Adverse reproductive outcomes associated with exposure to a municipal solid waste incinerator

 Introduction. The association between reproductive health outcomes and exposure to municipal solid waste incinerators (MSWIs) is inconclusive. This study investigates the association between exposure to a MSWI and various reproductive outcomes (preterm birth, low birth weight, small for gestational age, and sex ratio), taking into account other sources of pollution (industrial plants, highway, major roads with high traffic flows) and maternal factors, including the socioeconomic status. Methods. PM10 concentration maps were used for the exposure assessment to the MSWI and to other sources of pollution in the study area. Information on resident births and maternal covariates were selected from the delivery certificates referred to the period 2001-2010. Mothers’ addresses were geocoded in order to attribute the individual level of exposure. Odds ratio (OR) with a 95% confidence interval (CI) adjusted for maternal covariates and exposure to other pollutant sources were calculated. Results. A total of 3,153 newborns to 2,401 mothers residing in area during the study period were analyzed. A risk of preterm birth associated with increased exposure was detected (OR=1.61; 95%CI: 0.88-2.94; p test for trend 0.098). When newborns to primiparous women were considered an OR of 2.18 (95%CI: 1.05-4.53) and a significant trend were observed (p=0.033). No significant results for the other investigated outcomes were observed. Conclusions. The study detected a slight association between exposure at MSWI and preterm births. The results are in agreement with those of a previous multi-site study with similar design, and they strengthen the recommendation to consider gestational age in studies and surveillance in areas with MSWIs and similar sources of pollution

Enhanced expression of monocyte tissue factor in patients with liver cirrhosis

Background - Previous studies have shown that cirrhotic patients produce increased amounts of thrombin but the underlying mechanism is still unknown. Aims - To analyse the relation between the rate of thrombin generation and monocyte expression of tissue factor (TF) in cirrhosis. Patients - Thirty three cirrhotic patients classified as having low (n = 7), moderate (n = 17), or severe (n = 9) liver failure according to Child-Pugh criteria. Methods - Prothrombin fragment F1+2, monocyte TF activity and antigen, and endotoxaemia were measured in all patients. Polymerase chain reaction (PCR) analysis of TF mRNA was performed in monocytes of five cirrhotic patients. Results - Prothrombin fragment F1+2 was higher in cirrhotic patients,than in controls (p < 0.0001). Monocytes from cirrhotic patients had higher TF activity and antigen than those from controls (p < 0.001) with a progressive increase from low to severe liver failure. Monocyte expression of TF was significantly correlated with plasma levels of F1+2 (TF activity: r = 0.98, p < 0.0001; TF antigen: r = 0.95, p < 0.0001) and with endotoxaemia (TF activity: r = 0.94, p < 0.0001; TF antigen: r = 0.91, p < 0.0001). PCR analysis of TF mRNA showed TF expression only in three patients with endotoxaemia (more than 15 pg/ml). Conclusions - Cirrhotic patients have enhanced expression of TF which could be responsible for clotting activation, suggesting that endotoxaemia might play a pivotal role

ESITI RIPRODUTTIVI IN UNA COORTE DI NATI DA MADRI RESIDENTI NELLE VICINANZE DIUN INCENERITORE DI RIFIUTI SOLIDI URBANI

.Introduzione La letteratura fornisce evidenze limitate sull\u27associazione tra esposizione a Inceneritore di Rifiuti Solidi Urbani (IRSU) e Esiti Avversi della Riproduzione (EAR). Il dominio dello studio ? rappresentato dall\u27area di San Zeno in provincia di Arezzo, nella quale sono presenti un IRSU attivo dal 2000 e altre sorgenti di inquinamento. Obiettivi Valutare in una coorte di nati l\u27associazione tra gli EAR e l\u27esposizione a IRSU, tenendo conto dell\u27esposizione ad altre fonti di emissione presenti nell\u27area in studio, delle caratteristiche socio-demografiche e di altre covariate materne. Metodi Lo studio ha utilizzato un approccio retrospettivo di coorte. I nati, selezionati dai Certificati di Assistenza al Parto nel periodo 2001-2010, sono stati associati alle madri residenti nell\u27area durante il periodo di gestazione e opportunamente georeferenziate. Le esposizioni all\u27IRSU e alle altre fonti (industrie e autostrada) sono state stimate mediante le mappe di diffusione del PM10 e Cadmio (modelli ADMS-URBAN). ? stata inoltre stimata l\u27esposizione ad altre strade principali mediante la distanza. Sono state definite tre classi di esposizione utilizzando il 50? el\u2780? percentile della distribuzione delle concentrazioni. Sono stati analizzati i principali EAR: sexratio, nascite pretermine, basso peso alla nascita, basso peso per et? gestazionale. Le associazioni con l\u27esposizione all\u27IRSU sono state stimate con Odds Ratio (OR) aggiustato per le altre esposizioni ambientali, stato socioeconomico e variabili materne (et?, nazionalit?, ordine di gravidanza, sesso del neonato), utilizzando come riferimento la classe di esposizione pi? bassa. ? stato inoltre stimato il Trend (Tr) dei rischi all\u27aumentare della classe di esposizione. Risultati La coorte analizzata ? costituita da 3069 nati. ? stato riscontrato un eccesso di nascite pretermine nella classe di alta esposizione rispetto a quella a minore esposizione (OR=1,61; p=0,12) e un trend statisticamente significativo (Tr=1,28; p=0,099). Si segnala in oltre un eccesso, seppur non statisticamente significativo, di nati piccoli per et? gestazionale nella classe di alta esposizione (OR=1,31; p=0,144) e un Trend positivo (Tr=1,145; p=0,141). Non sono stati riscontrati eccessi relativamente agli altri EAR analizzati. Conclusioni L\u27evidenza di associazione tra esposizione a Inceneritore di Rifiuti Solidi Urbani e nascite pretermine trova riscontro in altri studi similari (Candelaet al.) e merita approfondimenti specifici anche attraverso studi multicentrici che consentirebbero di aumentare la precisione delle stime

Il percorso di sorveglianza sanitaria degli ex-esposti ad amianto in Toscana [Health surveillance programme for workers with past asbestos exposure in Tuscany Region (Central Italy)]

Asbestos-related diseases are characterized by a long latency time since exposure. This accounts for a health surveillance programme addressed to asbestos workers to be performed for decades after the cessation of occupational exposure. We describe the health surveillance programme for former asbestos-exposed workers in Tuscany Region (Central Italy), with particular attention to organization and related critical issues. The Deliberation of the Regional Administration of Tuscany (No. 396/2016) supports the programme, defined by a regional group of experts, and defines the public health services where the programme has to be implemented. The programme activities are classified in two levels: a first level for a basic health evaluation and a second level for in-depth analyses. The former asbestos workers, aged less than 80 years and with cessation of occupational asbestos exposure in the last 30 years, that might be included free of charge in the programme are about 5.600. The funds assigned to develop the programme from 2016 to 2024 were 2,044,808 euros. The Regional Administration of Tuscany decided to offer and guarantee a homogeneous programme in the whole region. The identification of a specific public health programme and the cooperation of social stakeholders, defined with specific regional agreements, might facilitate to overcome the problems which are still open, such as a broaden invitation to adhere to the programme, an extended knowledge on the service, and the application of a similar health programme for still-working former asbestos workers

Circulating Extracellular Vesicles Are Increased in Newly Diagnosed Celiac Disease Patients

Extracellular vesicles (EVs) are a class of circulating entities that are involved in intercellular crosstalk mechanisms, participating in homeostasis maintenance, and diseases. Celiac disease is a gluten-triggered immune-mediated disorder, characterized by the inflammatory insult of the enteric mucosa following local lymphocytic infiltration, resulting in villous atrophy. The goal of this research was the assessment and characterization of circulating EVs in celiac disease patients, as well as in patients already on an adequate gluten-free regimen (GFD). For this purpose, a novel and validated technique based on polychromatic flow cytometry that allowed the identification and enumeration of different EV sub-phenotypes was applied. The analysis evidenced that the total, annexin V+, leukocyte (CD45+), and platelet (CD41a+) EV counts were significantly higher in both newly diagnosed celiac disease patients and patients under GFD compared with the healthy controls. Endothelial-derived (CD31+) and epithelial-derived (EpCAM+) EV counts were significantly lower in subjects under gluten exclusion than in celiac disease patients, although EpCAM+ EVs maintained higher counts than healthy subjects. The numbers of EpCAM+ EVs were a statistically significant predictor of intraepithelial leukocytes (IEL). These data demonstrate that EVs could represent novel and potentially powerful disease-specific biomarkers in the context of celiac disease