During the activities of the Apulia Regional Operative Center (COR Puglia), pertaining to the National Registry of Mesothelioma (ReNaM), there was reported a case of malignant mesothelioma occurred in a male of 66 years old. The case we bring to the attention is about an university professor of chemistry who, since the early '70s, has conducted several studies on the physico-chemical properties of some metals, particulary in the field of thermochemical treatments of superficial hardening of steel for greater wear resistance, using a laboratory with ovens and asbestos-containing materials and consumables. In 2011, after almost 40 years, the subject comes to the attention of the Apulia Regional Operative Center, with histologic and immunohistochemical diagnosis of epithelioid mesothelioma, after completing the diagnostic procedure in a thoracic surgery ward, for the assessment and treatment of a right pleural effusion revealed during health checks.

The presence of ophiolites in areas of Basilicata, where there have been reports of mesothelioma in farmers, is known. This study evaluates the increased risk of exposure to tremolite in carrying out agricultural activities. Cases of mesothelioma occurred in farmers with unknown exposure to asbestos have been selected and assessed the employment in areas contaminated by tremolite. Personal samplings were conducted in a group of farmers employed in these areas and a group of subjects used in activities that do not involve contact with the ground. For the 5% of cases of mesothelioma in the lucan register emerged exposure to asbestos exclusively in farming activities in areas at tremolite risk. The analysis of the samples showed the presence of personal fibers of tremolite in 2/3 of the cases. In 60% there was an overcoming of the natural limit of 2 ff/l, with a peak up to 23.6 ff/l. The study shows that the risk of exposure to tremolite in agriculture is significantly higher than natural exposure.

BACKGROUND: Malignant Pleural Mesothelioma (MPM) is a tumour of the surface cells of the pleura that is highly aggressive and mainly caused by asbestos exposure. Electronic noses capture the spectrum of exhaled volatile organic compounds (VOCs) providing a composite biomarker profile (breathprint). OBJECTIVE: We tested the hypothesis that an electronic nose can discriminate exhaled air of patients with MPM from subjects with a similar long-term professional exposure to asbestos without MPM and from healthy controls. METHODS: 13 patients with a histology confirmed diagnosis of MPM (age 60.9±12.2 year), 13 subjects with certified, long-term professional asbestos exposure (age 67.2±9.8), and 13 healthy subjects without asbestos exposure (age 52.2±16.2) participated in a cross-sectional study. Exhaled breath was collected by a previously described method and sampled by an electronic nose (Cyranose 320). Breathprints were analyzed by canonical discriminant analysis on principal component reduction. Cross-validated accuracy (CVA) was calculated. RESULTS: Breathprints from patients with MPM were separated from subjects with asbestos exposure (CVA: 80.8%, sensitivity 92.3%, specificity 85.7%). MPM was also distinguished from healthy controls (CVA: 84.6%). Repeated measurements confirmed these results. CONCLUSIONS: Molecular pattern recognition of exhaled breath can correctly distinguish patients with MPM from subjects with similar occupational asbestos exposure without MPM and from healthy controls. This suggests that breathprints obtained by electronic nose have diagnostic potential for MPM.

Background: Sarcoidosis is a systemic granulomatous disease of unknown cause that affects the lungs in over 90% of cases. Breath analysis by electronic nose technology provides exhaled molecular profiles that have potential in the diagnosis of several respiratory diseases. Objectives: We hypothesized that exhaled molecular profiling may distinguish well-characterized patients with sarcoidosis from controls. To that end we performed electronic nose measurements in untreated and treated sarcoidosis patients and in healthy controls. Methods: 31 sarcoidosis patients (11 patients with untreated pulmonary sarcoidosis [age: 48.4 +/- 9.0], 20 patients with treated pulmonary sarcoidosis [age: 49.7 +/- 7.9]) and 25 healthy controls (age: 39.6 +/- 14.1) participated in a cross-sectional study. Exhaled breath was collected twice using a Tedlar bag by a standardized method. Both bags were then sampled by an electronic nose (Cyranose C320), resulting in duplicate data. Statistical analysis on sensor responses was performed off-line by principal components (PC) analyses, discriminant analysis and ROC curves. Results: Breathprints from patients with untreated pulmonary sarcoidosis were discriminated from healthy controls (CVA: 83.3%; AUC 0.825). Repeated measurements confirmed those results. Patients with untreated and treated sarcoidosis could be less well discriminated (CVA 74.2%), whereas the treated sarcoidosis group was undistinguishable from controls (CVA 66.7%) Conclusion: Untreated patients with active sarcoidosis can be discriminated from healthy controls. This suggests that exhaled breath analysis has potential for diagnosis and/or monitoring of sarcoidosis. (C) 2013 Elsevier Ltd. All rights reserved.

Pulmonary arterial hypertension (PAH) is a rare condition characterized by an increase in pulmonary arterial resistance leading to right heart failure and death. Arrhythmias are a growing problem in PAH; therefore, maintenance of sinus rhythm is considered to be an important treatment aim in these patients. We described the case of a 46-year-old woman with HIV-associated pulmonary arterial hypertension  who developed atrial flutter. After treatment with bosentan, it was observed a significant improvement in clinical and haemodynamic parameters. In addition, the AFL, which had previously persisted to both antiarrhythmic drug therapy and electrical stimulation, and had recurred after transthoracic electrical cardioversion, disappeared  in absence of any antiarrhythmic drug. Though the precise factors responsible for supraventricular arrhythmogenesis are still largely obscure, it is likely that initiation and maintenance of AFL may depend on all the conditions that can lead to increase in right atrial pressure, size, and wall stress, such as PAH. In our case, bosentan reduced both mean pulmonary artery pressure (mPAP) value and right heart chambers pressures. Therefore, it is conceivable that with the anatomical substrate needed for the maintenance of AFL being disappeared, sinus rhythm was restored.

A 57-year-old woman underwent an enucleoresection of her right kidney angiomyolipoma. Two weeks later she was admitted to our hospital because of dyspnea at rest with orthopnea. The chest x-ray showed the elevation of both hemidiaphragms and the measurement of the sniff transdiaphragmatic pressure confirmed the diagnosis of bilateral diaphragmatic paralysis. A diaphragm paralysis can be ascribed to several causes, i.e. trauma, compressive events, inflammations, neuropathies, or it can be idiopathic. In this case, it was very likely that the patient suffered from post-surgery neuralgic amyotrophy. To our knowledge, there are only a few reported cases of neuralgic amyotrophy, also known as Parsonage-Turner Syndrome, which affects only the phrenic nerve as a consequence of a surgery in an anatomically distant site.

BACKGROUND The Italian meat supply chain is a large-scale industry typically characterized linked to circuit of DOP (Protected Designation of Origin) products. In this reality all workers are exposed to a wide range of biological agents that have developed antibiotic resistance and, therefore, represent a public and occupational health issue. METHODS An anamnestic semi-structured interview was performed to the study participants, in order to better define the risk exposure, which was followed by physical examination of the skin and skin appendages. Samples of nasal swabs were sown, within 24 hours, in Mannitol Salt Agar growth medium, specific for the detection of Staphylococcus Aureus. After an incubation period, we selected positive colonies for S. aureus in order to undergo genetic tests to detect the presence of MRSA. MRSA positive samples were analyzed, at last, with a specific PCR for the ST398, swine specific sequence type. RESULTS 162 workers joined the study, which was performed a physical examination of hand skin, a nasal swab and then given an anamnestic semi-structured interview. The sample was composed of 139 males and 23 females, mean age 45 years, with average seniority of 10 years. From 162 nasal swabs championships, a first analysis of culture media for Staphylococcus Aureus showed 35 positive (21.6%). The molecular analysis revealed only one MRSA sample, belonging to a butcher's meat processing company. (0.6%). The molecular analysis did not confirm the positivity for genotype 398, which characterizes the infection in pigs. CONCLUSION Recontamination with Staphylococcus Aureus occurs via surface treating machinery, as a result of fecal contamination at evisceration, or via increased human handling during meat processing. Our study revealed a low risk for MRSA, because of superficial heat treatments such as scalding and flaming that reduce significantly the burden of MRSA on the carcasses.

MalignantPleuralMesothelioma(MPM)isanaggressiveneoplasm that isveryoftenassociatedwithasbestosexposure.MPMdiagnosisisdifficult, veryoftenrequiringinvasiveapproachessuchasthoracoscopy.Exhaledbreath containshundredsofdifferentvolatileorganiccompounds(VOCs)whichmaybe usedfordiagnosisofvariouspulmonaryandsystemicdisordersincludinglung cancer. Methods: Weenrolled13patientswithanestablisheddiagnosisofMPM,13 healthy controls(HC),and13subjectswithaprofessionalexposuretoasbestos without MPM(EXP).Tedlarbagswereusedtocollecthumanbreath.Samples werecollectedusingasorbent-trapfollowedbythermaldesorptionandanalysis by gaschromatographwithananalyticalmassspectrometer(GC-MS). Results: AnalysisshowedthatthemostabundantVOCs(>15 ng/L)inthein- vestigatedsampleswerecyclopentaneand cyclohexane.Thechemicalprofilewas differentforthesamplesclasses:EXPandMPM,showedalteredlevelsoftoluene, xylene, benzaldehyde,trimethylbenzene, limonene, 2-ethyl-1-hexanol,acetophe- none, cyclopentane.MPMpatientsshowed higherconcentrationofcyclohexane (meanvalue=339.31ng/L)comparedtoEXP(meanvalue=173.06ng/L)and controls(meanvalue=30.68ng/L).ByusingtheTukeyHSDtestitwasfound that cyclohexaneconcentrationforMPMwas significantlydifferentcomparedto HC (p=0.006)whereastheconcentrationforEXPwasnotsignificantlydifferent both comparedtoMPM(p=0.146)andcontrolgroup(p=0.285). Conclusions: BreathAnalysisbyGC-MSmayplayapotentialroleinthenon- invasiveassessmentofMPM.

Malignant pleural mesothelioma (MPM) is an aggressive tumour whose main aetiology is the long-term exposure to asbestos fibres. The diagnostic procedure of MPM is difficult and often requires invasive approaches; therefore, it is clinically important to find accurate markers for MPM by new noninvasive methods that may facilitate the diagnostic process and identify patients at an earlier stage. In the present study, the exhaled breath of 13 patients with histology-established diagnosis of MPM, 13 subjects with long-term certified professional exposure to asbestos (EXP) and 13 healthy subjects without exposure to asbestos (healthy controls, HC) were analysed. An analytical procedure to determine volatile organic compounds by sampling of air on a bed of solid sorbent and thermal desorption GC-MS analysis was developed in order to identify the compounds capable of discriminating among the three groups. The application of univariate (ANOVA) and multivariate statistical treatments (PCA, DFA and CP-ANN) showed that cyclopentane and cyclohexane were the dominant variables able to discriminate among the three groups. In particular, it was found that cyclohexane is the only compound able to differentiate the MPM group from the other two; therefore, it can be a possible marker of MPM. Cyclopentane is the dominant compound in the discrimination between EXP and the other groups (MPM and HC); then, it can be considered a good indicator for long-term asbestos exposure. This result suggests the need to perform frequent and thorough investigations on people exposed to asbestos in order to constantly monitor their state of health or possibly to study the evolution of disease over time. RI de gennaro, gianluigi/B-6237-2013 OI de gennaro, gianluigi/0000-0002-6868-6569

COPD is currently recognized as a syndrome associated with a high prevalence of comorbidities and various phenotypes. Exacerbations are very important events in the clinical history of COPD because they drive the decline in lung function. In the present study, we aim to identify whether there are any clinical and functional specific features of frequent exacerbators in a population of patients with severe COPD.

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We read with great interest the article of Dr. Blomster H and colleagues entitled:“Endothelial function is well preserved in obese patients with mild obstructive sleep apnea”[1]. In the manuscript, the authors clearly show that mild obstructive sleep apnea (OSA) does not correlate with endothelial dysfunction, measured by brachial artery flow-mediated dilatation (FMD), assuming that in mild OSA, endothelial function is still preserved. The data are very interesting, although the authors did not analyze the time of onset of symptoms, as well as ...

Abstract Background: Tremolite is one of the six recognized types of asbestos, whose toxicity and carcinogenity is welldocumented. Resident population in the area of Lagonegro (Basilicata, Italy) has been shown to be exposed to enviromental tremolite pollution, deriving from superficial rocks and asbestos caves. A branch of the ongoing health surveillance program for residents is evaluating the prevalence of pulmonary functional abnormalities. Methods: The study group was composed by 655 long-term residents in the tremolite-exposed area of Lagonegro (age 49.35 ± 16.68, current smokers 109, ex-smokers 126) . The control group was composed by 653 individuals living in areas not tremolite-exposed (age 54.45 ± 17.16, current smokers 128, ex-smokers 137). All the participants to the study performed a lung function test. Results: Prevalence of obstructive and restrictive diseases did not show significant differences between the two groups. Tremolite-exposed group showed a higher prevalence of small-airways disease compared to the nonexposed group (p<0.01). Odds Ratio for small-airways obstruction was 3.46 (95% CI, lower limit 2.55, upper limit 4.69). irrespective of smoking status. Conclusions: According to our data, tremolite exposure may be a risk factor for small airways disease. It is mandatory to follow these subjects longitudinally by repeated measurements

Recently, it has been clearly described an independent relationship between obstructive sleep apnea syndrome (OSAS) and cardiovascular risk, with underlying mechanisms also including endothelial dysfunction. We enrolled 32 consecutive non-obese patients (mean age of 39.5±11.5 years), of which 16 with mild OSAS and 16 snoring without OSAS. Mild OSAS is defined by an AHI index between 5 and 15. We have investigated if whether there was a relationship between mild OSAS, endothelial function and carotid intima-media thickness (C-IMT). The population was divided into two groups: Group 1 (16 simple snorer patients with an average age of 39.4±12.1 years) and Group 2 (16 subjects with mild OSAS with an average age of 39.6±11.2 years). Each group underwent cardiovascular investigation including measurement of flow-mediated dilation (FMD) of the brachial artery and C-IMT. Both groups comprised non-obese subjects. Patients with mild OSAS had serum total cholesterol values statistically significantly higher than simple snores patients (178.6±24.9 vs 159.2±25.3; p=0.038). OSAS patients had also a trend towards higher values of maximum C-IMT compared to simple snorer patients (0.70±0.15 vs 0.65±0.16), although below the level of significance. Between the two groups, no difference was found for FMD values. The present results on mild OSAS strengthen the importance of a diagnosis of OSAS as soon as possible, in order to encourage all primary prevention interventions to correct risk factors responsible for disease progression and the occurrence of cardiovascular diseases, not excluding the use of therapies of non-invasive ventilation even in the early stages of the disease.

Background: An effective screening tool for colorectal cancer is still lacking. Analysis of the volatile organic compounds (VOCs) linked to cancer is a new frontier in cancer screening, as tumour growth involves several metabolic changes leading to the production of specific compounds that can be detected in exhaled breath. This study investigated whether patients with colorectal cancer have a specific VOC pattern compared with the healthy population. Methods: Exhaled breath was collected in an inert bag (Tedlar (R)) from patients with colorectal cancer and healthy controls (negative at colonoscopy), and processed offline by thermal-desorber gas chromatographymass spectrometry to evaluate the VOC profile. During the trial phase VOCs of interest were identified and selected, and VOC patterns able to discriminate patients from controls were set up; in the validation phase their discriminant performance was tested on blinded samples. A probabilistic neural network (PNN) validated by the leave-one-out method was used to identify the pattern of VOCs that better discriminated between the two groups. Results: Some 37 patients and 41 controls were included in the trial phase. Application of a PNN to a pattern of 15 compounds showed a discriminant performance with a sensitivity of 86 per cent, a specificity of 83 per cent and an accuracy of 85 per cent (area under the receiver operating characteristic (ROC) curve 0.852). The accuracy of PNN analysis was confirmed in the validation phase on a further 25 subjects; the model correctly assigned 19 patients, giving an overall accuracy of 76 per cent. Conclusion: The pattern of VOCs in patients with colorectal cancer was different from that in healthy controls. The PNN in this study was able to discriminate patients with colorectal cancer with an accuracy of over 75 per cent. Breath VOC analysis appears to have potential clinical application in colorectal cancer screening, although further studies are required to confirm its reliability in heterogeneous clinical settings. Copyright (c) 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. RI de gennaro, gianluigi/B-6237-2013 OI de gennaro, gianluigi/0000-0002-6868-6569

Outcrops of ophiolites containing tremolite asbestos were found at the Basilicata-Calabria border, Italy. A previous study mapped the outcrops and assessed the exposure through environmental sampling of airborne asbestos fibers nearby towns, showing doses up to 22 ff/L. Our study assesses the presence and level of personal exposure to inhalable asbestiform fibers in residents employed in occupational activities involving earthmoving and soil disturbance and other activities. We recruited 20 workers employed in construction and agriculture and 10 people employed in other activities not involving movement of soil; in addition, were recruited 5 relatives of residents who died from malignant mesothelioma in areas with these outcrops. Personal sampling was performed during two summer days using portable suction pumps. Each sampling covered almost the whole work shift, however never less than 400 minutes; filters were analyzed with SEM/EDS. We observed personal values of tremolite fibers ranged 0.8 - 23.06 ff/L. In 50% of all samples exceeded the environmental level of 2 ff/L. 60% of farmers and 100% of construction workers reported a personal exposure exceeding 2 ff/L (range: 2.07 - 23.06 ff/L). The relatives exceeded also the limit values (range: 3,05 - 6,07 ff/L), suggesting an unconventional type exposure to tremolite asbestos suffered by relatives died from malignant mesothelioma. These results are in accordance with the data of regional mesothelioma register that counts, in these naturally-polluted areas, 19 cases of malignant mesothelioma in farmers and 9 in construction workers. There were no value above the limit in workers employed in activities not involving soil disturbance.

Introduzione La filiera della carne è una grande realtà industriale in Italia, caratterizzata dal circuito Denominazione di Origine Protetta (DOP).Tutti i lavoratori sono esposti a una vasta gamma di agenti biologici che hanno sviluppato antibiotico resistenza e, di conseguenza, rappresentano un problema di salute pubblica ed occupazionale. Obiettivi Valutare il rischio biologico da MRSA in lavoratori della filiera delle carni. Metodi Sono stati reclutati, previo consenso, 162 lavoratori della filiera delle carni del Sud Italia.Tutti i partecipanti hanno risposto ad una intervista semi-strutturata , sono stati sottoposti ad esame obiettivo della cute ed a prelievo di un tampone nasale.Il questionario ha indagato la storia clinica e professionale, storia residenziale, la presenza di animali domestici, il contatto extra-professionale con animali d’allevamento e sul consumo di carne cruda o poco cotta.Eventuali infezioni respiratorie e/o cutanee, dissenteria, malattie infettive, stato immunodepressivo, recenti interventi chirurgici e ricoveri ospedalieri, infortuni, assunzione di antibiotici, sono stati considerati criteri di esclusione ai fini della valutazione del tampone nasale.I campioni di tamponi nasali sono stati seminati, entro 24 ore, in terreno di crescita Mannitol Salt Agar, specifica per il rilevamento di Staphylococcus Aureus. Dopo un periodo di incubazione, sono state selezionate colonie positive per S. Aureus sulle quali sono stati ricercati i geni 447bp NUC, che codifica per la nucleasi, e il gene mecA, che codifica per la sequenza della meticillino-resistenza, utilizzando la procedura Multiplex Polymerase Chain Reaction (MPCR).I campioni positivi per MRSA sono stati analizzati, infine, con una PCR specifica per la ST398, sequenza specifica per la specie suina. Risultati Sono stati reclutati 139 maschi e 23 femmine, con età media di 45 anni ed anzianità lavorativa media di 10 anni. Dalla semina dei 162 tamponi nasali, una prima analisi ha mostrato positività per lo Staphylococcus Aureus in 35 campioni (21,6%).L'analisi molecolare ha rivelato un solo campione positivo per MRSA (0,6%), in un lavoratore addetto alla trasformazione della carne..L'analisi molecolare non ha confermato la positività per il genotipo ST398, caratteristico dell'infezione nei suini. Conclusioni Il nostro studio ha rivelato un basso rischio per MRSA, condizionato dall’uso di antibiotici in ambito veterinario e dai trattamenti termici superficiali effettuati sulle carcasse, come scottature e flambature, che riducono significativamente la presenza di MRSA. La ricontaminazione con S. Aureus, tuttavia, potrebbe verificarsi a seguito di contaminazione fecale durante l’eviscerazione, tramite una maggiore manipolazione delle carni da parte degli operatori durante la lavorazioni ed, infine, attraverso il contatto con le superfici potenzialmente infette dei macchinari. Bibliografia 1. Colosio C. et al. Linee Guida per la Sorveglianza Sanitaria in agricoltura. 2012 SIMLII 2. Il rischio biologico nei luoghi di lavoro (2011) INAIL 3. Livermore, Antibiotic resistance in staphylococci, International Journal of Antimicrobial Agent 16 (2000) S3 – S10

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by the progressive loss of central and peripheral motor neurons. Some studies have found discordant data in the presence of sleep apnea in ALS patients. An obstructive component also occurs with upper airways hypotonia and muscle weakness that may result in an excessive reduction of airway lumen, leading to obstructive sleep apnea (OSA). The aim of this study was to assess the role of obstructive apneic events at disease onset in the ALS prognosis.

Background Rural areas on the Calabro-Lucano border, Southern Italy, are characterized by the presence of ophiolites outcrops containing tremolite. A study mapped the outcrops and assessed the exposure through environmental sampling of airborne asbestos fibers nearby towns, showing doses up to 22 ff/L. Our study assesses the presence and level of personal exposure to inhalable asbestiform fibers in residents employed in occupational activities involving earthmoving and soil disturbance and other activities. Methods We recruited 30 volunteers including 20 employed in construction and agriculture and 10 employees working in other sectors not involving disturbance of the soil, and also five relatives of patients who died of pleural mesothelioma residents in areas with ophiolites outcrops. Sampling was conducted over two days later in the summer. The content and type of asbestos fibers were determined by technique of scanning electron microscopy (SEM) equipped with EDS (Energy Dispersive Spectrometer). Results The SEM analysis showed the presence of asbestos fibers serpentine type tremolite in 20 above 30 filters obtained by personal sampling. EDS microanalysis allowed to exclude titanium and organic material. The doses of tremolite fibers observed were between 0.8 and 23.06 ff/L. The environmental fund limit of 2 gg/L was exceeded in 50% of samples. 60% of farmers reported a personal exposure than 2 ff/L (from 2.07 to 23.06 ff/L) and 100% of construction workers (from 4.02 to 12.02 ff/L). The five relatives reported exposure values from 0.8 to 6.07 ff/L, exceeding in three cases the limit of 2 ff/L. Conclusion 90% of residents not employed in agriculture and construction has been exposed to doses of tremolite lower than the value of the fund. The information campaign, aimed at a proper risk management, was useful. Health surveillance of resident population is needed.