxicant, as compared with t,t-muconic acid (t,t-MA) and S-phenylmercapturic acid (SPMA), also taking into account the influence of cigarette smoking and co-exposure to toluene on the urinary excretion of benzene.

MATERIALS AND METHODS

The results obtained in two different studies were compared: in the first, workers occupationally exposed to low concentrations of benzene (18 fuel tanker drivers and 23 filling station attendants) were compared with 31 controls and in the second, workers exposed to very low concentrations of benzene (the same 23 filling station attendants) were compared with the 31 controls. Exposure to airborne benzene and toluene was monitored with passive personal samplers (Radiello). Then the urine collected at the end of the work shift was analyzed for t,t-MA, SPMA and urinary benzene. All participants also filled out a questionnaire about their lifestyle habits.

RESULTS

There were no differences among the three groups in terms of age and smoking habit. Occupational exposure to benzene and toluene and the urinary concentrations of t,t-MA, SPMA and urinary benzene were higher in the fuel tanker drivers than the filling station attendants and higher in the latter than in the controls. Cigarette smoking was found to be associated with urinary excretion of t,t-MA, SPMA and urinary benzene at both low and very low exposure to benzene. The biomarkers t,t-MA, SPMA and urinary benzene were almost always correlated, for both low and very low exposure to benzene. Notably, for low exposure to benzene a dependency relation was found with the levels of t,t-MA, SPMA and urinary benzene on both cigarette smoking and airborne benzene, whereas for very low exposure to benzene there was a dependency relation of SPMA on cigarette smoking and airborne benzene, of urinary benzene only on cigarette smoking and of t,t-MA on none of the variables considered.

CONCLUSIONS

For occupational exposure to low concentrations of benzene, urinary benzene and SPMA showed a comparable validity, while for exposure to very low concentrations of this toxicant the validity of SPMA was confirmed while urinary benzene was found to be less useful. Cigarette smoking was the main factor conditioning the excretion of all the biomarkers of benzene in conditions of both low and very low exposure to the toxicant, so for the analysis of occupational exposure to benzene it is best to recommend abstention from smoking at least in the hours immediately before urine collection.

Treatment efficacy of language and calculation disorders and speech apraxia: a review of the literature

The aim of the study was to evaluate the efficacy of the treatment for language and calculation disorders and for speech apraxia in vascular subjects. Only therapeutic methods that could be qualified as neuropsychological were taken into account. For language disorders, we searched the pertinent literature published from 1950 to August 31, 2007 by means of electronic data banks and we took into consideration the Cochrane review, and papers in Cicerone et al. and Cappa et al. systematic reviews. For acalculia we examined the literature from 1980 by carrying out research on electronic data banks; for speech apraxia, studies emerged from a search of PUBMED. Aphasia therapy has been clearly demonstrated efficacious in groups of subjects if sufficiently prolonged/intensive. Treatment for specific disorders (words and sentences processing, reading, writing) studied in series of single patients, though always efficacious, reaches a lower level of recommendation due to the lack of RCT. Only a few studies tackled the problem of efficacy in case of speech apraxia and calculation disorders. Results are positive but data are scanty. Efficacy of aphasia therapy seems well established in group of subjects and well-promising for speech apraxia and calculation disorders. It is suggested, however, that the term "aphasia" covers widely different impairments and that RCT are not the best instrument to evaluate efficacy; the importance of chronicity is underlined.

[The role of the occupational physician in the assessment of accident risk]

The prevention of accidents at work in Italy is a target still to be reached for the safety of workers in workplaces, despite the innovative provisions introduced by the Legislative Decree 81/08 and the decrease of the number of total and fatal accidents occurred in the period 2001-2008, as reported in the statistics of the Italian Workers' Compensation Authority (INAIL). The occupational physician performs a very important role in the accident risk assessment, based on his biomedical and ergonomic knowledge. His role is carried out during the phase of safety risk assessment, contributing to assess plants, machines, tools, personal protective equipments, to be used by the workers. His knowledge of the health status of workers, acquired by medical surveillance and aimed to prevent accidents by providing the fitness for work evaluation in relation to the presence of diabetes mellitus, musculoskeletal diseases, sleep disorders, or to the assumption of hypnotic drugs, when the employee works at height or as driver such as in the transport or construction industry, is not less important. Unfortunately, this latter role of the occupational physician is limited because the Italian Safety Legislation does not provide for the sanitary surveillance of all the workers employed in factories.

Optimized synthesis of phosphatidylserine

The synthesis of phosphatidyl serine containing saturated fatty acids was thoroughly studied and optimized in order to establish a protocol amenable to large-scale synthesis. The key step was a one-pot multicomponent reaction involving an O-benzyl phosphorodiamidite, protected serine and diacylglycerol, followed by in situ oxidation of the resulting phosphite. In order to replace expensive and poorly stable tetrazole, a screening of substitutes was carried out and imidazolium chloride was selected as the best suited one.

[A case of Kaposi's sarcoma in the rapamycin era]

We report a case of Kaposi's sarcoma in a patient who received a double kidney transplant in 2005. Immunosuppression was induced with rapamycin and antilymphocyte serum while maintenance therapy consisted of rapamycin, corticosteroids and mycophenolic acid. The patient developed delayed graft function but no rejection. In November 2006 and March 2007 two graft biopsies were taken because of a significant rise in serum creatinine; they revealed chronic allograft nephropathy and polyomavirus infection. Meanwhile a skin biopsy of the leg was performed to determine the nature of a discolored lesion. The morphohistological diagnosis was Kaposi's sarcoma. For this reason rapamycin was stopped and steroid treatment gradually reduced. Specific therapy with doxorubicin was started; radiological and endoscopic examination excluded disseminated disease while serological tests were positive for antibodies to HHV-8, a virus known to cause Kaposi's sarcoma. Unfortunately, withdrawal of antirejection therapy caused loss of the graft, so the patient had to start dialysis. In this report we stress the possible development of malignancy in transplanted patients who are given rapamycin. Rapamycin is known to be an antirejection drug and to have antineoplastic activity; the major risk of malignancy is probably related to immunosuppression rather than the type of drugs used to obtain it.

[Sleep disorders in cement workers]

Obstructive Sleep Apnea Syndrome (OSAS) and Excessive Daytime Sleepiness (EDS) are sleep disorders which can increase cardiovascular risk. An health survey was performed on the cement workers to estimate the prevalence of sleep disorders and to investigate occupational, personal and health risk factors that could influence it. A total of 761 male workers, employed at 10 different cement plants of South Italy and Sicily, were examined. All subjects gave informed consent to take part in the survey. The following questionnaires were administered: Berlin Questionnaire to estimate the high risk of OSAS, Epworth Sleepiness Scale for EDS, a questionnaire posing questions about working conditions, personal characteristic, lifestyle, past history of disease and present illness. Statistical analysis was performed with the statistical package SPSS. The prevalence of high risk of OSAS and of EDS resulted respectively in 24.2% and 3.4% of workers. Sleep disorders detected with the two questionnaires were significantly associated. A positive and significant association between OSAS and respectively age, time of employment, BMI, ex-smoker status, neck, waist or hip circumferences, chronic fatigue and arterial hypertension was observed. Subjective variables regarding working conditions (job interest, evaluation oforganization of work and job satisfaction) and alcohol consumption were not associated with the high risk of OSAS. Shift work (2 and 3 shifts) was not associated with the high risk of OSAS. An healthy worker effect was observed for workers who changed from shift work (2 or 3 shifts) to fixed daytime work. For them, this change to fixed daytime work was conditioned by chronic disease like hypertension and obesity. EDS was not dependent, associated or correlated with any of the occupational, personal or pathologic variables investigated in the study. In conclusion the research showed no relationship between working conditions, particularly shift work, and the high risk of OSAS, and the influence of obesity in determining the high risk of OSAS, itself a potential cardiovascular risk factor. The interest of occupational physician has been focused on introducing in health surveillance also measures of health promotion regarding sleep disorders with the aim of preserving health condition in workers.

[Validity of urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) as biomarker of exposure to very low concentrations of carbon disulphide: preliminary results]

The possibility to use urinary 2-thiothiazolidine-4-carboxylic acid (TTCA) as biomarker of occupational exposure to very low doses of carbon disulphide (CS2) was evaluated preliminarily in 10 workers employed in a chemical plant where rubber vulcanization accelerators are produced, and in 10 workers, residents in the same geographical area and not occupationally exposed to CS2 and dithiocarbamates (DTC). Exposure to airborne CS2 was assessed, only for exposed workers, by both personal and area samplers. For the determination of TTCA, a spot urine sample was collected for each worker, exposed and non exposed, at the end of work-shift. A questionnaire probing lifestyle and dietary habits and non occupational exposure to CS2 and DTC was administered to all workers involved in the study. Environmental exposure to CS2 in 2007 ranged between 0.21 mg/m3 and 0.73 mg/m3 for personal sampling, and between 0.23 mg/m3 and 0.41 mg/m3 for area sampling. Urinary TTCA levels resulted very low and did not show any significant difference between exposed (Median: 10.8 microg/g creat; Range: 6.1-26.4 microg/g creat) and non exposed workers (Median: 9.3 microg/g creat; Range: 3.0-33.0 microg/g creat), while higher, but not significant concentrations of TTCA were observed in smokers than in non smokers (p = 0.09). No correlation was found between urinary TTCA levels and environmental exposure to CS2, age, body mass index, smoking and dietary habits. In conclusion, the low sensibility and specificity in the assessment of occupational exposure to low doses of CS2 in workers compared to general population subjects, makes urinary TTCA a biomarker with a low usefulness in biological monitoring. ACGIH, besides, should also introduce "B" (background) notation, at present not considered for the BEI indicated for urinary TTCA.

[Influence of cigarette smoking on the excretion of urinary benzene in filling-station attendants]

The influence of cigarette smoking on concentrations of urinary benzene, a sensitive and specific biomarker proposed for biological monitoring of exposure to very low doses of benzene, was investigated in 24 filling-station attendants and 31 workers non occupationally exposed to benzene. Environmental monitoring was performed by personal passive samplers "Radiello", and a spot urine sample was collected at the end of the work shift, from all subjects, for the determination of urinary benzene. Exposure to benzene resulted significantly higher in filling-station attendants (mean 23.3 +/- 17.0 microg/m3; range 4.5-66.3 microg/m3) than in controls (mean 4.6 +/- 2.6 microg/m3; range < 3-11.5 microg/m3), while concentrations of urinary benzene did not show any significant difference between the two groups. Considering all subjects as a single group, it was observed that urinary benzene concentrations were positively correlated with the number of cigarettes smoked during the sampling time (rho = 0.38; p = 0.047) and with airborne benzene levels (rho = 0.32; p = 0.019), and negatively correlated with the time elapsed between the last smoked cigarette and urine collecting (rho = -0.40; p = 0.045). Multiple regression analysis confirmed the influence of cigarette smoking on urinary benzene concentrations. In conclusion, our study showed the validity of urinary benzene as a biomarker for biological monitoring of exposure to very low doses of benzene, although cigarette smoking determined a prevalent etiological role at the low environmental benzene concentrations observed.

[Significance and limitation of creatinine adjustment for urinary chromium and arsenic in biological monitoring of occupational exposure to these metallic elements]

Creatinine adjustment has been used to remove the influence of the effect of urine dilution on exposure biomarkers measured in spot samples. This research aimed to determine the reliability of creatinine adjustment for urinary chromium and arsenic in subjects from general population considering interferences able to influence creatinine excretion. 444 male subjects were examined and each participant was administered an anamnestic questionnaire. Chromium and arsenic were determined on second morning void urine samples by atomic absorption spectrophotometry and creatinine by Jaffè method. Urinary creatinine showed a significant negative decrease with age increasing (p < 0.001). Chromium concentrations resulted higher in subjects with renal disease, particularly after creatinine adjustment (p = 0.014). Age was negatively correlated with urinary creatinine (rho = -0.23; p < 0.001), and positively with chromium (rho = 0.13; p = 0.007) and arsenic (rho = 0.17; p = 0.004), only after creatinine adjustment. A positive correlation was also found between unadjusted chromium and arsenic (rho = 0.10; p = 0.039) and between urinary creatinine and both unadjusted chromium (rho = 0.32; p < 0.001) and arsenic (rho = 0.18; p < 0.001). An high coefficient of correlation was observed between unadjusted chromium (rho = 0.88; p < 0.001) and arsenic (rho = 0.90; p < 0.001) and the respective adjusted values. Multiple regression showed a dependence of urinary creatinine and adjusted chromium and arsenic concentrations on age. In conclusion, although chromium and arsenic seem to have a renal kinetics of excretion comparable to the creatinine one, the influence of age on creatinine elimination suggests that the expression of urinary values of these metallic elements as microg/L is more reliable.

The anti-schistosomal drug praziquantel is an adenosine antagonist

The mechanism of action of praziquantel (PZQ), the drug of choice against schistosomiasis, is still unclear. Since exposure of schistosomes to the drug is associated with calcium influx and muscular contraction, calcium channels have been suggested as the target, although direct combination of PZQ with their subunits was never demonstrated. We report a hitherto unknown effect of PZQ, namely the inhibition of nucleoside uptake, as observed in living worms using radio-isotope labelled adenosine and uridine. This effect is clearly seen in schistosomes but is absent in mammalian cells in culture. Moreover it is a specific pharmacological effect seen exclusively with the active levo-R(-)stereo isomer of the drug, and is shared by at least one benzodiazepine having antischistosomal activity. This novel effect acquires significance given that schistosomes cannot synthesize purine nucleosides de novo. A possible relationship between this novel effect and the known action of PZQ on calcium channels is discussed, since adenosine is known to bind to specific receptors and to behave as an indirect antagonist of calcium release in mammalian cells. If calcium channels were correlated with adenosine receptors also in schistosomes, as they are in mammals, this would support the hypothesis that PZQ-induced calcium influx may be correlated to adenosine receptor blockade.

Fractal characterisation of boundary irregularity in skin pigmented lesions

A growing literature shows researcher's interest in fractal analysis, arising from its ability to describe and characterise quantitatively the complexity of several tumour profiles. The aim of the work was to investigate the fractal properties of skin pigmented lesion boundaries. Although melanoma is one of the most aggressive tumours, early detection and a high rate of diagnostic accuracy, followed by timely excision, can allow complete recovery in melanoma patients. A modified approach to fractal dimension estimation was performed that was able to consider, in a data fit procedure, the range in which lesions show fractal properties. Identification of this zone is the most important step towards a correct fractal analysis procedure. The method was checked against a known fractal dimension object (Koch's curve) with an error of 0.007. The fractal dimension was estimated in 110 skin pigmented lesions and showed a significantly increasing linear regression (p < 0.05), from common naevi to naevi with dysplasia to melanomas. This result is important for screening, as it can inform the decision to excise precociously malignant lesions or to avoid unnecessary removal of benign ones. The limitations of the method are discussed.

[Evaluation of myopia in a group of people working with video terminals: first results]

Since the 70's the occupational use of electronic systems equipped with visual display terminals (VDTs) became wide-spread also in Italy. Some longitudinal studies on large samples of VDT workers found no significant changes of myopia (M) with regard to years and daily hours spent working at a VDT.

OBJECTIVE

To evaluate the prevalence and the time course of M in 209 VDT workers employed in the service sector.

MATERIALS AND METHODS

After obtaining workers' informed consent their work, social, family and personal medical histories were collected. Myopia was defined as need of >0.25 D negative spherical correction. Average daily hours duringfollow-up and overall years spent working at a VDT were calculated as exposure indexes.

RESULTS

The mean baseline age was 39.2 years (SD: 8.7, min-max: 22-62) and the mean education was 14 years (SD: 2.2). The mean follow-up period was 5.5 (3-9) years. The prevalence of M was 45.5% at the start and 49.8% at the end of the study. It was higher in workers with >13 years of education and in those < 40 year-old. A slight but significant increase of the degree of M (dioptres) occurred during the follow-up. The change in the degree of M was not different between the classes of VDT exposure (< or = 4 and >4 daily hours; < or =15 and >15 years spent), of education and of age at the end of follow-up.

DISCUSSION

The high mean educational level can partly explain the higher prevalence of M detected in the workers on study with respect to the one described elsewhere on VDT workers and general population. The progression of the M seems not to be related to the professional and personal variables analyzed, but to depend on the natural evolution of M. Further studies are needed to confirm these preliminary data in larger groups of VDT workers.

[Could VDT use induce thoracic hyperkyphosis? Preliminary data]

The association between sitting posture and degenerative alterations of intervertebral disks has been widely studied, while the possible relationship between sitting posture and thoracic hyperkyphosis has not been investigated sufficiently. The objective of this study, therefore, is to verify the possible association between video display terminal (VDT) use, which needs a sitting prolonged posture, and thoracic hyperkyphosis. 63 VDT workers and 71 telephone line maintenance workers (control group) have been examined. The two groups were different for the postural load required by the two jobs. A questionnaire about job and clinical history has been administered to workers included in the study. A complete orthopedical examination has been performed for all workers, while radiographic exams have been performed only in the cases requiring of further diagnostic investigations. The two groups have resulted homogenous for age, while were different for working age and body mass index (BMI). The frequency of subjects with rachialgia has resulted higher in VDT users than in maintenance workers. The prevalence of thoracic hyperkyphosis observed in VDT users has been higher than in maintenance workers, with a difference near to be statistically significant, and significantly associated with age in VDT users. The hyperkyphosis of the dorsolumbar tract have resulted significantly more frequent in VDT users than in maintenance workers (p<0.05). Preliminary results of this study suggest that fixed and prolonged sitting working posture would be able to determine thoracic hyperkyphosis, although constitutional factors and age could have a role in its determination. Preventive measures should be proposed for an adequate ergonomic training of VDT users.

[Oxidative stress in station service workers]

INTRODUCTION

The aim of this study is to identify an oxidative stress in service station workers. Previous studies verified an increased incidence of leukemia and myeloma, however other authors haven't verified it. There are reports of nasal, pharyngeal, laryngeal, and lung cancer in service station workers. Our study wants to evaluate the oxidative balance in the fuel workers.

MATERIAL AND METHODS

We studied 44 subjects with gasoline exposure and 29 control subjects. We determined the blood concentrations of Glutathione reduced and oxidized, Protein sulfhydrylic (PSH) Vitamine E, Vitamine C, Malondialdehyde, Protein oxidized (OX-PROT) and beta carotene. The t test was performed to analyze the differences between the means, the Chi square was used to evaluate the statistical significance of associations between variable categorical (redox index). The Anova test excluded the confusing effect of age, smoke and alcohol habit.

RESULTS

The mean age of the workers was 36.6 years, instead the control group was 38. In the workers Glutathione reduced, Vit. E and Beta carotene were lower than in the control subjects, this difference was statistically significant (p < 0.01). The Malondialdehyde concentration was higher in the workers higher than in the control group, but this difference wasn't statistically significant.

DISCUSSION AND CONCLUSIONS

Our data demonstrated Glutathione, Vit. E, and Beta carotene are useful to verify a reduction of the antioxidant activity. The only marker of the presence of oxidative injury that correlated to work exposure was the malondialdehyde. The redox index was surest marker. The limit of our study is the number of control group, it was little and lower than workers. Conclusively we believe it's useful to continue our studies and, if our results are going to be confirmed, we retain that stress oxidative determination would be verified in occupational medicine using these markers, especially to study exposure of the fuel workers who were investigated less and, in our opinion, would receive more attention.

Analytical control of photocatalytic treatments: degradation of a sulfonated azo dye

The degradation of Methyl Orange (C(14)H(14)N(3)SO(3)Na), chosen as a model sulfonated azo dye, was investigated in aqueous solutions containing suspended polycrystalline TiO(2) particles under irradiation with simulated sunlight. The dye disappearance and the formation of the mineralization end products were monitored; the formation of the main transient intermediates was also examined in detail. Particular attention was devoted to the identification and to the evolution of fragments retaining the chromophoric group. The comparison of data coming from various analytical techniques led to a possible reaction mechanism for the degradation process, giving insight into an aspect of the treatment which has not been considered in previous studies.

Effect of shift work on body mass index: results of a study performed in 319 glucose-tolerant men working in a Southern Italian industry

OBJECTIVE

To examine the influence of shift work on metabolic and cardiovascular risk factors in subjects working in an industry sited in Apulia, Southern Italy.

DESIGN

Cross-sectional study of metabolic effects of shift work in glucose tolerant workers in a chemical industry in southern Italy.

SUBJECTS

The subjects included 319 glucose tolerant male individuals, aged 35-60 y.

MEASUREMENTS

Anthropometric parameters (body mass index (BMI) and waist-to-hip ratio (WHR)), fasting concentrations of glucose, insulin, and lipids (total cholesterol, HDL-cholesterol, triglycerides), the sum of glucose levels during 75 g-oral glucose tolerance test (Sigma-OGTT), and systolic and diastolic blood pressure (SBP and DBP, respectively).

RESULTS

The prevalence of obesity was higher among shift workers compared to day workers, whereas body fat distribution was not different between the two groups. Shift workers had higher BMI than day workers, and shift working was associated with BMI, independently of age and work duration. Shift workers had significantly higher SBP levels, which were independently influenced by BMI, but not by shift work, thus suggesting that the difference in SBP may well be mediated by the increased body fatness.

CONCLUSION

In workers of an industry sited in Southern Italy, shift work may be directly responsible for increased body fatness and is indirectly associated with higher blood pressure levels and some features of metabolic syndrome.

[Occupational exposure to inhalation anesthetics: 10 years of measurements at hospitals in Puglia]

The Authors provide the data gathered from measurements of nitrous oxide in the operating room of Puglia during the period between 1993 and 2003. They prove significant reductions of pollution according with time and they verify lower pollution levels in the operating rooms of private hospitals with respect to public facilities. The importance of the maintenance of gas distribution and evacuation systems is shown and a method of environmental and biological monitoring is provided. Finally, the Authors prove the utility of the graphic representation of the measurements, conduced utilising dedicated instrumentation.