[Assessment of circadian rhythm in pain and stiffness in rheumatic diseases according the EMA (Ecologic Momentary Assessment) method: patient compliance with an electronic diary]. / Valutazione del ritmo circadiano del dolore e della rigidità nelle malattie reumatiche secondo la metodica EMA (Ecologic Momentary Assessment): compliance del paziente con un diario elettronico.

BACKGROUND: Many researchers have used paper diaries in an attempt to capture patient experience. However, patient non-compliance with written diary protocols is a serious problem for researchers. Electronic patient experience diaries (eDiary) facilitate Ecologic Momentary Assessment (EMA) study designs by allowing the researcher to administer flexible, programmable assessments and mark each record with a time and date stamp. OBJECTIVES: The objectives of the current study were to evaluate methodological issues associated with real-time pain reports (EMA) using electronic patient experience diaries, to quantify compliance (percentage of the total number of diary reports scheduled that were actually completed), and to examine the circadian rhythm in pain and stiffness of patients with rheumatic diseases in an ecologically valid manner. METHODS: In this cross-sectional study we examined 49 patients with rheumatic diseases (14 patients with rheumatoid arthritis, 18 with fibromyalgia and 17 with osteoarthritis of the knee), attending the care facilities of the Department of Rheumatology of Università Politecnica delle Marche. All patients fulfilling the American College of Rheumatology (ACR) criteria. The assessment of pain and stiffness in all patients were repeated seven times a day (8 A.M., 10 A.M., 12 A.M., 2 P.M., 4 P.M., 6 P.M. and 8 P.M.) on seven consecutive days using an electronic diary (DataLogger® - Pain Level Recorder). A datalogger is newly developed electronic instrument that records measurements of pain and stiffness over time. Dataloggers are small, battery-powered devices that are equipped with a microprocessor. Specific software is then used to select logging parameters (sampling intervals, start time, etc.) and view/analyse the collected data. Compliance is based on the time and date record that was automatically recorded by the devices. RESULTS: Using the data from the electronic diary, we determined that the average verified compliance rate for pain and stiffness were 93.8 and 93.6%, respectively. The two highest compliance rates were observed in patients with rheumatoid arthritis (95.6 and 95.2%, respectively). There were no statistically significant difference in compliance between females and males or patients above or below 60 years old. Significant circadian rhythms in patients with RA and OA of the knee were detected in pain and stiffness. No rhythm in pain or stiffness was observed in subjects with fibromyalgia. CONCLUSIONS: We conclude that collection of subjective data using electronic diary in rheumatologic setting is a feasible method than can be adopted with high compliance rates across a range of patient demographic subgroups. The identification of diurnal cycles of self-reported pain and stiffness, using EMA method, has important implications for patients with respect to planning their daily activities and in developing individual therapeutic programs with respect to diurnal variability, which therefore may be more effective.

[Assessment of asbestos exposure via mineralogical analysis of bronchoalveolar lavage fluid]. / Stima dell'esposizione ad asbesto mediante analisi mineralogica del liquido di lavaggio broncoalveolare.

BACKGROUND: Mineralogical analysis of bronchoalveolar lavage fluid (BALF) by electron microscopy could be the most suitable method for assessing asbestos exposure. However, it has been claimed that there is not a standardized or systematic approach to the subject of mineralogical analysis. OBJECTIVES: The aim of the study was to evaluate mineralogical analysis of BALF by transmission electron microscopy (TEM) as biomarker of asbestos fibre load. METHODS: BALF was examined in 193 exposed workers (189 men and 4 women) and in 84 patients (65 men and 19 women) who underwent diagnostic fibreoptic bronchoscopy for various clinical purposes. Asbestos bodies (AB) in BALF were counted with a phase contrast microscope, while fibres were counted and analysed by TEM. RESULTS: Fibre counting by TEM showed a significant difference in the two populations (two tailed Mann-Whitney U test, p=0.0044), since it was positive in all exposed subjects. Only 75.1% of the exposed population was positive for asbestos bodies (AB). Subjects who had been exposed over a long time period had higher concentrations of fibres than subjects who had been exposed more recently probably because of higher exposure in the past. CONCLUSIONS: The study confirms the results of a previous study on a limited number of subjects. Fibre concentrations in BALF can be considered as a reliable biomarker of past asbestos exposure even after many years after cessation of exposure.

[Skin and respiratory allergic disease caused by polyfunctional aziridine]. / Allergopatie cutanee e respiratorie da aziridina polifunzionale.

BACKGROUND: Polyfunctional aziridine (PFA) hardener is increasingly used in water-based paints and inks as a replacement for organic solvents. Allergic contact dermatitis, contact urticaria, respiratory allergy in occupationally exposed patients with hypersensitivity to PFA are reported. OBJECTIVES: The aim was to study a population of adhesive tape printers for occupational respiratory and skin sensitisation to PFA hardener. Also 2 cases of occupational asthma in workers exposed to PFA in tanneries are reported. METHODS: A standard series prick and patch tests was carried out on 15 workers with skin symptoms out of 36 adhesive tape printers exposed to PFA. Prick tests with a 1% PFA water solution and patch tests with a dilution series (0.1-0.32-0.5-1%) of PFA in petrolatum were performed. Lung and nasal provocation tests with PFA hardener were also carried out on 4 subjects with skin and respiratory symptoms. RESULTS: Skin sensitivity to PFA prick tests was demonstrated in 8.3% of the exposed population; 22.2% of the exposed workers suffered from allergic contact dermatitis due to PFA with positive patch tests for this compound. One case of occupational rhinitis due to PFA was diagnosed. CONCLUSIONS: PFA is a strong sensitizer and the use of gloves and protective clothing appears to be insufficient to prevent occupational allergic diseases. Elimination of PFA from production processes is desirable.

[Evaluation of sources of mercury absorption through studying urinary mercury levels in the general population]. / Valutazione delle fonti di assorbimento di mercurio tramite lo studio dei livelli di mercurio urinario della popolazione generale.

OBJECTIVES: The number of instances where mercury exposure is possible outside the workplace are numerous, with the main source being amalgam dental fillings and diet. It is also possible to envisage environmental exposure in subjects resident in areas where there is existing environmental contamination. This is probably what happened in Tuscany where past mining activity in the Monte Amiata area may have been the cause. This study estimated the concentration of urinary mercury (HgU) in non-occupationally exposed subjects from southern Tuscany, with the aim of evaluating the sources of mercury absorption in the general population. METHODS: A questionnaire aimed at collecting specific information on factors which might influence the uptake of mercury was used. 164 subjects were studied: 82 subjects (41 males, 41 females) came from the Monte Amiata area and the other 82 (41 males, 41 females) from the Province of Siena. In this way it was possible to evaluate the elements associated with everyday life which may have influenced the presence of the metal in the urine. Since the distribution of the variables cannot be assumed multivariate normal as usual, a recently-proposed method based on a permutation procedure was adopted that allows the analysis of the variables as well as the single marginal analyses, without assuming any model for the distribution of variables. RESULTS AND CONCLUSIONS: The results showed significantly lower levels of HgU in the subjects from the Monte Amiata area. Highly significant differences were demonstrated in the population which was sub-divided according to number and surfaces of amalgam fillings, use of contact lenses and type of water drunk (p < 0.001). Correlations between the levels of HgU and the investigated variables were not observed. It was confirmed that mercury uptake is simultaneously influenced by many factors. Probably the presence of higher levels of mercury in the environment in the Monte Amiata area is a factor of minor importance compared to others, especially the number of amalgam fillings, in determining mercury absorption in the general population.

[In vitro study of transcutaneous inorganic mercury absorption from solid soil]. / Studio in vitro dell'assorbimento transcutaneo del mercurio inorganico dal terreno solido.

OBJECTIVES: Skin is such an important route of absorption of mercury compounds that the ACGIH has assigned them a skin notation. Soil has been recognised as a potential source of exposure to chemical contaminants. It therefore seems advisable to establish maximum daily exposure levels for mercury in soil. In the past, areas adjacent to certain industries and smelters were heavily contaminated by mercury. For example, on Monte Amiata in Tuscany, which was an important mercury mining and production centre in the past, several areas have been polluted. To understand the dermal uptake of chemicals bound to soil and dust, information on the pure substance is helpful but does not seem sufficient. Other factors must be accounted for, that can easily be reproduced and controlled in in vitro experiments. METHODS: Using an in vitro diffusion cell system and human skin, we studied percutaneous penetration of mercury chloride (HgCl2) at different concentrations, with particular emphasis on skin absorption from soil. The test apparatus consisted of a flow-through diffusion cell system. Dermotomed human cadaver skin was used as the membrane, while the receiving liquid was a saline solution with 6% PEG-20 oleyl-ether and gentamycin sulphate. Mercury chloride was applied at two different concentrations using a buffered solution and soil as vehicles. RESULTS AND CONCLUSIONS: Increments of percentage of absorption at the different hours were found to be significantly lower in the cells where the higher concentration of mercury chloride was applied. In the receiving fluid of cells where soil was used as vehicle, the concentration of mercury was always below the detection limit. Skin contamination with soil containing inorganic mercury does not seem to be a dermal risk.

Determination of phenoxyalkanoic acids and other herbicides at the ng/ml level in water by solid-phase extraction with poly(divinylbenzene-co-N-vinylpyrrolidone) sorbent and high-performance liquid chromatography--diode-array detection.

A method for the determination of phenoxyalkanoic acids and other polar compounds in environmental water samples without pH adjustment before extraction has been developed. Recoveries were calculated from 500 ml of milliQ water spiked at the level of 0.5 ng/ml using solid-phase extraction (SPE) and HPLC-DAD. Different SPE materials (RP-C18, ENV+, ENV+-C8, SAX and Oasis HLB) were tested. After method optimization, 15 of the 16 compounds studied could be extracted with recoveries better than 70% on the most suitable copolymeric poly(divinylbenzene-co-N-vinylpyrrolidone) material (Oasis HLB cartridges).

Development of a solid phase microextraction method for detection of the use of banned azo dyes in coloured textiles and leather

A new method to detect the use of banned azo dyes in the manufacture and treatment of coloured textiles and leather is described. The determination of the azo dyes was made by quantification of aromatic amines generated by reductive cleavage in a citrate buffer medium. The aromatic amines were then extracted from 1 mL of the reaction solution by means of solid phase microextraction (SPME) and determined by gas chromatography/mass spectrometry (GC/MS). We also evaluate accuracy, precision, range of linearity and limit of detection for the eighteen aromatic amines investigated, and show that the method is comparable with current established methods. Copyright 1999 John Wiley & Sons, Ltd.

Inter-laboratory validation of solid-phase microextraction for the determination of triazine herbicides and their degradation products at ng/l level in water samples.

The accuracy and precision of solid-phase microextraction (SPME) were validated in an inter-laboratory study including ten laboratories for the analysis of triazine herbicides and their metabolites at ng/l level in aqueous samples. The SPME conditions were optimised in order to obtain maximum sensitivity. Especially, salt addition and choice of the SPME fibre coated with Carbowax-divinylbenzene increased the sensitivity. The average detection limits were in the range from 4 to 24 ng/l for the triazine herbicides, and 20 and 40 ng/l for desisopropylatrazine and desethylatrazine, respectively. The average r2 values of the calibration curves were above 0.99 for all of the analytes. The statistical data treatment was performed in accordance with the International Standardisation Organisation (ISO) standard 5725. Relative repeatability standard deviations between 6 and 14% and relative reproducibility standard deviations between 10 and 17% were found. The determined concentrations of the reference sample compared well to the "true" values, thus proving the good accuracy of the method. It is concluded that SPME is a reliable technique for the quantitative analysis of water samples containing triazine herbicides in concentrations around the European limit of 100 ng/l for individual pesticides in drinking water.

[Lp(a) and the cardiovascular risk in dyslipidemia subjects]. / Lp(a) e rischio cardiovascolare in soggetti dislipidemici.

In this paper the presence of a correlation between plasma Lp(a) levels and peripheral vascular disease (PVD) and/or coronary heart disease (CHD) was investigated in 20 dyslipidaemic patients (10 males and 10 females, well matched for age, type of hyperlydaemia and other CVD risk factors). Lp(a) plasma levels, ECG and carotid and femoral arteries duplex ultrasonography were performed in all the patients. No difference in plasma Lp(a) levels between patients without and with carotid and femoral arteries stenotic lesions was observed. On the contrary Lp(a) was significantly higher in patients with ECG signs of coronary ischaemic heart diseases than in patients with normal ECG. These observations confirm the importance of Lp(a) as a risk factor for coronary heart disease in dyslipidaemic patients.

Dissociation between urinary albumin excretion and variables associated with insulin resistance in a healthy population.

OBJECTIVES: To see if the cluster of metabolic and haemodynamic variables defined as comprising Syndrome X varied as a function of urinary albumin excretion (UAE) rate in a healthy population. DESIGN: A cross-sectional, population-based study. SETTING: A factory in Italy. SUBJECTS: Two hundred and twenty-five healthy volunteers, 115 men and 110 women. OUTCOME MEASURES. Measurements were made of the plasma glucose and insulin responses to oral glucose, fasting triglyceride (TG) and high density lipoprotein (HDL)-cholesterol concentrations, blood pressure, and UAE rates. RESULTS: Only five of the 225 volunteers had micro-albuminuria, defined as a UAE rate > 2 micrograms min-1, and the UAE rate was < 5 micrograms min-1 in 80% of the volunteers. Significant variations in the metabolic and haemodynamic variables measured were not associated with any differences in UAE. Finally, significant relationships were found between various measures of plasma insulin concentration and plasma glucose response to oral glucose, plasma TG and HDL-cholesterol concentrations, and mean arterial blood pressure, independent of variations in age, body mass index, ratio of waist-to-hip girth, and UAE rates. CONCLUSION: The widespread variability in plasma glucose and insulin responses, plasma TG and HDL-cholesterol concentrations, and blood pressure that are seen in the population at large cannot be attributed to variations in UAE rate.

Lipoprotein(a) and exercise.

Plasma levels of lipoprotein(a), total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apoprotein A1 and apoprotein B were assessed in 10 healthy, untrained volunteers subjected to a bicycle ergometric exercise equal to 50% of individual VO2max, followed by increasing loads until muscular exhaustion. Blood samples were taken before the exercise, immediately afterwards and then at 12-hourly intervals for a 72 hours period. Subsequently, the same parameters were evaluated for 8 long-distance runners during the XXIII New York Marathon, with blood samples being taken before and after the race, and then after one month of detraining. After the exercise, lipoprotein(a) in untrained subjects began to decrease significantly from the 24th hour on and remained lower than baseline levels up till the 72nd hour. After detraining, lipoprotein(a) in marathon runners increased significantly both with respect to basal values and especially to post-race values. Modifications of the other metabolic parameters evaluated in both tests were negligible and predictable. In the two groups of subjects examined, no correlation was found between lipoprotein (a) and the anthropometrical data and metabolic parameters considered.