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Background: The craniovertebral junction (CVJ) is often involved in a wide range of congenital, developmental and acquired pathologies that can create bony and ligamentous instability or cause direct compression on the medulla and cervical spine cord, resulting in significant impairment. Atlas assimilation is the most common malformation in the CVJ and can be frequently associated with basilar invagination (BI) and Chiari malformation (CM) type I. Posterior atlas assimilation more frequently leads to BI type II with a mass effect on neural structures but usually no signs of biomechanical instability. Operative approaches to the CVJ have undergone a remarkable evolution and can be divided into ventral, lateral and dorsal ones. In this kind of surgery, it is vital to detect and eventually treat any CVJ instability. Case description: We present a case of CVJ malformation comprising assimilation of the posterior arch of the atlas, BI type II and CM, treated by endoscopic endonasal odontoidectomy and partial clivus removal to spare CVJ stability. Conclusion: Neurological and biomechanical analysis of all CVJ malformations permits stratification and selection of those cases that can be managed by simple, direct, minimally invasive decompression with no need for surgical fusion.

Hygiene and surveillance in swimming pools are established by WHO Guidelines and national laws. Progress in water management and pool construction is revolutionizing the field, introducing new materials, systems, disinfection procedures or monitoring markers. Innovation advances challenge the upgrading of safety and quality in pools and the appropriate implementation of guidelines.In order to provide a device for laboratory test, a prototype was realized and applied to study and compare swimming pool materials and treatments.A pool scale-model was engineered and evaluated by computational fluid dynamics algorithms. An automated real time monitoring assured steady state. Critical control points along the water circuit were made accessible to allow the placing of different biocides or water sampling. Simulations were safely performed in a standard hood. Materials for pool surfaces and pipelines were evaluated for biofilm formation under different disinfection conditions. Adherent microorganisms were assayed by mfDNA analysis using real time PCR.The prototype reached the steady state within 5-25 hours under different conditions, showing chemical, physical and fluid-dynamic stability. A method was optimized for testing materials showing their different response to biofilm induction. Several innovative PVC samples displayed highest resistance to bacterial adhesion.A device and method was developed for testing swimming pool hygienic parameters in laboratory. It allowed to test materials for pools hygiene and maintenance, including biofilm formation. It can be applied to simulate contaminations under different water treatments or disinfection strategies. It may support technical decisions and help policymakers in acquiring evidences for comparing or validating innovative solutions.

Background Reprocessing of endoscopes is key to preventing cross-infection after colonoscopy. Culture-based methods are recommended for monitoring, but alternative and rapid approaches are needed to improve surveillance and reduce turnover times. A molecular strategy based on detection of residual traces from gut microbiota was developed and tested using a multicenter survey. Methods A simplified sampling and DNA extraction protocol using nylon-tipped flocked swabs was optimized. A multiplex real-time polymerase chain reaction (PCR) test was developed that targeted 6 bacteria genes that were amplified in 3 mixes. The method was validated by interlaboratory tests involving 5 reference laboratories. Colonoscopy devices (n = 111) were sampled in 10 Italian hospitals. Culture-based microbiology and metagenomic tests were performed to verify PCR data. Results The sampling method was easily applied in all 10 endoscopy units and the optimized DNA extraction and amplification protocol was successfully performed by all of the involved laboratories. This PCR-based method allowed identification of both contaminated (n = 59) and fully reprocessed endoscopes (n = 52) with high sensibility (98%) and specificity (98%), within 3-4 hours, in contrast to the 24-72 hours needed for a classic microbiology test. Results were confirmed by next-generation sequencing and classic microbiology. Conclusions A novel approach for monitoring reprocessing of colonoscopy devices was developed and successfully applied in a multicenter survey. The general principle of tracing biological fluids through microflora DNA amplification was successfully applied and may represent a promising approach for hospital hygiene.

The aim of this study was to investigate the current situation and the research agenda in the field of gender differences, both generically in the occupational settings and in the specific activity of risk assessment. Gender is a key determinant of health; the evaluation of documents and scientific literature shows increasing attention to a gender oriented approach, as demonstrated by the development of Gender Medicine, actually cross-oriented in all medical specialties, the publication of books dedicated to this topic and the birth of "ad hoc" new scientific societies and journals. Even today, however, the gender differences are not considered as they should in the context of health disciplines, including occupational medicine. In this respect, in fact, the critical issues to be overcome are numerous, such as the phenomena of "segregation", the exposure to risk factors and their effects, related also to non-professional, socio-cultural features that differentiate male and female workers. All these factors can lead to situations of inequality in health. In fact, the European directives on safety at work repeatedly highlight the attention to gender differences in prevention, assessment and management of risks. In this regard, the European Agency for Safety and Health at Work advocates an approach "more sensitive" to gender in all the processes of assessment and risk management, from the research of all potential sources of risk to the decision-making processes, in order to address the prevention of risks in a holistic manner.

Passive exposure profiles to submicronic particles (SMPs, 5.6-560 nm) of traditional cigarettes and new electronic commercial devices (e-cig and IQOS®, a new heat-not-burn smoking device) were compared. During smoking, SMPs released by traditional cigarettes resulted four-times higher than those released by electronic and heat-not-burn devices and remained high for at least one hour, while SMPs values returned immediately similar to background for electronic and heat-not-burn devices. In all experiments, approximately half of SMPs resulted so small to reach the alveolar region.

You may never have heard of thirdhand smoke, or THS, but chances are you’ve smelled it. THS is, in the words of The New York Times, “the invisible yet toxic brew of gases and particles clinging to smokers’ hair and clothing, not to mention cushions and carpeting, that lingers long after secondhand smoke [SHS] has cleared from a room.”1 Recent research exploring potential dangers of THS has received a flurry of coverage in the international media2,3,4 and the scientific press.5,6,7 And in the United States, court cases are beginning to appear in which plaintiffs are citing these alleged dangers,8,9 despite a lack of human health studies on the long-term health effects of THS exposure. So how dangerous might THS really be? The answer, still to be pronounced, will depend on many factors.

The aim of the study was to perform a preliminary analysis of the mortality data for cancer as widely as possible, in order to obtain useful information for planning specific public health interventions. For this purpose, data on cancer mortality in the province of Rieti (Latium, central Italy) have been collected and analysed. To date, in the Rieti province a Cancer Registry record is not available.The study was conducted through statistical analysis of cancer mortality data related to the years 2008 and 2009, obtained from the National Institute of Statistics. Data were cumulative for the province of Rieti and specific for the five districts in which the province is divided.The standardized mortality rates obtained for Rieti province resulted lower than those reported for the other provinces of the Latium region, for Italy and for the European Community, both for 2008 and 2009. In these years, the anatomical areas more affected in terms of mortality were "trachea, bronchus and lung", "colorectal" and "stomach", but gender differences were evidenced.The present study, also considering the limitation of two years studied only, leads to some basic insights about the importance of updating mortality data to trace an epidemiological profile, to evaluate the presence of risk and protective factors, to program strategically health interventions, and to assess the effectiveness of these interventions.

The e-cigarette, also known as e-cig, represents an emerging issue of great concern for public health. The aim of the present report was to explore the scientific literature about the use of electronic cigarette (e-cig), with a particular reference to the features of "toxicological safety", "effectiveness in overcoming the addiction to smoking the traditional cigarette" and "necessary research agenda". The efficacy of e-cig for smoking cessation is uncertain: some authors found that it can be a valid support, but long-term cessation rate has not be assessed. Other studies evidenced that e-cig is often used not for quitting smoking but to avoid smoking ban for traditional cigarettes and, even, some researches evidenced that it appears to contribute to nicotine addiction. E-cig smoking seems to be less dangerous of conventional cigarettes, but its use is not risk-free. Besides, cases of accidental or intentional poisoning with liquid solutions of e-cig have been reported. Also, the smoke of e-cig decreases indoor air quality, releasing particulate matter and other toxics that can persist on surfaces for days and generating passive exposure. These phenomena are similar to environmental tobacco smoke produced by conventional smoking, that is the sum of second- and third-hand smoke. We propose to call them "environmental electronic smoke", "electronic-second- hand smoke" and "electronic-third-hand smoke", respectively. Uncertainties relating to e-cig features determined the sequence, in the short term, of warnings and regulations approved and then replaced. In conclusion, although in recent years many researches were performed, evidences is limited and there is a need to study in deep all these issues.

The effect of exposure to some air pollutants during pregnancy on embryonic and fetal development has been evaluated by several studies, but it has not been well defined. The main objective of this study was to use a systematic review to evaluate the relationship between air benzene exposure in pregnant women and possible negative effects on intrauterine development and negative outcomes at birth.After a systematic literature search, we identified five peer-reviewed studies with quantitative results regarding the association between benzene exposure during pregnancy and adverse outcomes on intrauterine development and at birth. The characteristics of the study design and population of each selected article were summarised.There was evidence for the association between an increase in preterm birth or a decrease in biparietal diameter growth with maternal exposure to benzene or early exposure to aromatic solvents, while the evaluation of the relationship between benzene exposure during pregnancy and other parameters (i.e., birthweight, fetal weight, birth length, head circumference growth, fetal femur length, and abdominal circumference) returned no clear conclusions.Further studies are required to confirm and clarify the possible adverse outcomes of benzene exposure during pregnancy. Recommendations for future studies are related to the most appropriate strategies for outcomes and exposure assessment and the evaluation of "individual genetic susceptibility", which is a possible confounding factor in this kind of studies.