The surveillance of occupational diseases in Italy: the MALPROF system.

BACKGROUND: Occupational diseases data can guide efforts to improve worker's health and safety. AIMS: To describe MALPROF, the Italian system for surveillance of work-related diseases collected by the subregional Department of Prevention. METHODS: The MALPROF system started in 1999 with contributions from Lombardy and Tuscany and spread in the following years to collect contributions from 14 out of the 20 Italian regions. MALPROF data were explored to follow-up work-related diseases and to detect emerging occupational health risks by calculating proportional reporting ratio (PRR), as in pharmacosurveillance. It classified work-related diseases according to economic sector and job activity in which the exposure occurred. Occupational physicians of the Italian National Health Service evaluate the possible causal relationship with occupational exposures and store the data in a centralized database. RESULTS: From 1999 to 2012, the MALPROF system collected about 112000 cases of workers' diseases. In 2010, more than 13000 cases of occupational diseases were reported. The most frequently reported diseases were hearing loss (n = 4378, 32%), spine disorders (n = 2394, 17%) and carpal tunnel syndrome (n = 1560, 11%). The PRR calculated for cervical disc herniation, a disease whose occupational origin has to be studied, in 1999-2010 was 2.47 [95% confidence interval (CI) 1.76-3.47] for drivers and 36.64 (95% CI 22.03-60.93) for air transport workers. CONCLUSIONS: MALPROF is a sensitive system for identifying possible associations between occupational risks and diseases, it can contribute to the development of preventive measures, to evaluate the effectiveness of preventive interventions and to stimulate research on new occupational risks and diseases.

The plasticizer dibutyl phthalate (DBP) potentiates chemical allergen-induced THP-1 activation.

Recent studies suggest that phthalates may have a role in the development of allergic diseases, probably due to an adjuvant effect. The present study aimed to investigate the possible adjuvant effect of dibutyl phthalate (DBP) in two in vitro models of contact-allergen induced cell activation, namely the NCTC 2544 IL-18 assay and the THP-1 activation assay. Results show no adjuvant effect in the human keratinocyte cell line NCTC 2544, indicated by lack of increase in interleukin 18 (IL-18) production after exposure to p-Phenylenediamine (PPD) in association with DBP. On the contrary, increased upregulation of CD86 and interleukin 8 (IL-8) production were observed in THP-1 cells exposed to combinations of citral (Cit) or imidazolidinyl urea (IMZ) with DBP, indicative of an adjuvant effect. Additionally, higher production of reactive oxygen species (ROS) in THP-1 cells treated with DBP associated to Cit supports that oxidative stress could be part of the molecular mechanism of the observed adjuvant effect. In conclusion, we demonstrate that DBP presents in vitro an adjuvant effect for immune stimulation in dendritic cells but not in keratinocytes. Future studies are necessary to elucidate the precise mechanism underlying the adjuvant effect of DBP in vitro and in vivo.

Reduced SNAP-25 increases PSD-95 mobility and impairs spine morphogenesis.

Impairment of synaptic function can lead to neuropsychiatric disorders collectively referred to as synaptopathies. The SNARE protein SNAP-25 is implicated in several brain pathologies and, indeed, brain areas of psychiatric patients often display reduced SNAP-25 expression. It has been recently found that acute downregulation of SNAP-25 in brain slices impairs long-term potentiation; however, the processes through which this occurs are still poorly defined. We show that in vivo acute downregulation of SNAP-25 in CA1 hippocampal region affects spine number. Consistently, hippocampal neurons from SNAP-25 heterozygous mice show reduced densities of dendritic spines and defective PSD-95 dynamics. Finally, we show that, in brain, SNAP-25 is part of a molecular complex including PSD-95 and p140Cap, with p140Cap being capable to bind to both SNAP-25 and PSD-95. These data demonstrate an unexpected role of SNAP-25 in controlling PSD-95 clustering and open the possibility that genetic reductions of the protein levels - as occurring in schizophrenia - may contribute to the pathology through an effect on postsynaptic function and plasticity.

[B-BS and ergonomics: synergies for the prevention of occupational hazards]. / B-BS ed ergonomia: sinergie per la prevenzione dei rischi sul lavoro.

We intend to compare the potential of ergonomics and B-BS (Behavior-Based Safety) in the prevention of risk factors that may contribute to the occurrence of injuries, highlighting the differences that characterize them, but also the possible contact points. The ergonomics aims to optimize the work space, the equipment and the tasks to match with the needs and the mental and physical characteristics of the workers. From this perspective, the creation of conditions and situations that can produce high comfort levels becomes the first and the most effective and successful preventive measure. The B-BS focuses on the workers' behavior, where its adaptive modulation is able to optimize the performance of workers in relation to the probable, or possible, risk factors with an evident and statistically significant reduction in the number and severity of human errors. Then the human factor is central in both disciplines, but with a diametrically opposit involvement.

Ring keratopathy in a patient with psoriatic arthritis and ulcerative rectocolitis.

PURPOSE: To describe a bilateral ring-shaped corneal opacity associated to immunological bowel and skin diseases. METHODS: Ophthalmic examination, tear film evaluation, ultrasound biomicroscopy (UBM), rheumatologic examination, and haematological screening. RESULTS: A 30-year-old man with psoriatic arthritis and ulcerative rectocolitis showed an unusual bilateral ring keratopathy not responding to topical and oral anti-inflammatory treatment. UBM examination revealed the high reflectivity of lesions distributed in the anterior stroma. CONCLUSION: Although association with systemic autoimmune diseases together with the ring aspect could suggest the immunological origin of corneal lesions, degenerative keratopathy cannot be excluded because the poor response to therapy alongside the UBM findings.

[Subjective perception and comfort/discomfort ergonomic evaluation in school environment]. / Percezione soggettiva e valutazione ergonomica del comfort/discomfort in ambienti scolastici.

In order to carry out the present study a school place representative of the entire Italian school have been identified, an Institute within Rome province have been selected. The first step has been the measurement of the dimensional and structural features of the classrooms considered, their furniture and work-posts, also considering the activities carried on in the classrooms and their environmental conditions. Pictures and videos have been shot so as to have a deep analysis of the ergonomic level of the work-posts and, at the same time, an inquiry to understand the needs of the students with respect to the environment "classroom", the work-posts and didactical tools utilized, by means of a multiple answers questionnaire, drawing, and the implementation of the shared design method. Applying with the young users the creative sharing design method it have been produced the "diagnosis paper", where the problems and the criticalities relevant to the well-being and healthiness of the users of the school environment have been listed, and which allow to identify patterns, useful basis for future re-designs. The data obtained have been then the subject of an exact and deep analytical and statistical examination carried on by the multi-discipline.

Improvement of visual functions and fundus alterations in early age-related macular degeneration treated with a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10.

The aim of this randomized, double-blind, placebo-controlled clinical trial was to determine the efficacy of a combination of acetyl-L-carnitine, n-3 fatty acids, and coenzyme Q10 (Phototrop) on the visual functions and fundus alterations in early age-related macular degeneration (AMD). One hundred and six patients with a clinical diagnosis of early AMD were randomized to the treated or control groups. The primary efficacy variable was the change in the visual field mean defect (VFMD) from baseline to 12 months of treatment, with secondary efficacy parameters: visual acuity (Snellen chart and ETDRS chart), foveal sensitivity as measured by perimetry, and fundus alterations as evaluated according to the criteria of the International Classification and Grading System for AMD. The mean change in all four parameters of visual functions showed significant improvement in the treated group by the end of the study period. In addition, in the treated group only 1 out of 48 cases (2%) while in the placebo group 9 out of 53 (17%) showed clinically significant (>2.0 dB) worsening in VFMD (p = 0.006, odds ratio: 10.93). Decrease in drusen-covered area of treated eyes was also statistically significant as compared to placebo when either the most affected eyes (p = 0.045) or the less affected eyes (p = 0.017) were considered. These findings strongly suggested that an appropriate combination of compounds which affect mitochondrial lipid metabolism, may improve and subsequently stabilize visual functions, and it may also improve fundus alterations in patients affected by early AMD.

[Criteria for classification of upper limb work-related musculo-skeletal disorders due to biomechanical overload in occupational health. Consensus document by an Italian Working Group]. / Criteri per la trattazione e la classificazione di casi di malattia da sovraccarico biomeccanico degli arti superiori nell'ambito della medicina del lavoro. Documento di consenso di un gruppo di lavoro nazionale.

BACKGROUND AND OBJECTIVE: In a preliminary consensus document the authors proposed criteria and methods to identify upper limb work-related MSDs due to biomechanical overload. With this document they intend to define severity according to shared models and procedures so as to fit behaviours to diagnostic procedures and their medical-legal assessment. This becomes especially important in view of Ministerial Decree of April 27 2004 fixing the new lists of diseases having a possible work-related origin that must be reported by law in accordance with art. 139 of law n. 1124, and also on account of the impact of such diseases which, for the first time in Italy, are regulated by law. CONTENTS: The working group, which included INAIL and ISPESL experts and was fully supported by SIMFER (Italian Society of Physical Medicine and Rehabilitation) and SINC (Italian Society of Clinical Neurophysiology), defined a general clinical procedure (anamnesis, objective examination and instrumental assessment) regarding each portion of the concerned upper limb (shoulder, elbow and wrist/hand). Once the presence and characteristics of anatomic and functional damages are established, the results allow a classification scheme to be proposed of upper limb diseases (tendon disorders and entrapment neuropathy) divided into 6 increasing severity stages: initial, medium, medium-severe, severe and extremely severe. Special attention was paid to two instrumental examinations that proved to be of great clinical interest, at least in occupational health: echography of soft tissues (in appendix) and electroneurography for entrapment neuropathy. The limitations of this proposal are discussed but the main goal was achieved: to standardize terms and provide homogeneous criteria to achieve classification of upper limb damage due to biomechanical overload for increasing severity levels. The working group research activity is part of a research project funded by ISPESL.

Mitotropic compounds for the treatment of age-related macular degeneration. The metabolic approach and a pilot study.

Recent histopathologic studies have shown that mitochondria and peroxisomes of the retinal pigment epithelium may play a central role in the pathophysiology of age-related macular degeneration (AMD). We supposed that compounds which improve mitochondrial functions (mitotropic compounds) may show beneficial effects in preventing AMD. Fourteen patients affected by early AMD were treated with a mixture containing acetyl-L-carnitine (ALC), polyunsaturated fatty acids (PUFAs), coenzyme Q10 (CoQ10) and vitamin E, while an equal number of age- and sex-matched patients affected by early AMD were treated with vitamin E only. Recovery time after macular photostress, foveal sensitivity and mean defect in the visual field as well as blood lipid levels were recorded at the beginning and after 3, 6, 9, 12 and 24 months of follow-up. In the treated group, all the visual functions showed slight improvement which was evident after 3 months of treatment and remained nearly stationary by the end of 24 months. The same tests in the control group showed slow worsening. The divergence between treated and control groups became more marked with time, but the difference was not significant at any time of the follow-up. These findings suggest that the blend of ALC, PUFA, CoQ10 and vitamin E may improve retinal functions in early AMD.

[Musculoskeletal conditions of the upper and lower limbs as an occupational disease: what kind and under what conditions. Consensus document of a national working-group. ISPESL]. / Le affezioni muscolo-scheletriche degli arti superiori e inferiori come patologie professionali: quali e a quali condizioni. Documento di Consenso di un gruppo di lavoro nazionale. ISPESL.

BACKGROUND AND OBJECTIVES: In via of the progressive emergence in Italy of work-related musculoskeletal disorders, the EPM Research Unit decided to set up a national working group with the aim of producing a Consensus Document including methods and criteria as an initial attempt towards managing such diseases as true "listed" work-related diseases as is already done in the other European Union countries. The working group includes experts from INAIL, ISPESL, welfare assistance institutions, local prevention and health protection services: The group's research activity was included in ISPESL's funded research plan. CONTENTS: The Consensus Document includes a review of epidemiologic issues reported in the international literature, comments on the application of current legislation, observations on the guilt profiles of employers and occupational physicians, as well as medical-legal issues. The document proposes an analytical list of musculoskeletal disorders of upper (and lower) limbs and the operational criteria for identification of working activities involving a risk from upper limb biomechanical overload. In this case, more than on other occasions, it was realized how difficult it is to adopt consolidated task/risk/damage matrices since the same task may or may not be at risk depending both on the way the task is done and on the technical aspects (lines, work parts, procedures, tools) and organization (rate, rotas, breaks). CONCLUSIONS: For the specific aims of the present document, it is possible to identify, though not exhaustively and with some limitations, a series of jobs and working conditions where the risk may be reasonably presumed and for which it is possible to adopt a list system (at least as regards "significant exposure"). The document also includes a chapter on health surveillance recommendations for the occupational physician.

Use of Erbium:YAG laser in the treatment of palpebral xanthelasmas.

OBJECTIVE: In light of the research and the use of lasers in the therapy of xanthelasmas, the authors report their experience in the treatment of this pathology with Erbium:YAG laser. MATERIALS AND METHODS: In 30 patients, all female, 70 xanthelasmas were treated with Erbium:YAG laser, 65 (93%) of which were on the upper eyelid and 5 (7%) on the lower eyelid, varying from 1 x 1.5 mm to 11 X 20 mm in size. Spots with a diameter of 1.6 mm, energy of 300 mJ, frequency of 1-5 Hz and in a number varying were used in relation to the extent of the pathology. RESULTS: In all cases, the appearance and functional results were good, without leaving scars and/or dyschromia. CONCLUSIONS: Erbium:YAG laser, in the treatment of xanthelasmas, is a parasurgical method that is simple to perform and because of the successful aesthetic and functional results, is a valid alternative to the more traditional treatment methods.

[Morpho-functional evaluation of subjects who had undergone surgery for ano-rectal malformations using the Peña technique]. / Valutazione morfo-funzionale dei soggetti operati per malformazione ano-rettale secondo la tecnica di Peña.

The approach to patients with Ano-Rectal Malformations (ARM) has undergone a substantial change in these last years due to the evolution of the studies of the anatomy and physiology carried out by Peña and de Vries. The authors report their experience on 15 patients and analyse the clinical and instrumental results according to the quality of life of the patients. There are different clinical criteria for the postoperative evaluation of these patients. The authors considered the Kelly, Kiesewetter, Peña and Holdschneider methods and compared the different values obtained. Moreover, they analysed the results of anorectal manometry performed in 10 patients and their correlations with clinical scores. The authors assert that the TC or NMR tests are unnecessary for these patients, since these methods demonstrate a correct position of the rectum within the muscular structure, but do not allow a correct evaluation of the quality of life of these patients. The clinical results obtained by the authors are satisfying; however, the number of patients is limited and the follow-up is relatively short.

[Klippel-Trenaunay syndrome]. / La sindrome di Klippel e Trenaunay.

The Klippel-Trenaunay syndrome is a rare congenital pathology which includes varices, hemangiomas and hypertrophy of limbs. The Authors report two cases and pay particular attention to the diagnostic and therapeutical protocols. Although these aspects are still open questions, the Authors conclude that conservative therapy is often sufficient while surgery is requested only in the severe forms.

[Axillofemoral bypass: a potential solution of acute ischemia of the lower limb]. / Il bypass axillofemorale: una possibile soluzione dell'ischemia acuta dell'arto inferiore.

When deobstruction by Fogarty catheter fails, the axillofemoral bypass can be considered as a therapeutic solution of the acute ischaemia of the limb. The authors discuss a case occurred in their experience and focus their attention on the therapeutic potentiality of this kind of revascularization. As a matter of fact it is important to consider that the operation should not only eliminate the acute ischaemia, but also correct the atherosclerotic lesions that led to it. Therefore, if deobstruction by Fogarty catheter does not restore a good inflow, in high risk patients with acute arterial thrombosis of the limb, there is a well indication for extra-anatomic revascularization.

Retinal involvement in pigment dispersion syndrome.

Retinal involvement has been documented in a number of patients with pigment dispersion syndrome, which also appears to be associated with a higher than normal risk of retinal detachment. We studied 24 patients with this syndrome to determine the prevalence of lattice degeneration and other retinal disorders associated with a predisposition to detachment. Lattice degeneration was found in 8 of 24 patients examined, with a prevalence that is significantly higher than that reported for normal subjects. Four eyes presented areas of retinoschisis and only one displayed a rhegmatogenous detachment. A father and son (both myopes) were found to have similar lattice lesions in the same retinal quadrants. These findings suggest that pigment dispersion syndrome may be associated with developmental anomalies that are not restricted to the anterior chamber but involve other portions of the bulb as well.

[A proposed clinico-instrumental protocol for diagnostic guidance in breast lumps]. / Proposta di protocollo clinico-strumentale di orientamento diagnostico negli addensamenti mammari.

Women who practice self-examination of the breast often believe to identify lumps which produce much concern; in many cases differential diagnosis with cancer is therefore necessary. The authors propose a clinical-instrumental protocol as a guide to the right diagnosis in these patients.

Functional organization of thalamic projections to the motor cortex. An anatomical and electrophysiological study in the rat.

In rats, horseradish peroxidase crystals were injected in motor cortical foci functionally identified by means of the motor effects evoked by electrical stimulations. The location in the thalamus of the neurons linked to different motor cortical foci was studied. Thalamic neurons were retrogradely labeled in both "motor" (ventralis lateralis and ventralis medialis) and "non-motor" nuclei: centralis lateralis, lateralis posterior, mediodorsalis and posterior thalamic nuclear group, as well as the ventrobasal complex. The ventrobasal complex was labeled after horseradish peroxidase injections in hindlimb and trunk motor areas. The ascending projections toward the motor cortex from both "motor" and "non-motor" thalamic nuclei are organized more precisely and more elaborately than previously reported. The motor cortical afferents from the nucleus ventralis lateralis are organized in three planes, rostrocaudally, dorsoventrally and mediolaterally. An inverted relation exists in the rostrocaudal plane between the nucleus ventralis lateralis and the motor cortex: the caudal motor cortex region (hindlimb) receives fiber inputs from the rostral region of the nucleus ventralis lateralis, whereas the caudal zone of the nucleus ventralis lateralis projects to the rostral motor cortex region (forelimb and vibrissae). A dorsoventral organization has also been observed in the rostral region of the nucleus ventralis lateralis: the ventral aspect is the source of fibers directed to the distal hindlimb region, whereas fibers originating from the dorsal aspect are directed to the proximal hindlimb area. A mediolateral relationship exists between medial and lateral sides of the nucleus ventralis lateralis and, respectively, proximal and distal forelimb cortical areas. There is some overlap between the various nuclear regions thus delineated. Four functional zones were found in the lateral half of the nucleus ventralis medialis and were classified according to their projection to the motor cortex; these are involved in motor control of the proximal and distal forelimb, vibrissae and ocular movements. The projection is topographically organized according to both an inverted rostrocaudal and a direct dorsoventral-mediolateral arrangement. Caudally, dorsal and ventral nuclear parts project to rostromedial (vibrissae) and rostrolateral (distal forelimb) regions of the motor cortex, respectively. More rostral nuclear zones project to more caudal (proximal forelimb, eye) cortical regions. There is little overlap between these four nuclear subdivisions. The nucleus centralis lateralis projects to vibrissae and proximal, as well as distal, forelimb areas.(ABSTRACT TRUNCATED AT 400 WORDS)

[Spindle activity during sleep in subjects with a deficit in pallesthetic sensibility]. / Studio dell'attivita' spindle durante il sonno di soggetti con deficit della sensibilita' pallestesica.

Sleep spindle activity was studied on four subjects affected by pallesthesic deficit due to injury the posterior funiculi of the cord. The spindle activity was studied as density (number of spindles min.), duration and percent of sleep time utilized in spindle activity. The polygraph sleep records included EOG, EMG and 6 monopolar EEG recordings, 3 for each side, on the frontal, parietal and occipital regions. The records showed a spindle activity which was similar in different subjects and that was significantly higher than the physiological values. In fact, the spindle density was about 250%, the duration was about 130% and the spindle percent was about 280%, with respect to the physiological values assumed to be 100%.