Extra-auditory effects of noise exposure in school workers and preventive measures: a systematic review

OBJECTIVE

Noise is still today one of the main causes of occupational diseases; in fact, in Italy in the three-year period 2019-2022, hearing loss represented 15% of all occupational diseases recognized by the National Institute for Insurance against Accidents at Work. The extra-auditory effects related to noise exposure also require particular attention, because they can interfere with mental activities that require concentration, memory and ability to deal with complex problems, causing sleep and learning disorders. For this reason, acoustic comfort is considered a fundamental requirement for obtaining an optimal degree of well-being in closed environments. In schools, a high degree of noise pollution not only makes it difficult for students to listen and learn, but also affects school workers. The aim of this study was to perform a systematic review of international literature and analysis of the preventive measures of extra-auditory effects among school workers.

MATERIALS AND METHODS

The presentation of this systematic review is in accordance with the PRISMA statement. The methodological quality of the selected studies was assessed with specific rating tools (INSA, Newcastle Ottawa Scale, JADAD, JBI scale and AMSTAR). Only publications in English were selected. No restrictions were applied for the publication type. We excluded articles not concerned with the extra-auditory effects of noise exposure in school workers and preventive measures, findings of less academic significance, editorial articles, individual contributions, and purely descriptive studies published in scientific conferences.

RESULTS

Online research indicated 4,363 references: PubMed (2,319), Scopus (1,615) and Cochrane Library (429) have been consulted; 30 studies were included in this review (5 narrative or systematic reviews and 25 original articles). Regarding the scores of narrative reviews, the INSA score showed an average and a median value of 6.5, thus indicating an intermediate/high quality of the studies. Regarding the scores of systematic reviews, the AMSTAR score showed an average of 6.7 and a median and a modal value of 6, thus indicating a high quality of the studies. The scores assigned to the original articles have an average and median value of 7 and a modal value of 6 and this demonstrates an intermediate/high quality of the studies.

CONCLUSIONS

We can assume that, as it is highlighted by this study, to date these consequences are not considered at the legislative level for the protection of exposed workers. The extra-auditory effects impacting health afterward environmental noise exposure are many and widespread. Therefore, there is a need for interventions to be carried out by institutions and that the physician of the schools, during health surveillance, investigates the effects and clinical manifestations, in order to prevent disorders and deficits highlighted by our study.

What hides beneath the scar: sexuality and breast cancer what women don't say: A single-center study

BACKGROUND

Breast is a symbol of femininity, motherhood and sexuality. Breast cancer (BC) is the leading cause of cancer death in women worldwide and most frequent cancer in Italy: in 2019, 53.500 new cases were diagnosed. BC and its treatment, the disturbances of body image, and mental health problems such as anxiety and depression could influence sexuality. Very often the aspect of sexuality in BC is likely not to be fully investigated: cultural barriers may also contribute to lack of attention to these issues. In Italy, there are very few Breast Units that provide the figure of the sexologist and psycho-oncologist.

METHODS

We enlisted 141 BC patients (pts), mean age was 54 years afferent to Breast Unit S. Maria Goretti Hospital, Latina, from March 2019 to March 2020. All pts had undergone surgical intervention. Participants were invited to complete a structured questionnaire, which included four close-up questions regarding self-image, sexual activity, sexual satisfaction, analyzing these aspects before and after BC and its treatments. Finally the participants were asked if they needed the sexologist and psycho-oncologist.

RESULTS

Only 2/141 pts (1.41%) refused to participate in our study. Of 139 participants, 68 (48.92%) had disturbances of body image, 26 (18.7%) had sexuality greatly negatively affected, and 103 (74.1%) every kind of sexual dissatisfaction after BC. 38 pts (27.3%) would require the help of the sexologist. 135 ( 97%) would require the help of the psycho-oncologist. Despite the negative influence in their body-image and sexuality, few pts require the help of the sexologist, but nearly all pts require the help of the psycho-oncologist.

CONCLUSION

In our study nearly all pts require the help of the psycho-oncologist, but few pts of the sexologist. Further studies will be needed to understand the reasons for this disparity: at the moment we are carrying out another project following this illustration, with the aim of understanding why this disparity.

A case report: Use of FT-IR analysis to improve Colovesical fistula diagnosis

Colovesical fistula (CVF) is an abnormal connection between the colon and the urinary bladder. Faecaluria, reported in 40–70% of cases, is virtually pathognomonic for CVF. During the 5th day of recovery in an 84 years old subject, the passage of cloudy, malodorous urine with visible debris was observed. According to the pathognomonic character of faecaluria, the sample was signed to the laboratory for biochemical and microbiological investigation, able to define the type and origin of materials. Following clinical requirements, both biochemical pathways and instrumental procedures able to confirm or exclude the presence of faecal components in urine were considered. No biochemical compound or component addressing faecal compounds in urine results available between laboratory tests. The brown powder component of the pellet was identified as Keratin, with 90% overlapping with the reference spectrum of the compound. FT-IR analysis on urine pellet can be proposed as a simple, non-invasive, and fast method to improve the diagnostic course of CVF.

Development and validation of a specific real-time PCR assay for the detection of the parasite Perkinsus olseni

Perkinsus olseni is a protozoan parasite that infects a wide variety of molluscs worldwide, causing economic losses in the aquaculture sector. In the present study, a quantitative PCR (qPCR) assay was developed for the detection and quantification of P. olseni in clam gill tissue and hemolymph (Ruditapes philippinarum and R. decussatus), and the results were compared with those of the standard diagnostic methods recommended by the O.I.E. (World Organisation for Animal Health): Ray's fluid thioglycollate culture method (RFTM), a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay and histopathology. The efficiency, sensitivity and reproducibility of the newly described qPCR assay were also determined. The highest prevalence was detected using the qPCR assay, and the strongest linear correlation was obtained between the RFTM infection levels and the threshold cycle (Ct) number from the gill tissue. Although better results were obtained from gill than from the hemolymph in the qPCR assays, especially with lower infection levels of the parasite, a significant linear correlation was observed between Ct values from the gill and hemolymph. The qPCR assay that was developed in this study showed high sensitivity, specificity and reproducibility for the detection and quantification of P. olseni.

Mitomycin-c, Adriamycin, 5-Fluorouracil and Leucovorin (L-FAM2) in the Treatment of Advanced Gastric Cancer: A Phase II Study

Thirty previously untreated patients with advanced measurable gastric cancer were given a combination chemotherapy consisting of 5-fluorouracil, 400 mg/m2, and leucovorin, 200 mg/m2 iv on days 1 to 3, mitomicyn-C, 10 mg/m2 on day 1 (every other cycle) and adriamycin, 40 mg/m2 on day 2, repeated every 21 days. The overall response rate was 46 % (14/30; 95 % confidence limits: 28 %-64 %) including 4 patients with a complete remission. Eight patients progressed. Median duration of remission (CR+PR) was 10 months, with a median survival of 13, 8 and 4 months for CR + PR, NC and PD, respectively. Main toxicities were leukopenia (WHO grade III-IV in 36 % of the patients) and alopecia. One patient died from myocardial infarction after an adriamycin cumulative dose of 480 mg/m2. No other treatment-related death occurred. L-FAM2 is an effective combination for advanced gastric carcinoma. Further studies based on the association of leucovorin and 5-fluorouracil in combination with other active drugs are warranted.

Enhanced Effectiveness of Adriamycin and Bleomycin Combined with Local Hyperthermia in Neck Node Metastases from Head and Neck Cancers

The results of this study concern the comparison of the clinical effects of adriamycin (ADM) or bleomycin (BLM) alone and combined with local hyperthermia on 15 patients with multiple (29) neck node metastases from head and neck cancers. With repeated low fractional daily doses of drug a significant though transient tumor regression was obtained in 2/8 and in 3/6 of the lesions treated with ADM or BLM alone, respectively. When the drugs were combined with 42-43°C hyperthermia, an overall response, either complete or partial, was seen in all the lesions. Complete regression was observed in 38% (3/8) and 43% (3/7) of the lesions treated with ADM or BLM, respectively, combined with heat. At a 4-month follow-up, 33% (2/6) and 40% (2/5) of the same groups of lesions remained still undetectable. These results suggest that the combined treatment of drugs and local hyperthermia can be advantageously employed in clinical practice for treating local tumors, especially recurrences in previously irradiated areas.

Physicochemical Characterization of Exhaust Particulates from Gasoline and Diesel Engines by Solid-Phase Micro Extraction Sampling and Combined Raman Microspectroscopic/Fast Gas-Chromotography Mass Spectrometry Analysis

Ambient Particulate Matter (PM) has been shown to be associated with cardiopulmonary diseases and lung cancer. Several groups of investigators have shown that the size of the airborne particles and their surface area determine the potential to elicit inflammatory injury and other mechanisms of adverse cellular effects. Because traffic is an important source of PM, it seems obvious that physicochemical characterization of vehicles exhaust emission has an important impact on both quantitative and qualitative aspects of ambient PM. In the present study the exhaust emissions of 8 vehicles of different categories were analyzed to attempt to differentiate them. For such purpose the particulate was collected on SPME fibers exposed to the exhaust emission for 150 s. The particulate was first characterized by micro-Raman spectroscopy and then subjected to Fast Gas Chromatography-Mass Spectrometry analyses for the chemical identification of the Polycyclic Aromatic Hydrocarbons (PAHs) compounds, the organic fraction of particulate matter in air pollution with a major role in the toxicity, notably via its effects on inflammation. Both the particle count and the PAHs compositional data were assembled to be interpreted by Principal Components Analysis. This multivariate analysis grouped the data according mainly to the naphthalene amount, as well as the volume concentration of the particles smaller than 0.5 μm, suggesting that the different exhaust emissions could be easily differentiated. With this new methodology, future research should aim at establishing a mechanism of formation during internal engine combustion processes in order to obtain a clearer picture of the inflammatory and carcinogenic mechanisms of PM in the lungs.

Efficacy of domestic cooking inactivation of human hepatitis A virus in experimentally infected manila clams (Ruditapes philippinarum)

AIM

The aim of this work was to evaluate the efficacy of domestic cooking in inactivating Manila clams experimentally infected with human hepatitis A virus (HAV).

METHODS AND RESULTS

Electronic temperature probes were positioned to measure the internal temperature of Manila clams during domestic cooking. Two batches were infected with 10(7) and 10(5) TCID50  ml(-1) of HAV. The infected whole-in-shell clams were divided into three replicates and cooked on a conventional stove both singularly and in group and removed from the pan at fixed intervals. Pools of three digestive glands were examined by virus isolation for three blind passages and cell culture supernatant tested with real-time PCR.

CONCLUSION

Results showed that 2-min cooking by a traditional domestic method at a temperature close to 100°C, after the opening up of the valves of all the clams, can completely devitalize the HAV in high viral load-infected clams.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study on inactivation of HAV in experimentally infected Manila clams subjected to domestic cooking. At present, labelling all lagoon products as 'requiring cooking before consumption' is highly recommended, but no specifications are given on how long and at what temperature they should be cooked. Considering the high commercial value of Manila clams, our results can provide both the producers and the consumer with useful indications on how to cook clams to prevent the risk of HAV foodborne illness.

Ostreid herpesvirus type 1 genomic diversity in wild populations of Pacific oyster Crassostrea gigas from Italian coasts

Ostreid herpesvirus 1 (OsHV-1) is a significant pathogen affecting the young Pacific oyster Crassostrea gigas, worldwide. A new variant, OsHV-1 μVar, has been associated with recurrent mortality events in Europe since 2008. Epidemiological data collection is key for global risk assessment; however little is known about health status and genotypes present in European wild oyster beds. Most studies to date have involved only cultivated individuals during mortality events, and reported low genotype diversity. With this study, conducted along the Italian coasts, we investigated for the first time the presence of OsHV-1 in European natural oyster beds. Analysis of three genomic regions revealed the presence of at least nine different genotypes, including two variants close to the OsHV-1 reference, known since the early 1990s but with no European record reported since 2010, and highlights relevant genotype diversity in natural environment. Phylogenetic analysis distinguished two distinct clusters and geographical distribution of genotypes, with the exception of a variant very closely related to the μVar, which appeared the single genotype present in all the Adriatic sites. Interestingly, these wild symptom free populations could represent, in Europe, an accessible alternative to the import of OsHV-1-resistant oyster strains from the East Pacific, the native area of C. gigas, avoiding the high-risk of non-native marine species and new pathogen introductions.

Radical cystectomy versus organ-sparing trimodality treatment in muscle-invasive bladder cancer: A systematic review of clinical trials

BACKGROUND

Radical cystectomy (RC) represents the mainstay of treatment in patients with muscle-invasive urinary bladder cancer but how it compares with the best organ preservation approach is not known.

MATERIALS AND METHODS

The objective of our review is to compare the 5-year overall survival (OS) rates from retrospective and prospective studies of RC and trimodality treatment (TMT), i.e. concurrent delivery of chemotherapy and radiotherapy after a transurethral resection of bladder tumor (TURBT), involving a total of 10,265 and 3131 patients, respectively. We used random-effect models to pool outcomes across studies and compared event rates of combined outcomes for TMT and RC using an interaction test.

RESULTS

The median 5-year OS rate was 57% in the TMT group, when compared with 52% (P=0.04), 51% (P=0.02) and 53% (P=0.38) in the whole group receiving RC or the group treated with RC alone or RC+chemotherapy, respectively. The hazard risk (HR) of mortality of patients treated with TMT or RC was 1.22 (95% CI=1.13-1.32) with an absolute benefit of 5% in favor of the former. The HR of mortality from TMT persisted significantly better not only versus the group treated with RC alone (HR=1.22; 95% CI=1.12-1.32), but also versus the group receiving RC+chemotherapy (HR=1.22; 95% CI=1.09-1.36). Multivariate analysis confirmed TMT as a significant prognostic variable for both RC alone and RC+chemotherapy.

CONCLUSION

Compared with RC, TMT seems to be associated with a better outcome for patients with muscle-invasive bladder cancer (MIBC). The addition of chemotherapy may improve the RC outcome in some subgroups of patients with a higher probability of micrometastases. Prospective randomized trials are urged to verify these findings and better define the role of organ preservation and radical treatment strategy in the management of patients with MIBC.

Survey of Anisakis sp. and Hysterothylacium sp. in sardines and anchovies from the North Adriatic Sea

The occurrence of larval Anisakidae and Raphidascarididae in anchovies and sardines from the North Adriatic Sea has been estimated. Anisakis pegreffii and Hysterothylacium aduncum were reported, with low prevalence values. In brief, a total amount of 7650 fish specimens collected between September 2011 and 2012 were analysed using three different inspection analyses: a visual inspection of the coelomic cavity, an examination of the viscera exploiting the positive hydro-tropism of the larvae (modified Baermann technique) and enzymatic digestion of muscular tissue pools. Low level of infestation was reported for Anisakis sp. in both in anchovies and sardines, while higher values were reported for Hysterothylacium sp. Subsamples of nematodes collected were characterized at species level using the molecular diagnostic key based on ITS nuclear ribosomal region, and A. pegreffii and H. aduncum were identified. The low prevalence of Anisakis sp. in sardines and anchovies from the North Adriatic Sea could be related to the peculiar distribution of cetaceans and carnivorous zooplankton in the investigated region and could be used as a potential tag to define oily fishes from this specific fishing area as at low-risk for anisakiasis.

Dual analysis of host and pathogen transcriptomes in ostreid herpesvirus 1-positive Crassostrea gigas

Ostreid herpesvirus type 1 (OsHV-1) has become a problematic infective agent for the Pacific oyster Crassostrea gigas. In particular, the OsHV-1 μVar subtype has been associated with severe mortality episodes in oyster spat and juvenile oysters in France and other regions of the world. Factors enhancing the infectivity of the virus and its interactions with susceptible and resistant bivalve hosts are still to be understood, and only few studies have explored the expression of oyster or viral genes during productive infections. In this work, we have performed a dual RNA sequencing analysis on an oyster sample with a high viral load. High sequence coverage allowed us to thoroughly explore the OsHV-1 transcriptome and identify the activated molecular pathways in C. gigas. The identification of several highly induced and defence-related oyster transcripts supports the crucial role played by the innate immune system against the virus and opportunistic microbes possibly contributing to subsequent spat mortality.

[Promoting the quality of health surveillance of workers exposed to wood dust, with particular care to NPSC, in the territory of the Health Agency of Florence]

Wood dust can cause occupational-related naso-sinusal cancer, characterized by a latency period of about 40 years. The Tuscany Cancer Registry estimates that cases of NPSC are from 20-25 per year into the Region (33% related to wood dust). These neoplasms are surgically treatable at early-stage and, for this reason, a rapid endoscopic diagnosis is considered to be reasonably useful for prognostic issues. We used a questionnaire to investigate nasal symptoms and NOSQ and SOLAR questionnaires to highlight respiratory/skins diseases, and a spirometry for each worker. Subjects with a working-age of more than 15 years, and those that were positive to the questionnaire and/or to the medical history were were referred to a specialist in otolaryngology. The prevalence of endoscopic positive findings--detected especially in subjects with a working age of more than 15 years--confirms the significance of the problem.

[Employment of disabled people regarding Italian Law "68/99": Florence's ASL N. 10 experience]

The reform of mandatory employment in Italy, performed by the national Law 68/99, represented a crucial step for the assertion of the right to work for disabled people. The aim of our experience is to obtain information about health and safety conditions of disabled people employed in targeted workplaces and about the issues for that workers keep or lose their job, possibly in order to take actions on workplaces and to improve job conditions for all other workers also. In this paper we used data regarding targeted employments of disabled people, collected during the year 2008 in the Province of Florence.

[Risk assessment of arterial hypertension in a working population]

During last years life expectation and working-life are increased and, consequently, the evaluation of workers whit chronic age-related diseases is more frequent than in the previous decades. We analyzed 9616 (2337 females and 7279 males) medical reports collected during health surveillance. Workers with arterial hypertension were 1770 (254 females and 1516 males) with an average age of 49.02 years +/- 9.52, and an average BMI of 27.9 +/- 4.43 Kg/m_. Workers who reported a complete fitness-to-work certification were 88.6%, ones with a fitness-to-work certification whit limitations were 11.2%, and only 0.2% were unfit to work. Our data confirm the importance of company strategies oriented to health promotion on the workplaces considering the progressive ageing of the workforces.

[Cardiovascular risk factors and metabolic shift workers in a population of railway workers]

Cardiovascular and metabolic risk factors prevalence is studied with an increasing interest, involving also working-age people, Several studies had evidenced that shift-work is a key factor in the etiology of cardiovascular illnesses. Railway workers--especially those who are involved in the monitoring of rail traffic--are often shift-workers. Their shift-schedule is based on a rotation of--in this order--afternoon, morning and night. Regarding the important role played by this kind of workers for the public safety, the evaluation of their cardiovascular risk is of utmost importance. In this study we evaluated the prevalence of cardiovascular risk factors in railway shift-workers to define prevention strategies.

[Evaluation of the impact of night-work on health in a population of workers in Tuscany]

Night-work, loading to subversion of physiological circadian rhythms and habits, may cause a lowering of work performance, an increase in the risk of accidental events and, more generally, a perception of less satisfactory living condition. In our experience we have interviewed 359 workers (night-workers and not). We found, in line with the Literature, that night-workers receive a less satisfactory quality of sleep, often associated with daytime sleepiness. The prevalence of disorders of various organs and systems is higher in these subjects, as well as the consumption of caffeine and nicotine. Regarding road and work-accidents, a similar trend is not so clearly confirmed in our series; in this context we have, nevertheless, to take account of some potential bias. Our experience confirmed that night-work may produce animpact on the individual overall well-being and, consequently, on the companies' productivity. To reduce this impact and the related costs, it is necessary to plan interventions on both workers and work organization.

Fully automated solid-phase microextraction-fast gas chromatography-mass spectrometry method using a new ionic liquid column for high-throughput analysis of sarcosine and N-ethylglycine in human urine and urinary sediments

A fully automated, non invasive, rapid and high-throughput method for the direct determination of sarcosine and N-ethylglycine in urine and urinary sediments using hexyl chloroformate derivatization followed by direct immersion solid-phase micro extraction and fast gas chromatography-mass spectrometric analysis was developed and validated. The use of a new ionic liquid narrow bore column, as well as the automation and miniaturization of the preparation procedure by a customized configuration of the utilized XYZ robotic system, allowed a friendly use of the GC apparatus achieving a quantitation limit of 0.06 μg L(-1) for sarcosine, good repeatability with CV always lower than 7% and reduced analysis times useful for point-of-care testing. The method was then applied for the analysis of 56 samples of urine and urinary sediments in healthy subjects, in those with benign prostatic hypertrophy and in patients with clinically localized prostate cancer. The results obtained showed that the medians of sarcosine/creatinine in urine were 103, 137 and 267 μg g(-1) respectively, thus assessing the potential use of sarcosine as urinary biomarker for prostate cancer detection. The highest values of sensitivity (79%) and specificity (87%) were obtained in correspondence of a cut-off value of 179 μg sarcosine(g creatinine)(-1), thus by using this cut-off threshold, sarcosine was significantly associated with the presence of cancer (p<0.0001). Finally, ROC analyses proved that the discrimination between clinically localized prostate cancer and patients without evidence of tumor is significantly correlated with sarcosine.

[The control of drugs consumption in occupational contexts: management of the test results]

From November 2008 to July 2010 we made 8300 drug tests to verify the absence of drug addiction or drugs/psychotropic substances consumption. We found 101 positive subjects (1.2%) at the first screening test; for fifty-five of them (54.5% of positives) we obtain a confirmation at second level test (0.7% of total tests). Sixty percent of these were positive for cannabinoids, 18.1% for opiates, 12.7% for cocaine, 9.0% for methadone, 3.6% for ecstasy and nobody for amphetamines. We noticed a good correlation between screening and confirmation tests for cannabinoids, methadone and cocaine. The analysis of the population of positive subjects shows that it's almost entirely composed by males, Italians, middle aged, heavy smokers and generally overweight, in apparent good health (average blood tests, any reported illnesses, any disability or any contraindications/limitations in employment).

[Ultraconservative treatment in stage I and II breast carcinoma. Results of a long-term follow-up on 500 operated breasts]

AIM

Several randomized trials on conservative surgery compared with mastectomy in early-stage breast cancer have validated this technique in terms of local and distant relapse and survival of patients. Standard conservative approach includes surgical removal of the cancer with adequate cancer-free margins, axillary dissection, postoperative breast irradiation and adjuvant treatments when required.

METHODS

From 1987 to 2003, 500 early stage breast carcinoma were treated on 494 patients with conservative surgery and postoperative radiotherapy. Surgery consisted in a wide tumorectomy, with intraoperative control of R0 margins. The total postoperative radiation dosage was 50 Gy on the whole breast, associated with a boost of 10 Gy on tumor bed (20 Gy in T2 neoplasms). Before 1997 node-positive patients were treated with axillary irradiation with 50 Gy. Postoperative chemotherapy and/or hormonal therapy were administered to patients according with node-involvement, age and menopausal status. AJCC-stage was T1N0 in 44%, T2N0 in 15%, T1N1 in 19% and T2N1 in 22% of the patients.

RESULTS

In a postoperative setting, we observed 9% of axillary seromas or hematomas and 7% of oedema of the arm. At a median follow-up of 150 months (range 48-248 months), actuarial local recurrence rates were 7% at 5 years and 14% at 10 years. The actuarial rates of distant metastases were 18% at 5 years and 33% at 10 years. Ten-year overall and disease-free survival rates were 81% and 60%, respectively. Cosmetic results were good/excellent in 80%, satisfactory in 10% and poor in 10% of patients.

CONCLUSION

Recurrence and survival rates in breast-conserving surgery are consistent with indexed literature on conservative treatment of early breast cancer. Women eligible for conservative treatment should be offered the choice of either wide tumorectomy or quadrantectomy with axillary lymph nodes removal and postoperative radiotherapy, or modified radical mastectomy.

[Health problems in the working occupation of young people in handicraft factories]

The regulation of the work activity of young people (younger and apprentices) evolved in Italy - as in the others industrialized countries - in the last century. In the 1967 was promulgated the Law 977 (Protection of children and adolescent at work), still in force. To start the work activity, young people must be older than fifteen years and need to have ended the compulsory school. The most recent laws extend to the student the worker's rights. Many studies are conducted on the populations of apprentices - a sort of "virgin" subjects respect to work hazards - with the aim of early identify the subjects susceptible to develop, in future, illness related to work. In particular, many studies show an increased percentage in sensitization to high weight proteins, present in many working process, during the apprenticeship period. The practical stage activity, mainly necessary in the technical schools, can hide various hazards for the health of young students. The student must be followed by two different tutors, tightly collaborating together, one of the school and the other of the company where the work activity is done. The health status of the student could be evaluated before starting an hazardous work.

Safety, efficacy, and time to clinical response with bevacizumab plus FOLFIRI regimen in metastatic colorectal cancer

e15138

Background: Bevacizumab (BEV) has shown clinical activity in metastatic colorectal cancer patients (mCRC)and randomised phase III trials have demonstrated that this agent significantly improves overall and/or progression-free survival when added to first-line irinotecan based chemotherapy (CT) regimens. We evaluated the efficacy and safety of BEV plus FOLFIRI (irinotecan, 5- fluorouracil, and leucovorin) as first line treatment in 27 consecutive metastatic colorectal cancer cases, with the primary end point to calculate the median time to clinical response with this chemotherapeutic schedule. Methods: Between October 2007 and January 2008 we collected the data on 27 patients with mCRC treated with first line chemotherapy with BEV plus FOLFIRI. Elegibility criteria had to be: mCRC; no prior CT for metastatic disease; ECOG PS 0/1, adequate organ function; no CNS metastases. The treatment consisted of a minimum of six cycles of irinotecan plus infusional 5-FU/LV according to the classical FOLFIRI schedule; BEV (5mg/kg) was given on day 1 with CT and then every 2 weeks until disease progression. Safety and response were assessed at the time of first CT and every 4 weeks thereafter. Results: 27 pts were evaluable (male 18; median age 61 years (range 45–77), ECOG PS 0: 52%, PS 1: 48%. The sites of metastases were: liver (15 pts), lung (5 pts), liver and lung (5 pts), peritoneal wall (2 pts).Median follow-up was 18 weeks. Two patients had complete response(CR) and 13 pts partial response (PR), with an overall response rate of 57.7%. Five patients had stable disease and 6 patients showed progressive disease. A clinical benefit was demonstrated in 77 % of pts. We observed a median time to clinical response of 11 weeks, evaluated with tumor markers and with CT/NMR/US examinations. A grade 3 or 4 neutropenia was detected in 39% of pts and grade 2 or 3 hypertension in 9%. We did’nt observe cases of thrombosis, bleeding and gastrointestinal perforation, sometimes related to the use of BEV. Conclusions: In this little experience the efficacy and safety of BEV associated with FOLFIRI schedule, a first line therapy in mCRC,is consistent with results from other previous studies, showing moreover a short time to clinical response with this association.

No significant financial relationships to disclose.

A Double-Blind, Vehicle-Controlled Clinical Study to Evaluate the Efficacy of MAS065D (XClair™), a Hyaluronic Acid-Based Formulation, in the Management of Radiation-Induced Dermatitis

This study was designed to assess the efficacy and tolerability of MAS065D (Xclair) compared to a vehicle control in the management of radiation dermatitis in patients receiving radiotherapy for breast cancer. Twenty patients were randomized blindly to use the two study substances, three times daily, on separate sections of irradiated skin throughout the duration of radiotherapy and for two weeks afterwards. Patients were monitored before therapy, weekly during therapy, and for 2 weeks after radiotherapy was completed. Skin appearance according to National Cancer Institute (NCI) toxicity criteria, erythema rating, transepidermal water loss (TEWL), skin hydration, patients' view of itch, pain, acceptance, and view of each cream and adverse events, were monitored; at the final visit patients and investigators expressed their preference for one of the creams. MAS065D showed statistically significant superiority in the outcomes of NCI grading for radiation dermatitis and erythema. Patients' and investigators' preferences for one of the study substances were statistically in favor of MAS065D. Very few patients recorded nonzero itch and pain scales, so no significant differences emerged between the two groups. It was concluded that MAS065D can provide an effective option for managing radiation dermatitis although further studies are needed to assess its effect on pain and itch.

Single fraction partial breast irradiation in prone position

The purpose of this work is to introduce a new treatment approach and technique for partial breast irradiation in only one session to patients in prone position by using a dedicated positioning device. The patients were treated on a home-made treatment table top that allows the breast to hang down. A particular immobilization system was introduced in order to assure the reproducibility of patient positioning between the CT acquisition session and the treatment session. The clinical target volume (CTV) was outlined according to surgical clips position and/or tumor location on preoperative mammography. Because of negligible movement due to respiration, only an additional margin of 3 mm was added to obtain the planning target volume (PTV). Based on radiobiological calculations, a dose of 21 Gy was prescribed to PTV. The tumor bed was treated with 3D-CRT technique by using 5 fields and rotating the table while the gantry was approximately 90 or 270 degrees. Thirty patients were enrolled for this study chosen in conformity to an approved clinical protocol. The average percentage of PTV volume enclosed in the 90% and 95% of prescribed dose were 99.9 and 98.6% respectively, while only 3.4% of PTV volume received more than 105% of prescribed dose. Dose to 3% of skin volume was, on average, 15.2 Gy. In 97% of patients, less than 50% of the ipsilateral breast received a dose greater than half the prescribed dose. Mean doses to lungs, heart and contralateral breast were negligible. With a median follow-up of 9 months, no important early toxicity was observed both for skin and breast tissue. The treatment of breast tumor bed in prone position in only one session by using the 3D-CRT is technically feasible and seems to be a promising alternative to other accelerated partial breast irradiation techniques.

[Work related sensitization risk in hotel school students, the role of garlic]

We want to evaluate the incidence of allergic problems in a population of catering students at the beginning and after 3 and 5 years of their course. We enrolled in the study 601 students of a professional catering school: 412 in the first year and 189 in the fifth years. We used two questionnaires to investigate respiratory problems and dermatological ones. All the subjects were also patch tested with 10 aptens. The incidence of reported symptoms of allergy was higher in fifth year than in first one. We can observe a rising in positive reaction between the two group of students to Balsam Perù, Nickel, Fragrance mix and Garlic. In particular we found an higher incidence of positive patch reaction in female population. On the contrary the rising in positive reaction to Garlic is higher in male. About two third of the subjects positive to garlic present a sensitization to diallyl disulphide. The rising of positive patch test reactions to Garlic and Balsam Perù should be caused by the contact with cooking spices. The higher incidence of allergic pathology between students during fifth year of school and students at first year is probably due to scholastic practical activity.

[Accidents in health care workers: the experience from the Careggi Teaching Hospital]

In the last eleven years in the Careggi Hospital 4941 occupational accident has been registered, and 2951 workers were involved (28.9% of the total of the workers present in the period). The highest frequency of accident has been registered within the cooking staff, about one half of whom had an accident, and 7.2% more than 0.6 accident for person-year; the more serious consequences were registered for traffic accident, more than half happened coming to the workplace before the beginning of the work. Only 154 workers registered more than 0.6 accidents for person-year.

[Anesthetic gases exposure: findings from a 13 year environmental and biological monitoring in a hospital company]

The evolution of the modern anaesthesiologic technique aimed to detect more manageable and less toxic aesthetic gas, but adequately efficacy. This study considered the environmental and biological evaluation of the Careggi Hospital in Florence between 1991 and 2005. The pollution threshold of each aesthetic gas used (Nitrous oxide, Isoflurane and Sevoflurane) is reduced as time passed. The higher values about the pollution threshold have been found in the ophthalmology and in the otolaryngology operating room. We observed clinical and biological data of 74 health care workers (HCW). The anaesthetists and assistants were the more exposition. We didn't found any correlation between the exposure at gas and the clinical, and biological data. Some neurological and nonspecific symptoms (like head-ache and reduction of attention threshold) appear from the clinical informations; these symptoms suggest a possible effects on the HCW' health also for low pollution threshold.

Respiratory risks in tunnel construction workers

Respiratory diseases are frequent in tunnel construction workers. A group of 144 subjects randomly selected from the population of 2516 workers engaged in the construction of the railway tunnel under the Appennine Mountains, from Bologna to Firenze was investigated. A group of 69 males comparable for age, living area and habits was studied as a control group. Assessment of air pollutants (NO, NO2, SO2, total dust, silica %) was carried out by means of fixed monitoring stations as well as personal monitors. All the subjects included in the study were examined with a standardised protocol which included physical examination, lung function tests (before and after shift work) and a questionnaire to college respiratory symptoms. Low concentrations of environmental pollutants were evidenced. Significantly lower values of FEV1 and PEF were determined in the worker group pared to controls. A significant decrease in respiratory parameters was shown after shift work. Variables capable of influencing the decrease in parameters include smoking habits, work activity, presence of cough and expectoration, period of the year (spirometries resulted worse in the winter time). Significantly lower values of FEV1 and PEF were evidenced in the workers compared to controls. In spite of the present low work environmental exposure conditions, some physiologic parameters appear altered in tunnel construction workers. This may depend on a variety of noxious agents present in the working environment.

Evaluation of occupational exposure to high-level disinfectants in endoscopic services in an Italian hospital

The aim of this study is the evaluation of exposure to airborne, high-level disinfectants to efficiently organize prevention of the risks due to the manipulation of these substances in the endoscopic units in medical facilities. In field and personal samples in the breathing zone of the workers were taken in 27 endoscopic units in a hospital during the replacement of high-level disinfectants in basins, tubes and lavaendoscopes. After a campaign of environmental monitoring of glutaraldehyde in nineteen endoscopic units (176 employees) of the hospital and considering the entity of glutaraldehyde problem, two substitutes, peracetic acid and electrolyzed acid water, have recently been introduced. The level of glutaraldehyde was higher than the TLV-Ceiling in 13 out of 19 working units, while the value of peracetic acid resulted higher than TLV-TWA in 1 out of 15. EAW has recently been used in two units and the chlorine environmental concentrations resulted lower than the sensibility limit of the method (<75 microg/m3). The results obtained during this study of measurements allowed to identify those operations which have the highest degree of risk for employees; this serves for taking suitable measures for prevention and individual protection as well as for evaluating current practices and decisional processes in the hospital.

Hormonal adjuvant treatment plus radiotherapy versus exclusive radiotherapy in locally advanced prostate cancer: Pooled analsys of 6 randomized trials

4642

Background: The magnitude of the benefit of adding adjuvant hormonal treatment to radiotherapy for locally advanced prostate cancer is still unclear. We performed a pooled-analysis of phase III trials, to quantify the eventual benefit in recurrence decrease. Methods: All prospective phase III trials were considered eligible. A pooled analysis was accomplished, and event-based relative risk ratios (RR) with 95% confidence interval (CI) were derived through both a fixed- (FEM) and a random-effect model (REM) approach. Significant differences in primary outcome (recurrence rate), and secondary outcomes (overall survival), were explored. Magnitude outcome measures were: absolute benefits and number of patients needed to treat (NNT) for 1 patient to benefit. Heterogeneity test was applied as well. Results: Six trials designed to look if hormonal treatment plus radiotherapy decreases recurrence rate (3,571 patients) were gathered. In the primary outcome, the combined approach significantly improves the recurrence rate when applying the FEM (RR 0.72, 95% CI 0.68, 0.77, p < 0.0001), with an absolute benefit of 10.7%. The NNT was 9 patients. Although significant heterogeneity was found (p = 0.00001), the benefit remains significant at the REM as well (RR 0.67, 95% CI 0.54, 0.82, p < 0.0001). Although significant at FEM (RR 0.93, 95% CI 0.86, 1.00, p = 0.039) but heterogeneous (p = 0.0007), the overall survival demonstrated a not-significant trend in favour of the combined strategy at REM (RR 0.90, 95% CI 0.75, 1.10, p = 0.263). Conclusions: Considered all the available phase III trials, the combination of adjuvant hormonal treatment with radiotherapy over standard exclusive radiotherapy significantly decreases the recurrence rate in patients affected by localized prostate cancer. The significant heterogeneity in the analysis underscores the existing difference in patient’ characteristics. No significant benefit in overall survival was found.

No significant financial relationships to disclose.

Prolonged gemcitabine infusion as radiosensitizer for newly diagnosed glioblastoma multiforme (GBM): A phase I study

1581

Background: The use of cytotoxic drugs concurrent with RT represents a promising approach in the combined treatment of malignant gliomas. Gemcitabine (dFdCyd) is a drug widely explored for its potential radiomimetic activity in different tumors. The present study was aimed to evaluate the dose-limiting toxicity (DLT) and maximum tolerated dose (MTD) of weekly prolonged dFdCyd infusion, administered in combination with RT as first line treatment, in adult pts affected by supratentorial GBM. Methods: Within 6 weeks after surgery, in the presence of measurable residual disease and KPS >70, pts were treated with fractionated RT at a dose of 2.0 Gy/daily fractions, 5 days a week (global dose 60 Gy). From 24 to 72 hours before the first RT application, and afterwards once weekly, pts received concurrent dFdCyd, at fixed dose rate of 10 mg/m2/min, over a total period of six weeks. Planned dose levels of dFdCyd started from 200 mg/m2/weekly (level 1), with sequential steps of 25 mg/m2/w based on toxicity. Results: Ten pts were enrolled into the study: six were male, median age 55.2 years (range 44–75), with a median KPS at baseline of 85 (SD 9.71). The median time from diagnosis to the start of treatment was six weeks (range 4–7). The median RT duration was 6 weeks (range 4–7), all but one pt received the planned dose and all pts received concomitant CT. Four pts entered at Level 1; one pt was excluded from the study, due to rapid progressive disease during the treatment. Two of the three valuable pts presented a relevant neurological worsening; on this basis the dFdCyd dose was reduced to 175 mg/m2/w (Level -1). A total of six pts were entered at Level -1, and none of them reported DLT. No hematological grade 3–4 toxicity was reported. Grade 3 non-hematological toxicity was observed in one pt (transaminases increase). After a median follow-up of 13.4 months (range 3–24), the median progression-free survival was 8 months (CI 95% 1–18), and the median overall survival was 14 months (CI 95% 12–17). Conclusions: The recommended dose of prolonged infusion of dFdCyd concomitant with RT is 175 mg/m2/w. The observed activity has been considered interesting enough to support a phase II study of this concurrent CT-RT schedule as first line treatment in GBM.

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