First Evidence of Cardiac Stem Cells From the Left Ventricular Apical Tip in Patients With Left Ventricular Assist Device Implantation.

BACKGROUND: Recent studies have challenged the dogma that the adult heart is a postmitotic organ and raise the possibility of the existence of resident cardiac stem cells (CSCs). Our study aimed to explore if these CSCs are present in the "ventricular tip" obtained during left ventricular assist device (LVAD) implantation from patients with end-stage heart failure (HF) and the relationship with LV dysfunctional area extent. METHODS: Four consecutive patients with ischemic cardiomyopathy and end-stage HF submitted to LVAD implantation were studied. The explanted "ventricular tip" was used as a sample of apical myocardial tissue for the pathological examination. Patients underwent clinical and echocardiographic examination, both standard transthoracic echocardiography (TTE) and speckle tracking echocardiography (STE), before LVAD implantation. RESULTS: All patients presented severe apical dysfunction, with apical akinesis/diskinesis and very low levels of apical longitudinal strain (-3.5 ± 2.9%). Despite this, the presence of CSCs was demonstrated in pathological myocardial samples of "ventricular tip" in all 4 of the patients. It was found to be a mean of 6 c-kit cells in 10 fields magnification 40×. CONCLUSIONS: Cardiac stem cells can be identified in the LV apical segment of patients who have undergone LVAD implantation despite LV apical fibrosis.

[Measurement of real personal noise attenuation using earplugs with the E-A-Rfit system]. / La misura del reale abbattimento soggettivo di rumore con uso di inserti auricolari tramite sistema E-A-Rfit.

BACKGROUND: The assessment of efficiency of hearing protection devices (HPDs), conducted above statutory limits, must be made using a standardized method while devices are worn; however, standardized and suitable laboratory conditions are difficult to encounter at the workplace. To overcome this problem, there are methods of measurement at the workplace such as "field-microphone-in-real-ear" (F-MIRE). OBJECTIVES: The study was concerned with the measurement of real noise attenuation using earplugs and a new evaluation system: we checked the difference between "real" attenuation (at workplace) and "theorical" attenuation (reproduced in the laboratory) as stated by the manufacturer. METHODS: We used the E-A-Rfit computerized method, which measures the loss of attenuation of earplugs in the ear, calculating the difference of sound pressure between an "outside" microphone and an "inside" one, in relation to the same earplug. The measurements at the workplace were carried out on eight subjects with good hearing levels (aged between 20 and 25 years), who were trained to wear the devices correctly. After the tests carried out with the E-A-Rfit system, which does not require a subjective answer, we obtained graphs and tables showing real noise attenuation. RESULTS/CONCLUSIONS: We propose a comparison between hearing threshold for frequency, personal attenuation rating (PAR) and single number rating (SNR, provided by manufacturer): a difference of 10 dB (PAR 27 db vs. SNR 37 dB) was clearly evident although dissimilar methods were used to obtain such values. The instrument is rapid, simple and objective to use and also allows personalized information and training for every worker.

[Temporary hearing threshold shift in policemen after firearm training]. / Spostamento temporaneo di soglia uditiva in agenti di polizia dopo esercitazioni in poligono di tiro.

BACKGROUND: The paper involves exposure to noise of the State Police officers connected with the use of firearms. The noise generated by these weapons is of short duration and high intensity. METHODS: The research was carried out during the sessions of firearm training of State Police officers to assess exposure to noise. RESULTS: The values of the various investigations, both audiometric and phonometric, carried out made it possible to demonstrate a significant exposure and a temporary increase in the threshold, above the frequency of 6000 Hz. CONCLUSION: Even taking account of the abatement from use of headphones, an exposure was demonstrated that was above the statutory limits, as was confirmed by the temporary hearing threshold shift.

[Asbestos and agriculture: new perspectives of risk]. / Amianto e agricoltura: nuove prospettive di rischio.

The presence of ophiolites in areas of Basilicata, where there have been reports of mesothelioma in farmers, is known. This study evaluates the increased risk of exposure to tremolite in carrying out agricultural activities. Cases of mesothelioma occurred in farmers with unknown exposure to asbestos have been selected and assessed the employment in areas contaminated by tremolite. Personal samplings were conducted in a group of farmers employed in these areas and a group of subjects used in activities that do not involve contact with the ground. For the 5% of cases of mesothelioma in the lucan register emerged exposure to asbestos exclusively in farming activities in areas at tremolite risk. The analysis of the samples showed the presence of personal fibers of tremolite in 2/3 of the cases. In 60% there was an overcoming of the natural limit of 2 ff/l, with a peak up to 23.6 ff/l. The study shows that the risk of exposure to tremolite in agriculture is significantly higher than natural exposure.

[Exposure to asbestos in buildings in areas of Basilicata characterized by the presence of rocks containing tremolite]. / Esposizione ad amianto in edilizia in aree della Basilicata caratterizzate dalla presenza di rocce contaminate da tremolite.

Lucania, in southern Italy, is characterized by areas with natural outcrops of rocks containing tremolite. The study aims to assess the risk of exposure to asbestos in the building workers in these areas through environmental sampling near sites for implementation of safety of roads built on serpentinite rocks and personal sampling in a group of persons who work in the building industry and a group of residents engaged in activities without contact with the ground. Near road sites was found the presence of airborne tremolite in 66% of environmental samples with peaks up to 31 ff/l. The analysis of personal samples showed the presence of tremolite in doses higher than the natural background in 100% of the building workers, while there were no fibers in the samples of residents employed in activities without soil disturbance. The study shows that the building in areas with naturally occurring asbestos determines a condition of significant occupational exposure to asbestos. Adequate safety measures for workers exposed are needed.

[And yet there is a risk--do it yourself]. / Eppur c'è rischio--Il bricolage.

Our study has examined the valuation of exposure to dust, noise and hand-arm vibrations (HAVs) during "extra-professional" activities of do-it-yourself, like wood smoothing, considering a group of 8 heterogeneous volunteer subjects (not expert of the sector), to find any kind of variability among the subjects. The results have shown a moderate risk for dust exposure and a realer one for HAVs, also higher noise exposure levels when an aspiration system is added to the sander. It's important that the exposure time considered in this study is not comparable to professional time exposure, cause of the "domestic" feature of this activities. Moreover, data could be influenced by different use conditions, grip and material grounds. It's also significant that there are not controls, formation and information of the subjects about the health risks, as well as ipersusceptibility.

[Exposure to air pollutants in the city of Bari]. / Esposizione ad inquinanti atmosferici nella città di Bari.

BACKGROUND: Air pollution leads to increased levels of morbidity and mortality for cardiovascular and respiratory diseases in populations living in urban environments. OBJECTIVES: Our study tested the possibility of using sampling techniques that are typical of industrial hygiene to measure exposure to atmospheric pollutants and using personal samplers for concentrations of certain pollutants to which an ordinary resident of Bari is exposed on a daily basis. METHODS: We monitored dusts (PM10, PM2.5), CO, CO2, humidity, ventilation and noise, by dynamical sampling along a route on foot, bicycle, motorbike and automobile and then compared the results with data provided by fixed stations distributed in the municipality of Bari. RESULTS: By comparing our data with those values provided for by the law, we found out that the concentrations of all pollutants resulted to be higher than 50 microg/m3, with the exception of the measurements carried out along the route by car. The measurements of PM2.5 were, on average, similar to the values of PM10 for the route on foot, but they were totally different for the measurements made along the route by car, bicycle and motorbike. Moreover, comparing our data with those obtained from the municipal network of fixed stations, we found that results provided by our measurements were higher for PM10. CONCLUSIONS: Considering that compliance with the limits set by law refers to average values over 24 hours, we can conclude that those hours in which pollutant concentration reaches a risk level shall be considered especially regarding groups of people with respiratory disorders.

Effect of lead on the levels of some immunoregulatory cytokines in occupationally exposed workers.

Lead (Pb) may affect humoral and cellular immunity, acting on lymphocytes as well as on granulocytes and monocytes. Cytokines and nitric oxide (NO) play a central role in the immune balance. In this study, plasma levels of nitrites and nitrates (NOx), IL2, IL4, IL6, IL10, TNF-alpha and INF-gamma, were measured in healthy workers with very low (Pb-B=3.2-18.0 microg/dL) and low (Pb-B=9.1-46.0 microg/dL) Pb-exposure compared to non-exposed workers. Low Pb-exposed workers (Pb-B=9.1 -46.0 microg/ dL) were found to have significantly higher plasma IL-10 levels, and tendentially higher plasma TNF-alpha levels compared to non-exposed workers. This is the first report of a significant increase of plasma IL-10 levels in Pb-exposed workers. Plasma IL-10 increase was influenced by blood Pb levels even after correction for main confounding factors. No difference was found in plasma NOx levels between Pb-exposed and non-exposed workers, which is in agreement with previous findings exclusively regarding groups in the general population. Low Pb-exposure can induce an increase of pro-inflammatory cytokines, such as TNF-alpha, with a consequent increase of other cytokines, such as IL-10, considered a T cell cross-regulatory factor, suggesting possible interference of Pb in the system of immunophlogosis.

No-occupational exposure to noise.

The aim of the research was to evaluate the risk for the health of the disco-goers related to no-professional exposition to noise produced by speakers of discos. The noise has been measured in the middle of a disco using a class 1 phonometer. The exposition level was calculated using the formula quoted in the D.Lgs 277/91 (Italian legislative decree) and the possible damage was calculated using the Casini's formula. The calculated daily exposition level was 99,1 dBA and the weekly exposition was 92.1 dBA. The results indicate that the hypacusia damage due to these expositions can be considered almost sure.

[Report on the activities carried out in the research project of the Ministry of Instruction, University, and Research entitled "Environmental and occupational exposure to inorganic lead: assessment of toxic effects of current doses and related preventive measures"]. / Presentazione delle attività svolte nell'ambito del progetto di ricerca MIUR "Esposizione ambientale ed occupazionale a piombo inorganico: studio degli effetti tossici conseguenti alle dosi correnti e delle relative misure preventive".

It is here presented the project sustained by the Ministry of Public Instruction, University and Research "Environmental and Occupational Exposure to Inorganic Lead: assessment of human health effects due to current doses and preventive measures" ruled out between 2001 and 2003. The aim of the study was to investigate about the toxic effects related to current occupational exposures to inorganic lead (particularly those effects concerning blood pressure, carcinogenic risk, nervous and immunological systems), to identify hypersusceptibility conditions, particularly the ALAD genetic polymorphism and to evaluate the role of traditional biomarker and the possibility of introducing new ones. In the present article the procedures followed during the project lasting and the contribution of each Unit are described. The results of the research, presented in detail in the current issue, do confirm the inadequacy of the biological exposure index nowadays ruled by Lex 25/2002.

[Assessment of neurobehavioral functions of workers exposed to low doses of metallic lead]. / Valutazione delle funzioni neurocomportamentali di lavoratori esposti a basse dosi di piombo metallico.

The effects of low-dose lead occupational exposure on neurobehavioral functions are still not well defined by international literature. The objective of this study is to assess by psychometric testing the presence of possible neuropsychological impairment in a group of male Italian workers with low blood lead levels in comparison to an adequate non exposed worker group. Given informed consent to take part to the study, all workers were interviewed about their working and clinical history and underwent determination of blood lead levels (PbB). An internationally validated computerized battery of psychometric tests and a standardized paper-and-pencil version of mood self-rating scale and WAIS-R Vocabulary subtest were also administered to the workers. Exposed workers had a geometric mean of PbB significantly higher than non exposed workers, but rather low (16.4 +/- 1.7 microg/dl). The results of psychometric tests were not significantly different between the two worker groups, even after adjusting for the main confounding factors. In workers exposed to low lead doses no neurobehavioral abnormalities were demonstrated by the administered psychometric test battery.

[Anemia in workers exposed to lead: update on differential diagnosis]. / Anemie in lavoratori esposti a piombo: attualità della diagnosi differenziale.

Occupational lead exposure can cause anemia at blood lead levels >50 microg/dl, as high as rarely occurs in industrialized countries nowadays. Whereas other forms of anemia are fairly probable to be found in lead exposed workers, especially in areas highly endemicfor extraoccupational anemias, such as beta thalassemia and iron deficiency anemia. The etiology of anemias has to be correctly defined in order to assess suitable therapeutical approaches and medicolegal consequences. The objective of this study is to verify in male lead exposed workers whether an accurate evaluation of hemocromocytometric parameters and of usual biological indices of lead exposure and effect on heme can differentiate the most common forms of anemia in Southern Italy. 68 workers occupationally exposed to low to moderate lead doses were studied and 59 workers of an alimentary plant have been taken as control group. On venous blood samples collected from these workers a complete hemocromocytometric test was performed and blood lead and erythrocytic zincoprotoporphyrin were determined. Anemia (Hb

[Reduced thymulin production during occupational exposure to lead]. / Ridotta produzione di timulina in corso di esposizione professionale a piombo.

Thymulin is a thymic hormone that being activated by binding a zinc ion promotes differentiation and several functions of T lymphocytes. It has been demonstrated only in experimental animals that metallic lead (Pb) is able to cause adverse effects on thymocyte number and function. The objective of this study is to evaluate the plasmatic level of active thymulin of 58 male workers being exposed for more than one year to low lead doses with respect to 59 male never exposed workers. All these were subjected to anamnesis collection, medical examination and determination of blood lead (PbB), plasmatic lead (PbPl), plasmatic thymulin, urinary lead (PbU) and urinary zinc (ZnU) levels. The mean plasma concentration of active thymulin was significantly lower in lead exposed than in non exposed workers. Active thymulin was also significantly and negatively correlated to PbB, PbPl and PbU level and resulted to be significantly and negatively influenced by PbB. Lead exposed workers had slightly higher zinc concentration in urine than non exposed workers, increasing ZnU levels by class of PbB. It is the first time that a toxic effect of lead on plasmatic active thymulin levels is demonstrated in humans, particularly in occupationally exposed workers. This study opens perspectives for further research that would both confirm the results and verify the mechanisms of action of lead on thymulin either direct or indirect and the possible role of zinc.

[ALAD polymorphism and indicators of dose and effects of occupational exposure to inorganic lead]. / Polimorfismo ALAD ed indicatori di dose e di effetto dell'esposizione professionale a piombo inorganico.

The delta-aminolevulinate dehydrase (ALAD) genetic polymorphism was investigated along with biomarkers of lead exposure and effect on 333 male workers, occupationally exposed to lead, with blood lead levels (PbB) higher than 100 microg/l. ALAD genotype frequencies were distributed as expected among Caucasians. Workers bearing at least one ALAD-2 allele showed PbB values slightly higher than those from ALAD-1-1 subjects, who also exhibited higher urinary delta-aminolevulinic acid (ALAU) and blood zinc protoporphyrin (ZPP) levels. The plasmatic lead (PbP)/PbB ratio was similar in both groups. Exposure and effect biomarkers were significantly each other correlated among ALAD-1-1 subjects only, who showed also a significant inverse relationship between ALAD activity and ZPP values. Results confirm previous studies, supporting the hypothesis that ALAD polymorphism may interfere with toxico-kinetic and toxico-dynamic parameters of occupational exposure to Pb.

[Dose-response curve in the study of the effects of exposure to crystalline silica]. / La curva dose-risposta nello studio degli effetti dell'esposizione a silice cristallina.

The cumulative exposure to crystalline silica (SiO2) implies a linear relation between duration of exposure and SiO2 concentration, not always suitable to working situations of the last decades. A more correct definition of dose-response curve has currently to consider also different characteristics of SiO2, specifically: possible short-term increases in environmental SiO2 concentration, different mineralogical and surface properties of natural silica polymorphs, age of SiO2 particles, presence of contaminants on the surface of silica particles or even in the respirable fraction of total dust, respirable dust concentration in which SiO2 is diluted and other conditions, also affecting the host, able to slow alveolar clearance and lengthen permanence time of particles in the lung. Many models of definition of cumulative exposure so conceived have been proposed. However, to define the occupational risk threshold to contract silicosis and other silica-related diseases a number of models of cumulative exposure, i.e. biologically effective dose of SiO2, are likely to be delineated that take into account only factors specifically present in different occupational situations.

[Exposure to PAHs, urinary 1-pyrenol and DNA adducts in samples from a population living at different distances from a steel plant]. / Esposizione a IPA, 1-idrossipirene urinario e addotti al DNA in campioni di popolazione residenti a diversa distanza da un polo siderurgico.

This study aims at measuring association between environmental exposure to PAHs and internal or biologically effective dose biomarkers among 212 individuals living at different distance from the industrial area of Taranto, Italy. Environmental PAH exposure was determined by area monitoring. PAH levels was measured by HPLC UV/FL. Urinary 1-hydroxypyrene levels were measured by HPLC/Fluorescence. The levels of DNA adducts were determined by 32P. post-labelling. A questionnaire was administered to gather personal data, residence, occupational history, alcohol, tobacco smoke, and diet, to control for other sources of exposure to PAH. Blood and urinary samples, drawn from the subjects studied were collected and analysed. A multivariate regression model was used to investigate the influence of several confounding factors. Housing was placed within 1 km from smokestacks in Taranto and Statte, whereas they were more far away in Locorotondo and in Alberobello. The prevalence of current smokers was 31.6%.

[Increase of TNF-alpha in subjects occupationally exposed to lead]. / Aumento del TNF-alpha in soggetti professionalmente esposti a piombo.

Occupational exposure at low doses of lead induces a significant increase of TNF-alpha plasma levels. Recently has been showed the crucial role on atherosclerosis origin of this pro-inflammatory cytokine. It is assumable a contribution of lead in atherosclerosis course in exposed subjects.

[Effects on arterial pressure of exposure to low doses of inorganic lead: preliminary results]. / Effetti sulla pressione arteriosa di esposizioni a basse dosi di piombo inorganico: risultati preliminari.

The aim of this study is to evaluate the effects of occupational exposure to low inorganic lead (Pb) doses on blood pressure of exposed (E) workers. 44 workers of a foundry of lead wrecks and 14 workers employed in enameling and decoration of a manufacturing firm of artistic ceramics were examined. The group of non-exposed (NE) subjects is formed by 59 workers of packaging unit of a food industry. A questionnaire has been administered to all the workers on general characteristics and life habits. Systolic and diastolic blood pressure were also measured and venous blood collection performed for the determination of blood lead levels. Mean blood lead levels (PbB) and mean diastolic blood pressure (DBP) resulted significantly higher in the group of exposed workers of the foundry. Stratifing exposed workers with respect to the median of PbB (18 micrograms/dl), workers with PbB > 18 micrograms/dl presented a mean DBP significantly higher than exposed with PbB < or = 18 micrograms/dl and non-exposed subjects. PbB takes part significantly in determination of DBP, also considering main confounding factors as age, BMI, pack-years and alcohol consumption.

[Occupational exposure to inhalation anesthetics: 10 years of measurements at hospitals in Puglia]. / Esposizione professionale ad anestetici inalatori: 10 anni di misure in ospedali pugliesi.

The Authors provide the data gathered from measurements of nitrous oxide in the operating room of Puglia during the period between 1993 and 2003. They prove significant reductions of pollution according with time and they verify lower pollution levels in the operating rooms of private hospitals with respect to public facilities. The importance of the maintenance of gas distribution and evacuation systems is shown and a method of environmental and biological monitoring is provided. Finally, the Authors prove the utility of the graphic representation of the measurements, conduced utilising dedicated instrumentation.

[Non-occupational exposure to noise]. / Esposizione extraprofessionale a rumore.

The authors report the data related to the measures effected in some environments where leisure time activities are developed. In the light of the elevated values, the authors have effected the calculation of the Lep,d as laid down by D.Lgs 277/91 to verify the existence of conditions of risk that result verified.