Reconstructing historical exposure to asbestos: the validation of 'educated guesses'

BACKGROUND

In both the epidemiological and legal context, the causal attribution of asbestos-related lung diseases requires retrospective exposure assessment (REA).

AIMS

To assess the correlation between the retrospective assessment of occupational and anthropogenic environmental exposure to asbestos and its content in the lung tissue.

METHODS

Based on the available exposure information, a team of occupational physicians retrospectively assessed cumulative exposure to asbestos in 24 subjects who died of asbestos-related diseases. The asbestos lung content was analysed using analytical scanning electron microscope (SEM-EDS). The Log10 asbestos fibre count in the autoptic samples was predicted as a function of the Log10 estimated cumulative exposure using univariate regression analysis.

RESULTS

The median count of asbestos fibres by grams of dry weight (ff/gdw) in the lung tissue was 81 339 (range 0-2 135 849.06); it was 287 144 (range 0-2 135 849.06) among the occupationally exposed, and 29 671 (range 0-116 891) among the subjects who only had anthropogenic environmental and/or household exposure. Amphiboles, and particularly amosite (52%) and crocidolite (43%), were detected in all the study subjects. Chrysotile was not detected in any of the samples. Overall, the retrospective estimate of lifetime cumulative exposure to asbestos showed a moderate correlation with the total asbestos fibre count in the autoptic lung, with the regression model explaining 38-55% of the total variance.

CONCLUSIONS

Detailed information on occupational, environmental and household exposure circumstances would be indispensable for experienced industrial hygienists and/or occupational physicians to reliably assess past exposure to amphiboles or mixed types of asbestos.

Stable Operation of a Free-Electron Laser Driven by a Plasma Accelerator

The breakthrough provided by plasma-based accelerators enabled unprecedented accelerating fields by boosting electron beams to gigaelectronvolt energies within a few centimeters [1-4]. This, in turn, allows the realization of ultracompact light sources based on free-electron lasers (FELs) [5], as demonstrated by two pioneering experiments that reported the observation of self-amplified spontaneous emission (SASE) driven by plasma-accelerated beams [6,7]. However, the lack of stability and reproducibility due to the intrinsic nature of the SASE process (whose amplification starts from the shot noise of the electron beam) may hinder their effective implementation for user purposes. Here, we report a proof-of-principle experiment using plasma-accelerated beams to generate stable and reproducible FEL light seeded by an external laser. FEL radiation is emitted in the infrared range, showing the typical exponential growth of its energy over six consecutive undulators. Compared to SASE, the seeded FEL pulses have energies 2 orders of magnitude larger and stability that is 3 times higher.

Diagnostic accuracy of transvaginal ultrasound for detection of endometriosis using International Deep Endometriosis Analysis (IDEA) approach: prospective international pilot study

OBJECTIVE

To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in predicting deep endometriosis (DE) following the International Deep Endometriosis Analysis (IDEA) consensus methodology.

METHODS

This was an international multicenter prospective diagnostic accuracy study involving eight centers across six countries (August 2018-November 2019). Consecutive participants with endometriosis suspected based on clinical symptoms or historical diagnosis of endometriosis were included. The index test was TVS performed preoperatively in accordance with the IDEA consensus statement. At each center, the index test was interpreted by a single sonologist. Reference standards were: (1) direct visualization of endometriosis at laparoscopy, as determined by a non-blinded surgeon with expertise in endometriosis surgery; and (2) histological assessment of biopsied/excised tissue. Surgery was performed within 12 months following the index TVS. Accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV) and positive and negative likelihood ratios (LR+ and LR-) of TVS in the diagnosis of DE were calculated.

RESULTS

Included in the study were 273 participants with complete clinical, TVS, laparoscopic and histological data. Of these, based on histology, 256 (93.8%) were confirmed to have endometriosis, including superficial endometriosis, and 190 (69.6%) were confirmed to have DE. Based on surgical visualization, 207/273 (75.8%) patients had DE. For DE overall, the diagnostic performance of TVS based on surgical visualization as the reference standard was as follows: accuracy, 86.1%; sensitivity, 88.4%; specificity, 78.8%; PPV, 92.9%; NPV, 68.4%; LR+, 4.17; LR-, 0.15, and the diagnostic performance of TVS based on histology as the reference standard was as follows: accuracy, 85.9%; sensitivity, 89.8%; specificity, 75.9%; PPV, 90.4%; NPV, 74.6%; LR+, 3.72; LR-, 0.13.

CONCLUSIONS

Using the IDEA consensus methodology provides strong diagnostic accuracy for TVS assessment of DE. We found a higher TVS detection rate of DE overall than that reported by the most recent meta-analysis on the topic (sensitivity, 79%), albeit with a lower specificity. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

P-747 Prevalence of Caesarean scar defect (CSD) and clinical impact on reproductive outcomes in patients undergoing in vitro fertilization (IVF)

Study question

Can sonohysterography-detected CSD have a deleterious effect on reproductive outcomes in women with secondary infertility undergoing IVF?

Summary answer

A 68% prevalence of CSD has been estimated in the study population. CSD significantly reduces the ongoing pregnancy rates in women undergoing IVF cycles.

What is known already

here is limited and conflicting evidence about the relation between Caesarean section, CSD and IVF treatment outcomes. Notably, most of the previous studies did not investigate the presence of CSD in infertile women with a history of Caesarian delivery. Furthermore, even if considered, the diagnosis of CSD is commonly based on transvaginal ultrasound assessment. Given the lower sensitivity of this method compared to saline infusion sonohysterography, an underestimation of the real effect is plausible.

Study design, size, duration

Retrospective cohort study of 122 women with a history of Caesarean delivery and an indication to IVF for secondary infertility referred to an Italian public assisted reproductive centre between 1 January 2016 and 30 April 2021.

Participants/materials, setting, methods

Women aged 18-43 with secondary infertility and a history of Caesarean delivery, tested for CSD with a saline infusion sonohysterography were included. Women with congenital uterine anomalies, intra-cavitary uterine pathologies, adenomyosis or previous myomectomy were excluded. CSD was defined as an anechoic indentation on the cesarean scar at the midsagittal plane, with a depth ≥ 2 mm.

Main results and the role of chance

Among the 122 women included, 83 (68%) were diagnosed with CSD by saline infusion sonohysterography. One hundred and fourteen patients underwent at least one IVF cycle: 76 (case group) had a CSD, 38 (control group) had a normal Caesarean scar. Groups were similar in patients and treatment characteristics. Clinical pregnancy rate was 43% in the CSD group and 71% in the control group (odds ratio [OR] 0.31; 95% confidence interval [CI], 0.14-0.72; p = .006). Ongoing pregnancy rates were 33% and 58%, respectively (OR, 0.34; 95% CI, 0.15-0.76; p = .015). Similar results were obtained after adjusting for potential confounders on the regression analysis. Ectopic pregnancy and miscarriage rate along with obstetric and neonatal complications were similar in both groups. In a subgroup-analysis comparing women with CSD who achieved pregnancy and those who did not, pregnant patients had a greater residual myometrial thickness compared to those who did not get pregnant, even if this finding did not reach statistical significance (5.3 mm versus 4.4 mm, p .07).

Limitations, reasons for caution

Retrospective nature of the study does not permit to infer a causal association between CSD and the reduced chance of pregnancy. Our results are representative of an infertile population but generalization needs further investigation. The sample size was too small to reveal the potential effect on obstetric and neonatal outcomes.

Wider implications of the findings

In infertile patients with a previous Caesarean section, the presence of CSD is more common than previously thought. The presence of CSD might significantly reduce the IVF success rate. This finding is important in relation to the rising of Caesarean section rates and the possible application of CSD surgical repair.

Trial registration number

not applicable

P-438 Fertility outcomes in male cancer recipients of hematopoietic cell transplantation who stored their semen for fertility preservation

Study question

What are the prevalence estimates of post-hematopoietic cell transplantation (HCT) natural conceptions or after ART using stored semen?

Summary answer

Natural live birth rate following HCT can be estimated at 9% (95%CI:4-22%) but can be increased to 58% (95%CI:43-72%) with the use of frozen semen.

What is known already

With the improvements and expanding indications of HCT, the number of adult male cancer survivors who received HCT is increasing. These men face the risk of treatment-induced infertility and are generally recommended to store their semen prior to embark in HCT. However, information on long term usage and on effectiveness of frozen sperm samples in this specific population is not well defined.

Study design, size, duration

All male cancer recipients of autologous or allogeneic transplantation who cryopreserved semen between 1987 and 2016 in the biobank of the Assisted Reproductive Technology Unit of the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico in Milan were considered. Information was obtained from patients’ charts or through active investigation. The main studied topics included results from semen analyses, attempt to parenthood, use of stored spermatozoa and both natural and Assisted Reproductive Technique (ART) mediated conceptions.

Participants/materials, setting, methods

The study is restricted to men who met the following eligibility criteria: i) semen cryopreserved for fertility preservation between 1987 and 2016; ii) post-banking follow-up documenting HCT iii) survival of at least 5 years from HCT.

Main results and the role of chance

One-hundred and two HCT survivors were selected. The median [IQR] age at sperm banking was 29 [23-34]. About half of subjects had autologous HCT (n = 50), the remaining 52 received allogenic HCT. Lymphomas were the most frequent indications. The median spermatozoa concentration at the time storage was 39 [7-85] millions/ml. Fifty-four (53%) men performed a post-treatment sperm analysis and azoospermia was documented in 45 of them (83%, 95%CI: 71-91%). The remaining nine showed viable spermatozoa, of whom six had severe oligospermia (concentration <1 million/mL). The other three had semen concentration >5 Millions/ml, compatible with a natural conception. Overall, based on semen analyses, one could infer the necessity to use ART in 51 out of 54 subjects, corresponding to 94% (95%CI: 85-98%). Forty-three of the 102 included men (42%) sought childbearing. Four had a natural live birth (9%, 95%CI: 4-22%). Thirty-three used their cryopreserved sperm samples, corresponding to 32% (95%CI: 24-42%) of the whole cohort. Twenty-one of these 33 men had at least one live birth (64%, 95%CI: 47-78%). Finally, six men seeking pregnancy and who did not conceive have not used their frozen semen. Overall, 25 out of 43 men interested in fatherhood had a live birth (58%, 95%CI: 43-72%).

Limitations, reasons for caution

Limitation of our study is missing detailed information on status of illness and comorbidities (in particular the frequency of Graft-versus host disease) and lack precise information on the myeloablative regimen used. Furthermore, our sample size is not very large and therefore the 95%CI of the reported proportions are wide.

Wider implications of the findings

Autologous or allogeneic HCT induces infertility in a very high percentage of patients. These findings support the need to prioritize sperm preservation before HCT also in cancer patients who are not candidate for HCT at first instance but who may need this treatment for failure of first line treatments.

Trial registration number

not applicable

Free-electron lasing with compact beam-driven plasma wakefield accelerator

The possibility to accelerate electron beams to ultra-relativistic velocities over short distances by using plasma-based technology holds the potential for a revolution in the field of particle accelerators^1-4. The compact nature of plasma-based accelerators would allow the realization of table-top machines capable of driving a free-electron laser (FEL)⁵, a formidable tool to investigate matter at the sub-atomic level by generating coherent light pulses with sub-ångström wavelengths and sub-femtosecond durations^6,7. So far, however, the high-energy electron beams required to operate FELs had to be obtained through the use of conventional large-size radio-frequency (RF) accelerators, bound to a sizeable footprint as a result of their limited accelerating fields. Here we report the experimental evidence of FEL lasing by a compact (3-cm) particle-beam-driven plasma accelerator. The accelerated beams are completely characterized in the six-dimensional phase space and have high quality, comparable with state-of-the-art accelerators⁸. This allowed the observation of narrow-band amplified radiation in the infrared range with typical exponential growth of its intensity over six consecutive undulators. This proof-of-principle experiment represents a fundamental milestone in the use of plasma-based accelerators, contributing to the development of next-generation compact facilities for user-oriented applications⁹.

Thyroid Dysfunction after Gonadotropin-Releasing Hormone Agonist Administration in Women with Thyroid Autoimmunity

GnRH agonists (GnRHa) are a useful tool for pretreatment before artificial endometrial preparation for frozen-thawed embryo-transfer (FET). Their prolonged administration has been associated with thyroid dysfunction, both hyper and hypothyroidism. The aim of this study is to investigate the impact of GnRHa administration on thyroid function in women undergoing artificial endometrial preparation. Seventy-eight euthyroid women undergoing endometrial preparation with hormone replacement for FET were retrospectively reviewed. They were divided into two groups according to pretreatment with GnRHa (group A, 42 women) or with an oral contraceptive (group B, 36 women). Group A was subsequently divided into two subgroups according to thyroid autoimmunity presence. Thyroid function has been evaluated and compared among groups and subgroups. Our results did not show any statistically significant differences in age, body mass index, and basal thyroid stimulating hormone (TSH). Total estradiol dosage, duration of treatment, and endometrial thickness were comparable among groups. When TSH was measured 14 days after embryo transfer, no significant differences between the two groups were reported. Among women of group A, TSH was significantly higher only in women with thyroid autoimmunity. GnRHa seems to be associated with thyroid dysfunction in women with thyroid autoimmunity undergoing hormone replacement therapy for FET.

Chloracne: a case series on cutaneous expression of CYP1A1 as diagnostic biomarker

Chloracne, also known as metabolizing acquired dioxin-induced skin hamartomas (MADISH), is a rare disfiguring disease related to dioxin exposure. There is a paucity of literature on the clinical manifestations and pathogenesis of chloracne/MADISH. The aim of this study was to assess the clinical features of this very unusual acneiform eruption and to explore the pathogenesis of the disease. This was a retrospective, observational report study was conducted on five patients belonging to the same nuclear family (father, mother and three children) and a relative (father's brother) living in the same house. Histopathological, immunohistochemical, laboratory and toxicological analyses were performed for all patients. The results suggest that CYP1A1 in human skin is a diagnostic biomarker in chloracne, and was positive for all the patients in our sample. Tetrachlorodibenzo-p-dioxin is the most investigated dioxin responsible for chloracne; however, several other agonists, whether dioxin-like or not, can activate the aryl hydrocarbon receptor. To our knowledge, this Italian case series is the first study to suggest polychlorinated biphenyls as a possible cause of an overstimulation of aryl hydrocarbons causing the consequent acneiform eruption.

Longitudinal Phase-Space Manipulation with Beam-Driven Plasma Wakefields

The development of compact accelerator facilities providing high-brightness beams is one of the most challenging tasks in the field of next-generation compact and cost affordable particle accelerators, to be used in many fields for industrial, medical, and research applications. The ability to shape the beam longitudinal phase space, in particular, plays a key role in achieving high-peak brightness. Here we present a new approach that allows us to tune the longitudinal phase space of a high-brightness beam by means of plasma wakefields. The electron beam passing through the plasma drives large wakefields that are used to manipulate the time-energy correlation of particles along the beam itself. We experimentally demonstrate that such a solution is highly tunable by simply adjusting the density of the plasma and can be used to imprint or remove any correlation onto the beam. This is a fundamental requirement when dealing with largely time-energy correlated beams coming from future plasma accelerators.

Focusing of High-Brightness Electron Beams with Active-Plasma Lenses

Plasma-based technology promises a tremendous reduction in size of accelerators used for research, medical, and industrial applications, making it possible to develop tabletop machines accessible for a broader scientific community. By overcoming current limits of conventional accelerators and pushing particles to larger and larger energies, the availability of strong and tunable focusing optics is mandatory also because plasma-accelerated beams usually have large angular divergences. In this regard, active-plasma lenses represent a compact and affordable tool to generate radially symmetric magnetic fields several orders of magnitude larger than conventional quadrupoles and solenoids. However, it has been recently proved that the focusing can be highly nonlinear and induce a dramatic emittance growth. Here, we present experimental results showing how these nonlinearities can be minimized and lensing improved. These achievements represent a major breakthrough toward the miniaturization of next-generation focusing devices.

3D-printed capillary for hydrogen filled discharge for plasma based experiments in RF-based electron linac accelerator

Plasma-based acceleration experiments require capillaries with a radius of a few hundred microns to confine plasma up to a centimeter scale capillary length. A long and controlled plasma channel allows to sustain high fields which may be used for manipulation of the electron beams or to accelerate electrons. The production of these capillaries is relatively complicated and expensive since they are usually made with hard materials whose manufacturing requires highly specialized industries. Fine variations of the capillary shape may significantly increase the cost and time needed to produce them. In this article, we demonstrate the possibility of using 3D printed polymeric capillaries to drive a hydrogen-filled plasma discharge up to 1 Hz of repetition rate in an RF based electron linac. The plasma density distribution has been measured after several shot intervals, showing the effect of the surface ablation on the plasma density distribution. This effect is almost invisible in the earlier stages of the discharge. After more than 55000 shots (corresponding to more than 16 h of working time), the effects of the ablation on the plasma density distribution are not evident and the capillary can still be used. The use of these capillaries will significantly reduce the cost and time for prototyping, allowing us to easily manipulate their geometry, laying another building block for future cheap and compact particle accelerators.

Density and temperature characterization of long-scale length, near-critical density controlled plasma produced from ultra-low density plastic foam

The ability to produce long-scale length (i.e. millimeter scale-length), homogeneous plasmas is of interest in studying a wide range of fundamental plasma processes. We present here a validated experimental platform to create and diagnose uniform plasmas with a density close or above the critical density. The target consists of a polyimide tube filled with an ultra low-density plastic foam where it was heated by x-rays, produced by a long pulse laser irradiating a copper foil placed at one end of the tube. The density and temperature of the ionized foam was retrieved by using x-ray radiography and proton radiography was used to verify the uniformity of the plasma. Plasma temperatures of 5-10 eV and densities around 10(21) cm(-3) are measured. This well-characterized platform of uniform density and temperature plasma is of interest for experiments using large-scale laser platforms conducting High Energy Density Physics investigations.

Endotension-related aortic sac rupture treated by endograft relining

Endovascular aortic aneurysm repair is an effective alternative to open surgical repair in high risk patient. Endotension is an unpredictable late and rare complication of EVAR. Clinical significance and choice of technique for treatment are controversial. At present, there are no cases of endotension-related aneurysmal sac rupture reported in literature, altough it is frequently associated with late surgical conversion. In this case report is described a case of a patient treated with a first generation Gore Excluder(TM) endograft for abdominal aortic aneurysm, with late aneurysmal sac enlargement without evidence of endoleak and subsequent contained rupture without anemia and shock. We have successfully treated the patient by endovascular procedure, through bilateral percutaneous femoral approach, with relining technique. Three years CT scan follow-up showed the endograft patency and size sac reduction.

Diet assessment and the screening for osteoporosis: a survey in a healthy menopause population

AIM

The aim of this study was to investigate about diet assessment in the screening for osteoporosis.

METHODS

In 1,441 women (group A, mean age 53.5 years, mean time from menopause 3.92(+/-4.33)] the number of daily/weekly servings/cups of different foods has been collected. In 71 women (group B, mean age 59 years, mean time from menopause 6 years) diet was assessed through a detailed questionnaire. Demographic and clinical data and dietary habits were related to bone mineral density (BMD) values, using Student t-test and the chi2 test.

RESULTS

Group A: borderline/reduced BMD 40%, the percentage increasing with age and the duration of menopause (P<0.001). BMI within normal range 56.28%. BMD values were positively associated with Body Mass Index (BMI, P<0.001), education level (P<0.005), job (P<0.01), oral contraceptives use (P<0.001), negatively with family history of osteoporosis (P<0.05). BMD values showed a positive relation with the number of eggs per week (P<0.05), positive not significant trends were observed with dairy products, vegetables, red and white meat intake. A low/reduced BMD was related to low calcium food intake in less than 50% of the women. Group B: borderline/reduced BMD 55%; BMD showed positive trends, not significant, with daily calcium intake, BMI, physical exercise. Estimated calcium intake less than 700 mg/day was found in 33% of the sample.

CONCLUSION

Diet assessment is not useful in the screening for osteoporosis. In women with borderline or reduced BMD, diet assessment helps to detect those at low calcium intake who need calcium supplementation, alone or in combination with other treatments.

Characterization and induction of human pre-adipocytes

Human processed lipoaspirate is a source of multipotent adult stem cells that are able to differentiate between mesenchymal and neurogenic lineage. We characterized PLA cells by cytometry and then they were cultured to induce differentiation into myogenic and neurogenic lineage. Lipoaspirates were digested with collagenase to obtain the pellet, which was labelled with anti-CD44, anti-CD45, and anti-CD90. We used BD FACS Calibur flow cytometer to acquire cellular events. Some cells were cultured at 37 degrees C and 5% CO(2) in neurogenic or myogenic medium and analysed by immunocytochemistry, using Neuron specific enolase, Vimentin, Glial fibrillary acidic protein, Tau, MAP2 to confirm neurogenic differentiation, MyoD1, Myosin heavy chain, Actin smooth muscle, vimentin to confirm myogenic differentiation. The cytometry results suggest that a part of the cells are of a mesenchymal origin, among which there are progenitor endothelial cells and leucocytes. Microscopy observation already reveals neuronal morphology and longitudinal multinucleated cells compared to control cells. Neurogenic cells only express NSE (early neuronal progenitor marker), but not GFAP, Tau, MAP2 (mature neuron and glial markers); myogenic cells are positive for MyoD1 and Myosin heavy chain. This demonstrates that lipoaspirate cells are capable of differentiating in vitro over a short period of time, and could be employed in biological and clinical research, like mesenchymal adult stem cells.

[Minimally-invasive endoscopic transthoracic sympathectomy of the upper limbs. A new method]

OBJECTIVE

Indications for endoscopic transthoracic upper dorsal sympathectomy are axillary and palmar hyperhidrosis, upper extremities ischemia (due to, e.g., Raynaud s disease), and upper extremities causalgia.

METHODS

At present, this methodology relies on (at least) double trocar insertion (per side) and/or carbon dioxide insufflation. Thus, although this approach, compared with the traditional open sympathectomy techniques, it guarantees the smallest number of postoperative complications, it still determines a certain amount of postoperative discomfort as well as a risk of complications related to carbon dioxide insufflation, as intraoperative profound bradycardia and hypotension due to mediastinal shift, and postoperative subcutaneous emphysema. From December 1995, we are using a minimally-invasive endoscopic transthoracic sympathectomy technique, performed by a single-entry specifically modified thoracoscope and without the need for carbon dioxide insufflation, with the aim to reduce the drawbacks associated with the above-mentioned currently adopted endoscopic techniques. After general anesthesia with double-lumen endotracheal tube, with the patient placed in a half-sitting position with both arms abduced to 90 degrees, a 1 cm incision is performed, along the midclavear line (in male patients) or the anterior axillary line (in female patients), in the second or third intercostal space.

RESULTS

The effects of sympathectomy are immediate, and the patients wake up with warm and dry hands and axillae.

CONCLUSIONS

In personal opinion, this single-entry technique, compared with other reported approaches, should minimize any damage to the intercostal neurovascular bundle, while avoiding the complications connected with carbon dioxide insufflation.

Effect of chronic ozone fumigation on the photosynthetic process of poplar clones showing different sensitivity

Rooted cuttings from two poplar clones (Populus x euramericana, I-214, and Populus deltoides x maximowiczii, Eridano) were exposed for 15 days to diurnal square-wave treatment with ozone (60 nL L-1 for 5 h day-1). Completely fully expanded leaves exposed to ozone showed a reduction in net CO2 assimilation rate as compared to the control leaves during whole exposure period in both the clones. The reduction was related to a strong stomatal closure in clone I-214, but also to an altered mesophyll activity ascribed to limitation of the dark reactions of photosynthetic process. The results obtained in leaves of I-214 subjected to long-term fumigation seem to support the view that the decrease in quantum yield of electron transport may be a mechanism to down-regulate photosynthetic electron transport so that production of ATP and NADPH would be in equilibrium with the decreased demand in the Calvin cycle. In Eridano the CO2 assimilation was reduced because of the exposure and any alteration in stomatal conductance was observed. Thus, chlorophyll fluorescence parameters showed that an inhibition of photosystem II had occurred (reduction in Fv/Fm ratio), while no alterations in quenching parameters were observed upon illumination. The results seem to indicate that an alternative sink for reducing equivalent, other than carbon metabolism is present.

Endoscopic transthoracic dorsal sympathectomy for the treatment of upper extremity hyperhidrosis: a new minimally invasive approach

Palmar and axillary hyperhidrosis are best treated surgically by endoscopic transthoracic upper dorsal sympathectomy. At present, this methodology relies on (at least) double trocar insertion (per side), carbon dioxide insufflation, or both. We present a new minimally invasive endoscopic transthoracic technique, performed by a single-entry specifically modified thoracoscope and without the need for carbon dioxide insufflation, with the aim to reduce the drawbacks associated with the above-mentioned, currently adopted endoscopic technique. In our opinion, this "single-entry" technique, compared with the other reported approaches, should theoretically minimize any damage to the intercostal neurovascular bundle, while avoiding the complications related to carbon dioxide insufflation.

Follicular bisection in hair transplantation surgery: an in vitro model

The aim of this study was to evaluate, in an in vitro model, the survival and growth rates of transversely sectioned human hair follicles to assess experimentally the soundness of this approach as a future possible method for "duplicating" available donor hair grafts in hair transplantation procedures. A total of 300 human anagen hair follicles was obtained from 10 healthy male patients. Follicles were thus randomly assigned to one of the following groups: group A (control; n = 100 follicles), cultured intact as dissected, and group B (experimental; n = 200 follicles), transversely transected, parallel to the epidermal surface and immediately below the bulge area, to obtain 200 lower-half follicles and 200 upper-half follicles. Isolated hair follicles from both groups were maintained in culture for 10 days. The length of each follicle was measured immediately following isolation and at the end of the 10-day culture period. No statistically significant differences were found between the growth rate of intact follicles (mean 10-day growth rate = 2.71 mm) and of lower-half follicles (mean 10-day growth-rate = 2.64 mm), whereas a statistically significant difference was found between the growth rate of follicles from the two above-mentioned groups and the growth rate of the "upper-half" follicles (mean 10-day growth rate = 1.07 mm). Histologic analysis demonstrated that both intact and lower-half follicles maintained a normal histologic appearance, whereas in upper-half follicle sections we invariably detected a region of intense cell proliferation, reminiscent of a regenerated follicular papilla, surrounding the lowermost part of the follicle. In our opinion, the reported in vitro survival rate of transected human hair follicles might represent an interesting starting point in striving to augment the number of donor hairs available during a hair transplantation procedure.

[Meta-analysis and dose-response functions of air pollution respiratory effects]

A Meta-analysis was conducted on 107 original epidemiological papers published between 1980 and 1993 on the respiratory health impact of suspended particles, sulfur dioxide, ozone and nitrogen dioxide. These are the usual air quality indicators that are monitored in urban ambient air. The range of exposures that were studied (averages and 90th percentiles are respectively up to 88, 83, 124 and 53 mu/m3 (averages) and 180, 147, 234 and 131 micrograms/m3 (90th percentile) for each of the four pollution indicators) allowed assessment of dose-response functions for irritative pulmonary conditions (cough and/or asthma episodes) and respiratory function (FEVI and peak expiratory flow). The dose-response functions seem linear in the range of observed concentrations, with nitrogen dioxide showing the least consistent association across different health indicators. When applied to exposures measured as a 100 micrograms/m3 increase of pollutant's concentrations compared to low background values, the average relative risks of airway irritation (cough and/or asthma épisodes) range, according to the pollutant, from 1.08 to 1.47; average relative decreases of respiratory function amount to 1.1 to 2.2%. The effects are most often stronger among young subjects. The results of this study, when applied to air pollution concentrations in the range of values that were observed in this study, should foster health risk assessment studies in places where population air pollution exposures are available.

Moderate alcohol consumption and its relation to visceral fat and plasma androgens in healthy women

OBJECTIVE

To study the inter-relationships between daily alcohol intake, fat distribution and plasma androgens in order to verify whether daily alcohol intake correlates with abdominal body fat and, if so, to what extent such a relation is mediated by plasma androgens.

SUBJECTS

A random sample of 87 clinically healthy women (aged 38 y) with a light-moderate alcohol consumption and without clinical evidence suggestive of any endocrine disorder.

MEASUREMENTS

Anthropometric and computed tomography (CT scans made at the level of L4-L5 in a subgroup of 18 women) measurements of body fatness and adipose tissue distribution, main behavioural factors, including daily alcohol intake and plasma androgens (i.e. total and free testosterone levels).

RESULTS

After adjustment for BMI, cigarette smoking and physical activity, significant differences were found in waist circumference and waist-hip ratio as well as in plasma androgens with increasing daily alcohol intake. Waist-thigh ratio tended to parallel waist-hip ratio, but did not achieve statistical significance. In simple linear regression analysis, abdominal visceral fat area, derived from CT, correlated positively with both plasma free testosterone and alcohol intake. While the above reported difference in body fat distribution totally disappeared after controlling also for free testosterone level, the differences in plasma androgens with increasing alcohol intake remained essentially unchanged when allowance was made also for waist-hip ratio. In multiple linear regression analysis, daily alcohol intake appeared to be positively and independently correlated to both plasma total and free testosterone levels. Neither BMI nor waist-hip ratio nor fasting insulin made any significant contribution to the prediction of plasma androgens after daily alcohol intake had been taken into account.

CONCLUSIONS

The results of this study show that moderate alcohol consumption correlates with abdominal distribution of body fat, likely due to enlarged visceral fat area, and increased plasma androgenicity (i.e. higher total and free testosterone levels) in adult healthy women. These data also suggest that the relation between alcohol intake and fat distribution may be, at least in part, mediated by plasma androgens.

Combined management in the treatment of epidoxorubicin extravasation. A case report

Inadvertent extravasation during intravenous antitumor therapy is not an unusual complication and can cause damage ranging from minor erythema to severe local necrosis. The appropriate management of these iatrogenic accidents as a part of supportive care in oncology has been addressed by several experimental studies, but there has been little clinical study and no conclusive evidence on the best therapeutic strategies to adopt. The case reported here of a patient suffering from severe soft-tissue injury caused by extravasation of epidoxorubicin demonstrates the usefulness of a combined management (medical, surgical and rehabilitative) in the appropriate care of extravasation.

[Experimental considerations of the mechanism of lip and palate fusion]

Although harelip, cleft palate, or both, are by far the most common major facial malformations, the mechanisms underlying their embryogenesis are only now beginning to be understood; this is due to the complexity of primary and secondary palate development and the fact that appropriate methods for study have only recently been developed. The authors present a review of the most significant data regarding the etiology of hare lip and cleft palate, both in their physiopathogenic aspects and in their clinical morphology. The peculiarity of these malformations is outlined, supported by literature data and personal experimental experience.

[Etiopathogenesis of hand syndactyly in the light of several experimental findings]

The limb developmental program is comprised of processes of cell multiplication and of cell determination, differentiation and morphogenesis. Many of these processes depend on cell-cell communications within tissues and between different tissue types. The Authors present a review of the more significant data about the etiology of the syndactylies of the hand, both in their physiopathogenic aspects and in their clinical typology. The peculiarity of these malformations is outlined, supported by literature data and personal experimental experiences.

[Beta-cyclodextrin-piroxicam in the treatment of the active phase of osteoarthritic pathology]

The anti-inflammatory and analgesic activity of the beta-cyclodextrin-piroxicam (beta CDP) complex was assessed in a randomized single-blind controlled parallel study vs nabumetone (NAB). Forty patients, 18 men and 22 women aged 18 to 65 and suffering from chronic osteoarthritis, were treated. Both drugs were orally administered, once a day in the morning, for 4 consecutive weeks. PI and SPID, evaluated for 24 hours following the first drug administration, showed a quicker onset of the analgesic action of beta CDP, with statistically significant differences between treatments (p less than 0.05). In the medium-term treatment, beta CDP proved to be more effective on joint swelling, spontaneous pain, pain on passive movement and functional limitation. Both treatments were well tolerated but a higher gastro-intestinal side-effect incidence was recorded in NAB group.

Behcet's disease associated with HLA-B51 and DRw52 antigens in Italians

Thirty-eight Italian patients with Behcet's disease, all with ocular involvement, (28 complete type and ten incomplete) were typed for HLA A,B,DR, and DQ antigens. A significant increase of HLA-B51 (p less than 0.00001) and DRw52 (p = 0.045) with no significant difference between complete and incomplete syndrome was found. The involvement of B51 antigen as the main immunogenetic factor in the disease is suggested by the high value of relative risk (RR = 16.03). However, the association with the II class antigen DRw52 (RR = 2.77) cannot be easily explained as a secondary association due to linkage disequilibria with B51.