Adrenal epithelioidangiosarcoma (AEA) is a rare neoplasm that accounts for less than 1% of sarcomas. Due to its rarity, it can easily be misdiagnosed, both by the clinician and the pathologist. Data on the patient's occupational history was collected and analyzed. The bibliographic data was found on the PUBMED bibliographic search site after entering the word "extrahepaticangiosarcoma". We report a case of adrenal epithelioidangiosarcoma (AEA) in a 68 yr-old Caucasian male factory worker exposed to Vinyl Chloride (VC) for 15 yr. He underwent surgery, chemotherapy and radiotherapy. Hepatic angiosarcoma is a known consequence of VC exposure, but occupational causality of extra-hepatic angiosarcoma is controversial. Extra-hepatic angiosarcomas have been reported in VC workers, but never AEA. Cancerogenic effects of VC involve all endothelial areas of the body and extra-hepatic endothelial tumors may also be caused by this substance. This is the first published report of AEA diagnosed in a worker exposed to VC.

Objective: to evaluate the association between daily air pollutant concentration and daily data regarding mortality and hospital admissions among residents of Brindisi (Southern Italy) in the years 2003-2006. Design: the association between the time series of daily mortality (2003-2005) and hospital admissions (2003-2006) and the time series of daily pollutant concentration were analyzed using a case-crossover method and a conditional logistic regression. Bi-directional control periods were selected using a timestratified approach. Models include mean temperature, relative humidity, influence of epidemics, summer decrease of resident population and holidays as confounders. Specific models with the following variables: cause of death or hospital admission,cagender, age and season have been fitted. As hazard periods the following lags have been considered: single lag (from 0 to five) and cumulative lag (lag 0-1 for mortality and 0-3 for hospital admissions). Main outcome measures: a total of 1,792 subjects deceased of all natural causes (including cardiovascular and respiratory causes) and 6,925 hospital admissions for acute conditions (cardiac, cerebrovascular and respiratory diseases) were considered. PM10, NO2 and CO daily pollutant concentration series were examined. Results: PM10 was associated with mortality from all natural causes (10.36%; 95% CI 1.83-19.61 at lag 0-1). The risk was more pronounced for cardiovascular mortality (14.35%; 95% CI 2.11; 28.07 at lag 1). The association with hospitalization for cerebrovascular diseases was statistically significant for PM10 among females (13.4%; 95% CI 1.7; 26.4 at lag 4) and elderly over 75 years old (13.6%; 95% CI 0.4; 28.6 at lag 4). In specific population groups, increased mortality and hospital admissions have been associated with NO2. Conclusion: this study found strong and consistent associations between outdoor air pollution (coming from both industrial emissions and urban traffic) and short-term increases in

Exposure to air pollutants has been associated with increased hospital admissions (HAs) for respiratory and cardiovascular diseases. This work describes a short-term epidemiological study in Brindisi, a highly industrialized town in Southern Italy. The effects of daily exposure to PM10 and NO2 on daily HAs for cardiac, respiratory, and cerebrovascular diseases were investigated by means of a case-crossover design in the period 2001-2007. Results showed positive associations between PM10 and HAs for cardiac and respiratory diseases and between NO2 and HAs for all the categories of diseases considered, particularly among females. Although not statistically significant, increased risk was observed for wind blowing from the port and the industrial area. Findings confirm the health risks associated with ambient air pollution exposure, even though NO2 and PM10 concentrations were below the legal limits. This may be due to the complex scenario of emissions in the area, which should be better investigated.

PURPOSE:To analyze survival and complications in high dose 3D conformal radiotherapy (3DCRT) patients treated with curative and post-operative intent and compare radical surgery + radiotherapy (RT) patients vs. RT only patients.MATERIAL AND METHOD:103 patients were treated curatively (RAD), 94 postoperatively (POST-OP). The mean age was higher in RAD group (72.6 years, range 56.4-85.1) than in POST-OP group (65.4 years, 43.9-77) (p < 0.0001). According to NCCN prognostic classification 13 (12%) patients was low risk, 48 (47%) intermediate risk and 42 (41%) high risk in RAD group. In POST-OP group 13 (14%) patients were low risk, 37 (40%) intermediate risk and 44 (46%) high risk. Hormone Therapy (HT) was administered in 98 patients (95%) in RAD and in 45 patients (47.8%) in POST-OP. Patients were treated with a three-dimensional conformal radiotherapy (3D-CRT). In RAD 15 (15%) were alive with disease (AWD), 5 (5%) dead of disease (DOD) and 10 (10%) dead of other cause (DOC); in POST-OP 14 (14.8%) were AWD, 2 (2%) DOD and 3 (3%) DOC. The prescription dose was 80 Gy in 2-Gy fractions in the RAD group, and 70 Gy in 2-Gy fractions in the POST-OP, respectively.RESULTS:No biochemical or clinical relapse was found in low risk patients in RAD group and 1 relapse in POST-OP group. The largest number of relapses occurred and in intermediate-high risk in RAD (39%) and POST-OP group (33%). In the cause-specific survival analysis no significant differences were found in high risk group between RAD and POST-OP (p = 0.9). In the biochemical relapse-free survival (bRFS) at 5 years analysis no significant differences were found in the high risk group between RAD and POST-OP (p = 0.1020).CONCLUSION:RT in RAD low- risk is very effectiva. RAD and POST-OP RT were well tolerated with a very low toxicity. The cause-specific survival at 5 years was 95% and 97% for the two groups of treatment, RAD and POST-OP respectively (Log-rank test p = 0.2908).

The burden of cancer is difficult to study in the context of the occupied Palestinian territory because of the limited data available. This study aims to evaluate the quality of mortality data and to investigate cancer mortality patterns in the occupied Palestinian territory's West Bank governorates from 1999 to 2009. Methods: Death certificates collected by the Palestinian Ministry of Health for Palestinians living in the West Bank were used. Direct and indirect age-standardised mortality rates were computed and used to compare different governorates according to total and specific cancer mortality. Furthermore, standardised proportional mortality ratios were calculated to compare mortality by urban, rural and camp locales. Results: The most common cause of death out of all cancer types was lung cancer among males (22.8 %) and breast cancer among females (21.5 %) followed by prostate cancer for males (9.5 %) and by colon cancer for females (11.4 %). Regional variations in cancer-specific causes of death were observed. The central- West Bank governorates had the lowest mortality for most cancer types among men and women. Mortality for lung cancer was highest in the north among men (SMR 109.6; 95%CI 99.5-120.4). For prostate cancer, mortality was highest in the north (SMR 103.6; 95%CI 88.5-120.5) and in the south (SMR 118.6; 95%CI 98.9-141.0). Breast cancer mortality was highest in the south (SMR 119.3; 95%CI 103.9-136.2). Similar mortality rate patterns were found in urban, rural and camp locales. Conclusion: The quality of the Palestinian mortality registry has improved over time. Results in the West Bank governorates present different mortality patterns. The differences might be explained by personal, contextual and environmental factors that need future in-depth investigations.

OBIETTIVI: stimare la prevalenza della broncopneumopatia cronica ostruttiva (BPCO) nella Provincia di Brindisi nel periodo 2005-2009. DISEGNO: utilizzo dei dati degli archivi sanitari correnti seguendo un approccio longitudinale.SETTING E PARTECIPANTI: sono stati inclusi come casi di BPCO per la stima della prevalenza: i soggetti di 35+ anni residenti nella Provincia di Brindisi dimessi dall'ospedale tra il 2005 e il 2009 con diagnosi principale o secondaria di BPCO; i soggetti dimessi nei 4 anni precedenti l'anno di stima della prevalenza, se vivi al 1 gennaio dello stesso anno; i soggetti deceduti per BPCO in ciascun anno di stima che non abbiano avuto ricoveri precedenti per BPCO. Le diagnosi ospedaliere di BPCO e le cause di morte per BPCO sono state identificate in base ai codici 490-492, 494 e 496 della Classificazione internazionale delle malattie - IX revisione (ICD-9-CM).PRINCIPALI MUSURE DI OUTCOME: tassi di prevalenza grezzi (TG) e standardizzati (TS) per età (per 100 residenti), distinti per genere, con intervalli di confidenza al 95% (IC95%).RISULTATI: la prevalenza di BPCO nella Provincia di Brindisi è stabile nel periodo considerato, con unTS intorno al 6,6%. I tassi più alti si osservano negli uomini e aumentano con l'età in entrambi i generi. Per le donne, i tassi di prevalenza sono più elevati tra le residenti nel capoluogo rispetto alle residenti nei comuni della Provincia, mentre per gli uomini la prevalenza è simile nelle due aree. CONCLUSIONI: i risultati dello studio mostrano una prevalenza di BPCO più elevata a Brindisi rispetto a quanto osservato in altre aree italiane, e variazioni spaziali e temporali nella prevalenza per genere tra capoluogo e altri comuni della Provincia, la cui interpretazione necessita di approfondimenti. La disponibilità di stime di prevalenza basate su ulteriori fonti informative potrà consentire una valutazione più accurata delle differenze osservate.

Purpose: To report on the use of an internal system for incident reporting. Patients and Methods: From October 2001 until June 2009, data on incidents were collected in the radiotherapy department (RT) by means of an incident reporting worksheet. The risk analysis was based on the US Navy method of mishap cause investigation, the Human Factors Analysis and Classification System (HFACS). Results: 37 incidents over 5,635 treatments were collected. Of the incidents, 20 involved deviation of the dose to the patient; only 6 showed clinical evidence of overdosage, while 2 of them showed permanent evidence of overdosage. There were 24 incidents that were classified as near misses (NM). Incorrect data input and use of an incorrect treatment field were the most common causes of the registered incidents. Reactive risk analysis showed how skill-based errors were associated with attention failure at the unsafe act level. Dose prescription and dose calculation are the most critical phases of the entire process. Most of the errors were discovered in set-up/treatment and during treatment visit/follow-up phases. The highest number of correction procedures was necessary in the phases of dose prescription and dose calculation. Conclusion: Collecting and analyzing internal incidents improves the operative procedures used in the department.

Congenital anomalies and their primary prevention are a crucial public health issue. This work aimedto estimate the prevalence of congenital anomalies in Brindisi, a city in southeastern Italy at high risk ofenvironmental crisis.Methods: This research concerned newborns up to 28 days of age, born between 2001 and 2010 to mothersresident in Brindisi and discharged with a diagnosis of congenital anomaly. We classified cases according to thecoding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT).Prevalence rates of congenital anomalies in Brindisi were compared with those reported by EUROCAT. Logisticregression models were adapted to evaluate the association between congenital anomalies and municipality ofresidence of the mother during pregnancy.Results: Out of 8,503 newborns we recorded 194 subjects with congenital anomalies (228.2/10,000 total births), 1.2times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenitalheart diseases with an excess of 49.1%. Odds Ratios for congenital heart diseases significantly increased fornewborns to mothers resident in Brindisi (OR 1.75 CI 95% 1.30-2.35).Conclusions: Our findings indicated an increased prevalence of Congenital Anomalies (especially congenital heartdiseases) in the city of Brindisi. More research is needed in order to analyze the role of factors potentially involvedin the causation of congenital anomalies.

Maternal exposure to ambient pollution has been increasingly linked to the risk of congenital anomalies (CAs) in the fetus and newborns. Recently, a descriptive study in the high environmental risk city of Brindisi (Italy) revealed an increased prevalence of total CM, especially congenital heart disease (CHD) and ventricular septal defects (VSDs), both at the local level and in comparison with the pool of EUROCAT registries. This paper concerns a population-based case control study to investigate the association between maternal exposure to air pollutants - sulfur dioxide (SO2) and total suspended particulate (TSP) matter - and the risk of CA. Cases were newborns up to 28 days of age, born to mothers resident in Brindisi between 2001 and 2010, and discharged with a diagnosis of CA. Cases and controls were individually matched according to sex, socio-economic status of the census area of residence of the mother, and year of beginning of pregnancy. Up to four controls were extracted for each case. Concentration data from monitoring stations were used to estimate air pollution exposure. Each case and control was assigned pollutant concentration values as mean and 90th percentile of the daily average values during weeks 3-8 of pregnancy. Exposure as both continuous and categorical variables was considered and a conditional logistic regression model was constructed to quantify the odds ratios of exposure to air pollutants and the occurrence of total CAs, CHDs and VSDs.

Maternal exposure to ambient pollution has been increasingly linked to the risk ofcongenital anomalies (CAs) in fetus and newborns. Recently, a descriptive study(Gianicolo et al., 2012) revealed an increased prevalence of total CAs and in particular,congenital heart diseases (CHDs) and ventricular septal defects (VSDs) in Brindisi,both at local level and in comparison with the pool of EUROCAT registries. Due to thepresence of many sources of pollution near the urban area, in the 1980s, Brindisi andsurrounding municipalities were identifi ed by the Italian Ministry of Environment asan "area at high risk of environmental crisis". Epidemiological studies have revealedseveral critical situations in terms of increasing rates of mortality and morbidity directlyor potentially associated with environmental and occupational exposure to pollutants.This population-based case-control study investigated the association of maternalexposure to air pollutants sulfur dioxide (SO2) and total suspended particulate matter(TSP) with the risk of CA. Cases were newborns to mothers residing in Brindisi between2001 and 2010, up to 28 days of age, and discharged with a diagnosis of CA. Casesand controls were individually matched according to sex, socioeconomic status ofthe census area of residence of the mother, and year of conception. Four controlswere extracted for each case. Concentration data from monitoring stations datawere used to estimate air pollution exposure. Each case and control were assignedpollutant concentration values (weeks 3-8 of pregnancy). Exposure as both continuousand categorical variable was considered and a conditional logistic regression modelwas constructed to quantify the odds ratios of exposure to air pollutants and theoccurrence of total CAs, CHDs and VSDs. We found exposure to SO2 to be associatedwith CHDs and VSDs. Findings for TSP were less consistent.

Introduction Congenital anomalies (CAs) and their primary prevention are a public health issue and both genetic and environmental factors can contribute to their causation. Brindisi is an area "at high risk of environmental crisis". This work aimed at estimating the prevalence of CAs and at evaluating possible association with air pollution.Materials and methods Newborns up to 28 days of age, born between 2001 and 2010 to mothers resident in Brindisi and discharged with a diagnosis of CA have been considered. We classified cases according to the coding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT). We classified cases in the following categories: total CAs, congenital heart disease (CHDs) and other CAs according to the coding system adopted by EUROCAT. We classified CHDs in three classes according to their severity. Prevalence rates of CAs in Brindisi were compared with those reported by EUROCAT. Logistic regression models were adapted to evaluate the association between CAs and municipality of residence of the mother during pregnancy. Total suspended particles, nitrogen and sulfur dioxides were routinely monitored over the ten years. Exposition was then estimated from air quality monitors data as averages and percentiles over pregnancy 3rd-8th weeks. Results and discussion Out of 8,503 newborns we recorded 194 subjects with CAs (228.2/10,000 total births), 1.2 times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenital heart diseases (CHDs) with an excess of 49.1%. Odds Ratios for CHDs significantly increased for newborns to mothers resident in Brindisi. Out of 83 cases with CHD, we observed 9 cases (10.8%) with medium probability of perinatal mortality (Severity II) and 69 cases (83.1%) with low probability of perinatal mortality (Severity III). No case with high probability of perinatal mortality was registered. Five cases (6%) were not classified because of a poorly specified code. Two cases of CHDs (2.4%) were associated with a chromosomal anomaly. Among 109 cases with CAs observed from 2001 to 2005, 59.6% presented further hospital admissions; of these 38.5% reported the same diagnosis of CAs observed in the first 28 days of life. Our findings indicated an increased prevalence of CAs (especially CHDs) in the city of Brindisi.Averaged exposition for CA cases showed slightly higher values than that for newborns without CA. A case-control analysis might give more detailed results. More research in terms of etiological studies is needed, in order to analyze the role of different risk factors in the possible causation of CAs and to identify the best strategies for primary prevention.

Evaluating the extent of exposure to chemicals in absence of continuous measurements of their concentration in air and direct measures of personal exposure is crucial for epidemiological studies. Dispersion models can be a useful tool for reproducing spatio-temporal distribution of contaminants emitted by a specific source. However, they cannot easily be applied to short-term epidemiological studies because they require precise information on daily emission scenarios for a long time, which are generally not available. The aim of this study was to better assess the exposure in the industrial area of Brindisi, which suffers from various critical epidemiological situations, by integrating air pollution concentration data, emissions and model simulations concerning a specific point source. The results suggest that in the absence of direct exposure data and detailed information on specific pollutants associated to an emission, population exposure may be better assessed by taking into account proxy pollutants and the wind (direction and speed) as a potential health effects modifier.

Several studies have shown that common carotid intima-media thickness (IMT) is increased after radiotherapy (RT) to the head and neck. However, further studies are needed to define the exact mechanism of radiation-induced injury in large vessels, investigate the relationship between radiation dose and large vessel injury and evaluate the rate of progress of atherosclerosis in irradiated vessels. Objectives: To investigate whether external irradiation to the carotid area has any effect on IMT of the common carotid artery in a group of patients who received RT vs control group matched for age, gender and race. Methods: We studied 19 patients (10 male; 47.8 ± 17.4 years) during a 5-month period (January 2009-July 2009); they had completed RT with a mean of 2.9 years before (range: 1 month-6 years) The mean radiation dose to the neck in the irradiated patients was 41.2 ± 15.6 Gy (range: 25-70 Gy). Common carotid IMT was measured with echo-color Doppler. Nineteen healthy adult patients (10 male; 47.8 ± 17.6) were recruited as a control group. Results: IMT was not significantly higher in patients when compared to the control group (0.59 ± 0.16 vs 0.56 ± 0.16 mm, p = 0.4). There was no significant difference between the two groups in relation to the absence (p = 0.7) or presence (p = 0.6) of vascular risk factors. Although the difference did not reach statistical significance (p = 0.1), the irradiated young patients (age ! 52 years) had IMT measurements higher (0.54 ± 0.08 mm) than the nonirradiated young patients (0.49 ± 0.14 mm). The mean carotid IMT increased with increasing doses of radiation to the neck (p = 0.04). Conclusion: This study shows that increased IMT of the common carotid artery after RT is radiation-dose-related. Therefore it is important to monitor IMT, which can be used as an imaging biomarker for early diagnosis of cerebrovascular disease in patients who have had radiotherapy for treatment of cancer of the head and neck and who are at incre

Presentiamo il secondo contributo sul progettoManfredoniaAmbiente e Salute, una indagineepidemiologica basata su un approccio partecipativo avviata nel febbraio 2015.Un grave incidente industriale accaduto nel 1976, durante il quale diverse tonnellatedi arsenico si sono riversate nell'ambiente circostante causando problemi ambientali,ha generato sfiducia e sospetto verso le istituzioni, sentimenti ancora vivi nellasocietà civile.Il Progetto si basa su un forte impegno pubblico in ogni fase della ricerca epidemiologica.In questo articolo riportiamo la seconda fase dello studio, nella quale gli stakeholderdefiniscono i quesiti a cui l'indagine deve rispondere e prendono in considerazione tuttii possibili risultati e le implicazioni in termini di piani d'azione per la salute. Si tratta diun passo importante per riconoscere i limiti dello studio epidemiologico dovuti alle incertezzee assicurare trasparenza nei processi decisionali.

Uno studio di coorte americano stima che, su 600.000 persone con meno di 15 anni sottoposte a tomografia computerizzata (TC) alla testa o all'addome, sono 500 i casi di tumoreattribuibili all'esposizione a radiazioni ionizzanti a scopo diagnostico.La presente revisione sintetizza le evidenze sull'associazionetra esposizione a radiazioni ionizzanti da TC erischio di tumore. Sono stati trovati 5 studi di coorte; tre mostranochiari incrementi di rischio tra bambini e adolescentisottoposti ad almeno una TC. Tutti gli studi presentavano limitimetodologici, tra i quali l'assenza di una stima individualedella dose specifica per organo ricevuta dal paziente eproblemi di potenza statistica. I risultati di studi internazionalidi larghe dimensioni in corso permetteranno una migliorestima del rischio.Parole chiave: tomografia computerizzata, tumore, bambini,adolescenti, studio di coorte

Purpose: To evaluate the probability of late cardiac mortality resulting from left breast irradiation planned with tangential fields and to compare this probability between the wedged beam and field-in-field (FIF) techniques and to investigate whether some geometric/dosimetric indicators can be determined to estimate the cardiac mortality probability before treatment begins. Methods and Materials: For 30 patients, differential dose volume histograms were calculated for the wedged beam and FIF plans, and the corresponding cardiac mortality probabilities were determined using the relative seriality model. As a comparative index of the dose distribution uniformity, the planning target volume (PTV) percentages involved in 97-103% of prescribed dose were determined for the two techniques. Three geometric parameters were measured for each patient: the maximal length, indicates how much the heart contours were displaced toward the PTV, the angle subtended at the center of the computed tomography slice by the PTV contour, and the thorax width/thickness ratio. Results: Evaluating the differential dose volume histograms showed that the gain in uniformity between the two techniques was about 1.5. With the FIF technique, the mean dose sparing for the heart, the left anterior descending coronary artery, and the lung was 15% (2.5 Gy vs. 2.2 Gy), 21% (11.3 Gy vs. 9.0 Gy), and 42% (8.0 Gy vs. 4.6 Gy) respectively, compared with the wedged beam technique. Also, the cardiac mortality probability decreased by 40% (from 0.9% to 0.5%). Three geometric parameters, the maximal length, angle subtended at the center of the computed tomography slice by the PTV contour, and thorax width/thickness ratio, were the determining factors (p = .06 for FIF, and p = .10 for wedged beam) for evaluating the cardiac mortality probability. Conclusion: The FIF technique seemed to yield a lower cardiac mortality probability than the conventional wedged beam technique. However, although our study demonstrated that FIF technique improved the dose coverage of the PTV, the restricted number of patients enrolled and the short follow-up did not allow us to evaluate and compare the breast cancer survival rates of the patients

Purpose. The aim of the study was to retrospectively compare outcome and complications of prostate cancer patients treated with a curative and postoperative intent using a pretreatment defined NCCN classification.Material and methods. A total of 103 patients was treated curatively (RAD) and 94 postoperatively (POST-OP). The mean age was higher in the RAD group (72.6 years; range, 56.4-85.1) than in the POST-OP group (65.4 years; range, 43.9-77) (P <0.0001). According to the NCCN prognostic classification, 13 (12%) patients were at low risk, 48 (47%) at intermediate risk and 42 (41%) at high risk in the RAD group. In the POST-OP group, 13 (14%) patients were low risk, 37 (40%) at intermediate risk and 44 (46%) at high risk. Hormone therapy was used in 98 patients (95%) in the RAD group and 45 patients (47.8%) in the POST-OP group. Patients were treated with three-dimensional conformal radiotherapy. The prescription dose was 80 Gy in 2-Gy fractions in the RAD group and 70 Gy in 2-Gy fractions in the POST-OP.Results. No biochemical, clinical relapse was found in low-risk patients in the RAD group and 1 relapse was found in the POST-OP group. The largest number of relapses occurred (39%) and (33%) in intermediate-high risk in RAD and POST-OP groups, respectively. In the cause-specific survival analysis, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.9). In the analysis of 5-year biochemical relapse-free survival, no significant differences were found in the high-risk group between RAD and POST-OP groups (P = 0.1020).Conclusions. Radiotherapy in the RAD low-risk group was an excellent treatment. RAD and POST-OP radiotherapy were well tolerated with very low toxicity. The cause-specific survival at 5 years was 95% and 97% for the two treatment groups, RAD and POST-OP, respectively (logrank test, P = 0.2908).

Pubblicare studi sulla relazione fra salute e inquinamento suscita reazioni e interesse nell'opinione pubblica coinvolta, fino alle più alte istituzioni nazionali. Questo intervento, ispirato da una discussione parlamentare che ha riguardato anche un nostro recente articolo scientifico pubblicato su Environmental Research sull'associazione tra anomalie congenite e esposizione materna ad alcuni inquinanti atmosferici nella città di Brindisi, si propone di contribuire a rispondere ai seguenti quesiti: la tipologia e la qualità dei dati utilizzati nelle stime di esposizione deve essere certificata da organismi istituzionali? Si possono escludere effetti sanitari negativi in popolazioni esposte a inquinanti entro i limiti di legge? In conclusione, vengono espresse alcune considerazioni sulle misure a tutela della salute pubblica e sulla relazione fra l'operato dei ricercatori pubblici e le istituzioni.

OBIETTIVO: valutare gli effetti a breve termine dell'inquinamentoatmosferico sulla mortalità nelle 25 città italiane partecipantialla seconda fase del progetto EpiAir (Sorveglianzaepidemiologica dell'inquinamento atmosferico: valutazionedei rischi e degli impatti nelle città italiane).DISEGNO: studio di serie temporali con metodologia casecrossover,con aggiustamento per i fattori temporali emeteorologicirilevanti. L'associazione inquinamento atmosferico-mortalitàè stata analizzata per ciascuna delle 25 città in studio.Gliinquinanti considerati sono stati il particolato (PM10 e PM2.5),il biossido di azoto (NO2) e l'ozono (O3 estivo). Le stime complessivedi effetto sono state ottenute successivamentemedianteunametanalisi e sono state espresse per incrementi di 10 ?g/m3delle concentrazioni di inquinanti. Sono stati implementatimodellimono e bi-pollutant.SETTING E PARTECIPANTI: lo studio ha analizzato 422.723decessi verificatisi tra i residenti di 35 anni o più nelle 25città in studio per gli anni 2006-2010.PRINCIPALI MISURE DI OUTCOME: sono stati considerati iconteggi giornalieri di decessi per cause naturali, tra cui lecause cardiache, cerebrovascolari e respiratorie. Le informazionisulle cause di morte sono state ottenute dai Registridelle cause di morte delle singole città.RISULTATI: il numeromedio annuo di decessi per cause naturalivaria da 513 a Rovigo e 20.959 a Roma. Circa il 25% dellemorti è dovuto a cause cardiache, il 10%a cause cerebrovascolarie il 7%a cause respiratorie. Per incrementi di 10 ?g/m3 di PM10si osserva un effetto immediato sullamortalità naturale (0,51%;IC95%0,16-0,86; lag 0-1)..Effetti più importanti e prolungati(lag 0-5) si osservano per il PM2.5 (0,78%; IC95%0,12-1,46)e soprattutto per l'NO2 (1,10%; IC95%0,63-1,58). Incrementidellamortalità cardiaca sono associati al PM10(0,93%; IC95%0,16-1,70) e al PM2.5 (1,25%; IC95%0,17-2,34), mentre perla mortalità respiratoria l'effetto dell'esposizione a NO2 risultapiù importante (1,67%; IC95%0,23-3,13; lag 2-5) rispetto aquella a PM10 (1,41%; IC95%-0,23;+3,08).I risultati sono fortemente omogenei tra città per la mortalitàcardiaca e cerebrovascolare, ma non per quella respiratoria.Non si riscontrano effetti sulla mortalità cerebrovascolare.L'effetto dell'O3 sulla mortalità è al limite dellasignificatività statistica.CONCLUSIONI: lo studio conferma un chiaro incrementodellamortalità associata agli inquinanti atmosferici. Risultanopiù importanti gli effetti degli inquinanti correlati al trafficoautoveicolare, qualiNO2 (permortalità naturale) e PM2.5 (permortalità cardiaca e respiratoria), con un ruolo indipendentedi NO2 rispetto al particolato in base all'analisi bi-pollutant.

OBIETTIVO: valutare la relazione tra inquinamento atmosfericoe ricoveri ospedalieri nelle città italiane partecipanti allaseconda fase del progetto EpiAir (Sorveglianza epidemiologicadell'inquinamento atmosferico: valutazione dei rischie degli impatti nelle città italiane).DISEGNO: studio di serie temporali con metodologia casecrossover,con aggiustamento per i fattori temporali e meteorologicirilevanti. L'associazione inquinamento atmosferico-ospedalizzazioni è stata analizzata in ciascuna delle 25città in studio, le stime complessive di effetto sono state ottenutesuccessivamente mediante una metanalisi. Gli inquinanticonsiderati sono stati il particolato (PM10), il biossidodi azoto (NO2) e l'ozono (O3), quest'ultimo limitatamenteal semestre estivo (da aprile a settembre). In 13 città in cuii dati erano disponibili è stata analizzata anche la frazionefine del particolato (PM2.5).SETTING E PARTECIPANTI: lo studio ha esaminato 2.246.448ricoveri ospedalieri urgenti per cause naturali di pazienti residentie ricoverati, nel periodo 2006-2010, in 25 città italiane,di cui 10 già partecipanti alla prima fase del progettoEpiAir (2001-2005).PRINCIPALIMISURE DI OUTCOME: sono stati considerati i ricoveriospedalieri urgenti per malattie cardiache, cerebrovascolarie respiratorie per tutte le fasce di età. I ricoveri percause respiratorie sono stati analizzati separatamente ancheper la fascia di età 0-14 anni. L'esposizione è stata valutataper incremento sia di 10 ?g/m3 sia pari all'intervallo interquartile(IQR) della concentrazione di ciascun inquinante.RISULTATI: considerando un incremento di 10 ?g/m3 per inquinante,per il PM10 è stato osservato un incremento percentualedi rischio per patologie cardiache dello 0,34%a lag0 (IC95% 0,04-0,63), e per patologie respiratorie dello0,75% a lag 0-5 (IC95% 0,25-1,25). Per il PM2.5 l'incrementopercentuale di rischio per patologie respiratorie è risultatodell'1,23%a lag 0-5 (IC95%0,58-1,88). Per l'NO2la stima di effetto per patologie cardiache è risultata dello0,57% a lag 0 (IC95% 0,13-1,02), e per patologie respiratoriedell'1,29% a lag 0-5 (IC95% 0,52-2,06). L'ozononon è risultato positivamente associato né alle patologie cardiachené a quelle respiratorie (a differenza del periodo2001-2005).CONCLUSIONE: i risultati dello studio confermano l'effettoa breve termine dell'inquinamento atmosferico da PM10,PM2.5 e NO2 sulla morbosità, in particolare respiratoria,nelle città italiane. Non sono state rilevate associazioni positiveper l'O3.Parole

Epidemiological studies often assume that air pollution is spatially homogeneous within urban areas and estimate population exposure by using monitored data from averaged data from a few stations. This approach may present critical issues in industrialised areas, characterized by huge emissions. The purpose of this work is to study time-space variability of pollutants in order to refine population exposure and consequent health effects assessment. Time series of meteorological and pollution data (SO2, NO2 and PM10) measured in different sites within two industrialised cities are analysed through descriptive and statistical analyses. Results show inhomogeneous impact of the industrial and harbour sites on separate areas of cities, especially regarding SO2 data rather than PM10 values, showing higher concentration values downwind the higher emission sites. Implications on population exposure assessment are discussed.

OBJECTIVES:The purpose of this study was to investigate the role of various predictors to explain spatial mortality heterogeneity in Taranto.METHODS:Direct age-adjusted death rates (ADR) at a neighbourhood level for the period 1998-2010 were examined. SO2, PM10, distance from pollution sources, and socioeconomic status (SES) were tested as predictors within a meta-regression framework. We used ? (2) to quantify heterogeneity in ADR and I (2) statistic with 95 % confidence intervals to estimate the proportion of total variation across neighbourhoods attributable to the between-neighbourhood heterogeneity.RESULTS:High heterogeneity resulted for all and natural causes of death for both genders. One neighbourhood (Paolo VI) was detected as an outlier for all predictors except SO2, among males. After accounting for SES, moderate heterogeneity among residuals was observed for all-causes of death and was correlated with SO2. Higher concentrations of PM10 were observed in neighbourhoods close to the industrial site and higher concentrations of SO2 in neighbourhoods more distant from the industrial site.CONCLUSIONS:SES and air pollutants were predictors of spatial heterogeneity in ADR. Different distributions of SO2 and PM10 in the city suggested two exposure patterns.

The evaluation of the health effects of low-dose ionizing radiation has always been a focus of debate and investigation within the scientific community. During the last decade, epidemiological studies providedevidence that an excess risk of cardiovascular diseases (CVDs) can be associated with moderate and low dose radiation. The precise quantification of CVD risk in the low-dose radiation range (<500 mSv) is notwell characterized, and it is unclear whether there is a threshold dose below which there is no risk. A limited number of studies with imaging surrogate endpoints and cardiovascular biomarkers in asymptomaticpatients revealed early signs of cardiovascular alterations, even at a low dose. In vitro studies have shown that several mechanisms, including endothelial dysfunction, inflammation, oxidative stress,alterations of coagulation and platelet activity may have a relevant role in radiation-induced cardiovascular effects.Exposure to high-dose data in experimental models accelerates the development of atherosclerosis, predisposing to the formation of an inflammatory, thrombotic plaque phenotype, especially in animalsthat are genetically predisposed to this disease. On the contrary, low dose exposure produced both protective and detrimental effects, suggesting that multiple mechanisms may influence radiation-induced atherosclerosis. However, only very limited and specific information can be obtained from cell cultures and animal models. Planned studies of radiation-exposed cohorts need to be conducted to explore biological mechanisms of low-dose radiation-associated cardiovascular disease. Further investigations with functional imaging to assess vascular function and cardiovascular biomarkers have great potential for providing new insights into low-dose radiation cardiovascular risk, especially in occupational exposure and modern medicine.

PURPOSE:To analyse temporal changes of B-type natriuretic peptide (BNP) used as index of heart remodeling in left-sided breast cancer patients after radiotherapy (RT) and its relationship with dosimetric parameters.METHODS AND MATERIALS:BNP and dose-volume parameters for heart and ventricle were collected in 59 patients (median age 58.0 years) during a 1-year follow-up. Biochemical measurements were performed before the RT treatment (T0), at 15 days during RT (T15day), at the end of RT (TendRT), and then at 1, 3, 6, 9, 12 months (T1, T3, T6, T9, and T12). A logistical regression analysis was performed to identify demographic characteristics, dosimetric variables and risk factors associated with increased values of BNP.RESULTS:The ratio between the BNP value at T12 and the BNP value at T0 (BNPT12/BNPT0 ) increased significantly (p < 0.01). A significant association was found between the variation of BNP values after 1 year and the isodose received by 50% of the volume (D50% (Gy)) both to the heart (p = 0.03) and ventricle (p = 0.04) Conclusions: BNP plasma levels could provide additional information about subclinical RT-induced cardiotoxicity earlier than traditional ecocardiographic data.

The GSTP1 gene, highly expressed early in fetal life, is the most abundant phase 2 xenobiotic metabolism enzyme in a human placenta. Fetal inherited GSTP1 Ile105Val polymorphism may modify the metabolism and excretion of xenobiotics from fetal tissue and increase the risk of congenital heart disease (CHD). This study aimed to analyze the joint effects of GSTP1 genetic polymorphism (Ile105Val) and maternal environmental exposure on CHD risk. Within a case-control design, a total of 190 children with CHD (104 boys age 4 +/- A 5.6 years) and 190 healthy children (114 newborn boys) were genotyped for the GSTP1 Ile105Val polymorphism. Mothers completed a structured questionnaire on the demographics as well as the preconceptional and lifestyle exposures. A higher frequency of mothers of children with CHD (38 %) reported a positive history of exposure to toxicants (occupational and environmental) than mothers of healthy children (23 %) (p = 0.0013). Logistic regression analysis showed that maternal occupational and environmental exposures increased the risk of CHD (odds ratio, 2.6; 95 % confidence interval, 1.6-4.2; p < 0.0001). No significant differences in Ile105Val genotype frequencies were observed between the children with CHD and the healthy children (p = 0.9). Furthermore, case-control analysis showed no evidence of significant interaction between the maternal exposures and GSTP1 polymorphism. Maternal exposure to toxicants increased the risk of children with CHD. However, fetal GSTP1 Ile105Val polymorphism did not increase the risk of CHD.

On September 26th 1976 in Manfredonia (Italy), a mixture containing arsenic compounds was released into the atmosphere due to an accident in a fertilizer production plant. 39 years later, the municipality promoted an epidemiological study to investigate possible long-term health effects in the population. Aim of this work is to reconstruct dispersion of the cloud to estimate population exposure to the arsenic release. A participatory research approach was implemented with a group of citizens which supported every phase of the research, providing data and information on the event and territory. Cloud dispersion was simulated with the RAMS/CALMET/CALPUFF modeling system. Meteorological measurements and arsenic deposition data in soils around the town were used to test the model inputs. The modelling system is capable to reproduce the mean flow and dispersion with some uncertainties due to the hypothesis on the release characterization. Comparison with the deposition data shows that area affected by fallout is larger than it was supposed to in the days following the accident. This is partially confirmed by arsenic deposition data collected some months after the accident. The case study confirms the need to run a dispersion model during the early phase of an accident and to collect contamination data consequently. Otherwise, the real extension of contamination can be underestimated leading to a misclassification of exposure. Participatory approach allowed a better reconstruction both of meteorology and accident dynamic

IntroductionOn September 26th 1976, in Manfredonia, Italy, a mixture containing arsenic compounds was released into the atmosphere due to an accident in a fertilizer production plant. 40 years later, the municipality promoted an epidemiological programme to investigate possible long-term health effects in the population.Aim of this work is to estimate population exposure to arsenic, taking into account uncertainties on the accident dynamics by using a dispersion model with different setup initial conditions.MethodsContaminant dispersion was estimated with the CALPUFF model initialized with a meteorological model. Meteorological data were not available at the plant location but only at two Air Force weather stations, a few kilometers away. Evaluation of the meteorological model was performed with data available on the same day and with data available in later years in similar synoptic conditions. Different hypothesis on puff vertical release, puff status and composition were assumed from direct testimonies, documental and literature information. We used measured arsenic deposition in soils around the town to test the model inputs.ResultsMeteorological model during the accident evidences complex mountain/sea breeze circulations under high-pressure synoptic conditions. It matches the nearby meteorological station records. Results indicate that the model is capable to reproduce the mean flow and dispersion with some uncertainties due to the hypothesis on the release characterization.ConclusionsFor the first time an up-to-date dispersion model was used and integrated with environmental data, testimonies and proxies to assess the population exposure during the Manfredonia accident. Uncertainties of results should be taken into account in the epidemiological study. The case study confirms the need to collect data on concentration and dispersion of released chemicals during the early phase of an accident, considering the difficulties in collecting them in a late phase.

Objectives Taranto, a city in south-eastern Italy, suffersserious environmental pollution from industrial sources. Aprevious cohort analysis found mortality excesses amongneighbourhoods closest to industrial areas. Aim of thisstudy was to investigate whether mortality also increased inother neighbourhoods compared to Apulia region.Methods Standardized mortality ratios were computed.Number of deaths and of person-years at risk by neighbourhoodcame from the previous cohort study for1998-2008 period. Reference population was Apuliaregion excluding Taranto province. A meta-analysis wasconducted across less close neighbourhoods computingsummary SMR estimates and evaluating heterogeneity.Results For the entire city higher mortality values areconfirmed for all causes, all malignant neoplasms andseveral specific sites, neurological, cardiac, respiratory anddigestive diseases. High mortality values are not confinedto neighbourhoods closest to industrial areas for lungcancer, cardiac, respiratory and digestive diseases, in bothsexes, and among women for all malignant neoplasms andpancreatic cancer.Conclusions Increased mortality risks can also beobserved in Taranto neighbourhoods not directly adjacentto industrial areas. Spatial trend, impact of socio-economicfactors and

OBIETTIVI:valutare l'andamento temporale della mortalità per patologie respiratorie nelle province pugliesi utilizzando dati omogenei per fonte e metodologia di calcolo.DISEGNO:analisi ecologica storica degli andamenti temporali di mortalità per tumori e patologie dell'apparato respiratorio nelle province pugliesi, in Puglia e nelle ripartizioni geografiche italiane dal 1933 al 2010.SETTING E PARTECIPANTI:i dati di mortalità e le popolazioni residenti sono di fonte Istat. Sono state esaminate tutte le cause di decesso, il tumore della laringe, il tumore del polmone, l'insieme dei tumori respiratori, la bronchite, la polmonite e la broncopolmonite considerate congiuntamente, e l'insieme delle patologie respiratorie. Le analisi sono disaggregate per sesso dal 1969.PRINCIPALI MISURE DI OUTCOME:rapporti standardizzati di mortalità (SMR%) in riferimento all'Italia, con intervalli di confidenza al 95%, e tassi di mortalità standardizzati col metodo diretto (TSD ) in riferimento alla popolazione standard europea.RISULTATI:dal 1933 al 2010, i TSD per tumori respiratori e per bronchiti diminuiscono in tutte le aree analizzate. Tuttavia, nelle province di Taranto, Brindisi e Lecce, l'SMR% per tumori respiratori, inferiore al riferimento nazionale fino agli anni Sessanta, si allinea (a Brindisi) e supera (a Lecce e Taranto) il riferimento negli anni successivi. Nelle province di Foggia e Bari il numero dei decessi per tumore del polmone è costantemente inferiore all'atteso.CONCLUSIONI:la ricostruzione storica e l'analisi dei trend temporali di mortalità dal 1933 al 2010 mostrano alcune criticità sanitarie in periodi specifici. L'elaborazione dei dati di mortalità per un arco temporale di circa 80 anni ha messo in evidenza la maggiore rilevanza di queste criticità con l'avvio dello sviluppo industriale.

Purpose: Adjuvant radiotherapy (RT) after breast-conserving surgery has been associated with increased cardiovascular mortality. Cardiac biomarkers may aid in identifying patients with radiation-mediated cardiac dysfunction. We evaluated the correlation between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin (TnI) and the dose of radiation to the heart in patients with left-sided breast cancer. Methods and Materials: NT-proBNP and TnI plasma concentrations were measured in 30 left-sided breast cancer patients (median age, 55.0 years) 5 to 22 months after RT (Group I) and in 30 left-sided breast cancer patients (median age, 57.0 years) before RT as control group (Group II). Dosimetric and geometric parameters of heart and left ventricle were determined in all patients of Group I. Seventeen patients underwent complete two-dimensional echocardiography. Results: NT-proBNP levels were significantly higher (p = 0.03) in Group I (median, 90.0 pg/ml; range, 16.7-333.1 pg/ml) than in Group II (median, 63.2 pg/ml; range, 11.0-172.5 pg/ml). TnI levels remained below the cutoff threshold of 0.07 ng/ml in both groups. In patients with NT-proBNP values above the upper limit of 125 pg/ml, there were significant correlations between plasma levels and V 3Gy(%) (p = 0.001), the ratios D15 cm3(Gy)/ Dmean(Gy) (p = 0.01), the ratios D 15cm 3/D 50% (Gy) (p = 0.008) for the heart and correlations between plasma levels and V 2Gy (%) (p = 0.002), the ratios D1 cm3( Gy)/Dmean(Gy) (p = 0.03), and the ratios D0. 5cm3(Gy)/ D50%(Gy) (p = 0.05) for the ventricle. Conclusions: Patients with left-sided breast cancer show higher values of NT-pro BNP after RT when compared with non-RT-treated matched patients, increasing in correlation with high doses in small volumes of heart and ventricle. The findings of this study show that the most important parameters are not the mean doses but instead the small percentage of organ volumes (heart or ventricle) receiving high dose levels, supporting the notion that the heart behaves as a serial organ

Cancer incidence increases with age and several cancer types are observed in older patients, so the need for radiotherapy (RT) in treatment of older patients with cancer is also on the rise. This study's aims to evaluate retrospectively the pattern of care and the feasibility of RT in elderly patients (80 years old and over) treated with different intents, and the impact of RT prescription on survival. Materials and Methods. We reviewed 191 patient charts from the years 2005-2007, recording age, intent of treatment, site, and type of RT. Crude and actuarial survival were estimated. Results. One hundred patients were males (M) and 91 females (F); 162 were seen on an outpatient basis, 29 as inpatients. A total of 138 patients were recruited for RT; 113 were treated, 112 completed RT. The ratio to all treated patients was 113/2125 (5.3%). Overall (treated and non-treated) cumulative survival probability was 71% for the first year, 45% for the second and 27% for the third. For treated patients, the cumulative survival probability was 67% for the first year, 43% for the second year and 23% for the third year, while for untreated patients it was 76% for the first year, 47% for the second year and 32% for the third year (Log-rank test: p = 0.23). Conclusions. RT did not decrease survival in elderly patients.

A group of researchers of public national research council cooperated with different CSOs and authorities to debate and research on pollution and health risk evaluation, knowledge, and decision making. They are committed on such themes and were involved at different stages (scientific knowledge dissemination, debates, legal issues, education, and research).Can it the beginning for a science shop ?

The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestiveof cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas.For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding byindication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.

Epidemiological studies have reported adverse associations between long-term exposure to ambient particulate matter (PM<inf>2.5</inf>) and several health outcomes. One issue in this field is exposure assessment and, in particular, the role of secondary PM<inf>2.5</inf>, often neglected in environmental and health risk assessment. Thus, the aim of this work was to evaluate the long-term environmental and health impact of primary and secondary PM<inf>2.5</inf> concentrations originating from a single industrial source. As a case study, we considered a coal power plant which is a large emitter of both primary PM<inf>2.5</inf> and secondary PM<inf>2.5</inf> precursors. PM<inf>2.5</inf> concentrations were estimated using the Calpuff dispersion model. The health impact was expressed in terms of number of non-accidental deaths potentially attributable to the power plant. Results showed that the estimated secondary PM<inf>2.5</inf> extended over a larger area than that related to primary PM<inf>2.5</inf> with maximum concentration values of the two components well separated in space. Exposure to secondary PM<inf>2.5</inf> increased significantly the estimated number of annual attributable non-accidental deaths. Our study indicates that the impact of secondary PM<inf>2.5</inf> may be relevant also at local scale and ought to be considered when estimating the impact of industrial emissions on population health.

The Brindisi area is characterized by the presence of industries with high environmental impact, located along its eastern border. Epidemiological studies have revealed several critical situations: two short-term (2003-2005) epidemiological studies have shown that PM(10) and NO(2) are adversely associated with daily hospital admissions: one of the two pointed to the associations with wind blowing from the southern, eastern and western sectors. This study aims to expand the time span of available air quality data in order to provide a more complete and extensive epidemiological study. Multi-year series (from 1992 to 2007) of SO(2), NO(2), and TSP concentration data are presented and analyzed. Data show a significant downward trend of SO(2) from 1992 to 2007, while for the TSP series, the downward trend is limited to the period 1992-1994. Marked seasonal trends are evident for all three pollutants, especially for NO(2) and TSP. The NO(2) series shows higher levels in winter. Inversely, the TSP series shows its maximum values during the summer months, associated with a moderate correlation with temperature and a poor correlation with other pollutants. Analysis of the series for wind sectors revealed the influence of the industrial site and of the harbor. The concentration series exhibit high concentration values and stronger correlations between them and with meteorology for wind blowing from the eastern sectors. Overall analysis supports the hypothesis of a different origin for TSP during the year and for different wind regimes and therefore possible size and chemical differences in TSP, which should be further investigated due to their health implications.

Cigarette smoking is a powerful human germ cell mutagen and teratogen. Congenital heart defects (CHD) are the most prevalent of all birth defects and leading cause of death in the first year of life. The purpose of this article is to review the epidemiology of the impact of cigarette smoking on CHD risk as well as to discuss the potential biological mechanisms of smoking-mediated abnormal cardiac development. Although epidemiological studies of association between parental smoking and CHD are limited, biological evidence supports the concept that cigarette smoking may substantially contribute to the aetiology of CHD through induction of either male and female germ-cell mutation or interference with epigenetic pathways. Further research is needed to better define the relationship between parental smoking and the risk of heart defects as well as to assess parental-fetal gene-smoking interactions.

Epidemiological studies typically use monitored air pollution data from a single station or as averaged data from several stations to estimate population exposure. In industrialized urban areas, this approach may present critical issues due to the spatial complexities of air pollutants which are emitted by different sources. This study focused on the city of Taranto, which is one of the most highly industrialized cities in southern Italy. Epidemiological studies have revealed several critical situations in this area, in terms of mortality excess and short-term health effects of air pollution. The aims of this paper are to study the variability of air pollutants in the city of Taranto and to interpret the results in relation to the applicability of the data in assessing population exposure. Meteorological and pollution data (SO2, NO2, PM10), measured simultaneously and continuously during the period 2006-2010 in five air quality stations, were analyzed. Relative and absolute spatial concentration variations were investigated by means of statistical indexes. Results show significant differences among stations. The highest correlation between stations was observed for PM10 concentrations, while critical values were found for NO2. The worst values were observed for the SO2 series. The high values of 90th percentile of differences between pairs of monitoring sites for the three pollutants index suggest that mean concentrations differ by large amounts from site to site. The overall analysis supports the hypothesis that various parts of the city are differently affected by the different emission sources, depending on meteorological conditions. In particular, analysis revealed that the influence of the industrial site may be primarily identified with the series of SO2 data which exhibit higher mean concentration values and positive correlations with wind intensity when the monitoring station is downwind from the industrial site. Results suggest evaluating the population exposure to air pollutants in industrialized cities by taking into account the possible zones of influence of different emission sources. More research is needed to identify an indicator, which ought to be a synthesis of several pollutants, and take into account the meteorological variables.

OBIETTIVI: valutare lo stato di salute della popolazione residente nel comune di Manfredonia dal 1970 al 2013. DISEGNO: analisi descrittiva dell'andamento temporale della mortalita generale, per gruppi di cause, dal 1970 al 2013. SETTING E PARTECIPANTI: i dati di mortalita e le popolazioni residenti sono di fonte Istat. Sono state esaminate 55 cause di decesso. Le analisi sono disaggregate per sesso e periodo. PRINCIPALI MISURE DI OUTCOME: sono stati elaborati i rapporti standardizzati di mortalita (SMR%), con i rispettivi intervalli di confidenza al 90% (IC90%), e i tassi di mortalita standardizzati col metodo diretto (TSD ). RISULTATI: lo stato di salute misurato dal tasso di mortalita per tutte le cause migliora nel tempo: i TSD passano da 92 x10.000 negli anni 1970-1974 a 52 x10.000 nel biennio 2012-2013 negli uomini, da 70 x10.000 a 39 x10.000 nelle donne. Tuttavia, rispetto alla media regionale Manfredonia perde progressivamente il suo vantaggio, passando da -20% a -10% negli uomini, e da -20% a +1,5% nelle donne. Questo andamento e molto evidente per il complesso delle cause cardiovascolari, mentre i tumori maligni sono in generale nella media regionale. Nell'ultimo periodo disponibile per causa di decesso (2006-2011), la mortalita per infarto miocardico e stata pio alta della media regionale (uomini: +35%; donne: +54%). I rapporti standardizzati di mortalita (SMR) mostrano tra gli uomini valori in crescita, in particolar modo rispetto al riferimento provinciale, con un eccesso a cominciare dal periodo 2006-2011 (22 decessi/anno e 19 attesi; SMR%: 117,2; IC90% 101,1-135,2; riferimento: provincia di Foggia). Anche tra le donne gli SMR% superano i riferimenti provinciali negli ultimi periodi esaminati (nel 2012-2013: 7 decessi/ anno e 4,2 attesi; SMR%: 116,4; IC90% 97,0-260,7; riferimento: provincia di Foggia). CONCLUSIONI: la mortalita a Manfredonia e diminuita in misura minore rispetto a quella osservata nei riferimenti provinciali e regionali. Il vantaggio che si osservava negli anni Sessanta si e, infatti, ridotto nel tempo, fino ad anarsi negli ultimi anni. Dal 1970, Manfredonia ha progressivamente perso il vantaggio che aveva. Dagli anni Duemila, la mortalita per infarto del miocardio e in eccesso sulla media regionale e provinciale. Da casi documentati in letteratura si osserva che le popolazioni che sperimentano catastrofi di origine naturale o antropica possono fronteggiare un aumento di patologie cardiovascolari. La mortalita per tumore polmonare mostra un eccesso sulla media regionale, in particolare provinciale, a cominciare dal 2000, coerentemente con i tempi di latenza legati all'esposizione ad arsenico negli anni Settanta.

Breast cancer patients exposed to doses of radiation after radiotherapy could develop toxicity to lung. Lung ultrasound (LUS) is able to detect interstitial lung disease by the evaluation of B-lines. The aim of our study was to assess the number of B-lines to diagnose lung involvement after chest radiotherapy.Materials and MethodsWe measured LUS B-lines in the treated and contralateral lung of 20 breast cancer patients, 1-3 months after the end of radiotherapy and 1 year after previous LUS. The sum of the B-lines number in the 72 sites on anterior and posterior chest yielded a global B-lines score.ResultsB-lines were more numerous in treated (median: 21; 1st-3rd quartiles: 11-31) versus untreated hemithorax (median: 3; 1st-3rd quartiles: 1-5) in both examination at T1-3 months (Kolmogorov-Smirnov test P < 0.001) and T1 year (median: 21; 1st-3rd quartiles: 12-28 vs. median: 4; 1st-3rd quartiles: 1-10; Kolmogorov-Smirnov test P < 0.01). Within the treated hemithorax, B-lines were more frequent in the anterior than in the posterior chest in both examination at T1-3 months (Kolmogorov-Smirnov test: P < 0.0001) and T1 year (Kolmogorov-Smirnov test: P < 0.01). Abnormal scores (B-lines>5) were present in 17/20 treated versus 7/20 untreated hemithoraxes (85.0 vs. 35.0%, P < 0.01) in the first LUS and likewise in 16/17 treated versus 7/17 in untreated hemithorax (94.1% vs. 41.2%, P < 0.01) after 1-year follow-up.ConclusionAmong women receiving radiotherapy after breast cancer, B-lines are present predominantly in the irradiated lung. These data suggest that B-lines by LUS could provide, at a subclinical stage, a radiation-free biomarker of radiotherapy-induced lung damage.

In a recent study on mortality on municipalities at high risk of environment crisis, significant excesses concerning all causes of death have been localized in the municipality of Brindisi. Focusing on cardiac pathology, we investigated the time course of the daily occurrences of acute cardiovascular events (OCE) leading to unscheduled hospitalization of subjects residents in Brindisi, during years 2001-2008. OCE series was analyzed by Detrended Fluctuation Analysis. The results indicate presence of long-term positive correlation, suggesting a role of atmospheric agents and air quality effects: increase/decrease of OCE following persistent high/low levels of air pollution.

The article concerns potential harmful effects of exposure to lead. Although the occurrence of severe lead poisoning has receded in several countries, occupational exposure resulting in moderate and clinically symptomatic toxicity is still common. An earlier and precise characterization of an individual response is obligatory in order to assess the possible risks for human health. Biomarkers may fill important gaps in the path from exposure to a disease. Specifically speaking, emerging (DNA double strand breaks and telomeric DNA erosion) and validated (micronuclei induction and chromosomal aberrations) biomarkers of genotoxicity seem to provide evidence for the assessment of molecular and cellular damage. Moreover, identi.cation of genetic variability with a key role in modulating genotoxic damage may help minimize risks for susceptible subjects. Further investigations are naturally needed to properly define their diagnostic and/or prognostic value as "early warning" signs of a long-term risk for a subsequent clinically overt disease.

Several epidemiological studies have reportedadverse associations between exposure to ambientparticulate matter (PM) and mortality and morbidity forseveral causes. A crucial issue in the integratedenvironmental health impact assessment is the prognosisof PM pollution and, in particular, the way to accountfor secondary PM2.5 formation in presence of largeemissions of SO2 and NOx.Due to the complex non-linear gas-particlechemistry, modelling the formation of secondary PM2.5from a single point source would require theimplementation of complex photochemical grid models,which need as input all the emissions of the area andcontributions from external sources. These data arealmost never available. Consequently, the estimation ofthe impact of a single point source in forming secondaryPM2.5 is often disregarded in environmental and healthimpact assessments.The aim of this work was to estimate primary andsecondary PM2.5 originating from a single source usingthe dispersion model CALPUFF (Scire at al., 2000) intwo different simplified configurations and to assess theimpact in terms of attributable deaths. In Case A thechemical mechanism MESOPUFF was activated. Underthis chemical five species scheme (SO2, SO4+, NOx,HNO3, NO3-), daytime SO2 and NOx oxidation arehourly varying functions of background ozoneconcentration, solar radiation, atmospheric stability andplume NOx concentration. In Case B specific SO2 andNOx offset ratios (10:1 for SO2 and 100:1 for NO2) wereconsidered (Guerra et al. 2014), converting emissions ofprecursors into equivalent amounts of direct PM2.5emissions.As case of study, we considered the emissions ofthe coal power plant located in the municipality ofBrindisi in southern Italy (Figure 1). The study area is105x135 km2 wide and comprises two towns (Brindisiand Lecce) and 125 villages with a total population of1,152,000 individuals. We considered a 105 km x 135km Calmet/Calpuff modelling domain with a resolutionof 1.5 km x 1.5 km. Simulations were performed for theyear 2006.Figure 1. The area of studyThe estimated annual average and annual localmaximum values of primary PM2.5 were 0.02 and 0.22?g/m3 respectively. Primary PM2.5 decreases at half of itsmaximum values within 10 km from the source. In CaseA the estimated total (primary plus secondary) PM2.5extended over a larger area with annual average andannual spatial maximum values of 0.09 ?g/m3 and 0.43?g/m3, respectively. In Case B the total PM2.5 patternresembles that of the primary PM2.5; the estimatedannual average and maximum values of total PM2.5become 0.04 ?g/m3 and 0.55 ?g/m3, respectively.The number of estimated natural deaths potentiallyattributable to annual increased PM2.5 levels was derivedby a three-step procedure (Künzli et al., 1999, Beelen etal. 2014). This resulted in 4 deaths (95% CI 1-7)attributable to primary PM2.5 and increased respectivelyto 19 (95%