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The waste-to-energy (WTE) incinerator plant located in the Turin area (Italy) started to recover energy from the combustion of municipal solid waste in 2013. A health surveillance program was implemented to evaluate the potential health effects on the population living near the plant. This program included a longitudinal biomonitoring to evaluate temporal changes of some environmental pollutants, including polycyclic aromatic hydrocarbons (PAHs), in residents living in areas near the Turin incinerator (exposed group, E) compared to those observed in subjects living far from the plant (not exposed group, NE). Ten monohydroxy-PAHs (OH-PAHs), consisting in the principal metabolites of naphthalene, fluorine, phenanthrene, and pyrene, were analyzed in urines collected from the E and NE subjects after one (T

Objective: Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium. Design: Cross-sectional study nested in the 2017 "Delirium Day" project. Setting and participants: Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy. Methods: Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters). Results: A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63). Conclusions and implications: Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

The goal of this work is to investigate the thermal effects of femtosecond laser (fs-laser) ablation for the removal of carious dental tissue. Additional studies identify different tooth tissues through femtosecond laser induced breakdown spectroscopy (fsLIBS) for the development of a feedback loop that could be utilized during ablation in a clinical setting. Scanning Election Microscope (SEM) images reveal that minimal morphological damages are incurred at repetition rates below the carbonization threshold of each tooth tissue. Thermal studies measure the temperature distribution and temperature decay during laser ablation and after laser cessation, and demonstrate that repetition rates at or below 10kHz with a laser fluence of 40 J/cm2 would inflict minimal thermal damage on the surrounding nerve tissues and provide acceptable clinical removal rates. Spectral analysis of the different tooth tissues is also conducted and differences between the visible wavelength fsLIBS spectra are evident, though more robust classification studies are needed for clinical translation. These results have initiated a set of precautionary recommendations that would enable the clinician to utilize femtosecond laser ablation for the removal of carious lesions while ensuring that the solidity and utility of the tooth remain intact.

Rationale: Coronavirus 2019 disease (COVID-19) can develop acute respiratory failure symptoms and carries a high risk of malnutrition, due to hyperinflammatory and hypercatabolic state and to the heavy state of fatigue We aim to explain the nutritional management of non-critically ill hospitalized patients with COVID-19 carried out by dietitians in an Italian single center highly affected by COVID-19 Methods: Fifty-three non-critically ill patients hospitalized into the Civil Hospital of Sanremo, Italy, were considered at risk of malnutrition using a short-age adjusted NRS-2002 Dietitians evaluated weight, height and malnutrition signs Nutrition-related laboratory parameters were collected and energy needs were estimated All patients were administered with a fractionated pureed diet enriched with ready pasteurized high-protein and high-calories pureed meals in order to reduce energy expenditure during feed Eighteen out of 53 patients were supplemented with Oral Nutritional Supplements (ONS) because they did not reach their energy needs with diet alone Results: The pureed diet and ONS were well tolerated and accepted by the 92 5% of patients Thirty-two out of 53 (60 4%) non-ICU patients reached their nutritional needs with the personalized nutritional management Nine up to 21 (42 9%) patients who did not reach nutritional target died, while only 1 up to 31 (3 1%) patients at target died during hospitalization (p

Resume Le lymphome anaplasique a grandes cellules (LAGC) est une pathologie rare, son incidence aux Etats-Unis est de un cas pour 500 000 femmes et de trois pour 100 millions de patientes pour la seule localisation mammaire. Quarante-six cas ont ete recenses dans la litterature. Ils peuvent se developper sur tout type d’implant : expandeur, prothese en silicone et serum physiologique, enveloppe lisse ou texturee. Actuellement, le consensus de traitement comprend la capsulectomie, l’ablation de l’implant, la chimiotherapie et la radiotherapie. Cependant, certains auteurs le classent dans le cadre de pathologie indolente, mais nous pensons que certains cas peuvent echapper a toute therapeutique et deviennent des formes tres agressives. Il est donc important de faire un diagnostic precoce et commencer un traitement en urgence. Sa gravite et la suspicion du caractere iatrogene ont fait du LAGC une obligation d’information des futures porteuses d’implants.

BACKGROUND Pleural malignant mesothelioma (PMM) is a rare and highly aggressive tumor, whose development is strictly related to occupational exposure to asbestos. The prognosis of PMM is generally poor (median survival, 4–12 months), but a few have a relatively long survival. The objective of this study was to evaluate the use of the cell cycle–related proteins p27kip1 and MIB-1 as prognostic indicators of survival in PMMs. METHODS Of 621 PMMs, the authors selected 27 cases with a relatively long-term survival (> 24 months) and a control group of 36 PMMs having a shorter (usual) survival (< 24 months). RESULTS The expression of the p27kip1 was significantly higher in the long-term survival group compared with the control (short survival) group (81.41% vs. 31.94%; P < 0.0001). The PMMs of epithelioid histotype had a significantly higher p27kip1 immunoreactivity compared with those of biphasic type (59.24% vs. 38.94%; P = 0.02). In agreement with the data in the literature, the proliferative activity (as detected by MIB-1 immunoreactivity) was significantly higher in short than long survival PMMs (43.53% vs. 14.11%; P < 0.0001) and in the biphasic histotype than in the epithelioid type (43.19% vs. 26.02%; P = 0.006). CONCLUSIONS The combined expression of high/low p27kip1 and low/high Ki-67 values identified with 100% specificity and sensitivity long versus short survivors. p27kip1 represents a reliable additional predictive factor for PMMs and a useful marker to identify patients having a more favorable prognosis. Cancer 2001;92:1245–50. © 2001 American Cancer Society.

OBJECTIVE: The largest Italian asbestos cement factory had been active in Casale Monferrato until 1986: in previous studies a substantial increase in the incidence of pleural mesothelioma was found among residents without occupational exposure to asbestos. To estimate exposure to asbestos in the population, this study evaluated the presence of histological asbestosis and the lung burden of asbestos fibres (AFs) and asbestos bodies (ABs). METHODS: The study comprises the consecutive series of necropsies performed at the Hospital of Casale Monferrato between 1985 and 1988. A sample of lung parenchima was collected and stored for 48 out of 55 necropsies. The AF concentration was measured with a TEM electron microscope with x ray mineralogical analysis. The ABs were counted and fibrosis evaluated by optical microscopy. The nearest relative of each subject was interviewed on occupational and residential history. Mineralogical and histological analyses and interviews were conducted in 1993-4. RESULTS: Statistical analyses included 41 subjects with AF, AB count, and interview. Subjects without occupational exposure who ever lived in Casale Monferrato had an average concentration of 1500 AB/g dried weight (gdw); Seven of 18 presented with asbestosis or small airway lung disease (SAL). G2 asbestosis was diagnosed in two women with no occupational asbestos exposure. One of them had been teaching at a school close to the factory for 12 years. Ten subjects had experienced occupational asbestos exposure, seven in asbestos cement production: mean concentrations were 1.032 x 10(6) AF/gdw and 96,280 AB/gdw. Eight of the 10 had asbestosis or SAL. CONCLUSION: The high concentration of ABs and the new finding of environmental asbestosis confirm that high asbestos concentration was common in the proximity of the factory. Subjects not occupationally exposed and ever living in Casale Monferrato tended to have higher AB concentration than subjects never living in the town (difference not significant). The concentrations of ABs and AFs were higher than those found in other studies on nonoccupationally exposed subjects.

A commercially available echelle spectrometer with a segmented array charge coupled detector (SCD) was used with a xenon arc lamp and graphite furnace atomizer for continuum source atomic absorption spectrometry (CS-AAS). Approximately 67% of the spectral wavelengths corresponding to the resonance transitions used for routine AAS determinations were available on the SCD. As many as eight elements were determined simultaneously with a read frequency of 50 Hz for each array. The high luminosity of the echelle and the high quantum efficiency SCD provided photoelectron levels that ranged from equivalent to 7 times higher than those previously measured by CS-AAS using a linear photodiode array (LPDA) detector. The low read noise of the SCD resulted in the absorbance measurements being limited by the photon shot noise of the continuum source. Detection limits were obtained that ranged from equivalent to a factor of 3 better than those previously obtained for CS-AAS and from a factor of 2 worse to a factor of 10 better than those for conventional, line source AAS. Sensitivities, as determined by intrinsic mass (mass necessary for an absorbance of 0.0044 pm s), were similar to those measured previously with an LPDA. The high resolution of the echelle allowed detailed inspection of the spectra surrounding the wavelength of the elements determined. Data were displayed using contour absorbance plots. Molecular peaks were observed within the spectral window of the sub-arrays for As (193.7 nm) and Se (196.0 nm). These peaks were spectrally and temporally resolved from the analyte peaks and disappeared in the presence of a Pd chemical modifier. A low sensitivity Pd line was identified that was 15 pm from the Se line. The Pd and Se peaks were resolved using a spectral bandwidth of 3 pm per pixel.

The anaplastic large cell lymphoma (ALCL) is a rare disease, its incidence in the United States is one case per 500,000 women and three for 100 million patients for breast single location. Forty-six cases have been reported in the literature. They can grow on any type of implant: expander prosthesis silicone and saline, smooth or textured envelope. Currently, the consensus process includes capsulectomy, removal of the implant, chemotherapy and radiotherapy. However, some authors classify under indolent disease, but we believe that some cases may escape any therapeutic and become very aggressive forms. It is therefore important to make an early diagnosis and start treatment urgently. Severity and suspicion of iatrogenic nature of ALCL have an obligation to inform future with implants.

An evaluation of precision improvements using real-time internal standardization with an axially-viewed inductively coupled plasma (ICP) is presented. New findings are presented with respect to the nature of the noise in the analytical signals from the axial ICP. It is observed that a high degree of correlation exists in the line signals from the axial ICP. Using the yttrium ion line at 371.030 nm as the internal standard, the analytical precision after the application of real-time internal standardization is maintained between 0.1 and 0.2% relative standard deviation (RSD) for ion lines. Precision improvement factors of 3 to 4 are obtained by comparison with the uncorrected results. With atomic lines, real-time internal standardization using the yttrium ion line is less effective, yielding precision values between 0.2 and 0.7% RSD. The precision improvement factors for atomic lines are between 1.5 and 3. Thus, real-time internal standardization provides significant improvements in the RSDs of the line signals. The limits of these improvements are explored and an equation is presented which yields the fundamental shot noise limit for precision. Shot noise limited precision is demonstrated. However, this is not possible for all elements using a single internal standard signal. The effectiveness of real-time internal standardization is shown to be dependent on the nature of the specific spectral line. With the axially-viewed ICP, the dominant phenomenon preventing the full benefit of internal standardization from being obtained is the amplitude of the noise in the line signals and not the degree of correlation between analyte and internal standard signals. A trend is observed for atomic transitions in which lower excitation energy is correlated with higher relative noise amplitudes. This finding is in contrast with previously published work on the radially-viewed ICP. An explanation of this result is proposed which takes into account the influence of vaporizing sample droplets in the observation volume.

A performance evaluation of a horizontal axially viewed inductively coupled plasma (ICP) for optical emission spectrometry is presented. The main contribution of this work is the elucidation of the sources of analytical performance differences using practical diagnostics in the comparison of axial and conventional radial viewing of the ICP. Figures of merit such as detection limit, background equivalent concentration, precision, and dynamic range are compared for both viewing arrangements. The detection limit improvements with axial viewing, known from previous work in the literature, are shown to be understood in the context of the signal-to-background-ratio relative-standard-deviation-of-the-background (SBR-RSDB) theory. The usefulness of the SBR-RSDB approach as a diagnostic tool for understanding the detection limit improvement and identifying performance differences is demonstrated. This approach can be further utilized for quality control and quality assurance of instrument performance and detection limit results. Other characteristic differences between axial and radial viewing are presented including matrix effects on line signals and the magnitudes of spectral interferences from OH bands. An overall improvement factor of five in detection power was observed when using axial viewing compared with radial viewing.

The application of multivariate data reduction to simultaneous inductively coupled plasma (ICP) optical emission spectra collected with an echelle spectrometer and matched segmented array charge-coupled device (SCD) detector is investigated. An example of the determination of indium in a W/Mo matrix is examined. The combination of simultaneous spectra from the SCD detector and multivariate data reduction permits the discrimination of correlated noise that exists in the background signals of ICP spectra. This leads to improvements in the detection limits not possible with sequentially scanned or direct-reading spectrometers. Detection limits for a group of elements are reported and examined using the signal-to-background ratio relative standard deviation of the background signal approach.

A new type of solid-state detector has been designed to meet the needs of inductively coupled plasma optical emission spectroscopy (ICP-OES), including high quantum efficiency in the UV, low noise, wide dynamic range, rapid readout, broad spectral coverage, and high spectral resolution. The device is based on buried-channel charge-coupled-device (CCD) technology with unique features for optical emission spectroscopy and is matched to a specific echelle grating optical system described in the companion paper. It measures simultaneously 5.7% of the continuous ICP spectrum from 167 to 782 nm with 220 linear photodetector arrays. These arrays are targeted on three to four primary analytical lines for each of 72 elements and cover over 5000 ICP emission lines

An echelle polychromator for inductively coupled plasma optical emission spectroscopy (ICP-OE9) was designed for use with the multichannel solid- state detector described in the companion article. The optical system has separate output sections for the UV and visible wavelength ranges, which permit high spectral resolution and high optical throughput nahile covering the spectral range from 167 to 782 nm. A novel component in the UV section corrects spherical aberration, cross-disperses the spectrum, and separates the UV and risible beams. A large-area echelle grating has been ruled for this system which has high diffraction efficiency and constant blaze angle across the spectrum and low stray light

A population-based case-control study was conducted in Biella, which is located in northwestern Italy, to investigate the reported association between sinonasal carcinomas and woolen fabrics production. The study included 33 cases diagnosed during 1976-1988 (14 adenocarcinomas, 11 epidermoid carcinomas, 3 other specified carcinomas, 1 unspecified carcinoma, and 4 cases without histologic confirmation) and 131 controls. No association was found with smoking. As reported previously, excess risks were observed in wood and furniture workers (odds ratio [OR] = 4.4, 95% confidence interval [95% CI] = 1.41-13.4) and in the leather industry (OR = 3.5, 95% CI = 0.6-20.3). Odds ratios in the wood and furniture industry were 22.0 (95% CI = 4.4-124.0) for adenocarcinomas and 0.9 (95% CI = 0.4-8.3) for epidermoid carcinomas. No association was found with the woolen textile or garment industries (OR = 0.8, 95% CI = 0.2-2.8), nor with farming, construction, metal works, and transport. Odds ratios for the textile industry did not vary with length of exposure or histologic type. Power for detecting an odds ratio of 3.0 at the 95% level of significance was 40%.

Multivariate methods are described which improve the quality of the information which is extracted from inductively coupled plasma (ICP) atomic emission spectra. The enhancements provided by these methods result from using more of the spectral information than is used by simpler peak height measurement schemes. The detection limit of an analyte is significantly improved when mathematical treatment is applied to emission spectra at multiple wavelengths near the peak maximum compared to peak height measurements which make use of only one bandpass of information. The advantages of these multivariate methods are greatest in situations where spectral interferences are present at the analyte wavelength. These algorithms replace auxiliary background correction routines since a background profile can be fit to the unknown spectrum. Even very small wavelength registration errors can be corrected using numerical derivatives of the unknown spectrum as components in the linear model. In this paper, multivariate methods for ICP are developed using only the method of least squares (MLS). The method is applied to simulated spectra and to real spectra collected on the Plasma 2000 spectrometer. A trace level determination of cobalt in the presence of an interfering concentration of iron is demonstrated at the 238.892-nm cobalt line.

A version of the conespray nebulizer proposed by Sharp has been designed and evaluated for routine liquid sample introduction for inductively coupled plasma atomic emission spectrometry (ICP-AES). The short-term analytical precision was better than 1% RSD with the conespray nebulizer using both simple aqueous solutions and solutions containing a matrix of 10% NaCl. The long-term %RSD (about 8 hr) was typically about 1% with simple (low matrix) solutions. The precision and stability of the analytical signal while nebulizing solutions with a 10% NaCl matrix during continuous runs were not distinguishable from the case when simple solutions were used. Sensitivity and detection limit data collected for the conespray nebulizer at a solution flow rate of 2 ml min and the cross-flow nebulizer at 1 ml min showed similar performance for these figures of merit. Wash-in and wash-out times for the conespray nebulizer were 9 and 40 s, respectively. Generally, this version of the conespray nebulizer provided similar overall performance to the best of the currently available Babington style nebulizers such as the V-groove nebulizer.

Objective: Analysing the differences in number of diseases reported, medicines taken and American Society of Anaesthesiologists (ASA) scores in young/adult and elderly dental patients. Subject: Forty-seven young/adult and 47 elderly dental patients living in the community. Setting: Private dental practice. Main outcome measures: Age, number of systemic diseases reported during anamnesis, number of medicines taken, seriousness of pre-existent diseases measured according to the ASA (American Society of Anaesthesiologist) scale. Study design: Analytical study. Results: The differences between young/adult and elderly dental patients as far as self-reported medical conditions, medicines taken and ASA scores were statistically significant (p

157 nm has been explored as a lithographic technology for several years on small field imaging tools with encouraging results. Significant progress has occurred in tool platform design, resist performance, and optical material quality. However, a major test of a new lithography comes when full field, scanned images can be produced as this becomes a crucial test of system performance and uniformity. We report on early results from a 22 mm x 26 mm (slot x scan) field Micrascan VII 157 nm lithography scanner obtained using a binary reticle. In addition, a full field alternating phase shift reticle was fabricated on modified fused silica1 and used to extend the imaging capability. Resolution and uniformity data from both reticles will be presented. The lithographic performance will also be compared to simulations using predicted performance from the scanner.

The association of malignant mesothelioma (MM) and nonoccupational asbestos exposure is currently debated. Our study investigates environmental and domestic asbestos exposure in the city where the largest Italian asbestos cement (AC) factory was located. This population-based case-control study included pleural MM (histologically diagnosed) incidents in the area in 1987-1993, matched by age and sex to two controls (four if younger than 60). Diagnoses were confirmed by a panel of five pathologists. We interviewed 102 cases and 273 controls in 1993-1995, out of 116 and 330 eligible subjects. Information was checked and completed on the basis of factory and Town Office files. We adjusted analyses for occupational exposure in the AC industry. In the town there were no other relevant industrial sources of asbestos exposure. Twenty-three cases and 20 controls lived with an AC worker [odds ratio (OR) = 4.5; 95% confidence interval (CI), 1.8-11.1)]. The risk was higher for the offspring of AC workers (OR = 7.4; 95% CI, 1.9-28.1). Subjects attending grammar school in Casale also showed an increased risk (OR = 3.3; 95% CI, 1.4-7.7). Living in Casale was associated with a very high risk (after selecting out AC workers: OR = 20.6; 95% CI, 6.2-68.6), with spatial trend with increasing distance from the AC factory. The present work confirms the association of environmental asbestos exposure and pleural MM, controlling for other sources of asbestos exposure, and suggests that environmental exposure caused a greater risk than domestic exposure.

Using discharge abstract data, we analysed hospital mortality comparing four different methods of risk adjustment. All patients discharged from the S. Giovanni Battista (Molinette) hospital in Turin (Italy) between January 1996 and June 1999 (n = 169,746) were classified with All Patient Refined--Diagnosis Related Groups (APR-DRG). A first analysis evaluated the time trend of hospital mortality by semester. A second analysis compared hospital mortality during the last 12 months among eight units of internal medicine (n = 5592). All comparisons were made through logistic regression models. As the quality of discharge abstracts increased during time and showed variation among units with similar patients, all comparisons were repeated using four models, characterised by increasing predictivity and sensitivity to quality of data. In addition to crude comparisons (A), the other models included as risk factors: B) age and emergency admission; C) same as 'B' plus expected mortality by APR-DRG; D) same as 'B' plus expected mortality by APR-DRG and risk of death subclass. If no risk factors were considered (A), hospital mortality showed an increasing trend, with an odds ratio (OR) of 1.02 by semester, with a 95% confidence interval (CI) between 1.01 and 1.03. The association was weakened when age and mode of admission were taken into account (B) and disappeared when the APR-DRG expected mortality was also considered (C) (OR = 1.00; CI = 0.98-1.01). Finally, if the comparisons were adjusted also for the expected mortality by APR-DRG and risk of death subclass (D) a reversed trend appeared (OR = 0.95; CI = 0.94-0.97). The comparison among the units of internal medicine gave discordant results according to the method used to adjust for confounders. The most striking variations were detected for those units with the best and the worst clinical data. The unit with the poorer clinical data (average number of diagnoses per patient = 2.9) showed a crude OR of 1.38 (CI = 0.99-1.93) and an adjusted OR (D) of 1.71 (CI = 1.10-2.66); the unit with the best quality of data (average number of diagnoses per patient = 4.4) changed the OR from 1.55 (CI = 1.06-2.26) (A) to 0.66 (CI = 0.37-1.17) (D). In conclusion, these results confirm the high sensitivity of the APR-DRG classification to the quality of data and, more in general, suggest to be prudent when using powerful instruments like this to assess quality of care, especially if the quality of data among the units compared is less than optimal or not homogeneous.

Data available from the standard hospital discharge database (SDO) allow us to explore differences in health conditions according to different indicators of socioeconomic status (SES). We analysed all the patients aged 30-59, discharged from the S. Giovanni Battista (Molinette) hospital (the main general hospital in Turin, Italy) during three years (1996-1998) (n = 49949). Three health indicators were used as outcomes: a) emergency admission; b) severity of illness (according to the "All Patient Refined DRGs" subclasses); c) hospital mortality. Patients were compared for each outcome according to two different SES indicators: a) level of education; b) employment status. Logistic regression models (both conditional and unconditional) were used to adjust for several potential confounders. Patients with lower education (up to 5 years of schooling), compared to those with 13 or more years of schooling, showed a higher probability of being admitted through the emergency ward (29.1% vs 23.3%), with an odds ratio (OR) = 1.56-95% confidence interval (95% CI) = 1.45-1.68; of being classified in higher severity subclasses of illness (23.3% vs 17.7%, OR = 1.14; 95% CI = 1.07-1.22) and of dying in hospital (2.3% vs 1.6%). However, after adjustment for other prognostic factors (as severity of illness and specific expected mortality), this association disappeared (OR = 1.05, 95% CI = 0.84-1.32). Similar, but somewhat stronger, associations were observed when comparing the unemployed versus the employed. The corresponding figures (ORs; 95% CI) were 1.57 (1.42-1.74) for emergency admission; 1.31 (1.18-1.45) for severity of illness and 1.55 (1.10-2.16) for hospital mortality. In conclusion, this study showed that SES differentials in health are clearly measurable through routine hospital information systems, and documented that patients of low SES, particularly unemployed, experienced a delayed access to hospital, were admitted in poorer general health conditions and had a more unfavourable prognosis.

This paper describes methods and results of the Piedmont Malignant Mesothelioma Registry. The Registry is active since 1990 and collects all histologically confirmed incident cases of malignant mesothelioma (m.m.) occurring in the residents of Piedmont. In the period 1990-95, 346 cases of pleural m.m. (211 males and 135 females) and 41 (28 males and 13 females) of peritoneal m.m. have been observed. Amongst the inhabitants of the Local Health Authority of Casale Monferrato, where manufacturing of cement asbestos has determined serious asbestos exposures both in the work place and general environment, there have been 105 pleural m.m. and 17 peritoneal m.m. (incidence rate were 15.6 for men and 13.0 for women and 3.6 for men and 0.6 for women respectively). Leaving out the Local Health Authority (LHA) of Casale Monferrato, the annual incidence rate in Piedmont (for 10(5) person-years, age standardised on the 1981 Italian population), has been 1.0 in men and 0.6 in women for the pleural m.m. (respectively 154 and 87 cases) and 0.09 and 0.06 for peritoneal m.m. (14 and 10 cases). Possible cases of m.m. (cytological and/or x-ray diagnosis) have been searched in the file of hospital admission and discharges (SDO) in 1994-95: 46 additional cases were found, with a 25% increase in incidence rates. The analysis of incidence according to geographical aggregations (defined according to the LHA borders) has identified, besides some already known important sources of exposures, as Casale Monferrato and the LHA of Lanzo (Balangero mine), other areas with excess of incidence as the LHA's of Galliate and Caluso which show an increased incidence of pleural m.m. in men or Vercelli and Chieri with increased incidence of pleural m.m. in women. These observation deserves further analysis.

A case-control study on pleural malignant mesothelioma (MM) was conducted in Casale Monferrato, where the largest Italian asbestos cement (AC) factory had been operating from 1907 to 1985. In a previous study we observed a five to seven-fold increase in the incidence of MM among people living in that city and never employed in the factory mentioned. The present study includes cases of MM with histological diagnosis over the period 1.1.1987-30.6.1993 among residents in the Local Health Unit (LHU) of Casale Monferrato. Population controls were randomly extracted from the list of the residents in the LHU, matched to cases on sex, date of birth, vital status and date of death. Cases and controls (or their closest relative) were interviewed with a standardised questionnaire focusing on asbestos exposure in the (life-long) residential and occupational histories and in leisure time activities as well as on occupational asbestos exposure of relatives and cohabitants, smoking and chest or occupational diseases. The interview was blind in respect to case or control status. For the analyses the addresses were coded on map grids with a 500 m. mesh size. Statistical analyses were conducted with conditional logistic regression in order to keep the matching between cases and controls. Eighty-eight cases and 244 controls were interviewed (95.6% of cases and 80.1% of controls): 26 and 11 respectively reported an activity in the AC industry. Seven cases and 7 controls were also exposed because of parental occupation. The main analyses are based on the conditional regression model including both occupational and residential exposure. The different modes of exposure are included on an ordinal scale: each subject is classified according to their highest level. Domestic exposure is included as an independent factor. Odds Ratios (OR) are estimated with reference to subjects without either occupational or residential exposure. The OR is 39.3 among subjects reporting occupational exposure, 11.9 among those never engaged in the AC industry but living within 1000 m. of the factory. A statistically significant risk is also observed for persons at some time living in the other areas of Casale Monferrato.

The present report updates a mortality cohort study of workers in the largest Italian asbestos cement plant. The plant had been active in Casale Monferrato in 1907-1986 and produced boards, corrugated sheets, tubes and high-pressure pipes. Raw material included both chrysotile and crocidolite but not amosite. Airborne asbestos concentrations were measured for the first time in 1971 (over 20 ff/cc in most areas). Regular monitoring started in 1978, when the concentration measured in most samples was below 1 ff/cc. The cohort included 3367 blue-collar workers (2605 men and 762 women) employed at the plant at any time between 1950 and 1980. At the end of the follow-up in 1993, 57% were alive, 41% were dead and 2% were either lost or had moved abroad. Mortality in the cohort was compared to mortality rates in Piedmont; local rates have been available only since 1969 and mortality analyses were limited to the period since 1965. Both sexes showed a statistically significant increase in mortality for all causes: lung cancer (males: 162 obs. vs. 65.4 exp.; females 9 vs. 3.2), malignant neoplasm (MN) of the pleura (males 53 vs. 1.7; females 21 vs. 0.4), MN of the peritoneum (males 23 vs. 1.2; females 8 vs. 0.5) and asbestosis (males 118 vs. 0.2; females 14 vs. 0.1). No excesses were observed for MN of the larynx or of the digestive tract. Women show a statistically significant increase in MN of the ovary (7 vs. 2.7) and of the uterus (14 vs. 4.3). Mortality from MN of the lung increased with latency but, in men, showed a curvilinear trend with the highest SMR for those with between 10 and 19 years of employment. The curve could be related to workers with the highest seniority employed in better jobs. The study includes a review of epidemiological studies on mortality among asbestos cement workers.

OBJECTIVES--To assess and quantify the occurrence of pleural malignant mesotheliomas in people who neither experienced occupational exposure to asbestos nor were married to (or known to live with) workers exposed to asbestos in the workplace. The study was conducted in the area of the local health authority of Casale Monferrato, in north western Italy, where a large factory that produced asbestos cement was active up to 1985. No other major activities related to asbestos have ever been present in the area. METHODS--A retrospective survey covering the period 1980 to 1991 identified 126 incident pleural malignant mesotheliomas histologically diagnosed among residents in the local health authority (population at the 1981 census 98,000). Submission of 83 of 95 cases diagnosed during 1980-9 for revision by a panel of five expert pathologists led to the exclusion of 21. The 31 cases diagnosed in 1990-1 were not submitted for revision. For 64 of the 105 retained cases, information derived from different sources (rosters of the employees in the asbestos cement factory dated back to 1907, list of their spouses, clinical records) did not suggest occupational or paraoccupational exposure to asbestos. RESULTS--Incidence excludes cases for which there was some suggestion of occupational or paraoccupational exposure to asbestos. Incidence of histologically confirmed malignant mesothelioma among residents in the local health authority (annual x 100,000; age adjusted) was 4.2 in men and 2.3 in women (based on 26 and 18 cases respectively). In both sexes, rates in 1985-9 were higher than in the previous quinquennium. Corresponding estimates for 1990-1 (based on unrevised diagnoses) suggest similar rates in men and women. CONCLUSION--Rate ratios which are four to six times those measured by conventional Italian cancer registries can hardly be totally explained by bias produced by lack of recognition of occupational or paraoccupational exposure. The problem of proving this type of negative data is common to other circumstances of alleged cancer clusters of environmental (non occupational) origin.

Population survival studies are usually carried out within population-based cancer registries and are useful mainly for geographical and temporal survival comparisons. Survival studies based on clinical series of patients are traditionally executed to evaluate the efficacy of a given treatment or to analyze the prognostic role of clinical factors. Subjects from a case-control study on incidence of larynx and hypopharynx cancers in Turin, for the period 1979-82, were followed-up in order to study their survival. The analysis was based on 347 cases of larynx cancer (319 males and 28 females) and 48 cases of hypopharynx cancer (47 males and 1 female). For larynx cancer, observed five-years survival was 59% in males and 64% in females. Hypopharynx cancer had a worse prognosis (21%). In males suffering from larynx cancer, older age, extent of spread, birth in Northern Italy, and being unmarried proved to be statistically significant negative prognostic factors. The same variables were also predictive of survival for hypopharynx cancer. The one- and three-year relative survival for larynx cancer in Turin was higher than that reported by other cancer registries. For males, relative five-year survival figures range from 47% to 65%. Survival for hypopharynx cancer is considerably lower, five-year figures ranging from 13% to 35%. The survival study on lung cancer was based on all the incident cases recorded by the Lombardy Cancer Registry (L.C.R.) from 1976 to 1981; during this period there were 2042 cases of primary lung cancers occurred in males and 217 in females. Observed survival at one, three and five years from diagnosis was 29%, 8% and 5%, respectively. Survival decreased with increasing age; no important differences between sexes are evident. Information on tumor stage was available in 1904 cases and histotype was known in 1605. Three-year survival was 17% for localized tumors, 8% for tumors with regional metastasis, and 1% for tumours with distant metastasis. Epidermoid carcinomas had a better prognosis than non-epidermoid carcinomas in the first year of follow-up, survival being 38% and 29%, respectively; among non-epidermoid carcinomas the worst prognosis was for small-cell carcinomas. Comparisons between the LCR relative survival and that reported by other cancer registries did not show important differences, five-year figures ranging from 5% to 10% in males.(ABSTRACT TRUNCATED AT 400 WORDS)

The use of real-time internal standardization for inductively coupled plasma atomic emission spectrometry (ICP-AES) was investigated using a new echelle spectrometer equipped with a custom segmented-array charge coupled device detector. The simultaneous data acquisition system is useful for the study of the degree of correlation in the line signals for a multi-element line set. Precision values below 0.1% RSD were readily obtained when the proper conditions were used. Shot noise, which cannot be correlated, degrades the correlation between the analyte and the reference signal. The instrumentation used permitted the examination of the same spectral line signal of an element in adjacent orders of the echelle grating, thus providing a useful means of studying signal correlation and the effect of shot-noise. A signal which is generated from a linear combination of signals coming from a multi-element line set was used as the reference signal for internal standardization. Results with this synthetic signal were compared with the use of a Sc reference line. Precision improvements as large as a factor of three were observed with simultaneous internal standardization when the analytical signal was limited by flicker noise. Improvement factors of ≈50 were observed when the signal contained a significant drift component. The precision of shot-noise limited signals was not improved by applying simultaneous internal standardization. Methods are described for discriminating between flicker noise, shot noise and drift in the analytical signal.

The performance of cross-flow pneumatic nebulisers for the inductively coupled plasma was studied. The parameters studied included the precision of the analytical signal and its stability. The test protocol was chosen to provide a performance index (PI) for the nebulisers in order to rate them. The PI is based on the average short-term relative standard deviations (RSDs) measured over extended periods of time. The measurements were used to test reliability across different lots of nebulisers and to investigate the consistency of performance. Also, the effects on performance of replacing the removable cross-flow tips was studied. The test protocol included the use of Triton X-100 surfactant in the standards to eliminate potential variability of wetting in the spray chamber. The use of surfactant also helps to ensure the smooth transfer of the sample liquid through the pump and capillary tubing leading to the nebuliser. The PI for the cross-flow nebulisers was typically between 0.5 and 1.0% and always less than 1.5%, expressed as RSD.

Anecdotal data in the last few years suggest that protein-sparing modified diet (PSMF) delivered by naso-gastric tube enteral (with continuous feeding) could attain an significant weight loss and control of appetite oral feeding, but no phase II studies on safety and efficacy have been done up to now. To verify the safety and efficacy of a protein-sparing modified fast administered by naso-gastric tube (ProMoFasT) for 10 days followed by 20 days of a low-calorie diet, in patients with morbid obesity (appetite control, fat free mass maintenance, pulmonary function tests and metabolic pattern, side effects), 26 patients with a BMI ≥30 kg/m2 have been selected. The patients had to follow a protein-sparing fast by enteral nutrition (ProMoFasT) for 24 h/day, for 10 days followed by 20 days of low-calorie diet (LCD). The endpoint was represented by body weight, BMI, abdominal circumference, Haber’s appetite test, body composition by body impedance assessment (BIA), handgrip strength test, metabolic pattern, pulmonary function test. Safety was assessed by evaluation of complications and side effects of PSMF and/or enteral nutrition. In this report the results on safety and efficacy are described after 10 and 30 days of treatment. After the recruiting phase, a total of 22 patients out of 26 enrolled [14 (63.6 %) females] were evaluated in this study. Globally almost all clinical parameters changed significantly during first 10 days. Total body weight significantly decreased after 10 days (∆−6.1 ± 2; p