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Background: The number of cancer survivors continues to increase, thanks to advances in cancer diagnosis and treatment. Unfortunately, the incidence of a second primary cancer (SPC) is also increasing, but limited studies reporting incidence data are available regarding multiple cancers. This study presents our observations on multiple primary malignant cancers, the associations between sites, and the inherent sex differences., Patients and Methods: We report the data, disaggregated by sex, concerning the SPCs that were recorded in the "Registro Tumori Integrato" (RTI) a population-based cancer registry in Sicily, Italy, as observed in the period from 2003 to 2017, in a total population of approximately 2,300,000. SPCs were divided into synchronous and metachronous cancers. The International Classification of Diseases for Oncology , third edition (ICD-O-3), was used for topographical and morphological classifications. Multiple primary cancers with multi-organ primitiveness were selected from the database of the RTI by extracting patients with more than one diagnosis. SPCs had different histology or morphology from the particular cancer that was considered to be the index cancer case. Multicenter or multifocal cancers, or metastases, were excluded. The percentages of cancer by sex and topography, the average age of incidence, and a breakdown by age were computed., Results: Differences were observed between sexes in terms of incidence and site for SPCs. The most frequent SPC was skin cancer (20% of the SPCs observed). The associations among sites of multiple cancers are reported., Conclusion: There are many gaps in our knowledge of sex differences in cancer. The study of multiple primary cancers could bring more likely opportunities for evaluation of the cancer burden and trends that can be used to identify new research areas by population health programs, as well as for clinical researchers.

Several cardiovascular conditions exhibit seasonality in frequency and mortality, but little is known about the seasonality of Venous ThromboEmbolism (VTE), a very relevant medical condition, and seasonal influences are still conflicting. Patients having co-morbidities, individual suffered from dyspnea, swelling, edema of lower limb, pain (chest, lower limbs) are admitted frequently to the hospital emergency room (HER), particularly. Both mark a potential risk for VTE, that can be increased also by seasonality. A four years retrospective analysis (2016-2019) was carried out in individuals and patients admitted to the HER of the Hospital of Catania (a Mediterranean city of Sicily, Italy) to evaluate the VTE frequency and its seasonal differences, common symptoms, potential usage of some common laboratory tests. Dyspnea, swelling, edema of lower limb and pain (chest, lower limbs) were considered to suspect pulmonary embolism (PE) or for deep vein thrombosis of lower limb (DVT). Platelet count, platelet volume, fibrinogen, C-reactive protein, and D-dimer were considered. VTE frequency per year was 2.9/10,000 (2016), 4.9/10,000 (2017) 3.6/10,000 (2018), and 5.1/10,000 (2019) respectively. Dyspnea was highly frequent for PE, edema and lower limb pain were frequent in DVT patients. Fibrinogen, C reactive protein, and D-dimer values were found raised in all the VTE patients. Platelet volume was found higher in DVT than PE VTE events that occurred in warm periods were modestly greater (57 VTE: 38 DVT, 19 PE) compared to cold months (52 VTE: 34 DVT, 18 PE). Our results could be explained by the increased sweating due to the high temperatures, which in turn, can affect both on plasma concentration and on hematocrit value coupled to the reduction in atmospheric pressure determining both a hyper-coagulative condition. Climate seasonal characteristics, and environmental conditions in Catania city (Sicily) may be as reasonable items in expecting on different VTE rates in warm period compared to cold. This study highlights no specific symptoms, and confirms the common lab tests for individuals and patients admitted to HER as simple and helpful tools in initiating none or mini-invasive diagnostic strategy for the VTE. Finally, the climate/seasonality coupled with latitude can have a direct influence on the incidence of DVT., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The Erice 56 Charter titled "Impact of the environment on the health: from theory to practice" was unanimously approved at the end of the 56th course of the "International School of Epidemiology and Preventive Medicine G. D'Alessandro" held from 3rd to November 7, 2019 in Erice - Sicily (Italy) and promoted by the Study Group of "Environment and Health" of the Italian Society of Hygiene, Preventive Medicine and Public Health. The course, that included lectures, open discussions and guided working groups, was aimed to provide a general training on epidemiological and toxicological aspects of the environmental health impact, to be used by public health professionals for risk assessment, without forgetting the risk communications. At the end of the course 12 key points were agreed among teachers and students: they underlined the need of specific training and research, in the perspective of "One Health" and "Global Health", also facing emerging scientific and methodological issues and focusing on communication towards stakeholders. This Discussion highlight the need to improve knowledge of Health and Environment topic in all sectors of health and environmental prevention and management., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Due to population growth, urbanization and economic development, demand for freshwater in urban areas is increasing throughout Europe. At the same time, climate change, eutrophication and pollution are affecting the availability of water supplies. Sicily, a big island in southern Italy, suffers from an increasing drought and consequently water shortage. In the last decades, in Sicilian freshwater reservoirs several Microcystis aeruginosa and more recently Planktothrix rubescens blooms were reported. The aims of the study were: (1) identify and quantify the occurring species of cyanobacteria (CB), (2) identify which parameters, among those investigated in the waters, could favor their growth, (3) set up a model to identify reservoirs that need continuous monitoring due to the presences, current or prospected, of cyanobacterial blooms and of microcystins, relevant for environmental and, consequentially, for human health. Fifteen artificial reservoirs among the large set of Sicilian artificial water bodies were selected and examined for physicochemical and microbiological characterization. Additional parameters were assessed, including the presence, identification and count of the cyanobacterial occurring species, the measurement of microcystins (MCs) levels and the search for the genes responsible for the toxins production. Principal Component Analysis (PCA) was used to relate environmental condition to cyanobacterial growth. Water quality was poor for very few parameters, suggesting common anthropic pressures, and PCA highlighted clusters of reservoirs vulnerable to hydrological conditions, related to semi-arid Mediterranean climate and to the use of the reservoir. In summer, bloom was detected in only one reservoir and different species was highlighted among the Cyanobacteria community. The only toxins detected were microcystins, although always well below the WHO reference value for drinking waters (1.0 μg/L). However, molecular analysis could not show the presence of potential cyanotoxins producers since a few numbers of cells among total could be sufficient to produce these low MCs levels but not enough high to be proved by the traditional molecular method applied. A simple environmental risk-based model, which accounts for the high variability of both cyanobacteria growth and cyanotoxins producing, is proposed as a cost-effective tool to evaluate the need for monitoring activities in reservoirs aimed to guarantee supplying waters safety., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The overall efficiency of a pilot-scale hybrid constructed wetland (H-CW), located on a retail store's parking area in Eastern Sicily, for alternative treatment of stormwater runoff and of sequential batch reactor (SBR) effluent was evaluated. Experimental activities were focused on system performances, including wastewater (WW) quality and hydraulic monitoring. System design, macrophyte growth and seasonal factors influenced the pilot plant performance. Very high removal efficiency for microbial indicators were reported within the subsurface horizontal flow unit (HF), playing a strategic role for Clostridium perfringens. The algal growth occurred in the free water surface (FWS) unit and inhibited removal efficiencies of total suspended solids (TSS), biochemical oxygen demand (BOD 5 ) and chemical oxygen demand (COD), impairing water quality. The whole H-CW showed good efficiency in trace metals removal, especially for Pb, Zn, and Cu. Preliminary results suggested the reliability of the H-CW technology in decentralised water treatment facilities for enhancing water recovery and reuse.

Objectives: to propose a composite indicator for maternity hospital classification., Design: descriptive analysis of maternity hospitals through a composite indicator and analysis of its association with infant readmissions within 30 days from the childbirth., Setting and Participants: 56 maternity units in Sicily, accounting for 44.436 newborns in 2014., Main Outcome Measures: infant readmission rates within 30 days from the childbirth., Results: low-level hospitals show higher infant readmission rates (odds ratio: 1.3) which may be seen as a signal of inappropriateness of maternity care., Conclusions: the proposed indicator allows for a classification of maternity hospitals taking into account for different dimensions of the quality of care; it allows the identification of critical signals related to the considered dimensions.

A significantly increased incidence of pleural mesothelioma in Biancavilla (Sicily, Italy) has been attributed to exposure to fluoro-edenite (FE), a fibrous amphibole extracted from a local stone quarry. The lymph-nodes draining the pulmonary lobes of sheep grazing around the town were examined, to gain insights into fibre diffusion. The pasture areas of six sheep flocks lying about 3km from Biancavilla were located using the global positioning system. The cranial tracheobronchial and one middle mediastinal lymph-node as well as four lung tissue samples were collected from 10 animals from each flock and from 10 control sheep for light and scanning electron microscopy (SEM) examination. The lymph-nodes from exposed sheep were enlarged and exhibited signs of anthracosis. Histologically, especially at the paracortical level, they showed lymph-follicle hyperplasia with large reactive cores and several macrophages (coniophages) containing grey-brownish particulate interspersed with elements with a fibril structure, forming aggregates of varying dimensions (coniophage nodules). Similar findings were detected in some peribronchiolar areas of the lung parenchyma. SEM examination showed that FE fibres measured 8-41µm in length and 0.4-1.39µm in diameter in both lymph-nodes and lung tissue. Monitoring of FE fibres in sheep lymph-nodes using appropriate techniques can help set up environmental pollution surveillance., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objectives: to analyse the effect of distance between the Municipality of residence and the nearest hospital on out-of-hospital mortality rate of patients died for acute myocardial infarction (AMI)., Design: analysis of out-of-hospital mortality using a record linkage database., Setting and Participants: Sicilian Municipalities; 4,999 deaths with acute myocardial infarction as primary cause of death, by excluding patients hospitalised within the 15 days before the death event., Main Outcome Measures: acute myocardial infarction out-of-hospital mortality in Sicilian Municipalities, with the exclusion of patients hospitalised within 15 days before the death event., Results: during the years 2009-2011, 7,473 subjects died for acute myocardial infarction in Sicily. 4,999 (66.92%) patients were not hospitalised in the 15 days before the death event; 2,001 of these (40.01%) lived quite far from the nearest hospital (more than 17 minutes of traveling time). After adjustment for age, gender and socioeconomic status, the distance between the residential Municipality and the nearest hospital was significantly associated with increased mortality (27% higher risk of out-of-hospital mortality for patients living far from the nearest hospital, compared to those living in municipalities with at least one hospital)., Conclusions: the distance between the residential Municipality and the nearest Municipality with at least one hospital is associated with an increase in out-of-hospital mortality rate after acute myocardial infarction. However, besides the limitations of using a distance metric (at a municipality level), the clinical history of the subjects under study is not explicitly taken into account. Further studies are needed in order to explore the reasons for this correlation and to further analyse the relationship between distance and mortality (in- and out-of-hospital). Nevertheless, the results presented provide useful information for healthcare service management policies.

The objective in our study was to evaluate the worker's exposition to lead and cadmium in 32 radiology technicians in an eastern Sicily hospital in workers of low melting point alloy of lead, tin, cadmium and bismuth (league that can be melted at 73 degrees C as CERROBEND). Such alloy is used for the fabrication of objects used for the personal protection of cancer patients subject to high energy treatment. The parameters taken into consideration for this study were sex, age and smoking habits. In the test subject's working cycle reported in our case, there were traces of smoke formation containing lead, tin, bismuth and cadmium. Cadmium is a substance considered by IARC to be cancerous and can be found in both work and living environments, therefore it is often difficult to establish rather its presence in the organism is due to working activities and/or the living environment. In these cases it is necessary to evaluate whether the work represents an added risk to develop neoplasia, compared to the consequences due to normal environmental exposure. The added risk linked to work is evaluated comparing the concentration of toxic substances found in the living environments (Environmental Reference Value) with the toxic and/or metabolite found in the working environment, and comparing the biological reports of the population not directly exposed by work (Biological Reference Value) and those exposed. We performed a biological monitoring for lead and cadmium on the workers examined. The Italian Legislature, aside from lead, has not yet issued guidelines pertaining to professional exposure to cadmium, and therefore it is mandatory to take reference to the American Hygienist's charts both for environmental exposure (TLVs) andfor biological monitoring (BEI). Biological monitoring, which allows to evaluate the absorption by both inhalation and gastrointestinally, was performed through measuring the levels of lend and cadmium in the bloodstream (PbB and CdB) and the Cd in urine (CdU). The results show that in no case the levels of lead in the bloodstream (PbB) were above the reference value and BEI. The levels of cadmium urine (CdU) weren't above the reference level and the BEI, while the haematic levels of cadmium (CdB) were higher than the reference value in 8 subjects, each long time smokers, each of about 20 cigarettes a day. This data shows how, in the evaluation of exposition to cadmium, aside from the exam of data pertaining to work, the study of ways of absorption and the interpretation of the results of environmental and biological monitoring, it is important to consider the possibility of intoxication outside of the workplace. Cigarette smoke, as already indicated by other authors, is also confirmed in our studies as one of the major fonts of non professionally linked inhalation of cadmium.

In this study, we evaluated the possible role of Ligia italica as a bioindicator for the monitoring of heavy metals pollution in the suppralittoral zone of marine rocky coasts. Between 2004 and 2011 specimens of L. italica were collected along the Eastern Sicilian coasts from sites known for their high pollution levels as they are near to an area where in September 2001 a refinery plant discharged into the sea some waste containing Hg. Other specimens were collected from the Vendicari Natural Reserve located about 30 miles from the polluted sites and used as control area. On a consistent number of animals, the concentration in toto of As, Cd, Cr, Hg, Ni, Pb, V, was determined by Atomic Absorption Spectrometry. On other animals, investigations were carried out in order to check for ultrastructural alterations of the hepatopancreas, that is the main metals storage organ in isopods. Results revealed the presence, in the animals collected in 2004 from the polluted sites, of considerable concentrations of Hg and of lower concentrations of other metals such as As, Pb and V. The Hg bioaccumulation resulted in remarkable ultrastructural alterations of the two cellular types (B and S cells) in the epithelium of the hepatopancreas. Surprisingly, a moderate amount of Hg was also found in specimens collected in 2004 from the Vendicari Natural Reserve, proving that the Hg pollution can also spread many miles away. Animals collected from the polluted sites in the following years showed a progressively decreasing Hg content, reaching very low levels in those from the last sampling. Also, the ultrastructural alterations found in the hepatopancreas of the animals from the last sample were quite irrelevant. In conclusion, Ligia italica can represent a good bioindicator and the ultrastructure of the hepatopancreas could be used as ultrastructural biomarker of heavy metals pollution in the supralittoral zones.

Cadmium, lead, mercury and chromium concentrations in fish muscle tissue taken from various Sicilian areas were detected. Fish caught in Siracusa, nearby a petrochemical industrial area, were more contaminated by cadmium, lead and chromium (respectively 0.366, 0.32, 0.72 μg/g) than those from the other sites. In the Sicily Channel, we found the highest bioaccumulation of mercury (0.31 μg/g). Although some metals concentrations exceed the limits set by the European regulation, the estimated weekly intake was below the Provisional Tolerable Weekly Intake established by the European Food and Safety Authority, and the Target Hazard Quotient values indicate that there is no carcinogenic risk for humans.

A literature review was conducted in order to give an update on data regarding the various factors involved in the pathogenesis of allergic rhinitis and asthma. Preventive strategies are also discussed.