The cost-effectiveness of transcatheter aortic valve implantation: exploring the Italian National Health System perspective and different patient risk groups

OBJECTIVES

To assess the cost-effectiveness (CE) of transcatheter aortic valve implantation (TAVI) in Italy, considering patient groups with different surgical risk.

METHODS

A Markov model with a 1-month cycle length, comprising eight different health states, defined by the New York Heart Association functional classes (NYHA I-IV), with and without stroke plus death, was used to estimate the CE of TAVI for intermediate-, high-risk and inoperable patients considering surgical aortic valve replacement or medical treatment as comparators according to the patient group. The Italian National Health System perspective and 15-year time horizon were considered. In the base-case analysis, effectiveness data were retrieved from published efficacy data and total direct costs (euros) were estimated from national tariffs. A scenario analysis considering a micro-costing approach to estimate procedural costs was also considered. The incremental cost-effectiveness ratio (ICER) was expressed both in terms of costs per life years gained (LYG) and costs per quality adjusted life years (QALY). All outcomes and costs were discounted at 3% per annum. Univariate and probabilistic sensitivity analyses (PSA) were performed to assess robustness of results.

RESULTS

Over a 15-year time horizon, the higher acquisition costs for TAVI were partially offset in all risk groups because of its effectiveness and safety profile. ICERs were €8338/QALY, €11,209/QALY and €10,133/QALY, respectively, for intermediate-, high-risk and inoperable patients. ICER values were slightly higher in the scenario analysis. PSA suggested consistency of results.

CONCLUSIONS

TAVI would be considered cost-effective at frequently cited willingness-to-pay thresholds; further studies could clarify the CE of TAVI in real-life scenarios.

Prognostic role of sonographic decongestion in patients with acute heart failure with reduced and preserved ejection fraction: a multicentre study

Aims

Our aim was to assess the dynamic changes of pulmonary congestion (PC) through variations of sonographic B-lines, in addition to conventional clinical, biohumoral and echocardiographic findings, to improve prognostic stratification of patients admitted for acute heart failure with reduced and preserved ejection fraction (HFrEF, HFpEF).

Methods

In this multicenter, prospective, observational study, lung ultrasound was performed in all patients at admission and before discharge by trained investigators, blinded to clinical findings and outcomes.

Results

We enrolled 208 consecutive patients admitted for acute heart failure (125 HFrEF, 83 HFpEF, mean age 75.9±11.7 years, 36% females, mean ejection fraction 38%). After 180-day follow-up, 38 composite endpoint events occurred (cardiovascular deaths or HF re-hospitalisations). In a multivariate model, B-lines at discharge had independent prognostic value in the overall population together with NT-proBNP, moderate-to-severe mitral regurgitation (MR) and inferior vena cava diameter at admission. When dividing the population in HFrEF and HFpEF, B-lines at discharge was the only independent parameter to predict events in all subgroups. At ROC analysis, a cut-off of B-lines>15 at discharge displayed the highest accuracy in predicting adverse events (AUC=0.80, p<0.0001). The identification of patients unable to halve B-lines during hospitalization (ΔB-lines%), in addition to B-lines >15 at discharge, improved event classification (integrated discrimination improvement=4%, p=0.01; continuous net reclassification improvement=22.8%, p=0.04).

Conclusions

The presence of residual subclinical sonographic PC at discharge predicts adverse events in the whole spectrum of acute HF patients, independently of conventional biohumoral and echocardiographic parameters. The dynamic evaluation of pulmonary decongestion during hospital stay can further improve patient risk stratification.

Funding Acknowledgement

Type of funding source: None

Perfluoroalkyl substances and lipid profile in exposed pregnant women in the Veneto Region, Italy

Background

Perfluoroalkyl substances (PFASs) are persistent and widespread environmental pollutants. Residents of a large area of the Veneto Region (North-Eastern Italy) were exposed to high concentrations of PFASs through drinking water from the late-1970s to 2013. PFASs have been consistently associated with raised serum lipids, but only few studies have been conducted among pregnant women, and none has stratified analyses by trimesters of gestation. Our main objective was to evaluate the association between perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) levels and lipid profiles in high-exposed pregnant women.

Methods

A cross-sectional analysis was conducted in 319 pregnant women (age 14-48 years) recruited in the Regional health surveillance program. Serum PFASs were measured by HPLC-MS/MS. Non-fasting serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were measured by enzymatic assays in automated analysers, and low-density lipoprotein cholesterol (LDL-C) was calculated. The associations between ln-transformed PFASs (and categorized into quartiles) and lipids were assessed using generalized additive models. Analyses were adjusted for potential confounders and stratified according to pregnancy trimester.

Results

In the first trimester, plasma concentrations of both PFOA and PFOS were positively associated with TC. However in the third trimester PFOA levels were instead inversely significantly associated with TC and LDL-C levels. Overall, both PFOA and PFOS were positively associated with HDL-C, and PFOA negatively with LDL-C.

Conclusions

In a small highly exposed population of pregnant women, the associations between PFASs concentrations and lipid profile were modified by trimester of gestation. Patterns late in pregnancy were different to the positive associations with LDL-C generally found. Differential transfer and bioaccumulation of lipids and PFAS in the placenta across gestation might explain our findings.

Key messages

This study provides evidence of different patterns of PFAS associations with lipids in pregnant women across the trimesters of gestation. The different patterns of association from general population studies sheds light on the role of fetal nutrition during pregnancy affecting both lipids and PFAS in serum.

Perfluoroalkyl substances and blood pressure in exposed young population in the Veneto Region, Italy

Background

Residents in a large area of the Veneto Region (North-Eastern Italy) were exposed to perfluoroalkyl substances (PFASs) via drinking water. Studies on the association between PFASs and blood pressure (BP) levels are limited and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence.

Methods

The study included 16,224 individuals aged 20-39 years. Pregnant women (n = 327), participants with self-reported diagnosis or under treatment (n = 296) or with missing information on the selected covariates (n = 114) were excluded, leaving 15,487 subjects. Hypertension (HYP) was defined as any self-reported diagnosis, use of antihypertensive drugs, or raised systolic/diastolic blood pressure (SBP)≥140, DBP ≥90 mmHg). Serum PFASs were measured by HPLC-MS. Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, HYP, adjusted for potential confounders.

Results

Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFASs concentration in a monotonic way. The predicted increase in SBP and DBP were 1.62 (95% CI = 0.69, 2.55), 1.64 mmHg (95% CI = 0.96, 2.31) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each ln-PFAS was positively associated with an increased odds of HYP in men: PFOA OR = 1.07 (1.01-1.14), PFOS OR = 1.18 (1.05-1.32), PFHxS OR = 1.11 (1.03-1.19), PFNA OR = 1.19 (1.01-1.41).

Conclusions

Our findings suggest that exposure to PFAS is associated with increased blood pressure and thus may contribute as a risk factor for the development of cardiovascular diseases.

Key messages

Serum PFASs were associated with raised systolic blood pressure in men and diastolic blood pressure in women in a large highly exposed young adult population. Serum PFASs were associated with raised prevalence of hypertension in men.

Optical particle counter data collected in two inhabited sites close to an industrial hot spot during a three months survey

Data on this paper describe the monitoring of different size ranges of particulate matter on dwellings positioned close to an integral cycle steel plant. Data were collected by eight channel (PM_0.3, PM_0.5, PM_0.7, PM₁, PM₂, PM₃, PM₅, PM₁₀) optical particle counters positioned in two sites. The data were recorded as counts-per-minute for every size channel in a three months survey from June to September 2015. Basic statistical elaboration and boxplot graphs as well as raw data are included. The data are related to “Characterization of variability of air particulate matter size profiles recorded by Optical Particle Counters near a complex emissive source by use of Self-Organizing Map algorithm” Licen et al.,2019, in which a statistical elaboration by Self-Organizing Map algorithm is proposed.

Involvement of MAF/SPP1 axis in the development of bone marrow fibrosis in PMF patients

Primary myelofibrosis (PMF) is a myeloproliferative neoplasm characterized by hyperplastic megakaryopoiesis and myelofibrosis. We recently described the upregulation of MAF (v-maf avian musculoaponeurotic fibrosarcoma oncogene homolog) in PMF CD34+ hematopoietic progenitor cells (HPCs) compared to healthy donor. Here we demonstrated that MAF is also upregulated in PMF compared with the essential thrombocytemia (ET) and polycytemia vera (PV) HPCs. MAF overexpression and knockdown experiments shed some light into the role of MAF in PMF pathogenesis, by demonstrating that MAF favors the megakaryocyte and monocyte/macrophage commitment of HPCs and leads to the increased expression of proinflammatory and profibrotic mediators. Among them, we focused our further studies on SPP1 and LGALS3. We assessed SPP1 and LGALS3 protein levels in 115 PMF, 47 ET and 24 PV patients plasma samples and we found that SPP1 plasma levels are significantly higher in PMF compared with ET and PV patients. Furthermore, in vitro assays demonstrated that SPP1 promotes fibroblasts and mesenchymal stromal cells proliferation and collagen production. Strikingly, clinical correlation analyses uncovered that higher SPP1 plasma levels in PMF patients correlate with a more severe fibrosis degree and a shorter overall survival. Collectively our data unveil that MAF overexpression contributes to PMF pathogenesis by driving the deranged production of the profibrotic mediator SPP1.

CO2 conversion in a photocatalytic continuous membrane reactor

CO₂ was photocatalytically reduced over TiO₂–Nafion membranes in a continuous flow membrane reactor. MeOH production is considered as a relevant advance over the existing literature results which mostly propose CH₄ as the reaction product.

Optimization of buffer solutions to analyze inflammatory cytokines in gingival crevicular fluid by multiplex flow cytometry

Objective: the aim of this study was to test two buffer solutions in order to attain a reliable and reproducible analysis of inflammatory cytokines (IL-1β, IL-6, TNF-α, OPG, OPN and OC), in gingival crevicular fluid (GCF) by flow cytometry. Material and Methods: GCF samples from healthy volunteers were collected with perio-paper strips and diluted either in phosphate buffered saline (PBS) or Tris-HCl buffer, with and without protease inhibitors (PI). Cytokine immunoassays were carried out by flow cytometry (Luminex Xmap 200) generating standard curves. Results: standards curves generated with the use of phosphate-buffered saline (PBS) demonstrated best adjustment for cytokines IL-1ß, IL-6 and TNF- α levels, when using Tris-HCl (p<0.05). Conclusions: The use of PBS buffer with the addition of PI provided reliable measurements of inflammatory biomarkers in GCF samples of healthy volunteers.

Key words:Curve fitting, flow cytometer, immunoassay buffer, crevicular fluid, cytokines.

The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review

Gait and balance disorders are often major causes of handicap in patients with cerebellar ataxia. Although it was thought that postural and balance disorders in cerebellar ataxia were not treatable, recent studies have demonstrated the beneficial effects of rehabilitation programs. This article is the first systematic review on the treatment of postural disorders in cerebellar ataxia. Nineteen articles were selected, of which three were randomized, controlled trials. Various aetiologies of cerebellar ataxia were studied: five studies assessed patients with multiple sclerosis, four assessed patients with degenerative ataxia, two assessed stroke patients and eight assessed patients with various aetiologies. Accurate assessment of postural disorders in cerebellar ataxia is very important in both clinical trials and clinical practice. The Scale for the Assessment and Rating of Ataxia (SARA) is a simple, validated measurement tool, for which 18 of the 40 points are related to postural disorders. This scale is useful for monitoring ataxic patients with postural disorders. There is now moderate level evidence that rehabilitation is efficient to improve postural capacities of patients with cerebellar ataxia - particularly in patients with degenerative ataxia or multiple sclerosis. Intensive rehabilitation programs with balance and coordination exercises are necessary. Although techniques such as virtual reality, biofeedback, treadmill exercises with supported bodyweight and torso weighting appear to be of value, their specific efficacy has to be further investigated. Drugs have only been studied in degenerative ataxia, and the level of evidence is low. There is now a need for large, randomized, controlled trials testing rehabilitation programs suited to postural and gait disorders of patients with cerebellar ataxia.

Soilless cultivation of soybean for Bioregenerative Life-Support Systems: a literature review and the experience of the MELiSSA Project - Food characterisation Phase I

Higher plants play a key role in Bioregenerative Life-Support Systems (BLSS) for long-term missions in space, by regenerating air through photosynthetic CO2 absorption and O2 emission, recovering water through transpiration and recycling waste products through mineral nutrition. In addition, plants could provide fresh food to integrate into the crew diet and help to preserve astronauts' wellbeing. The ESA programme Micro-Ecological Life-Support System Alternative (MELiSSA) aims to conceive an artificial bioregenerative ecosystem for resources regeneration, based on both microorganisms and higher plants. Soybean [Glycine max (L.) Merr.] is one of the four candidate species studied for soilless (hydroponic) cultivation in MELiSSA, because of the high nutritional value of the seeds. Within the MELiSSA programme - Food characterisation Phase I, the aim of the research carried out on soybean at the University of Naples was to select the most suitable European cultivars for cultivation in BLSS. In this context, a concise review on the state-of-the-art of soybean cultivation in space-oriented experiments and a summary of research activity for the preliminary theoretical selection and subsequent agronomical evaluation of four cultivars will be presented in this paper.

Calcitonin gingival crevicular fluid levels and pain discomfort during early orthodontic tooth movement in young patients

OBJECTIVES

To investigate the previously unreported presence of calcitonin (CT) levels in gingival crevicular fluid (GCF), its variations during initial orthodontic tooth movement in both tension and compression sites, and its possible association with the experienced dental pain.

DESIGN

Fifteen children (mean age: 12.6 years) requiring orthodontic closure of the upper midline diastema were included. We collected GCF from the compression and tension sites of the upper right central incisor (experimental) and first bicuspid (control), before and after (1h, 24h, 7d, 15d) beginning of treatment. Calcitonin levels were determined by Western blot. Pain intensity was assessed using a visual analogue scale.

RESULTS

Calcitonin levels were higher in the compression site versus the control site at 7d (p=0.014). Intragroup comparisons showed an increment of CT between 1h and 7d (680.81±1672.60pg/30s, p=0.010) in the compression site. No significant changes were found in the tension and control sites. Calcitonin levels and pain intensity were negatively associated during the period from 24h to 15d (r=-0.54, p=0.05).

CONCLUSIONS

CT levels in the GCF significantly increased in the compression site after the short term after application of orthodontic forces. These changes were negatively associated with the perceived patient's dental pain during the period from 24h to 15d.

Measuring trunk orientation with a CMOS camera: feasibility and accuracy

The purpose of this study was to develop and validate a new tool to objectively quantify trunk orientation at the bedside, especially dedicated to the measurement of the lateropulsion in acute and subacute stroke patients. We developed software to analyze 2D movement with a CMOS camera (Logitech Quickcam Pro 4000) and to calculate the orientation of a segment defined by two color markers. First, the accuracy, reproducibility and noise when measuring segment orientations were evaluated with the CMOS camera placed in different positions, and second trunk orientation was measured in static and in dynamic conditions both with a CMOS camera and with a gold standard 3D video system (BTS SMART-e). Results showed that the measurement was accurate (mean error=0.05+/-0.12 degrees), reproducible (S.D. over five measurements=0.005 degrees ) and steady (noise signal=0.02 degrees ). The data obtained with the CMOS camera were highly correlated with those obtained with the 3D video system both in static and in dynamic conditions. However, the CMOS camera must be relatively well centered on the measured segment to avoid error due to image distortion. The parallax error was negligible. In conclusion, this could be an important step in the postural assessment of acute and subacute stroke patients. The CMOS camera, a simple, portable, compact, low-cost, commercially available apparatus is the first tool to objectively quantify lateropulsion at the bedside. This method could also support the development of a rehabilitation program for trunk orientation based on biofeedback using the real-time signal provided by the device.

Identification of hidden allergens: Detection of pistachio traces in mortadella

An analytical method based on the detection of specific DNA was developed and applied to mortadella samples with and without pistachio (Pistacia vera). The method is proposed for the detection of traces of pistachio deriving from previous processes or from accidental contamination, since in predisposed individuals pistachios can cause allergic reactions leading to anaphylactic shock. Three pairs of primers were identified and tested by polymerase chain reaction (PCR) on mortadella samples prepared with pistachio. Accidental contamination was also simulated. The optimized PCR was able to detect the presence of pistachio, even at low concentrations. The primers pair PSTC 1-2 is suggested for unambiguous identification of pistachio in mortadella. The limit of detection for this primers pair was 100 mg kg-1. No interference was observed from other spices or ingredients utilized in the formulation of the mortadella. The method enabled the identification of possible traces of pistachio remaining in the production plant after less than thorough washing.

Efficacy of a 0.15% benzydamine hydrochloride and 0.05% cetylpyridinium chloride mouth rinse on 4-day de novo plaque formation

OBJECTIVE

To evaluate the effect of a mouth-rinse formulation combining benzydamine hydrochloride and cetylpyridinium chloride (BNZ+CPC) in preventing de novo plaque formation, in comparison with CPC and placebo mouth rinses.

PATIENTS AND METHODS

This was a controlled, observer-blind, cross-over study. In this model of plaque re-growth, subjects received a session of oral prophylaxis and were directed to withdraw oral hygiene measures for the next 4 days, using only the mouth rinse assigned. The outcome parameters were the plaque index (PlI) and gingival index (GI). In addition, microbiological evaluation of the subgingival microflora, by means of culture, was performed, as well as patient-based variables. Data analysis was carried out using anova for Latin-square design.

RESULTS

The analysis of variance showed a significant statistical difference between the BNZ+CPC association and placebo (p<0.0001). No differences between CPC and placebo were detected considering multiple comparisons between treatments. The 90% confidence interval of the differences between BNZ+CPC and CPC showed no equivalence between treatments, being the PlI lower in the BNZ+CPC group. No significant difference between groups in GI was observed. Mean anaerobic colony-forming units (CFU) demonstrated a significant increase between visits in all groups (p<0.001) and differences among groups were not significant. Subjects treated with BNZ+CPC frequently reported "tingling mouth" and "numbness mouth".

CONCLUSION

Within the limitations of the study model, the BNZ+CPC combination showed a statistically significant plaque-inhibitory capacity, as compared with the placebo mouth rinse, and an additive effect as compared with CPC. No relevant clinical or microbiological adverse effects were detected.

Parotid secretory protein is expressed and inducible in human gingival keratinocytes

BACKGROUND

Parotid secretory protein (PSP) is a major salivary protein that is thought to possess both antibacterial and anti-inflammatory activity. A major question is whether PSP expression can be regulated by humoral factors and bacteria. Periodontitis is an inflammatory lesion initiated by interaction between gingival keratinocytes and periodontopathogenic microorganisms such as the Gram-negative anaerobe Porphyromonas gingivalis. Cytokines and sex hormones have been implicated in the progression of various forms of periodontal diseases.

MATERIALS AND METHODS

We investigated the expression of PSP and its regulation in primary cultures of human gingival keratinocytes (HGK). HGK at the third or fourth passage were exposed to heat-killed P. gingivalis, tumor necrosis factor-alpha (TNF-alpha) and 17beta-estradiol. The PSP mRNA levels were examined by real-time polymerase chain reaction (PCR). The protein expression of PSP was confirmed by immunofluorescence.

RESULTS

Heat-killed P. gingivalis, TNF-alpha and 17beta-estradiol all resulted in increased HGK levels of mRNA for PSP as determined by real-time PCR analysis. Immunofluorescence demonstrated increased PSP localized within the cytoplasm of HGK following exposure to killed P. gingivalis.

CONCLUSION

The present study has demonstrated for the first time that PSP is expressed in keratinocytes and that it can be up-regulated by bacteria and humoral factors. Thus PSP may have a role in the innate defense system at the gingival epithelial surface.

Diffusive and convective transport through hollow fiber membranes for liver cell culture

For an efficient membrane bioreactor design, transport phenomena determining the overall mass flux of metabolites, catabolites, cell regulatory factors, and immune-related soluble factors, need to be clarified both experimentally and theoretically. In this work, experiments and calculations aimed at discerning the simultaneous influence of both diffusive and convective mechanisms to the transport of metabolites. In particular, the transmembrane mass flux of glucose, bovine serum albumin (BSA), APO-transferrin, immunoglobulin G, and ammonia was experimentally measured, under pressure and concentration gradients, through high-flux microporous hydrophilic poly-ether-sulphone (PES-HFMs) and poly-sulphone hollow fiber membranes (PS-HFMs). These data were analyzed by means of a model based on the mechanism of capillary pore diffusion, assuming that solute spherical molecules pass through an array of solvent-filled cylindrical pores with a diffusive permeation corrected for friction and steric hindrances. Additionally, resistances to the mass transfer were taken into account. Convective permeation data were discussed in terms of morphological properties of the polymeric membranes, molecular Stokes radius, and solute-membrane interactions according to information given by contact angle measurements. The observed steady-state hydraulic permeance of PS-HFMs was 0.972 L/m2hmbar, about 15.6-fold lower than that measured for PES-HFMs (15.2 L/m2h); in general, PS-HFMs provided a significant hindrance to the transport of target species. Diffusion coefficients of metabolites were found to be similar to the corresponding values in water through PES-HFMs, but significantly reduced through PS-HFMs (D(Glucose)(Membrane)=2.8x10(-6)+/-0.6x10(-6)cm2/s, D(BSA)(Membrane)=6.4 x 10(-7)+/-1 x 10(-7)cm(/s, D(Apotransferrin)(Membrane)=2.3 x 10(-7)+/-0.25 x 10(-7)cm2/s).

Age and growth of the porthole shovelnose catfish (Hemisorubim platyrhynchos) in the Pantanal

The Porthole Shovelnose Catfish, Hemisorubim platyrhynchos, is the sixth largest pimelodidae of the Pantanal. Its age and growth were studied using pectoral fin-spines from fish collected in the Cuiabá river basin, Pantanal. The fish, which came from commercial and experimental fisheries, were all caught with hook and line. Growth-ring formation time could not be defined through the Kruskal-Wallis test on marginal increment (H = 4.142; p = 0.247). Nevertheless, decrease in the marginal increment index occurring as waters recede suggests this as the probable time when growth rings form. Estimation of the parameters of von Bertalanffy growth curve, adjusted through nonlinear regression to observed fork lengths, with L<FONT FACE=Symbol>¥</FONT> fixed at 64 cm, were: k = 0.222 year-1; t o = -2.149 years. Individual life span was estimated at 11.4 years. The results suggest that fork length is a good predictor of age for individuals of this species.

Defective class II transactivator expression in a B lymphoma cell line

Loss of MHC class II expression in B-cell lymphoma has been associated with a higher tumorigenicity resulting from lower titers of tumor-infiltrating lymphocytes. This report aims towards the identification of the molecular mechanism leading to defective MHC class II expression in a B-cell lymphoma cell line, Rec-1. We evidenced a coordinated alteration of HLA-D gene transcription, reminiscent of B lymphoblastoid cell lines from patients with MHC class II deficiency. Genetic complementation performed between these cell lines and the lymphoma cells indicated that Rec-1 is altered in the MHC2TA gene. MHC2TA encodes the class II transactivator (CIITA), the master regulator of HLA-D gene expression. However, the coding sequence of the Rec-1 CIITA transcript did not reveal any mutation that could hamper the activity of the encoded protein. In agreement with the genetic complementation analysis, we evidenced a highly residual CIITA protein expression in the Rec-1 cell line resulting from a transcriptional defect affecting MHC2TA expression. Anti-HLA-DR monoclonal antibody treatment has proved efficient in the destruction of B lymphoma cells. Our data indicate that the appearance of variants losing CIITA, and thereby HLA-DR, expression will require a thorough monitoring during such immunotherapy protocols.

Age and growth of the Duckbill Catfish (Sorubim cf. lima) in the Pantanal

The Duckbill Catfish, Sorubim lima, is a predator of large South American rivers. The age and growth of S. lima were studied based on the pectoral fin-spines of samples collected from the Cuiabá River, Pantanal. The samples were taken from commercial and experimental hook-and-line fishing. An analysis of the marginal increment suggests that the growth rings are formed once a year during the dry season, from July to September (ANOVA type I: F = 4.183; g.l. = 3 and 104; p = 0.008). The estimate of the parameters that describe von Bertalanffy's growth curve by nonlinear regression of the observed lengths in the age were: L<FONT FACE=Symbol>¥</FONT> = 56.0 cm (fork length); k = 0.245 year-1; t o = -2.605 years. The animals were estimated to have a life span of 9.6 years. The findings indicate that the fork length is a good predictor of the age of individuals of this fish species.

[Progress of studies promoted by the MODS collaborative group]

In industrialised countries, carpal tunnel syndrome (CTS) is considered an epidemic work-related disease. We have set up the MODS (Malattie Occupazionali Da Sovraccarico biomeccanico, biomechanical overload-related occupational diseases) collaborative group, formed by epidemiologists, ergonomists and occupational physicians to investigate CTS in Italy, applying the methods that epidemiologists commonly use to understand epidemics. Several studies are already ongoing. Two different descriptive studies based on current hospitalisation data are in the reporting phase. A pilot case-control multicentre study (260 cases and 520 controls in 13 centres) is in the final phase of data collection. A longitudinal study on a cohort of 3000 subjects exposed to different risk factors has reached the third year of follow-up. Moreover, a surveillance system has been set up to cover selected districts of the Emilia Romagna region. These studies will generate new information about the prevalence and incidence of CTS in Italy, along with identification of regional, high-risk job titles and work sectors, and the relative influence of non-occupational factors.