Determinants of exposure to polychlorinated biphenyls in the Italian population in the last decades.

Polychlorinated biphenyls (PCBs) are industrial products extensively used in the past. Because of their widespread presence and toxic effects, the international community adopted control measures to reduce their release into the environment. Currently, PCB concentrations are decreasing, but humans are still exposed. In this paper, we reported the results of a study concerning PCB concentrations in human serum samples collected in Italy over two decades. The aim of the study was to investigate the trend of major determinants of PCB human exposure, several decades after the end of their production. PCB concentrations ranged over three orders of magnitude (from 0.4 to 958 ng/g lipid), with a median value of 85 ng/g lipid. We identified age, sampling year, body mass index, sex, and living near hot spots or being occupationally exposed as relevant factors in determining body burden. Our results can give indications to refine regulatory policies on PCBs in Italy, with particular attention to the disposal of residue PCB-containing products. To improve control measures can further decrease the exposure of citizens to PCBs, limit health implications, and improve citizens' perception about chemical risk management.

Comparison between actigraphy and parental reporting for sleep assessment in hospitalized infants.

BACKGROUND: Our aim is to compare data obtained through actigraphy with data from parental diaries to evaluate their concordance. METHODS: We enrolled 55 hospitalized infants aged 1-12 months with a gestational age higher than 35 weeks and without sleep disorders, complications due to perinatal events or movement deficits. They were monitored using both methods for 24 hours. Total diurnal and nocturnal sleep times and the numbers of awakenings were evaluated. Actigraph data were analyzed with Sadeh's algorithm. RESULTS: Sleep time was analyzed in 51 infants. The average sleep time was 724.33 (±104.69) minutes according to the diaries and 625.18 (±109.14) minutes according to the actigraphy data, yielding a difference of 99.16 (±97.53) minutes (P<0.0001). The average number of awakenings was 8.65 (±3.78) according to the diaries and 13.43 (±5.09) according to the actigraphy data, with a difference of -4.78 (±4.50) (P<0.0001). A low concordance (≤0.66) was found between the two methods. The two methods provided different results (P<0.05) regarding nocturnal and diurnal sleep. After accounting for differences in disease and feeding types, the actigraphy and diary data were significantly different except for the number of daily awakenings. Concordances were higher in infants with respiratory diseases and those who were breastfed, except for the evaluation of nocturnal sleep. CONCLUSIONS: Concordance between actigraphy and parental reporting is low. Actigraphy may be a useful and easy to use method for collecting data on infants' sleep than a parental diary, but actigraphy data should be analyzed in conjunction with infants' passive movement records.

Time trends of PCDDs, PCDFs, DL-PCBs, and NDL-PCBs in Italian women from biomonitoring studies.

A number of biomonitoring investigations were carried out in Italy between 2000 and 2018 by the Unit of Human Exposure to Environmental Chemicals of the Italian National Institute of Health (Rome). The investigations were characterized by different features (case-control or cross-sectional studies, participants from impacted or no impacted areas, etc), but despite the differences, it was possible to study the time trends of Σ7(PCDDs), Σ10(PCDFs), Σ12(DL-PCBs), and Σ6(NDL-PCBs) (analytical and TEQ cumulative concentrations, as appropriate). All the chemicals considered showed clear rates of a time-dependent concentration decrease, data having previously been adjusted for the sampled Region and subject age. Σ7(PCDDs) exhibited the fastest decrease with an average rate of -4.44 pg/g-fat year-1 (2009-2018), whereas Σ6(NDL-PCBs) was characterized by the slowest decrease with a rate of -0.771 ng/g-fat year-1 (2000-2018). A clear distinction between the decreasing rates of Σ7(PCDDs) and Σ10(PCDFs) was observed, as the latter decreased at half the rate of the Σ7(PCDDs). The slower rate of the Σ10(PCDFs) decline may be due to an ongoing source of PCDFs in the environment beyond those traditionally considered for this group of contaminants such as the production of PCDFs due to PCBs thermal conversion from matrices contaminated with PCBs. Production of PCDFs due to thermal conversion of matrices contaminated with PCBs could be an ongoing source which may be of concern because recent data have highlighted the diffusion of PCBs in the European environment. The decreasing rates of PCDDs + PCDFs, DL-PCBs, and PCDDs + PCDFs + DL-PCBs - original analytical data converted to "dioxin equivalents" - were respectively estimated as (pgTEQ/g-fat year-1) -2.08, -2.06, and -2.10, values exhibiting good compatibility between one another.

Mercury (Hg) and methylmercury (MeHg) in sediment and biota: A case study in a lagoon in Central Italy.

A quantification of total mercury (Hgtot) and methylmercury (MeHg) concentrations in sediment and mussels was carried out in the east basin of the Orbetello lagoon in order to assess their bioaccumulation potential. The sediment was sampled in four macroareas, mussels were transplanted in the same sites and collected after seven weeks. The results show that Hgtot concentrations in sediments exceeded (0.21-16.9 mg/kg dry weight (dw)) the environmental quality standard of the Italian legislation (0.3 mg/kg dw). The Hgtot concentration in mussels (0.050-0.324 mg/kg wet weight (ww)) does not exceed the limit values (0.5 mg/kg ww) of the European food legislation. The biota-sediment accumulation factors (BSAFs) derived for MeHg (80-306.7) and a biomagnification factor (BMF) greater than 1 for Hgtot demonstrate that in the lagoon, these compounds can be transferred in the upper levels of the trophic chain and pose a risk to human health.

Iron Deficiency Anemia in Celiac Disease.

The iron absorption process developsmainly in the proximal duodenum. This portion of the intestine is typically destroyed in celiac disease (CD), resulting in a reduction in absorption of iron and subsequent iron deficiency anemia (IDA). In fact, the most frequent extra-intestinal manifestation (EIM) of CD is IDA, with a prevalence between 12 and 82% (in relation with the various reports) in patients with new CD diagnosis. The primary treatment of CD is the gluten-free diet (GFD), which is associated with adequate management of IDA, if present. Iron replacement treatment historically has been based on oral products containing ferrous sulphate (FS). However, the absorption of FS is limited in patients with active CD and unpredictable in patients on a GFD. Furthermore, a poor tolerability of this kind of ferrous is particularly frequent in patients with CD or with other inflammatory bowel diseases. Normalization from anemic state typically occurs after at least 6 months of GFD, but the process can take up to 2 years for iron stores to replenish.

Iron Deficiency Anemia Refractory to Conventional Therapy but Responsive to Feralgine® in a Young Woman with Celiac Disease.

Iron, which is an important micronutrient in the human body may be deficient in people with celiac disease (CD). Iron deficiency anemia (IDA) may be the presenting feature of celiac disease, also in the absence of diarrhea or weight loss. The treatment of IDA in patient with CD is primarily a gluten-free-diet (GFD), but it is also very important oral iron supplementation until the iron stores have been restored. However, a frequent problem in CD is the poor tolerability and poor efficacy of oral iron preparations. A new product, consisting of the combination of Ferrous Bysglicinate Chelate and Sodium Alginate (Feralgine™), has been demonstrated to be more bioavailable and well tolerated in CD. We present a case report that showed a clear efficacy of this product in a form of IDA refractory to conventional therapy in a woman with CD and we demonstrated a clear increase of serum iron after administration of this new type of ferrous.

Camel milk: a possible alternative for children with cow's milk allergy?

BACKGROUND: Cow's milk protein allergy (CwMPA) is the most common food allergy during early childhood and its therapy consists in the elimination of cow's milk proteins (CwMP) from the diet and the introduction of alternative formulas. Evidence about clinical use of camel's milk (CM) in CwMPA in children is scarce. The aim of this study was to determine the entity of cross-sensitization between CM and CwM in children with CwMPA. METHODS: This prospective study was performed in children affected by CwMPA. We evaluated skin prick tests (SPT) for CwM, CwMP (alpha-lactalbumin [ALA], beta-lactoglobulin [BLG] and casein [CAS]) and CM and serum levels of CwM, ALA, BLG, CAS-sIgE. RESULTS: Sixty-seven children with CwMPA were included in this study: twenty-one resulted SPT+ to CM. Mean wheal diameters towards raw CwM, ALA, BLG and CAS resulted significantly larger in the CM SPT+ group than in the CM SPT- group (P<0.02). Likewise, mean IgE titers against CwM, ALA and CAS were significantly higher in the CM SPT+ group than in the CM SPT-group (P<0.01). The mean wheal diameter towards raw CwM was significantly larger than that towards CM (P<0.0001). CONCLUSIONS: This study confirms the presence of cross-sensitization between CwM and CM that remains lower if compared to other mammalian milks. Small wheals at the SPT towards CwM antigens together with low IgE titers against them could work as predictors in selecting patients that are expected to have negative CM SPT and then could be fed with CM with lower risks of allergic reactions.

Heavy metal spatial and temporal trends (2008-2018) in clams and mussel from Adriatic Sea (Italy): Possible definition of forecasting models.

In 2008-2018, 1458 georeferenced samples of clams and 343 of mussels were harvested in Italy from classified areas along Marche coast and analyzed within food-safety monitoring plans. Pb, Cd, V, Ni, Cr, and As median levels (mg kg-1) were 0.09, 0.08, 0.29, 0.77, 0.35, and 2.35 in clams and 0.16, 0.15, 0.46, 0.48, 0.25, and 3.34 in mussels. The reported levels were comparable with the published ones, and Hg always fell below LOQ (0.025 mg kg-1). Pb and Cd datasets, based on quarterly results, show a decreasing trend in clams and constant baseline value for mussels. Time-trends and forecasting models represent an asset to predict emerging food safety/security risks. The metal levels in mussels and clams from the same area allow environmental safety assessment and thus enable the evaluation of contaminants in both water column and sediment. Monitoring of elements that are not regulated may help in preserving food and environmental safety.

Evaluation of factors affecting total nucleated cells in umbilical cord blood collected for the Calabria cord blood bank.

BACKGROUND: Total nucleated cell (TNC) count is the most important biological feature to consider in assessing the quality of umbilical cord blood (UCB) for haematopoietic stem cell (HSC) transplantation. Certain obstetric factors have been reported to increase TNC count in UCB units collected for transplantation. The aim of our study was to analyze how various maternal, neonatal and obstetric factors affected TNC count in the UCBs we collected for our cord blood bank in southern Italy. MATERIAL AND METHODS: We performed a retrospective analysis of 634 medical records of UCBs collected by Calabria Cord Blood Bank (CCBB), between January 1, 2010 and December 31, 2016. We analyzed various maternal, neonatal and obstetric variables factors and related this factor with the characteristic of TNC. RESULTS: We found that the average number of TNCs was significantly greater in vaginal delivery than in caesarean delivery. We also found that TNCs were higher in the 40th week of pregnancy and when Apgar 1' scores were ≤ 9. The effect of a newborn's gender was less evident on TNC count. CONCLUSIONS: Knowledge of factors predictive of a higher TNC count would help cord blood banks more efficiently identify donors likely to yield high-quality UCBs for transplantation.

Biomonitoring of the adult population in the area of turin waste incinerator: Baseline levels of polycyclic aromatic hydrocarbon metabolites.

Exposure to polycyclic aromatic hydrocarbons (PAHs) was assessed in a cohort of 394 subjects, 198 residing in three small municipalities near a new waste-to-energy (WTE) incinerator located in the Turin area, and 196 residing in neighbouring control areas in the town (of Turin). The assessment of exposure to PAHs was part of a human biomonitoring study aimed at assessing potential incremental exposure to pollutants related to incineration activities through the analysis of such pollutants before the plant start-up, and after one and three years of operation. The exposure assessment described in this study was carried out before the start-up of the WTE incinerator. Ten monohydroxy-PAHs (OH-PAHs) were analyzed in urine samples, consisting in the principal metabolites of naphthalene (NAP), fluorene (FLU), phenanthrene (PHE), and pyrene (PYR). Concentrations of the sum of OH-PAHs (Σ10OH-PAHs) were in the range of 525-85200 ng/g creatinine, with P50 equal to 6770 ng/g creatinine. Metabolites of naphthalene were found at the highest concentrations (P50 values of 892 and 4300 ng/g creatinine for 1- and 2-OH-NAP, respectively) followed by the three OH-FLUs (P50 values of individual compounds in the range of 58.2-491 ng/g creatinine), the four OH-PHEs (P50 values in the range of 30.5-145 ng/g creatinine), and 1-OH-PYR (P50 value of 82.8 ng/g creatinine). Concentrations of 1-OH-NAP, 9-OH-FLU, 1-, 2-, 3, 4-OH-PHE, and 1-OH-PYR were significantly lower in subjects living near the WTE plant compared to those living in the town of Turin, with differences between the two groups in the range 14-31%. Smoking habits markedly influence the urinary concentrations OH-PAHs. Median concentrations of the single metabolites in smokers were from 1.4 fold (for 4-OH-PHE) to 14 fold higher (for 3-OH-FLU) than those observed in non-smokers. The heating system used also resulted to be a major contributor to PAH exposure. Concentrations of OH-PAHs were generally comparable with those observed in other industrialized countries. The profile pattern was consistent with those reported in the literature. Concentrations of OH-PAHs assessed in this study may be considered indicative of the background exposure to PAHs for adult population living in an urban and industrialized area.

Bone marrow harvesting from paediatric patients undergoing haematopoietic stem cell gene therapy.

Collection of an adequate amount of autologous haematopoietic stem progenitor cells (HSPC) is required for ex vivo manipulation and successful engraftment for certain inherited disorders. Fifty-seven paediatric patients (age 0.5-11.4 years) underwent a bone marrow harvest for the purpose of HSPC gene therapy (GT), including adenosine deaminase-severe combined immunodeficiency (ADA-SCID), Wiskott-Aldrich syndrome (WAS) and metachromatic leukodystrophy (MLD) patients. Total nucleated cells and the percentage and absolute counts of CD34+ cells were calculated at defined steps of the procedure (harvest, CD34+ cell purification, transduction with the gene transfer vector and infusion of the medicinal product). A minimum CD34+ cell dose for infusion was 2 × 106/kg, with an optimal target at 5-10 × 106/kg. Median volume of bone marrow harvested was 34.2 ml/kg (range 14.2-56.6). The number of CD34+ cells collected correlated inversely with weight and age in all patients and particularly in the MLD children group. All patients reached the minimum target dose for infusion: median dose of CD34+ cells/kg infused was 10.3 × 106/kg (3.7-25.9), with no difference among the three groups. Bone marrow harvest of volumes > 30 ml/kg in infants and children with ADA-SCID, WAS and MLD is well tolerated and allows obtaining an adequate dose of a medicinal product for HSPC-GT.

Occurrence of Fipronil in residential house dust in the presence and absence of pets: a hint for a comprehensive toxicological assessment.

The presence of the insecticide Fipronil and its main products of toxicological relevance, namely Sulfone and Desulfinyl, was assessed in 161 residential house dust samples in the absence (N = 101) and presence (N = 60) of cats and dogs in Italy. High-resolution mass spectrometry analysis revealed a significant difference (p < 0.001) in the dust contamination in the presence of pets (median: 467 vs. 24 ng/g dry weight), even if the highest value was found in the absence of pets (82,069 vs. 67,799 ng/g dry weight). Fipronil intake estimates from dust in toddlers, computed according to US-EPA and EU-ECHA guidelines, ranged from 333 to 556 and from 20 to 34 ng/kg per day for acute and chronic scenario, respectively. Dust seemed not able itself to lead to Fipronil overexposure with respect to acute and chronic toxicity health-based guidance values. Kittens were potentially overexposed to Fipronil under both acute (26,076 ng/kg per day) and chronic (1,633 ng/kg per day) scenarios. The mild symptomatology associated with acute intoxication could possibly determine case underreporting within pharmacosurveillance schemes. Its administration was estimated in 7.3-9.7 tons per year. Such a range suggests its prudent use under strict veterinary control to prevent pest resistance and ecotoxicological outcomes.

Feralgine™ a New Approach for Iron Deficiency Anemia in Celiac Patients.

BACKGROUND: Celiac disease (CD) is an immunologically-mediated disorder characterized by duodenal mucosa villi atrophy. Iron absorption is usually reduced in celiac patients making every kind of oral iron treatment unhelpful because of malasorption. Feralgine™ is a new product that has been demonstrated to be more bioavailable. As such, the aim of our study was to evaluate the absorption of Feralgine™ in adult patients with CD. METHODS: Twenty-six adults affected by Iron Deficiency Anemia (IDA), of which 14 were also affected by CD and 12 were not affected by CD, were enrolled. An oral iron absorption test (OIAT) was performed in each patient by administrating Feralgine™, and serum iron was evaluated at baseline (T0) and after 2 h (T1) from the oral iron ingestion. RESULTS: The OIAT was well tolerated in all patients, and, surprisingly, an equivalent statistically significant improvement in serum iron occurred in the two groups of patients (IDA plus CD: T0 = 28.21 µg/dL vs. T1 = 94.14 µg/dL p = 0.004 and IDA without CD: T0 = 34.91 µg/dL vs. T1 = 118.83 µg/dL, p = 0.0003). CONCLUSIONS: These results demonstrated the high absorption of Feralgine™ in celiac patients, confirming our previous data obtained with Ferrous Bysglicinate in children with CD.

Oral iron absorption test with ferrous bisglycinate chelate in children with celiac disease.

BACKGROUND: Celiac disease (CD) is an immunologically-mediated enteropathy resulting in small-bowel mucosal villous atrophy with crypt hyperplasia. Iron malabsorption is usually observed in CD. Only few studies investigated oral iron absorption in subjects with gastrointestinal diseases and Iron Deficiency Anemia (IDA), using the oral iron absorption test (OIAT). We considered useful to investigate the OIAT, using ferrous bisglycinate chelate (FBC), in patients with CD at diagnosis or on gluten free diet (GFD) from at least 1 year. METHODS: A total of 25 patients with CD (3-18 years old) and iron depletion, at diagnosis of CD (N.=12) or on GFD from at least 12 months (N.=13), were considered. Serum iron was evaluated at baseline (T0) and after 3 hours (T1) from the oral iron ingestion. Statistical analyses were conducted using SPSS 21.0 software for Mac. RESULTS: OIAT was well tolerated by all patients. An important increase of the serum iron at T1, of at least twice the baseline values, occurred in all patients except in one (P value <0.0005). CONCLUSIONS: These results demonstrated good efficacy of the FBC, not only in patients with CD on GFD but also in children with newly diagnosed CD with the characteristic intestinal lesions.

Perfuorooctane Sulfonate (PFOS), Perfluorooctanoic Acid (PFOA), Brominated Dioxins (PBDDs) and Furans (PBDFs) in Wild and Farmed Organisms at Different Trophic Levels in the Mediterranean Sea.

The present study shows the results of perfuorooctane sulfonate (PFOS), perfluorooctanoic acid (PFOA), brominated dioxins (PBDDs) and furans (PBDFs) measured in several marine fish and seafood of commercial interest at different trophic levels of the food chain. The aims were to investigate the level of the contamination in Mediterranean aquatic wildlife, and in farmed fish, to assess human exposure associated to fishery products consumption. Samples of wild fish were collected during three different sampling campaigns in different Food and Agriculture Organization (FAO) 37 areas of the Mediterranean Sea. In addition, farmed fish (gilthead sea bream and European sea bass) from off-shore cages from different marine aquaculture plants. Results showed contamination values of PFOS and PFOA were lower than those detected in sea basins other than the Mediterranean Sea. Concentration values of PFOS were generally higher than those of PFOA; moreover, levels in farmed fish were lower than in wild samples from the Mediterranean Sea. Intake of PFOS and PFOA through fishery products consumption was estimated to be 2.12 and 0.24 ng/kg·BW·day, respectively, for high consumers (95th percentile). Results of 2,3,7,8-substituted congeners of PBDDs and PBDFs were almost all below the limit of detection (LOD), making it difficult to establish the contribution of these compounds to the total contamination of dioxin-like compounds in fish and fishery products.

Polychlorobiphenyl levels in the serum of cats from residential flats in Italy: Role of the indoor environment.

The domestic cat (Felis catus) was used as a sentinel of exposure to polychlorobiphenyls (PCBs) in indoor urban environments y. Sera from 120 cats were pooled to form 30 different groups selected by age (<2 years; > 2 ≤ 8 years; > 8 years), sex, municipality (Bologna and Turin) and environment (indoor vs. outdoor). Test portions of 1 mL were analyzed by means of gas chromatography coupled to high-resolution mass spectrometry (GC-HRMS) for six selected indicators non-dioxin-like PCBs (∑6 PCBs: congeners #28, #52, #101, #132, #153 and #180) and the results were computed in the upper-bound mode. The internal dose of PCBs attributable to the cats' alimentary lipid intake ranged from 32.4 to 1,446 ng/g (P50 165; mean 258). The Wilcoxon test revealed significantly lower PCB burden in "outdoor" groups than in "indoor" groups. Age correlated well with the heptachlorinated and most bio-accumulative congener, PCB #180, and slightly with hexachlorinated PCBs #138 and #153. Contamination attributable to house dust collected in 15 living-rooms ranged from 10.0 to 279 ng/g dry weight (P50 97.4; mean 94.4). Exposure estimates indicated a 0.6-16 ng/kg bw range of daily ∑6 PCB intake from a default value of 200 mg/cat of dust ingestion. The intake of PCBs due to dust ingestion fell within the same order of magnitude as that computed from a 60 g daily intake of commercial dry pet foods, while inhalation accounted for 0.21-8.2 ng/kg bw/day, on setting the nominal ∑6 PCB contamination in outdoor and indoor air at 0.37 and 15 ng/m3, respectively. Italian indoor cats could be exposed to higher levels of ∑6 PCBs than the Reference Dose (RfD) of 10 ng/kg/bw/day; this supports the World Health Organization's statement that the quality of the indoor environment is a major determinant of health.