Occupational Exposure to Chromium of Assembly Workers in Aviation Industries.

Aircraft are constructed by modules that are covered by a "primer" layer, which can often contain hexavalent chromium [Cr(VI)], known carcinogen to humans. While the occupational exposure to Cr(VI) during aircraft painting is ascertained, the exposure assessment of assembly workers (assemblers) requires investigations. Three biological monitoring campaigns (BM-I,II,III) were performed in an aviation industry, on homogeneous groups of assemblers (N = 43) and controls (N = 23), by measuring chromium concentrations in end-shift urine collected at the end of the working week and the chromium concentration difference between end- and before-shift urines. BM-I was conducted on full-time workers, BM-II was performed on workers after a 3-4 day absence from work, BM-III on workers using ecoprimers with lower Cr(VI) content. Samples were analyzed by atomic absorption spectroscopy and mean values were compared by T-test. Even if Cr concentrations measured during BM-I were lower than Biological Exposure Indices by ACGIH, statistically significant differences were found between urinary Cr concentrations of workers and controls. Despite 3-4 days of absence from work, urinary chromium concentrations measured during BM-II were still higher than references from nonoccupationally exposed populations. In the BM-III campaign, the obtained preliminary results suggested the efficacy of using ecoprimers. The healthcare of workers exposed to carcinogenic agents follows the principle of limiting the exposure to "the minimum technically possible". The obtained results evidence that assemblers of aviation industries, whose task does not involve the direct use of primers containing Cr(VI), show an albeit slight occupational exposure to Cr(VI), that must be carefully taken into consideration in planning suitable prevention measures during risk assessment and management processes.

Carbon nanotubes: Properties, biomedical applications, advantages and risks in patients and occupationally-exposed workers.

Since the beginning of the 21st century, carbon-based nanomaterials (CNTs) have been introduced in pharmacy and medicine for drug delivery system in therapeutics. CNTs have proved able to transport a wide range of molecules across membranes and into living cells; therefore, they have attracted great interest in biomedical applications such as advanced imaging, tissue regeneration, and drug or gene delivery. Although there are many data on the advantages in terms of higher efficacy and less adverse effects, several recent findings have reported unexpected toxicities induced by CNTs. The dose, shape, surface chemistry, exposure route, and purity play important roles in these differential toxicities. Mapping these risks as well as understanding their molecular mechanisms is a crucial step in the development of any CNT-containing nanopharmaceuticals. This paper seeks to provide a comprehensive review of all articles published on cellular response to CNTs, underlining their therapeutic applications and possible toxicity in patients and occupationally exposed workers.

Muscoloskeletal disorders and occupational stress of violinists.

Although musculoskeletal disorders are the most frequent cause of occupational diseases in musicians, very few studies have focused attention on a single category of instruments, in particular on the violin. This involves, in its practice, almost all the areas of the body, besides being in the category of strings which is the most numerous in an orchestra. A specific protocol, investigating postural and clinical profiles of the musculoskeletal apparatus as well as job stress, was utilized in a conservatory on graduates in the tenth year of violin study, who regularly participated in activities of orchestras or string quartets. The investigation revealed target segments of osteoarticular apparatus (jaw, vertebral spine, shoulders, elbows, hands and fingers, lower limbs) electively subjected to overuse, as well as muscle contracture of trapezoids and hyperkeratosis of fingers and clavicle. Although the work environment was comfortable, most violinists claimed to undergo intense rhythms and competitiveness. This study, highlighting subclinical occupational diseases in young musicians (violinists) suggests adequate prevention measures.

Evaluation by environmental monitoring of pesticide absorption in farm workers of 18 Italian tomato cultivations.

Tomato cultivation farms of Southern Italy were investigated in order to evaluate the general working conditions and the levels of exposure of farm workers to pesticides, during the mixing/loading and the application of pesticides on fields. Information on working modalities, personal protective equipment, etc. was collected using a questionnaire. Inhaling and cutaneous exposure levels were measured, and the estimated pesticide total absorbed dose was compared with Admissible Daily Intakes (ADIs). Field treatments were mainly carried out by using sprayers with open cab tractors, and, in 57.9 percent of cases, the pesticide mixture was manually prepared by mixing pesticides in a pail, often without using gloves (59.5 percent). The estimated pesticides absorbed doses varied in the range 0.56-2630.31 mg (mean value, 46.9 mg), and 20 percent of the measured absorbed doses exceeded ADIs. The findings obtained in the 18 examined farms show a worrying situation, suggesting the investigation of many more farms, so that a statistically significant picture of tomato cultivations in Southern Italy could be formed. Besides, the planning of training courses aimed to increase workers consciousness about health risks and how they can be prevented is advisable.

[Managment of tuberculosis in an University of Campania]. / La gestione di casi di tubercolosi in un'Azienda Ospedaliera Universitaria Campana.

Tuberculosis (TBC) is an infectious disease with the highest mortality and morbidity by single pathogen, affecting about one third of worldwide population. Although Mantoux test is the most used, IGRA (Interferon-gamma Release Assays) tests seem to give good results for presumptive diagnosis of active or latent tuberculosis. From June 2011 to June 2012 we made about 1,000 visits for TBC prevention among the exposed to biological risks of our University. The management of suspected latent or active tuberculosis infection was carried out in collaboration with the pulmonologist, assessing the risk of contagion among exposed or affected operators. Health surveillance protocol and judgements of suitability for specific task were made not only in consideration of worker health, but also considerating the possible risk for patients, since this disease is a major problem for public health.

[Functional changes in human peripheral neutrophils in workers with different exposure to noxious agents]. / Valutazione delle modifiche funzionali dei neutrofili in lavoratori esposti a xenobiotici.

Free radicals have a role in interaction between occupational exposure to multiple agents and biological systems; peripheral neutrophils (PMNs) are a source of free radicals and other reactive oxygen species. PMN's activity was evaluated by chemiluminescence assays referring to different noxious agents exposure levels. Two office workers groups were recruited: first one was exposed to several agents, control group was composed by lower exposure workers. Intra and extracellular chemiluminescence evaluation was performed to obtain radical species information. Stimulated PMNs from exposed subjects respond to the stimuli less than unexposed, and can be suggested as chronic exposure markers to noxious agents.

[Evaluation in vitro of the cardiotoxic effects of 5-fluorouracil for the prevention of cardiovascular damage in health workers occupationally exposed]. / Valutazione in vitro degli effetti cardiotossici da 5-fluorouracile per la prevenzione dei danni cardiovascolari negli operatori sanitari professionalmente esposti.

The occupational exposure to antineoplastic drugs in health care workers determines a risk of absorption through inhalation of vapors or skin contact with drops. Even if many data confirm the cardiotoxicity of anthracyclines, is not clear the evidence of cytotoxicity of 5-Fluorouracil, thoug in a percent of patients receiving this chemotherapy, there is the presence of heart pain, aspecific ECG disorders and induction of coronary disease. This experimental study wants to analyze on the H9c2 cardiomyocyte cell model the effects of 5-Fluorouracil, commonly used in hospital realities of the South Italy, for the prevention of the possible cardiovascular damage in workers occupationally exposed.

[Ultrafine particles and effects on the body: review of the literature]. / Particolato ultrafine ed effetti sull'organismo: revisione della letteratura.

The International laws and the technology developments led to a situation where the current levels of environmental pollution are below those that existed at the beginning of the century: however, these pollution levels produce harmful effects to health linked to an increase in morbidity and mortality. Over the years the pollution has changed: following the transformation of heating, motor innovation and emissions reducing, has been a reduction in air concentration of some conventional pollutants (sulfur dioxide, carbon monoxide, benzene), while there wasn't a significant reduction of particulate air pollution. In this work have been questioned several electronic databases of scientific literature based on a selection algorithm that contains expressions for the following topics: "ultrafine particles", "effects on human health", "occupational and environmental exposure". We analyzed 200 articles, progressively reduced to 88, selected for keywords, year of publication and arguments; the main topics covered by the articles were related to chemical and physical UFP properties, UFP exposure, European legislation relating to the values of particle concentrations in the atmosphere, toxicokinetics and effects on various organs such as, in particular, the respiratory system, cardiovascular system, central nervous system and the intracellular mechanism of action. Analysis of the literature showed that ultrafine particles (PM0.1 aerodynamic diameter less than 0.1 microm) are more powerful than the coarse particle fraction (2.5-10 microm) and fine (0.1-2.5 microm) in inducing adverse effects to human health. Unfortunately, the study of mechanisms of action of these particles presents particular difficulties because of the large number of chemical and biological mechanisms that come into play in the body after exposure to ultrafine particles.

[Human health effects of ultrafine particles]. / Effetti dell'inquinamento da particolato ultrafine sulla salute umana.

Epidemiologic and clinical studies have linked elevated concentrations of ambient ultrafine particles (UFPs) to adverse health effects. In particular, has been demonstrated an association between UFPs exposure and occurrence of acute respiratory infections, lung cancer, chronic chronic obstructive pulmonary diseases and cardiovascular diseases. Although the biological mechanisms behind these associations are not fully understood, the results of in vitro toxicological research have shown that UFPs induces several types of adverse cellular effects, including cytotoxicity, mutagenicity, DNA oxidative damage and stimulation of proinflammatory cytokine production. In this reviewer are summarized the results of the recent epidemiological and toxicological studies on adverse health effects from exposure to UFPs.

[Production cycles and risk agents]. / I cicli produttivi e di relativi fattori di rischio.

Agricultural working contexts are characterized by numerous and heterogeneous working activities, leading to a noteworthy variety of risks for workers' healthcare. Safety and health risks vary according to each specific working activity, following seasonal cycles and productive process's phases. In particular, here the attention has been focused on the main risks factors present in large farms for fruit crops production, greenhouses and silos. Preventive measures for risks management are indicated in relation to each working activity step. Together with injury risks, essentially due to work equipment and machinery, unfavourable microclimatic conditions and hazards related to the manual handling of loads are often present, as well as chemical and biological risk agents adopted during the sterilization, disinfection and fertilization of grounds, plants and storage places. The reported findings highlight the necessity of increasing the risk consciousness of agricultural operators in order to facilitate the adoption of indispensable preventive and protective measures.

Toxicological properties of nanoparticles of organic compounds (NOC) from flames and vehicle exhausts.

We examined the biological reactivity in vitro of nanoparticles of organic compounds (NOC) with diameters, d = 1-3 nm, a class of combustion-generated particulate relatively unstudied compared to larger more graphitic soot particles because of their small size even though they may contribute significantly to the organic fraction of PM sampled from vehicle exhausts and urban atmospheres. We tested NOC samples collected from 2004 model vehicle emissions and laboratory flames. NOC produced a dose dependent mutagenic response in Salmonella bacteria, suggesting that NOC may add significantly to the overall mutagenicity of vehicle emissions. Incubation with peptides caused agglomeration and precipitate of the otherwise stable NOC suspension, but the chemical and/or physical nature of the NOC-peptide interactions could not be resolved. A significant cytotoxic response was measured above a critical dose of NOC in mouse embryo fibroblasts NIH3T3 cells along with possible evidence of cellular uptake by optical and confocal microscopy. The toxicological assays showed that NOC collected from flames and vehicle exhausts effectively interacted in vitro with both prokaryotic and eukaryotic cells. Differences in mutagenic potencies observed for various Salmonella strains with and without metabolic activation indicate differences in the chemical composition of NOC collected from different vehicles and flames.

[Algorithm validation for pesticide exposure risk evaluation by environmental monitoring data]. / Validazione di un algoritmo per la valutazione dei rischi da esposizione a pesticidi mediante dati di monitoraggio ambientale.

The risk evaluation related to the occupational exposure to hazardous substances can be performed either by analytical data coming from environmental and/or biological monitoring or by using models and mathematical algorithms. Models are often considered economically more advantageous, nevertheless, in order to assure their reliability, they need to be validated by objective monitoring data. A predictive model for the evaluation of risks due to the exposure to pesticides in agriculture was elaborated, and, for model validations, 20 tomato farms were examined. For each farm, information necessary to the risk evaluation by using the elaborated algorithm were collected and, simultaneously, an environmental monitoring for the evaluation of inhaling and cutaneous exposure was carried out. The potential risk was estimated by comparing analytical data from environmental monitoring with respect to ADI (Admissible Daily Intake) values, for each investigated pesticide. Then, the accordance between the potential risk and the risk given by the elaborated model was evaluated and an agreement of 85.6% was found, showing a substantial reliability of the proposed model.

[Matrix metalloproteinases: new effect biomarkers in the occupational exposure of toxic agents]. / Le metalloproteasi: nuovi biomarkers di effetto nell'esposizione professionale ad agenti tossici.

Matrix metalloproteinases belong to a growing family of proteases controlled by specific tissue inhibitors, involved in tissutal flogosis, wound healing, cancer invasion and metastasis. We developed an in vitro model to screen for potential toxic compounds in professional exposure. Human keratinocytes (HaCat) were used as target cells while matrix metalloproteinases (MMP) were selected as responders, developing and in vitro model of allergic dermatitis. The chemical agents: potassium dichromate and nickel sulphate as positive teste, because represent the main etiological agents of allergic dermatitis. Nickel contact at very low concentrations (10(-5), 10(-6) M) induced upregulation of MMP-2 and IL-8 mRNA production; chromium contact at very low concentrations killed all cells. Actually, our in vitro research is based on analysis of cytotoxic effects of xenobiotics on human lung fibroblasts; simultaneously we verified serum increasing in vivo of MMP-9, determinated in workers serum, exposed to anesthetic gas (fluorane). In only six exposed workers we observed MMP9 increasing over than normal range. Actually, we are continuing our research on a more representative sample.

[Antiblastic drug exposure: statistical analysis of the data coming from environmental monitoring of a site devoted to drug production]. / Esposizione a farmaci antiblastici: analisi statistica dei dati di monitoraggio ambientale in una sala di allestimento dei farmaci.

An environmental monitoring strategy was carried out for the determination of surface concentrations of cyclophosphamide (CP), ifosfamide (IF) and 5-fluorouracil (5-FU) in a drug preparation room of an oncology ward. Analytes were determined by wipe tests, liquid-liquid extraction with diatomaceous earths and GC/MSMS or HPLC/UV analysis. The analysed 249 samples showed concentrations of CP, IF and 5-FU varying in the ranges 0.020-18.83, 0.100-26.96, 0.740-208.9 microg/dm2, respectively. It is noteworthy that the 9.3% (CP), 18.6% (IF) and 76.3% (5-FU) of the investigated surfaces showed high contamination levels, with analytes amount higher than 0.5 microg/dm2 and a progressive contamination decrement going from workbenches, floor, hood planes and other examined surfaces (interphone, telephone etc.). A significant correlation (rhos = 0.303, p = 0.001) between the measured analyte concentration and the analyte handled amount was found only in the case of IF, and a diffuse contamination (traces of all the three analytes) was found on all investigated surfaces, even when analytes were not been used during the sampling days.

[Perception of alcoholism risk in health workers: medical role in prevention and surveillance]. / La percezione del rischio alcol negli operatori sanitari: il ruolo del medico competente nell'attività di sorveglianza sanitaria e di prevenzione.

According to Italian laws (legge 125/01, art. 15, comma 1) about safety on workplaces, it's forbidden alcohol drinking and taking for health workers (art. 8, comma 6, legge 5/06/2003 number 131) (e.g. anaesthesiology, surgery, radiology, nursing etc.). National alcoholism risk prevention program to assess number for year of accidents in health workplaces, is actually in progress leaded by Health Minister and Regional administration (e.g. Tuscany). Particularly, prevention program acts consist in comprehensive informations for health workers and their co- workers, about prevention and identification of alcoholism- related risks. To assess the size of alcohol problems in health workplaces, Occupational Health Medicine Institute of Second University of Naples is going to enrol 500 subjects (200 nursing students, 200 Specialist Registrars of different areas, 100 Consultants). Actually our population consists in 160 Specialist Registrars of different medical subjects (surgery, clinical and laboratory). To verify the importance of alcoholism risk perception, a not validated questionnaire was administrated. This original assessing instrument consists in 23 items with closed answers about demographic information, university, career, lifestyle, knowledge about rules taking alcoholic drinks. Results show a dangerous lack of information about alcohol health effects, even in Medical Specialist Registrars.

[Combustion generated nanoparticles: mutagenicity and chemical reactivity]. / Nanoparticelle generate dalla combustione: mutagenicità e reattività.

Nanoparticles of organic carbon (NOC) are formed in combustion of hydrocarbon-rich fuels and have been detected in vehicle exhausts, suggesting their presence in urban atmospheres. Epidemiological studies showed that some causal relationships exist between particle concentration in the air and a wide range of health effects, but no toxicological studies are reported on the potential health risk of particles smaller than 4 nm. The present study investigated the mutagenicity and the reactivity of NOC collected in water samples from the exhausts of diesel and gasoline engines. Mutagenicity was tested following the Ames Test, with and without metabolic activation. Reactivity was investigated by using a new approach aimed to identify electrophilic agents present in the sample material, which if introduced into the organism, could interact with nucleophilic sites of biological macromolecules (DNA and proteins), forming adducts. Given the large number of nucleophilc sites within biological macromolecules, the complexity of NOC, and the inexact knowledge of its chemical structure, this approach was simplified by examining in vitro interactions between NOC particles and model peptides through LCIMS analyses of incubation mixtures The results indicate a high reactivity and, in several cases, the mutagenicity of NOCs, thus calling for suitable biomarkers assess NOC exposure associated with vehicle emissions.

Mono- and diiodocyclophosphamide as possible internal standards for cyclophosphamide quantification: characterization by ion trap multi-stage mass spectrometry and effects of iodine-chlorine substitution on the fragmentation pattern.

Hospital personnel involved in antineoplastic drug preparation and administration to patients are exposed to large amounts of these drugs. Labour legislation indicates the necessity of planning monitoring strategies aimed at prevention and/or reduction of drug exposure. Monitoring strategies consist of quantitative determinations of indicators, present in environmental and biological matrices. Among the antineoplastic drugs widely used, cyclophosphamide (CP) has been identified as a suitable indicator of potential exposure to mixtures of antineoplastic drugs. Many literature methods for quantitative analysis of CP involve either liquid (LC) or gas chromatography (GC) with mass spectrometry (MS), both of which require use of a suitable internal standard. The present work focuses on the synthesis of mono- and diiodocyclophosphamide (CPI and CPI(2)) to be used as internal standard. These compounds were analyzed by GC/EI-MS/MS and LC/ESI-MS(n) using ion trap mass spectrometry. The product ion mass spectra are interpreted in terms of proposed structures of fragment ions. Iodine-chlorine substitution resulted in a weakening of the carbon-halogen bond with a noteworthy influence on the ion fragmentation processes. The proposed suitability of CPI and CPI(2) as internal standards was based on similarities to CP as regards ionization and fragmentation processes. The results obtained suggest that CPI could be used as internal standard for CP quantification by LC/ESI-MS/MS, and CPI(2) for GC/EI-MS/MS analyses.

Magnetic field exposure and arrythmic risk: evaluation in railway drivers.

Recent studies suggest that professional exposure to Extremely Low Frequency-Electro Magnetic Field (ELF-EMF) can increase the risk of sudden cardiac death. Aim of our work was to find predictive parameters of arrhythmic risk in a population of 28 railways drivers exposed to ELF-EMF. Our findings were that the exposure did not reduce HRV and did not increase the risk of arrhythmias.

[Toxicological significance of biological markers]. / Significato tossicologico degli indicatori biologici.

Biological monitoring or, simply, biomonitoring (BM), refers to the periodic measurement of biological markers, or biomarkers (BMKs), in human fluids and tissues to assess the interaction (absorption, early health effects, susceptibility) between physical, chemical or biological agents and the human organism. The primary aim of BM in the workplace is to integrate environmental monitoring data and detect early, reversible biochemical or functional changes in workers exposed to chemicals before they become clinically relevant. BM also contributes to the assessment of chemical risk to workers, as individuals or as a group. Biomarkers are generally divided into three main types: biomarkers of exposure (BME), response/effect (BMR), and susceptibility (BMS). Other, more specific types of biomarkers are those of internal dose (BID), those of biologically effective dose (BED) and early biomarkers of disease (EBD). It is not always easy, however, to allocate a given BMK--such as the measurement of cytochrome P450 phenotype in subjects exposed to organic solvents--to one or the other type. Biomonitoring provides several advantages over environmental monitoring or health surveillance. For example, it allows an estimate of inter- and intra-individual variability in the absorption, distribution and excretion of chemicals. It also allows the detection of reversible changes before the appearance of a clinically relevant occupational impairment or disease. For these reasons, BM has become a routine procedure in occupational health practice throughout the world. Even the widely acknowledged, recently updated Code of Ethics for Occupational Health Professionals, a milestone in occupational health practice, only provides the basic ethical principles associated with biological monitoring. The aim of the present paper is to survey the various types of BMK available today with two main objectives: to discuss their toxicological significance and highlight the substantial differences that exist between their use in the practice of occupational health and in medical research. The development of new, more valid and reliable BMKs is strongly dependent on the understanding not only of the toxicokinetic and toxicodinamic mechanisms of chemicals, but also of the various susceptibility factors involved, whether genetic or environmental. It is hoped that the concurrent use of BMKs of different types may improve chemical risk assessment in workers, both individually and as a group.

[Biologically effective dose biomarkers]. / Indicatori di dose biologicamente efficace.

Biologically effective dose markers--DNA and protein adducts--are classified among exposure biomarkers, and are currently used to assess the biologically active fraction of xenobiotics, which is capable of interacting with cellular macromolecules at the target site. Macromolecular adducts should not only be considered as exposure indicators; indeed, their biological significance can also be extended to biomarkers of effect and of susceptibility. The achievement of such a goal needs research programs aimed both at studying molecular mechanisms related to each step along the continuum of events between exposure and disease, and at establishing quantitative relationships between exposure levels and adduct formation, between adducts and early biological effects, effects and cellular structural/functional modifications, leading to the development and eventual increase in incidence of specific diseases. Moreover, different factors must be considered during data evaluation, such as interindividual variability, the background levels of biomarkers in non occupationally exposed population, the gradually decreasing doses of genotoxic agents involved in occupational exposure, and confounding factors such as diet and smoking habits. Despite the large body of literature documenting DNA and protein adduct molecular dosimetry for many carcinogen exposures, many authors highlight the need for systematic interlaboratory comparison and collaboration by measuring the same biomarkers using different techniques and/or different biomarkers related to the same exposure levels. There is also general agreement about reducing costs, so that dosimetric analyses can become economically more advantageous and accessible in all cases where they prove to be useful in preventing health risks.