Bilateral orbital myositis in a patient with rheumatoid arthritis on treatment with tofacitinib: a report and review of literature

Orbital myositis is a rare inflammatory condition affecting the extraocular muscles of the eyes. It has also been linked to systemic autoimmune diseases. We present a case of orbital myositis in a 57-year-old male undergoing treatment for rheumatoid arthritis (RA) with tofacitinib, a Janus kinase inhibitor (JAK). Prompt administration of intravenous steroids led to rapid symptom improvement. To date, only six published cases have documented the association between RA and orbital myositis. This is the first description of orbital myositis occurring during treatment with the anti-inflammatory drug tofacitinib, an increasingly used disease-modifying anti-rheumatic drug (DMARD). We review the literature and emphasize the importance of ongoing vigilance regarding adverse events linked to tofacitinib.

Rapid scientific update response to public health professions during Phase I of COVID-19 pandemic

Issue

Preparedness can be considered the Achilles heel in Western Coutries to adequately fight Sars-CoV-2 pandemy. The Istituto Superiore di Sanità (ISS) has been challenged to give rapid technical and scientific advices to the State and Regions on a huge variety of Sars-CoV-2 aspects related to public health.

Description of the problem

Rapid and timely accumulation of knowledge and empirical evidence is critical for policymakers and emergency managers to maximally inform their decisions through scientific evidence and to better guide and mobilise the expertise of academics and general practitioners towards effective solutions.

Results

An ad hoc “Scientific Literature working group” at ISS in the period 23/03 - 31/05 screened a total of 4,568 pre-prints and 15,590 peer reviewed papers extracted from PubMed, arXiv.org, medRxiv and bioRxiv, which gave rise to the following deliverables: a) a daily pre-prints alert selection delivered to ISS President for the routine national Scientific Technical Committee meetings on Sars-CoV-2 chaired by Italian Civil Protection (still ongoing), and, b) a weekly open access issue of Covid Contents publications (8 volumes, https://www.iss.it/en/covid-contents), as summary of most interesting peer-reviewed papers for public health professions.

Lessons

The needed cross-cutting approach is leading to: interdisciplinarity enhancement within the ISS; coverage of broad expertise areas and interest of health care providers; cross-linkage between the different aspects/disciplines involved in this pandemic and share of experiences.

Key messages

Committed Institutions have the responsibility to support practitioners and decision makers to understand relevant aspects of medical, physical, occupational and public safety, in case of emergency.

The Silos culture has to be overcome. There is nothing more powerful in any Institution than having all researchers rowing fiercely in the same direction.

Liquid Chromatographic Method for Nicarbazin in Broiler Feeds and Premixtures: Development, Validation, and Interlaboratory Study

A reversed-phase liquid chromatography method for nicarbazin in broiler feeds and premixtures was developed, validated, and interlaboratory studied. The extraction solvent was an acetonitrile–methanol (1 + 1) mixture. For feedingstuffs, water was also added. The 4,4′-dinitrocarbanilide moiety of nicarbazin was detected at a wavelength of 350 nm. Recovery was ≥ 87%. At 20 mg/kg, the repeatability was 0.7% and the within-laboratory reproducibility was 2.7%. The limit of determination was <20 mg/kg. Other feed additives did not interfere in the assay that proved to be applicable to broiler feeds from different European Union countries. In an interlaboratory study, 4 positive broiler feeds, 1 blank pig feed, and 1 broiler premixture were analyzed by 19 laboratories using the method developed in this study. The relative standard deviation for repeatability (RSDr) of the feedingstuffs (20–240 mg/kg) varied between 2.6 and 10.2%. The HORRAT ranged between 0.70 and 1.22. Recoveries were 91–108%. Three laboratories detected small signals in the blind blank samples, ranging from 0.4 to 2 mg/kg. For the premixture, acceptable results for reproducibility could only be obtained after the sample weight and volume of extraction had been doubled. To avoid excessive dilution of the extracts, the range of the calibration curve had also been doubled. With this modified method, the RSDr was 5.7% and the HORRAT was 1.95 (10 laboratories).

Simple method for estimating the fractional Raman contribution

We propose a novel and simple method for estimating the fractional Raman contribution, f_R, based on an analysis of a full model of modulation instability (MI) in waveguides. An analytical expression relating f_R to the MI peak gain beyond the cutoff power is explicitly derived, allowing for an accurate estimation of f_R from a single measurement of the Raman gain spectrum.

Direct Interaction with Cellular Targets as the Mechanism for Chromium Carcinogenesis

The carcinogenic activity of chromium appears to be due to its direct interaction with cellular targets and not to nonspecific solid-state carcinogenesis. Chromium was evaluated at 2 valences, Cr+3 (as CrCl3 and Cr+6 (as K2Cr2O7), for its toxicity, transforming activity, and ability to induce chromosomal aberrations in tertiary cultures of mouse fetal cells. The ID50 (dose for 50 percent inhibition of cell growth) of Cr+3 was approximately 4 times greater than that of Cr+6 after 96 h of exposure, and about 29 times greater than that of Cr+6 after 1 h of exposure. At equitoxic concentrations, both chromium valences induced the same degree of morphologic changes and alterations of growth behavior, but Cr+6 produced more chromosomal aberrations. Using autoradiography in an established cloned line of mouse cells, unscheduled DNA synthesis was observed in cells previously exposed to Cr+6 but not in cells previously exposed to Cr+3.

40 Gb/s indoor optical wireless system enabled by a cyclically arranged optical beamsteering receiver

Indoor optical wireless communication with optical beamsteering capability is currently attracting a lot of attention. One major two-dimensional (2D) optical beamsteering scheme is realized by 2D grating or its active counterpart, which is usually based on a spatial light modulator (SLM). However, there is a fundamental trade-off between the field of view (FoV) and power efficiency due to the inherent feature of gratings. In this Letter, we propose a new class of 2D beamsteering, named cyclically arranged optical beamsteering (CAO-BS), which can break that trade-off. Traditional 2D gratings extend the optical beam in the Cartesian coordinates (1D grating in horizontal + 1D grating in vertical), while CAO-BS extends the optical beam in the polar coordinates (1D grating + angular rotation). Since only 1D grating is engaged, the power efficiency increases with the number of grating lobes reduced. In the polar coordinates, the angle rotation tuning in a SLM is quasi-continuous in a full 2π range. The CAO-BS is demonstrated at the receiving end in an indoor experimental system. The FoV is 18° by 360° in polar coordinates without any additional mechanical parts. Based on the CAO-BS, 40 Gbit/s on-off keying data is also successfully transmitted over 1 km single-mode fiber and 0.5 m free space.

Point-by-point femtosecond laser micro-processing of independent core-specific fiber Bragg gratings in a multi-core fiber

Four 3rd order fiber Bragg gratings were inscribed into separate cores of a 7 core multi-core fiber using the point-by-point inscription technique. A 1030 nm, 206 ± 5 fs laser was used, operating at a frequency of 1 kHz and pulse energy of 2.1 ± 0.2 µJ. Independent Bragg resonances at λ_B = 1541.01 ± 0.02, 1547.82 ± 0.02, 1532.66 ± 0.02, and 1537.42 ± 0.02 nm and extinction ratios of 13.97 ± 0.4, 16.02 ± 0.4, 10.08 ± 0.4 and 13.40 ± 0.4 dB were recorded. Our data analysis shows that refractive index changes, Δn, of the order 10^-3 were induced. Core-specific inscription of fiber Bragg gratings in a multi-core fiber can provide a flexible and versatile platform to address the needs of recent space division multiplexed transmission and optical sensor networks.

Orbital angular momentum beam excitation using an all-fiber weakly fused mode selective coupler

Orbital angular momentum beam excitation through direct phase-matched coupling is experimentally demonstrated using an all-fiber weakly fused mode selective coupler consisting of a single-mode fiber and a ring-core fiber. Experimental results showing the excited OAM mode purity of up to 75% measured through the standard ring technique not only demonstrate the proof of concept but also provide a baseline for further improvement.

Pathogenic Escherichia coli and enteric viruses in biosolids and related top soil improvers in Italy

AIMS

To investigate the presence of genomic traits associated with a set of enteric viruses as well as pathogenic Escherichia coli in top soil improvers (TSI) from Italy.

METHODS AND RESULTS

Twenty-four TSI samples originating from municipal sewage sludges, pig manure, green and household wastes were analysed by real time PCR for the presence of hepatitis E virus (HEV), porcine and human adenovirus (HuAdV), norovirus, rotavirus and diarrhoeagenic E. coli. None of the samples was found positive for HEV or rotavirus. Four samples were positive for the presence of nucleic acids from human norovirus, two of them being also positive for HuAdV. Real time PCR screening gave positive results for many of the virulence genes characteristic of diarrhoeagenic E. coli in 21 samples. These included the verocytotoxin-coding genes, in some cases associated with intimin-coding gene, and markers of enteroaggregative, enterotoxigenic and enteroinvasive E. coli.

CONCLUSIONS

These results provide evidence that enteric viruses and pathogenic E. coli may be released into the environment through the use of sludge-derived TSI.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results highlight that the TSI-related environmental risk for the food chain should be more deeply assessed.

Potential impact on food safety and food security from persistent organic pollutants in top soil improvers on Mediterranean pasture

The organic carbon of biosolids from civil wastewater treatment plants binds persistent organic pollutants (POPs), such as polychlorodibenzo -dioxins and -furans (PCDD/Fs), dioxin and non-dioxin -like polychlorobiphenyls (DL and NDL-PCBs), polybrominated diphenyl ethers (PBDEs), and perfluorooctane sulfonic acid (PFOS). The use of such biosolids, derived digestates and composts as top soil improvers (TSIs) may transfer POPs into the food chain. We evaluated the potential carry-over of main bioavailable congeners from amended soil-to-milk of extensive farmed sheep. Such estimates were compared with regulatory limits (food security) and human intakes (food safety). The prediction model was based on farming practices, flocks soil intake, POPs toxicokinetics, and dairy products intake in children, of the Mediterranean area. TSI contamination ranged between 0.20-113 ng WHO-TEQ/kg dry matter for PCDD/Fs and DL-PCBs (N = 56), 3.40-616 μg/kg for ∑6 NDL-PCBs (N = 38), 0.06-17.2 and 0.12-22.3 μg/kg for BDE no. 47 and no. 99, 0.872-89.50 μg/kg for PFOS (N = 27). For a 360 g/head/day soil intake of a sheep with an average milk yield of 2.0 kg at 6.5% of fat percentage, estimated soil quality standards supporting milk safety and security were 0.75 and 4.0 ng WHO-TEQ/kg for PCDD/Fs and DL-PCBs, and 3.75 and 29.2 μg/kg for ∑6 NDL-PCBs, respectively. The possibility to use low-contaminated TSIs to maximize agriculture benefits and if the case, to progressively mitigate highly contaminated soils is discussed.

Cluster categorization of urban roads to optimize their noise monitoring

Road traffic in urban areas is recognized to be associated with urban mobility and public health, and it is often the main source of noise pollution. Lately, noise maps have been considered a powerful tool to estimate the population exposure to environmental noise, but they need to be validated by measured noise data. The project Dynamic Acoustic Mapping (DYNAMAP), co-funded in the framework of the LIFE 2013 program, is aimed to develop a statistically based method to optimize the choice and the number of monitoring sites and to automate the noise mapping update using the data retrieved from a low-cost monitoring network. Indeed, the first objective should improve the spatial sampling based on the legislative road classification, as this classification is mainly based on the geometrical characteristics of the road, rather than its noise emission. The present paper describes the statistical approach of the methodology under development and the results of its preliminary application to a limited sample of roads in the city of Milan. The resulting categorization of roads, based on clustering the 24-h hourly L Aeqh, looks promising to optimize the spatial sampling of noise monitoring toward a description of the noise pollution due to complex urban road networks more efficient than that based on the legislative road classification.

Dual mode fused optical fiber couplers suitable for mode division multiplexed transmission

We experimentally demonstrate 2 × 2 and 3 × 3 fused fiber couplers made from dual mode fiber. A unique mode dependent power transfer characteristics as a function of pulling length is obtained that support various optical functionalities. Exploiting this we demonstrate several devices of interest for mode division multiplexed data transmission including LP11 mode filter, LP11 mode tap coupler, and 50:50 power splitter for both LP01 and LP11 modes.

Simultaneous measurement of the microscopic dynamics and the mesoscopic displacement field in soft systems by speckle imaging

The constituents of soft matter systems such as colloidal suspensions, emulsions, polymers, and biological tissues undergo microscopic random motion, due to thermal energy. They may also experience drift motion correlated over mesoscopic or macroscopic length scales, e.g. in response to an internal or applied stress or during flow. We present a new method for measuring simultaneously both the microscopic motion and the mesoscopic or macroscopic drift. The method is based on the analysis of spatio-temporal cross-correlation functions of speckle patterns taken in an imaging configuration. The method is tested on a translating Brownian suspension and a sheared colloidal glass.

Exposure to priority organochlorine contaminants in the Italian general population. Part 2

Concentrations of 36 polychlorinated biphenyl (PCB) congeners were measured in serum of 372 Italian residents of general population living in Novafeltria, Pavia, and Milan. Total PCB level differed significantly between these sites ( p < 0.0001) with median concentrations of 836.50, 1354.57, and 2062.08 pmol/g lipid, respectively. However, there is no evidence for the difference in distribution of total PCB levels by genders. Total dioxin-like PCBs differed significantly ( p < 0.0001) between the sites (median 109.78, 50.88, and 166.99 pmol/g lipid, respectively) and genders of Novafeltria and Pavia ( p = 0.011 and 0.009, respectively). PCB 138, 153, 170, and 180 differed significantly between the places of residence ( p < 0.0001) with higher values in Milan population. In the overall population, total PCB and PCB 138, 153, 156, 170, and 180 correlated positively with age (correlations range between 0.320 and 0.569, p < 0.0001). In Novafeltria, the correlations ranged between 0.545 and 0.670, and in Pavia, the correlations ranged between 0.516 and 0.666. In Milan, correlations with age range between 0.327 and 0.417 for total PCB and congeners 138, 153, and 180. With an exception of PCB 170, there was no evidence of significant difference in the distribution of most abundant PCB congeners and total PCB across the body mass index categories.

Exposure to priority organochlorine contaminants in the Italian general population. Part 1. Eight priority organochlorinated pesticides in blood serum

Despite extensive use of organochlorinated pesticides (OCPs) such as dichlorodiphenyltrichloroethane (DDT) in Italy in the 1940s to 1970s, especially for public health control of malaria mosquitoes, information on their exposure levels among the general population is limited. These OCPs can be a source of health risk to human. A total of 137 blood samples were collected from residents of the general population of three Italian towns, Novafeltria, Pavia and Milan, to determine the levels of eight OCPs in blood serum. The concentrations of beta-hexachlorocyclohexane, hexachlorobenzene (HCB), 1,1-dichloro-2-( o-chlorophenyl)-2-( p-chlorophenyl)ethylene, 1,1-dichloro-2,2-bis( p-chlorophenyl)-ethylene ( p, p' -DDE), 1,1-dichloro-2-( o-chlorophenyl)-2-( p-chlorophenyl)ethane, 1,1-dichloro-2,2-bis (4-chlorophenyl)ethane, 1,1,1-trichloro-2-( o-chlorophenyl)-2-( p-chlorophenyl)-ethane and 1,1,1-trichloro-2,2-bis( p-chlorophenyl) ethane were measured by gas chromatography–mass spectrometry. Variations in serum concentrations of OCPs with respect to place of residence, gender, age and body mass index (BMI) were evaluated by non-parametric tests. p, p' -DDE and HCB were the most abundant and major contributors of total OCP concentration. Their levels differed significantly between the three towns with a trend Milan > Novafeltria > Pavia (  p < 0.0001). Females had significantly higher concentrations of HCB and p, p'-DDE than males in the overall population sample. HCB concentrations were significantly higher in females than in males of Milan ( p = 0.029). We observed positive correlations of p, p'-DDE and HCB with age in Novafeltria subjects ( r = 0.468, p = 0.004). Total OCP concentrations differed significantly across BMI categories ( p = 0.018) in overall population. We have demonstrated a clear pattern of the main OCPs in a fairly large population. Generally, our study provides information on OCPs exposure among the Italian general population and provides indications for further investigations.

Impact of body mass index and waist circumference on the cardiovascular risk and all-cause death in a general population: data from the PAMELA study

BACKGROUND AND AIMS

Elevated values of body mass index (BMI) and waist circumference (WC) are associated with an augmented cardiovascular (CV) risk. It is debated, however, whether and to what extent this depends on the body fat increase 'per se' or on the related cardiometabolic alterations.

METHODS AND RESULTS

In 2005 subjects randomly selected from the general population of Monza (Italy), we assessed BMI, WC, office, home and 24 h blood pressure (BP), heart rate and metabolic variables. The impact of BMI and WC on the incidence of CV events, CV and all-cause mortality was estimated during a 148-month follow-up. Progressively higher values of BMI and WC were associated with a progressive increase in office, home and 24 h BP and in erratic BP variability (P < 0.0001 for trend). Metabolic variables were directly and significantly (P < 0.0001) related to BMI and WC, while an inverse significant relationship was detected with high-density lipoprotein (HDL)-cholesterol. The incidence of CV events, CV and all-cause deaths increased progressively from the lowest to the highest quintile of BMI and WC (P for trend always <0.005). Baseline BMI and WC higher by respectively 1 kg m⁻² and 1 cm were associated with an increased risk of CV events, CV and all-cause death by 8%, 12% and 7% (for baseline BMI) and 4%, 5% and 4% (for baseline WC), respectively. After adjustment for confounders, only the increased risk of CV death related to higher baseline BMI remained significant (hazard ratio (HR) 1.062, confidence interval (CI) 95% 1.003-1.126, P < 0.05).

CONCLUSION

The adverse prognostic impact of the accumulation of body fat is mediated by the associated haemodynamic and metabolic alterations. Baseline values of BMI, however, are an independent predictor of CV mortality.

Psychiatric disorders in patients suffering from an acute cerebrovascular accident or traumatic injury, and their effects on rehabilitation: an observational study

BACKGROUND

The presence of a post-traumatic psychiatric disorder in patients with acute injuries may have adverse effects on outcomes.

AIM

In this study our aims were: (1) to assess the frequency of psychiatric disorders after a cerebrovascular accident or traumatic injury requiring rehabilitation; (2) to examine whether there was any correlation between psychiatric disorders and patients' baseline demographic and clinical variables.

DESIGN

The study consisted of two phases: the first was cross-sectional and the second prospective with a 12-month follow-up. The period of recruitment was two years. The results of the first phase are presented here.

SETTING

The study sample consisted of a consecutive series of patients admitted to hospital because of an acute cerebrovascular accident or a traumatic injury and referred for a rehabilitation program. Two inpatient Rehabilitation Hospitals were involved in the study.

POPULATION

The sample consisted of 230 consecutive patients with a recent cerebrovascular accident or trauma included in a rehabilitation program.

METHODS

The sample included: 89 men (39%) and 141 women (61%) aged 20-97 years. Psychiatric disorders and motor disabilities were assessed through psychiatric interview and the mini-international neuropsychiatric interview plus (MINI Plus) and, respectively, with the functional independent measure (FIM). In case of post-traumatic stress disorder (PTSD), severity was assessed through the Davidson's Trauma scale. Psychiatric disorders were correlated to demographic and clinical variables through univariate and multivariate analyses, the latter with logistic regression models.

RESULTS

The most frequent entry diagnoses were traumatic fracture (41.3%) and stroke (37.0%). Ninety-three patients (40.4%) had one or more psychiatric disturbances at study entry, the commonest being depression (56 cases, 24.7%) and anxiety (23 cases, 10.0%). PTSD was present in 8 cases (3.5%). A history of psychiatric disorder was reported by 55 patients (24.2%) Compared to the rest of the study population, these subjects had more psychopathologic complaints (P<0.001). Mean total FIM score was 54.4 (SD=17.8) and 61.2 (SD=19.6) in patients with and without psychopathology (P<0.01) Independent predictors of psychopathology included past psychiatric history, lower total FIM scores, and limb amputation. Depression was predicted by history of psychiatric disorders and lack of partner.

CONCLUSION

History of psychiatric disorders is the most relevant factor associated with psychopathology in patients with an acute cerebrovascular accident or traumatic injury, followed by lower total FIM scores, and type of pathologic event.

CLINICAL REHABILITATION IMPACT

The presence of psychiatric disorders may potentially influence the rehabilitation process and outcomes; thus their recognition and management are key factors during a rehabilitation program.

Polychlorinated dibenzodioxins, dibenzofurans, and biphenyls in fresh water fish from Campania Region, southern Italy

Twenty-eight fish muscle specimens from the main water bodies of the Campania Region were analyzed in our laboratory. On average, results showed a low contamination by PCDDs+PCDFs and a relatively more important presence of DL-PCBs. All specimens were compliant with EU regulatory maximum levels. Cumulative PCDD+PCDF+DL-PCB concentrations (TEQ(TOT)) were comprised in the range 0.223-11.4 pgWHO(97)-TEQ g(-1) fresh weight (fw). DL-PCB contribution to TEQ(TOT) was on average greater than 86% (range, 50.2-97.1%). The cumulative concentrations of 30 non-dioxin-like PCB congeners (Σ(30)(NDL-PCBs)) and of the six indicators (Σ(6)(NDL-PCBs)) were respectively in the ranges 3.30-515 and 1.30-195 ng g(-1) fw. The hybrid clustering approach adopted to analyze the sample-specific congener profiles indentified the main analytical patterns present in the database and, in particular, two main diverse exposure macro-areas that seem to exist north and south of the city of Naples. The distribution of PCDD and PCDF congeners among different species showed significant variations from chub (Leuciscus cephalus), characterized by a higher proportion of low-chlorinated congeners (e.g. 2,3,7,8-T(4)CDD), to eel (Anguilla anguilla), whose contamination consisted mainly of highly chlorinated congeners (e.g. O(8)CDD). To have a more complete perspective in relation to the contaminants present in the environment, the study suggestion is to use benthic as well as pelagic species to obtain an integrated characterization of fish tissue contamination.

[New pharmacological approaches to ischemic heart disease]

Major steps have been made in the treatment of ischemic heart disease from the discovery of nitrates as antianginal medication to the techniques of percutaneous angioplasty. This incredible therapeutic progress has resulted in a reduced incidence of ischemic heart disease and related mortality and morbidity. However, statistical and epidemiological data indicate that in ischemic heart disease, despite the achievement of great success, there is a necessity for a further step toward treatment, considering the fact that the characteristics of this population are changing (increased prevalence of subendocardial infarction compared with classic transmural infarction, especially in the elderly population). Furthermore, the need for alternative therapeutic approaches to traditional ones is recognized. Ranolazine is a selective inhibitor of Na channels that prevents pathological extension of late Na current developing in the ischemic myocardial cell. This current is responsible for calcium overload, with consequent impairment of diastolic relaxation. Ranolazine reduces Na overload induced by calcium and improves diastolic relaxation and coronary subendocardial flow, without affecting hemodynamic parameters such as blood pressure, heart rate, or inotropic state of the heart, avoiding undesirable side effects. Efficacy of ranolazine has been evaluated in several trials, using clinical and instrumental endpoints (MARISA and CARISA) or, more recently, using endpoints such as mortality and reinfarction (ERICA and MERLIN-TIMI 36). Ivabradine acts through the inhibition of late Na current (also known as If), which controls the spontaneous diastolic depolarization of sinus node cells. The partial inhibition of these channels reduces the frequency of sinus node action potential initiation, resulting in decreased heart rate without effects on contractility, atrio-ventricular conduction, or repolarization. The BEAUTIFUL trial has tested whether the effect of ivabradine in lowering heart rate is able to reduce mortality and cardiovascular morbidity in patients with coronary artery disease and left ventricular systolic dysfunction. The most significant results were obtained in the subgroup of patients with life-limiting exertional angina. In this group, ivabradine significantly reduced the primary endpoint, a composite of cardiovascular death, hospitalization for fatal and nonfatal acute myocardial infarction (AMI) or heart failure, by 24%, and hospitalizations for AMI by 42%. In the subgroup of patients with baseline heart rate >70 bpm, hospitalizations for AMI and revascularization were reduced by 73% and 59%, respectively.

The effect of transport on some metabolic parameters and meat quality in pigs

Two groups of 40 castrated male pigs were selected at random in an abattoir from pigs arriving from two farms, situated 650 km (group A) and 180 km (group B) from the plant, respectively. The animals were kept in lairage overnight and slaughtered the following morning. At slaughter, samples of blood were collected to determine serum levels of some enzymes [lactic dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT) and glutamic phosphatase transaminase (GPT)]. Measurements of pH were then taken on the Longissimus thoracis at the level of the last rib 45 min, 3 h and 24 h post mortem. After overnight chilling of the sides at +2°C, a portion of the Longissimus thoracis was removed for colour and drip measurements. Results show that distance travelled affects pH values at 45 min and 24 h, group A presenting higher values than group B (P < 0·001). Drip loss did not differ significantly between the two groups, while group A showed lower values of L (∗) and higher a (∗) values than group B (P < 0·05 and P < 0·01, respectively), with no differences in the mean values of b (∗). In group A, a higher value of LDH was observed (P < 0·001) than in group B. GOT and GPT showed no significant difference between the two groups. It is concluded that, although some significant effects of treatment were recorded on some quality traits, the magnitude of the differences are not considered of much practical significance.

[Provocative tests and electrophysiological study in athletes]

Provocative tests can be divided into three main categories: first-level or screening tests, consisting basically of step test, which all athletes undergo during pre-participation screening; second-level tests, which include exercise test (simple or cardiopulmonary), performed on the basis of specific clinical indications or for the assessment of functional capacity; and third-level tests, consisting of complex methods such as myocardial scintigraphy and stress echo (or exercise echo), which are performed in subjects adequately selected according to clinical characteristics or to the results of first- and second-level tests. The electrophysiological endocavitary study has specific indications in sustained or frequent ventricular arrhythmias, while it is not useful in diagnostic evaluation of athletes with supraventricular arrhythmias, where it has been replaced in most cases by transesophageal electrophysiological study.

Decreased adrenergic tone in acromegaly: evidence from direct recording of muscle sympathetic nerve activity

OBJECTIVE

Sympathovagal imbalance has been shown in acromegaly by indirect measurements of adrenergic tone. Data regarding direct measurement of sympathetic activity are lacking as yet. Aim of this study was to assess the adrenergic tone through direct recording of muscle sympathetic nerve activity (MSNA) in acromegalic patients.

DESIGN

Fifteen patients (age 26-66 years, eight women) with newly diagnosed active acromegaly without hyperprolactinaemia, pituitary hormone deficiencies, obstructive sleep apnoea and cardiac hypertrophy, and 15 healthy subjects matched for age, sex and body mass index were recruited. After evaluating anthropometric and echocardiographic parameters, anterior pituitary function, glucose and lipid metabolism, and measuring plasma leptin, direct recording of sympathetic outflow via the microneurographic technique was performed.

RESULTS

For similar anthropometric and metabolic parameters in patients and controls, HOMA index was significantly increased in the former (4·2 ± 2·39 vs 1·6 ± 0·19, P < 0·001). Surprisingly, this finding of insulin resistance was accompanied by a marked sympathetic inhibition (MSNA 18·3 ± 8·10 vs 37·3 ± 6·48 bursts/min, P < 0·0001, respectively in patients and controls). A reduction in plasma leptin (1·6 ± 1·04 vs 6·5 ± 2·01 μg/l, P < 0·0001) was also recorded in the patients. MSNA was positively correlated with leptin (P < 0·0001).

CONCLUSIONS

Newly diagnosed acromegalic patients without cardiac hypertrophy display a decreased sympathetic outflow in spite of insulin resistance. This finding might be related to hypoleptinaemia.

Equilibrium concentration profiles and sedimentation kinetics of colloidal gels under gravitational stress

We study the sedimentation of colloidal gels by using a combination of light scattering, polarimetry and video imaging. The asymptotic concentration profiles (z,t → ∞) exhibit remarkable scaling properties: profiles for gels prepared at different initial volume fractions and particle interactions can be superimposed onto a single master curve by using suitable reduced variables. We show theoretically that this behavior stems from a power law dependence of the compressive elastic modulus versus , which we directly test experimentally. The sedimentation kinetics comprises an initial latency stage, followed by a rapid collapse where the gel height h decreases at constant velocity and a final compaction stage characterized by a stretched exponential relaxation of h toward a plateau. Analogies and differences with previous works are briefly discussed.

[Plant protection products: new tools for exposure and risk assessment in agriculture]

Our experience in assessment and management of chemical risk in agriculture consists of three lines: i) definition and modeling of the relationships between different exposure determinants to create the possibility of doing risk assessment without measurements ii) identification, from the Acceptable Operator Exposure Levels (AOEL), of provisional biological exposure indices for pesticides; iii) identification of analytical approaches adequate for the production of the measures needed to support the above mentioned activities starting from the use of multi-residue methods, allowing the determination in one run of several active ingredients and metabolites.

[Physically-based model of pesticide application for risk assessment of agricultural workers]

Due to their unavoidable toxicity to non-target organisms, including man, the not of Plant Protection Products requires a thorough risk assessment to rationally advise safe use procedures and protection equipment by farmers. Most information on active substances and formulations, such as dermal absorption rates and exposure limits are available in the large body of regulatory data. Physically-based computational models can be used to forecast risk in real-life conditions (preventive assessment by 'exposure profiles'), to drive the cost-effective use of products and equipment and to understand the sources of unexpected exposure.

[Biological agents in animal breeding: an ancient but still relevant risk]

Agricultural activities expose workers to biological risk, due to the close contact that could occur with pathogens' reservoirs, such as soil, animals, manure and animal products. The paper describes factors that have contributed on the reduction or eradication of zoonoses, such as brucellosis, salmonellosis and bovine tuberculosis (monitoring and prevention of animal infectious diseases, industrialization and mechanization of agricultural activities), and on the other hand the emergence of new risks and new diseases (adaptability of microorganisms, generation of new strains, antibiotic resistance, dissemination of vectors). The role of Occupational Medicine in the prevention of zoonoses is discussed.

[The allergic risk in agriculture: current situation and specific high-risk areas]

Contradictory aspects apparently coexist in relation to the causes of bronchial allergic inflammation in agriculture. It's worth notion that either exposure to inhalable dust and endotoxins or exposure to molecular patterns play a role in such a pathology; in particular endotoxins should protect against the onset of allergic diseases. Likewise, the exposure to pesticides would not lead to allergic asthma, but could facilitate the onset of pollinosis and contact dermatitis in gardeners. Moreover, the risk of anaphylaxis from bee sting would be lower in repeatedly bitten beekeepers if compared to sensitized and less exposed population, while atopy by itself is not evaluable as a risk factor for sensitization to hymenoptera. In conclusion either frequency and strength of exposure or distinctive feature of the subject are able to determine the occurrence of allergic disease in an almost different manner.

Medium term endoscopic assessment of the surgical outcome following laryngeal saccule resection in brachycephalic dogs

Laryngeal saccule eversion has been widely reported as an important component of brachycephalic airway obstructive syndrome (BAOS). The authors hypothesised that saccules affected by acute histological changes in patients showing marked improvement following palate and nares surgery might spontaneously return to normal; moreover, spontaneous resolution of the eversion in patients with fibrotic saccules and/or without clinical improvement following BAOS surgery might be impossible and, on the contrary, the persistence of turbulent airflow and associated ongoing inflammation might lead to aberrant tissue proliferation after resection. In order to demonstrate our hypotheses, the authors decided to perform a unilateral sacculectomy and to postpone and assess the need for the execution of the contralateral saccule resection according to the findings of a second-look laryngoscopy. Ten dogs were enrolled. None of the saccules left in situ underwent spontaneous resolution of the eversion. In one dog, after sacculectomy, proliferation of a soft tissue lesion endoscopically similar to a newly formed saccule occurred. The results of the present study suggest that spontaneous resolution of saccule eversion is uncommon, even after the correction of the primary abnormalities (palate, nares). Resection of the saccules can relieve ventral rima glottidis obstruction; however, secondary intention healing might occasionally result in the recurrence of the obstruction.

Compact optical microfiber phase modulator

A compact optical microfiber phase modulator with MHz bandwidth is presented. A micrometer-diameter microfiber is wound on a millimeter-diameter piezoelectric ceramic rod with two electrodes. When a voltage is applied to the piezoelectric ceramic, the rod is strained, leading to a phase change along the microfiber; because of the small size, the optical microfiber phase modulator can have as high as a few MHz bandwidth response.

Theoretical and experimental demonstrations of a microfiber-based flexural disc accelerometer

The proof-of-concept demonstration of a microfiber-based flexural disc accelerometer is presented. The reduced microfiber size and bending radii give rise to high device compactness and responsivity. A flexural disc accelerometer manufactured from a 10 mm long microfiber showed a performance of ~2.2 rad/g, with the responsivity expected to increase proportionally with the microfiber length.

Recurrent acute idiopathic pericarditis: rheumatologic therapy, autoantibodies and long term outcome

OBJECTIVE

To evaluate therapy and rheumatologic aspects of recurrent acute idiopathic pericarditis (RAIP).

METHODS

We studied 46 patients. We used non-steroidal anti-inflammatory drugs (NSAIDs) at high dosage. We did not start corticosteroid: if already started, we planned a very slow tapering; 37 patients (80.4%) were treated with colchicine. We also assessed the frequency of ANA, anti-SSA and Rheumatoid factor.

RESULTS

With our protocol recurrences dropped from 0.46 to 0.03 attacks/patient/month (p<0.00001) within 12 months and remained at the same level (0.024) till the end of the follow-up (mean 8 years). In the 37 patients treated with colchicine recurrences dropped from 0.5 to 0.03 (p<0.0001) within 12 months, and in 9 patients not given colchicine from 0.27 to 0.045 (p<0.005). When colchicine was used the decrease was significantly higher (0.47 vs 0.23) (p<0.001). In 27 (58.7%) patients ANA were positive at a titre >1/80, in 7 (15.2%) >1/160. Rheumatoid factor was positive in 7 (15.2%) and anti-SSA in 4 (8.7%). During the follow-up 4 (8.7%) new diagnosis of Sjogren and 1 (2.2%) of Rheumatoid Arthritis were made.

CONCLUSION

NSAIDs at high dosage, slow tapering of corticosteroid and colchicine are very effective in RAIP. The improvement is more dramatic in colchicine treated patients, but also other patients can achieve good control of the disease. The finding of ANA, anti-SSA and the new rheumatological diagnoses support the involvement of autoimmunity.

[Diet as a key element of health promotion at the workplace in scientific research and practice. First results of the EU project FAHRE]

The globalization of markets have led to rapid changes in diet and lifestyle in the developed countries, where living standards have improved, and availability and variety of food has increased while physical activity decreases have led to an augment in chronic diseases (obesity and diabetes mellitus), cardiovascular diseases and some specific cancers. In this context there is a need to develop health promotion activities. Workers represent a very appropriate group for such activities because they are relatively homogeneous, easily reachable because they can be found together in the same place and time and the occupational physician has good knowledge of the of health status of individual worker. In this scenario, a renew interest must be posed to the relationship between diet and health. In this context our Group is participating at the FAHRE project (Food and Health Research in Europe). The project aims to establish the state of the art of research at the interface of nutrition and health in the European Union, identifying its strengths and weaknesses in order to propose strategies to increase coordination and improve its functioning as a European Research Area.

[Occupational health surveillance in agriculture: the experience of the International Centre for Rural Health]

The results of the activities of occupational health surveillance in agriculture carried out by the International Centre for Rural Health since 2008 are described. The activities involve 800 workers employed in 260 farms in the Region of Lombardy (Italy). The types of farms reflect the vocation toward agricultural sector of the Po Valley and the most representative tasks are related to animal care and use of agricultural machinery. Based on the specific risks, workers are provided with preventive and periodic examinations, and complementary laboratory and instrumental evaluations (hearing and respiratory functions, electrocardiography), related to the different risk factors present in the enterprises. The occupational health priorities identified are, for the time being, noise-induced hearing loss and insufficient immunization against tetanus.

[Migrant workers in agriculture and animal husbandry: experiences of health surveillance]

In Italy, 5 millions migrants live and work. Among them, the employment rate is much higher in comparison with the Italians' one (75% versus 62%). The well known "healthy migrant effect" is confirmed by statistics from the National Institute for Statistics: according to it, migrants access the National Health System for pregnancy and delivery and for accidents. The chronic pathology is not a major concern. Moreover, their work ability is generally complete, without any limitation. Nevertheless, migrants seem to represent a vulnerable subgroup with regard to the risk of 1) occupational injuries: this is strongly linked with the risk of Tetanus infection; 2) disorders of the metabolism, like hyperglycaemia and hyperlipemia, which is linked to a higher cardiovascular risk. In this light data from health surveillance carried out by the International centre for Rural Health of the San Paolo University Hospital in agricultural setting in the Region of Lombardy and the participation of the Centre itself to the Promovax EC-cofunded project are presented.

Highly nonlinear dynamics in a slowly sedimenting colloidal gel

We use a combination of original light scattering techniques and particles with unique optical properties to investigate the behavior of suspensions of attractive colloids under gravitational stress, following over time the concentration profile, the velocity profile, and the microscopic dynamics. During the compression regime, the sedimentation velocity grows nearly linearly with height, implying that the gel settling may be fully described by a (time-dependent) strain rate. We find that the microscopic dynamics exhibit remarkable scaling properties when time is normalized by the strain rate, showing that the gel microscopic restructuring is dominated by its macroscopic deformation.