PFOA and testis cancer in the Veneto Region (Italy).

The largest documented episode of human contamination by PFOA in the world (approximately 150,000 actual residents on 1 January 2020) has occurred in Italy's Veneto Region. In this large, mostly flat plain area, a cluster of testicular cancers has also been observed. Preliminary data are reported, and the most relevant and recent recommendations regarding the health surveillance of exposed individuals are emphasized.

Impact of local food consumption on exposure to perfluorooctanoic acid and perfluorooctane sulfonate in a contaminated community in North-Eastern Italy.

OBJECTIVES: to estimate the contribution of locally-grown food consumption to perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) human exposure. DESIGN: residents of a PFAS-contaminated community of the Veneto Region (North-Eastern Italy) were categorized into two exposure groups, which refer to the period after the determination of serum levels of PFOA and PFOS conducted at baseline: 1. people drinking water filtered with double granular activated carbon (GAC) and not consuming locally-grown foods at all (reference group); 2. people drinking the same filtered water and which continue to consume only locally-grown foods. For each group, PFOA and PFOS daily intake rates (IR, ng/kg-day) were derived from measured PFOA and PFOS concentrations in treated water and local vegetable and animal food matrices. Then a one-compartment pharmacokinetic model was applied to predict PFOA and PFOS serum concentrations over time and the time needed to fall below a clinically significant threshold level of PFOA and PFOS (e.g., 20 ng/mL). SETTING AND PARTICIPANTS: the study area included 21 municipalities and 3 provinces (Vicenza, Verona, and Padua) located in the Veneto plain. Approximately 127,000 people lived in the most PFAS-contaminated areas on 31.12.2016; those aged 9 to 65 years were invited to participate in the Health Surveillance Plan (HPS), including laboratory tests and medical examination. MAIN OUTCOMES MEASURES: predicted PFOA and PFOS serum levels (ng/mL) among residents in the contaminated area. RESULTS: compared to the reference group, residents who continued to consume locally-grown foods had an approximately 24% higher IR of PFOA and PFOS and this resulted in 3 more years for their PFOA and PFOS concentrations to fall below the threshold level of 20 ng/mL. CONCLUSIONS: this study showed that the contribution of locally-grown food consumption cannot be ignored for people living in PFAS-contaminated areas.

Survey of Caries Experience in 3- to 5-year-old Children in Northeast Italy in 2011 and Its Trend 1984-2011.

PURPOSE: To describe dental caries experience by age and gender among preschool children in a health district in northeast Italy and to plot a trend of primary-dentition dental caries prevalence and severity over a 27-year time span (1984-2011). MATERIALS AND METHODS: In a cross-sectional survey, 27 out of 88 kindergartens were randomly selected with a sample of 2603 preschoolers drawn from a population of 8328 3-, 4- and 5-year-old children. Dental caries (d3 t) experience according to the criteria of the British Association for the Study of Community Dentistry was evaluated by two calibrated examiners at schools in 1960 (75.3%) 3- to 5-year-old children from October 2010 to May 2011. Three previous surveys performed in the same area, applying the criteria of the World Health Organization, were used to plot a trend over a 27-year period. Comparisons between groups were made using Pearson's chi-squared test, and caries occurrence was established by logistic regression analysis to assess the influence of sex and age (independent variables) on caries experience (dependent variable). RESULTS: Prevalence (%) and severity (mean dmft ± SD) increased with age (17% and 0.5 ± 1.7 at age 3; 24% and 0.8 ± 2.2 at age 4; 35% and 1.3 ± 2.6 at age 5). The level of untreated caries was 85.8%. No statistically significant difference was found for gender. From 1984 to 2004, the prevalence and severity of caries declined at all examined ages, but were unchanged from 2004 to 2011. CONCLUSION: The current caries scores in preschoolers are low and similar to those reported in other western European countries. Nevertheless, as very early childhood is a key opportunity to intervene, an effort must be made to provide clear oral health guidance and increase the cooperation among all health professionals.

A new management for limb graft occlusion after endovascular aneurysm repair adding a vollmar ring stripper: the unclogging technique.

BACKGROUND: Lower extremity ischemia for limb thrombosis is a well-known adverse event after endovascular abdominal aortic aneurysm repair (EVAR), ranging from 2.6-7.4%. We report our experience in the management of graft limb occlusion that occurred in patients who underwent EVAR in our institution. In cases in which balloon catheter thrombectomy is not useful or is risky, it is important to take into consideration the use of a Vollmar ring stripper (Aesculap, San Jose, CA) to avoid dislodging or disrupting the sealing zones. This technique has taken from thromboendarterectomy the principle of detaching plaque from adventitia and transformed it in a less traumatic way for dissecting thromboses from endografts. METHODS: Between September 1999 and December 2011, 608 patients underwent EVAR in our institution. In cases of severe claudication or critical ischemia, we tried to remove the thrombus using mild Fogarty balloon traction; in cases of progressive and old stratification, we added the Vollmar ring stripper. After recanalization, if there was a stenosis, an angioplasty was performed and in most patients an adequately size Cheatham platinum stent was positioned. If the endovascular approach failed, bypass procedures were considered. RESULTS: In 608 patients over a mean follow-up time of 72 months, there were 23 cases of limb thrombosis. Fifteen of the 23 limb occlusions were identified within 6 months after aneurysm repair. The mean time to occlusion was 8.2 ± 4.3 months (range: 20 days-25 months). Presenting symptoms were mild to moderate claudication (Rutherford classification I) in 3 patients (13%), medium severe claudication (Rutherford classification IIA) in 18 patients (78.3%), and paresthesia and rest pain (Rutherford classification IIB) in 2 patients (8.7%; 1 of those patients had a loss of motor function). Four (17.4%) were stable during follow-up, and in 1 of these cases we tried thrombolysis without thrombosis resolution. In 13 (56.5%) cases, we performed balloon catheter thrombectomy with a LeMaitre over the wire embolectomy catheter (LeMaitre Vascular, Burlington, MA). In 8 of 13 (61.5%) patients with certain thrombosis characteristics, we decided to add to the balloon catheter a Vollmar ring stripper for mechanical catheter thrombectomy. In all 13 thrombectomy cases, blood flow was restored through the limb with the endograft itself. There were no episodes of graft dislocation, disruption of the sealing zones, or recurrences. In 5 (21.7%) cases, a femorofemoral crossover was performed, and in 1 (4.3%) case, an axillofemoral bypass was performed. During the follow-up period, 2 of the 5 femorofemoral crossovers closed after 6 and 8 months, respectively. CONCLUSIONS: This unclogging technique, alone or associated with Vollmar ring stripper, proves to be simple, safe, and effective in the treatment of graft limb occlusion. Additional research will help confirm the role of Vollmar ring stripper.

Validity of Italian version of the Child Perceptions Questionnaire (CPQ11-14).

BACKGROUND: The Child Perceptions Questionnaire (CPQ11-14) is the most commonly used indicator of child oral health-related quality of life (OHRQoL), and its validity and reliability have been studied both in English and in other linguistic contexts. The aim of this study was to develop a CPQ11-14 for use in Italy and to test its validity in a random sample of fourteen year-old Italian adolescents. METHODS: Once the CPQ11-14was translated into Italian and adapted for an Italian public, five hundred sixty-one adolescents were recruited for testing. Parents rated their social status; the children/adolescents were administered the questionnaire and underwent a dental examination during which their dental status was taken and recorded. Cronbach's alpha was used to assess the questionnaire's internal consistency. Spearman's correlation coefficients were calculated to assess construct validity between the total and subscale scores and the respondents' global ratings on oral health and well-being. Discriminant validity was analysed using the Kruskal-Wallis or Mann-Whitney tests in groups defined by gender, social position, caries experience and previous or no orthodontic treatment. RESULTS: The mean score on the CPQ11-14 was 15.4 (SD=11.9), and the scores on all the domains were found to be highly skewed. Cronbach's alpha ranged from 0.85 to 0.90. The global ratings on oral health and well-being were correlated to the total score and to the sub-scores except for those regarding the functional limitations. There were significant differences in the two genders, in the groups that had already or had not yet undergone orthodontic treatment, and in the social classification groups, while the difference between those who had and those who did not have caries experience did not reach statistical significance. CONCLUSIONS: The Italian version of the CPQ11-14 appears to be a reliable, valid instrument for Italian children/adolescents.

Early Childhood Caries in a Preschool-based Sample in Northeast Italy: Socioeconomic Status and Behavioral Risk Factors.

Aim: To assess the relationship among caries and age, gender, immigrant condition, socioeconomic status (SES), and a behavioral risk factor (toothbrushing) in a sample of 3-5-year-old children. Materials and methods: We performed a random cross-sectional survey from January to December 2017, carrying out clinical examinations to estimate the decayed, missing, and filled teeth (dmft) score. Parents filled in a questionnaire reporting their education level (SES) and the daily frequency of children's toothbrushing. The multivariate analysis assessed the association between caries occurrence and the independent variables. The dmft score was assessed by zero-inflated negative binomial regression (ZINBR). Results: Out of 1,441 children in the sample, 357 (26.0%) presented at least one caries-affected tooth. Caries risk significantly increased with age and irregular toothbrushing, and it was significantly higher in children with lower SES levels. We modeled caries risk by means of ZINBR. The degree of caries experience increased in children from lower SES positions, immigrant status, and of older age; regular toothbrushing (twice a day) is a predicting factor to belong to the "zero caries" group. Conclusion: Dental caries represent a significant burden in preschool children and can be regarded as an early marker of social disadvantage. Clinical significance: The confirmation of the earliest preventive approach as the only chance to grant a "caries free" dentition in all ages and the first target for a pediatric dentist. How to cite this article: Ferro R, Besostri A, Olivieri A, et al. Early Childhood Caries in a Preschool-based Sample in Northeast Italy: Socioeconomic Status and Behavioral Risk Factors. Int J Clin Pediatr Dent 2022;15(6):717-723.

Aneurysm sac "thrombization" and stabilization in EVAR: a technique to reduce the risk of type II endoleak.

PURPOSE: To evaluate the reduction in type II endoleak risk after introducing a new prevention method, "thrombization" or clotting of the aneurysm sac, during endovascular aneurysm repair (EVAR) versus the standard EVAR technique. METHODS: From September 1999 to December 2008, 469 consecutive patients underwent EVAR for AAA at our institution. In 2003, the injection of fibrin glue with or without microcoils into the aneurysm sac was added to the EVAR treatment plan ("thrombization" technique). Patients who did not meet the inclusion criterion (at least 1-year follow-up imaging) were censored at the end of 2007, leaving 404 patients eligible for the study: 224 patients (210 men; mean age 71.9+/-8.5 years, range 25-88) undergoing EVAR alone from September 1999 to May 2003 (group 1) compared to 180 patients (161 men; mean age 72.6+/-8 years, range 46-89) who underwent EVAR + thrombization from June 2003 to December 2006 (group 2). RESULTS: The 2 treatment groups were similar with regard to aneurysm morphology. No allergic or anaphylactic reactions were encountered related to the fibrin glue. Over median follow-up times of 72 months in group 1 and 26 months in group 2, there were 34 (15.2%) endoleaks in group 1 versus 4 (2.2%) in group 2 (p<0.0001). The incidence of type II endoleak was 0.25/100 person-months for group 1 versus 0.07/100 person-months for group 2. The preventive sac thrombization technique was significantly associated with a reduced risk of type II endoleak (HR 0.13, 95% CI 0.05 to 0.36; p<0.0001) regardless of the type of stent-graft fixation (infrarenal versus suprarenal). CONCLUSION: The preventive method of intrasac "thrombization" using fibrin glue injection with or without the insertion of coils proves to be a simple, low cost, safe, and effective technique to significantly reduce the risk of type II endoleaks irrespective of the endograft used.

[Short and medium term functional capacity after single cycle of controlled physical training in subjects with claudication]. / Risultati a breve e medio termine dei parametri funzionali dopo singolo ciclo di training fisico controllato in soggetti con claudicatio.

BACKGROUND: Previous studies have shown the positive effect of exercise rehabilitation in patients with claudication, but uncertainties remain surrounding the optimal exercise program strategy and the persistence of the benefits over time. The purpose of the present study has been to prospectively assess the feasibility of short-course intensive supervised exercise training beyond pain threshold and to verify the maintenance of walking capacity during a medium term follow-up. METHODS: Ninety patients with intermittent claudication due to peripheral artery disease were enrolled in a supervised intensive exercise training. Seventy six of them (67 +/- 7 years, 64 male and 12 female, 48 with bilateral claudication) performed a graded treadmill testing at baseline and after 3 months. Sixty patients completed also a specific questionnaire (Walking Impairement Questionnarie). After a mean follow-up of 2.6 years, fifty six patients repeated treadmill testing and 24 patients repeated the questionnaire. RESULTS: After training, the patients showed a 91% and 53% increase in the initial and absolute claudication distance time, respectively (p = 0.0000). At follow-up there was no change in the initial claudication distance time, whereas absolute claudication distance time was reduced by only 13% (p = 0.0001). All items of the questionnaire showed a statistically significant improvement after training (from 30 to 71%) and remained unchanged at follow-up. Sixty seven percent of the patients were considered responder, 15% partial responder and 18% no-responder to exercise training, whereas at follow-up these percentages were 55%, 13% and 32%, respectively. These results after training and at follow-up were independent from age, sex, smoke, hypertension, coronary artery disease and diabetes. CONCLUSIONS: Our findings confirm that a short supervised exercise therapy in the form of walking out over pain threshold is effective in maximizing the walking time of the majority of patients with intermittent claudication, independently of demographic data and their associated cardiac risk factors or comorbidities. After a mean follow-up of 2.6 years there was only a minor reduction of absolute claudication distance time and no modification of initial claudication distance time and questionnaire's score, despite the fact that none of these patients were contacted by the rehabilitation centre after their physical training period.

An Observational Veneto Research on Ventilator-Associated Pneumonia (OVeRVAP): attributable mortality and cumulative incidence of ventilator-associated pneumonia.

BACKGROUND: The relationship between ventilator-associated pneumonia (VAP) and mortality varies from study to study, and its entity is uncertain due a considerable variation in the attributable mortality. The aim of this study was to evaluate the relationship between VAP frequency and mortality in a cohort of mechanically ventilated patients. METHODS: A multicenter prospective observational study was conducted in 21 Intensive Care Units (ICUs). The patients were recruited from 2008 to 2010 within randomly selected periods. 842 patients of 2595 admitted, met the eligibility criteria and were enrolled in the study. The study's primary outcome was death by any cause in one of the ICUs. We modelled VAP occurrence as a time-dependent covariate and fitted a competing risk analysis model. We estimated the attributable mortality of VAP as the population-attributable fraction of ICU mortality. RESULTS: A total of 121 patients developed VAP (14.4%), for an incidence rate of 15.7 cases per 1000 ventilator days; of the 175 patients (20.8%) who died during the study period, 31 (25.6%) had VAP. The ICU mortality rate in the patients who developed VAP was 22.6 per 1000 ventilator days (95% CI: 15.9-32.1). We estimated an attributable mortality of 8.4%. CONCLUSIONS: In 8.4% of cases, VAP was the leading cause of death in our study. This indicates that the patients died more frequently with VAP rather than because of it.

Multicentre comparison Of shock efficacy using single-vs. Dual-coil lead systems and Anodal vs. cathodaL polarITY defibrillation in patients undergoing transvenous cardioverter-defibrillator implantation. The MODALITY study.

PURPOSE: An optimal active-can lead configuration during implantable cardioverter defibrillator (ICD) placement is important to obtain an adequate defibrillation safety margin. The purpose of this multicenter study was to evaluate the rate of the first shock success at defibrillation testing according to the type of lead implant (single vs. dual coil) and shock polarity (cathodal and anodal) in a large series of consecutive patients who received transvenous ICDs. METHODS: This was a multicenter study enrolling 469 consecutive patients. Single- versus dual-coil leads and cathodal versus anodal polarity were evaluated at defibrillation testing. In all cases, the value of the energy for the first shock was set to 20 J less than the maximum energy deliverable from the device. RESULTS: A total of 469 patients underwent defibrillation testing: 158 (34 %) had dual-coil and 311 (66 %) had single-coil lead systems configuration, 254 (54 %) received anodal shock and 215 (46 %) received cathodal shock. In 35 (7.4 %) patients, the shock was unsuccessful. No significant differences in the outcome of defibrillation testing using single- versus dual-coil lead were observed but the multivariate analysis showed an increased risk of shock failure using cathodal shock polarity (OR 2.37, 95 % CI 1.12-5.03). CONCLUSIONS: Both single- and dual-coil transvenous ICD lead systems were associated with high rates of successful ICD implantation, and we found no significant differences in ventricular arrhythmias interruption between the two ICD lead systems configuration. Instead, anodal defibrillation was more likely to be successful than cathodal defibrillation.

Randomized study comparing mechanical with electronic 2-dimensional intracardiac ultrasound monitoring (MEDIUM) during percutaneous closure of patent foramen ovale in adult patients with cryptogenic stroke.

BACKGROUND: Previous studies have shown that mechanical and electronic intracardiac echocardiography (ICE) improves ultrasound monitoring during transcatheter patent foramen ovale (PFO) interventional closure. OBJECTIVES: This study sought to compare the procedural data, clinical imaging quality, and effectiveness PFO closure by using two different ICE monitoring modalities. METHODS: Patients referred for PFO closure (n = 82) were randomly assigned to mechanical (group 1) or electronic (group 2) ICE monitoring of Amplatzer device implantation. The digital ICE images were evaluated offline by means of absolute visual grading analysis score (VGAS(abs)), and the residual shunting at follow-up were assessed by means of contrast echocardiographic studies, all blinded regarding the ICE closure monitoring modality. RESULTS: The two groups were comparable with respect to clinical baseline characteristics, intracardiac fossa ovalis measurements, and procedural data (fluoroscopy time, procedure time and measurement of the amount of radiation that the patients absorbed). The total VGAS(abs) ranked the mechanical clinical images in a higher order than the electronic ones (3.78 +/- 0.09 vs 3.58 +/- 0.12, P = 0.005); additionally, three patients (7.3%) of group 2 needed to cross over to mechanical ICE monitoring because a right-convex atrial septal aneurysm configured itself incompletely. No differences in rates of residual shunting were observed at 12 months follow-up between the two groups (97.5% vs 94.7%, P = 0.951). CONCLUSIONS: Electronic monitoring of PFO closure performed a less diagnostic impact than the mechanical one while maintaining comparable procedural data and clinical outcome. These results represent an important step in validating these new intracardiac ultrasound imaging modalities.