Addressing the different paces of climate and air quality combustion emissions across the world

Greenhouse gases (GHG) and air pollutants (AP) share several anthropic sources but evolve differently in time across the various regions of the globe. Fossil and biological fuel combustion is by far the single process producing the highest amounts of both types of compounds. We have analyzed the paces of change of both GHG and AP emissions across the world and in some selected highly emitting regions using purposely designed indicators. We have observed that, overall, combustion processes are generally producing a lower amount of pollutants per unit of GHG emitted in 2018 than in 1970, with the noticeable exception of ammonia emissions in transport. Nevertheless, comparing countries at different development levels, evidence of possible further improvement clearly emerges, depending on the technological evolution of the most important emitting sectors and on the implementation of appropriate control measures and policies.

Near-real-time global gridded daily CO2 emissions 2021

We present a near-real-time global gridded daily CO₂ emissions dataset (GRACED) throughout 2021. GRACED provides gridded CO₂ emissions at a 0.1° × 0.1° spatial resolution and 1-day temporal resolution from cement production and fossil fuel combustion over seven sectors, including industry, power, residential consumption, ground transportation, international aviation, domestic aviation, and international shipping. GRACED is prepared from the near-real-time daily national CO₂ emissions estimates (Carbon Monitor), multi-source spatial activity data emissions and satellite NO₂ data for time variations of those spatial activity data. GRACED provides the most timely overview of emissions distribution changes, which enables more accurate and timely identification of when and where fossil CO₂ emissions have rebounded and decreased. Uncertainty analysis of GRACED gives a grid-level two-sigma uncertainty of value of ±19.9% in 2021, indicating the reliability of GRACED was not sacrificed for the sake of higher spatiotemporal resolution that GRACED provides. Continuing to update GRACED in a timely manner could help policymakers monitor energy and climate policies' effectiveness and make adjustments quickly.

Modelling the air quality benefits of EU climate mitigation policies using two different PM2.5-related health impact methodologies

The EU, seeking to be a global leader in the fight against climate change, is moving ahead with ambitious policies to mitigate greenhouse gases emissions. In this context, the Fit for 55 package (FF55) is a set of proposals to revise and update EU legislation, to ensure that policies are in line with the climate goals of cutting emissions by at least 55% by 2030. Whilst these policies are designed for climate purposes, they will have positive side-effects (co-benefits) on air quality. Separately, additional policies are also in place to reduce emissions of related air pollutants and to improve air quality concentrations on EU territory. In this work, through a modelling study, we analyse the benefits of these policies via the health benefits arising from the resulting reductions in yearly average PM2.5 concentrations. Results are analysed by assessing and comparing morbidity and mortality impacts as computed using both the HRAPIE (Health risks of air pollution in Europe, WHO, as implemented in the CaRBonH model) and the GBD (Global Burden of Disease, as implemented in FASST-GBD model) approaches. Even when considering the uncertainty and variability in the results obtained using the two approaches, it is clear that EU policies can bring health and economic benefit in EU, with several Billions of Euro of benefits both in terms of morbidity and mortality indicators.

Air pollutant emissions from global food systems are responsible for environmental impacts, crop losses and mortality

Food systems are important contributors to global emissions of air pollutants. Here, building on the EDGAR-FOOD database of greenhouse gas emissions, we estimate major air pollutant compounds emitted by different stages of the food system, at country level, during the past 50 years, resulting from food production, processing, packaging, transport, retail, consumption and disposal. Air pollutant estimates from food systems include total nitrogen and its components (N₂O, NH₃ and NO_x), SO₂, CO, non-methane volatile organic compounds (NMVOC) and particulate matter (PM₁₀, PM_2.5, black carbon and organic carbon). We show that 10% to 90% of air pollutant emissions come from food systems, resulting from steady increases over the past five decades. In 2018, more than half of total N (and 87% of ammonia) emissions come from food systems and up to 35% of particulate matter. Food system emissions are responsible for about 22.4% of global mortality due to poor air quality and 1.4% of global crop production losses.

Near-real-time global gridded daily CO2 emissions

Precise and high-resolution carbon dioxide (CO₂) emission data is of great importance in achieving carbon neutrality around the world. Here we present for the first time the near-real-time Global Gridded Daily CO₂ Emissions Dataset (GRACED) from fossil fuel and cement production with a global spatial resolution of 0.1° by 0.1° and a temporal resolution of 1 day. Gridded fossil emissions are computed for different sectors based on the daily national CO₂ emissions from near-real-time dataset (Carbon Monitor), the spatial patterns of point source emission dataset Global Energy Infrastructure Emissions Database (GID), Emission Database for Global Atmospheric Research (EDGAR), and spatiotemporal patters of satellite nitrogen dioxide (NO₂) retrievals. Our study on the global CO₂ emissions responds to the growing and urgent need for high-quality, fine-grained, near-real-time CO₂ emissions estimates to support global emissions monitoring across various spatial scales. We show the spatial patterns of emission changes for power, industry, residential consumption, ground transportation, domestic and international aviation, and international shipping sectors from January 1, 2019, to December 31, 2020. This gives thorough insights into the relative contributions from each sector. Furthermore, it provides the most up-to-date and fine-grained overview of where and when fossil CO₂ emissions have decreased and rebounded in response to emergencies (e.g., coronavirus disease 2019 [COVID-19]) and other disturbances of human activities of any previously published dataset. As the world recovers from the pandemic and decarbonizes its energy systems, regular updates of this dataset will enable policymakers to more closely monitor the effectiveness of climate and energy policies and quickly adapt.

Effects of extreme meteorological conditions in 2018 on European methane emissions estimated using atmospheric inversions

The effect of the 2018 extreme meteorological conditions in Europe on methane (CH4) emissions is examined using estimates from four atmospheric inversions calculated for the period 2005-2018. For most of Europe, we find no anomaly in 2018 compared to the 2005-2018 mean. However, we find a positive anomaly for the Netherlands in April, which coincided with positive temperature and soil moisture anomalies suggesting an increase in biogenic sources. We also find a negative anomaly for the Netherlands for September-October, which coincided with a negative anomaly in soil moisture, suggesting a decrease in soil sources. In addition, we find a positive anomaly for Serbia in spring, summer and autumn, which coincided with increases in temperature and soil moisture, again suggestive of changes in biogenic sources, and the annual emission for 2018 was 33 ± 38% higher than the 2005-2017 mean. These results indicate that CH4 emissions from areas where the natural source is thought to be relatively small can still vary due to meteorological conditions. At the European scale though, the degree of variability over 2005-2018 was small, and there was negligible impact on the annual CH4 emissions in 2018 despite the extreme meteorological conditions. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 2)'.

Targeted whole exome sequencing and Drosophila modelling to unveil the molecular basis of primary ovarian insufficiency

STUDY QUESTION

Can a targeted whole exome sequencing (WES) on a cohort of women showing a primary ovarian insufficiency (POI) phenotype at a young age, combined with a study of copy number variations, identify variants in candidate genes confirming their deleterious effect on ovarian function?

SUMMARY ANSWER

This integrated approach has proved effective in identifying novel candidate genes unveiling mechanisms involved in POI pathogenesis.

WHAT IS KNOWN ALREADY

POI, a condition occurring in 1% of women under 40 years of age, affects women’s fertility leading to a premature loss of ovarian reserve. The genetic causes of POI are highly heterogeneous and several determinants contributing to its prominent oligogenic inheritance pattern still need to be elucidated.

STUDY DESIGN, SIZE, DURATION

WES screening for pathogenic variants of 41 Italian women with non-syndromic primary and early secondary amenorrhoea occurring before age 25 was replicated on another 60 POI patients, including 35 French and 25 American women, to reveal statistically significant shared variants.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The Italian POI patients’ DNA were processed by targeted WES including 542 RefSeq genes expressed or functioning during distinct reproductive or ovarian processes (e.g. DNA repair, meiosis, oocyte maturation, folliculogenesis and menopause). Extremely rare variants were filtered and selected by means of a Fisher Exact test using several publicly available datasets. A case-control Burden test was applied to highlight the most significant genes using two ad-hoc control female cohorts. To support the obtained data, the identified genes were screened on a novel cohort of 60 Caucasian POI patients and the same case-control analysis was carried out. Comparative analysis of the human identified genes was performed on mouse and Drosophila melanogaster by analysing the orthologous genes in their ovarian phenotype, and two of the selected genes were fruit fly modelled to explore their role in fertility.

MAIN RESULTS AND THE ROLE OF CHANCE

The filtering steps applied to search for extremely rare pathogenic variants in the Italian cohort revealed 64 validated single-nucleotide variants/Indels in 59 genes in 30 out of 41 screened women. Burden test analysis highlighted 13 ovarian genes as being the most enriched and significant. To validate these findings, filtering steps and Burden analysis on the second cohort of Caucasian patients yielded 11 significantly enriched genes. Among them, AFP, DMRT3, MOV10, FYN and MYC were significant in both patient cohorts and hence were considered strong candidates for POI. Mouse and Drosophila comparative analysis evaluated a conserved role through the evolution of several candidates, and functional studies using a Drosophila model, when applicable, supported the conserved role of the MOV10 armitage and DMRT3 dmrt93B orthologues in female fertility.

LARGE SCALE DATA

The datasets for the Italian cohort generated during the current study are publicly available at ClinVar database (http://www.ncbi.nlm.nih.gov/clinvar/): accession numbers SCV001364312 to SCV001364375.

LIMITATIONS, REASONS FOR CAUTION

This is a targeted WES analysis hunting variants in candidate genes previously identified by different genomic approaches. For most of the investigated sporadic cases, we could not track the parental inheritance, due to unavailability of the parents’ DNA samples; in addition, we might have overlooked additional rare variants in novel candidate POI genes extracted from the exome data. On the contrary, we might have considered some inherited variants whose clinical significance is uncertain and might not be causative for the patients’ phenotype. Additionally, as regards the Drosophila model, it will be extremely important in the future to have more mutants or RNAi strains available for each candidate gene in order to validate their role in POI pathogenesis.

WIDER IMPLICATIONS OF THE FINDINGS

The genomic, statistical, comparative and functional approaches integrated in our study convincingly support the extremely heterogeneous oligogenic nature of POI, and confirm the maintenance across the evolution of some key genes safeguarding fertility and successful reproduction. Two principal classes of genes were identified: (i) genes primarily involved in meiosis, namely in synaptonemal complex formation, asymmetric division and oocyte maturation and (ii) genes safeguarding cell maintenance (piRNA and DNA repair pathways).

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by Italian Ministry of Health grants ‘Ricerca Corrente’ (08C621_2016 and 08C924_2019) provided to IRCCS Istituto Auxologico Italiano, and by ‘Piano Sostegno alla Ricerca’ (PSR2020_FINELLI_LINEA_B) provided by the University of Milan; M.P.B. was supported by Telethon-Italy (grant number GG14181). There are no conflicts of interest.

Improved Constraints on Global Methane Emissions and Sinks Using δ 13C-CH4

We study the drivers behind the global atmospheric methane (CH4) increase observed after 2006. Candidate emission and sink scenarios are constructed based on proposed hypotheses in the literature. These scenarios are simulated in the TM5 tracer transport model for 1984-2016 to produce three-dimensional fields of CH4 and δ 13C-CH4, which are compared with observations to test the competing hypotheses in the literature in one common model framework. We find that the fossil fuel (FF) CH4 emission trend from the Emissions Database for Global Atmospheric Research 4.3.2 inventory does not agree with observed δ 13C-CH4. Increased FF CH4 emissions are unlikely to be the dominant driver for the post-2006 global CH4 increase despite the possibility for a small FF emission increase. We also find that a significant decrease in the abundance of hydroxyl radicals (OH) cannot explain the post-2006 global CH4 increase since it does not track the observed decrease in global mean δ 13C-CH4. Different CH4 sinks have different fractionation factors for δ 13C-CH4, thus we can investigate the uncertainty introduced by the reaction of CH4 with tropospheric chlorine (Cl), a CH4 sink whose abundance, spatial distribution, and temporal changes remain uncertain. Our results show that including or excluding tropospheric Cl as a 13 Tg/year CH4 sink in our model changes the magnitude of estimated fossil emissions by ∼20%. We also found that by using different wetland emissions based on a static versus a dynamic wetland area map, the partitioning between FF and microbial sources differs by 20 Tg/year, ∼12% of estimated fossil emissions.

Food systems are responsible for a third of global anthropogenic GHG emissions

We have developed a new global food emissions database (EDGAR-FOOD) estimating greenhouse gas (GHG; CO₂, CH₄, N₂O, fluorinated gases) emissions for the years 1990-2015, building on the Emissions Database of Global Atmospheric Research (EDGAR), complemented with land use/land-use change emissions from the FAOSTAT emissions database. EDGAR-FOOD provides a complete and consistent database in time and space of GHG emissions from the global food system, from production to consumption, including processing, transport and packaging. It responds to the lack of detailed data for many countries by providing sectoral contributions to food-system emissions that are essential for the design of effective mitigation actions. In 2015, food-system emissions amounted to 18 Gt CO₂ equivalent per year globally, representing 34% of total GHG emissions. The largest contribution came from agriculture and land use/land-use change activities (71%), with the remaining were from supply chain activities: retail, transport, consumption, fuel production, waste management, industrial processes and packaging. Temporal trends and regional contributions of GHG emissions from the food system are also discussed.

High-resolution array-CGH analysis on 46,XX patients affected by early onset primary ovarian insufficiency discloses new genes involved in ovarian function

STUDY QUESTION

Can high resolution array-CGH analysis on a cohort of women showing a primary ovarian insufficiency (POI) phenotype in young age identify copy number variants (CNVs) with a deleterious effect on ovarian function?

SUMMARY ANSWER

This approach has proved effective to clarify the role of CNVs in POI pathogenesis and to better unveil both novel candidate genes and pathogenic mechanisms.

WHAT IS KNOWN ALREADY

POI describes the progression toward the cessation of ovarian function before the age of 40 years. Genetic causes are highly heterogeneous and despite several genes being associated with ovarian failure, most of genetic basis of POI still needs to be elucidated.

STUDY DESIGN, SIZE, DURATION

The current study included 67 46,XX patients with early onset POI (<19 years) and 134 control females recruited between 2012 and 2016 at the Medical Cytogenetics and Molecular Genetics Lab, IRCCS Istituto Auxologico Italiano.

PARTICIPANTS/MATERIALS, SETTING, METHODS

High resolution array-CGH analysis was carried out on POI patients’ DNA. Results of patients and female controls were analyzed to search for rare CNVs. All variants were validated and subjected to a gene content analysis and disease gene prioritization based on the present literature to find out new ovary candidate genes. Case-control study with statistical analysis was carried out to validate our approach and evaluate any ovary CNVs/gene enrichment. Characterization of particular CNVs with molecular and functional studies was performed to assess their pathogenic involvement in POI.

MAIN RESULTS AND THE ROLE OF CHANCE

We identified 37 ovary-related CNVs involving 44 genes with a role in ovary in 32 patients. All except one of the selected CNVs were not observed in the control group. Possible involvement of the CNVs in POI pathogenesis was further corroborated by a case-control analysis that showed a significant enrichment of ovary-related CNVs/genes in patients (P = 0.0132; P = 0.0126). Disease gene prioritization identified both previously reported POI genes (e.g. BMP15, DIAPH2, CPEB1, BNC1) and new candidates supported by transcript and functional studies, such as TP63 with a role in oocyte genomic integrity and VLDLR which is involved in steroidogenesis.

LARGE SCALE DATA

ClinVar database (http://www.ncbi.nlm.nih.gov/clinvar/); accession numbers SCV000787656 to SCV000787743.

LIMITATIONS, REASONS FOR CAUTION

This is a descriptive analysis for almost all of the CNVs identified. Inheritance studies of CNVs in some non-familial sporadic cases was not performed as the parents’ DNA samples were not available. Addionally, RT-qPCR analyses were carried out in few cases as RNA samples were not always available and the genes were not expressed in blood.

WIDER IMPLICATIONS OF THE FINDINGS

Our array-CGH screening turned out to be efficient in identifying different CNVs possibly implicated in disease onset, thus supporting the extremely wide genetic heterogeneity of POI. Since almost 50% of cases are negative rare ovary-related CNVs, array-CGH together with next generation sequencing might represent the most suitable approach to obtain a comprehensive genetic characterization of POI patients.

STUDY FUNDING/COMPETING INTEREST(S)

Supported by Italian Ministry of Health grants ‘Ricerca Corrente’ (08C203_2012) and ‘Ricerca Finalizzata’ (GR-2011-02351636, BIOEFFECT) to IRCCS Istituto Auxologico Italiano.

High resolution temporal profiles in the Emissions Database for Global Atmospheric Research

Emissions into the atmosphere from human activities show marked temporal variations, from inter-annual to hourly levels. The consolidated practice of calculating yearly emissions follows the same temporal allocation of the underlying annual statistics. However, yearly emissions might not reflect heavy pollution episodes, seasonal trends, or any time-dependant atmospheric process. This study develops high-time resolution profiles for air pollutants and greenhouse gases co- emitted by anthropogenic sources in support of atmospheric modelling, Earth observation communities and decision makers. The key novelties of the Emissions Database for Global Atmospheric Research (EDGAR) temporal profiles are the development of (i) country/region- and sector- specific yearly profiles for all sources, (ii) time dependent yearly profiles for sources with inter-annual variability of their seasonal pattern, (iii) country- specific weekly and daily profiles to represent hourly emissions, (iv) a flexible system to compute hourly emissions including input from different users. This work creates a harmonized emission temporal distribution to be applied to any emission database as input for atmospheric models, thus promoting homogeneity in inter-comparison exercises.

A balanced reciprocal translocation t(10;15)(q22.3;q26.1) interrupting ACAN gene in a family with proportionate short stature

PURPOSE

Few examples of the involvement of a single gene in idiopathic short stature have been described until now. Our aim was to identify the causative gene of proportionate short stature in a large family showing co-segregation of the phenotype with the reciprocal translocation t(10;15)(q22;q24).

METHODS

FISH mapping was carried out with BACs and long-range PCR probes to identify the smallest genomic regions harboring the translocation breakpoints. Real-Time RT-PCR was performed in blood after pre-amplification of target genes cDNA.

RESULT

The affected family members presented with a final height of between - 2.41 and - 4.18 SDS and very mild skeletal dysmorphisms. Growth rates of the proband and of her cousin, whose childhood and pre-pubertal bone age corresponded to the chronological age, showed a poor growth spurt during treatment with rhGH. However, their adult height was greater than that of their untreated mothers, suggesting efficacy of GH therapy. Breakpoint mapping revealed that the translocation t(10;15)(q22.3;q26.1) disrupts, on 15q, the ACAN gene at intron 1, decreasing its transcriptional expression.

CONCLUSIONS

This is the first description of a chromosome rearrangement disrupting ACAN and leading to its haploinsufficiency. ACAN loss of function should be considered a potential underpinning of short patients who display a poor growth spurt and belong to families with autosomal dominant segregation of proportionate short stature. Besides this core phenotype, literature review suggests that advanced bone age, early onset osteochondritis dissecans, osteoarthritis, intervertebral disc disease as well as craniofacial dysmorphisms can be important suggestive phenotypes in affected families.

Novel insights on new particle formation derived from a pan-european observing system

The formation of new atmospheric particles involves an initial step forming stable clusters less than a nanometre in size (<~1 nm), followed by growth into quasi-stable aerosol particles a few nanometres (~1–10 nm) and larger (>~10 nm). Although at times, the same species can be responsible for both processes, it is thought that more generally each step comprises differing chemical contributors. Here, we present a novel analysis of measurements from a unique multi-station ground-based observing system which reveals new insights into continental-scale patterns associated with new particle formation. Statistical cluster analysis of this unique 2-year multi-station dataset comprising size distribution and chemical composition reveals that across Europe, there are different major seasonal trends depending on geographical location, concomitant with diversity in nucleating species while it seems that the growth phase is dominated by organic aerosol formation. The diversity and seasonality of these events requires an advanced observing system to elucidate the key processes and species driving particle formation, along with detecting continental scale changes in aerosol formation into the future.

Trends in Chemical Composition of Global and Regional Population-Weighted Fine Particulate Matter Estimated for 25 Years

We interpret in situ and satellite observations with a chemical transport model (GEOS-Chem, downscaled to 0.1° × 0.1°) to understand global trends in population-weighted mean chemical composition of fine particulate matter (PM_2.5). Trends in observed and simulated population-weighted mean PM_2.5 composition over 1989-2013 are highly consistent for PM_2.5 (-2.4 vs -2.4%/yr), secondary inorganic aerosols (-4.3 vs -4.1%/yr), organic aerosols (OA, -3.6 vs -3.0%/yr) and black carbon (-4.3 vs -3.9%/yr) over North America, as well as for sulfate (-4.7 vs -5.8%/yr) over Europe. Simulated trends over 1998-2013 also have overlapping 95% confidence intervals with satellite-derived trends in population-weighted mean PM_2.5 for 20 of 21 global regions. Over 1989-2013, most (79%) of the simulated increase in global population-weighted mean PM_2.5 of 0.28 μg m^-3yr^-1 is explained by significantly (p < 0.05) increasing OA (0.10 μg m^-3yr^-1), nitrate (0.05 μg m^-3yr^-1), sulfate (0.04 μg m^-3yr^-1), and ammonium (0.03 μg m^-3yr^-1). These four components predominantly drive trends in population-weighted mean PM_2.5 over populous regions of South Asia (0.94 μg m^-3yr^-1), East Asia (0.66 μg m^-3yr^-1), Western Europe (-0.47 μg m^-3yr^-1), and North America (-0.32 μg m^-3yr^-1). Trends in area-weighted mean and population-weighted mean PM_2.5 composition differ significantly.

EU effect: Exporting emission standards for vehicles through the global market economy

Emission data from EDGAR (Emissions Database for Global Atmospheric Research), rather than economic data, are used to estimate the effect of policies and of the global exports of policy-regulated goods, such as vehicles, on global emissions. The results clearly show that the adoption of emission standards for the road transport sector in the two main global markets (Europe and North America) has led to the global proliferation of emission-regulated vehicles through exports, regardless the domestic regulation in the country of destination. It is in fact more economically convenient for vehicle manufacturers to produce and sell a standard product to the widest possible market and in the greatest possible amounts. The EU effect (European Union effect) is introduced as a global counterpart to the California effect. The former is a direct consequence of the penetration of the EURO standards in the global markets by European and Japanese manufacturers, which effectively export the standard worldwide. We analyze the effect on PM_2.5 emissions by comparing a scenario of non-EURO standards against the current estimates provided by EDGAR. We find that PM_2.5 emissions were reduced by more than 60% since the 1990s worldwide. Similar investigations on other pollutants confirm the hypothesis that the combined effect of technological regulations and their diffusion through global markets can also produce a positive effect on the global environment. While we acknowledge the positive feedback, we also demonstrate that current efforts and standards will be totally insufficient should the passenger car fleets in emerging markets reach Western per capita figures. If emerging countries reach the per capita vehicle number of the USA and Europe under current technological conditions, then the world will suffer pre-1990 emission levels.

Spatial Variation of Aerosol Chemical Composition and Organic Components Identified by Positive Matrix Factorization in the Barcelona Region

The spatial distribution of PM1 components in the Barcelona metropolitan area was investigated using on-road mobile measurements of atmospheric particle- and gas-phase compounds during the DAURE campaign in March 2009. Positive matrix factorization (PMF) applied to organic aerosol (OA) data yielded 5 factors: hydrocarbon-like OA (HOA), cooking OA (COA), biomass burning OA (BBOA), and low volatility and semivolatile oxygenated OA (LV-OOA and SV-OOA). The area under investigation (∼500 km(2)) was divided into six zones (city center, harbor, industrial area, precoastal depression, 2 mountain ranges) for measurements and data analysis. Mean zonal OA concentrations are 4.9-9.5 μg m(-3). The area is heavily impacted by local primary emissions (HOA 14-38%, COA 10-18%, BBOA 10-12% of OA); concentrations of traffic-related components, especially black carbon, are biased high due to the on-road nature of the measurements. The formation of secondary OA adds more than half of the OA burden outside the city center (SV-OOA 14-40%, LV-OOA 17-42% of OA). A case study of one measurement drive from the shore to the precoastal mountain range furthest downwind of the city center indicates the importance of nonfossil over anthropogenic secondary OA based on OA/CO.

High secondary aerosol contribution to particulate pollution during haze events in China

Rapid industrialization and urbanization in developing countries has led to an increase in air pollution, along a similar trajectory to that previously experienced by the developed nations. In China, particulate pollution is a serious environmental problem that is influencing air quality, regional and global climates, and human health. In response to the extremely severe and persistent haze pollution experienced by about 800 million people during the first quarter of 2013 (refs 4, 5), the Chinese State Council announced its aim to reduce concentrations of PM2.5 (particulate matter with an aerodynamic diameter less than 2.5 micrometres) by up to 25 per cent relative to 2012 levels by 2017 (ref. 6). Such efforts however require elucidation of the factors governing the abundance and composition of PM2.5, which remain poorly constrained in China. Here we combine a comprehensive set of novel and state-of-the-art offline analytical approaches and statistical techniques to investigate the chemical nature and sources of particulate matter at urban locations in Beijing, Shanghai, Guangzhou and Xi'an during January 2013. We find that the severe haze pollution event was driven to a large extent by secondary aerosol formation, which contributed 30-77 per cent and 44-71 per cent (average for all four cities) of PM2.5 and of organic aerosol, respectively. On average, the contribution of secondary organic aerosol (SOA) and secondary inorganic aerosol (SIA) are found to be of similar importance (SOA/SIA ratios range from 0.6 to 1.4). Our results suggest that, in addition to mitigating primary particulate emissions, reducing the emissions of secondary aerosol precursors from, for example, fossil fuel combustion and biomass burning is likely to be important for controlling China's PM2.5 levels and for reducing the environmental, economic and health impacts resulting from particulate pollution.

ATRX mutation in two adult brothers with non-specific moderate intellectual disability identified by exome sequencing

In this report, we describe two adult brothers affected by moderate non-specific intellectual disability (ID). They showed minor facial anomalies, not clearly ascribable to any specific syndromic patterns, microcephaly, brachydactyly and broad toes. Both brothers presented seizures. Karyotype, subtelomeric and FMR1 analysis were normal in both cases.

We performed array-CGH analysis that revealed no copy-number variations potentially associated with ID. Subsequent exome sequence analysis allowed the identification of the ATRX c.109C>T (p.R37X) mutation in both the affected brothers. Sanger sequencing confirmed the presence of the mutation in the brothers and showed that the mother is a healthy carrier.

Mutations in the ATRX gene cause the X-linked alpha thalassemia/mental retardation (ATR-X) syndrome (MIM #301040), a severe clinical condition usually associated with profound ID, facial dysmorphism and alpha thalassemia. However, the syndrome is clinically heterogeneous and some mutations, including the c.109C>T, are associated with a broad phenotypic spectrum, with patients displaying a less severe phenotype with only mild-moderate ID. In the case presented here, exome sequencing provided an effective strategy to achieve the molecular diagnosis of ATR-X syndrome, which otherwise would have been difficult to consider due to the mild non-specific phenotype and the absence of a family history with typical severe cases.

[Chemical risk management in health care settings]

The aim of this review is pointing out the most relevant allergic and chemical risk factors in health care settings. Some tables summarize the main sensitizing agents, the most frequent allergic diseases and examples of alternative gloves and materials currently available. Some suggestions, to evaluate the allergic risk related to specific tasks in the different hospital departments, are given in order to underline possible failures and to plan focused preventive actions. The chemical hazard has been valued on the basis of the current exposure, which is significantly improved due to structural and technological changes adopted in almost all hospitals. However there are still some critical points due to the use of particularly toxic substances and new molecules, whose health effects should be carefully evaluated, and to a more extensive use of techniques and procedures previously limited to a few work realities.

[The movement computerized analysis as instrumental support for occupational doctors in evaluation of upper limb pathologies in engineering workers]

The movement computerized analysis of upper limb is a valid support in the definition of residual functional capability and of specific work suitability in complex cases. This methodology of evaluation is able to correctly and objectively define the tridimensional ranges of motion of every patient's upper limb. This fact can be particularly useful for workers coming back to work after a work-related or a not work-related accident of for handicapped workers at the beginning of a new work activity. We report a research carried out using computerized analysis of motion of upper limbs in 20 engineering workers.

IVM – the first choice for IVF in Italy

In March 2004, a new law was introduced in Italy to regulate assisted reproduction; at present it is impossible to use more than a maximum of three oocytes per IVF cycle, nor can embryos or prezygotes (2PN cells) be selected or cryopreserved. The prohibitions introduced by the new law have, on the one hand, reduced the expectations of success of current techniques and, on the other hand, stimulated clinicians and embryologists to work on new therapeutic strategies so as to offer the highest chances of success with the lowest risks. In-vitro maturation (IVM) of oocytes fits very well with these new requirements: ovarian stimulation is avoided and the handling of spare oocytes is facilitated. The IVM protocol is an intriguing alternative to conventional IVF techniques, since it removes the side-effects of drug stimulation, especially ovarian hyperstimulation syndrome, and it also reduces the costs of the entire procedure, both in terms of 'time consumption' and 'patient/society costs for drugs'. In the authors' IVF centre the IVM technique has been used for more than a year, with significant success in terms of maturation and fertilization rates, percentage of embryo transfers, number of pregnancies and, finally, healthy babies born.

[Effects of Maitland's manual mobilization on the thoracic spine]

The goal of manual therapy is to decrease pain and to increase function of the spine and peripheral joints. The method introduced by Maitland is widely used in manual medicine. However, no objective changes in the mobility of the thoracic spine after performing manual mobilization have been published in the literature. The aim of this study is to reveal possible changes in the segmental mobility of the thoracic spine after posterior-anterior manipulations without thrust in comparison with a control group. In addition, significant changes within the treatment group were examined. Thirty-six volunteers were randomized into an intervention (16) and a control group (20). The intervention group was treated two times a week for three weeks. The control group received no treatment. The mobility was objectively measured by using Medimouse. No significant difference in the mobility of the thoracic spine could be shown within the intervention group and in comparison with the control group.

[Latex allergy in health care workers: frequency, exposure quantification, efficacy of criteria used for job fitness assessment]

BACKGROUND

The main purpose of this study was to evaluate the latex allergy prevalence in a large population of health care workers, to quantify latex exposure deriving from use of gloves and to verify the efficacy of job fitness evaluations in allergic workers.

METHODS

In the period 2001-2002, latex allergy prevalence was evaluated in 1962 health care workers by means of a self-administered questionnaire, clinical evaluation and specific allergological tests. Also, the total protein content (by means of Lowry method modified EN455-3: 1996) and the antigenic latex proteins (by means of RAST inhibition) in 4 different types of gloves were measured. Job fitness assessments for latex allergic workers were made in accordance with the criteria established by the Italian Association of Preventive Medicine for Health Care Workers criteria. The efficacy was verified one year later.

RESULTS

1557 questionnaires out of 1962 (79.35%) were completed; 504 (32.4%) reported work-related symptoms, in particular 283 subjects had probable irritant contact dermatitis, 66 allergic contact dermatitis and 118 reported irregular non-specific symptoms related to the use of both vinyl and latex gloves; 20 subjects out of the remaining 37 had a latex allergy (1.3% out of the 1557 workers responding to the questionnaire), 8 subjects had only urticaria while 12 subjects had urticaria associated with respiratory symptoms and/or angioedema. The measurement of total protein and antigenic protein content showed the highest levels in powdered latex examination gloves, the lowest levels in surgical powder-free latex gloves. Low concentrations of antigenic proteins were also found in nitrile gloves. Job fitness evaluations were efficacious in 11 out of 20 workers, and inefficacious in 3 cases (6 workers had resigned).

CONCLUSIONS

This study revealed a very low prevalence of latex allergy probably due to the fact that we examined an unselected population, and only symptomatic subjects were considered; moreover, in our hospital, vinyl examination gloves had been prevalently used during the last ten years. The criteria followed for job fitness assessment seem to be efficacious on the whole. In spite of a low prevalence of latex allergy, we found a high frequency of irritant contact dermatitis in the examined workers, mainly due to the lubricant powder in both synthetic and natural rubber gloves. Most workers made a complete recovery when they started using powder-free gloves. The high biocompatibility of powder-free gloves was confirmed by the measurement of total protein and latex antigenic protein content in the gloves used in the hospital. Moreover, it should be noted that latex antigenic proteins were also demonstrated in nitrile gloves, this is a relevant information since nitrile gloves are often used as an alternative in latex allergic workers.

[Protein content of latex gloves used in hospitals]

In this study the total protein content and the latex allergenic protein content in different types of medical gloves commonly used in our hospital were evaluated. The correlation between these two parameters and the correctness of the data provided by the glove manufacturers have been also verified. The main purpose of this study was to acquire information useful for preventing latex allergy in our hospital personnel. 29 different types of medical gloves were examined. The total protein contents were evaluated with Lowry modified method and the allergenic latex protein contents were evaluated with RAST-inhibition assay, both on glove samples and glove extracts. The correlation between inhibition percentages found in glove samples and in glove extracts and the correlation between total protein content and inhibition percentages determined in samples of the same gloves was verified. The highest concentrations of total proteins and allergenic latex proteins were found in examination powdered latex gloves and in surgical powdered latex gloves. A good correlation was observed between the total protein content and the inhibition percentages determined in samples of the same gloves, and between inhibition percentages found in glove samples and glove extracts. A significant amount of latex proteins was found in some brands of nitryl gloves. The clear association between the total protein levels and the allergenic latex protein levels suggests that the gloves with highest total protein content have the greatest allergenic potential. We believe that the total protein content is relevant from a preventive point of view for a proper gloves selection in the workplaces. Therefore, manufacturing companies should provide package inserts including at least the total protein contents and possibly allergenic latex protein levels, with specific measurement methods. Since the highest total protein and allergenic latex protein contents were found in latex powdered gloves, powder-free gloves must be of first choice. RAST-inhibition assays directly on glove samples instead of glove extract seems to be a good reliable and faster alternative for the evaluation of the allergenic potential of latex gloves. For latex allergic subjects it is necessary to pay attention in choosing nitryl gloves, especially as an alternative to natural rubber gloves since some brands may contain significant amounts of allergenic latex proteins.

Features and severity of occupational asthma upon diagnosis: an Italian multicentric case review

BACKGROUND

The severity of occupational asthma (OA) at the time of diagnosis is not known. In this study we aimed to evaluate some features of the disease at the time of diagnosis, particularly looking at severity and treatment before diagnosis.

METHODS

Medical records of subjects (n = 197) who had received a diagnosis of OA in six specialized centres of Northern and Central Italy in the period 1992-97 were reviewed. The severity of the disease at the time of diagnosis was determined on the basis of symptoms, peak expiratory flow (PEF, percentage predicted), forced expiratory volume in one second (FEV1, percentage predicted), and PEF variability, following the criteria of the National Institutes of Health and World Health Organizaton (NIH/WHO) guidelines on asthma. Medications used in the month before diagnosis were recorded.

RESULTS

The most common etiological agents were isocyanates (41.6%), flours (19.8%), woods (9.7%) and natural rubber latex (7.6%). The level of asthma severity (AS) was mild intermittent in 23.9% patients, mild persistent in 28.9%, moderate in 41.6%, and severe in 5.6%. Asthma severity was positively associated with current or previous smoking (P < 0.05), and was not related to atopy and current exposure. A relationship with bronchial reactivity to methacholine was shown in subjects at work. Treatment before diagnosis was consistent with the NIH/WHO guidelines in only 13.2% patients, whereas 75.6% were undertreated and 11.2% were overtreated.

CONCLUSIONS

In this study we found that the majority of patients had mild asthma at the time of diagnosis and that cigarette smoking was associated with a greater severity. Moreover, the majority of patients were undertreated before etiological diagnosis.

[Skin disorders and job fitness assessment]

BACKGROUND

Assessment of fitness for employment represents the final phase of the risk evaluation and health surveillance carried out during pre-employment and periodical medical examination. Dermatoses are frequent diseases both in the general population and workers, therefore job fitness assessment for workers with skin problems will frequently fall within the occupational health area. The physician must verify whether or not the dermatosis is an occupational disease and must adopt preventive measures to avoid any worsening or relapse of the clinical situation due to occupational factors.

OBJECTIVES

This article gives suggestions for correct management of occupational and non-occupational skin diseases in the workplace, with practical examples of job fitness assessment.

METHODS

We first examined the role of the occupational physician in the evaluation of occupational risk factors that can induce work-related dermatoses or aggravate other dermatoses. We then discussed the factors that must be considered during assessment of fitness for employment when dermatoses are present. Finally, we examined practical examples of occupational or non-occupational dermatoses that can cause functional limitations, factors that can influence job fitness evaluation, and the possible role of allergological tests.

RESULTS AND CONCLUSIONS

Several dermatoses can be aggravated or caused by occupational factors (e.g. atopic dermatitis, allergic contact dermatitis, irritant contact dermatitis, keratinization disorders, lichen planus, physical urticaria). Close cooperation between the dermatologist and the occupational physician is very important in order to make an etiological diagnosis that is necessary for the job fitness assessment. It is difficult to define definitive criteria for the assessment of fitness for employment; in this article only some suggestions are made and they can vary according to the different situations.

Occupational dermatitis in a highly industrialized Italian region: the experience of four occupational health departments

There is a need for several research centers to carry out coordinated large-scale evaluation of the spread of occupational irritant and allergic dermatitis. The Occupational Health Departments of Bergamo, Brescia, Lecco and Cremona therefore decided to join their experiences and bring together all the cases of occupational irritant and allergic dermatitis diagnosed by these Departments between 1993 and 1998. In this period, 1169 cases of occupational dermatitis were diagnosed, subdivided into 768 cases of allergic contact dermatitis (ACD), 337 of irritant contact dermatitis (ICD), 54 of urticaria and 10 of airborne contact dermatitis, and there has not been a trend towards increase of occupational dermatitis over the years. Our population included 724 males and 445 females and average latency after the beginning of exposure to occupational allergens was 8.01 years for ACD, 6.4 for ICD, 3.22 for urticaria and 5.57 for airborne contact dermatitis. The frequency of atopy was 33.9%, in females and 19.5% in males. The frequency of atopy was particularly high (89%) in subjects with urticaria. Among subjects with allergic dermatitis, 362 had had only one sensitization while 406 had had two or more sensitizations. The working areas where we found the highest number of ACD were metal working industry, building, health care workers and hairdressers and the frequency of ICD was high in metal workers and health care workers. Most of the cases of urticaria were diagnosed in health care workers (68.5%) and the main causing agent was latex. These are only preliminary data but occupations at risk and the substances expected to be the most frequent etiological agents do not differ significantly from those reported in the literature. It is hoped that as a result of this project there will be in the future: standardization of diagnostic procedures, uniform assessment of allergological risk in working environments not yet fully investigated, standardization of preventative measures and proper evaluation of their effectiveness.

[Occupational skin allergies in 1993-1998]

There are few data on the frequency of occupational allergic dermatitis in the context of occupational diseases and there is a need for coordinated large-scale studies to compare the experiences of different Occupational Health Departments involved in the surveillance of allergic occupational diseases. Therefore 6 Occupational Health Departments of Northern Italy (Bergamo, Brescia, Cremona, Desio, Lecco and Milano-CEMOC) decided to bring together all the cases of occupational allergic dermatitis diagnosed between 1993 and 1998. In this report the main characteristics of these 961 allergic dermatitis (888 allergic contact dermatitis, 63 urticaria and 10 airborne contact dermatitis), the possible correlations with gender, age, length of employment, atopy and the occupations at high risk of acquiring allergic dermatitis have been described.

Treatment of two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana modifies the immunohistological profile but not the disease outcome

Two patients with diffuse cutaneous leishmaniasis caused by Leishmania mexicana were treated with two leishmanicidal drugs (pentamidine and allopurinol) combined with recombinant interferon-gamma restoring Th-1 favouring conditions in the patients. Parasites decreased dramatically in the lesions and macrophages diminished concomitantly, while IL-12-producing Langerhans cells and interferon-gamma- producing NK and CD8 + lymphocytes increased in a reciprocal manner. The CD4+/CD8 + ratio in the peripheral blood normalized. During exogenous administration of interferon-gamma the parasites' capacity to inhibit the oxidative burst of the patients' monocytes was abolished. Even though Th-1-favouring conditions were restored, both patients relapsed two months after therapy was discontinued. We conclude that the tendency to develop a disease-promoting Th-2 response in DCL patients is unaffected by, and independent of, parasite numbers. Even though intensive treatment in DCL patients induced Th-1 disease restricting conditions, the disease-promoting immunomodulation of few persistent Leishmania sufficed to revert the immune response.

Spondylodiscitis caused by viridans streptococci: three cases and a review of the literature

Three cases of spondylodiscitis caused by viridans streptococci were observed within the course of 1 month. Although streptococci have been reported as the third most frequent cause of spondylodiscitis after staphylococci and gram-negative bacteria, alpha-haemolytic streptococci are rarely seen. The three patients presented with symptoms of low back pain; they felt well and did not have a fever or chills. Laboratory examinations revealed inflammation. Further examinations such as scintigraphy, computed tomography or magnetic resonance imaging were done. Bacteriological diagnosis was established by blood cultures in two cases and by needle biopsy of the disco-vertebral space in one. In one patient endocarditis was also documented. Because the prevalence of endocarditis was found to be higher in our cases of spondylodiscitis due to Streptococcus viridans than for other bacteria, the exclusion of this diagnosis must be pursued aggressively. These observations lead us to question if the spectrum of bacteria causing spondylodiscitis is undergoing a change. an aetiological agent could be isolated in 1168 patients (85.4%): in 48% a staphylococcus, in 28% a gram-negative bacterium and in only 10% a streptococcus. There were two cases of viridans streptococci (0.2%). These two cases together with other single case reports [14-22] account for 15 cases of spondylodiscitis due to alpha-haemolytic streptococci. Differentiation of the organisms to the species level was accomplished in six cases: S. mitis (3), S. sanguis (2) and S. anginosus (1). Although a multitude of organisms, bacterial as well as fungal, causing spondylodiscitis has been reported in recent years, almost all were single cases [23-42]. The unusual observation of three cases of spondylodiscitis due to alpha-haemolytic streptococci within 1 month prompted us to review the clinical and laboratory findings and to compare these cases with those caused by Staphylococcus aureus.

Transcriptional regulation of the murine urokinase-type plasminogen activator gene in skeletal myoblasts

We have previously shown that urokinase-type plasminogen activator (uPA) is highly expressed in murine C2C12 myoblasts and that antibodies against uPA are able to block both myoblast fusion and differentiation. Here we show the characterization of cis-acting elements in the mouse uPA promoter in vitro which are involved in uPA gene expression in C2C 12 myoblast cells. DNase I hypersensitive (HS) site analysis revealed the presence of three HS sites in myoblasts. Deletion analysis of stably transfected uPA-promoter constructs revealed that at least two of the three HS sites accounted for the high transcriptional expression in C2C12 cells. One was located at -2.4 kb and corresponded to a known PEA3/AP1A element and the other one was located at -4.9 kb and contained a CArG box and a CRE element. So far, no regulatory function had been assigned to this CRE/CArG element. Both HS sites alone were able to activate transcription of a heterologous promoter and showed a cooperative effect when placed together. Electrophoretic mobility-shift assays using myoblast nuclear extracts and specific antibodies demonstrated that cJun, JunD and ATF2 bound to the PEA3/AP1A element, whereas the CRE/CArG element bound SRF. Altogether, these results suggest that high uPA expression in myoblasts is dependent on the cooperation of two regulatory sites in the uPA promoter.

Cisplatin-vindesine-mitomycin (MVP) vs cisplatin-ifosfamide-vinorelbine (PIN) vs carboplatin-vinorelbine (CaN) in patients with advanced non-small-cell lung cancer (NSCLC): a FONICAP randomized phase II study. Italian Lung Cancer Task Force (FONICAP)

In the present multicentre randomized phase II trial, the activity and toxicity of three platinum-based combination regimens for the treatment of advanced non-small-cell lung cancer (NSCLC) were evaluated. The three regimens were: MVP (mitomycin-C 6 mg m(-2) on day 1, vindesine 3 mg m(-2) on days 1 and 15, and cisplatin 80 mg m(-2) on day 1 every 28 days), PIN (cisplatin 80 mg m(-2) day 1, ifosfamide 3 g m(-2) day 1 and vinorelbine 25 mg m(-2) day 1 and 8 every 21 days) and CaN (carboplatin 350 mg m(-2) day 1 and vinorelbine 25 mg m(-2) days 1 and 8 every 28 days). A total of 140 chemotherapy-naive patients entered the study; 49 patients were treated with MVP, 48 with PIN and 43 with CaN. Sixty-seven per cent of the patients had stage IV disease. Response rates, calculated on an 'intention to treat' basis, were as follows: MVP, 14.3% (95% CI 5.94-27.2%); PIN, 16.7% (95% CI 7.4-30.2%); and CaN, 14% (95% CI 5.3-27.9%). The overall median survivals were 256, 269 and 243 days for patients treated with MVP, PIN and CaN respectively. Myelosuppression was the most frequent toxicity: grade 3-4 leucopenia was observed in 14.3%, 25% and 18.6% of patients treated with MVP, PIN and CaN respectively. This multicentre phase II randomized trial shows that MVP, PIN and CaN can be administered on an outpatient basis with acceptable toxicities. Unfortunately, the three regimens showed an activity significantly lower than that reported in previous single-institution phase II trials.

Ventricular arrhythmias in normotensive subjects and in mild hypertensive patients

Twenty-five normotensive subjects (14 men, 11 women) aged from 25 to 60 years (mean 36) and 30 untreated patients with mild hypertension (stages 1 and 2, JNC V) without target organ damage (16 men, 14 women), aged 26-59 years (mean 35.8) underwent continuous 24-hour ECG Holter monitoring with a Fukuda Denshi SM-40 ambulatory recorder and SCM-400 ECG analyzer. During 24-hour ambulatory ECG recording, mean heart rate was slightly but not significantly higher in hypertensive patients (73.3 +/- 10 beats per minute [bpm]) in comparison with normotensive subjects (71.2 +/- 12 bpm). The prevalence of premature atrial contractions was similar in the two groups. Total ventricular arrhythmias were more prevalent in the group of mild hypertensive patients (P < 0.05), who also had a higher prevalence in complex forms of ectopy (r = 0.81 for bigeminy; r = 0.83 for trigeminy; r = 0.83 for couplets). Holter recordings did not show abnormalities of ST-T wave or episodes of silent ischemia.

Allergic reactions due to glove-lubricant-powder in health-care workers

Eight glove-wearing hospital personnel were evaluated for suspected type I-like allergic manifestations due to corn-starch powder. All subjects were clinically examined, the presence of atopy was assessed by administration of a questionnaire, the on-off test was verified (the clinical feature behavior was verified with regard to the beginning and the cessation of the work shift), levels of specific serum IgE for maize and latex were measured, and prick tests for the same allergens were performed. The on-off test was positive for everyone. The symptom associated with glove use was urticaria, which was also associated in one case with intermittent dyspnea and in another with oculorhinitis, angioedema, and asthma. Five workers were atopic. The serum IgE test found three positive responses to maize, three positive responses to both latex and maize, and two negative responses to both. However, in the two patients testing negative to IgE, the prick tests were positive: one for maize and the other for both maize and latex. All workers evaded further relapses by avoiding exposure to powdered gloves. There is general agreement that corn-starch powder may cause irritant dermatitis and that it may be a vehicle for other allergens. This study seems to suggest that corn-starch powder may act as a type I allergen itself. Further studies on a larger number of subjects and further research on the chemical properties of corn-starch powder, in particular on its protein content, are needed to confirm this hypothesis.

Allergic and Irritant Glove-related Diseases in Health Care Workers and Their Prevention

Because the widespread use of gloves by health care workers has induced an increase of both irritant and type I or type IV allergic glove-related diseases, the Italian Society of Preventive Medicine for Health Care Workers set up a working group to collect information about glove composition and to standardize procedures for the diagnosis and prevention of glove-related disease and job-fitness evaluation of employees who will be wearing gloves. In addition, the group made recommendations for educational programs focusing not only on users but also on purchasers, who presently favor glove selection for economic reasons. The group's recommendations are summarized in a consensus document, but cannot be considered definitive. More research is needed to achieve answers to questions raised by the working group, indicated in the consensus document. In particular, diagnostic criteria must be standardized to plan multicenter studies to verify the real extent of the problem, and further studies are needed to verify whether limit values for substances contained in the gloves (e.g., latex proteins, residual chemicals) can be established.

Ambulatory-determined 24-hour blood pressure in mild hypertensives and in normotensives

Noninvasive ambulatory twenty-four-hour blood pressure (BP) monitoring was carried out in 30 normotensive subjects (16 women, 14 men), aged twenty-five to sixty years (mean thirty-eight) and in 29 mild essential hypertensive patients without target organ damage (14 women, 15 men), aged twenty-three to sixty-one years (mean thirty-nine). Hypertensive patients were not treated, and they discontinued any antihypertensive treatment at least four weeks before the study. During the daytime period (6 AM-10 PM) BP was monitored every fifteen minutes, and during the night (10 PM-6 AM), every thirty minutes. Obviously, mean twenty-four-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher in hypertensive patients (P < 0.001). There was a persistent correlation in the group of mild hypertensives between successive BP hourly mean readings (r ranged from 0.61 to 0.93 for SBP and from 0.45 to 0.82 for DBP). In normotensive subjects these correlations failed in particular periods: 8 AM-9 AM, r = 0.30 for SBP and 0.45 for DBP; 1 PM-3 PM, r = 0.17-0.49 for SBP and 0.28-0.37 for DBP; 9 PM to midnight, r = 0.21-0.57 for SBP and 0.23-0.38 for DBP.

[Blood rheology and fibrinogenemia: two independent parameters in the assessment of cerebral vascular damage]

The increase in fibrinogen level is consequent on several hurtful events: inflammatory, traumatic, stress reaction. Traumatic event, during cerebral vasculopathies, often causes an inflammatory reaction, certainly in the acute phase, inducing fibrinogen synthesis. There are also other inflammatory changes as the increase in WBC and PLT counts and in other hematic components, both in increase and in decrease. Patients with cerebral vasculopathies were divided in two groups according to the clinic picture seriousness. Haemorheologic characteristics were measured with a double filtering method I (with 5 and 12 mu filters) and under a filtering pressure of 15 cm H2O, eliminating WBC interference even if using native blood. In this way we have determined whole blood, plasma, and plasma-erythrocyte viscosities. From these measures we have obtained corpuscular viscosity and erythrocyte deformability. Fibrinogen concentration is increased in all patients with acute vasculopathies, but there is not a difference in relation to the clinic pictures seriousness. Also other inflammatory parameters, namely: total protein, gamma-globulins, ESR, are increased in a significant way without difference in relation the clinic seriousness. The WBC count is more increased in the group with Stroke than in the other one with TIA. The corpuscular viscosity is almost doubled with consequent decrease in deformability; plasma-erythrocyte viscosity, measured with both methods, is quite increased. These parameters show the same behaviour in both groups. Only plasma viscosity increased in the group with Stroke. Haemorheology alteration is not statistically correlated to the fibrinogen level. The decrease in deformability can be related to the viscouselastic membrane properties, and the fibrinogen, because of its adhesive properties, can contribute to such a decrease.