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The Italian Interministerial Decree of February 11, 2021, introduces the diesel engine exhaust (DDE) among the carcinogenic occupational compounds, also establishing an occupational exposure limit. Elemental carbon (EC), improperly called black carbon, has been proposed as a tracer of DDE exposure; EC is the carbon that is quantified in the ambient matrixes after all the organic carbon has been removed; traditionally, EC is measured with a thermo-optical analytical technique. EC determination and relative interpretation are challenging for the following reasons: (i) the scarce availability of equipped laboratories hampers EC analysis, (ii) EC interpretation is not easy due to the lack of reference values. Finally, (iii) the limit value of 0.050 mg/m3 of EC in the workplace appears too high compared to recently published exposure data. All these aspects stimulate a reflection on the significance of EC data in the context of both occupational hygiene and occupational medicine.

Background: Bradyarrhythmia requiring pacemaker implantation among patients undergoing valve surgery may occur even after several years, with unclear predictors. Our aim was to investigate the incidence of pacemaker implantation at different follow-up times and identify associated predictors., Methods: We conducted a retrospective study evaluating 1046 consecutive patients who underwent valve surgery at the Cardiac Surgery Division of Bologna University Hospital from 2005 to 2010., Results: During 10 ± 4 years of follow-up, 11.4% of these patients required pacemaker implantation. Interventions on both atrioventricular valves independently predicted long-term pacemaker implantation (SHR 2.1, 95% CI 1.2-3.8, p = 0.014). Preoperative atrioventricular conduction disease strongly predicted long-term atrioventricular block, with right bundle branch block as the major predictor (SHR 7.0, 95% CI 3.9-12.4, p < 0.001), followed by left bundle branch block (SHR 4.9, 95% CI 2.4-10.1, p < 0.001), and left anterior fascicular block (SHR 3.9, 95% CI 1.8-8.3, p < 0.001)., Conclusion: Patients undergoing valvular surgery have a continuing risk of atrioventricular block late after surgery until the 12-month follow-up, which was clearly superior to the rate of atrioventricular block observed at long-term. Pre-operative atrioventricular conduction disease and combined surgery on both atrioventricular valves are strong predictors of atrioventricular block requiring pacemaker implantation.