Healthy Diet and Reduction of Chronic Disease Risks of Night Shift Workers.

BACKGROUND: The large increase in epidemiological studies on night shift work is due to the important effects of night shift work on workers' health and psychophysical wellbeing. The short-term effects-insomnia, difficulties in managing work and private life, lower work performance, and more work and extra-work accidents-are easily studied. However, there are several long-term effects that are difficult to study because of the need for detailed exposure assessment and the long latency periods of these diseases. OBJECTIVE: The aim was to collect epidemiologic evidence of diseases in night shift workers, describing their biological pathways and a set of dietary guidelines. METHODS: This is a review on diet and health effects in night shift workers. RESULTS: Significant increases in the rate ratios and hazard ratios of different diseases were associated with modified eating behaviours and poor eating habits among night shift workers. Night shift work is a risk factor for disruption of the circadian rhythms and for some genetic deregulation because it produces the inversion of the sleep/wake cycle and modifies the alternation between activity and rest. CONCLUSION: A healthy diet and improved dietary practices, together with other factors, can reduce shift workers' chronic disease risk. The literature showed the importance of eating behaviour in order to prevent diseases in these workers; therefore, educational programmes are necessary to encourage several important lifestyle changes. The target of our future research will be the role of food components in some dietetic habits for the prevention of disease in night shift workers.

Malignant mesothelioma in construction workers: the Apulia regional mesothelioma register, Southern Italy.

OBJECTIVE: Asbestos was widely used in construction in both a friable and a compact form until the 1990s, before its use was banned. Today, many of these materials are still in situ and represent a source of risk for construction workers. The objective of the study was to analyse the cases of mesothelioma arising among construction workers registered in the Apulia regional register of mesothelioma. RESULTS: For the period 1993-2018, there were 178 male cases, and 10.2% of the cases were present in the regional register. The average age at diagnosis was 64.7 years. The site was pleural in 96.06% of cases, with a diagnosis of certainty in 86.5% of the total cases and 61.8% of cases with epithelial histology. The average latency is 43.9 years. In 75.2% of cases, the exposure began between 1941 and 1970, with an average duration of 24.3 years. The age at the start of exposure in 68.5% of cases is between 8 and 20 years. The ORs were 2.5 (C.I. 95% 1.01-6.17) for the epithelioid histotype and the high duration of exposure. The data underline the need for prevention and information on all activities involving construction workers in which asbestos-containing materials are still used.

Urine chemokines: biomarkers of human lupus nephritis?

Lupus nephritis is characterized by intrarenal inflammation. Leukocytes trafficking from peripheral blood into affected tissues spaces represent an important factor in the development of many renal diseases. During the past few years has been attributed the crucial role of a family of chemotactic cytokines--the chemokines--in this process. In the course of renal diseases, the infiltration of monocytes/macrophages and T cells into kidneys represent an important role in progressive interstitial fibrosis and the progression of chronic renal failure. In this review, we summarize the in vitro and in vivo data on chemokines and chemokine receptors in kidney diseases, with a special focus on urine chemokine measurement as possible biomarker of human lupus nephritis.

Increased sensitivity for determination of polycyclic aromatic hydrocarbon-DNA adducts in human DNA samples by dissociation-enhanced lanthanide fluoroimmunoassay (DELFIA).

A competitive enzyme-linked immunosorbent assay (ELISA), the most frequently used immunoassay for the determination of polycyclic aromatic hydrocarbon-DNA adducts in human tissues, has been modified to achieve approximately a 6-fold increase in sensitivity. The new assay, a competitive dissociation-enhanced lanthanide fluoroimmunoassay (DELFIA) has utilized the same rabbit antiserum as the ELISA, antiserum elicited against DNA modified with benzo[a]pyrene. However, the alkaline phosphatase conjugate has been replaced with a biotin-europium-labeled streptavidin signal amplification system, and the release of europium into the solution forms a highly fluorescent chelate complex that is measured by time-resolved fluorometry. The DELFIA has achieved a 5- to 6-fold increase in sensitivity for measurement of DNA samples modified in vitro with benzo[a]pyrene, for cultured cells exposed to radiolabeled benzo[a]pyrene, and for human samples from occupationally exposed workers. The assay has been validated by comparison of adduct levels determined by DELFIA, ELISA, and radioactivity in DNA from mouse keratinocytes exposed to radiolabeled benzo[a]pyrene. Human lymphocyte DNA samples from 104 Hungarian aluminum plant workers were assayed by ELISA and compared to blood cell DNA samples from 69 Italian coke oven workers assayed by DELFIA. The standard curves demonstrated that the limit of detection of 4.0 adducts in 10(8) nucleotides for polycyclic aromatic hydrocarbon-DNA adducts by ELISA, using 35 micrograms of DNA/microtiter plate well, has been decreased to 1.3 adducts in 10(8) nucleotides by DELFIA, using 20 micrograms of DNA/microtiter well. If 35 micrograms of DNA were used in the DELFIA, the calculated detection limit would be 0.7 adducts in 10(8) nucleotides.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-neutrophil cytoplasmic antibodies in echinococcus granulosus hydatid disease.

The authors studied the presence of ANCA, evaluated by indirect immunofluorescence (IIF) and ELISA for anti-lactoferrin (LF), and anti-myeloperoxidase antibodies (anti-MPO), in sera of 69 patients with cystic echinococcosis (CE). According to Caremani's classification, 27 patients were considered to have active cysts and 42 patients were considered to have inactive cysts. ANCA were detected in 9 out of 27 patients (33.3%) with active cysts and in 3 out of 42 patients (7.1%) with inactive cysts. Differences between the two groups were statistically significant (P < 0.05). Anti-LF antibodies were found in seven patients (10.14%) and anti-MPO antibodies in ten patients (14.5%).

Biomarkers of carcinogen exposure and cancer risk in a coke plant.

To evaluate the association between an indicator of carcinogen exposure (peripheral blood leukocyte DNA adducts of polycyclic aromatic hydrocarbons) and an early indicator of neoplastic transformation (sputum epithelial cell membrane antigens binding by monoclonal antibodies against small cell lung cancer and against nonsmall cell lung cancer), a survey of 350 coke-oven workers and 100 unexposed workers was planned. This paper reports a pilot investigation on a subgroup of 23 coke-oven workers and 8 unexposed controls. A "gas regulator" worker with positive tumor antigen binding was identified. Results show that smokers, subjects with decreased pulmonary function (forced expiratory volume in 1 sec/forced vital capacity% < 80), and those with morphological dysplasia of sputum cells have higher levels of DNA adducts. The gas regulators showed the highest values for adducts; however, no significant difference of adduct levels was found between the coke-oven group and unexposed controls.

Prediction of cardiac events after uncomplicated myocardial infarction by cross-sectional echocardiography during transesophageal atrial pacing.

Atrial pacing can safely be utilized shortly after myocardial infarction. To evaluate the prognostic value of wall motion abnormalities induced by such pacing 83 consecutive patients with recent uncomplicated myocardial infarction underwent transthoracic cross-sectional echocardiography during transesophageal atrial pacing and upright bicycle exercise stress test. Patients were followed-up for 14 +/- 5 months. During the atrial pacing and the echocardiography, patients were defined at high risk if abnormalities of wall motion were detected in left ventricular regions remote from the infarcted area. Then, during the exercise stress test, high risk patients were those with ST segment depression greater than or equal to 1 mm. On the other hand, patients were considered to be at low risk if they had no abnormalities of wall motion during atrial pacing in remote regions or, in the case of the stress test, if they did not develop ST depression greater than or equal to 1 mm. Of the 83 patients, 21 had major cardiac events during the period of follow-up. Cardiac events occurred in 15/23 (65%) and 5/60 (8%, P less than 0.001) patients assigned to the groups adjudged to be at high and low risk, respectively, on the basis of echocardiographic results. Exercise testing was less reliable in identifying patients at risk of future cardiac events. Major events occurred in only 6 of the 19 patients with a positive stress test (32%, P less than 0.05 vs positive stress echocardiography) and in 14 of the 64 patients with a negative exercise stress test (22%, P = NS vs positive exercise stress test, P less than 0.05 vs negative atrial pacing echocardiography).

Immune imbalance in the synovial fluid of rheumatoid arthritis patients: effects of intra-articular injection of thymopentin.

T cell subsets in the synovial fluid (SF) and peripheral blood (PB) of RA patients and controls suffering from different forms of chronic synovitis have been investigated. The immunological evaluation showed a reduction of CD4 subsets in RA-SF compared to RA-PB (p less than 0.001), and an almost complete absence of the suppressor-inducer/naive T cells in RA-SF compared to RA-PB and SF from patients with other forms of chronic synovitis. The CD8 subpopulation showed an increased proportion of cytotoxic cells only in RA-SF. On the basis of these results, an intra-articular immunomodulating treatment with thymopentin has been performed: its effects were characterized by an increase of CD8+CD11b+ T cells in the CD8 subset parallel to the enhancement of the suppressor-inducer/naive T cells in the CD4 subset with a statistically significant correlation. The enhanced levels of soluble CD8 decreased after treatment in RA-SF, whereas the soluble IL-2R levels were not significantly modified. Clinical evaluation showed a significative amelioration in all considered parameters.

Methimazole treatment in Graves' disease: behaviour of CD5+B lymphocytes and regulatory T cell subsets.

In the present study we analyzed some circulating lymphocyte subsets in eleven patients affected by Graves' disease before and after three and six months of methimazole treatment. Peripheral blood mononuclear cells were studied by a panel of monoclonal antibodies with single and double fluorescence cytometric analysis. Our results demonstrated an increased percentage of CD5+B cells and HLADR+T lymphocytes at the beginning of the disease in comparison to the normal controls (p < 0.001), and a significant decrease after six months of treatment (p < 0.01 and p < 0.05, respectively). The CD4+ CD45RA+ subset was significantly reduced in untreated Graves' patients in comparison to the normal group (p < 0.01), and increased towards normalization after six months of treatment. The significant modifications of lymphocyte subsets, as well as the reduction of thyroid autoantibodies, support a direct or mediated effect of methimazole on the immune system.

Pathophysiology, clinical features and management of hepatorenal syndrome.

Hepatorenal syndrome (HRS) is a form of functional renal failure occurring in patients with advanced liver disease. Hypoperfusion of the kidney, due to renal vasoconstriction, is the main feature of HRS. Conversely, the extrarenal circulation is characterized by low systemic resistance, especially occurring in splanchnic vessels, and arterial hypotension. It has been postulated that renal vasoconstriction is induced either by a hepatorenal reflex related to the diseased liver or by arterial vasodilation and the subsequent baroreceptor-mediator activation of systemic vasoconstrictor factors. The diagnosis of HRS requires the exclusion of other causes of renal failure in patients with liver disease. On the basis of clinical and prognostic differences, two types of HRS have been defined. The prognosis of HRS is poor and, to date, the only effective treatment is the liver transplantation.

Anti-TNF-alpha antibodies are not associated with Helicobacter pylori induced gastritis.

Over the past few years, it has been suggested that increased gastric production of some cytokines, including tumor factor-alpha (TNF-alpha), play a crucial role in the pathogenesis of H. pylori associated gastroduodenal diseases. On the other hand, it has been postulated that the presence of autoantibodies directed against several cytokines could represent or a down-regulatory response of the host to limit the damage associated with chronic bacterial infection or a specific cytokine inhibitor. The aim of this study was to evaluate whether serum anti-TNF-alpha antibodies are produced in response to H. pylori infection. The anti-TNF-alpha antibody titer among H. pylori positive and H. pylori negative patients showed no statistically significant difference. Interestingly, after eradication of H. pylori, no significant modification in anti-TNF-alpha antibody levels was found. In H. pylori positive patients, no correlations (either positive or negative) was demonstrated between anti-TNF-alpha antibody and activity of gastritis, nor between these antibodies levels and presence of duodenal ulcer. The lack of correlation between anti-TNF-alpha antibody levels and activity of gastritis indicates that these autoantibodies do not affect the clinical course of the H. pylori associated gastroduodenal diseases. Therefore, the biological and clinical relevance (if any) of anti-TNF-alpha antibodies in H. pylori associated gastritis remains to be better elucidated.

Neurological involvement in antiphospholipid antibodies syndrome (APS).

Antiphospholipid antibodies (aPL) have been most strongly associated with a syndrome (APS) characterized by venous and/or arterial thrombosis, thrombocytopenia, recurrent fetal losses and a variety of non-thrombotic and thrombotic neurological disorders. Cerebral ischemia associated with aPL is the most common arterial thrombotic manifestation. Other neurological syndromes, such as cognitive dysfunction, dementia, psychosis, depression, seizures, chorea and transverse myelopathy, have all been associated with antiphospholipid antibodies.

Two spatially distant epitopes of human lactoferrin.

Lactoferrin (LF) is an iron binding protein, which may represent a target for antineutrophil cytoplasmic antibodies (ANCA) in patients affected by rheumatoid arthritis, ulcerative colitis, and primary sclerosing cholangitis. Here we describe the production and characterization of two new monoclonal antibodies (MAbs) against human LF. These MAbs (AGM 10.14, an IgG1, and AGM 2.29, an IgG2b) recognize spatially distant epitopes of LF as assessed by cross-blocking experiments. We also demonstrated by indirect immunofluorescence that both MAbs react with ethanol-fixed neutrophil granulocytes showing a perinuclear staining pattern. AGM 2.29 and AGM 10.14 have been utilized as capture and labeled tracer antibody, respectively, in a double determinant immunoassay (DDIA) to measure soluble LF. The results obtained show that this DDIA allows us to quantify even low concentrations of LF, the maximal range of the assay sensitivity being between 12 and 780 ng/ml. Therefore, AGM 10.14 and AGM 2.29 may represent useful reagents for studying the role of autoantibodies to LF as well as for measuring soluble LF, which is a reliable secretory marker of neutrophil activation.

Assessment of echocardiographic abnormalities in patients with systemic lupus erythematosus: correlation with levels of antiphospholipid antibodies.

BACKGROUND: The aim of this study was to evaluate the incidence of morphologic and functional cardiac abnormalities in patients with systemic lupus erythematosus and correlate the data with antiphospholipid antibody (aPL) levels. METHODS: Ninety-one patients with systemic lupus erythematosus were enrolled and divided into two groups according to the presence (Group 1, n = 45) or absence of aPL (Group 2, n = 46). All patients underwent standard two-dimensional and Doppler echocardiographic examination. aPL were detected by a standardized and validated ELISA test. Five patients with regional ventricular dysfunction also underwent coronary angiography. The chi2 test was used for the statistical analysis of the data. For smaller groups of samples the Fisher's exact test was employed. RESULTS: Pericardial effusion was detected in 19 patients without any statistical difference between the two groups. A valvular involvement was present in 39 patients: a moderate-severe degree was more frequent in Group 1 (p = 0.02). Regional wall motion abnormalities were observed in 8 patients: only 1 in Group 2 and 7 in Group 1 (p = 0.03). Coronary angiography showed normal arteries in all patients of Group 1. CONCLUSIONS: aPL play a role in the pathogenesis of the severity of valvular lesions as well as in regional myocardial dysfunction, suggesting a small vessel disease.

[Molecular epidemiology in occupational medicine: methodological features and impact of individual genetic susceptibility]. / Epidemiologia molecolare in medicina del lavoro: aspetti metodologici e influenza della suscettibilità genetica individuale.

A review of main methodological questions regarding biomarkers is reported focusing on validation, laboratory variability, study design and statistical analysis. The indicated perspective is the setup of protocols finalized at the study of multiple panels of genotoxicity biomarkers taking into account the influence of gene-environment interaction at low doses, of the modulation of the biomarkers associated to the genetic polymorphism. An overview on the influence of metabolic and DNA repair polymorphisms on biological indicators of genotoxic risk in occupational, environmental or life-style exposure is also presented. Genetic polymorphisms that influence human genotoxic risk are those of glutathione s-transferase and cytochrome P450 in exposure to polycyclic aromatic hydrocarbons (PAHs), those of N-acetyltransferase in both occupational and environmental exposures to aromatic amines (AAs) and similar compounds. Lastly recent and important studies, on the effect of the newly discovered polymorphisms affecting DNA repair enzymes on the modulation of genotoxic risk linked to life style (i.e., aflatoxin and PAHs from diet) and smoking behaviour and to environmental genotoxic exposure, are reported. To date biomarkers represent a new tool for epidemiological research in occupational medicine and they could represent a valid instrument for group evaluation but they are not useful for the risk assessment on individual basis. To achieve this objective it is necessary to demonstrate a stronger association with the endpoint that perhaps the future development of genetic and molecular epidemiology will make possible.

[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%.

[Glomerulonephritis with mesangial deposition of IgA]. / Le glomerulonefriti con deposizione mesangiale di IgA.

Presently, IgA nephropathy represents a disease of unknown etiology. On the basis of the most recent data available in the literature, the authors describe the possible immunological mechanisms of this immuno-mediated renal disease. Moreover, the clinical findings and diagnostic and therapeutic tools are discussed.

[A clinico-epidemiological study on the efficacy of thymopentin therapy in patients with chronic bronchitis and cellular immunity deficiency]. / Studio clinico-immunologico a medio termine sull'efficacia della terapia con timopentina in pazienti affetti da bronchite cronica e deficit dell'immunità cellulare.

The immunological in vivo effects of thymopentin (TP5) treatment in eleven hypo-anergic patients affected with chronic bronchitis are reported. Significant improvement of cellular immunity, evaluated by skin tests, and an increase of percentage of CD4+ cells and natural killer activity are demonstrated. The clinical evaluation showed an evident reduction of infectious episodes of acute bronchitis after TP5 treatment.