Subclinical coronary atherosclerosis, detected by computer tomography with coronary calcium score, and the occurrence of major cardiovascular events at 5 years of follow-up in a cohort of patients with systemic sclerosis

BACKGROUND

Spreading data describe cardiovascular disease (CVD) as a growing cause of hospitalization in systemic sclerosis (SSc) patients. Although interstitial lung disease and pulmonary arterial hypertension (PAH) remain the principal causes of mortality, the presence of CVD has been shown to further increase mortality in SSc patients. Few and contrasting data are available on cardiovascular impairment, particularly of subclinical coronary arteries disease, in SSc patients. The aims of this study were: 1) to determine the demographic, clinical, and cardiovascular differences between the groups of SSc patients with and without subclinical coronary atherosclerosis (SCA) assessed by coronary calcium score; 2) to verify the performance of cardiovascular risk scores in SSc for detection of SCA major cardiovascular events (MCVE); 3) to evaluate the risk factors associated to MCVE in 5 years of follow-up in this study group of patients.

METHODS

Sixty-seven SSc patients were enrolled in this study. SCA was assessed using quantification of coronary calcium score by computerized tomography, reported as Agatson. Evaluation of common cardiovascular risk scores, carotid plaques by Doppler ultrasonography, the history of peripheral artery disease (PAD), lipid profiles, and clinical and laboratiristic characteristics of SSc were assessed at baseline visits for each patient. Factors associated with the presence of SCA were assessed by multivariate logistic analysis. A five years prospective study was performed for the evaluation of MCVE occurrence and its possible predictors.

RESULTS

The prevalence of SCA was 42% (Agatston scores of 266.04 ± 455.9 units) in our group of SSc patients. Patients with SCA were principally older (p = 0.0001) and had higher rates of CENP-B antibodies (57% vs 26%; p = 0.009), pulmonary arterial hypertension (PAH) (25% vs 3%; p = 0.008), dysphagia (86% vs 61%; p = 0.027), and users of statins (36% vs 8%; p = 0.004), carotid plaque (82% vs 13%; p = 0.0001), PAD (79% vs 18%; p = 0.0001), and metabolic syndrome (25% vs 0%; p = 0.002) than patients without SCA. Metabolic syndrome (OR: 8.2, p = 0.0001), presence of a PAD (OR: 5.98, p = 0.031), and carotid plaque (OR: 5.49, p = 0.010) were the main factors associated with SCA in SSc patients, by multivariate regression analysis. MCVE occurred in 7 patients. By multivariate COX regression analysis unique predictor of MCVE in 5 years of follow-up in our SSc patients was the presence of PAH (HR: 10.33, p = 0.009). Of note, the contemporary presence of PAH and SCA (defined as "not pure" pattern of PAH) was observed in 71% of patients with the occurrence of MCVE CONCLUSION: This study evidenced the high presence of the new "not pure" pattern of PAH, which could worsen the outcome in SSc in a medium-term (5 years) observation period. Furthermore, our data confirmed a higher cardiovascular impairment in SSc due to the presence of both SCA, mainly associated with typical cardiovascular risk factors, and PAH, life-threatening complications of SSc, that is the principal cause of the occurrence of MCVE in our SSc patients. A careful assessment of cardiovascular involvement in SSc and a more aggressive therapeutic strategy for preventing CAD and treating PAH should be highly suggested to reduce MCVE in SSc patients.

POS0927 CORONARY ARTERY CALCIFCATION IN SYSTEMIC SCLEROSIS: EVALUATION OF CARDIOVASCULAR RISK AND CLINICAL OUTCOME

Background

The primary prevention of cardiovascular disease (CVD) is a priority element of the worldwide health care agenda. An increased risk of CVD and CV mortality has been shown in lots of studies conducted on patients affected by inflammatory and autoimmune diseases. A routine evaluation of CV risk in these patients should be encouraged and in particular cases is recommended.

Objectives

The aim of this study is to evaluate the presence of subclinical atheromatosis, the CV risk and its performance in a cohort of patients affected by Systemic Sclerosis (SSc) from a single reference tertiary care hospital.

Methods

Sixty-seven patients with SSc according to the ACR/EULAR 2013 criteria were included. Traditional CV risk factors and SSc related factors were analyzed. Thoracic high resolution computed tomography (CT) was performed, using the quantification of coronary calcium for the study. Furthermore, a doppler ultrasonography of the carotids and the lower extremity arteries was conducted for the detection of subclinical atheromatosis. The CV risk has been calculated through different CV risk scales including the MESA CAC, the Italian Progetto Cuore, the Framingham score, the Score2 and the QRISK3. After conducting a 5-year follow up, CV outcome and electrocardiography abnormalities were examined.

Results

Calcium artery coronary score > 0 was reported in twenty-eight SSc patients (41,8%). Considering traditional CV risk factors, the multivariate regression analysis showed a correlation with age (OR 1.151 [95% CI 1.06–1.25], P = 0.001) and systemic arterial hypertension (OR 5 [95% CI 1.148–22.357], P = 0.032). Instead, the presence of anti-CENP-B (OR 3.47 [95% CI 1.09–11.06], P = 0.035) and late-onset disease (OR 1.062 [95% CI 1.007–1.119], P = 0.026) were identified as potential specific disease risk factors. The prevalence of ultrasonography atherosclerosis was high: peripheral artery disease (PAD) and carotid plaque were respectively 43% and 41%, and the presence of coronary calcifications was a risk factor for their detection with a OR respectively of 20.39 and 20.49 (p=0.0001). All CV risk scores considered SSc patients in a low risk, except for the QRISK3, whose values were higher in patients with coronary calcifications (18.4±12.6 vs 5.1±4.9, p=0.0001). In 5-years follow up only 1 patient died for CVD and 2 CV events occurred. Electrocardiography anomalies were found in 28.35% of patients, and in particular in 43% of patients with coronary calcifications (OR 3.321 [95% CI 1.094-10.08], P = 0.03).

Conclusion

Subclinical coronary atherosclerosis seems to be largely observed in SSc patients and may represent an additional risk factor for electrocardiography anomalies and subclinical atheromatosis in other anatomical districts, with no impact on CVD mortality. In our study coronary calcifications well correlated with CV risk score, especially the novel QRISK3 by classifying these patients between low and moderate CV risk. Other studies are needed to support the hypothesis that subclinical coronary atherosclerosis, occasionally detected in thoracic CT, may represent a clinical alert to establish timing and weight of diagnostic and specific treatment protocols for the CV prevention in SSc patients.

References

[1]Agca R, Heslinga SC, Rollefstad S, et al. EULAR recommendations for cardiovasculardisease risk management in patients with rheumatoidarthritis and otherforms of inflammatory joint disorders: 2015/2016 update. Ann RheumDis 2017; 76(1):17–28.

[2]Ungprasert P, Charoenpong P. Risk of coronary artery disease in patients with systemic sclerosis: a systematic review and meta-analysis. ClinRheumatol. 2014;33(8):1099-1104

[3]Sanz Pérez I, Martínez Valle F. Subclinical cardiovascular disease and Systemic Sclerosis: A comparison between risk charts, quantification of coronary calcium and carotid ultrasonography. Autoimmun Rev. 2018;17(9):900-905

[4]Di Battista M, Barsotti S, Della Rossa A, Mosca M. Cardiovascular burden in systemic sclerosis: QRISK3 versus Framingham for risk estimation. ModRheumatol. 2021; roab011.

Disclosure of Interests

None declared

Impact of the environment on the health: From theory to practice

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management.

COVID-19 Stroke Apical Lung Examination Study: A Diagnostic and Prognostic Imaging Biomarker in Suspected Acute Stroke

BACKGROUND AND PURPOSE

Diagnosis of coronavirus disease 2019 (COVID-19) relies on clinical features and reverse-transcriptase polymerase chain reaction testing, but the sensitivity is limited. Carotid CTA is a routine acute stroke investigation and includes the lung apices. We evaluated CTA as a potential COVID-19 diagnostic imaging biomarker.

MATERIALS AND METHODS

This was a multicenter, retrospective study (n = 225) including CTAs of patients with suspected acute stroke from 3 hyperacute stroke units (March-April 2020). We evaluated the reliability and accuracy of candidate diagnostic imaging biomarkers. Demographics, clinical features, and risk factors for COVID-19 and stroke were analyzed using univariate and multivariate statistics.

RESULTS

Apical ground-glass opacification was present in 22.2% (50/225) of patients. Ground-glass opacification had high interrater reliability (Fleiss κ = 0.81; 95% CI, 0.68-0.95) and, compared with reverse-transcriptase polymerase chain reaction, had good diagnostic performance (sensitivity, 75% [95% CI, 56-87]; specificity, 81% [95% CI, 71-88]; OR = 11.65 [95% CI, 4.14-32.78]; P < .001) on multivariate analysis. In contrast, all other contemporaneous demographic, clinical, and imaging features available at CTA were not diagnostic for COVID-19. The presence of apical ground-glass opacification was an independent predictor of increased 30-day mortality (18.0% versus 5.7%, P = .017; hazard ratio = 3.51; 95% CI, 1.42-8.66; P = .006).

CONCLUSIONS

We identified a simple, reliable, and accurate COVID-19 diagnostic and prognostic imaging biomarker obtained from CTA lung apices: the presence or absence of ground-glass opacification. Our findings have important implications in the management of patients presenting with suspected stroke through early identification of COVID-19 and the subsequent limitation of disease transmission.

AB0608 CARDIAC VESSELS CALCIFICATION IN A COHORT OF SYSTEMIC SCLEROSIS PATIENTS: POSSIBLE ROLE IN VASCULOPATHY AND HEART ABNORMALITIES

Background:

Cardiovascular disease is the leading cause of morbidity and mortality worldwide. Myocardial calcifications have been related with cardiovascular diseases (CVD) such as focal wall motion abnormalities and arrhythmias. The impact of vascular calcifications is under investigation in order to define the risk of cardiovascular events. The relationship between cardiac calcification and systemic sclerosis (SSc) has not been investigated.

Objectives:

The aim of the study is to evaluate the frequency of different patterns of cardiac calcification in SSc patients, and to correlate them to other CVD risk factors.

Methods:

We analyzed thoracic-CT scanners of 35 SSc patients (88% female, aged 47,8 ys ±12,9, disease duration 12,8 ys ±9) to determine the location and extension of vascular and cardiac calcification. All recruited patients fulfilled the 2013 ACR-EULAR classification criteria for SSc. No one patients had renal failure, cardiomyopathy, myocarditis, history of cardiac surgery or radiotherapy.

Results:

We found myocardial vessels calcifications (MCv) in 37% SSc patients, aortic wall calcifications (ACw)in 60% SSc patients, cardiac valve calcifications (VC) in 28% SSc patient and heart wall calcifications (HCw) in 20%.

The SSc patients with almost one calcification had older age (65±9,8 ys vs 50±8,8 ys; p=0,0001) and higher values of circulating NTproBNP (336,9±351,9 vs 144,2±107,8; p=0,04) compared to those without.

In particular, the SSc patients with MCv had and uric acid (5,3 ±1,5 vs 4,1 ±1,3; p=0,05), higher rate of PAH (25% vs 0%; p=0,037), arrhythmia (38,5% vs 9%; p=0,036) and higher prevalence of CENP-B antibodies(46% vs 4%; p=0,01) compared to patients without MCv.

Patients with HCw had lower C reactive protein (0,16 ±0,10 vs 0,7±0,7; p=0,008) compared to those without HCw. No differences in the rate of heart and vascular complications of SSc were observed.

The SSc patients with ACw had higher frequency of arrhythmia (33% vs 0%; p=0,016) and longer disease duration (15,5 y ±9,9 vs 8,8 ±5,8; p=0,03).

The SSc patients with VC had higher rate of PAH (33%vs0%; p=0,003) and uric acid (6±0,5vs3,8±1,2 p=0,0001).

Regression analysis excluded any association with gender, BMI, systemic arterial hypertension, steroid therapy, hypovitaminosis D or smoke habit. No cardiovascular event was recorded in one year of observation.

Conclusion:

All patterns of calcifications may be related mostly with the older age. Myocardial vessels calcifications have been found in a high percentage of SSc patients and in particular in those with PAH and positive for anti CENP-B. Furthermore, myocardial vessels calcifications could be associated to the higher occurrence of arrhythmia. More studied are needed to assess the importance of vascular calcification as a part of the vascular involvement in SSc.

References:

[1]John W. Nance Jr. MD. Myocardial calcifications: Pathophysiology, etiologies, differential diagnoses, and imaging findings. Journal of Cardiovascular Computed Tomography 9 (2015) 58 e 67.

[2]Pagkopoulou E, Poutakidou M. Cardiovascular risk in systemic sclerosis: Micro- and Macro-vascular involvement. Indian J Rheumatol 2017;12, Suppl S1:211-7

[3]Plastiras SC, Toumanidis ST. Systemic sclerosis: the heart of the matter. Hellenic J Cardiol. 2012;53(4):287–300.

Disclosure of Interests:

None declared

Vegetarianism and breast, colorectal and prostate cancer risk: an overview and meta-analysis of cohort studies

BACKGROUND

Vegetarian diets may be associated with certain benefits toward human health, although current evidence is scarce and contrasting. In the present study, a systematic review and meta-analysis of prospective cohort studies was performed with respect to the association between vegetarian diets and breast, colorectal and prostate cancer risk.

METHODS

Studies were systematically searched in Pubmed and EMBASE electronic databases. Eligible studies had a prospective design and compared vegetarian, semi- and pesco-vegetarian diets with a non-vegetarian diet. Random-effects models were applied to calculate relative risks (RRs) of cancer between diets. Statistical heterogeneity and publication bias were explored.

RESULTS

A total of nine studies were included in the meta-analysis. Studies were conducted on six cohorts accounting for 686 629 individuals, and 3441, 4062 and 1935 cases of breast, colorectal and prostate cancer, respectively. None of the analyses showed a significant association of vegetarian diet and a lower risk of either breast, colorectal, and prostate cancer compared to a non-vegetarian diet. By contrast, a lower risk of colorectal cancer was associated with a semi-vegetarian diet (RR = 0.86, 95% confidence interval = 0.79-0.94; I² = 0%, P_{heterogeneity} = 0.82) and a pesco-vegetarian diet (RR = 0.67, 95% confidence interval = 0.53, 0.83; I² = 0%, P_{heterogeneity} = 0.46) compared to a non-vegetarian diet. The subgroup analysis by cancer localisation showed no differences in summary risk estimates between colon and rectal cancer.

CONCLUSIONS

A summary of the existing evidence from cohort studies on vegetarian diets showed that complete exclusion of any source of protein from the diet is not associated with further benefits for human health.

Dietary patterns and risk of colorectal adenoma: a systematic review and meta-analysis of observational studies

BACKGROUND

Current evidence suggests that dietary patterns may play an important role in colorectal cancer risk. The present study aimed to perform a systematic review and meta-analysis of observational studies exploring the association between dietary patterns and colorectal adenomas (a precancerous condition).

METHODS

Pubmed and EMBASE electronic databases were systematically searched to retrieve eligible studies. Only studies exploring the risk or association with colorectal adenomas for the highest versus lowest category of exposure to a posteriori dietary patterns were included in the quantitative analysis. Random-effects models were applied to calculate relative risks (RRs) of colorectal adenomas for high adherence to healthy or unhealthy dietary patterns. Statistical heterogeneity and publication bias were explored.

RESULTS

Twelve studies were reviewed. Three studies explored a priori dietary patterns using scores identifying adherence to the Mediterranean, Paleolithic and Dietary Approaches to Stop Hypertension (DASH) diet and reported an association with decreased colorectal adenoma risk. Two studies tested the association with colorectal adenomas between a posteriori dietary patterns showing lower odds of disease related to plant-based compared to meat-based dietary patterns. Seven studies identified 23 a posteriori dietary patterns and the analysis revealed that higher adherence to healthy and unhealthy dietary patterns was significantly associated risk of colorectal adenomas (RR = 0.81, 95% confidence interval = 0.71, 0.94 and RR = 1.24, 95% confidence interval = 1.13, 1.35, respectively) with no evidence of heterogeneity or publication bias.

CONCLUSIONS

The results of this systematic review and meta-analysis indicate that dietary patterns may be associated with the risk of colorectal adenomas.

[Nanotechnology and nanoparticles]

The authors address the innovative topic of nanotechnology and nanoparticles, a multidisciplinary phenomenon important in the development of science and technology and yet not well-known. At the same time, given that nanoparticles will represent an important exposure factor for humans, it is fundamental to describe their features, benefits and potential adverse health effects. The authors therefore describe the characteristics, origins, and various methods of detecting nanoparticles. In addition, they highlight the promising implications arising from their use, especially in pharmacological research, and the still not well-known negative health effects.

Traumatic brain injury in the elderly: considerations in a series of 103 patients older than 70

AIM

Mortality and morbidity due to brain injury in the elderly population is a growing clinical problem: among older patients, those >70 years have a considerably higher risk both in terms of mortality and morbidity. Thereafter, the reasons influencing outcome have not been clearly examined: in the present study we addressed these questions considering the main clinical characteristics exerting a significant impact on the outcome of patients aged > 70, with emphasis for the severity of brain injury and anticoagulant (CAW) treatments.

METHODS

We performed a retrospective analysis of 103 consecutive isolated head injury patients older than 70, admitted at our Department in the period November 2004-November 2009. The clinical variables considered were as follow: age, sex, type of TBI, GCS, pre-TBI use of anti-coagulants (aspirin, warfarin, clopidogrel), INR at admission (INR values were subdivided in values >1.25 as at risk for hemorrhagic events and <1.25 as normal), initial CT scan classification looking at the presence of subarachnoid hemorrhage (t-SAH) or mass lesions; the main outcome measure was the Glasgow Outcome Scale.

RESULTS

The most frequent cause of TBI was accidental fall (65%): 39 were in CAW therapies and in 36 cases the cause of falling down injury was recorded due to a sincopal event (arterial hypotension, atrial fibrillation); in the older patients an accidental fall is significantly related to the TBI, while in the patients aged 70-75 years, TBI is related to a traffic accident (P=0.002). Moreover the cause of TBI correlates with the CAW treatment, the accidental fall being significantly more frequent in patients in CAW treatment (P=0.003). Overall mortality rate is significantly related to an elevated INR class, to presence of t-SAH (16/50 patients) and subdural hematoma (26/46).

CONCLUSION

The results of the present study show that in a population of patients aged > 70, TBI is a high risk event if patient has concurrent treatment with CAW therapies and if an accidental fall is the cause of TBI. In these cases the finding of t-SAH represents a high-risk parameter for mortality but not for morbidity.

[Biological tracking on the presence of Hg, PCB and HCG in milk and hair of women resident in a region with high incidence of children born with malformation (Augusta)]

Following the findings of some studies that have found the presence of Hg, HCB and PCBs in fish from the bay of Augusta and showed a strong association between the consumption of local fish and the increased risk of children born malformed among women of the same city, the authors, in collaboration with the judicial authorities, have initiated a study on the tracking of these substances in biological tissues of mothers exposed to risk of contamination because resident in the Syracusan industrial area. The study showed differences in excess, and statistically significant, among mothers of Augusta respect to a sample of Controls selected in another Sicilian region not exposed to the same risk of contamination, thereby reinforcing the idea that some substances from industrial source found in the environment and in the body of the mothers of Augusta have been able to contribute to the higher incidence of congenital malformations and abortions in the examined region, and leading a company petrochemicals to recognize the families of born malformed an economic compensation.

[Drug misuse in the community: factors which influence patients to self-prescribe antibiotics]

This study aimed at deepening our knowledge about patients' non-compliance with antibiotic treatment, at determining which patients in our community use antibiotics without consulting a physician and at examining patient characteristics associated with such antibiotic misuse. The study focused on the correlation between self-prescribing antibiotic and socioeconomic and cultural status. Data were obtained by using a questionnaire-based survey and we computed univariate and multivariate analysis using chi-square test and logistic regression model. Of 663 respondents, 18.7% admitted using non-prescribed antibiotics. Multivariate analysis identified four variables associated with self-prescribing antibiotic: age [p= 0.009; for patients aged 25-44 and over 65 OR: 1.87 (95% C.I.: 0.66-5.32) and OR: 0.55 (95% C.I.: 0.17-1.80) respectively], gender [p=0.027; for women OR: 1.67 (95% C.I.: 1.06-2.64)], socioeconomic (p=0.022) and cultural status (p=0.037) where classes associated with high risk are the most elevated [for highest socioeconomic class OR: 3.99 (95% C.I.: 1.47-10.85) and for highest cultural class OR: 1.37 (95% C.I.: 0.65-2.86)]. Our study demonstrates that high socioeconomic and cultural status is associated with self-administering antibiotics. These results can be used to design appropriate interventions and target future educational campaigns to control and correct use of antibiotics.

Non compliance to therapeutic prescriptions in paediatric patients: role of social communication

The aim of this pilot study was to identify prevalent non-compliance behaviour in paediatric antibiotic therapy and to investigate the possible role of its social correlates. Patients' parents were surveyed at two paediatric practices in Catania, Italy, using an interviewer-administered questionnaire. The two practices were chosen for their location, in two different urban areas, to represent different sets of parents in terms of social status. Anticipated suspension of prescribed antibiotic therapy was the most frequently encountered form of non-compliance, shown by 41.2% of the parents. After partitioning the sample by mothers' occupational status--housewives versus working women--anticipated suspension revealed a positive association with educational level among the former group and a negative one, although not statistically significant, among the latter. Exposition to mass media messages about bacterial antibiotic resistance appeared to be a key intervening variable in interpreting these results, especially among more educated parents. Non-compliance was also associated with perceived characteristics of doctor-parents communication, particularly, with parents' perceived understanding of prescribed therapy.

Molecular epidemiology of Pseudomonas aeruginosa from cystic fibrosis in Sicily: genome macrorestriction analysis and rapid PCR-ribotyping

This study addresses the epidemiologic relatedness of a collection of Pseudomonas aeruginosa isolates from cystic fibrosis patients attending the Pediatric Clinic, Catania, Sicily. Genome macrorestriction analysis after pulsed field gel electrophoresis (PFGE) was used to characterise all strains. Furthermore, a rapid typing procedure, developed in this study, based on polymerase chain reaction amplified ribosomal DNA spacer polymorphisms (PCR-ribotyping), straight from bacterial cultures, was used. On the basis of macrorestriction analysis after PFGE, persistence of infection was shown in all patients; two cross-transmission episodes were identified in the nosocomial as well as in the familiar environment. PCR-ribotyping proved to be useful for a DNA-based identification test, suitable for screening purposes. The rapid amplification protocol here tested is proposed to evaluate the discriminatory power of other specific target sequences in PCR-based typing assays, for epidemiologic purposes.

Biomarker alterations produced in rat lung by intratracheal instillations of air particulate extracts and chemoprevention with oral N-acetylcysteine

Organic matter extracts were obtained from particulates recovered from 10,000-m3 air samples collected in Sicily (Italy). The overall concentrations of acenaphthene, benzo(a)pyrene, phenanthrene, anthracene, fluoranthene, and pyrene were 526 ng/m3 air in a highly polluted urban area and 48 ng/m3 in a rural area affected by motor vehicle traffic pollution. After metabolic activation, both samples were mutagenic in Salmonella typhimurium his(-) strains of the TA and YG series, with potencies in TA100 of 140.7 and 11.8 revertants/m3 air, respectively. The samples, resuspended in tricaprylin, were instilled intratracheally in Sprague-Dawley rats for 5 consecutive days, accounting for a cumulative dose in each animal of the organic fractions extracted from 400 m3 air, which corresponds approximately to the volume of air inhaled by a man in 1 month. Treatment with the rural area sample and, at higher levels, with the urban area sample resulted in the formation of adducts to lung DNA, as assessed both by synchronous fluorescence spectrophotometry and by 32P postlabeling, which showed the appearance of up to six individual adducts emerging from diffuse diagonal radioactive zones. The adducts were more efficiently detected by extraction with butanol than by digestion with nuclease P1. DNA binding of air particulate extracts was followed by alterations of early damage biomarkers only in the rats treated with the urban area sample. Repair of DNA damage in lung cells was inferred from a significant stimulation of the nuclear enzyme poly(ADP-ribose) polymerase compared with that in sham-exposed rats. Among the cells recovered by bronchoalveolar lavage, an increase in polymorphonucleate leukocytes and cells of the ciliated respiratory epithelium was accompanied by a relative decrease in pulmonary alveolar macrophages. The frequency of micronuclei was significantly enhanced both in epithelial cells and alveolar macrophages, and binucleated macrophages were also more frequent in treated rats. The thiol N-acetylcysteine, one of the most promising cancer chemopreventive agents, was administered with drinking water to a group of animals receiving the air particulate polycyclic aromatic hydrocarbon fraction from the urban area. N-acetylcysteine prevented or considerably attenuated the alterations of all monitored parameters. These findings provide evidence that, even under outstandingly high exposure conditions, it is possible to protect the respiratory tract from DNA-binding and DNA-damaging air particulate carcinogens.

[Experiences with sclerostomy with the Holmium laser]

The THC-YAG laser (holmium laser) war used to perform ab externo sclerostomies in patients affected by various types of glaucoma. This approach was employed in 48 eyes with diagnoses of medically uncontrolled chronic open angle glaucoma, plateau iris or neovascular glaucoma. Post-operatively, 5-FU was injected. At the tend of the follow-up (mean 10.22 +/- 3.4 months), in 25 eyes (52.1%) the IOP was under control without medical therapy. In 12 eyes (25.0%) it was necessary to use antiglaucomatous topical therapy, and in 11 eyes (22.9%) the IOP was uncontrolled despite therapy. The authors stress the importance of a correct pharmacological protocol before and after operation and describe the surgical technique. They confirm the validity of this approach, owing to its minical invasiveness, the possibility of repeating the procedure, and the low complication rate.

Leukocyte alkaline phosphatase (LAP). A useful marker of zinc status in beta-thalassemic patients

Intensive desferrioxamine treatment may negatively affect zinc stores in thalassemic patients. Two groups of young thalassemic patients, with good and poor compliance to desferrioxamine treatment, and a control group were investigated. Leukocyte alkaline phosphatase (LAP), zinc content in neutrophils, plasma zinc levels, and urinary zinc excretion were determined. LAP score, and neutrophil zinc and plasma zinc levels of the good compliance patients were statistically lower than those seen in the controls and in the poor compliance patients. Urinary zinc excretion was statistically higher in good compliance patients than in controls and poor compliance patients only during high-dose intravenous desferrioxamine. On the contrary, poor compliance patients had LAP scores, neutrophil zinc, plasma zinc, and urinary zinc excretion values within the normal range. We conclude that high-dose desferrioxamine produces a reduction of zinc stores in thalassemic patients. LAP scores determinations, which are a reliable and inexpensive marker of body zinc, could become a routine test for monitoring thalassemic patients undergoing hypertransfusion programs.