P2875Comparison between ejection fraction, global longitudinal strain, mechanical dispersion and delta contraction duration in predicting first and subsequent arrhythmic events in ICD patients

Background

According to current guidelines, left ventricular ejection fraction (LVEF) is currently the most important parameter for primary prevention of sudden cardiac death in patients with structural heart disease. Unfortunately, LVEF has low sensitivity in detecting arrhythmic events and presents a significant intra- and inter-operator variability. For these reasons, alternative predictors in patients with structural heart disease are being sought. Among those, speckle-tracking derived parameters such as global longitudinal strain (GLS), mechanical dispersion (MD), and delta contraction duration (DCD) have been proposed as better alternatives.

Purpose

To assess speckle-tracking derived parameters as predictors of first and subsequent arrhythmic events in implantable cardioverter-defibrillator (ICD) patients with structural heart disease, and to compare their performance with LVEF.

Methods

Prospective, observational study enrolling all consecutive patients with structural heart disease admitted for an ICD implant. Patients not followed by a home-monitoring system were excluded. 2D speckle-tracking analysis was used to derive GLS, MD, and DCD of all patients at enrolment. Home monitoring was checked weekly in order to detect all ventricular arrhythmias (VA) and ICD therapies. A recurrent-event statistical approach (Prentice, Williams, and Peterson model) was applied in order to evaluate subsequent events after the first ones.

Results

Two-hundred-and-three patients were consecutively enrolled and followed-up for a median follow-up of 2.2 years. Kaplan-Meier curves showed an increased risk of ATP or shock (Log-rank p=0.003) and VAs (Log-rank p=0.001) associated with lower quartiles of GLS (Figure 1). An impaired GLS was independently associated with an increased risk for the first ICD therapy (HR 1.94; 95% CI 1.30–2.91; p=0.001), and for the first VA (HR 1.42; 95% CI 1.01–1.98; p=0.04). GLS impairment was not significantly associated with an increased risk of recurrent ICD therapies or VAs. LVEF, MD and DCD were not associated with an increased risk of first, second and third ICD therapy or VA.

Conclusions

Impaired GLS is associated with an increased risk of VAs and appropriate ICD therapies in a consecutive, “real-world”, unselected population of remote-monitored patients with structural heart disease, although it does not seem reliable in predicting further arrhythmic event after the first one. LVEF, MD, and DCD do not predict first or subsequent arrhythmic events in ICD patients with structural heart disease.

Acknowledgement/Funding

Marche Polytechnic University

[Estimate of uncertainty of measurements in clinical laboratories and in environmental, occupational, and preventive medicine]

According to recently issued (UNI CEI EN ISO/IEC 17025, UNI CEI ENV 13005 and prEN ISO 15189) standards, to assure the quality of analytical results and their comparability in time and in different places, testing and clinical laboratories must demonstrate to use validated methods, guarantee the traceability of their measurements and state the measurement uncertainty associated with each result. For some SI quantities, such as the mass, the traceability to SI and the estimate of measurement uncertainty are warranted by established methods. In the clinical laboratory and especially in preventive, environmental and occupational laboratory medicine, specific difficulties arise to warrant the traceability to the mole. On one hand, the whole concept of measurement uncertainty is new in laboratory medicine, on the other hand, its application faces practical difficulties, because of the wideness and the complexity of the analytical repertory, the lack of officially validated methods and matrix-specific reference materials traceable to SI. In this paper we discuss briefly the concept of measurement uncertainty and its meaning in comparison with other parameters used to define the performance of analytical methods. In addition, we describe the procedures recommended by international organisations for estimating measurement uncertainty and interpreting analytical results with an associated measurement uncertainty in comparison with limit values.

Second-line with paclitaxel and carboplatin for recurrent disease following first paclitaxel and platinum compounds in ovarian carcinoma

OBJECTIVE

The combination of paclitaxel and platinum compounds is considered the best first-line regimen for advanced ovarian carcinoma. The purpose of this study was to evaluate a paclitaxel and carboplatin combination in pretreated patients who recurred within 24 months after a complete clinical response with the same regimen used as first-line chemotherapy.

METHODS

18 patients were included in this study. Second-line chemotherapy consisted of paclitaxel, 175 mg/m2 as a 3-hour infusion, and carboplatin AUC 6 every 21 days.

RESULTS

Among 15 evaluable patients, eight (53%) complete and five (34%) partial responses were observed, while two (13%) patients had stable disease (SD). The response rate was 67% among patients with measurable disease and 52% for evaluable disease. The median progression-free interval after second-line chemotherapy was 8.3 months. The median progression-free interval for patients with measurable disease was 8.6 months and for evaluable disease it was 7.9 months. Seven (46%) of 15 patients have developed recurrence after second-line chemotherapy with paclitaxel and carboplatin with a median time to recurrence of 9.8 months.

CONCLUSION

Paclitaxel 175 mg/m2 and carboplatin AUC 6 as second-line chemotherapy in this sensitive population is effective in terms of response rate and progression-free interval.

Women with a pelvic mass: indicators of malignancy

OBJECTIVE

To evaluate the efficacy of five methods: pelvic examination (PE), transvaginal ultrasonography (US), Doppler ultrasonography, serum CA125 assay and serum CA72-4 assay, alone or associated, to predict malignancy in patients presenting a pelvic mass originating in the ovary.

METHODS

92 patients underwent a standard protocol for physical examination, CA125, CA72-4, transvaginal ultrasonography and Doppler ultrasonography.

RESULTS

Eighteen women were dropped from the study because they had clearly benign masses; two women were dropped from the study because they had clearly malignant lesions. Twenty-two malignant (30%) and 50 benign (70%) pelvic tumors were found. When one method was considered alone the best sensitivity (SENS) was found in physical examination (90%) and the best specificity (SPEC) was found in CA72-4: 88%. If all indicators were positive, the SPEC was 100% but the SENS was 40%. Logistic regression analysis prediction of the character of the pelvic masses was correct in 86%.

CONCLUSION

Some additional information to discriminate between malignant and benign pelvic masses can be obtained from the valuation of serum tumor markers, particularly CA72-4. Also Doppler ultrasonography appeared to be useful in the differential diagnosis of pelvic tumors. The prediction of the character of the pelvic masses calculated by a logistic model in which PE, US, CA 125, and CA72-4 are included is very good.

Paclitaxel and carboplatin as outpatient therapy for stage III and IV epithelial ovarian cancer

BACKGROUND

To determine the toxicity and the response rate of a three-hour paclitaxel infusion and carboplatin administered as outpatient treatment for stage III and IV epithelial ovarian cancer.

METHODS

Forty-three patients with stage III/IV epithelial ovarian cancer underwent cytoreductive surgery and then received paclitaxel 175 mg/m2 over 3-hr infusion and carboplatin AUC5 every 21 days for six cycles. Elegible patients had adequate bone marrow, renal and hepatic function; G-CSF was recommended if white cell count fell under 3,000/mm3.

RESULTS

No patients had hypersensivity reactions; 15 out of 43 patients (35%) required colony-stimulating factors, 39 patients (91%) had general alopecia, three patients (7%) had severe emesis, 20 patients (46%) had mild emesis, four patients (9%) had severe myalgias, eight patients (18%) had moderate myalgias, one patient (2%) had grade 3 neurotoxicity. Three patients experienced grade 3 thrombocytopenia (7%). At a median follow-up of 29 months, 32 of 43 patients are alive (74%). Median progression-free survival is 14 months. Median overall survival has not been reached.

CONCLUSIONS

Three-hour infusion paclitaxel and carboplatin is an effective and safe outpatient therapy for epithelial ovarian cancer.

Heart rate as a predictor of mortality: the MATISS project

OBJECTIVES

This study sought to verify the independent role of heart rate in the prediction of all-cause, cardiovascular, and noncardiovascular mortality in a low-risk male population.

METHODS

In an Italian population-based observational study, heart rate was measured in 2533 men, aged 40 to 69 years, between 1984 and 1993. Data on cardiovascular risk factors were collected according to standardized procedures. Vital status was updated to December 1997.

RESULTS

Of 2533 men followed up (representing 24,457 person-years), 393 men died. Age-adjusted death rates for 5 heart rate levels showed increasing trends. The adjusted hazard rate ratios for each heart rate increment were 1.52 (95% confidence interval [CI] = 1.29, 1.78) for all-cause mortality, 1.63 (95% CI = 1.26, 2.10) for cardiovascular mortality, and 1.47 (95% CI = 1.19, 1.80) for noncardiovascular mortality. Relative risks between extreme levels were more than 2-fold for all endpoints considered.

CONCLUSIONS

Heart rate is an independent predictor of cardiovascular, noncardiovascular, and total mortality in this Italian middle-aged male population.

[Gestational HSV in the work setting]

OBJECTIVE

The purpose of our studies has been that to individualize the in partnership factors of risk to infection Herpes Simplex Virus-Type 2 in pregnant women and to appraise the role of the job in such context.

METHODS

A champion of 79 pregnant women with infection from HSV-2 has responded to a questionnaire regarding the appearance of the infection, her own job and the degree of stress, if they used services hygienic public.

RESULTS

In this champion of pregnant women 63% they are workers. Of these the 85% they introduced signs of a reinfection. For the housewives in 67% there was a reinfection. 84% of the housewives it uses services hygienic privacies. The infection from HSV has appeared in 28.5% of the been born by women with first infection from HSV genitalis, and in 12.5% of the been born by women with reinfection from HSV.

CONCLUSIONS

The women that work are mostly to risk of reinfection, they have more evident troubles. This is consequence of a style of life that contemplates a state of superior stress and a great tiredness from the same and of the appearance of vulvo-vaginal infections sustained by microorganisms transmitted through the hygienic services.

Influence of menstrual factors and dietary habits on menstrual pain in adolescence age

OBJECTIVES

The aim of this study was to determine the frequency of the primary dysmenorrhea in adolescence age and investigate correlation between menstrual factors, dietary habits and this pathology.

STUDY DESIGN

The sample was constituted from 356 students that were subjected to questionnaire, abdominal ultrasound, and in some cases, hormonal dosing.

RESULTS

The frequency of the primary dysmenorrhea was 85%. Early menarche was related to an increase of its prevalence and its severity. A long and heavy menstrual flow was related to an increase of its severity. As far as dietary habits, it was noted that a higher consumption of fish, eggs, fruit and a lower consumption of wine is correlated with a lower frequency.

CONCLUSION

Primary dysmenorrhea is very common in young women. The risk factors for this pathology are early menarche, long and heavy menstrual flow, and lower consumption of fish, eggs, and fruit.

[Prevention of vaginal prolapse in patients undergoing abdominal hysterectomy]

BACKGROUND

In our study we evaluate a personally developed surgical technique that, when used for abdominal hysterectomy, helps prevent posthysterectomy vaginal wall prolapse.

METHODS

We have used this modified surgical procedure in 244 consecutive abdominal hysterectomies performed from January 1973 through December 1986, compared with 133 abdominal hysterectomies performed without this new procedure. Patients returned monthly and annually thereafter for follow-up. The longest follow-up period to date is 12 years.

RESULTS

Of the 244 patients in our study followed up for 12 years, 234 (95.9%) retained excellent vaginal support. Vaginal wall prolapse occurred in 10 patients (4.1%), and it was asymptomatic prolapse, with the vaginal wall descending less than halfway from the ischial spines to the hymen.

CONCLUSIONS

This procedure is an acceptable method to help prevent posthysterectomy vaginal wall prolapse.

[Changes of the pulsatile index in ovarian and uterine arteries of infertile women. Case-control study]

BACKGROUND

This study was performed to evaluate the frequency of female pathology that cause infertility and to appraise the difference of pulsatility index in the ovarian and uterine arteries in infertile women and in a control group of healthy women.

METHODS

In the period between January 1997 and March 1999 52 infertile couples were examined carrying out an accuracy anamnesis and objective examination. The dosing of FSH, LH, estrogens, progesterone, and an ultrasound examination for each woman was required. The pulsatility index in the ovarian and uterine vases was calculated with the color Doppler technique.

RESULTS

A female pathology caused infertility in 24 couples, where only in nine couples the cause was masculine. In 14 couples there was a pathology in both the partners. In 5 couples any pathology was identified. The median of pulsatility index in healthy women was 1.8. Variations were observed in all the women with ovarian or uterine pathology unless in those with uterine malformations. An increase of the pulsatility index was observed also in 3 couples in which any cause of infertility was identified.

CONCLUSIONS

Female pathology is a very common cause of infertility. The evaluation of the pulsatility index in ovarian and uterine arteries can be useful diagnosing the cause of infertility and in to explain an infertility due to unknown cause.

Fetuses with cystic hygroma. A retrospective study

BACKGROUND

The aim of this study is to analyse several theories of pathogenesis of cystic hygroma, its correlation with chromosomal abnormalities and the indicators of poor or good prognosis.

METHODS

EXPERIMENTAL DESIGN

This is a retrospective study that evaluates all cases of cystic hygroma seen during the four-year period from January 1994 to December 1997.

SETTING

This study was performed in the center of prenatal diagnosis of institutional hospital in Caserta.

PATIENTS

All cases of fetuses with cystic hygroma were examined in 2100 pregnant female who visited the ambulatory.

INTERVENTIONS

The modality of diagnosis of this pathology and the presence of abnormal maternal serum levels of alpha-fetoprotein, human chorionic gonadotropin and unconjugated estriol were evaluated. Moreover, the presence of karyotype abnormalities or other non chromosomal abnormalities were also evaluated. Prognostic indicators such as the presence of septae seen by sonography were examined.

RESULTS

Nine fetuses with cystic hygroma were diagnosed sonographically. Septae were identified in six cases. Chromosomal abnormalities were found in five cases. Two cases presented Turner's syndrome and one case Downs' syndrome. There were two cases with associated anomalies. The amniotic fluid alpha-fetoprotein (AFP) levels were high in all cases.

CONCLUSIONS

Cystic hygroma is a malformation of the lymphatic system that is diagnosed by ultrasound very well from the first quarter of pregnancy. It is frequently associated with chromosomal and non chromosomal abnormalities. The presence of septae in it and amniotic fluid AFP levels are prognostic indicators.

[Human reproduction and environmental risk factors]

Environmental pollution is a great cause of concern, in particular, growing attention is being paid to the potential of many chemicals to affect the reproductive system in humans. The key role of prevention and control of reproductive hazards is recognized world-wide. Many chemicals have been shown to impair fertility and/or prenatal and perinatal development in experimental studies. However, a sufficient evidence of an effect on human reproduction is available for some compounds only. The use of biological markers may improve the assessment of exposure to chemicals, contribute to identify mechanisms of action and put into evidence early, reversible, biological effects. Valid biological markers are also needed in epidemiological studies: without reliable data on the level of current and past exposures it is difficult to establish a causal relationship between a pollutant and the occurrence of adverse health effects. A multidisciplinary approach to risk assessment is required. Priorities for interdisciplinary research on environmental chemicals and reproduction include the identification of susceptible population subgroups and risk assessment of exposure to multiple chemicals.

[The role of biological monitoring in the evaluation of the risk of from chemical compounds]

Over the years, the assessment of the risk to human health from occupational and environmental exposure to chemicals has become increasingly important. Exposure to chemicals, their biochemical effects and individual susceptibility can be estimated by biological monitoring carried out on potentially exposed subjects. Valid markers are needed to be effectively used within the framework of biological monitoring programs. Quality assurance, which includes all those activities necessary to provide adequate confidence that the results of laboratory test are reliable, is of the utmost importance. Among these activities the participation in external quality assessment schemes is strongly recommended. Biological monitoring has a key role also in the field of human reproduction since the level of exposure to many chemicals which are known or suspected to be reproductive toxicants can be assessed by specialized laboratories.

[Obstetric conduct in IUGR]

Purpose of the study is to identify the correct attitude that the obstetrician must engage in the management of pregnancy and birth in case of IUGR. Different methods of diagnosis and therapy of IUGR and the formalities of assistance to the birth have been examined and compared. Accurate clinical examinations of the mother, the study of fetal kariotype and ultrasonography, are essential for the diagnosis of IUGR. The genetic study could be performed by collecting chorionic villi, amniocentesis, cordocentesis or placenta biopsy. Ultrasonography identifies the cases of IUGR, and distinguishes early IUGR from late IUGR. Color Doppler identifies the pathology of the flow in the umbilical artery, in the abdominal aorta and in the middle cerebral artery. After the 26th week, the follow-up of the fetus with IUGR is done with cardiotocography with or without acoustic stimulation or oxytocin. The amelioration of maternal conditions is obtained by avoiding the cigarette smoking, preferring to rest in bed and a balanced feeding; the hyperoxygenation doesn't find unanimous consent. The treatment off IUGR can consist of abdominal decompression, intra-abdominal infusion of amniotic liquid, or use of aspirin. The birth is carried out in the hospital, when the fetus has reached a sufficient maturity. The management of IUGR requires an accurate follow-up and an adequate antepartum therapy. The goal is a birth with less risk.

Environmental and biological monitoring of endocrine disrupting chemicals

Trends toward an increase of adverse health effects on reproductive organs have been reviewed. An urgent need has been recognised to establish validated in vivo and in vitro screening assays to test for hormonal activities of chemicals. Relevant existing OECD guidelines have been reviewed and enhancements of some of these have been identified, mainly to test for estrogenic and androgenic activity of chemicals. The problems connected to monitoring activities are outlined, particularly for ambient and biological monitoring. Indeed, the problem of assessing human exposure to endocrine disrupting chemicals through environmental chemical analysis tends to a very high level of complexity. This has been illustrated through the example of one single subclass of endocrine disrupting compounds (EDCs), the organohalogen compounds. Valid biological markers are also needed to be effectively used in epidemiological studies and risk assessment. A multidisciplinary approach and the collaboration among experts in the field of clinical biochemistry, toxicology, and epidemiology is required.

[Macrophage-colony stimulating factor and ovarian cancer]

BACKGROUND

In this study the use of macrophage-colony stimulating factor (M-CSF) as tumor marker for ovarian cancer is evaluated.

METHODS

Serum samples were obtained from 74 patients, 43 of these were affected by ovarian carcinoma and 31 by benign ovarian tumors. The M-CSF levels were assayed with an ELISA method and compared with those of 148 healthy women. CA 125 levels were also evaluated.

RESULTS

In healthy women the M-CSF levels were 770.4 +/- 145.9 U/ml, the upper limit of normal level was considered 1056 U/ml. Serum M-CSF levels were significantly high in patients with ovarian cancer (1425.3 +/- 1007.1 U/ml; p < 0.001) and in 29 of the 43 patients exceeded the limit of 1056 U/ml. No differences were observed among the histologic types. There were no significant differences between patients with benign ovarian pathology and healthy women. No definite relationship was found with CA 125, but evaluating at the same time M-CSF and CA 125 positive results were found in 95.3% of cases.

CONCLUSIONS

Therefore M-CSF can be considered a marker for ovarian cancer, and the assay of its serum levels can be particularly useful in association with those of CA 125.

[Climacteric and quality of life]

BACKGROUND

Menopause is for women a critical period of their life, in which organic troubles and psychological problems cherish themselves. With particular reference to hot flushes and impaired sleep (the frequently found troubles), the benefits of physical exercise in women of this age have been evaluated.

METHODS

A study based on a questionnaire has been carried out on 79 women of age between 51 and 58 (who practised regular physical activity, selected at sporting centers), and 481 women of age between 52 and 58, selected between patients who came to the University Hospital for reasons not ascribed to menopause. All the women selected in the study underwent to natural menopause, and didn't use hormonal therapy. The questionnaire evaluated symptomatology and its level of severity.

RESULTS

In the first group 57% of the women didn't report symptoms, 30% light symptoms, 12% medium, 1% severe. In the second group 52% didn't report symptoms, 15% light symptoms, 22% medium, 11% severe.

CONCLUSIONS

Besides verifying a bigger well-being among women who practice physical activity, the interesting result is that 52% of the second group didn't refer symptomatology. The advantages of a balanced diet, with particular attention to food with phytoestrogens, is discussed and the psychosocial problems of woman in menopause, covering a fundamental role to explain a great part of the symptomatology, are underlined. Finally, the guide lines for a right preparation to menopause are presented.

[Lead exposure: risk evaluation for the general Italian population in 1990]

The second Italian campaign for the biological surveillance of the general population against the risk of lead intoxication has been carried out according to the regulations contained in the Presidential Decree DPR 496/82. The investigations of the second campaign--based on the measurement of blood lead levels (PbB)--have been carried out mainly between 1992 and 1996 by various operating centers in some Italian regions. A work group from the Istituto Superiore di Sanità (Italian National Institute of Health) coordinated the activity of the various centers and organised an appropriate quality control program to guarantee the quality of the analytical data collected. A total of 7749 non exposed subjects (4346 females and 3403 males) has been examined, 1170 of which (559 females and 611 males) were under 15 years of age. The median PbB was, for adults, 86 micrograms/l in males and 53.5 micrograms/l in females. As for subjects under the age of 15, PbB levels were 50 micrograms/l and 43 micrograms/l in males and females, respectively. Our investigation confirms the correlation between blood lead levels, wine, and cigarette smoking. The comparison with the results of previous investigations shows a reduction between 40% and 50% of PbB in the general Italian population during the 1985-96 period. It should be pointed out that in certain areas more than 5% of subjects under 15 years of age had PbB exceeding the level (100 micrograms/l) considered safe for avoiding irreversible injury to the central nervous system.

[Evaluation of environmental lead exposure in Latium: 2d DPR 496/82 campaign]

In the Latium region, according to the regulations contained in the presidential decree DPR 496/82, the investigations of the second campaign--based on the measurement of blood lead levels (PbB)--have been carried out between 1992 and 1994. Three samples of subjects were examined: adult subjects (33 males and 628 females) living in Priverno, a small town in the South of the Latium region; adults subjects living in the Rome area (81 males and 168 females; subjects under the age of 15 (65 males and 54 females) living in the Rome area. Concerning Priverno, the median PbB was 70 micrograms/l in males and 40 micrograms/l in females; in Rome 66 micrograms/l and 42 micrograms/ l in males and females, respectively. In subjects under the age of 15, PbB levels were 40.5 micrograms/l and 35.5 micrograms/l in males and females, respectively. As for adults PbB levels were significantly higher in female than in male subjects and in subjects aged 41 years and over in comparison with subjects aged 15-40 years. PbB levels were significantly higher in wine drinkers in comparison with non-drinkers. The difference between smokers and non smokers was significant only in female subjects living in Rome. In multiple regression analysis the association of PbB with age, sex, alcohol consumption and smoking habit were confirmed, and a positive relation between PbB and the condition of being living in Rome. As for Rome, the comparison with the results of previous investigations shows a reduction between 50% and 60% of PbB during the 1985-1992 period.

[Quality control of data produced in biological population surveillance studies on the risk of environmental lead poisoning]

The biological surveys of the general population against the risk of lead intoxication carried out in Italy--in accomplishment both of the EEC directive EEC 77/312 and the Presidential Decree 496/1982--have been always conceived as multicentric activities. Therefore, starting from the first campaign carried out in 1979, strict quality control procedures have been adopted. In brief, each participant laboratory used internal quality control samples and took part in external quality assessment exercises. In addition, ten percent of the blood samples collected during the campaign were analyzed as blind duplicate by both participating laboratories and a reference laboratory. In this paper the quality control procedures adopted will be presented and discussed in detail together with the quality of results obtained in each campaign.

Change in cardiovascular risk factors during a 10-year community intervention program

The study describes changes in cardiovascular risk factors during 10 years of a community intervention program conducted in a rural area in Central Italy. Two areas were involved, one for treatment and one for reference. In 1983-84, 739 men and 859 women in the treatment area and 942 men and 1045 women in the control area, aged 20-69 years, were screened; total and HDL cholesterol, systolic and diastolic blood pressure, fasting blood glucose, smoking habit, weight and height were measured. Between 1983 and 1993 several intervention activities based on community medicine were carried out in the treatment area. They were based on interaction with the local socio-sanitary institutions and school system in order to influence individual persons, small groups and entire community. Major effort was addressed to mass health education, nutrition education, antismoking-propaganda and detection and treatment of hypertension, diabetes and hyperlipidemia.

Ascorbic acid in human seminal plasma is protected from iron-mediated oxidation, but is potentially exposed to copper-induced damage

The aim of this study was to assess the interaction of endogenous ascorbate with iron and copper ions in aerobic seminal plasma. The rate of ascorbate consumption was measured by high-performance liquid chromatography and by the concentration of its primary oxidation product, ascorbyl radical (Asc.-) detected by electron spin resonance spectroscopy. The modification in the levels of Asc.- was used to investigate non-invasively and in real time whether metal ions, either present in this fluid or exogenously added, were catalytically active. The Asc.- was detected in seminal plasma as well as in whole semen of all subjects and was unaffected by superoxide dismutase, catalase or metal chelators. These findings and the rapid decrease of Asc.- under nitrogen suggest that Asc.- is probably a result of non-metal-catalysed air auto-oxidation, a reaction generating low levels of reactive oxygen species. Loading of seminal plasma with either Fe2+ or Fe3+ up to a concentration of 50 microM did not increase, or increased only slightly, the rate of ascorbate oxidation. Taking into consideration the concentrations of iron-binding proteins in this fluid, these results suggest that seminal plasma possesses a 'physiological ligand(s)' able to maintain iron ions in a catalytically inactive form. Our results indicate that citrate, which is present in seminal plasma at very high concentrations (10-25 mM), is responsible for the inhibition of iron-dependent catalysis. On the contrary, the loss of ascorbate and the levels of Asc.- were significantly increased by the addition of physiologically relevant concentrations (1 microM) of copper ions (Cu2+ but especially Cu+). We suggest that seminal plasma is potentially exposed to copper-mediated oxidation, a finding that could be of importance in situations of increased copper-loading such as in some pathological conditions or in smoking subjects.

The international register of potentially toxic chemicals : Challenges of data collection in the field of toxicology

The benefits and drawbacks consequent to the widespread use of chemicals are inextricably interwoven. According to recent estimates, more than 8 million substances are presently known, 70,000 of which are in common use as industrial compounds, pesticides, Pharmaceuticals, food additives, cosmetics and the like. It is estimated that substances used as such will increase annually by 1000 in number. The deleterious consequences deriving from their exploitation pose tremendous challenges to the scientific community for the protection of human health and the environment. Therefore it is of utmost priority to appropriately select valid information generated in this investigation area and to convey it correctly to users. Here, the adoption of the principles of good laboratory practice in experimental activities is essential, as well as the creation of global networks for data exchange on the safe use of chemicals. The structure and goals of the International Register of Potentially Toxic Chemicals (IRPTC, the database of the United Nations Environment Programme) are detailed to give an example of such an undertaking. Seventeen fields are covered,i.e. identifiers, properties and classification, production/trade, production processes, use, pathways into the environment, concentrations, environmental fate tests, environmental fate, chemobiokinetics, mammalian toxicity, special toxicity studies, effects on organisms in the environment, sampling/preparation/analysis, spills, treatment of poisoning, waste management and recommendations/legal mechanisms.

Association of blood lead to blood pressure in men aged 55 to 75 years: effect of selected social and biochemical confounders. NFR Study Group

The association of blood lead (B-Pb) concentration to blood pressure was investigated in men aged 55 to 75 years living in the Rome area, who had no history of exposure to lead in the workplace and who participated between 1989 and 1990 in an epidemiologic survey for coronary heart disease (New Risk Factor Project). Of the 1856 individuals eligible for the study, 59 were excluded from analyses because not all relevant data were available; and 478 were excluded because they were treated for hypertension. In the remaining subjects (n = 1319) the median B-Pb concentration was 113 micrograms/l (range: 40-442 micrograms/l). Systolic blood pressure (SBP) averaged 140 +/- 18 (standard deviation) mm Hg (range 98-220) and diastolic blood pressure (DBP) 84 +/- 9 mm Hg (range 56-118). Median B-Pb values increased significantly from 111 micrograms/l in subjects with normal blood pressure (n = 668) to 113.5 micrograms/l in subjects with borderline high blood pressure (n = 373) and to 120 micrograms/l in subjects with increased blood pressure (n = 278). After log-normal conversion of B-Pb, the linear correlation coefficient between In[B-Pb(ug/l)] and both SBP and DBP was statistically significant (r = 0.1332, p < 0.001 and r = 0.0737, p = 0.007, respectively). The linear regression coefficient was 6.8 mm Hg/In(micrograms/l) for SBP and 1.8 mm Hg/In(microgram/l) for DBP. Multiple regression analyses revealed that, after correction for body mass index (BMI), age, heart rate, skinfold thickness, serum lipids, and glucose levels; blood lead was still a significant predictor of increased SBP and DBP.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of serum copper and zinc with serum electrolytes and with selected risk factors for cardiovascular disease in men aged 55-75 years. NFR Study Group

Serum Cu (S-Cu) and Zn (S-Zn) levels were determined in 1468 out of 1856 male subjects aged 55-75 years living in the Rome area who participated, between 1989 and 1990, in the second examination in an epidemiological (New Risk Factors) survey. Mean S-Cu and S-Zn concentrations were 15.98 mumol/l (mean +/- 2SD: 10.38-21.58 +/- mumol/l) and 13.69 mumol/l (mean +/- 2SD: 8.94-18.44 mumol/l), respectively. S-Cu levels were directly related to serum calcium levels (S-Ca), serum magnesium levels (S-Mg), daily cigarette consumption, total cholesterol and age (years). S-Zn levels were directly related to S-Ca, S-Mg and cholesterol and inversely related to age. A weak inverse linear relationship existed between S-Zn and S-Cu. After adjustment for body mass index (BMI), smoking habit, alcohol consumption and blood biochemistry in a multiple linear regression model, the relationship of S-Cu (direct) and S-Zn (inverse) to age remained statistically significant.

The quality of analytical determinations of copper and zinc in serum. A collaborative study in a sample of Italian laboratories

An external quality assurance scheme for Cu and Zn analysis in serum was carried out in Italy between 1989 and 1990. It included: preparation of control materials by the organizing centre; distribution of control samples to the participants according to a random selection; elaboration of results and evaluation of laboratory performance. Inter-laboratory variability was 16.9% and 16.4%, at concentrations of 0.94 and 1.08 mg/l, for Cu and Zn, respectively. Laboratory performance in terms of percentage of results within the limits of acceptability, improved for Cu, but not for Zn analysis.

[Prevalence of some cardiovascular risk factors in a sample of the aged population]

The distribution of some cardiovascular risk factors in a cohort of elderly population is reported. The study population consisted of 427 males aged 71-91, examined in 1991 and belonging to the Italian rural section of the Seven Countries Study on Cardiovascular Diseases. Systolic blood pressure shows an increasing trend with age, with mean levels greater than 160 mmHg in each quinquennium, while the prevalence of hypertension ranges between 60 and 75%. Other risk factors considered such as serum cholesterol, triglycerides, weight, height and smoking habit show decreasing levels with ageing. This trend is clear also for fasting glucose from the age group 76-80.

Iron-induced ascorbate oxidation in plasma as monitored by ascorbate free radical formation. No spin-trapping evidence for the hydroxyl radical in iron-overloaded plasma

A study was made of the interaction of plasma ascorbate and ascorbate free radical (AFR) with exogenously added iron. The quantitative determination of AFR has the advantage that transient increases in ascorbate oxidation can be directly monitored by e.p.r. spectroscopy. An AFR signal was found in the plasma of all donors and was unaffected by superoxide dismutase, catalase and the strong iron chelator deferoxamine. These findings and the rapid decrease in AFR under a nitrogen atmosphere suggest that plasma AFR is probably a result of air auto-oxidation. Iron loading of plasma did not affect the intensity of the AFR signal until the iron concentration approached or exceeded the plasma latent iron-binding capacity. In iron-overloaded plasma, the intensity of the AFR signal increased to about 10 times the normal level before decreasing rapidly to undetectable levels after 15-20 min. Determination of plasma ascorbate showed that the disappearance of AFR was due to a complete loss of the vitamin. When 50 microM-ascorbate was loaded with iron in iso-osmotic phosphate buffer there was an increase in the AFR signal, independent of the iron concentration, which was stable at least for 15 min. Thus the rate of ascorbate loss in the iso-osmotic phosphate buffer was considerably lower than in iron-overloaded plasma. The addition of different iron chelators produced comparable effects on the intensity of the AFR signal in both iron-overloaded plasma and ascorbate solution. These results suggest that the characteristic behaviour of plasma AFR after iron loading is due to its specific iron-binding capacity and to plasma ferroxidase activity. The ferroxidase activity of plasma is important to promote the transfer of Fe2+ into transferrin without a transient ascorbate oxidation. Spin-trapping studies with 5,5-dimethyl-1-pyrroline N-oxide and N-t-butyl-alpha-phenylnitrone revealed that iron-overloaded plasma was unable to produce spin-trap adducts even in the presence of 50-300 microM-hydrogen peroxide or 100 microM-azide. Evidence of OH. radical formation was obtained only after the addition of EDTA. Therefore, iron-overloaded plasma itself does not produce a Fenton reaction and, if ascorbate does indeed have a free-radical-mediated pro-oxidant role, it is not detectable in plasma by spin-trapping experiments.

Zinc uptake in human seminal spermatozoa: characterization and effects on cell membranes

Human ejaculated spermatozoa take up zinc in a time- and concentration-dependent manner. The kinetics of 65Zn2+ uptake is suggestive of an at least partly carrier-mediated transport. The lack of effect of the respiratory chain inhibitor antimycin A could mean that mitochondrial ATP is not required as an energy source for the uptake. The failure of nonpermeant SH reagent mersalyl to modify zinc uptake indicates that functional membrane sulfhydryl groups are not involved in the process. A dose-dependent inhibition of 65Zn2+ uptake was induced by the "anticalmodulin" drug trifluoperazine, suggesting that the calcium-binding protein calmodulin could have a role in zinc transport. In in vitro experiments this cation brought about a powerful effect in protecting the spermatozoa from being damaged by hypo-osmosis.

Calcium uptake in human spermatozoa: characterization and mechanisms

Basal 45Ca2+ influx was analyzed in human seminal spermatozoa using a method that allows these highly reactive cells to be easily and safely handled. The uptake was a time-dependent process, with its maximum at 400 s. The kinetics of 45Ca2+ transport was saturating as a function of extracellular Ca2+ concentration with a Km of 429 microM and a Vmax of 1.6 nmol 45Ca2+/mg protein/2.5 min. Depolarizing conditions and the calcium channel blocker verapamil did not affect the uptake; based on this, the presence of operating calcium channels in seminal spermatozoa is excluded. The independence of 45Ca2+ uptake on external concentration of both Na+ and Ca2+ suggests that Na+/Ca2+ exchange does not occur in these cells. The anticalmodulin drug trifluoperazine, the mitochondrial inhibitor antimycin A, and the SH reagents N-ethylmaleimide and mersalyl all inhibited the ion transport. A calmodulin-regulated, energy-requiring, proteinaceous Ca2+ transporter seems to be the main operating mechanism of calcium uptake in human seminal gametes.

Identification of calcitonin receptors in human spermatozoa

Calcitonin (CT) is a powerful hypocalcemic hormone which regulates calcium balance in cells. The presence of CT and CT receptors has been demonstrated in many extrathyroidal tissues, including the male genital tract. CT immunoreactivity has also been found in human seminal fluid, and an inhibitory effect of salmon CT on human sperm motility in vitro was recently reported. In this study the presence of specific binding sites for synthetic salmon CT in intact human spermatozoa was investigated using [125I]salmon CT. Binding experiments demonstrated a CT-sperm interaction involving a receptor-mediated mechanism. The binding was very rapid and minimally reversible, with the maximal site saturation occurring at approximately 2 nM labeled peptide. The dissociation of the CT-receptor complex was only slightly influenced by the addition of unlabeled hormone. Increasing concentrations of unlabeled salmon, eel, and human CT produced a dose-dependent inhibition of [125I]salmon CT binding. These data fulfill the major criteria for demonstration of specific receptors for salmon CT in human spermatozoa. Owing to the key role of calcium ions in regulating sperm motility and the onset of the acrosomal reaction, CT receptors could be important in male gamete physiology.