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The presence of naturally occurring asbestos (NOA) in many areas worldwide requires an enhanced geological risk evaluation to ensure workplace safety from asbestos during large construction projects. Due to the complexity of the geological risk definition, health and safety regulations for working with asbestos-bearing materials are often not enforceable in NOA settings. Therefore, to correctly estimate the risk of NOA in these scenarios, new procedures are urgently needed to provide (1) a detailed geological model representative of the possible presence of the asbestos, (2) representative sampling, and (3) a reliable quantitative determination of asbestos content in rocks. This work aims to discuss the improvements on the two latter points specifically developed during the design of the “Gronda di Genova” project, a 50-km-long tunnel bypass partially designed in the NOA-bearing meta-ophiolites of the Ligurian Alps and ophiolites of the northern Apennines in Italy. Implementation of Gy's theory on sampling was used to maintain statistical validity during sample processing from the primary sample to the analytical sample and is here described. The scanning electron microscopy/energy dispersive spectroscopy procedure for the quantification of NOA was improved with an error analysis delivering the minimum number of fibers to be measured to achieve the best analytical results.

In Naturally Occurring Asbestos (NOA) rich areas, water flows through asbestos bearing rocks and soils and generates waterborne fibres that may migrate in air and become a risk for humans. Research on the migration and dispersion after water vaporisation has been so far only marginally evaluated. This study investigates the migration in air of asbestos from a set of suspensions contaminated by chrysotile from Balangero (Italy), under controlled laboratory conditions. We evaluated i) the morphological modifications that might occur to chrysotile during migration from water to air, and ii) the amount of airborne chrysotile mobilised from standardised suspensions. Morphological alteration of asbestos fibres occurred during water-air migration and impacted on the analytical response of electron microscopy. Waterborne asbestos concentration higher than 40 ∙ 106 f/L generates in air concentration higher than 1 fibre per litre [f/L], the alarm threshold limit set by World Health Organization for airborne asbestos. A possible correlation between the waterborne fibre concentration as mass or number of fibres per volume unit [μg/L or f/L] was observed.

The study aims to evaluate the performance of selected, high-volume, highly specialized, Italian Breast Centers at the time of COVID-19 pandemic (year 2020), compared to pre-pandemic time (year 2019), highlighting differences in terms of clinical presentation of breast cancer (BC) and therapeutic strategies.Patients' data were provided by the Senonetwork data warehouse Senonet. In order to examine changes in the surgical and oncological management of BC patients during different phases of COVID-19 pandemic, we took advantage of a selection quality indicators (QIs). We performed the analyses in two time-frames, from July to September (Jul-Sep) (2019 versus 2020) and from October to December (Oct-Dec) (2019 versus 2020).Our analysis did not show any statistically significant difference in terms of diagnosis, surgical, oncological and radiation therapy procedures between the two trimesters 2019 and 2020. Nevertheless, we observed statistically significant differences, favoring 2020, when analyzing time-to surgery and time-to radiotherapy. On the other hand, we observed a significant reduction of neoadjuvant chemotherapy and we did not recollect any data on a major use of neoadjuvant endocrine therapy.In Italian Breast Centers, partners of Senonetwork, we could not observe any treatment delay or change in standard clinical practice for BC care during the 2020 pandemic year, compared to 2019 pre-pandemic year. This finding is in contrast with the globally reported decrease in the performance of the Italian Breast Centers due to the COVID-19 pandemic, and has to be linked to the sharp selection of Senonetwork Breast Centers.

Among asbestos minerals, fibrous riebeckite (crocidolite) and tremolite share the amphibole structure but largely differ in terms of their iron content and oxidation state. In asbestos toxicology, iron-generated free radicals are largely held as one of the causes of asbestos malignant effect. With the aim of clarifying i) the relationship between Fe occurrence and asbestos surface reactivity, and ii) how free-radical generation is modulated by surface modifications of the minerals, UICC crocidolite and fibrous tremolite from Maryland were leached from 1 day to 1 month in an oxidative medium buffered at pH 7.4 to induce redox alterations and surface rearrangements that may occur in body fluids. Structural and chemical modifications and free radical generation were monitored by HR-TEM/EDS and spin trapping/EPR spectroscopy, respectively. Free radical yield resulted to be dependent on few specific Fe2+ and Fe3+ surface sites rather than total Fe content. The evolution of reactivity with time highlighted that low-coordinated Fe ions primarily contribute to the overall reactivity of the fibre. Current findings contribute to explain the causes of the severe asbestos-induced oxidative stress at molecular level also for iron-poor amphiboles, and demonstrate that asbestos have a sustained surface radical activity even when highly altered by oxidative leaching.

The aim of this study is to assess age-specific compliance to quality indicators (QIs) regarding the treatment of breast cancer as defined by European Society of Breast Cancer Specialists (EUSOMA) for patients across Europe.All patients entered into this study were affected by in situ or invasive breast cancer, diagnosed and treated between 2003 and 2012 at 27 Breast Units across Europe, who were entered into the EUSOMA database. Patients were categorised according to age; compliance to thirteen QIs was assessed for each age group and per time period (2003-2007 and 2008-2012). Compliance to QIs was tested by multivariable logistic regression models adjusted for breast unit, incidence year and tumour characteristics.Overall, 41,871 patients with a mean age of 59.6years were available for analysis. The highest compliance was reached for patients aged 55-64years and in the time period 2008-2012, whilst the lowest compliance was observed for women aged over 74 or under 40years and in the earlier time period. In multivariable logistic regression models, a significant difference between age categories was shown for 12 out of 13 QIs (P0.001). Compliance to the QIs for patients aged ⩾75years was significantly lower when compared to patients aged 55-64years for ten QIs, whilst for patients in the youngest age group this was true for seven QIs.In conclusion, we found that among the 27 included breast units across Europe, compliance to QIs for breast cancer treatment is often lower in the youngest and oldest breast cancer patients, with a tendency to overtreatment in the youngest patients, and to under-treatment in the elderly.

In many urban and natural areas, the presence of naturally occurring asbestos (NOA) requires a geological risk evaluation to enforce safety and exposure monitoring during the achievement of surface and subsurface infrastructures. A set up of proper procedures must provide: (i) a detailed geological model of the possible presence of the asbestos, (ii) a representative sampling, (iii) a correct analytical approach, and (iv) a working procedure that can be efficiently applied during excavation activities. At present, the EU regulations for a safety work in asbestos-bearing materials are still not exhaustive because of the great complexity of the matter and uncertainties in geological risk definition. This paper presents two case studies where the different involved parties (scientific community, environmental agencies, and private companies) jointly contributed to find technical solutions for a correct risk management of excavations in asbestos-bearing rocks as well as reliable analytical procedures for quantitative determination of the fibre content.

Within this survey, conducted by the Italian Breast Screening Network (Gruppo Italiano per lo Screening Mammografico, GISMa), individual data are collected yearly on more than 50% of all screen-detected operated lesions in Italy. In 2006, results showed overall good diagnosis and treatment quality and an improving trend over time. Critical issues were identified in waiting times, compliance with recommendations on not performing frozen section examination on small lesions and on performing specimen X-ray. Pre-operative diagnosis reached the acceptable target, but there is a large variation between Regions and programmes. The sentinel lymph node technique (SLN) was performed on the axilla in more than 70% of screen-detected invasive cancers, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN in ductal carcinoma in situ deserves further investigation. The detailed results have been distributed to regional and local screening programmes, also by means of an online database, in order to allow multidisciplinary discussion and the identification of appropriate solutions to any problems documented by the data. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making audit effective in producing quality improvement with a shortening of waiting times.

Item does not contain fulltext BACKGROUND: There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection. PATIENTS AND METHODS: Data were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS. RESULTS: Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS. CONCLUSIONS: Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.

The six week eruption of Eyjafjallajokull volcano in 2010 produced heavy ash fall in a sparsely populated area of southern and south eastern Iceland and disrupted European commercial flights for at least 6 days. We adopted a protocol for the rapid analysis of volcanic ash particles, for the purpose of informing respiratory health risk assessments. Ash collected from deposits underwent a multi-laboratory physicochemical and toxicological investigation of their mineralogical parameters associated with bio-reactivity, and selected in vitro toxicology assays related to pulmonary inflammatory responses. Ash from the eruption of Grimsvotn, Iceland, in 2011 was also studied. The results were benchmarked against ash from Soufriere Hills volcano, Montserrat, which has been extensively studied since the onset of eruptive activity in 1995. For Eyjafjallajokull, the grain size distributions were variable: 2–13 vol% of the bulk samples were

This survey, conducted by the Italian breast screening network (GISMa), collects yearly individual data on diagnosis and treatment on about 50% of all screen-detected, operated lesions in Italy. The 2010 results show good overall quality and an improving trend over time. Critical issues were identified, including waiting times and compliance with the recommendations on not performing frozen section examination on small lesions. Preoperative diagnosis improved constantly over the years, but there is still a large variation between regions and programmes. For almost 90% of screen-detected invasive cancers the sentinel lymph node technique (SLN) was performed on the axilla, avoiding a large number of potentially harmful dissections. On the other hand, potential overuse of SLN for ductal carcinoma in situ deserves further investigation. The detailed results have been distributed, also by means of a web data warehouse, to regional and local screening programmes in order to allow multidisciplinary discussion and identification of the appropriate solutions to any issues documented by the data. It should be assigned priority to the problem of waiting times. Specialist Breast Units with adequate case volume and enough resources would provide the best setting for making monitoring effective in producing quality improvements with shorter waiting times.

Objectives To summarize participation and coverage rates in population mammographic screening programmes for breast cancer in Europe. Methods We used the European Network for Information on Cancer (EUNICE), a web-based data warehouse (EUNICE Breast Cancer Screening Monitoring, EBCSM) for breast cancer screening, to obtain information on programme characteristics, coverage and participation from its initial application in 10 national and 16 regional programmes in 18 European countries. Results The total population targeted by the screening programme services covered in the report comprised 26.9 million women predominantly aged 50-69. Most of the collected data relates to 2005, 2006 and/or 2007. The average participation rate across all programmes was 53.4% (range 19.4-88.9% of personally invited); or 66.4% excluding Poland, a large programme that initiated personal invitations in 2007. Thirteen of the 26 programmes achieved the European Union benchmark of acceptable participation (>70%), nine achieved the desirable level (>75%). Despite considerable invitation coverage across all programmes (79.3%, range 50.9-115.2%) only 48.2% (range 28.4-92.1%) of the target population were actually screened. The overall invitation and examination coverage excluding Poland was 70.9% and 50.3%, respectively. Conclusions The results demonstrate the feasibility of European-wide screening monitoring using the EBCSM data warehouse, although further efforts to refine the system and to harmonize standards and data collection practices will be required, to fully integrate all European countries. The more than threefold difference in the examination coverage should be taken into account in the evaluation of service screening programmes.

Since its foundation in 2002, the Italian Silica Network (NIS), a collaborative network of professionals and public authorities, has been engaged in several aspects of research, control, and prevention of silica exposure and effects, and also in support for compensation claims for silica-related occupational health effects in Italy.We start with a report on the NIS point of view concerning the recent scientific results (from epidemiology and laboratory studies), including those carried out by NIS in cooperation with Italian universities and other public agencies. This is followed by a description of the data on silica exposure in different Italian workplaces and guidelines for the management of occupational exposure to silica, as developed by two model regional programmes for the ceramics industry, metal foundries and tunnel excavation.The NIS initiatives highlighted the persistence of workplace conditions posing a significant risk for silica-related health effects, particularly in small industries and workshops. Experimental work has also shown that a number of physical and chemical factors affect the bioreactivity of silica particles.Based on NIS experience, it appears clear that currently conditions exist in Italy so as to positively contribute to the WHO Programme for the eradication of silicosis and the other diseases related to silica exposure. In order to achieve this goal, a coordinated and wide-ranging effort is required to reduce the wide gap in specific prevention activities, particularly in small industries and workshops, where high levels of silica exposure sometimes occur.

Combustion-derived soot is a polydispersion of carbon-based molecules/particles ranging from a molecular scale length to a particle scale length (1-100 nm). It is considered responsible of respiratory and heart disease (Kumfer et al., 2009), and its mechanisms of action is related to the composition and structure, in turn mainly depending on the fuel and temperature environment in which soot is generated. Soot particles present a structural variability at a mesoscopic scale (size, geometry, nanostructure, primary particle diameter) that can be responsible of a different lung deposition degree and particle translocation behaviour. The toxic effects of inhaled dusts are believed to be mainly driven by oxidative stress which is the result of reactive oxygen species (ROS) (i.e. hydrogen peroxide, superoxide anion, hydroxyl radical) either generated directly by the particles/molecules or by cells in response to the particle exposure (Donaldson et al., 2005). This work aims to gain insights about the radical activity measured by electron spin resonance of soot generated from different fuels, namely benzene and ethylene, in relation to the specific local chemistry and nanostructural features as inferred by FT-IR and Raman spectroscopy. This study was performed on soot washed by solvent in order to eliminate light PAH (< 300u) adsorbed on soot surface with the aim to study the specific soot activity independently from the well known role of PAH. Copyright © 2010 AIDIC servizi S.r.l.

Background A randomized clinical trial was performed to compare D1 and D2 gastrectomy in specialized Western centres. This paper reports short-term results. Method A total of 267 patients with gastric cancer were randomly assigned to either a D1 or a D2 procedure in five specialized centres. Based on the findings of the phase II trial and published phase III trials, a prespecified non-inferiority boundary at 12 per cent difference between groups was set regarding total morbidity. Results In the intention-to-treat analysis, the overall morbidity rate after D2 and D1 dissections was 17·9 and 12·0 per cent respectively (P = 0·178), with a 95 per cent confidence interval of the difference of 0 to 13·0 per cent, slightly exceeding the prespecified non-inferiority limit. There was a single duodenal stump leak in the D2 arm (0·7 per cent). The postoperative 30-day mortality rate was 3·0 per cent after D1 and 2·2 per cent after D2 gastrectomy (P = 0·722). Conclusion In specialized centres the rate of complications following D2 dissection is much lower than in published randomized Western trials. D2 dissection, in an appropriate setting, can therefore be considered a safe option for the radical management of gastric cancer in Western patients. Registration number: ISRCTN11154654 (http://www.controlled-trials.com).

To determine whether the guidelines (LGR) prepared in Piedmont for the treatment of colorectal and breast cancer reached the targetphysician population and how they were been perceived by physicians.We invited all Piedmont hospital units that had treated at least 5 cases of colon-rectal or breast cancer in 2002 to participate to the survey. Physicians had to fill a short mail questionnaire. The questionnaire had three sections: distribution and implementation, quality of the instrument, utility and applicability.Replies were 65% (53/82) and 73% (105/143) respectively for the for colon rectal cancer guidelines (LGR-CR) and for breast cancer guidelines (LGR-M)). Among responders, 6% and 9% units ignored the existence of the LGR-CR and LGR-M respectively. More than 50% responders participated in the LGR presentation meetings and/or working groups for the local implementation of LGR. Overall the units judged the LGR quality positively. The LGR utility was judged positively for LGR-CR but opinions were heterogeneous for LGR-M. The LGR-M were judged unable to improve the doctor-patient relationship--or the continuity of care.The physicians who replied to the questionnaires had received the LGRs and are familiar with them. Furthermore they had a positive attitude towards the instrument. The LGR-CR seems to be better accepted than LGR-M, for which some resistance was found among gynaecologists and radiotherapists. However, very few responders described how they formally implemented the instrument in their clinical practice. Absence of LGR promotion activities (such as working groups) and low patient volume were relevant factors in limiting local implementation.