Steps dominate gas evasion from a mountain headwater stream

Steps are dominant morphologic traits of high-energy streams, where climatically- and biogeochemically-relevant gases are processed, transported to downstream ecosystems or released into the atmosphere. Yet, capturing the imprint of the small-scale morphological complexity of channel forms on large-scale river outgassing represents a fundamental unresolved challenge. Here, we combine theoretical and experimental approaches to assess the contribution of localized steps to the gas evasion from river networks. The framework was applied to a representative, 1 km-long mountain reach in Italy, where carbon dioxide concentration drops across several steps and a reference segment without steps were measured under different hydrologic conditions. Our results indicate that local steps lead the reach-scale outgassing, especially for high and low discharges. These findings suggest that steps are key missing components of existing scaling laws used for the assessment of gas fluxes across water-air interfaces. Therefore, global evasion from rivers may differ substantially from previously reported estimates.

Heterogeneity Matters: Aggregation Bias of Gas Transfer Velocity Versus Energy Dissipation Rate Relations in Streams

The gas transfer velocity, k , modulates gas fluxes across air-water interfaces in rivers. While the theory postulates a local scaling law between k and the turbulent kinetic energy dissipation rate ε , empirical studies usually interpret this relation at the reach-scale. Here, we investigate how local k ( ε ) laws can be integrated along heterogeneous reaches exploiting a simple hydrodynamic model, which links stage and velocity to the local slope. The model is used to quantify the relative difference between the gas transfer velocity of a heterogeneous stream and that of an equivalent homogeneous system. We show that this aggregation bias depends on the exponent of the local scaling law, b , and internal slope variations. In high-energy streams, where b > 1 , spatial heterogeneity of ε significantly enhances reach-scale values of k as compared to homogeneous settings. We conclude that small-scale hydro-morphological traits bear a profound impact on gas evasion from inland waters.

Accurate Molecular Diagnosis of Gaucher Disease Using Clinical Exome Sequencing as a First-Tier Test

Gaucher disease (GD) is an autosomal recessive lysosomal disorder due to beta-glucosidase gene (GBA) mutations. The molecular diagnosis of GD is complicated by the presence of recombinant alleles originating from a highly homologous pseudogene. Clinical exome sequencing (CES) is a rapid genetic approach for identifying disease-causing mutations. However, copy number variation and recombination events are poorly detected, and further investigations are required to avoid mis-genotyping. The aim of this work was to set-up an integrated strategy for GD patients genotyping using CES as a first-line test. Eight patients diagnosed with GD were analyzed by CES. Five patients were fully genotyped, while three were revealed to be homozygous for mutations that were not confirmed in the parents. Therefore, MLPA (multiplex ligation-dependent probe amplification) and specific long-range PCR were performed, and two recombinant alleles, one of them novel, and one large deletion were identified. Furthermore, an MLPA assay performed in one family resulted in the identification of an additional novel mutation (p.M124V) in a relative, in trans with the known p.N409S mutation. In conclusion, even though CES has become extensively used in clinical practice, our study emphasizes the importance of a comprehensive molecular strategy to provide proper GBA genotyping and genetic counseling.

Deferoxamine mesylate improves splicing and GAA activity of the common c.-32-13T>G allele in late-onset PD patient fibroblasts

Pompe disease (PD) is an autosomal recessive lysosomal storage disorder due to deficient activity of the acid alpha glucosidase enzyme (GAA). As a consequence of the enzymatic defect, undigested glycogen accumulates within lysosomes. Most patients affected by the late-onset (LO) phenotype carry in at least one allele the c.-32-13T>G variant, which leads to exon 2 exclusion from the pre-mRNA. These patients display a variable and suboptimal response to enzyme replacement therapy. To identify novel therapeutic approaches, we developed a fluorescent GAA exon 2 splicing assay and screened a library of US Food and Drug Administration (FDA)-approved compounds. This led to the identification of several drugs able to restore normal splicing. Among these, we further validated the effects of the iron chelator deferoxamine (Defe) in c.-32-13T>G fibroblasts. Defe treatment resulted in a 2-fold increase of GAA exon 2 inclusion and a 40% increase in enzymatic activity. Preliminary results suggest that this effect is mediated by the regulation of iron availability, at least partially. RNA-seq experiments also showed that Defe might shift the balance of splicing factor levels toward a profile promoting GAA exon 2 inclusion. This work provides the basis for drug repurposing and development of new chemically modified molecules aimed at improving the clinical outcome in LO-PD patients.

The unknown shown by numerical tools: application to right dysfunction

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Ph.D. Research Grant

Introduction. Numerical modelling of cardiovascular flows is emerging as a powerful tool when applied to clinical practice, thanks to its capability of describing hemodynamics non-invasively. Among the different approaches, lumped parameters (0D) models present the advantage of describing the complete circulation at low computational cost, with strong stress on cause-effect relationships between the different functional elements and flow/pressure waveforms. 0D models fully express their potentiality when applied to complex physio-pathological conditions. This work applies such an approach to the right ventricular (RV) dysfunction, modelling the case of an equal systolic and diastolic percentage dysfunction, i.e., 60%. The model highlights how the right dysfunction affects the left performances, despite the unaltered left ventricular (LV) functionality.

Purpose. Numerical tools may help clinicians in understanding the characteristic features of physio-pathological conditions, clearly differentiating the contributions of single functional elements.

Methods. We develop a 0D model of both left and right circulation, in which heart chambers are simulated with the time-varying elastance concept. Ideal diodes associated with resistances are adopted for the heart valves, and the dissipative effects for the vascular beds and elastic properties for the great vessels are considered. The healthy and the RV dysfunction cases are considered, and, for the pathological condition, we impose a 60% right systolic and diastolic dysfunction.

Results. Fig. 1 shows an example of the outputs calculated by our model e.g., the pressure-volume (pV) loops which, in the clinical practice, are obtained with invasive measurements. On the right heart, the simulated dysfunction reduces systolic pressures, augments diastolic pressures and causes an enlargement of the ventricle (Fig. 1a). Interestingly, the pathology reflects also on the LV: the left pV loop exhibits a left/downward shift, despite the unaltered functionality (Fig. 1b). Overall hemodynamic variables reported in Fig. 1c confirm that RV dysfunction causes a deterioration of the global hemodynamics, i.e., CVP increases and, SV and CI decrease. Moreover, RV dysfunction reduces not only the RV performances (EFrv), but the well-functioning LV activities (EFlv) as well. These findings strengthen the arising clinical practice of checking the LV performance to understand when it is necessary to intervene, e.g., in the presence of the Tetralogy of Fallot.

Conclusion. Numerical models are powerful tools that can help clinicians in understanding the featuring element of a physio-pathological condition. Here, we have shown that RV dysfunction reduces LV functionalities, thus corroborating the emerging idea that optimal timing for intervention in right diseases requires that also the left side circulation is considered.

Abstract Figure. Fig. 1.

Changes in global gene expression indicate disordered autophagy, apoptosis and inflammatory processes and downregulation of cytoskeletal signalling and neuronal development in patients with Niemann-Pick C disease

Changes in gene expression profiles were investigated in 23 patients with Niemann-Pick C1 disease (NPC). cDNA expression microarrays with subsequent validation by qRT-PCR were used. Comparison of NPC to control samples revealed upregulation of genes involved in inflammation (MMP3, THBS4), cytokine signalling (MMP3), extracellular matrix degradation (MMP3, CTSK), autophagy and apoptosis (CTSK, GPNMB, PTGIS), immune response (AKR1C3, RCAN2, PTGIS) and processes of neuronal development (RCAN2). Downregulated genes were associated with cytoskeletal signalling (ACTG2, CNN1); inflammation and oxidative stress (CNN1); inhibition of cell proliferation, migration and differentiation; ERK-MAPK pathway (COL4A1, COL4A2, CPA4); cell adhesion (IGFBP7); autophagy and apoptosis (CDH2, IGFBP7, COL4A2); neuronal function and development (CSRP1); and extracellular matrix stability (PLOD2). When comparing NPC and Gaucher patients together versus controls, upregulation of SERPINB2 and IL13RA2 and downregulation of CSRP1 and CNN1 were characteristic. Notably, in NPC patients, the expression of PTGIS is upregulated while the expression of PLOD2 is downregulated when compared to Gaucher patients or controls and potentially could serve to differentiate these patients. Interestingly, in NPC patients with (i) jaundice, splenomegaly and cognitive impairment/psychomotor delay-the expression of ACTG2 was especially downregulated; (ii) ataxia-the expression of ACTG2 and IGFBP5 was especially downregulated; and (iii) VSGP, dysarthria, dysphagia and epilepsy-the expression of AKR1C3 was especially upregulated while the expression of ACTG2 was downregulated. These results indicate disordered apoptosis, autophagy and cytoskeleton remodelling as well as upregulation of immune response and inflammation to play an important role in the pathogenesis of NPC in humans.

Form follows function: estimation of CSF flow in the third ventricle-aqueduct-fourth ventricle complex modeled as a diffuser/nozzle pump

OBJECTIVE

In the last 20 years, researchers have debated cerebrospinal fluid (CSF) dynamics theories, commonly based on the classic bulk flow perspective. New hypotheses do not consider a possible hydraulic impact of the ventricular morphology. The present study investigates, by means of a mathematical model, the eventual role played by the geometric shape of the "third ventricle-aqueduct-fourth ventricle" complex in CSF circulation under the assumption that the complex behaves like a diffuser/nozzle (DN) pump.

METHODS

DN pumps are quite recent devices introduced as valveless micropumps in various industrial applications given their property of driving net flow when subjected to rhythmic pulsations. A novel peculiar DN pump configuration was adopted in this study to mimic the ventricular complex, with two reservoirs (the ventricles) and one tube provided with a conical reach (the aqueduct-proximal fourth ventricle). The flow was modeled according to the classic equations of laminar flow, and the external rhythmic pulsations forcing the system were reproduced as a pulsatile pressure gradient between the chambers. Several physiological scenarios were implemented with the integration of data acquired by MRI in 10 patients with no known pathology of CSF dynamics, and a quantitative analysis of the effect of geometric and hydraulic parameters (diverging angle, sizes, frequency of pulsations) on the CSF net flow was performed.

RESULTS

The results showed a craniocaudal net flow in all the given values, consistent with the findings of cine MRI studies. Moreover, the net flow estimated for the analyzed cohort of patients ranged from 0.221 to 0.505 ml/min, remarkably close to the values found on phase contrast cine MRI in healthy subjects. Sensitivity analysis underlines the pivotal role of the DN configuration, as well as of the frequency of forcing pressure, which promotes a relevant net flow considering both the heart and respiration rate.

CONCLUSIONS

This work suggests that the geometry of the third ventricle-aqueduct-fourth ventricle complex, which resembles a diverter, appears to be functional in the generation of a net craniocaudal flow and potentially has an impact on CSF dynamics. These conclusions can be drawn by observing the analogies between the shape of the ventricles and the geometry of DN pumps and by recognizing the basis of the mathematical model of the simplified third ventricle-aqueduct-fourth ventricle complex proposed.

Molecular genetics of Pompe disease: a comprehensive overview

Pompe disease (PD) is an autosomal recessive lysosomal disorder caused by the deficient activity of acid alpha-glucosidase (GAA) enzyme due to mutations in the GAA gene. The enzymatic deficiency leads to the accumulation of glycogen within the lysosomes. Clinically, the disease has been classically classified in infantile and childhood/adult forms. The GAA gene has been localized to chromosome 17q25.2-q25.3 and to date, 582 mutations distributed throughout the whole gene have been reported (HGMD: http://www.hgmd.cf.ac.uk/ac/). All types of mutations have been described; missense variants are the most frequent type followed by small deletions. Most GAA mutations are private or found in a small number of families. However, an exception is represented by the c.-32-13T>G splice mutation that is very common in patients of Caucasian origin affected by the childhood/adult form of the disease, with an allelic frequency ranging from 40% to 70%. In this article, we review the spectrum of GAA mutations, their distribution in different populations, and their classification according to their impact on GAA splicing process, protein expression and activity. In addition, whenever possible, we discuss the phenotype/genotype correlation. The information collected in this review provides an overview of the molecular genetics of PD and can be used to facilitate diagnosis and genetic counseling of families affected by this disorder.

In vitro assessment of pacing as therapy for aortic regurgitation

Background and objective

Clinical evaluation of pacing therapy in mitigating the aortic insufficiency after transchateter aortic valve implantation often gives contradictory outcomes. This study presents an in vitro investigation aimed at clarifying the effect of pacing on paravalvular leakage.

Methods

A series of in vitro tests reproducing the heart operating changes clinically obtained by pacing was carried out in a 26 mm Edwards Sapien XT prosthesis with mild paravalvular leakage. The effect of pacing on the regurgitant volumes per cycle and per minute was quantified, and the energy and power consumed by the left ventricle were calculated.

Results

Results indicate that though pacing results in some reduction in the total regurgitation per cycle, the volume of fluid regurgitating per minute increases substantially, causing overload of left ventricle.

Conclusions

Our tests indicate no effective haemodynamic benefit from pacing, suggesting a prudential clinical use of this therapy for the treatment of postoperative aortic regurgitation.

The heat shock protein amplifier arimoclomol improves refolding, maturation and lysosomal activity of glucocerebrosidase

BACKGROUND

Gaucher Disease is caused by mutations of the GBA gene which encodes the lysosomal enzyme acid beta-glucosidase (GCase). GBA mutations commonly affect GCase function by perturbing its protein homeostasis rather than its catalytic activity. Heat shock proteins are well known cytoprotective molecules with functions in protein homeostasis and lysosomal function and their manipulation has been suggested as a potential therapeutic strategy for GD. The investigational drug arimoclomol, which is in phase II/III clinical trials, is a well-characterized HSP amplifier and has been extensively clinically tested. Importantly, arimoclomol efficiently crosses the blood-brain-barrier presenting an opportunity to target the neurological manifestations of GD, which remains without a disease-modifying therapy.

METHODS

We used a range of biological and biochemical in vitro assays to assess the effect of arimoclomol on GCase activity in ex vivo systems of primary fibroblasts and neuronal-like cells from GD patients.

FINDINGS

We found that arimoclomol induced relevant HSPs such as ER-resident HSP70 (BiP) and enhanced the folding, maturation, activity, and correct cellular localization of mutated GCase across several genotypes including the common L444P and N370S mutations in primary cells from GD patients. These effects where recapitulated in a human neuronal model of GD obtained by differentiation of multipotent adult stem cells.

INTERPRETATION

These data demonstrate the potential of HSP-targeting therapies in GCase-deficiencies and strongly support the clinical development of arimoclomol as a potential therapeutic option for the neuronopathic forms of GD.

FUNDING

The research was funded by Orphazyme A/S, Copenhagen, Denmark.

Glycogen Reduction in Myotubes of Late-Onset Pompe Disease Patients Using Antisense Technology

Glycogen storage disease type II (GSDII) is a lysosomal disorder caused by the deficient activity of acid alpha-glucosidase (GAA) enzyme, leading to the accumulation of glycogen within the lysosomes. The disease has been classified in infantile and late-onset forms. Most late-onset patients share a splicing mutation c.-32-13T > G in intron 1 of the GAA gene that prevents efficient recognition of exon 2 by the spliceosome. In this study, we have mapped the splicing silencers of GAA exon 2 and developed antisense morpholino oligonucleotides (AMOs) to inhibit those regions and rescue normal splicing in the presence of the c.-32-13T > G mutation. Using a minigene approach and patient fibroblasts, we successfully increased inclusion of exon 2 in the mRNA and GAA enzyme production by targeting a specific silencer with a combination of AMOs. Most importantly, the use of these AMOs in patient myotubes results in a decreased accumulation of glycogen. To our knowledge, this is the only therapeutic approach resulting in a decrease of glycogen accumulation in patient tissues beside enzyme replacement therapy (ERT) and TFEB overexpression. As a result, it may represent a highly novel and promising therapeutic line for GSDII.

Transformation by different oncogenes relies on specific metabolic adaptations

Metabolic adaptations are emerging as common traits of cancer cells and tumor progression. In vitro transformation of NIH 3T3 cells allows the analysis of the metabolic changes triggered by a single oncogene. In this work, we have compared the metabolic changes induced by H-RAS and by the nuclear resident mutant of histone deacetylase 4 (HDAC4). RAS-transformed cells exhibit a dominant aerobic glycolytic phenotype characterized by up-regulation of glycolytic enzymes, reduced oxygen consumption and a defect in complex I activity. In this model of transformation, glycolysis is strictly required for sustaining the ATP levels and the robust cellular proliferation. By contrast, in HDAC4/TM transformed cells, glycolysis is only modestly up-regulated, lactate secretion is not augmented and, instead, mitochondrial oxygen consumption is increased. Our results demonstrate that cellular transformation can be accomplished through different metabolic adaptations and HDAC4/TM cells can represent a useful model to investigate oncogene-driven metabolic changes besides the Warburg effect.

In vitro hemodynamic testing of Amplatzer plugs for paravalvular leak occlusion after transcatheter aortic valve implantation

OBJECTIVE

We aimed to in-vitro test Amplatzer devices (Amplatzer Vascular Plug II and Amplatzer Vascular Plug III, SJM, St. Paul, MN) in closing PVL generated by transcatheter balloon expandable aortic valve prosthesis in order to quantify the effective treatment of PVL.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) procedures represent the treatment of choice for high risk patients. Despite evolving technologies paravalvular leak (PVL) is still a major unaddressed issue. This severe complication significantly impairs long-term survival. Percutaneous treatment of this complication is usually performed with the implantation of not specifically designed and not approved vascular devices.

METHODS

A 26 mm Sapien XT (Edwards Lifesciences, Irvine, CA) was implanted in a rubber aortic root and a semi-elliptical shape PVL was created. The vascular occluder devices were implanted in the PVL and hemodynamic performance was tested in a pulse duplicator according to international standard ISO 5840-3:2013. Different type of comparison tests together with high speed camera recording allowed us to define the global efficiency of the occluders and their interaction with the transcatheter prosthesis.

RESULTS

The results revealed that the use of vascular plugs was not per se sufficient to produce an effective or substantial reduction of PVL with a maximum efficiency of less than 50%. Recorded video showed clearly that the vascular plug always interfered with the leaflet of the prosthetic valve.

CONCLUSIONS

Currently used devices do not guarantee effective treatment of PVL and may otherwise compromise the structural integrity of the prosthetic valve implanted. Specifically designed devices are required.

CONDENSED ABSTRACT

Despite evolving technologies, paravalvular leak (PVL) is still a major unaddressed issue after transcatheter aortic valve implantation. Percutaneous treatment of this complication is usually performed with the implantation of Amplatzer devices not specifically designed and not approved for this specific use. We tested Amplatzer devices in a pulse duplicator to occlude PVL generated after implantation of a 26 mm SAPIENT XT prosthesis. The results revealed that the use of vascular plugs was not per se sufficient to produce an effective or substantial reduction of PVL. The video showed clearly that the vascular plug always interfered with the leaflet of the prosthetic valve.

Capillary interception of floating particles by surface-piercing vegetation

Surface-piercing vegetation often captures particles that flow on the water surface, where surface tension forces contribute to capture. Yet the physics of capillary capture in flow has not been addressed. Here we model the capture of floating particles by surface-piercing collectors at moderately low Reynolds numbers (Re<10). We find a trade-off between the capillary force, which increases with the collector diameter, and the relative size of the meniscus, which decreases with the collector diameter, resulting in an optimal collector diameter of ~1-10 mm that corresponds to the regime in which many aquatic plant species operate. For this diameter range the angular distribution of capture events is nearly uniform and capture can be orders of magnitude more efficient than direct interception, showing that capillary forces can be major contributors to the capture of seeds and particulate matter by organisms.

Functional induction of the cystine-glutamate exchanger system Xc(-) activity in SH-SY5Y cells by unconjugated bilirubin

We have previously reported that exposure of SH-SY5Y neuroblastoma cells to unconjugated bilirubin (UCB) resulted in a marked up-regulation of the mRNA encoding for the Na⁺ -independent cystine∶glutamate exchanger System X_c⁻ (SLC7A11 and SLC3A2 genes). In this study we demonstrate that SH-SY5Y cells treated with UCB showed a higher cystine uptake due to a significant and specific increase in the activity of System X_c⁻, without the contribution of the others two cystine transporters (X_AG⁻ and GGT) reported in neurons. The total intracellular glutathione content was 2 folds higher in the cells exposed to bilirubin as compared to controls, suggesting that the internalized cystine is used for gluthathione synthesis. Interestingly, these cells were significantly less sensitive to an oxidative insult induced by hydrogen peroxide. If System X_c⁻ is silenced the protection is lost. In conclusion, these results suggest that bilirubin can modulate the gluthathione levels in neuroblastoma cells through the induction of the System X_c⁻, and this renders the cell less prone to oxidative damage.

[Time trend in cancer incidence among 0-24 year-old residents of the Province of Trieste, Italy, 1972-2003]

OBJECTIVE

to report and analyse time trends in cancer incidence among children (0-14 years of age), adolescents (15-19 years) and young adults (20-24 years) living in the Italian province of Trieste (2003 population, 242,000), between 1972 and 2003.

DESIGN

population-based study of descriptive epidemiology.

SETTING AND PARTICIPANTS

the new cases of cancer diagnosed to the residents of the province of Trieste below 25 years of age were extracted from the database of the Trieste Cancer Registry (period 1972-1994) and from the database of the Friuli-Venezia Giulia Cancer Registry (period 1995-2003), according to the International Classification of Childhood Cancer (3rd edition).

MAIN OUTCOME MEASURES

age-specific and age-standardized (Italian 1981 census population as standard) incidence rates, by diagnostic group, sex and period of diagnosis. Time trend in incidence was analysed by using a Poisson regression model adjusted for calendar year, sex and 5 year age-group, and was expressed as annual percent change (APC) in rates.

RESULTS

in the period 1972-2003, the new cases of cancer were 168 in the age-group 0-14 years, 79 in the age-group 15-19 years and 111 in the age-group 20-24 years, while the person-years at risk were respectively: 1,050,027; 431,673; 496,450. The APC in the incidence of all cancers combined was 2.3% (IC 95% 0.6%-3.9%) in children, 4.4% (IC 95% 1.8%-7.1%) in adolescents and 5.1% (IC 95% 2.8%-7.5%) in young adults. Hodgkin lymphomas (APC =12.7%; IC 95% 2.6%-23.7%; 7 cases) in the age-group 0-14 years, skin melanomas and carcinomas (APC =8.2%; IC 95% 4.5%-12.0%; 49 cases) and central nervous system tumours (APC = 6.4%; IC 95% 1.5%-11.5%; 25 cases) in the age-group 15-24 years were the malignancies characterised by the highest increase in incidence.

CONCLUSION

the increase in incidence rates observed in this study can be only partly explained by the small number of ascertained cases, by an improvement in diagnostic techniques and by more efficient registration. However, few environmental and hereditary factors are consistently associated with cancers affecting young people. Therefore, it is imperative to continue to carry out descriptive and analytical studies with primary prevention as the ultimate aim.

Causes of death and clinical diagnostic errors in extreme aged hospitalized people: a retrospective clinical-necropsy survey

BACKGROUND

There are little data on causes of death in extreme aged. We compared, using autopsy findings, main cause of death, overall disease status, and accuracy rate of clinical diagnoses in extreme aged and persons dying at younger ages.

METHODS

We reviewed the complete clinical and autopsy records of 114 consecutive inpatients (97 women, 17 men, age range 97-106, mean 99, median 98) who died in Trieste, Italy, and represented 99% of all extreme-aged person deaths in the hospital and 70% in the area. The control group included 151 patients (66 women, 85 men, age range 65-74, mean 70, median 70) who died during the same period in that hospital.

RESULTS

Vascular and respiratory diseases together caused 84% of deaths in extreme aged. The main causes of death were pneumonia (n = 40, 35%), pulmonary embolism (n = 16, 14%), stroke (n = 12, 11%), and myocardial infarction (n = 8, 7%). Cancer was responsible for 6% (7/114) of deaths in extreme aged and 42% (64/151) in the control group. In 5% of extreme aged, autopsy findings did not explain death. The premortem diagnostic accuracy rate for clinical diagnoses was good in 44% of extreme aged, sufficient in 18%, poor in 28%, and not evaluable in 10%, and was significantly different from controls. Pneumonia, pulmonary embolism, and myocardial infarction were markedly underestimated by clinicians in both groups.

CONCLUSIONS

Extreme aged die mainly of cardiovascular and respiratory diseases and, in most cases, of acute events. Senescence is a rare cause of death. Death from cancer is substantially lower than in persons dying at younger ages. In contrast to no autopsy studies, most extreme aged in our study were found to have specific diseases that explained their deaths.

[Lung cancer in the province of Trieste]

In our study we analyzed a file of 756 males with lung cancer and an equal number of controls matched by sex, age and year of death. All the subjects were resident in the Trieste area, died between 1979-81 and 1985-86 and underwent autopsy at the Istitute of Pathological Anatomy of the University of Trieste. The aim of the research was to analyze and quantify the risk to develop lung cancer in those exposed to asbestos, and well-recognized carcinogens (list A of I.A.R.C.) or suspected (list B). We have also analyzed the relative risk (R.R.) for lung cancer among those subjects with environmental exposure to air pollution in industrial and urban areas. The study was set up in the Trieste province, a geographic area which is particularly suitable for epidemiological studies. We have demonstrated on excess of risk for males exposed to asbestos (R.R. = 1.99) and to other well known carcinogens (R.R. = 2.28). The capability in differentiating the relative risk of smoking and professional exposure to oncogenetic substances allowed us to detect an excess of risk for people living in industrial and urban areas, when compared to those living in rural and peripheral areas.

Occupational exposure and lung cancer risk in a coastal area of northeastern Italy

A case-control study of lung cancer and occupational exposure was conducted in a coastal area of Northeastern Italy where metallurgical and mechanical industries, docks and shipyards are located. Cases comprised 756 men who died of primary lung cancer in a 5-year period. Controls comprised 756 male subjects dying from other causes during the same period. Occupational exposures to lung carcinogens were assessed according to a job title-based approach, using two separate lists of industries/occupations recognized as being causally associated (list A) or suspected of being causally associated (list B) with lung cancer in humans. Exposure to asbestos was classified as absent, possible, or definite. After adjustment for cigarette smoking and place of residence, a significant association was found between lung cancer and occupations in both list A [relative risk (RR) = 2.25, 95% confidence interval (CI) = 1.68-3.03] and list B (RR = 1.33, 95% CI = 1.03-1.71). A significant excess risk was found for workers with definite exposure to asbestos as compared to those with no exposure to lung carcinogens (RR = 1.98, 95% CI = 1.42-2.75). Among occupations with recognized exposure to lung carcinogens other than asbestos, a significant excess risk for lung cancer was observed in iron and metalware workers. In occupational groups with definite exposure to asbestos, elevated risk estimates were found for shipyard workers, dockworkers, carpenters, and electricians. The combined effect of smoking and asbestos was found to be compatible with that expected under a multiplicative model. The overall population-attributable risk (ARp) for cigarette smoking was found to be 87.5%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Occupation and lung cancer risk in the province of Trieste: a case-control study]

To investigate the relationship between occupation and lung cancer, a case-control study was performed in the province of Trieste, Italy, where metallurgical and mechanical industries, dock activities and shipbuilding and ship repairing are predominant. Through the local Cancer Registry, pathology records of 938 men who died of primary lung cancer (ICD 162) in a five-year period were examined. Residential, smoking and occupational histories were obtained from interviews of next of kin of 756 cases and 756 age-matched male controls (+/- 2 years). Occupational exposures to lung carcinogens were assessed according to a job-title based approach, identifying industries/occupations with well-recognized lung carcinogen exposures (list A) and industries/occupations with suspected lung carcinogen exposures (list B). Exposure to asbestos was classified as absent, possible or definite. After adjustment for cigarette smoking (four levels) and residence (three levels), a significant association was found between lung cancer and occupations in list A (RR = 2.28, 95% CI = 1.70-3.07) and in list B (RR = 1.33, 95% CI = 1.04-1.71). A significant excess risk was found for workers with definite exposure to asbestos when compared to those with no exposure to lung carcinogens (RR = 1.99, 95% CI = 1.43-2.76). A very high relative risk was observed among heavy smokers with definite exposure to asbestos (RR = 42.8). A stratified analysis showed that the combined effect of asbestos and smoking was compatible with that expected under a multiplicative model. The overall attributable risk in the population (ARp) for cigarette smoking was found to be 87.6%. The ARp fraction for occupations with well-established exposures to lung carcinogens (list A) was 16.2%. The ARp fraction increased to 25.5% (85% CI = 1.4-34.6) when occupations with suspected exposure to lung carcinogens (list B) were included. The ARp fraction for possible or definite exposure to asbestos was 20.1% (95% CI = 11.6-28.6).

[Cancer of the liver (analysis of autopsy data)]

The findings at 26.879 autopsies, that is 70% of all the deaths registered in the Province of Trieste, obtained at the Institute of Pathologic Anatomy and Histology of Trieste from 1976 to 1985 were studied. Liver cancer showed in the Province the World Standardized Incidence Rate (WR) of 1.87 (females) and 12.78 (males), one of the highest ever observed in nonendemic areas. In view of close association between cancer of the liver and cirrhosis (88%), the authors studied the most important etiological factors of cirrhosis in the region, i.e. hepatitis B and alcohol abuse. Some effective measures are suggested to decrease the incidence of cirrhosis and eventually cancer of the liver.