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Circulating tumor DNA (ctDNA) levels can help predict outcomes in diffuse large B-cell lymphoma (DLBCL), but its integration with DLBCL molecular clusters remains unexplored. Using the LymphGen tool in 77 DLBCL with both ctDNA and tissue biopsy, a 95.8% concordance rate in molecular cluster assignment was observed, showing the reproducibility of molecular clustering on ctDNA. A multicenter, prospective cohort of 166 newly diagnosed DLBCL was analyzed for ctDNA levels and molecular clusters using CAPP-seq. Patients with ctDNA levels < 2.5 log10hGE/mL had a 4-year progression-free survival (PFS) and overall survival (OS) of 71.7% and 85.7%, respectively, compared to 50.3% and 61.0% for those with higher ctDNA levels (p=0.0018 and p=0.0017). Recursive partitioning showed that patients with ctDNA levels > 2.5 log10hGE/mL were further stratified by clusters ST2/BN2. In this group, ST2/BN2 patients associated with a favorable outcome with a 4-year PFS and OS of 87.5% and 100%, respectively, compared to 38.0% and 47.1% for other clusters (p=0.003 and p=0.001). Combining ctDNA levels and ST2/BN2 clusters improved outcome prediction. Low-risk patients (N=51), characterized by ctDNA levels < 2.5 log10hGE and/or BN2/ST2 cluster, had a 4-year PFS and OS of 75.3% and 87.8%. High-risk patients (N=115), with ctDNA levels > 2.5 log10hGE and no BN2/ST2 cluster, had a 4-year PFS and OS of 38.0% and 47.1%. Adding cluster assignment to ctDNA levels improved the model's C statistics (0.63 vs. 0.59 for PFS and 0.68 vs. 0.63 for OS). Liquid biopsy thus provides a multi-layered approach for outcome prediction in DLBCL., (Copyright © 2025 American Society of Hematology.)

This paper uses a simulation model to evaluate the effects of river flooding events occurring within Germany on regional banks. Under a 1.5 °C increase in temperature, the impact is overall rather small, even accounting for the devaluation of loans exposed to floods. Specifically, climate related risks would increase bank losses by 0.1% with large variability across NUTS2 regions. However, under a 3 °C increase, bank losses increases up to 1% of total assets. We show that the implementation of adaptation solutions would be successful in keeping risks at the current level. By supporting adaptation initiatives, such as investing in climate-resilient infrastructure or providing financial services to support sustainable practices, banks can play a crucial role in building the resilience of the financial sector and reducing the overall impact on the economy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The mutational status of immunoglobulin (IG) light chain genes in chronic lymphocytic leukemia (CLL) and its clinical impact have not been extensively studied. To assess their prognostic significance, the IG light chain gene repertoire in CLL patients has been evaluated using a training-validation approach. In the training cohort (N = 573 CLL), 92.5% showed productive IG light chain genes rearrangements, with IGKV4-1 (20.5%) and IGLV3-21 (19.0%) being the most common. A 99.0% somatic hypermutation cut-off was identified as the best predictor for time to first treatment (TTFT) in 414 Binet A CLL patients of the training cohort. Patients with unmutated (UM) light chain genes displayed a 10-year treatment free probability of 32.4% versus 73.2% for those with mutated (M) genes (p < 0.0001). Importantly, UM light chain genes maintained an independent association with a shorter TTFT when adjusted for the IPS-E prognostic model variables, that also includes IGHV mutational status. The validation cohort of 343 Rai 0 patients confirmed these findings, with UM light chain genes predicting a 7-year treatment free probability of 42.0% versus 73.7% for M genes (p < 0.0001). These results indicate that the mutational status of the light chain genes is an independent predictor of shorter TTFT in early-stage CLL patients., Competing Interests: Competing interests: The authors declare no competing interests. Ethics: The study was approved by local Ethical Committees (study number CE 120/19 for the training cohort; Approval n. IRB-05-2010 for the validation cohort)., (© 2024. The Author(s).)

Here we evaluated the epigenomic and transcriptomic profile of XPO1 mutant chronic lymphocytic leukaemia (CLL) and their clinical phenotype. By ATAC-seq, chromatin regions that were more accessible in XPO1 mutated CLL were enriched of binding sites for transcription factors regulated by pathways emanating from the B-cell receptor (BCR), including NF-κB signalling, p38-JNK and RAS-RAF-MEK-ERK. XPO1 mutant CLL, consistent with the chromatin accessibility changes, were enriched with transcriptomic features associated with BCR and cytokine signalling. By combining epigenomic and transcriptomic data, MIR155HG, the host gene of miR-155, and MYB, the transcription factor that positively regulates MIR155HG, were upregulated by RNA-seq and their promoters were more accessible by ATAC-seq. To evaluate the clinical impact of XPO1 mutations, we investigated a total of 957 early-stage CLL subdivided into 3 independent cohorts (N = 276, N = 286 and N = 395). Next-generation sequencing analysis identified XPO1 mutations as a novel predictor of shorter time to first treatment (TTFT) in all cohorts. Notably, XPO1 mutations maintained their prognostic value independent of the immunoglobulin heavy chain variable status and early-stage prognostic models. These data suggest that XPO1 mutations, conceivably through increased miR-155 levels, may enhance BCR signalling leading to higher proliferation and shorter TTFT in early-stage CLL., (© 2023 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Background and Aims: Patients with systemic sclerosis (SSc) often complain reduced capacity at submaximal exercise; conversely, physical capacity in performing daily duties has never been measured in SSc. The aim of this study is to evaluate this performance and its correlates, in patients with SSc compared with healthy controls, in a free-living setting., Methods: Twenty-seven outpatients with stable SSc and 11 controls were recruited. Physical activity was assessed by portable multiple sensor device (SenseWear Armband) worn for at least 6 days. Physical activity duration (PAD; in minutes) for non-sedentary activities and physical activity level (PAL = total daily energy/resting energy expenditure) per day were calculated. Nutritional status was estimated by bioelectrical impedance analysis and pulmonary arterial hypertension excluded by echocardiography., Results: Daily physical activities (243 ± 145 min per day vs 397 ± 142 min, respectively; P = 0.005) and PAL were significantly reduced in SSc compared with controls (1.5 ± 0.4 vs 2 ± 0.7, respectively; P = 0.019). Seventy-four per cent of SSc patients showed PAL < 1.70, whereas only 27% of controls were below this threshold for sedentary life style. Both PAD and PAL positively correlated with DLco. Patients and controls did not differ for spirometric parameters, body mass index, phase angle at bioelectrical impedance analysis, fat mass or fat-free mass indexes. In SSc, exercise capacity during daily activity was reduced compared with controls, and was associated with early evidence of functional decay (decreasing DLco) but not with malnutrition (undernutrition)., Conclusions: A reduction of daily physical activity is already present even in early stages of lung involvement in SSc, characterized by unaltered spirometry and well-preserved nutritional status., (© 2015 John Wiley & Sons Ltd.)

Introduction: Decreased airway distensibility (AD) in response to deep inspirations, as assessed by HRCT, has been associated with the severity of asthma and COPD., Aims: The current study was designed to compare the magnitude of AD by HRCT in individuals with asthma and COPD with comparable degrees of bronchial obstruction, and to explore factors that may influence it., Results: We enrolled a total of 12 asthmatics (M/F:7/5) and 8 COPD (7/1) with comparable degree of bronchial obstruction (FEV1% predicted mean ± SEM: 69.1 ± 5.2% and 61.2 ± 5.0%, respectively; p = 0.31). Each subject underwent chest HRCT at FRC and at TLC. A total of 701 airways (range 20 to 38 airway per subject; 2.0 to 23.1 mm in diameter) were analyzed. AD did not differ between asthmatics and COPD (mean ± SEM: 14 ± 3.5% and 17 ± 4.3%, respectively; p = 0.58). In asthmatics, AD was significantly associated with FEV1% predicted (r(2) = 0.45, p = 0.018). We found a significant correlation between the change in lung volume and the change in AD by HRCT (r(2) = 0.64, p = 0.002). In COPD, we found significant correlations between AD and the RV% predicted (r(2) = 0.51, p = 0.046) and the RV/TLC (r(2) = 0.68, p = 0.01)., Conclusions: AD was primarily affected by the dynamic ability to change lung volumes in asthmatics, and by static lung volumes in COPD.

Background: Italian Legislative Decree No. 81/2008 foresees the involvement of a "specialised physician" in activities for the promotion of health at the workplace., Objectives: These activities are aimed at modifying erroneous lifestyles (such as smoking, drinking, bad diet, etc.) which are responsible for serious illnesses and also for repercussions on the assessment of fitness for a specific task. Obesity, as we know, represents the major risk factor in the onset of metabolic, neoplastic, cardiovascular and respiratory diseases and also in the increased incidence of accidents at the workplace and sick absence., Methods: A specific questionnaire was administered to 700 health care workers of a Hospital in Catania to estimate the incidence of factors which favour the onset of these diseases: factors such as familiarity, endocrinal dysfunction problems (diabetes mellitus, hypothyroidism), shift work and little physical exercise., Results and Conclusion: Statistical processing of the data confirmed, partially, that little physical exercise, hypothyroidism, diabetes mellitus, familiarity in the > 36 age group were the major risk factors in the onset of obesity, as reported in the literature. However, contrary to the literature reports, shift work did not seem to be a risk factor in the sample under study. A programme of rehabilitation, on a voluntary basis, will be offered to those workers who are overweight/obese. This programme will involve professionals such as nutritionists, endocrinologists and psychologists, and it will aim at improving workers' health conditions as well as their work performance.

Background and Aims: An ageing lung is characterised by distal airspace enlargement without alveolar wall destruction: therefore the anatomical distinction between senile lung and emphysema is clear-cut. In clinical settings the definition of precise boundaries between normalcy and pathology is more difficult with the risk of overdiagnosis. CT is an important diagnostic advancement in the field of COPD. Most methods for the evaluation of emphysema are based on the detection and measurement of areas characterised by a density level below a threshold assumed to characterize parenchymal destruction., Methods: Our retrospective study included 47 healthy subjects (65-91 years), 36 never smokers and 11 former smokers. As a reference sample we recruited 9 patients with emphysema (69-81 years). Thoracic scan was performed by single slice spiral CT and acquired without contrast enhancement. For each scan and on both lungs we sampled eighteen regions of interest in the upper, middle and lower field. Mean lung density (MLD) and lower limit of normal (LLN) of density distribution were calculated., Results: MLD for the whole study sample was -846 +/- 41 HU. -901 HU was the LLN of density distribution in the study sample. No significant correlation was noted between age and MLD. In the emphysematous sample the average lung density was -946 +/- 18 HU. The mean coefficient of variation was 3% in the healthy sample and 2% in the emphysematous one. The difference between groups was significant (p < 0.0001). In one healthy subject only we measured a value slightly below the threshold reported in literature for conventional CT; no emphysematous value fell above the LLN., Conclusions: This study highlights the fact that in the elderly the threshold level of lung density commonly adopted in diagnostic algorithms of emphysema is fully applicable. When applying this method to older subjects the risk of misinterpreting areas of physiologic non-destructive reduction of density as emphysema is low.

We describe a rare case of pedunculated endobronchial hemangioma observed in a 60-years-old patient complaining of chronic productive cough and accessional dyspnea which had been progressively worsening over 20 years. The lesion was first noticed at fiberoptic bronchoscopy; then computed tomography scan was performed and integrated with tridimensional reconstruction techniques. Pathology showed the picture of a vascular neoplasm, compatible with capillary hemangioma. The lesion was submitted to laser-assisted endoscopic removal in order to relieve the obstruction, leading to remission of symptoms.

The case of a 43-year-old woman with intralobar pulmonary sequestration, Pryce type one, is presented. The medical history was characterised by recurrent bronchopneumonia, productive cough with purulent sputum and hemoptysis in the last three years. Diagnosis was made by CT angiography: multiplanar, maximum intensity projection and volume rendering reconstructions were visualised. A volume reduction of middle and lower lobe with multiple cyst-like bronchiectasis was detected and no evident relationship with tracheobronchial tree was pointed out. Reconstructions aimed at evaluating bronchial structures demonstrated no patency of middle and lower lobar bronchi. The study carried out after contrast medium infusion in arterial phase showed a vascular disorder characterised by an accessory arterial branch arising from the upper portion of thoracic aorta which, after moving caudally to pulmonary hilus with a tortuous course, supplied the atelectatic parenchyma. No anomalous venous drainage was detected. The patient underwent surgery with resection of two pulmonary lobes. CT compares favourably with other alternative imaging technique for pulmonary sequestration as multiplanar reconstructions allow not only the detection of supplying vessel, but also the accurate description of heterogeneous characteristics of the mass and adjacent structures. Finally an imaging-based diagnostic algorhithm is proposed.

In patients with mild chronic obstructive pulmonary disease (COPD), the effect of deep inspirations (DIs) to reverse methacholine-induced bronchoconstriction is largely attenuated. In this study, we tested the hypothesis that the effectiveness of DI is reduced with increasing disease severity and that this is associated with a reduction in the ability of DI to distend the airways. Fifteen subjects [Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I-II: n = 7; GOLD stage III-IV: n = 8] underwent methacholine bronchoprovocation in the absence of DI, followed by DI. The effectiveness of DI was assessed by their ability to improve inspiratory vital capacity and forced expiratory volume in 1 s (FEV(1)). To evaluate airway distensibility, two sets of high-resolution computed tomography scans [at residual volume (RV) and at total lung capacity] were obtained before the challenge. In addition, mean parenchymal density was calculated on the high-resolution computed tomography scans. We found a strong correlation between the response to DI and baseline FEV(1) %predicted (r(2) = 0.70, P < 0.0001) or baseline FEV(1)/forced vital capacity (r(2) = 0.57, P = 0.001). RV %predicted and functional residual capacity %predicted correlated inversely (r(2) = 0.33, P = 0.02 and r(2) = 0.32, P = 0.03, respectively), and parenchymal density at RV correlated directly (r(2) = 0.30, P = 0.03), with the response to DI. Finally, the effect of DI correlated to the change in large airway area from RV to total lung capacity (r(2) = 0.44, P = 0.01). We conclude that loss of the effects of DI is strongly associated with COPD severity and speculate that the reduction in the effectiveness of DI is due to the failure to expand the lungs because of the hyperinflated state and/or the parenchymal damage that prevents distension of the airways with lung inflation.

Diagnostic protocol and special tests to ionizing radiations have a preventive function in the medical surveillance of the exposed worker. This protocol must be provided with laboratory and special test assessing fitness for working at the risk of ionizing radiations. The health of workers must be compatible with working conditions and radiation risk. This healthiness of workers is evalued in the time to give an assessment fitness for working at ionizing radiations. For this purpose the basic diagnostic protocol must guarantee minimum information about state of organs and apparatus in addition to the normality of the metabolisms. The diagnostic protocol of the exposed worker to ionizing radiations must be adapted to the specific clinical situation so as to finally make a costs-benefits balance sheet.

Background: It has been postulated that the beneficial effects of deep inspiration are dependent on the magnitude of airway distension by virtue of airway to parenchyma interdependence., Objective: This study was designed to examine whether the changes that occur in pulmonary fibrosis affect the beneficial effect of deep inspiration., Methods: Thirty-one subjects with scleroderma underwent lung volume and diffusion capacity assessment as well as high-resolution computed tomography. To assess the effect of deep inspiration, each subject underwent methacholine provocations in the absence of deep breaths. When the targeted change in lung function was achieved, subjects were asked to take 4 consecutive deep inspirations after which lung function measurements were repeated. The inspiratory vital capacity (IVC) was used as primary outcome., Results: Only 19 subjects attained the desired reduction in IVC in the absence of deep breaths. In those subjects, deep inspiration reversed the effect of methacholine on IVC by 48 +/- 8.4%. The effect of deep inspiration correlated with DLCO% predicted (r = 0.55, p = 0.01), but not with high-resolution computed tomography abnormalities or baseline lung function measurements. When all subjects were considered, responsiveness to methacholine in the absence of deep inspiration was progressively lower with decreasing DLCO% predicted values (r = 0.51, p = 0.003)., Conclusions: In systemic scleroderma, pulmonary abnormalities resulting in mild to moderate reduction in the diffusion capacity are associated with reduced ability of deep inspiration to reverse methacholine-induced early airway closure and bronchoconstriction. When diffusion capacity is severely affected, methacholine fails to produce obstructive airway changes., (Copyright 2008 S. Karger AG, Basel.)

The sewage from urban settlements is an important cause of water pollution. Recent Italian legislation offers new possibilities for intervention in the purification of wastewater. The "Decreto Legislativo" 152 of April 3, 2006, indicating "Environmental Standards", recommends the possible use of constructed wetlands considered particularly suitable for small and medium communities according to low operating costs, lack of energy, and manageability. The Authors, after describing the characteristics of these facility, analyze the occupational risks associated with the control and maintenance of a experimental subsurface constructed wetland (H-SSF, SubSurface Horizontal Flow) coming to the conclusion that the management of this type of facility has a low risk of exposure to biological agents.

Brachytherapy is an effective radiotherapeutic treatment for localized prostatic cancer. The permanent brachytherapy is a particular kind of radiotherapy which, US guided, uses permanently implanted seeds containing radioactive sources (Pd103 or I 125). The procedure is minimally invasive and allows to obtain high percentage of success which is comparable to surgery. The possibility to confine permanent radioactive implants in a well delimitated area doesn't exclude the exposition of both the medical staff and family's members of implanted patients. The radiation exposure involves the medical physicists, the radiotherapists, the Medical Radiology Technician, the anaesthetists, the surgeons, the professional nurses but also, after the brachytherapy treatment, public and family members, comforters and cares. It's necessary to consider radiation safety aspects of brachytherapy in order to reduce the risks of exposition. At the end, several studies showed that cremation of bodies could be a possible radiation source that remains in the patient's ashes, potentially inhaled by crematorium staff or members of the public.

Background: Until the early 1980's there was a general consensus that no relationship existed between occupational silica exposure and lung cancer, in spite of a number of reports to the contrary. Confirmation arrived later from animal experiments and in 1997 the IARC modified its carcinogenic agents classification to include silica in group 1, human carcinogens. This fact brought about a change in insurance practice regarding occupational diseases due to silica, with greater attention dedicated to pneumoconiosis-related lung cancers., Objective: To describe a clinical case of lung cancer due to occupational exposure to silica in a worker of a ceramics industry already receiving compensation for silicosis., Methods: Diagnosis and recognition of the occupational origin of the disease were achieved via assessment of exposure to silica in the past and review of the medical examinations over the years., Results: The pathogenesis and the causative relationship between pneumoconiosis and cancer is debated and lung cancer was recognized as an occupational disease., Conclusions: It is concluded that a causative relationship can exist more due to the presence of silicosis than due to occupational exposure to silica.

Some categories of workers (actors, teachers, singers) use a particular working tool: their voice. In order to assess the spread of dysphonia and its possible causes across a specific class of workers--the teachers of some schools in the city of Catania--we have set up a ad hoc questionnaire. A special database has been subsequently arranged, aimed at the statistical analysis of the responses obtained. The analysis of the responses shows that the phenomenon is more present in female than male teachers, 48% versus 30%. The dysphonia occurs mainly at the end of the working day, lasts throughout the school year and improves in summer, demonstrating the importance of teaching activity in its pathogenesis. One aspect especially stands out: dysphonia occurs exclusively in those individuals suffering from diseases with possible alterations of the voice, such as allergopathies, tireopathies and gastropathies. Therefore, work activity alone does not seem able to cause a chronic dysphonia, whereas the presence of diseases causing disability of vocal cords appears to play an important role.

Benzene is a common element of environmental pollution. Although this substance is not recognized as a teratogenic agent, it is not known whether prenatal exposure to benzene may induce neurobehavioral changes in the progeny. Benzene 0.1mg/kg was injected subcutaneously (s.c.) acutely at day 15 of gestation into pregnant female rats of the Sprague-Dawley strain and neurotoxicity of the substance was studied in pups and male adult animals of the same progeny. No change was found in total number of neonates, body weight and eye opening time between benzene-exposed animals and controls. No malformations were observed. At birth, neonatal reflexes (cliff aversion, forelimb placing, bar holding, forelimb grasping, startle) were scored in benzene-exposed pups and their percent appearance was found to be anticipated (more benzene-exposed pups exhibited reflexes each day) in comparison to that of control animals. Also, the completion (maximum appearance, i.e. 100% of the brood was found to exhibit each reflex) of neonatal reflexes in benzene-exposed animals preceded that of controls. Starting 2 months after birth, cognitive and motor performance was assessed only in male animals of the prenatally benzene-exposed progeny. The overall evaluation of motor activity in benzene-exposed animals in the open-field test revealed reduced ambulation in these rats as compared to control animals. Acquisition of active avoidance responses in the shuttle-box test, as assessed by the number of conditioned avoidance responses and the percent of learners, was impaired in benzene-exposed rats as compared to control animals. Prenatal exposure to benzene was also followed by reduced retention latency in a step-through passive avoidance task in two retention tests. These results suggest that acute exposure to benzene during gestational organogenesis may cause long-lasting changes in motor behavior and cognitive processes. This may be relevant for the assessment of benzene toxic profile for the progeny of pregnant subjects, although teratogenic effects are not observed.

The purpose of this study was to determine in vitro the relationship between ionizing radiation (IR) treatment, reactive oxygen species (ROS) production, lipid peroxidation, glutathione (GSH) levels, and DNA damage of the human benign prostate hyperplasia BPH-1 cell line, and two prostate cancer cell lines, LNCaP, which is androgen-sensitive, and DU-145, which is androgen non-responsive. The cells were analysed after exposure to 1.0 or 2.0 Gy of X-ray radiations. The response to IR treatment was evaluated by examining: ROS production by quantitative analysis with fluorescent probe 5 and 6-carboxy-2'7'-dichlorodihydrofluorescein diacetate bis acetomethyl ester (DCFH-DA), GSH levels by 2,2'-dinitro-5,5'-dithio-benzoic acid (DTNB), and lipoperoxidation by thiobarbituric acid reactive substances (TBARS) analysis. To study IR-induced DNA damage, Single Cell Gel Electrophoresis or comet assay was performed. DU-145 cells were characterized by higher DNA damage, more evident extent of lipid peroxidation, and slighter levels of ROS and GSH compared to BPH-1 or LNCaP. Human benign BPH-1 and cancer LNCaP and DU-145 cell lines are not equal regarding their capability of IR resistance in terms of ROS production, antioxidant potential, IR-induced lipid peroxidation and DNA damage.

It is not known whether sputum elastase, metalloproteinase (MMP)-9 and tissue-inhibitor metalloproteinase (TIMP)-1 are related to structural changes of the airways, as assessed by high-resolution computed tomography (HRCT) scan. The relationships between these markers and the magnitude of structural changes of the airways in asthma and chronic obstructive pulmonary disease (COPD) were assessed. Induced sputum and HRCT scan were performed in 30 asthmatics (14 mild and 16 severe) and in 12 patients with COPD. A greater extent of HRCT scan abnormalities was found in COPD than in severe and mild asthmatics. HRCT scan abnormalities correlated with the degree of airway obstruction in COPD and in severe asthma. HRCT scan abnormalities also correlated with the levels of sputum elastase both in COPD and in severe asthma. HRCT scan abnormalities were associated with sputum MMP-9/TIMP-1 ratio in mild asthma, severe asthma and COPD. In conclusion, this study demonstrates that sputum elastase and the metalloproteinase-9/tissue-inhibitor metalloproteinase-1 ratio are associated with the magnitude of high-resolution computed tomography scan abnormalities of the airways in asthma and chronic obstructive pulmonary disease, and suggests that the levels of these markers reflect the extent of structural changes of the airways.

Purpose: To describe an original protocol for single slice spiral Computed Tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy., Materials and Methods: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy., Results: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed., Conclusions: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.

Purpose: The study is aimed at proposing the use of digital cineradiography in the evaluation of swallowing disorders in children affected by severe neurological or developmental disability, in order to correctly identify these conditions and provide therapeutic approaches that could solve their feeding problem, improve their nutritional conditions and decrease the risk of infections., Materials and Methods: In the period between March 2001 and July 2003, 12 children (8 males and 4 females), aged between 9 months and 13 years, (average 6.2 years), affected by severe neurological or psychomotor disorders were evaluated with digital cineradiography. This investigation was requested for recurrent pulmonary infections and/or dysphagia with weight loss. All the examinations were performed with radio-controlled equipment provided with a digital C arm., Results: Using the above mentioned technique, in all 12 patients, it was possible to differentiate those with disorders of the oral and/or pharyngeal swallowing phase (9/12) from those without swallowing dysfunction (3/12). In 9/9 patients passage of contrast medium into the upper airways was observed during swallowing: in 2 of them this was limited to the laryngeal vestibule (sub-epiglottic penetration), while in 7/9 cases aspiration of contrast medium into the trachea (5/9) or into the right bronchus (1/9) or into both bronchi (1/9) was recorded. In one patient the aspiration decreased in the sequences acquired with hyperflexion of the head. In 3/9 patients we recorded the transition of contrast medium into the nasopharynx during swallowing caused by incomplete closing of the oropharyngeal isthmus by the soft palate. In 3/9 patients there was incomplete clearing of the pharynx with contrast medium deposition in glosso-epiglottic vallecules and in the pyriform sinuses; only in one case did this stagnation result in post-swallowing aspiration. More than one disorder was found in 5/9 patients, and one only in 4/9., Conclusions: On the basis of our preliminary data it is possible to conclude that the dynamic swallowing study with digital technique allows a clear-cut evaluation of the swallowing process with minimum discomfort for the patient. On the other hand, the technique exposes to the risk of ionizing radiation; however, in consideration of the important clinical and therapeutic implications and in agreement with the literature, we believe that the importance of the information provided by the technique outweighs the risks linked to radiations.

Taking in consideration the suggested guide-lines for the health-surveillance on workers exposed to N.I.R. and in particular to ELF and radio-frequency, a work-group of A.I.R.M. suggests the constitution of an italian network for electro-magnetic fields. An observatory will be founded to value the professional exposures and the undue situations of risk, a parallel one will take the census of the workers subdivided into classes for exposure levels, pathologies or symptomatologies imputable to electro-magnetic fields. This suggestion is addressed to the national environmetal hygienists and occupational physicians that are interested.

The Authors report a particular case of occupational asthma observed in a greenhouse worker. They describe the diagnostic procedure followed after identification on the cultivated plants of colonies of aspergillus niger, a fungus identified as an etiologic agent of the allergic disease. The peculiarity of the causative agent is stressed and it is recommended that environmental and health prevention measures be improved for this poorly protected class of workers.

An 18-year-old man with severe haemophilia A (FVIII:C < 1%) and human immunodeficiency virus 1 (HIV-1) infection was admitted to the hospital with fever and chest pain for 7 days. Eight weeks prior to his admission he had an accident for which he underwent, at another hospital, clinical and laboratory examination that revealed bone fractures of the nose cavity, and he was given factor VIII concentrates for seven days due to nasal bleeding. On admission, chest roentgenogram showed a large cardiac silhouette and echocardiography confirmed the presence of a large quantity of pericardial fluid. A presumptive diagnosis of the post-cardiac injury syndrome was made and he was given anti-inflammatory drugs plus infusion of recombinant factor VIII concentrate (35 units kg-1 b.i.d.). On the seventh day he exhibited cardiac tamponade for which he underwent subxiphoid pericardiotomy with drainage of approximately 1500 mL of bloody exudate. He had an uncomplicated recovery and 10 days later he left hospital. He was given a continuous prophylactic treatment of 15 units kg-1 of recombinant FVIII every 2 days for 6 months, and 30 months after this episode the patient is free of any symptom.

The Authors describe the clinical case in which a 30 years old male patient presents anomalous pigmentation of the oral mucosa after the endodontic treatment of the upper right central incisive. The mucosa's anomaly appeared at the height of the lower third of the root near the branch of an accessory endodontic canal previously filled and it was caused by the outlet of filling material. After the examination of this case, the Authors affirme the importance of an accurate anamnesis in order to obtain a correct diagnosis of the various kinds of pigmented lesions, distinguishing the etiology, the pathogenesis and the histologic patterns.

MDH and GLDH activity changes have been studied in kidney homogenized of rats exposed to double stress (dry heat and starvation) for 24 and 72 hours respectively. MDH behaviour activity decrease after 24 hours and increase to basic values after 72 hours leads to suspect the primer of a defence mechanism that precedes to face up increased metabolic needs. GLDH activity shows a constant decrease after 24 hours and after 72 hours; this was explained as a premature acclimatization reaction.

MDH and GLDH activity modifications have been studied in heart homogenized of rats exposed to double stress (dry heat and starvation). MDH activity shows statistically significant variations only after 72 hours. This induces to suspect a decrease of energetic metabolism due to a probable substratum lack. GLDH activity shows a statistically significant decrease after 24 hours, and this decrease increases after 72 hours. This behaviour could be explained by an acclimatization reaction of such an amount to delete the hunger effect on protein catabolism.

We have studied MDH and GLDH behaviour in liver homogenized of rats exposed to double stress (dry heat and starvation) for 24 hours respectively. Both enzyme showed a statistically significant activity increase, either after 24 and 72 hours. Such an increase is affected mainly by starvation. This behaviour reflects the metabolic needs of organism, related to increased energetic requirements.