Reply to the Letter of Terracini B. et al. "Comment on Piscitelli et al. Hospitalizations in Pediatric and Adult Patients for All Cancer Type in Italy: The EPIKIT Study under the E.U. COHEIRS Project on Environment and Health". Int. J. Environ. Res. Public Health 2017, 14, 495

A letter to the IJERPH Editor was submitted by Terracini B. et al. as a comment to our latest paper "Hospitalizations in Pediatric and Adult Patients for all Cancer Type in Italy:[...].

Hospitalizations in Pediatric and Adult Patients for All Cancer Type in Italy: The EPIKIT Study under the E.U. COHEIRS Project on Environment and Health

Background: Cancer Registries (CRs) remain the gold standard for providing official epidemiological estimations. However, due to CRs’ partial population coverage, hospitalization records might represent a valuable tool to provide additional information on cancer occurrence and expenditures at national/regional level for research purposes. The Epidemiology of Cancer in Italy (EPIKIT) study group has been built up, within the framework of the Civic Observers for Health and Environment: Initiative of Responsibility and Sustainability (COHEIRS) project under the auspices of the Europe for Citizens Program, to assess population health indicators. Objective: To assess the burden of all cancers in Italian children and adults. Methods: We analyzed National Hospitalization Records from 2001 to 2011. Based on social security numbers (anonymously treated), we have excluded from our analyses all re-hospitalizations of the same patients (n = 1,878,109) over the entire 11-year period in order to minimize the overlap between prevalent and incident cancer cases. To be more conservative, only data concerning the last five years (2007–2011) have been taken into account for final analyses. The absolute number of hospitalizations and standardized hospitalization rates (SHR) were computed for each Italian province by sex and age-groups (0–19 and 20–49). Results: The EPIKIT database included a total of 4,113,169 first hospital admissions due to main diagnoses of all tumors. The annual average number of hospital admissions due to cancer in Italy has been computed in 2362 and 43,141 hospitalizations in pediatric patients (0–19 years old) and adults (20–49 years old), respectively. Women accounted for the majority of cancer cases in adults aged 20–49. As expected, the big city of Rome presented the highest average annual number of pediatric cancers (n = 392, SHR = 9.9), followed by Naples (n = 378; SHR = 9.9) and Milan (n = 212; SHR = 7.3). However, when we look at SHR, minor cities (i.e., Imperia, Isernia and others) presented values >10 per 100,000, with only 10 or 20 cases per year. Similar figures are shown also for young adults aged 20–49. Conclusions: In addition to SHR, the absolute number of incident cancer cases represents a crucial piece of information for planning adequate healthcare services and assessing social alarm phenomena. Our findings call for specific risk assessment programs at local level (involving CRs) to search for causal relations with environmental exposures.

Eosinophil granule proteins are selective activators of human heart mast cells

Eosinophilia in humans is associated with eosinophil infiltration and cardiac localization of eosinophil granule proteins. Eosinophil cationic proteins are responsible for cardiac disease in some patients with eosinophilia. We have investigated the in vitro effect of four eosinophil granule proteins: eosinophil cationic protein (ECP), major basic protein (MBP), eosinophil-derived neurotoxin (EDN) and eosinophil peroxidase (EPO), on mast cells isolated from human cardiac tissue (HHMC). ECP and, to a lesser extent MBP (0.3-3 microM), but not EDN and EPO, stimulated the release of histamine and tryptase from HHMC. This release reaction induced by ECP and MBP was Ca(2+)- and temperature-dependent and was abolished by preincubation with anti-ECP and anti-MBP, respectively. The activation of HHMC by ECP and MBP was abolished by preincubation with 2-deoxy-D-glucose and antimycin A. These data demonstrate that some eosinophil cationic proteins, ECP and MBP, are selective activators of HHMC, thus contributing to the cardiac lesions in patients with eosinophilia.

Distribution of infecting hepatitis C virus genotypes in end-stage liver disease patients at a large American transplantation center

The distribution of hepatitis C virus (HCV) genotypes was studied in 202 anti-HCV-positive liver transplant candidates with end-stage liver disease. HCV sequences were successfully amplified from 185 patients: In the first 100, the genotype was determined by direct sequencing in the NS5 region, and in the remaining 85, type-specific primers were used for genotyping. Eighty-five patients (46.0%) were infected with type 1a HCV strains, 52 (28.1%) with type 1b, 14 (7.6%) with type 2b, 13 (7.0%) with type 4, 5 (2.7%) with type 3a, 2 (1.1%) with type 2a, and 1 (0.5%) with type 2c. Thirteen HCV-positive patients (7.0%) could not be genotyped. The relatively low prevalence of genotype 1b in this population of end-stage liver disease patients speaks against postulated higher pathogenicity of this genotype.

Computer-guided randomized concentration-controlled trials of tacrolimus in autoimmunity: multiple sclerosis and primary biliary cirrhosis

A randomized concentration-controlled clinical trial (RCCCT) is a trial design in which patients are randomized to predefined blood drug concentrations (low, medium, high). If the concentration ranges are sufficiently separated, this study design can reveal important blood concentration-response relations. Tacrolimus is a potent yet "infant" immunosuppressant for the treatment and prevention of graft rejection and has been shown to exhibit significant clinical activity in some immune-mediated disorders. A tacrolimus artificial intelligence modeling system (AIMS) was used to guide patient dosing to achieve target concentrations specified by the study protocols. In the Multiple Sclerosis study group, we were able to define a concentration range (0.3-0.7 ng/ml) that appeared to show efficacy and minimal tacrolimus toxicity. Patients randomized to the high zone (0.6-1.2 ng/ml) in the Primary Biliary Cirrhosis study group showed significant reduction (approximately 50%) in surrogate efficacy markers [aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT)] compared with patients in the low zone (0.1-0.6 ng/ml). Therefore the RCCCT allowed the detection and delineation of clinically significant concentration-response relations in an ethical and efficient manner.

[Effect of some drugs on physiological icterus in the newborn]

The Authors have correlated neonatal jaundice with the administration of oxytocin and prifinium bromide to the mother either alone or in association during labour. The percentage of neonatal jaundice in women treated with ritodrine hydrochloride during the second and third trimester of pregnancy was also calculated. A total of 1.101 deliveries were taken into consideration between January 1984 and June 1986. Thirty-three patients were treated with oxytocin alone; 444 patients with oxytocin and prifinium bromide; 81 patients with ritodrine hydrochloride during the second and third trimesters of pregnancy, and 192 patients were untreated. This study indicates that all drugs may contribute to producing neonatal jaundice, as shown in the graphs, and drugs during labour should be used with extreme caution and be limited in quantity and period.

Experimental induction of microphthalmia in the chick embryo with a single dose of cisplatin

Chick embryos were injected on the fifth day of incubation with 75 ng cis-diamminedichloroplatinum II (cisplatin) and killed at daily intervals. Bilateral microphthalmia appeared in 88% of the surviving embryos; the decrease in eye size was noticeable 2 or 3 days after injection. Coinciding with this, macroscopic, histological, and ultrastructural changes started to appear in the ciliary body: ciliary processes failed to form and the cells in the inner layer of the ciliary epithelium underwent degenerative changes. Changes in the retina appeared somewhat later. Despite the decreased growth rate of the whole eye the neural layer of the retina continued to grow rapidly; as a result, it formed numerous folds and acquired a glandular appearance. In the most severe cases the rapidly growing retina would invade the ciliary region and replace completely the degenerated inner layer of the ciliary epithelium. It has been shown by previous authors that intraocular pressure is a determinant of eye expansion and also that the secretion of water and ions by the ciliary epithelium is important for the maintenance of that intraocular pressure. On this basis, our results are interpreted as indicating that the primary lesion induced by cisplatin was in the ciliary epithelium and that microphthalmia was the consequence of decreased pressure. It is also concluded that the retinal changes were due to the fact that the retina continued to grow despite the lack of expansion of the eye as a whole.

Lead-induced early lesions in the brain of the chick embryo

A single dose consisting of a solution of lead nitrate containing 1 mg lead in 0.1 ml distilled water was injected into the air chamber of chicken eggs on the tenth day of incubation. The injected embryos were killed 24, 48, or 72 hours after the injection. Control embryos were injected with a similar volume of distilled water or of an equimolar calcium nitrate solution on the tenth day and killed 72 hours after. Portions of the optic lobes were processed for their electron microscopic study. Multiple hemorrhagic foci appeared 24 hours after the administration of lead. Red blood cells were found to exit the blood vessels through the spaces between otherwise normal-looking endothelial cells; tight junctions were always found blocking the interendothelial spaces except during the migration of red blood cells through them. Vacuolization of the cytoplasm and mitochondrial swelling and disorganization were observed in the endothelial cells only during the third day after the injection. Similarly, histological and ultrastructural alterations of nerve cells were only found on the third day after the treatment. Hemorrhagic foci were never found in control embryos. Our observations are consistent with the idea that the hemorrhages constitute the primary lesion produced by lead. They also suggest that the hemorrhages are not the result of rupture of previously altered endothelial walls but occur by diapedesis through the interendothelial clefts.

Studies on inhalation toxicity of 2-propanol

Biological effects of a single exposure to moderate or high concentrations of 2-propanol were investigated in Sprague-Dawley rats. Acute toxicity (LC50, t:8 hours) of this widely used solvent was determined and found to be 19000 ppm (17380-20760 ppm) for females and 22500 ppm (19200-26400 ppm) for males. Determination of blood levels of 2-propanol and its metabolite, acetone, was carried out during and after a single 4-hour exposure (Concentration range: 500 to 8000 ppm). The amount of acetone and 2-propanol was directly related to the various air concentrations of alcohol inhaled. Increase of exposure time to 8 hours enhanced considerably the amount of blood acetone which could be determined even 20 hours after exposure. These findings indicate a slow conversion of this alcohol to acetone which can be used as biochemical indicator to exposure. Histopathological examination of rats exposed to high levels of 2-propanol shows typical lesions of chemical pneumonitis and pulmonary edema accompanied by foamy vacuolization of liver cells and severe focal cytoplasmic degradation.