Occupational physical activity, mortality and CHD events in the Italian Longitudinal Study

PURPOSE: Several recent studies have suggested a ‘physical activity paradox’ whereby leisure-time physical activity benefits health, but occupational physical activity is harmful. However, other studies imply that occupational physical activity is beneficial. Using data from a nationally representative Italian sample, we investigate if the context, or domain, of physical activity matters for mortality and coronary heart disease (CHD) events. METHODS: Among 40,220 men and women aged 40–55 at baseline, we used Cox models to compare associations of occupational, domestic and leisure-time physical activity with risk of mortality and CHD events over a follow-up period of up to 14 years. We accounted for sociodemographic factors, smoking, body mass index (BMI), physical and mental health, and educational qualifications. RESULTS: Occupational physical activity was not significantly associated with risk of mortality or CHD events for women, or with CHD events for men. In crude models, risk of mortality was higher for men in the highest occupational activity group, compared to the lowest (HR 1.26, 95% CI 1.01, 1.57). This attenuated with adjustment for health-related behaviours, health, and education (HR 1.03, 95% CI 0.77, 1.38). In crude models, leisure-time physical activity was significantly associated with decreased mortality and CHD risk only for men. Domestic physical activity was not associated with either outcome for either gender. CONCLUSION: In a large sample of middle-aged Italian workers, we found limited evidence of harmful or beneficial effects of occupational physical activity on mortality or CHD events. However, confidence intervals were wide, and results consistent with a range of effects in both directions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00420-021-01765-0

Off-label use of rituximab for systemic lupus erythematosus in Europe

K

Off-label use of rituximab for systemic lupus erythematosus in Europe

Objectives: Rituximab (RTX) is a biological treatment used off-label in patients with systemic lupus erythematosus (SLE). This survey aimed to investigate the off-label use of RTX in Europe and compare the characteristics of patients receiving RTX with those receiving conventional therapy. Methods: Data on patients with SLE receiving RTX were taken from the International Registry for Biologics in SLE retrospective registry and complemented with data on patients with SLE treated with conventional therapy. For nationwide estimates of RTX use in patients with SLE, investigators were asked to provide data through case report forms (CRFs). Countries for which no data were submitted through CRFs, published literature and/or personal communication were used, and for European countries where no data were available, estimates were made on the assumption of similarities with neighbouring countries. Results: The estimated off-label use of RTX in Europe was 0.5%-1.5% of all patients with SLE. In comparison with patients with SLE on conventional therapy, patients treated with RTX had longer disease duration, higher disease activity and were more often treated with immunosuppressives. The most frequent organ manifestations for which either RTX or conventional therapy was initiated were lupus nephritis followed by musculoskeletal and haematological. The reason for treatment was, besides disease control, corticosteroid-sparing for patients treated with conventional therapy. Conclusions: RTX use for SLE in Europe is restrictive and appears to be used as a last resort in patients for whom other reasonable options have been exhausted

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

Formation and function of binucleated human hepatocytes

Development of multicellular organisms, including humans, begins with one cell. Through many cell divisions and differentiations, this cell ultimately develops into an organism. All the information that is needed for the development of an organism is coded in its DNA and it is crucial that the DNA is passed on correctly to all cells. To protect the DNA during cell division, DNA is carefully packaged into X-shaped structures called chromosomes. Most human cells are diploid, which means they contain two sets of chromosomes. However, some cells accumulate more than two sets of chromosomes as part of their normal development. Cells that contain more than two sets of chromosomes are called polyploid cells. In humans, polyploid cells can be found in the liver, heart, mammary gland, and bone marrow. Even though polyploid cells are found in many organs, we do not completely understand how and why they are formed. In this thesis, I present the results of our studies on the mechanism, regulation, and function of polyploid cells in diploid organisms, with a focus on human hepatocytes. In Chapter 1, we present an overview of previous studies on the regulation and formation of polyploid cells during animal development. In addition to polyploid cells that are formed as part of normal development, polyploid cells can also arise due to errors in cell division or in response to organ damage. The parallels in the function of polyploidy in development and disease are reviewed in Chapter 2. One of the ways in which polyploid cells are formed is through a process called endomitosis. In endomitosis, a cell replicates its DNA and package it into chromosomes as it would during a normal division; however, the cell does not physically divide in two, resulting in a polyploid cell that has twice the amount of DNA. How this process happens in human cells is not completely understood. In Chapter 3, we look into the mechanisms of endomitosis in human hepatocytes. Apart from E2F proteins, not much is known about which other proteins regulate endomitosis. In Chapter 4, we use a CRISPR-based method to look for genes that promote endomitosis. This study identifies new candidate regulators of endomitosis, but a lot of work is still required to understand the role of these candidate regulators in the regulation of endomitosis. Polyploid cells are often thought to have increased capacity for cellular processes, such as protein synthesis, but there are not many studies that have tested this hypothesis directly. In Chapter 5, we look at the effect of polyploidy towards cellular processes in human hepatocyte organoids and in the intestines of the nematode Caenorhabditis elegans, which represents an ideal model organism to study the effect of extreme polyploidy in a diploid organism. Finally, in Chapter 6 we present how the results of our studies on polyploidy contribute to the field of developmental biology. The studies presented in this thesis represent one of the first steps on our journey to understand the mechanism and function of polyploidy

Risk of symptomatic osteoarthritis associated with exposure to ergonomic factors at work in a nationwide Italian survey

OBJECTIVE: The risk of developing osteoarthritis (OA) has been reported to increase with exposure to various ergonomic factors at work, although this finding is still debated in the literature. Aim of this study was to assess the association between prevalence of symptomatic OA and exposure to workplace ergonomic factors assigned through a job-exposures matrix (JEM). METHODS: The study population was composed of 24,604 persons of 40–69 years who participated in the National Health Survey 2013 and were employed at that occasion. Exposure to ergonomic factors was assigned to the study population through a JEM constructed from the Italian O*NET database, consisting of 17 physical factors, which were summed and averaged by job title (796 jobs) to obtain a combined exposure index. The outcome was self-reported OA characterized by moderate or severe limitations in daily activities. The relationship between OA prevalence and the combined exposure index in quartiles was examined using robust Poisson regression models adjusted for socio-demographics and potential confounders. RESULTS: In the analysis adjusted for age and gender, the risk of OA was increased by approximately 20–30% in the second and third quartiles, and by 80% in the highest exposure quartile, compared to the least exposed, with a risk attenuation by approximately 15–20% controlling for other significant covariates. CONCLUSION: Our results support a causal role of exposure to physical factors at work in the development of OA. As OA is associated with a great burden of disability, any effort should be made to reduce workers’ exposure to ergonomic factors

Socio-economic Inequality in Mortality in Italy

     &nbsp

The Immunogenetics of the Antiphospholipid Syndrome, Anticardiolipin Antibodies, and Lupus Anticoagulant.

Whether a genetic predisposition to develop the antiphospholipid syndrome (APS) and to produce anticardiolipin antibodies (aCL) and lupus anticoagulant (LAC) exists has been addressed by family studies and by population studies on primary APS and on aCL in diseases other than primary APS. Various studies suggest a familial occurrence of aCL and LAC, with or without clinical evidence of APS. This familial tendency could be genetically determined, because APS, aCL, and LAC occur in families carrying haplotypes which contain HLA-DR4, -DR7, and -DRw53. Population studies on primary APS also indicate that HLA genes have a role in conferring susceptibility to develop primary APS. Again, DR4, DR7, and DRw53 are the relevant loci. Population studies on aCL in diseases other than primary APS indicate that aCL are associated with DR4, DR7, and DRw53, at least when they are found in patients with systemic lupus erythematosus. Because HLA-DR4, -DR7, and -DRw53 are in linkage disequilibrium, the genetic association of aCL could be with DRw53 and, depending on the regional frequency of DR4 or DR7, it could be linked with either DR4 or DR7. HLA-DR4 seems to be more important in Anglo-Saxons, whereas DR7 emerges in populations of Latin origin. In this report we review our studies and the pertinent literature in this field

Professional development of university staff in an international affairs division in Japan

Background: Previous studies have shown that mortality inequalities are smaller in Italy than in most European countries. This may be due to the weak association between socioeconomic status and smoking in Italy. However, most published studies were based on data from a single city in northern Italy (Turin). In this study, we aimed to assess the size of mortality inequalities in Italy as a whole, their geographical pattern of variation within Italy, and the contribution of smoking to these inequalities. Methods: Participants in the National Health Interview Survey 1999-2000 were followed up for mortality until 31 December 2007. Using Cox regression, we computed the age-adjusted relative index of inequality (RII) for allcause mortality with and without controlling for smoking status and intensity. Education was used as an indicator of socioeconomic status. Results: A