In vitro exposure to PM2.5 of olfactory Ensheathing cells and SH-SY5Y cells and possible association with neurodegenerative processes

PM2.5 exposure represents a risk factor for the public health. PM2.5 is able to cross the blood-alveolar and blood-brain barriers and reach the brain through three routes: nasal olfactory pathway, nose-brain pathway, blood-brain barrier pathway. We evaluated the effect of PM2.5 to induce cytotoxicity and reduced viability on in vitro cultures of OECs (Olfactory Ensheathing Cells) and SH-SY5Y cells. PM2.5 samples were collected in the metropolitan area of Catania, and the gravimetric determination of PM2.5, characterization of 10 trace elements and 16 polycyclic aromatic hydrocarbons (PAHs) were carried out for each sample. PM2.5 extracts were exposed to cultures of OECs and SH-SY5Y cells for 24-48-72 h, and the cell viability assay (MTT) was evaluated. Assessment of mitochondrial and cytoskeleton damage, and the assessment of apoptotic process were performed in the samples that showed lower cell viability. We have found an annual average value of PM2.5 = 16.9 μg/m3 and a maximum value of PM2.5 = 27.6 μg/m3 during the winter season. PM2.5 samples collected during the winter season also showed higher concentrations of PAHs and trace elements. The MTT assay showed a reduction in cell viability for both OECs (44%, 62%, 64%) and SH-SY5Y cells (16%, 17%, 28%) after 24-48-72 h of PM2.5 exposure. Furthermore, samples with lower cell viability showed a decrease in mitochondrial membrane potential, increased cytotoxicity, and also impaired cellular integrity and induction of the apoptotic process after increased expression of vimentin and caspase-3 activity, respectively. These events are involved in neurodegenerative processes and could be triggered not only by the concentration and time of exposure to PM2.5, but also by the presence of trace elements and PAHs on the PM2.5 substrate. The identification of more sensitive cell lines could be the key to understanding how exposure to PM2.5 can contribute to the onset of neurodegenerative processes.

Single and combined effects of caffeine and salicylic acid on mussel Mytilus galloprovincialis: Changes at histomorphological, molecular and biochemical levels

Caffeine (CAF) and salicylic acid (SA) are frequently detected in waterbody, though information on their biological impact is poor. This work assesses the effects of CAF (5ng/L to 10µg/L) and SA (0.05µg/L to 100µg/L) alone and combined as CAF+SA (5ng/L+0.05µg/L to 10µg/L+100µg/L) on mussel Mytilus galloprovincialis under 12-days exposure by histomorphology of digestive gland and oxidative stress defense at molecular and biochemical levels. Besides evaluating tissue accumulation, absence of histomorphological damage and haemocyte infiltration highlighted activation of defensive mechanisms. Up-regulation of Cu/Zn-sod, Mn-sod, cat and gst combined with increased catalase and glutathione S-transferase activity were found in CAF-exposed mussels, while SA reduced ROS production and mitochondrial activity. CAF+SA exposure induced differential responses, and the integrated biomarker response (IBR) revealed more pronounced effects of SA than CAF. These results enlarge knowledge on pharmaceuticals impact on non-target organisms, emphasizing the need for proper environmental risk assessment.

Healthcare University Courses Fail to Improve Opinions, Knowledge, and Attitudes toward Vaccines among Healthcare Students: A Southern Italy Cross-Sectional Study

(1) Background: Healthcare providers have a crucial role in contrasting vaccine hesitancy (VH). We aimed to investigate opinions, knowledge, and attitudes toward vaccines in healthcare students (HS) at the University of Catania (Italy). (2) Methods: A survey was conducted from 1 October 2019 to 31 January 2020. Data on the opinions, knowledge, and attitudes of HS toward vaccinations were collected using an anonymous self-administered questionnaire. The opinion answers were added to calculate the VH index (<18 = low, 19−22 = medium, >23 = high). Data were summarized by the VH index, degree, year of study, and sex differences, using descriptive statistics. (3) Results: A total of 1275 students (53.7% females) participated in the study, with a median (IQR) age of 21 (19−22) years. The median level of VH was 20 (17−23), with slightly higher values in males. We found an inverse trend between VH and opinions, knowledge, and attitudes toward vaccines. The same trend was confirmed in all study courses. Furthermore, the comparison between sexes revealed a higher level of knowledge in women. (4) Conclusions: The results highlight a lack of knowledge about vaccines, as well as contrasting opinions and attitudes among future health professionals. Therefore, future interventions on these topics in the preparation of future healthcare providers are needed.

Effects of Nano and Microplastics on the Inflammatory Process: In Vitro and In Vivo Studies Systematic Review

BACKGROUND

Microplastics (MPs) and Nanoplastics (NPs) are plastic fragments that spread in the environment and accumulate in the human body, so they have been becoming a worldwide environmental concern because of their potential human health effects. The aim of this systematic review was to investigate the prospective impact of MPs and NPs on the inflammatory process.

METHODS

Electronic article search was performed on PubMed, Scopus and Web of Science international databases from 1 Jan 2012 to 31 Dec 2021. Screenings of titles, abstracts and full texts were performed according to the Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA). The methodological quality of the studies was checked by the Toxicological data Reliability Assessment Tool.

RESULTS

Electronic article search identified 125 records, from which 6 in vitro, 11 in vivo and 2 both in vivo and in vitro studies were included. Both in vivo and in vitro studies have showed an increase ofdifferent inflammatory outcomes (Interleukines, Tumor necrosis factor, Chemokines, Interferones, Transcription factors, Growth factors, Oxydoreductase, Proteins and others), thus it seems to confirm the association withthe exposure to microplastics of different types, sizes, exposure times and exposed species.

CONCLUSIONS

This systematic review seems to support the relationship between the exposure to MPs and the inflammatory processboth in vivo and in vitro. Greater caution is needed about the role of NPs because ofa very small number of studies. Additional high-quality studies are warranted to confirm these results, especially the research should be focused on NPs being lacking literature.

Benefits of Physical Activity during and after Thyroid Cancer Treatment on Fatigue and Quality of Life: A Systematic Review

Simple Summary

The usefulness of physical activity in a preventive key is no longer in question, whereas sports therapy is assuming an increasingly important role in cancer rehabilitation. This review provides an overview on the effects of physical activity on fatigue, quality of life (QoL) and health-related quality of life (HRQoL) in patients with thyroid cancer diagnosis both during and after treatment, with a focus on sex. We found that the level of confidence in the available evidence is very low. Future studies are needed to understand which training programs are optimal, both in terms of beneficial effects and to avoid potential adverse responses, in addition to focusing on gender differences.

Abstract

Background: Several epidemiological studies have provided evidence of the usefulness of physical activity for cancer prevention, increased survival and quality of life (QoL), but no comprehensive review is available on the effects on thyroid cancer. The present systematic review provides an overview of the effects of physical activity on fatigue, QoL and health-related quality of life (HRQoL) in patients with thyroid cancer diagnosis both during and after treatment, with a focus on sex. Methods: A literature search was conducted in the PubMed and Scopus databases. We included studies investigating the impact of physical activity during and after thyroid cancer treatment, including fatigue, QoL and/or HRQoL among the outcomes. Review articles, conference papers, short communications and articles written in a language other than English articles were excluded. Study selection followed the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA). Two reviewers independently selected the studies and assessed their eligibility. The same two reviewers independently screened studies, extracted data and assessed the risk of bias. Outcomes of interest were fatigue, QoL and HRQoL. The Newcastle–Ottawa Scale was used to assess the quality of the selected studies. We compared the outcomes between groups of patients with subclinical hyperthyroidism undergoing a physical activity program and a sedentary group, evaluating the possible presence of sex differences. Results and Discussion: We found five studies eligible for inclusion in our review; only two were prospective studies including an exercise training program. One study was a quasi-experimental study with a non-equivalent control group. Three out of five studies comprised low-quality evidence with a high risk of bias. Conclusion: The level of confidence in the available evidence is very low. A close association between physical activity and fatigue, QoL and HRQoL in patients with thyroid cancer diagnosis with a focus on sex can neither be supported nor refuted. Future studies are needed to understand which training programs are optimal, both in terms of beneficial effects and to avoid potential adverse responses, in addition to focusing on gender differences. The protocol of this systematic review was registered with PROSPERO: CRD42022322519.

Trace elements in the muscle tissue of Hemiculter leucisculus and Abramis brama orientalis from the Anzali International wetland, south-west of Caspian Sea: An exposure risk assessment

High levels of trace elements in aquatic environments can affect the quality of seafood. We analyzed the concentrations of As, Cd, Co, Hg, Mn, Ni and Pb, in the edible muscles of Hemiculter leucisculus and A. brama orientalis caught in four different areas of southwest of the Caspian Sea. We estimated the potential risks for human health deriving by the oral consumption of these two species, and the Target Hazard Quotient (THQ) according to the US-EPA approach. THQ by adults and children was always below 1 for all stations. The greater contribution was given by Co, followed by Cd, Hg, Pb, Ni, As and Mn. Total-THQ was 0.538 and 0.246 for children and adults, respectively. Trace elements detected by our study were not elevated, highlighting a positive picture of the studied area and a lower risk of developing chronic systemic effects deriving from the consumption of local fish products.

Possible association between PM2.5 and neurodegenerative diseases: A systematic review

Air pollution is one of the most serious environmental problems that afflict our planet and one of the greatest risk factors for human health. In particular, PM_2.5 is able to cross the blood-alveolar and blood-brain barriers, thus increasing the onset of respiratory, cardiovascular and neurodegenerative diseases. Neurodegenerative disease is a progressive neuronal dysfunction that leads to neuronal lesions in both structure and function, and includes several diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), vascular dementia (VaD), multiple sclerosis (MS), and others. We carried out a systematic review using PRISMA approach to investigate on the possible association between exposure to PM_2.5 and neurodegenerative diseases. The international databases (PubMed, Science Direct, Web of Sciences) were used to find published studies on the topic. The search period was between January 2011 and June 2021. About 2000 full research articles were selected, and finally, we included 20 full-research articles. Selected studies have highlighted how PM_2.5 exposure can be associated with the onset of neurodegenerative diseases (AD, PD, MS, VaD). This association depends not only on age, PM_2.5 levels and exposure time, but also on exposure to other air pollutants, proximity to areas with high vehicular traffic, and the presence of comorbidities. Exposure to PM_2.5 promotes neuroinflammation processes, because through breathing the particles can reach the nasal epithelial mucosa and transferred to the brain through the olfactory bulb. Furthermore, exposure to PM_2.5 has been associated with an increased expression of markers of neurodegenerative diseases (e.g. alpha-synuclein or beta-amyloid), which can contribute to the etiopathogenesis of neurodegenerative diseases. Although many studies have revealed the pathological relationship between PM_2.5 exposure and cognitive impairment, the potential cellular and molecular mechanisms of PM_2.5 leading to neurodegenerative disease remain not entirely clear, and then, further studies need to be carried out on the topic.

Bioaccumulation and health risk assessment of exposure to potentially toxic elements by consuming agricultural products irrigated with wastewater effluents

Potentially toxic elements (PTEs) have many adverse health effects due to bioaccumulation capability and their long persistence in the environment. As a renewable water source, the effluents of municipal wastewater treatment systems have been used to irrigate agricultural products widely. However, the evidence on the bioaccumulation of PTEs in crops irrigated with these effluents is still scarce, with no available study in low and middle-income countries. Therefore, this study aimed to assess the PTEs concentration in the soil and crops irrigated with effluents of Sabzevar wastewater treatment plant and the related health risk by that. The clustered method was used to determine the soil and craps samples. Seventy cumulative samples were randomly prepared in summer and autumn 2016 and 2017 from crops, soil and effluent. Inductively coupled plasma mass spectrometry (ICP-MS) was used to measure PTEs. The health risk of exposure to PTEs was assessed using Monte Carlo simulation technique. Kruskal Wallis test and Posthoc Tukey HSD test were used to assess the mean difference of PTEs between soil, effluent and crops as well as between crops together. The bioaccumulation factor (BAF) magnitude order in different crop samples was Cd > Sr > Cu > Pb > Zn > Co > As > Cr > Ni, respectively. The Cd accumulation in Sugar beet plant was significantly higher than in other samples. The highest hazard quotient (HQ) based on single PTEs was observed for As (mineral) (mean: 5.62 × 10^-1 and percentile 95th: 2.13) in Okra. Regarding total HQ (THQ), the highest and lowest mean (percentile 95th) values were 1.50 (3.22) and 2.40 × 10^-1 (4.01 × 10^-1) for Okra and Watermelon, respectively. The mean concentrations of Co, Cr, Ni and Zn were significantly higher in crops compared to soil and influent samples. Posthoc tests indicated that the concentration of PTEs between investigated crop samples were not statistically significant different (p > 0.05). Overall, our study suggested that irrigation with the effluent of stabilization pond wastewater treatment system exerts a potential health risk due to bioaccumulation of PTEs in crops.

Dietary exposure of zinc oxide nanoparticles (ZnO-NPs) from canned seafood by single particle ICP-MS: Balancing of risks and benefits for human health

The present study aims to give information regarding the quantification of ZnO-NPs in canned seafood, which may be intentionally or unintentionally added, and to provide a first esteem of dietary exposure. Samples were subjected to an alkaline digestion and assessment of ZnO-NPs was performed by the single particle ICP-MS technique. ZnO-NPs were found with concentrations range from 0.003 to 0.010 mg/kg and a size mean range from 61.3 and 78.6 nm. It was not observed a clear bioaccumulation trend according to trophic level and size of seafood species, although the mollusk species has slightly higher concentrations and larger size. The number of ZnO-NPs/g does not differ significantly among food samples, observing an average range of 5.51 × 10⁶ - 9.97 × 10⁶. Dissolved Zn determined with spICP-MS revealed comparable concentration to total Zn determined with ICP-MS in standard mode, confirming the efficiency of alkaline digestion on the extraction of the Zn. The same accumulation trend found for ZnO-NPs was observed more clearly for dissolved Zn. The ZnO-NPs intake derived from a meal does not differ significantly among seafood products and it ranges from 0.010 to 0.031 µg/kg b.w. in adult, and from 0.022 to 0.067 µg/kg b.w. in child. Conversely, the intake of dissolved Zn is significantly higher if it is assumed a meal of mollusks versus the fish products, with values of 109.3 µg/kg b.w. for adult and 240.1 µg/kg b.w. for child. Our findings revealed that ZnO-NPs have the potential to bioaccumulate in marine organisms, and seafood could be an important uptake route of ZnO-NPs. These results could be a first important step to understand the ZnO-NPs human dietary exposure, but the characterization and quantification of ZnO-NPs is necessary for a large number of food items.

Evaluation of ZnO-NPs in canned seafood by single particle ICP-MS determination

 

Zinc is a well-known essential micronutrient, widely used as a food supplement, antimicrobial agent and food preservation. NOAEL was established at 50 mg/person per day and an upper limit of 25 mg/person per day was recommended. ZnONPs are GRAS substances approved by FDA. Nanotechnology is an emerging issue because of the industrial widespread use of ZnO nanoparticles and their potential toxicity and bioaccumulation. Aim of this study is to provide information regarding the quantification of ZnO-NPs, which may be intentionally or unintentionally added, in different brands of canned tuna (CT) and canned clam (CC), and to provide a first esteem of dietary exposure. Canned seafood was subjected to an alkaline digestion with TMAH. Assessment of ZnONPs was performed using a NexION 350D with the Syngistix Nano Application software (Perkin Elmer), allowing to identify number of particles, size and size distribution of metal NPs with the simultaneous quantification of the dissolved elemental concentration. Estimated Meal Intake was evaluated for adults by assuming a meal size of 227 g, 70 years old and 70 Kg of b.w. Results revealed a comparable mean size range between the considered food item (CT 69-80 nm; CC 75-83 nm). Concentration of ZnONPs are significantly higher in CC versus CT (CT 3.2-9.8 µg/Kg; CC 7.7-11.3 µg/Kg). The same we found for dissolved Zn concentration (CT 19.1-28.4 mg/Kg; CC 27.4-39.2 mg/Kg). For CT it was estimated an EMI of 0.018 µg/Kg bw for ZnONPs and 79.9 µg/Kg bw for dissolved Zn. For CC it was estimated an EMI of 0.031 µg/Kg bw for ZnONPs and 109 µg/Kg bw for dissolved Zn. Our findings revealed that ZnO-NPs have the potential to bioaccumulate in marine organisms, and seafood could be an important uptake route of ZnONPs. These results are a first important step to understand the ZnONPs human dietary exposure, but the characterization and quantification of ZnONPs is necessary for a large number of food items.

Key messages

The extensive use and discharge of ZnONPs will probably expose human population to concentration higher than the recommended upper limit 25 mg/person per day. The quantification of ZnONPs dietary exposure will be useful for risk assessors in developing provisional tolerable daily intake.

Oncogenic Role of miRNA in Environmental Exposure to Plasticizers: A Systematic Review

The daily environmental exposure of humans to plasticizers may adversely affect human health, representing a global issue. The altered expression of microRNAs (miRNAs) plays an important pathogenic role in exposure to plasticizers. This systematic review summarizes recent findings showing the modified expression of miRNAs in cancer due to exposure to plasticizers. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, we performed a systematic review of the literature published in the past 10 years, focusing on the relationship between plasticizer exposure and the expression of miRNAs related to cancer. Starting with 535 records, 17 articles were included. The results support the hypothesis that exposure to plasticizers causes changes in or the deregulation of a number of oncogenic miRNAs and show that the interaction of plasticizers with several redundant miRNAs, such as let-7f, let-7g, miR-125b, miR-134, miR-146a, miR-22, miR-192, miR-222, miR-26a, miR-26b, miR-27b, miR-296, miR-324, miR-335, miR-122, miR-23b, miR-200, miR-29a, and miR-21, might induce deep alterations. These genotoxic and oncogenic responses can eventually lead to abnormal cell signaling pathways and metabolic changes that participate in many overlapping cellular processes, and the evaluation of miRNA-level changes can be a useful target for the toxicological assessment of environmental pollutants, including plastic additives and plasticizers.

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.

Water quality and human health: A simple monitoring model of toxic cyanobacteria growth in highly variable Mediterranean hot dry environments

Due to population growth, urbanization and economic development, demand for freshwater in urban areas is increasing throughout Europe. At the same time, climate change, eutrophication and pollution are affecting the availability of water supplies. Sicily, a big island in southern Italy, suffers from an increasing drought and consequently water shortage. In the last decades, in Sicilian freshwater reservoirs several Microcystis aeruginosa and more recently Planktothrix rubescens blooms were reported. The aims of the study were: (1) identify and quantify the occurring species of cyanobacteria (CB), (2) identify which parameters, among those investigated in the waters, could favor their growth, (3) set up a model to identify reservoirs that need continuous monitoring due to the presences, current or prospected, of cyanobacterial blooms and of microcystins, relevant for environmental and, consequentially, for human health. Fifteen artificial reservoirs among the large set of Sicilian artificial water bodies were selected and examined for physicochemical and microbiological characterization. Additional parameters were assessed, including the presence, identification and count of the cyanobacterial occurring species, the measurement of microcystins (MCs) levels and the search for the genes responsible for the toxins production. Principal Component Analysis (PCA) was used to relate environmental condition to cyanobacterial growth. Water quality was poor for very few parameters, suggesting common anthropic pressures, and PCA highlighted clusters of reservoirs vulnerable to hydrological conditions, related to semi-arid Mediterranean climate and to the use of the reservoir. In summer, bloom was detected in only one reservoir and different species was highlighted among the Cyanobacteria community. The only toxins detected were microcystins, although always well below the WHO reference value for drinking waters (1.0 μg/L). However, molecular analysis could not show the presence of potential cyanotoxins producers since a few numbers of cells among total could be sufficient to produce these low MCs levels but not enough high to be proved by the traditional molecular method applied. A simple environmental risk-based model, which accounts for the high variability of both cyanobacteria growth and cyanotoxins producing, is proposed as a cost-effective tool to evaluate the need for monitoring activities in reservoirs aimed to guarantee supplying waters safety.

Chemical Characterization and Quantification of Titanium Dioxide Nanoparticles (TiO2-NPs) in Seafood by Single-Particle ICP-MS: Assessment of Dietary Exposure

The significant increase in the production and variety of nanoparticles (NPs) has led to their release into the environment, especially into the marine environment. Titanium dioxide nanoparticles (TiO₂-NPs) are used in different industrial sectors, from the food industry to several consumer and household products. Since the aquatic environment is highly sensitive to contamination by TiO₂-NPs, this work aimed to give a preliminary assessment of the contamination of packaged seafood, where the food additive TiO₂ (E171) is not to be intentionally added. This allowed providing a chemical characterization and quantification of TiO₂-NPs in processed canned fish products belonging to different trophic positions of the pelagic compartment and in canned clam. The new emerging technique called single-particle inductively coupled plasma mass spectrometry (spICP-MS) was applied, which allows the determination of nanoparticle number-based concentration, as well as the dissolved titanium. This study highlights how processed food, where the pigment E171 was not intentionally added, contains TiO₂ in its nanoparticle form, as well as dissolved titanium. Processed clam represented the seafood with the highest content of TiO₂-NPs. In pelagic fish species, we found progressively higher levels and smaller sizes of TiO₂-NPs from smaller to larger fish. Our results highlight the importance of planning the characterization and quantification of TiO₂-NPs in food both processed and not, as well as where the pigment E171 is intentionally added and not, as it is not the only source of TiO₂-NPs. This result represents a solid step toward being able to estimate the real level of dietary exposure to TiO₂-NPs for the general population and the related health risks.

The role of air pollution (PM and NO2) in COVID-19 spread and lethality: A systematic review

A new coronavirus (SARS-CoV-2) has determined a pneumonia outbreak in China (Wuhan, Hubei Province) in December 2019, called COVID-19 disease. In addition to the person-to person transmission dynamic of the novel respiratory virus, it has been recently studied the role of environmental factors in accelerate SARS-CoV-2 spread and its lethality. The time being, air pollution has been identified as the largest environmental cause of disease and premature death in the world. It affects body's immunity, making people more vulnerable to pathogens. The hypothesis that air pollution, resulting from a combination of factors such as meteorological data, level of industrialization as well as regional topography, can acts both as a carrier of the infection and as a worsening factor of the health impact of COVID-19 disease, has been raised recently. With this review, we want to provide an update state of art relating the role of air pollution, in particular PM_2.5, PM₁₀ and NO₂, in COVID-19 spread and lethality. The Authors, who first investigated this association, often used different research methods or not all include confounding factors whenever possible. In addition, to date incidence data are underestimated in all countries and to a lesser extent also mortality data. For this reason, the cases included in the reviewed studies cannot be considered conclusive. Although it determines important limitations for direct comparison of results, and more studies are needed to strengthen scientific evidences and support firm conclusions, major findings are consistent, highlighting the important contribution of PM_2.5 and NO₂ as triggering of the COVID-19 spread and lethality, and with a less extent also PM₁₀, although the potential effect of airborne virus exposure it has not been still demonstrated.

Dietary habits and thyroid cancer risk: A hospital-based case-control study in Sicily (South Italy)

Several studies have investigated the role of diet as a risk and/or protective factor against thyroid cancer, both considering individual foods, groups of foods and dietary patterns, but the results are not consistent. The aim of the study was to investigate the relationship between dietary habits and thyroid cancer. Cases and controls were recruited at the University Hospital "G. Rodolico" of Catania. The dietary habits were defined through the "Lifestyle Assessment Questionnaire". The frequency of consumption of each food item was reported on a 4-level scale (never, one time a week, 2-3 times a week, every day of the week). We computed the odds ratios (ORs) of thyroid cancer and the corresponding 95% confidence intervals (CIs) according to the median of control group daily intake of each food group, using multiple logistic regression models adjusted for major confounding factors. Starchy foods (OR = 1.39, 95% CI 0.83-2.32), sweets (OR = 1.39, 95% CI 0.81-2.40) and products rich in salt and fat showed a positive association with thyroid cancer risk. Conversely, an inverse association with disease risk was found for vegetables (cruciferous OR = 0.30, 95% CI 0.10-0.92, non cruciferous OR = 0.57 (0.20-1.57) milk and dairy products (OR = 0.68, 95% CI 0.40-1.13) and seafood (OR = 0.68, 95% CI 0.34-1.22). An increased risk was observed for consumption of iodized salts (OR 2.06, 95% CI 1.21-3.51), tea (OR = 1.42, 95% CI 0.84-2.41) and coca-cola (OR = 3.08, 95% CI 1.53-6.20). Finally, our results confirm the protective effect of a daily water intake of 1-2 L, but unfortunately this quantity is usually consumed by about a quarter of the sample. Dietary habits appear to modify the risk of thyroid carcinoma. A diet with a limited consumption of starchy foods, products rich in salt, fat and sugar and a higher consumption of, cruciferous/non-cruciferous vegetables, milk and dairy products and seafood could be protective towards thyroid cancer. Moreover, the water intake should be increased and the actual need to consume iodized salt should be verified for each subject/area. These results warrant further investigations and, if confirmed, they might have important public health implications for the reduction of thyroid cancer through the improvement of dietary habits.

Reply to Comment on "Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study"

We much appreciate the positive comments and interest concerning our study on the environmental and occupational risk factors of amyotrophic lateral sclerosis (ALS) [...].

Micro- and nano-plastics in edible fruit and vegetables. The first diet risks assessment for the general population

Microplastics (MPs) represent a current public health concern since toxicity has not yet fully investigated. They were found in several foods, but to the best of our knowledge, at this time no data was reported for the edible vegetables and fruits. We focused on diet exposure aiming to evaluate the number and the size (<10 μm) of MPs in the most commonly consumed vegetables and fruits, in relation to their recommended daily intake too. MPs extraction and analysis were carried out using an innovative Italian methodology and SEM-EDX, respectively. Finally, we calculated the Estimated Daily Intakes (EDIs) for adults and children for each type of vegetal and fruit. The higher median (IQR) level of MPs in fruit and vegetable samples was 223,000 (52,600-307,750) and 97,800 (72,175-130,500), respectively. In particular, apples were the most contaminated fruit samples, while carrot was the most contaminated vegetable. Conversely, the lower median (IQR) level was observed in lettuce samples 52,050 (26,375-75,425). Both vegetable and fruit samples MPs levels were characterized by wide variability. The smallest size of MPs was found in the carrot samples (1.51 μm), while the biggest ones were found in the lettuce (2.52 μm). Both vegetable and fruit samples had size of the MPs characterized by low variability. We found the highest median level of MPs in samples purchased from the "fruiter 3" (124,900 p/g) and the lowest in those purchased in "supermarket" (87,600 p/g). The median size of the MPs had overlapping dimensions in all the purchase sites, with the exception of the samples purchased at the "shop at km zero 2″ which had slightly smaller size (1.81 μm). The highest adults' (4.62 E+05) and children's (1.41 E+06) EDIs are due the ingestion of apples, instead the lowest are due to the ingestion of carrots (adults: 2.96 E+04; children: 1.15 E+05). We hypothesized that the mechanism of uptake and translocation of MPs can be the same described and reported for carbon-nanomaterials. This may be a possible translocation route of MPs by environment to vegetables permitting, so, the translocation or uptake inside of their biological systems. Based on the results obtained it is urgent important to perform toxicological and epidemiological studies to investigate for the possible effects of MPs on human health.

Phytoremediation potential of Arundo donax (Giant Reed) in contaminated soil by heavy metals

Soil pollution from heavy metals poses a serious risk for environment and public health. Phytoremediation is an eco-friendly and cheaper alternative compared to chemical-physical techniques. We carried out in vitro tests where three microorganisms Trichoderma harzianum, Saccharomyces cerevisiae and Wickerhamomyces anomalus were exposed to eight different heavy metals (one metal at a time) in order to evaluate resistance, growth and bioaccumulation capability for each metal (Ni, Cd, Cu, V, Zn, As, Pb, Hg). Taking into account the natural characteristics of T. harzianum, (resistance to environmental stress, resistance to pathogenic fungi, ability to establish symbiotic relationships with superior green plants) and the good bioaccumulation capacity for V, As, Cd, Hg, Pb shown after in vitro tests, it was chosen as a microorganism to be used in greenhouse tests. Controlled exposure tests were performed in greenhouse, where Arundo donax and mycorrhized Arundo donax with T. harzianum were exposed for 7 months at two different doses (L1 and L2) of a heavy metal mix, so as to assess whether the symbiotic association could improve the bioaccumulation capability of the superior green plant A. donax. Heavy metals were determined with ICP-MS. The average bioaccumulation percentage values of A. donax for L1 and L2 were, respectively: Ni (31%, 26%); Cd (35%, 50%); Cu (30%, 35%); As (19%, 27%); Pb (18%, 14%); Hg (42%, 45%); V (39%, 26%); Zn (23%, 9%). The average bioaccumulation percentage values of mycorrhized A. donax with T. harzianum for L1 and L2 were, respectively: Ni (27%, 38%); Cd (44%, 42%); Cu (36%, 29%); As (17%, 23%); Pb (37%, 54%); Hg (44%, 60%); V (16%, 20%); Zn (14%, 7%). A. donax showed the highest BAF (bioaccumulation factor) for Cd (0.50), Cu (0.35), As (0.27) and Hg (0.45) after exposure to L2; mycorrhized A. donax with T. harzianum showed the highest BAF for Ni (0.38), Cd (0.42), Pb (0.54) and Hg (0.60) after exposure to L2. A. donax showed the highest TF (translocation factor) values for Cd (0.28) and Hg (0.26) after exposition at L1 and L2 respectively; A. donax mycorrhized with T. harzianum showed the highest TF values for Cd (0.70), As (0.56), V (0.24), Pb (0.18) after exposition at L2, and Zn (0.30) after exposition at L1. Our study showed a good growth capability in contaminated soils and a good bioaccumulation capability of heavy metals, both for A. donax and mycorrhized A. donax with T. harzianum. Furthermore, for three metals (Ni, Pb and Hg) the bioaccumulation capability was improved by the symbiosis of T. harzianum with A. donax. So, these results proved the suitability both for A. donax and mycorrhized A. donax with T. harzianum for phytoremediation processes.

Environmental and Occupational Risk Factors of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study

Objectives: Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neurodegenerative disease with still unknown etiology. We aimed at investigating the association between environmental and occupational factors with ALS risk. Methods: We performed a population-based case-control study in four Italian provinces (Catania, Modena, Novara, and Reggio Emilia) by administration of tailored questionnaires to ALS cases (n = 95) and randomly selected population referents (n = 135). We estimated ALS risk by calculating the odds ratio (OR) with its 95% confidence interval (CI) using an unconditional logistic regression model. Results: We found a positive association with disease risk for history of occupation in the agricultural sector (OR = 2.09, 95% CI 0.79-7.54), especially for longer than 10 years (OR = 2.72, 95% 1.02-7.20). Overall occupational exposure to solvents also suggested a positive association, especially for thinners (OR = 2.27, 95% CI 1.14-4.54) and paint removers (OR = 2.01, 95% CI 0.90-4.48). Both occupational and environmental exposure to electromagnetic fields show a slightly increased risk with OR = 1.69 (95% CI 0.70-4.09) and 2.41 (95% CI 1.13-5.12), respectively. Occupational but not environmental exposure to pesticides (OR = 1.22, 95% CI 0.63-2.37), particularly fungicides, and exposure to metals (OR = 4.20, 95% CI 1.88-9.38), particularly lead, mercury, and selenium, showed an imprecise but positive association. Finally, there was an indication of increased risk for living in proximity to water bodies. Conclusions: Despite the caution that needs to be used due to some study limitations, such as the low number of exposed subjects and the possibility of recall bias, these results suggest the potential role of some environmental and occupational factors in ALS etiology.

Clinical and Lifestyle Factors and Risk of Amyotrophic Lateral Sclerosis: A Population-Based Case-Control Study

Background: Amyotrophic lateral sclerosis (ALS) is a progressive, fatal neurodegenerative disease of the motor neurons. The etiology of ALS remains largely unknown, particularly with reference to the potential environmental determinants. Methods: We performed a population-based case-control study in four provinces from both Northern and Southern Italy in order to assess non-genetic ALS risk factors by collecting through tailored questionnaires information about clinical and lifestyle factors. We estimated ALS risk by calculating odds ratio (OR) with its 95% confidence interval (CI) using unconditional logistic regression models adjusted for sex, age and educational attainment. Results: We recruited 230 participants (95 cases and 135 controls). We found a possible positive association of ALS risk with trauma, particularly head trauma (OR = 2.61, 95% CI 1.19–5.72), electric shock (OR = 2.09, 95% CI 0.62–7.06), and some sports, although at a competitive level only. In addition, our results suggest an increased risk for subjects reporting use of private wells for drinking water (OR = 1.38, 95% CI 0.73–2.27) and for use of herbicides during gardening (OR = 1.95, 95% CI 0.88–2.27). Conversely, there was a suggestion of an inverse association with overall fish consumption (OR = 0.27, 95% CI 0.12–0.60), but with no dose-response relation. Consumption of some dietary supplements, namely those containing amino acids and, in the Southern Italy population, vitamins and minerals such as selenium, seemed associated with a statistically imprecise increased risk. Conclusions: Our results suggest a potential etiologic role a number of clinical and lifestyle factors with ALS risk. However, caution is needed due to some study limitations. These include the small sample size and the low number of exposed subjects, which affect statistical precision of risk estimates, the potential for exposure misclassification, and the uncertainties about mechanisms underpinning the possible association between these factors and disease risk.

Metal and essential element levels in hair and association with autism severity

BACKGROUND

Autism Spectrum Disorder (ASD) is a complex disorder with heterogeneous etiology and wide clinical severity which supports the needs of recognizing biological and clinical features in patient subsets. The present study aimed to understand possible associations between the hair levels of metals and essential elements and some specific features of ASD measured by the Autism Diagnostic Observation Schedule (ADOS) that represents the gold-standard instrument to objectively confirm ASD diagnosis.

METHODS

A cross-sectional study was performed in the province of Catania (Sicily, South Italy). Forty-eight subjects with ASD (70.8% male), aged from 2 to 17 years were studied. Metals (Li, Be, Al, Ni, As, Mo, Cd, Hg, U, Pb) and essential trace elements (Cr, Co, Mn, Zn, Cu, Se) were quantified in hair by inductively coupled plasma mass spectrometry analysis. Participants were characterized by measuring the severity of autism symptoms and cognitive levels.

RESULTS

A significant and positive correlation was found between hair metal burden (lead, aluminum, arsenic and cadmium levels) and severity of ASD symptoms (social communication deficits and repetitive, restrictive behaviors). Hair zinc level were inversely related with age while there was a negative, significant association between hair zinc level and severity of autistic symptoms (defective functional play and creativity and increase of stereotyped behavior). Lead, molybdenum and manganese hair levels were inversely correlated with cognitive level (full intelligence quotient) in ASD individuals.

CONCLUSIONS

The present study suggests the importance to combine metallomics analysis with pertinent disease features in ASD to identify potential environmental risk factors on an individual level possibly in the early developmental period.

Reply for comment on "Exposure to microplastics (<10 μm) associated to plastic bottles mineral water consumption: The first quantitative study by Zuccarello et al. [Water Research 157 (2019) 365-371]"

Microplastics (MPs) are a threat to both the environment and human health. In the absence of an official method that would allow the analysis of all MPs with diameters less than 10 μm, it was not possible to estimate the exact exposure to these contaminants, yet. In the last years, few studies are available in literature with the first data concerning the concentrations of MPs on bottle mineral waters. Zuccarello et al. (2019) carried out an exposure assessment study where a high value of EDI (Estimated Daily Intake) has been reported. This rebuttal letter aims to reply to the comments of Oßmann et al. (2018) on the article of Zuccarello et al. (2019) about the new analytical method and both the use and the interpretation of Principal Component Analysis.

Vaccine hesitancy among parents in the general population in Sicily (South Italy): A survey study

Background

Vaccine hesitancy (VH) has become the focus of growing attention because of decreased vaccination rates and increased emergency department use, morbidity, and mortality. VH has not been deeply studied in Sicily. The aim of this study was to estimate the prevalence of VH among parents and to investigate the potential determinants.

Methods

We performed a survey from 1 March to 1 June 2018, using a random sample of parents who reported on median 10 year-old children. The parents were recruited in pediatrician’s offices and elementary schools. Information pertaining to socio-demographic characteristics, sources of information regarding vaccination and VH was collected. VH was calculated using the Parents Attitudes about Childhood Vaccines (PACV) questionnaire. Associations between VH and predictors were tested using Multivariable Logistic Regression.

Results

In total 471 questionnaires were collected, 77.7% of respondents were mothers. Based on the PACV 100-point scale, 73.2% (95% CI: 69.0-77.2) of parents had a 0 to &lt;49 score (low level of VH); and 26.8% (95% CI: 22.8-31.0) had a score of 50 and higher (high level of VH). Internet (66.9%, 95% CI: 62.4-71.1) was the main source of information on vaccination followed by television (29.1%, 95% CI: 25.0-33.4). In the bivariate analyses, VH was associated with education, marital status and occupation, but not with gender and age of parents. In multivariate analyses, highly educated (ORadj = 0.297, 95% CI = 0.141-0.626) and married (ORadj = 0.457, 95% CI = 0.213-0.977) parents were more prone to be nonhesitant, but not so unemployed parents (ORadj = 1.787, 95% CI = 1.083-2.956).

Conclusions

The prevalence of VH among the Sicilian parents was comparable with other populations. These results could be an important starting point to support the implementation of effective vaccination strategies.

Key messages

Implement interventions and strategies to further understand the issue of VH, to restore trust in authorities and vaccines. Suggest strategies that could improve childhood vaccination rates.

Efficacy of different citrus essential oils to inhibit the growth and B1 aflatoxin biosynthesis of Aspergillus flavus

Food contamination by aflatoxin B1 (AFB1), produced by mycotoxigenic strains of Aspergillus spp., causes severe medical and economic implications. Essential oils (EOs) are mixtures of eco-friendly natural volatile substances. Their ability to inhibit fungal growth has been investigated, while no data are available about their efficacy in inhibition of AFB1 biosynthesis. This study investigates the efficacy of five different citrus EOs to inhibit the growth and AFB1 synthesis of A. flavus through in vitro tests for a future application in food matrices. AFB1 detection was carried out by LC-ESI-TQD analytical approach. Lemon (Citrus limon (L.) Burm. f.), bergamot (Citrus bergamia Risso), and bitter orange (Citrus aurantium L.) EOs were the most effective causing a 97.88%, 97.04%, and 96.43% reduction in mycelial growth, respectively. Sweet orange and mandarin EOs showed the lowest percentage of mycelial growth reduction. Citrus EOs showed different capacity of AFB1 inhibition (lemon > bitter orange > bergamot > sweet orange > mandarin). Our results showed a dose-dependent antifungal activity of lemon, bitter orange, and bergamot EOs which at 2% (v/v) inhibited both mycelium growth and AFB1 genesis of A. flavus. Our results show that EOs' use can be a pivotal key to recovery and reuse of citrus fruit wastes and to be used as eco-friendly fungicides for improvement of food safety. The use of EOs obtained at low cost from the residues of citric industry presents an interesting option for improving the profitability of the agriculture.

Exposure to microplastics (<10 μm) associated to plastic bottles mineral water consumption: The first quantitative study

The uncontrolled introduction into the environment of plastic polymers have caused the dispersion of plastic fragments, known as Microplastics (MPs), that represent an important topic for public health. This study was the first to investigate the cause of the release of MPs in mineral waters and to estimate the concentration of MPs smaller than 10 μm both in number of particles and in mass unit. This study was carried out using a patent method regarding the extraction and analysis of MPs in more kind of matrix. Therefore, aims of this study were a) to assess the number of MPs with diameters of between 0.5 and 10 μm in mineral waters contained in plastic bottles, b) to evaluate if the physical-chemical properties of mineral waters and bottle quality could influence the release of MPs and, finally, c) to estimate the human daily exposure to MPs due to mineral water consumption. The Mps were found in every sample. The main concentration of MPs was 656.8 μg/L ± 632.9 or 5.42E+07 p/L ± 1.95E+07. The main diameter of detected MPs was 2.44 μm ± 0.66 (where p/L, where p was the number of MPs). The Estimated Daily Intake (EDI) for adults and children were 1,531,524 p/kg/body-weight/day corresponding to 40.1 μg/kg/body-weight/day and 3,350,208 p/kg/body-weight/day corresponding to 87.8 μg/kg/body-weight/day, respectively. The number of MPs contamination in bottled mineral waters was strongly correlated to the pH of waters and to plastic density of bottle. Otherwise, micrograms of MPs per liter and the MPs diameters were strongly affected by plastic thickness. The most mineral water brand contaminated by MPs was the one whose bottles were made from poor quality plastic. In absence of reference values, it was no possible carried out a risk assessment for MPs exposure. It is fundamental to establish the reference method of analysis to monitoring every source of human intake.

Physical Activity and Thyroid Cancer Risk: A Case-Control Study in Catania (South Italy)

Background: The health benefits of physical activity are well established, but the association between physical activity and thyroid cancer remains poorly understood. The aim of the study was to investigate the relationship between physical activity and thyroid cancer in order to determine type, frequency, and duration of exercise needed to maximize prevention. Method: Cases, diagnosed from January 2009 to July 2018, and controls were enrolled at the University Hospital “Policlinico-Vittorio Emanuele” of Catania (South Italy). Logistic regression models were used to estimate the crude and adjusted odds ratios (ORs) and their 95% confidence intervals. Results: A total of 106 cases (91.2% papillary type) and 217 controls were enrolled. Physical activity was rare in Catania (32.8%) and was not correlated to risk of total thyroid cancer (OR: 0.997; 95% CI: 0.515–1.929). Conversely, walking every day for at least 60 minutes reduced the risk of thyroid cancer (OR: 0.357; 95% CI: 0.157–0.673). Conclusions: Our study showed that daily walking duration was associated with lower risk of thyroid cancer using a case-control study. Unfortunately, the frequency of physical activity often declines with age, particularly among the elderly, thus more research on physical activity adherence is needed to determine which approaches are most effective in promoting sustained physical activity participation.

Systematic review of arsenic in fresh seafood from the Mediterranean Sea and European Atlantic coasts: A health risk assessment

Arsenic in the environment pose major threats to human health, and especially the inorganic form can result in adverse health effects. This review analyse papers from 2004 to 2017 on As in fresh fish and molluscs caught in the Mediterranean sea and the European coast of the Atlantic ocean allowing the identification of the marine area with a greater As bioavailability and in particular the identification of the European populations more exposed to In-As by consuming fresh seafood. Results were separated on the base of the fishing site and the concentrations were reworked to assess the average daily intake to In-As as well as Target Hazard Quotient and Cancer Risk. Overall, the greater availability in Tot-As concentration in the pelagic compartment found in the Mediterranean Sea is not present along the European coasts of Atlantic Ocean. Furthermore, only in the Mediterranean Sea, results highlighted significant differences between Tot-As concentrations in seafood subgroups. In both areas, In-As concentrations showed the following trend: molluscs > pelagic > demersal with significant differences between subgroups. The European populations more exposed to In-As from fish and molluscs are the French, Spanish, Italian and Greek, with particular regards to children of 3-6 years old, which should minimize the consumption of molluscs to avoid carcinogenic and non-carcinogenic risks.

PAHs in seafood from the Mediterranean Sea: An exposure risk assessment

Seafood represent an important food source for human, and seafood quality is associated with marine environment quality. PAHs are one of the main organic environmental contaminants and they can be introduced into the body through different way (ingestion, inhalation, dermal absorption). We present data on bioaccumulation of the sixteen PAHs, defined priority by the U.S.- EPA, in Sardina pilchardus, Solea solea and Donax trunculus, three species caught in the Catania Gulf and highly consumed by the local population. The risk to develop chronic systemic and carcinogenic effects due to the consumption of these target species was evaluated through the EDI, THQ and CR. EDI derived from D. trunculus ingestion falls within the range calculated by the EFSA. The THQ is less than 1, and the CR calculated for the Benzo(a)Pyrene is at the limit of the ARL (1✕10^-5). EDI derived from S. pilchardus and S. solea ingestion are below the range calculated by the EFSA. The THQ is less than 1, and the CR is below the acceptable risk level. The contamination level found in local seafood determines a low risk to develop chronic systemic effects, but the cancer risk could be of health concern especially for high-frequency molluscs consumers.

Trace elements in seafood from the Mediterranean sea: An exposure risk assessment

Fish and shellfish belonging to five different species among pelagic, benthonic and molluscs, were collected from the Gulf of Catania in 2017 to evaluate arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), manganese (Mn), nickel (Ni), selenium (Se) vanadium (V) and zinc (Zn). Risk of developing chronic systemic effects derived from seafood consumption was evaluated with the Target Hazard Quotient (THQ) and compared with the results obtained from the same area and the species, collected in 2012. Hg, Cd and Pb concentrations were found below the limits set by European Community for human consumption in all the analysed species. The total risk is reduced from 1.1 to 0.49, and this result is strongly associated with the lower bioaccumulations levels found for Hg, Mn, Se and V. Others metals such as As, Pb, Ni and Zn bioaccumulation levels remain approximately the same, conversely, it is revealed a slight increase of Cd and Cr. Overall, the present study show a positive picture of the studied area, the Gulf of Catania, highlighting not only a decreased metal availability of the study area, but, above all, a decreased risk to develop chronic systemic effects derived from consumption of local seafood.

Health impacts quantification of ambient air pollutants using AirQ model approach in Hamadan, Iran

Iranian western cities, including Hamadan, have been experiencing Middle East Dust Storms (MEDS) phenomenon problems in recent years, so the air quality is getting worse every year in these cities. The aim of this study was to evaluate the human health impacts of criteria air pollutants including PM₁₀, PM_2.5, NO₂, SO₂, CO and O₃ on the citizens of Hamadan using AirQ model software 2.2.3. Considering the determined baseline incidence (BI) and relative risk (RR) rate, the attributable proportion (AP) of deaths due to cardiovascular and respiratory mortality attributed to PM_2.5, PM₁₀, O₃, NO₂, and CO pollutants was estimated to be 4.42%, 3.37%, 1.75%, 1.74% and 0.92% (95% CI) of the total mortality and the excess death cases were respectively estimated to be 131.9, 100.4, 52.1, 51.9 and 27.3 persons. In addition, cardiovascular mortality brings more contribution than respiratory mortality in total death number. The results of our study also showed that PM_2.5 poses the greatest health effects on the citizens. Analyzing the average seasonal concentrations of studied pollutants (PM₁₀, PM_2.5, and NO₂) and the mean seasonal temperature values revealed a positive linear correlation. Significant negative correlations were observed between the studied pollutants (PM₁₀, PM_2.5 and NO₂) and relative humidity, and between PM and wind speed. This study, therefore, provides additional data in decision-makings for the development of strategies for reduction of ambient air pollution which will result in improvements of air quality.

[Algal biotoxins in Dialysis Water: a risk not managed]

A literature review was performed to retrieve updated information on the quality of dialysis water, with a focus on the emerging problem of the presence of algal toxins (microcystins) produced by cyanobacteria. Current legislation was examined as well as studies conducted to date in different geographic areas. In this article, the authors present review results along with recommendations to operators and managers of dialysis units, for preventing possible risks for patients.

Length of gestation and gender are associated with HLA genotypes at risk for Type 1 diabetes (Italian DIABFIN 3)

AIM

The aim of this study, which is part of the ongoing DIABFIN project, was to correlate HLA class II genotypes, classified for their effect on susceptibility to Type 1 diabetes (T1D), with various risk factors during pregnancy and the neonatal period.

METHODS

Cord blood was collected from 4349 neonates; 1.0% were at high HLA risk (HR), 9.0% at moderate HLA risk (MR), and 90.0% at low HLA risk (LR) for T1D. Information about the mother's pregnancy, type of delivery, the neonates' clinical features at birth, and family history for autoimmune diseases were collected.

RESULTS

Significant correlations were found between the different HLA risk categories and length of gestation, even when adjusted for sex, weight and length at birth of the neonate, birth order and mother's age (adjusted P = 0.007). The male : female ratio tended to increase from the LR to the HR category, from 1.00 and 1.21, respectively, in the LR and MR groups, to 1.62 in the HR group (P = 0.05).

CONCLUSIONS

Length of gestation is inversely correlated with HLA risk categories for T1D. The higher the HLA risk for T1D, the shorter the gestational age, especially in male neonates.

Effect of low dose fentanyl-droperidol administration on respiratory drive, respiratory pattern and gas exchange in ASA 1 spontaneously breathing patients

The aim of this study was to investigate the short term effects of low doses of fentanyl and droperidol on central respiratory drive, gas exchanges, respiratory pattern and inspiratory impedance of the respiratory system in a group of ASA 1 patients. Fourteen ASA 1 patients scheduled for minor surgery or endoscopic procedures were enrolled in the study, thirty minutes before the intervention. During spontaneous breathing of air we evaluated, by recording airflow, airway opening pressure and volume, the following variables: Respiratory Rate (RR), Tidal Volume (TV), Total respiratory cycle, Inspiratory and Expiratory Time (Ti, Te), mean inspiratory flow, P0.1, pH, PaO2 and PaCO2. After obtaining basal measurements, droperidol and fentanyl were injected and the above mentioned variables evaluated at 5 min (T1), 10 min (T2), 15 min (T3) intervals. Arterial blood was age, sampled at T3 for blood gas evaluation. The administration of droperidol (0.1 mg/kg) and fentanyl (0.002 mg/kg) significantly reduced P0.1 and Tidal Volume comparing basal with T1 and, T2 values. The other variables did not significantly modify. Two patients showed transient respiratory rhythm abnormalities in the first 180 sec following the administration of droperidol+fentanyl. Our results suggest that, in ASA 1 patients, droperidol+fentanyl preoperative administration, has no significant effects on respiratory pattern, respiratory impedance and gas exchanges: however also at low doses, the association of droperidol+fentanyl can reduce the respiratory center activity, expressed as P0.1, with a consequent reduction in Tidal Volume.

Hemimegalencephaly, hemihypertrophy and vascular lesions

We report on two children with hemihypertrophy and ipsilateral hemimegalencephaly. Vascular lesions in one were consistent with a diagnosis of the Klippel-Trénaunay-Weber Syndrome. MRI performed in the first days of life and at 1 month of age revealed the presence of the neuronal anomaly.

CONCLUSION

The occurrence of hemimegalencephaly in our patients indicates that hemihypertrophy and vascular dysplasia are pathogenetically related phenomena of a continuous spectrum in which this brain disorder may appear.

[Reoperation in patients with heart valve prostheses. Analysis of risk factors affecting perioperative mortality]

Sixty-two patients with at least one prosthetic heart valve each underwent a total of 70 reoperations. Their cases were analysed with special regard to the risk of perioperative mortality and to the factors affecting that risk. The age of the patients studied was 47 +/- 14.6 years (mean +/- 1 SD), and 4.75 +/- 4 years had elapsed since their previous operation. A total of 85 prostheses were implanted at the time of initial surgery. Forty-nine of those were mitral, 28 were aortic, and 8 were tricuspid prostheses. There were 48 mechanical valves, 24 bioprostheses and 13 Carpentier rings (9 of the latter being mitral and 4 tricuspid). At reoperation (n = 70) 95 valves required treatment. Eighteen patients died following their first reoperation (18/62, 29%), and two more died after a second reoperation (2/8, 25%). Actuarial probability of hospital survivors being alive 8-9 years following reoperation was 47 +/- 15%. It was found by multiple regression analysis that the duration of cardiopulmonary bypass (p less than 0.01), surgical priority (p less than 0.05) and the patient's age (p less than 0.05) were the only independent predictors of hospital death. A review of the literature and our own results suggest that surgical problems encountered with reoperation have unfavourably affected surgical results in the past. Objective risk factors are currently more related to the operative outcome. For these to be neutralised, patients with dysfunctioning prosthetic heart valves should be operated at an early stage before they reach a critical one. Only patients with stable, mild dysfunction unlikely to worsen acutely may probably be followed-up safely.