Cadmium and hypertension in exposed workers: A meta-analysis

Abstrac

AIRO Breast Cancer Group Best Clinical Practice 2022 Update

Introduction: Breast cancer is the most common tumor in women and represents the leading cause of cancer death. Radiation therapy plays a key-role in the treatment of all breast cancer stages. Therefore, the adoption of evidence-based treatments is warranted, to ensure equity of access and standardization of care in clinical practice.Method: This national document on the highest evidence-based available data was developed and endorsed by the Italian Association of Radiation and Clinical Oncology (AIRO) Breast Cancer Group.We analyzed literature data regarding breast radiation therapy, using the SIGN (Scottish Intercollegiate Guidelines Network) methodology (www.sign.ac.uk). Updated findings from the literature were examined, including the highest levels of evidence (meta-analyses, randomized trials, and international guidelines) with a significant impact on clinical practice. The document deals with the role of radiation therapy in the treatment of primary breast cancer, local relapse, and metastatic disease, with focus on diagnosis, staging, local and systemic therapies, and follow up. Information is given on indications, techniques, total doses, and fractionations.Results: An extensive literature review from 2013 to 2021 was performed. The work was organized according to a general index of different topics and most chapters included individual questions and, when possible, synoptic and summary tables. Indications for radiation therapy in breast cancer were examined and integrated with other oncological treatments. A total of 50 questions were analyzed and answered.Four large areas of interest were investigated: (1) general strategy (multidisciplinary approach, contraindications, preliminary assessments, staging and management of patients with electronic devices); (2) systemic therapy (primary, adjuvant, in metastatic setting); (3) clinical aspects (invasive, non-invasive and micro-invasive carcinoma; particular situations such as young and elderly patients, breast cancer in males and cancer during pregnancy; follow up with possible acute and late toxicities; loco-regional relapse and metastatic disease); (4) technical aspects (radiation after conservative surgery or mastectomy, indications for boost, lymph node radiotherapy and partial breast irradiation).Appendixes about tumor bed boost and breast and lymph nodes contouring were implemented, including a dedicated web application. The scientific work was reviewed and validated by an expert group of breast cancer key-opinion leaders.Conclusions: Optimal breast cancer management requires a multidisciplinary approach sharing therapeutic strategies with the other involved specialists and the patient, within a coordinated and dedicated clinical path. In recent years, the high-level quality radiation therapy has shown a significant impact on local control and survival of breast cancer patients. Therefore, it is necessary to offer and guarantee accurate treatments according to the best standards of evidence-based medicine

Genome-wide analysis of 53,400 people with irritable bowel syndrome highlights shared genetic pathways with mood and anxiety disorders

Funder: Kennedy Trust Rheumatology Research Prize StudentshipFunder: DFG Cluster of Excellence “Precision Medicine in Chronic In-flammation” (PMI; ID: EXC2167)Funder: EC | EC Seventh Framework Programm | FP7 Ideas: European Research Council (FP7-IDEAS-ERC - Specific Programme: “Ideas” Implementing the Seventh Framework Programme of the European Community for Research, Technological Development and Demonstration Activities (2007 to 2013)); doi: https://doi.org/10.13039/100011199; Grant(s): 715772Funder: NWO-VIDI grant 016.178.056, the Netherlands Heart Foundation CVON grant 2018-27, and NWO Gravitation grant ExposomeNLFunder: Li Ka Shing Foundation (Li Ka Shing Foundation Limited); doi: https://doi.org/10.13039/100007421Abstract: Irritable bowel syndrome (IBS) results from disordered brain–gut interactions. Identifying susceptibility genes could highlight the underlying pathophysiological mechanisms. We designed a digestive health questionnaire for UK Biobank and combined identified cases with IBS with independent cohorts. We conducted a genome-wide association study with 53,400 cases and 433,201 controls and replicated significant associations in a 23andMe panel (205,252 cases and 1,384,055 controls). Our study identified and confirmed six genetic susceptibility loci for IBS. Implicated genes included NCAM1, CADM2, PHF2/FAM120A, DOCK9, CKAP2/TPTE2P3 and BAG6. The first four are associated with mood and anxiety disorders, expressed in the nervous system, or both. Mirroring this, we also found strong genome-wide correlation between the risk of IBS and anxiety, neuroticism and depression (rg > 0.5). Additional analyses suggested this arises due to shared pathogenic pathways rather than, for example, anxiety causing abdominal symptoms. Implicated mechanisms require further exploration to help understand the altered brain–gut interactions underlying IBS

Flebopatie e lavoratori

The few studies in literature about the relationship between venous diseases and work show that the posture assumed while working could promote the occurrence of venous disease in lower limbs. We compared male workers belonging to different occupational categories, matched for age, BMI and traditional risk factors for venous diseases, in order to assess the prevalence of venous disease and occupational and not-occupational postural risk factors. We found that maintaining a standing position for more than 50% of the shift appears the most important occupational risk factor in provoking the observed higher prevalence of venous disease in the workers studied. It can be assumed the venous diseases are often determined by occupational factors which could be main or concomitant causes. The identification of preventive measures to apply in workplaces, such as better organization of work, targeted examinations and therapeutic indications as the prescription of elastic stockings, is very important

Prognostic Significance of Organ-Specific Metastases in Patients with Metastatic Upper Tract Urothelial Carcinoma

Background: Existing data on metastatic upper tract urothelial carcinoma (mUTUC) are limited. In this study, we investigated the prognostic value of site-specific metastases in patients with mUTUC and its association with survival outcomes. Methods: We retrospectively collected data from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2016. Kaplan–Meier analysis with a log-rank test was used for survival comparisons. Multivariate Cox regression was employed to predict overall survival (OS) and cancer-specific survival (CSS). Results: 633 patients were selected in this study cohort. The median follow-up was 6 months (IQR 2–13) and a total of 584 (92.3%) deaths were recorded. Within the population presenting with a single metastatic organ site, the most common metastatic sites were distant lymph nodes, accounting for 36%, followed by lung, bone and liver metastases, accounting for 26%, 22.8% and 16.2%, respectively. In patients with a single metastatic organ site, the Kaplan–Meier curves showed significantly worse OS for patients with liver metastases vs. patients presenting with metastases in a distant lymph node (p < 0.001), bone (p = 0.023) or lung (p = 0.026). When analyzing CSS, statistically significant differences were detectable only between patients presenting with liver metastases vs. distant lymph node metastases (p < 0.001). Multivariate analyses showed that the presence of liver (OS: HR = 1.732, 95% CI = 1.234–2.430, p < 0.001; CSS: HR = 1.531, 95% CI = 1.062–2.207, p = 0.022) or multiple metastatic organ sites (OS: HR = 1.425, 95% CI = 1.159–1.753, p < 0.001; CSS: HR = 1.417, 95% CI = 1.141–1.760, p = 0.002) was an independent predictor of poor survival. Additionally, survival benefits were found in patients undergoing radical nephroureterectomy (RNU) (OS: HR = 0.675, 95% CI = 0.514–0.886, p = 0.005; CSS: HR = 0.671, 95% CI = 0.505–0.891, p = 0.006) and chemotherapy (CHT) (OS: HR = 0.405, 95% CI = 0.313–0.523, p < 0.001; CSS: HR = 0.435, 95% CI = 0.333–0.570, p < 0.001). Conclusions: A distant lymph node was the most common site of single-organ metastases for mUTUC. Patients with liver metastases and patients with multiple organ metastases exhibited worse survival outcomes. Lastly, CHT administration and RNU were revealed to be predictors of better survival outcomes in the mUTUC cohort

Correlation between total blood lead values and peripheral blood counts in workers occupationally exposed to urban stressors

The aim of the study was to assess the relationship between occupational exposure to airborne lead (Pb) and alterations in peripheral blood counts in workers of the Municipal Police assigned to different types of outdoor tasks. Then, 337 both male and female subjects were enrolled and divided on the basis of sex, cigarette smoking habit and kind of task. Exposure to airborne Pb, dosage of total blood Pb and peripheral blood count were carried out. A significant positive correlation was detected between the values of total blood Pb and values of plasma reticulocytes (%RET) both in the total sample and for all the classes of the subdivision except for police drivers. Some statistically significant correlations were present but discontinuous for other variables of peripheral blood counts. Results suggest that occupational exposure to low doses of airborne Pb is able to influence lines of the hematopoietic system in exposed workers, with special reference to %RET

Exposure to antineoplastic drugs in health care and blood chemistry parameters

Objectives. The purpose of the research is to evaluate whether the exposure to antineoplastic drugs of health workers may cause alteration of blood chemistry parameters. Materials and Methods. Research was conducted on 5800 health workers employed in a hospital in a big Italian city. The final sample is composed of 57 people in charge of cytotoxic drugs compared with 57 subjects not exposed; each worker underwent a general clinical examination and determination of the following values: complete blood count (CBC), white blood cell count (WBC), total protein, BUN, total bilirubin, creatinine, GOT, GPT, alkaline phosphatase, gamma GT. Statistical analysis of data was based on calculation of the mean, standard deviation and the distribution into classes according to the nature of each variable. Differences were considered significant when p was <= 0.05. Results. The mean and the distribution of values of total bilirubin were significantly higher in the workers exposed to antineoplastic drugs than in workers non-exposed; the mean and the distribution of values of monocytes were significantly lower in subjects exposed compared to controls. Conclusions. According to the results antiblastic drugs, at the doses used in the departments we studied, can induce an increase in the values of total bilirubin for liver toxicity and a reduction in the monocyte line due to myelosuppression. Clin Ter 2012;163(6):e387-39

Different Jobs, Different Perceived Stress: A Work-Related Stress Analytical Study

Background: Subjective cognitive decline is considered to be a risk for Alzheimer’s disease. However, it can also be associated with non-cognitive variables. Objectives: This study analyzes the association between Subjective Cognitive Decline (SCD) and variables related to memory, mental health, morbidity, pain, quality of life, loneliness, lifestyle, and social aspects; analyzes predictors of SCD. Methods: Cross-sectional epidemiological study of a sample of individuals randomly selected from a city census. Telephone interviews were conducted with 1775 individuals aged over 55 years. We administered a 7-item questionnaire on SCD and asked about health, lifestyle, and social variables; we also administered a measure of general mental health, the Goldberg Health Questionnaire, and the health-related quality of life scale COOP/ WONCA. Results: SCD showed statistically significant associations with orientation in time (r=0.16), mental health variables (r=0.41), quality of life (r=0.36), loneliness (Eta =0.04), disability (R =0.05), pain (R =0.12), hearing difficulties (R =0.03), vision problems (R =0.05), and chronic disease (R =0.04). The variables orientation in time, mental health, depression, sleep quality, multimorbidity, and hearing difficulties were identified as predictors of SCD (p&lt;0.001; R =0.30). Conclusion: The heterogeneity of the variables associated with SCD should be taken into account to differentiate individuals at increased risk of developing Alzheimer’s disease from those in whom the condition may be explained by other factors