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Objectives Standard of care sepsis biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT) can be affected by several perinatal factors, among which perinatal asphyxia (PA) has a significant role. In this light, new early sepsis biomarkers such as presepsin (P-SEP) are needed to enact therapeutic strategies at a stage when clinical and laboratory patterns are still silent or unavailable. We aimed at investigating the potential effects of PA on longitudinal P-SEP urine levels. Methods We conducted an observational case-control study in 76 term infants, 38 with PA and 38 controls. Standard clinical, laboratory, radiological monitoring procedures and P-SEP urine measurement were performed at four time-points (first void, 24, 48, 96 h) after birth. Results Higher (p0.05, for all) at T0 were observed between groups. P-SEP urine levels were higher (p0.05) at 48 and 96 h were observed. No significant correlations were found (p>0.05) between P-SEP and urea (R=0.11) and creatinine (R=0.02) blood levels, respectively. Conclusions The present results, showed that PA effects on P-SEP were limited up to the first 24 h following birth in absence of any kidney function bias. Data open the way to further investigations aimed at validating P-SEP assessment in non-invasive biological fluids as a reliable tool for early EOS and LOS detection in high-risk infants.

Background: real-life studies are encouraged to evaluate the effectiveness and safety of allergen immunotherapy (AIT). In this context, a retrospective cohort study was conducted to assess the effectiveness and safety of carbamylated monomeric allergoid subcutaneous immunotherapy (MA-SCIT), along with patient satisfaction. Methods: a total of 291 patients with rhinoconjunctivitis with or without asthma with inhalant (house dust mite, grass, and pellitory) allergies were enrolled in this study. Perceived efficacy and perceived satisfaction with MA-SCIT, symptom score by VAS, ARIA classification of rhinitis, drug consumption, number of asthma worsening episodes, and asthma symptom control were evaluated by questionnaires before, after one year, at the end of treatment, and after one or two years of MA-SCIT. Results: the overall symptom score significantly decreased over the years of MA-SCIT, irrespective of specific sensitization (p < 0.01). There was a substantial amelioration of rhinitis severity, with a significant reduction (p < 0.01) in drug use. A significant reduction was observed in the asthma symptom VAS score and asthma-worsening episodes requiring systemic steroids. None of the patients reported any severe adverse reactions. Finally, 90% of the patients reported full satisfaction with the treatment. Conclusions: the study showed that AIT with carbamylated monomeric allergoids of grass, pellitory, and mites was effective and well tolerated by patients.

To provide an update on the possible role of nanoparticles as sensitizing occupational agents and on the influence of nanoparticles-exposure on the appearance/exacerbation of occupational allergy.Recent case reports, epidemiological studies, and experimental investigations in cellular and animal models demonstrated the potential for nanomaterials to favor/interfere with occupational allergy. First data are emerging on the sensitizing potential of nanoparticles that can act as haptens linking to proteins, with a formation of a 'corona'. Nanoparticles with carrier protein become a complete antigen and induce specific immune response. Moreover, they act as adjuvant favoring sensitization to bound molecules. The disruption of the respiratory and skin barrier, the modulation of immune response toward Th1 or Th2 immune reaction and the interaction with immune effector cells (mast cells and eosinophil in particular) can explain the potential for nanoparticles to exacerbate pre-existing allergic conditions.the exposure to nanoparticles represents a possible risk for occupational allergy both in the respiratory tract and in the skin. A deeper knowledge on the role of nanomaterials in the etiology/development of the allergic disease will allow to implement risk assessment and preventive measures for nanosafety in the contest of technological expansion.

The novel Coronavirus Disease 2019 (COVID-19) pandemic has renewed attention to aerosol-generating procedures (AGPs). Dental-care workers are at high risk of contamination by SARS-CoV-2. The aim of this study was to evaluate the efficacy of standard saliva ejectors and natural ventilation in reducing particulate matter (PM) concentration during different routine dental procedures in the pandemic period. The DustTrak monitor was used to measure PM1, PM2.5, PM10, and breathable (&lt, 4 microns) total dust during 14 procedures performed with and without the presence of natural ventilation in a dental unit. Moreover, measurements were performed near the practitioners or near the standard saliva ejectors during the different procedures. In the latter condition, reduced levels of PM10 were recorded (82.40 ± 9.65 μg/m3 vs. 50.52 ± 0.23 μg/m3). Moreover, higher levels of PM (53.95 ± 2.29 μg/m3 vs. 27.85 ± 0.14 μg/m3) were produced when the dental unit’s windows were open. At the same time, the total level of PM were higher during scaling than during other procedures (data suggest not to adopt natural ventilation—both window and door opened—during dental procedures). It was also demonstrated that the use of standard saliva ejectors can considerably reduce the total released amount of PM10.

Background. Spondylodiscopathies are usually counted among the "work-related diseases" that are those chronic-degenerative diseases with multifactorial etiology where the work environment can sometimes assume the role of direct and efficient contributing cause. Low back pain is the main cause of functional limitation and absence from work in the western world, resulting in a huge individually and socially economic burden. Objective. This work was designed to provide an overview of the impact that lumbar rachipathies have on health surveillance, highlighting the correlations between the pathology severity, characterization of professional risk and issue of elegibility for the specific task. Methods. Was analyzed a case studies of lumbar rachipathies reports received by INAIL in the entire Abruzzo region in 2017, the last year available in the INAIL database at the time of data extrapolation dating back to May 2019. For each dossier were collected data extrapolated from: DVR, medical record and risk, instrumental examinations and specialist visits. The software "Epi Info" version 7 was used for the statistical analysis of the sample, provided by the CDC (Centers for Disease Control and Prevention) in Atlanta. Results. The expression of work elegibility with limitations and/or prescriptions by the phisicians is related only to clinical symptoms and not to the presence of a herniated disc on CT or MRI tests. The exposure to risk from MMH and WBV, documented in the DVR, was not found to be related to the presence of a herniated disc on instrumental examinations. There was no significant difference in the average age between workers recognized as technopathic from non-technopathic. Conclusions. Although biomechanical overload has always been considered as an important wear element of the intervertebral disc, genetic influences and constitutional factors seem to be elements more implicated in the development of hernial disc disease.Introduzione. Le spondilodiscopatie vengono usualmente annoverate tra le “work-related diseases”, ovvero tra quelle patologie cronico-degenerative ad eziologia multifattoriale rispetto alle quali l’ambiente di lavoro può assumere talvolta il ruolo di concausa diretta ed efficiente. La lombalgia rappresenta la principale causa di limitazione funzionale e di assenza lavorativa nel mondo occidentale, determinando un enorme onere economico sia a livello individuale che sociale. Obiettivi. Il presente lavoro è stato ideato per fornire un inquadramento dell’impatto che le rachipatie lombari hanno sulla sorveglianza sanitaria, evidenziando le correlazioni tra gravità della patologia, caratterizzazione del rischio professionale ed emissione del giudizio d’idoneità alla mansione specifica. Materiali e metodi. È stata analizzata una casistica di denunce di rachipatie lombari pervenute all’INAIL nell’intera regione Abruzzo nel corso del 2017, ultimo anno disponibile nel database al momento dello studio. Esaminando ogni pratica, sono stati raccolti dati estrapolati dal DVR, dalla cartella sanitaria e di rischio, dagli esami strumentali e dalle visite specialistiche. Per l’analisi statistica del campione è stato utilizzato il Software “Epi Info” versione 7, fornito dal CDC (Centers for Disease Control and Prevention) di Atlanta. Risultati. L’espressione di una idoneità con limitazioni e/o prescrizioni da parte dei medici competenti è correlata alla sola sintomatologia clinica e non al riscontro di ernia del disco agli esami TC o RMN. L’esposizione ai rischi “movimentazione manuale dei carichi” e “vibrazioni a corpo intero”, documentati nel DVR, non sono correlati al riscontro strumentale di ernia discale. Non è risultata alcuna differenza significativa dell’età media tra i lavoratori riconosciuti affetti da tecnopatia rispetto a quelli senza riconoscimento. Conclusioni. Nonostante il sovraccarico biomeccanico sia considerato come importante elemento di usura del disco intervertebrale, influenze genetiche e fattori costituzionali sembrano essere elementi maggiormente implicati nello sviluppo della patologia erniaria discale.

The literature highlights differences in the dental conditions of people with disabilities compared with the general population. The aim of this study was to provide an overview of the dental health of people with disabilities in order to understand if their needs are met and to identify their most critical issues as per dentists. A paper and a Google Form platform were used in conducting a survey in Central Italy (the Abruzzo region), by performing an analysis on different points of view as reported by people with disabilities and dentists. The results showed that only 69.2% of dentists treat persons with disabilities. Of these, 73.5% treat less than 10 patients with physical disabilities per year. However, 54% of dentists do not treat people with cognitive impairment and a poor ability to collaborate during treatment. More than 80% of respondent dentists report that people with disabilities do not have good oral hygiene. On the other hand, 49.1% of people with disabilities (or their caregivers in cases where the patient was unable to answer) report that they rarely or never go to the dental office. Moreover, when they do go, it is mainly for emergencies. Despite this, respondents are well aware of their dental problems. However, they have difficulties in communicating their dental problems to their dentist. The 50% of dentists who treat people with cognitive impairment do not include them in follow-up, while only 20% of these patients reported being regularly recalled. This illustrates the importance of the implementation of follow-up. In addition, training courses could help clinicians to reduce this gap and create barrier-free dental offices.

Retinopathy of prematurity (ROP) is a leading cause of potentially preventable blindness in low birth weight preterm infants. Several perinatal and postnatal factors contribute to the incomplete maturation of retinal vascularization, leading to oxidative stress damage. Literature data suggest that the lack of equilibrium between pro-oxidants and anti-oxidants plays a key role. In the last decade, there has been an increasing interest in identifying the antecedents of ROP and the relevant pathogenic mechanisms involved. In this context, a panel of biomarkers was investigated in order to achieve early detection of oxidative stress occurrence and to prevent retinal damage. Several nutritional elements have been found to play a relevant role in ROP prevention. At this stage, no conclusive data have been shown to support the usefulness of one biomarker over another. Recently, the Food and Drugs Administration, the European Medicine Agency, and the National Institute of Health proposed a series of criteria in order to promote the inclusion of new biomarkers in perinatal clinical guidelines and daily practice. The aim of the present review is to offer an update on a panel of biomarkers, currently investigated as potential predictors of ROP, highlighting their strengths and weaknesses.

To test whether gas and oil field work is accompanied by stress and altered immune function, the perception of workplace stress, levels of salivary cortisol, plasma levels, and mononuclear cell production of cytokines were examined in 80 healthy workers recruited among a population of operators on gas and oilfields. Specific questionnaires for determining the perception of anxiety, occupational stress, and subjective symptoms were administered. Salivary cortisol and cytokines plasma levels were evaluated by Elisa and to investigate immune function, both spontaneous and PHA- or LPS-induced expression and production of cytokines were assessed by qRT-PCR. Workers showed medium stress levels at work, with growth and increased motivation for work, and based on salivary cortisol concentrations, were divided into two groups of &le, 10 ng/mL (n = 31) or &gt, 10 ng/mL (n = 49). Statistically significant higher plasma levels of IL-6, while lower TNF&alpha, were detected in workers with cortisol &gt, 10 ng/mL. Also, BMI, DL, JD and Job strain were significantly higher in workers with cortisol &gt, 10 ng/mL. Thus, even modest variations of cortisol might have a role in the modulation of immune response and worker&rsquo, s vulnerability to health imbalance.Thus, the evaluation of immune status, in addition to cortisol levels, could be useful to prevent illnesses, exacerbation of pre-existing conditions, morbidity, and consequent absences from work, with economic repercussions.

Nickel is one of the most common skin sensitizers, usually responsible for allergic contact dermatitis (ACD). The ingestion of nickel-rich foods is also able to elicit cutaneous (in the absence of physical contact with nickel) and gastrointestinal symptoms in some subjects with nickel ACD, a condition referred to as systemic nickel allergy syndrome (SNAS). The pathogenesis of this disease involves both Th1 and Th2 cells and cytokines, with involvement of both CD8- and CD4-positive T lymphocytes. Clinical aspects include flares of previous ACD lesions and/or positive nickel patch test reactions, widespread eczema, and gastrointestinal disturbance essentially characterized by meteorism and colic. This diagnosis may be suspected in patients with nickel ACD whose gut and skin symptoms disappear or improve after a low nickel diet. Essential for the diagnosis is to confirm that symptoms reappear after a double-blind placebo-controlled oral nickel challenge. In such cases, the low nickel diet can be used as treatment. Of note, to maintain a nickel-free diet for a long time may strongly impact a patient’s quality of life. Therefore, a desensitization treatment should be considered in these patients. Nickel hyposensitization is effective in patients suffering from SNAS. The majority of such patients can safely ingest nickel-containing foods after 1 year of treatment. Clinical experience in patients with ACD alone, although positive and encouraging, is scarce in terms of the number of patients treated and length of the hyposensitization course, which is usually followed, after a relatively short period of time, by a relapse of cutaneous symptoms. In any case, nickel hyposensitization is able to modulate immune responses to nickel by restoring a state of tolerance that seems to be mediated by T regulatory lymphocytes.

Background: This is the first randomized, double-blind, placebo-controlled trial (EUDRACT No. 2009-013923-43) evaluating nickel oral hyposensitizing treatment (NiOHT) in patients with “systemic nickel allergy syndrome” (SNAS), characterized by Ni-allergic contact dermatitis and systemic reactions after eating Ni-rich food. Methods: Adults with positive Ni-patch test, who reported symptoms suggesting SNAS, which improved after Ni-poor diet, and were positive to Ni-oral challenge were eligible. Patients were randomly assigned to three treatments (1.5 μg, 0.3 μg, or 30 ng Ni/week) or placebo for a year, with progressive reintroduction of Ni-rich foods form the 5th month. Out of 141 patients randomized, 113 completed the trial. Endpoints were efficacy and tolerability of treatment. Results: During Ni-rich food re-introduction, the 1.5 μg Ni/week group had a mean VAS score significantly higher than placebo (p = 0.044), with significant improvement of gastrointestinal symptoms (p = 0.016;) and significantly fewer rescue medications. Cutaneous manifestations also improved but without reaching statistical significance. After the treatment, oral challenge with higher Ni doses than at baseline were needed to cause symptoms to flare-up in significantly more patients given 1.5 μg Ni/week than placebo (p = 0.05). Patients reported no side-effects. Conclusions: NiOHT is effective in SNAS, in particular on gastrointestinal manifestations, with trend toward improvement of cutaneous symptoms.

The first essential aspect for the prevention of occupational allergy is related to the accurate allergen identification and characterization. At present many efforts are made to characterize the potential for a chemical to be a sensitizing agent.'Omics' show great promise to identify key cellular and molecular events relevant to development of an adverse outcome pathway for respiratory sensitizers. One approach that shows promise is based on the measurement of the peptide reactivity of chemicals; the potential to form stable associations with protein/peptide being a key requirement for the induction of sensitization.Sensitization is a dose-related phenomenon, therefore the lower the exposure the lower the risk of sensitization.In any way, establishing occupational exposure limits for chemical allergens presents numerous difficulties. Therefore it is important using alternative exposure recommendations and risk management practices, including medical surveillance and tertiary prevention, to aid in protecting workers from exposures to allergens.L’identificazione e la caratterizzazione degli allergeni è un passo fondamentale per la prevenzione dell’allergia occupazionale. Al momento le ricerche sono rivolte alla identificazione del potenziale sensibilizzante di una determinata sostanza chimica. Tra le varie metodiche, le scienze ”omiche” sembrano in grado di identificare gli eventi molecolari e cellulari rilevanti per lo sviluppo di una sensibilizzazione. Inoltre, è promettente in quest’ottica la misurazione della reattività peptidica di una sostanza chimica, visto che la possibilità di formare legami stabili con proteine/peptidi è un fondamentale presupposto per l’induzione di sensibilizzazione. L’evento sensibilizzazione è un fenomeno dose-dipendente, quindi la riduzione dell’esposizione sarà importante per la prevenzione. Purtroppo, non sempre è possibile identificare i limiti di esposizione per tutte le sostanze sensibilizzanti. Pertanto sarà importante utilizzare sostanze alternative e una corretta gestione del rischio, tra cui fondamentali la sorveglianza sanitaria e la prevenzione terziaria.

This article reviews the main aspects for the prevention and management of occupational asthma due to allergic sensitization in the workplace. An accurate allergen identification and characterization is the essential aspect of the primary prevention. Both high and low molecular weight molecules (the first acting as complete antigens the second as haptens) can induce asthma. Sensitization is a dose-related phenomenon, therefore the lower the exposure the lower the risk of sensitization. Health surveillance is the key action of the secondary prevention; it aims at the early identification of workers with occupational exposure to asthma-causing agents by means of respiratory questionnaires; preplacement and periodic visits, with spirometry; immunologic tests; and further investigations to confirm diagnosis and then remove the person from further exposure. Asthma management may be identified with the tertiary prevention. In this phase other than the pharmacological treatment, the occupational doctor should remove the worker from the exposure, as the reduction of allergens is a negative prognostic factor for a severe decline of lung function. In any case, workers should be informed on the risk they encounter at work for a better outcome of the preventive measures.

Sublingual immunotherapy with monomelic carbamylated allergoid (LAIS) is an effective and well tolerated treatment of respiratory allergy. The aim of the present study was to correlate the efficacy of two maintenance doses (1000 AU vs 3000 AU) of LAIS with the immunological modulation of allergen-driven Th1, Th2 and T regulatory cytokines produced in vitro by PBMCs, in patients suffering from mite allergic rhinitis. Forty-eight consecutive patients with mite allergic rhinitis were recruited. Patients were randomly assigned to group A (n=24) or group B (n=24), respectively receiving 1000 AU or 3000 AU weekly during one-year maintenance phase. Each patient was evaluated for rhinitis severity (ARIA protocol), and for drug consumption at the time of the inclusion and after 6 and 12 months of treatment. Patients were also asked to report the perceived severity of the disease and the tolerability of the treatment in a visual analogical scale (VAS). Before and at the end of the treatment allergen-driven release of cytokines by PBMCs in vitro was measured. After 1-year treatment, a statistically significant reduction of all clinical parameters was observed in all patients, associated with reduction of IL-4 and increase of INF-γ secreted in vitro by mite-challenged PBMCs. Notably, the group treated with the higher dose showed significantly better clinical and immunological results. The efficacy of LAIS is correlated to the immune modulation in a clear dose-dependent effect.

Ultrasoundelastography (USE) is a new imaging technique that is performed with a normal ultrasound transducer. It provides improved characterization of a tissue or nodule based on the latter's elasticity and stiffness. The aim of the present, prospective study was to assess the validity of USE in characterizing thyroid nodules. USE patterns were analyzed in light of nodule cytology (British Thyroid Association classification) to determine whether these patterns can be used to decide whether or not fine-needle aspiration cytology (FNAC) is indicated. We examined a consecutive series of 617 thyroid nodules in patients referred for the first time to the Endocrinology Unit of Atri Hospital (Atri, [TE]). Patients underwent ultrasonographic and USE examinations of their thyroid nodules, which were then subjected to FNAC. All nodules with Thy 1 cytology were excluded, leaving 567 nodules for analysis. USE findings were classified on the basis of the degree and distribution of elasticity within the lesion: four patterns were identified (1, 2, 3a, 3b, or 4).None of the nodules with Thy 4 cytology (malignant) had USE pattern 1 or 2; patterns 3 and 4 were associated with higher cytologic grades. In conclusion, USE provides additional information on thyroid nodules, which can be used with ultrasound features of the nodules, to decide whether FNAC is indicated. In fact, patterns 1 and 2 do not seem to be associated with Thy 4 cytology.SommarioL’Elastosonografia (ESG) è una nuova tecnica d’immagine che, utilizzando una normale sonda ecografica, consente una migliore caratterizzazione tissutale, fornendo informazioni su elasticità e durezza di un tessuto o di un nodulo.L’obiettivo di questo studio prospettico è quello di valutare l’effettiva validità della ESG nel caratterizzare i noduli tiroidei, associando il pattern elastosonografico al grading citologico e, quindi, valutare se eseguire o meno l’agoaspirazione del nodulo tiroideo, in base al pattern ESG. Sono stati studiati, in serie successiva, 617 noduli tiroidei di pazienti afferiti per la prima volta presso la nostra UO di Endocrinologia del P.O. di Atri (TE), sottoposti ad esame ecografico, elastosonografico e ad agoaspirato con ago sottile (FNAC), per lo studio citologico. Tutti i noduli che al referto citologico presentavano un grado Thy 1 sono stati esclusi dallo studio, pertanto sono stati esaminati 567 noduli. Lo score elastosonografico utilizzato prevede 5 patterns cromatografici (1; 2; 3a; 3b e 4) a seconda della distribuzione di tessuto più o meno elastico all’interno del nodulo.I risultati dell’ESG hanno evidenziato che nessun nodulo con citologico Thy 4 presenta un grado elastosonografico 1 o 2; passando ai patterns elastosonografici 3 e 4 si assiste ad una crescita concomitante del grading citologico. In conclusione l’ESG può essere considerata un ulteriore parametro, in associazione alle caratteristiche ecografiche del nodulo, per decidere se eseguire o meno lo studio citologico. Infatti i patterns elastosonografici 1 e 2 sembrerebbero non associarsi a citologici Thy 4.

Inhaled corticosteroids (ICS)/long-acting beta-agonists (LABA) association offers a better asthma control than a higher steroid dose with short-acting beta-agonists as needed. In this study, we evaluated the effect of the association on bronchial hyperreactivity (BHR) and peak expiratory flow (PEF) variability, as such parameters are positively correlated with increased asthma morbidity and exacerbations. Thirty-six adult patients with mild persistent asthma were enrolled. After a 7-day run-in, they were randomly assigned to three therapy regimens for 6 weeks: Group 1, fluticasone 125 μg + formoterol 5 μg in the same device; Group 2, fluticasone 125 μg + formoterol 12 μg as needed; Group 3, fluticasone 250 μg + formoterol 12 μg as needed. We evaluated changes induced in weekly PEF variability (measured during the entire study and 4 weeks of follow-up) and pre- and post-study PD20 methacholine (MCH). Weekly PEF variability decreased in all groups during treatment with the greatest reduction in Group 1, followed by Group 3, and finally Group 2. During the follow-up, no significant changes were detected in Group 1, whereas a trend towards an increased variability was found in Groups 2 and 3. Post-treatment PD20 MCH was significantly higher versus the pre-treatment. The increase observed in Group 1 was significantly higher compared to Groups 2 and 3 and that observed in Group 3 in respect to Group 2. The study proves that both BHR and PEF variability are influenced by ICS. This effect was greater with fluticasone/formoterol association compared to fluticasone alone with formoterol as needed even at higher steroid dose.