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The ability of transplanted lichen Evernia (E.) prunastri (L.) to act as a high spatial biomonitoring tool for 14 polybrominated diphenyl ethers (PBDEs) was evaluated at 23 monitoring sites in a very polluted area in central Italy. The selected area is characterized by the presence of numerous emission sources, such as waste-to-energy plant, steel plant, vehicular traffic, and domestic heating. Transplanted E. prunastri proved to be a useful tool to biomonitor PBDEs, due to its ability to bioaccumulate individual congeners in varying concentrations in relation to the strength of the emission sources present over the territory. PBDEs levels widely ranged from 132 to 24,237 ng kg -1 dry weight, according to the sources of emission located around the monitoring sites. The highest concentrations were detected at the sites close to the municipal solid waste incinerator, steel plant, and high busy roads, confirming their important role as PBDEs emissions sources., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Native and transplanted lichens were analyzed as bioaccumulators of airborne particulate matter (PM) in an eastern district of Rome, Italy, where frequent fraudulent fires are set to recover metals, mostly copper, from waste electrical and electronic equipment (WEEE). The presence of native lichens was scarce, due to the drought of spring-summer 2017, thus, sampling was extended to a neighboring area for toughening the dataset to a similar context. The magnetic analyses revealed intense properties connected to the anthropic complexity of the zone, where industrial, traffic and arson-related dusts are emitted and bio-accumulated. Magnetic and chemical analyses were compared, leading to significant linear correlations between the concentration dependent magnetic parameters (susceptibility, saturation magnetization and saturation remanence) and the concentration of heavy metals, among which copper, chrome, lead and zinc. Moreover, selected magnetic particles were chemically and morphologically characterized by Scanning Electron Microscope and Energy Dispersion System microanalyses. Magnetic particles resulted incorporated into the lichens' tissues and their composition, morphology and grain size strongly supported their anthropogenic, mostly combustion-related, origin. Even if, given the complexity of the area, it was not feasible to fully discriminate the multiple anthropogenic sources, magnetic biomonitoring of lichens, especially when combined with microtextural and compositional analyses, confirmed to be an excellent methodology for a rapid characterization of environmental pollution., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Telemedicine has changed over the last years, becoming an integrated service used in various clinical settings such as stroke units or radiological departments, but also as an important tool for home rehabilitation. Assessment of usefulness and efficiency of performing teleconsultations to manage stroke from acute care hospital to tertiary care rehabilitation hospital has not been referred by scientific literature., Aim: This article analyzes the process of discharging stroke patients from acute care to intensive rehabilitation, based on the comparison between conventional bedside patient evaluations and teleconsultation patient evaluations, to assess efficiency and efficacy of two different discharging workflows., Design: Retrospective study., Setting: Consultations were carried out between the Acute Care Stroke Unit and the Stroke Rehabilitation Unit of Valduce Hospital System., Population: The study included 257 stroke patients who underwent physiatric consultation during 2 years considered in this study and 101 patients were considered eligible for intensive rehabilitation treatment after a physiatric consultation., Methods: We compared the efficiency and efficacy of the dismission workflow of bedside medical consultation and teleconsultation over a 12 months period. We considered the following outcome measures: time elapsed between consultation and Rehabilitation Unit admission, number of re-admissions to acute care hospital, complications occurred during rehabilitation, length of stay in the rehabilitation hospital and clinical outcomes of rehabilitation process., Results: We observed a significant reduction in waiting time from the acute event to the admission in rehabilitation department, an improvement in efficiency of the admission process itself in the Rehabilitation Unit and a reduction of clinical complications occurred during rehabilitation period, without changes in rehabilitative outcomes., Conclusions: It has been highlighted that the use of telemedicine to perform medical consultation as a tool to evaluate patients eligible for tertiary care rehabilitation hospital admission from Stroke Care Unit is feasible and more efficient when compared with conventional bedside consultations., Clinical Rehabilitation Impact: This study reveals teleconsultations as a useful tool to improve efficiency of the stroke management workflow.

Introduction: Chronic prostatitis (CP)/chronic pelvic pain syndrome (CPPS) represents a challenge for the urologist, since the therapeutic efficacy does not always result in a satisfactory quality of life for the patients. Often the side effects of the medications used (antiinflammatories, antibiotics, alpha blockers) far outweighs the benefits gained with their admission. The choice of nutraceutical medications is preferred for their effectiveness, that has been accepted and proven by the scientific community, and for the low incidence of side effects. The objective of this study to compare the therapeutic efficacy of the flower pollen extracts (Deprox®) versus Bioflavonoids in terms of reduction of symptoms, and in the average waiting time of the variation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), and to evaluate the quality of life improvement of the patients affected by CP/CPPS., Methods: Among the 68 patients presented with prostatic symptoms to the Hospital "Umberto I" in Rome, Italy between March 2016 and June 2016, 54 patients met the clinical diagnosis of CP/CPPS (class IIIa or IIIb according to the NIH classification). The patients were assigned to either treatment with Deprox® or quercetin based on a randomization scheme previously determined.The NIH- CPSI, IPSS, QoL questionnaires were administered. Every patient underwent bacterial cultures and trans-rectal ultrasound., Results: There was a statistically significant improvement of the NIH-CPSI score and QoL in the Deprox® group (p = < 0.0001 and p = 0.003 respectively). The average waiting time of the variation of the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was statistically significant (p = 0.0019). In the absence of efficacy of the "conventional" medications, which also carries significant side effects, the dietary supplements may represent a valid alternative., Conclusions: DEPROX® has demonstrated a significant improvement of the symptoms and quality of life of patients diagnosed with by CP/CPPS. Furthermore, there was a statistical difference in the average waiting time of the variation of the NIH-CPSI) score without side effects as compared to the bioflavonoids complex with quercetin.

Background and Purpose: Early treatment (i.e. thrombolysis) is crucial for a successful care of ischemic stroke. In the management of stroke, two phases are crucial: the pre-hospital and the in-hospital interval. This work investigated factors influencing pre- and in-hospital delay in a large geographic area of Northern Italy., Methods: Enrolled were patients presenting with ischemic stroke in four administrative districts of Northern Italy (Como, Lecco, Sondrio and Varese) over a 4-month period. Pre-hospital time and in-hospital time with single management steps were recorded prospectively. Age, gender, recruiting hospital, EMS transport and triage codes, clinical severity and thrombolytic treatment were also recorded. Univariate and multivariate analysis of factors predicting pre- and in-hospital delay were performed., Results: Median pre-hospital time and in-hospital time were, respectively, 120 min (interquartile range, IQR 62-271) and 150 min (IQR 80-214). Pre-hospital time was halved in patients hospitalized via EMS (p<0.001) and clinically more severe (p<0.001). At multivariate analysis, transport code was associated with delay at any time (p<0.05)., Conclusions: EMS use and transport code predicted treatment delay in patients with ischemic stroke. A more intensive use of EMS and high urgency codes could help increase the number of stroke patients treated appropriately., (Copyright © 2013 S. Karger AG, Basel.)

Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the diagnostic workup exceeds the time limit. In this article, we described the design of a study conducted in the northern Lombardy, within the district of Sondrio, Lecco, Como, and Varese. The awaited results of this study are reduction of avoidable delay, organization of an operative stroke emergency network, and identification of highly specialized structures. The study schedules education and data registration with implementation and training of acute stroke management algorithms. The use of standardized protocols during prehospital and in-hospital phase can optimize acute stroke pathways. The results of this study could contribute to the assessment of an effective and homogeneous health system to manage acute stroke., (© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.)

Background: Secondhand smoke (SHS) represents a major preventable cause of morbidity for communities, especially for children, who are more susceptible than adults to the adverse effects of passive smoking. SHS contains several carcinogens, including benzene., Objective: To investigate the role of household characteristics and the smoking behaviours of cohabitants in predicting SHS-derived benzene exposure levels. Methods In this cross-sectional study, 122 children (aged 5-11 years old) were selected from a school in rural Italy. Characteristics of their home environment and the smoking habits of the children's cohabitants were obtained via questionnaire, and urinary unmodified benzene (u-UB) and cotinine (a specific nicotine metabolite) levels were determined from spot urine samples., Results: Significant differences between SHS-exposed and SHS-unexposed children were found with respect to u-UB levels (median values 359.50 and 92.50 ng/litre, respectively; p<0.001). The excretion of u-UB increased significantly in parallel to increased SHS exposure as follows: unexposed to SHS (median value 92.50 ng/litre)

Some current evidences suggest that stroke incidence and mortality may be higher in elevated air pollution areas. Our study examined the hypothesis of a correlation between air pollution level and ischemic stroke admission and in Hospital mortality in an urban population. Data on a total of 759 stroke admissions and 180 deaths have been obtained over a 4-year period (2000-2003). Five air ambient particles have been studied. A general additive model estimating Poisson distribution has been used, adding meteorological variables as covariates. NO(2) and PM(10) were significantly associated with admission and mortality (P value < 0.05) and with estimated RR of 1.039 (95% CI 1.066-1.013) and 1.078 (95% CI 1.104-1.052) for hospital admission at 2- and 4-day lags, respectively. In conclusion, this study suggests an association between short-term outdoor air pollution exposure and ischemic stroke admission and mortality.

In Italy most herbal products are sold as food supplements and are subject only to food law. A list of about 1200 plants authorised for use in food supplements has been compiled by the Italian Ministry of Health. In order to review and possibly improve the Ministry's list an ad hoc working group of Istituto Superiore di Sanità was requested to provide a technical and scientific opinion on plant safety. The listed plants were evaluated on the basis of their use in food, therapeutic activity, human toxicity and in no-alimentary fields. Toxicity was also assessed and plant limitations to use in food supplements were defined.

Car repair painters usually experience long-term exposure to many different solvents. In Italy, the greater part of car painting shops are "handicraft", i.e. 2-5 workers and small premises. Usually workers do not have specific duties, but everyone takes part in all different operations. Moreover, working time is not standardized but varies according to the workload, working methods tend to be traditional, and compliance to individual protection devices is poor. We have hence assessed, on a sample of 8 italian handicraft car painting shops, the exposure levels to solvents, implementing three classic exposure monitoring methods: environmental sampling with charcoal tubes, personal sampling with diffusive charcoal samplers, and urinary determination of unmetabolised solvents. A simple regression analysis was performed to evaluate relationships between the three series of data. The solvents analysed were toluene, ethylbenzene, 1, 2-dichloropropane, n-butylacetate, n-amylacetate, xylene isomers, ethylacetate, and benzene. Benzene was included due to several factors, among others its presence (1% v/v) in the italian unleaded gasoline. Benzene was found in all shops, at levels around or higher than the 8-h time-weighted average limit (8-h TLV-TWA). Other solvents were found in the different shops at various levels, 10(-2) - 10(-1) times the 8-h TLV-TWA. Air concentrations of toluene, n-butylacetate, xylenes, and benzene were positively correlated with urinary levels of the parent compounds, while a negative correlation was found for ethylbenzene. The health implications of workers' exposure level was briefly discussed.

The genotoxic effects associated with automobile painting were analyzed using a panel of biomarkers. Chromosomal aberrations (CAs), sister chromatid exchange (SCE), and micronuclei were evaluated in 25 car painters (12 smokers, 13 nonsmokers) working in different automobile paint-shops in Italy and in 37 control subjects. The controls were healthy blood donors (14 smokers, 23 non-smokers) that were matched with the experimental population for gender and age. Air samples were analyzed regularly at the work places, and elevated concentrations of benzene and toluene were detected consistently. The exposed group had higher frequencies of CAs (both chromosome- and chromatid-type), micronuclei, and SCE (P < 0.5 - P < 0.001). Furthermore, exposed and control subjects were also genotyped for GSTM1 and GSTT1 polymorphism. No significant associations were detected between the biomarker responses and either the GSTM1 or GSTT1 genotype of the subjects, but the small sample size does not allow definite conclusions on the relationship between the genetic polymorphism and the biomarkers. The results indicate that automobile painters have increased levels of clastogenic and possible aneugenic damage and that smoking may be a confounding factor for the responses.

Method description and initial results of a study to assess risks to health sector workers and environment due to chemical agents used and waste products generated in diagnostic clinical chemical laboratories, and image diagnostic testing. A survey was conducted of the methods and agents used and their toxicological classification, the number of workers exposed and an analytical profile of the waste produced. The assessment of risk to workers was based on cytogenetic tests (chromosome aberrations and micronuclei); the assessment of environmental risk from waste disposal was based on tests on plant systems.