Mechanical circulatory support with the Impella 5.0 device for postcardiotomy cardiogenic shock: a three-center experience.

AIM: Postcardiotomy cardiogenic shock (PCCS) is associated with high mortality rates, despite full conventional treatment. Although the results of treatment with surgically implantable ventricular assist devices have been encouraging, the invasiveness of this treatment limits its applicability. Several less invasive devices have been developed, including the Impella system. The objective of this study was to describe our three-center experience with the Impella 5.0 device in the setting of PCCS. METHODS: From January 2004 through December 2010, a total of 46 patients were diagnosed with treatment-refractory PCCS and treated with the Impella 5.0 percutaneous left ventricular assist device at three european heart centers. Baseline and follow-up characteristics were collected retrospectively and entered into a dedicated database. RESULTS: Within the study cohort of 46 patients, mean logistic and additive EuroSCORES were 24 ± 19 and 10 ± 4. The majority of patients underwent coronary artery bypass grafting (48%) or combined surgery (33%). Half of all patients had been treated with an intra-aortic balloon pump before 5.0-implantation, 1 patient had been treated with an Impella 2.5 device. All patients were on mechanical ventilation and intravenous inotropes. The Kaplan-Meier estimate of overall 30-day survival was 39.5%. CONCLUSION: Thirty-day survival rates for patients with PCCS, refractory to aggressive conventional treatment and treated with the Impella 5.0 device, are comparable to those reported in studies evaluating surgically implantable VADs, whereas the Impella system is much less invasive. Therefore, mechanical circulatory support with the Impella 5.0 device is a suitable treatment modality for patients with severe PCCS.

Cadmium accumulation and antioxidant responses in Sparus aurata exposed to waterborne cadmium.

Cadmium (Cd), a nonessential trace element, is rapidly accumulated by most living organisms and subsequently exerts its toxicity at different molecular levels. This study exposed gilthead sea bream (Sparus aurata) to waterborne 0.1 mg/l Cd for 11 days and investigated the Cd accumulation pattern, lipid oxidation, and response of antioxidant defences. At the end of the experiment, mean Cd concentrations in gills and liver, the organs most prone to metal accumulation, were 209.4 and 371.7 ng/g ww, respectively. Muscle did not show any Cd retention during the 11 days of exposure. In liver, the cytosolic fraction of the metal was chelated into the nontoxic form by metallothionein (MT), a specific Cd-inducible protein. Zn and Cu concentrations were not influenced by Cd exposure. Glutathione (GSH) concentrations and the antioxidant enzyme activities of GSH reductase and GSH peroxidase showed an overall decreasing trend. In addition, lipid and aqueous hydroperoxide levels did not show any significant variation. Oxidative stress indirectly generated by Cd seems to be compensated for by the different biochemical systems tailored to decrease cellular damage. In particular, the negative effects of Cd accumulation in tissues were probably counteracted by the induction of MT.

Assessment of the dietary habits and polycyclic aromatic hydrocarbon exposure in primary school children.

Thirty Italian children, 7-9 year aged, living in Naples were investigated on their dietary habits and on polycyclic aromatic hydrocarbon (PAH) exposure by a food diary-questionnaire and one week duplicate diet sample analyses. Daily total food consumption mean value was 632 +/- 215 g day(-1), median value 613 g day(-1). The daily energy intake and the diet composition meanly agreed with the official guidelines for the Italian children. Sixteen PAHs were simultaneously detected and, according to the European Food Safety Authority (EFSA) approach, benzo[a]pyrene; benzo[a]pyrene + chrysene (PAH2); PAH2 + benz[a]anthracene + benzo[b]fluoranthene (PAH4); PAH4 + benzo[k]fluoranthene + benzo[ghi]perylene + dibenz[a, h]anthracene + indeno[1,2,3-cd]pyrene (PAH8) were considered in evaluating the children's dietary exposure to PAHs. The benzo[a]pyrene (BaP) median concentrations in foods varied from 0.06 to 0.33 microg kg(-1). Only three samples of cooked foods (one fish and two meat samples) exceeded legal limits fixed by the European Union for BaP. Daily median intakes of benzo[a]pyrene, PAH2, PAH4, and PAH8 were 153; 318; 990; 1776 ng day(-1); their median exposure values were 5; 10; 28; 54 ng kg(-1) bw day(-1). The Margins of Exposure (MOEs) in median consumers agreed with the EFSA safety values except for PAH8.

Polychlorinated biphenyls, organochlorine pesticides, and polycyclic aromatic hydrocarbons in wild, farmed, and frozen marine seafood marketed in Campania, Italy.

Polychlorinated biphenyls (PCBs), organochlorine pesticides, and polycyclic aromatic hydrocarbons (PAHs) were detected in fresh-catch, farmed, and frozen marine fish marketed in Campania, Italy. Additionally, polychlorobiphenyl congeners were found: six were non-dioxin-like (NDL-PCB) (IUPAC no. 28, 52, 101, 138, 153, and 180), and one was dioxin-like (DL-PCB) (IUPAC no. 118). In all, 93% of fresh-catch, 100% of aquaculture, and 74% of the frozen specimens contained PCBs at concentrations varying from 0.12 to 35.11 ng/g, wet weight; NDL-PCBs ranged between 0.12 and 32.44 ng/g. Penta-, hexa-, and heptachlorobiphenyls were predominant. Regarding organochlorine pesticides, hexachlorobenzene was detected in 35% of fresh catch, 36% of farmed, and 46% of the frozen fish specimens, in a range between < 0.01 and 3.29 ng/g. Contents of the dichlorodiphenyltrichloroethane isomer amounted to 0.12 to 11.00 ng/g. Finally, PAHs were detected in 100% of the specimens. Benzo[a]pyrene was detected in 66% of the aquaculture, 35% of the fresh catch, and 24% of the frozen species, at concentrations varying from 0.03 to 9.18 ng/g. On the basis of annual fish consumption, an average daily intake of NDL-PCBs of 6.02 ng/kg of body weight was estimated. Calculated daily hexachlorobenzene and total dichlorodiphenyltrichloroethane intakes were, respectively, 0.11 and 0.90 ng/kg of body weight per day. The contribution of fish to the daily consumption of the noncarcinogenic PAHs can be considered low; for benzo[a]pyrene, the estimated daily intake is considerably lower than the doses considered carcinogenic for experimental animals by the European Union Scientific Committee on Food.

Occurrence of polychlorobiphenyls in buffalo mozzarella cheese from Campania (Italy).

Buffalo milk and mozzarella cheese produced in the Caserta and Salerno areas in Campania region have been investigated on the presence and the levels of polychlorobiphenyls (PCBs). Seven congeners, six non dioxin-like (NDL-PCBs nos. 28, 52, 101, 138, 153 and 180) and one dioxin-like (DL-PCB n. 118), were detected. PCBs were found at detectable levels in the 83% of the buffalo milk and in the 100% of the mozzarella cheese samples from Caserta; in those from Salerno the prevalence of contamination was 77% for milk and 73% for mozzarellas, respectively. The NDL-PCB content of mozzarellas collected in Caserta was significantly higher than that found in those from Salerno. The more diffuse congeners were PCB 28, 138 and 153 both in milk and in mozzarella cheese; PCB 118 contributed to the total PCB content for the 7% in milk and 2-3% in mozzarella cheese. On the basis of the Italian annual average consumption the contribution of mozzarella to the daily dietary intake of NDL-PCB can vary between 0.41 and 21.33 ng kg(-1) bw, median value of 3.66 ng kg(-1) bw. The levels of contamination in milk and dairies analyzed are similar or quite lower than those found in other European countries.

Natural co-occurrence of deoxynivalenol and fumonisins B1 and B2 in Italian marketed foodstuffs.

A survey was performed to obtain the frequency and levels of contamination by deoxynivalenol (DON) and fumonisins B1 and B2 (FB1, FB2) mycotoxins in Italian marketed foods. Of 202 samples investigated, including raw materials and processed cereal foods (bread, pasta, breakfast cereals, biscuits, baby and infant foods), 84% were contaminated with DON at levels from 0.007 to 0.930 microg x g(-1) (median 0.065 microg x g(-1)); 26% contained FB1 ranging from 0.010 to 2.870 microg x g(-1) (0.070 microg x g(-1)); 35% contained FB2 at 0.010-0.790 microg x g(-1) (0.080 microg x g(-1)). The highest levels of DON and FB1 were detected in raw cereals and wholemeal flours. The highest levels of FB2 were detected in durum wheat pasta. A widespread DON contamination was found in baby and infant foods at levels varying from 0.007 to 0.166 microg x g(-1).

Evaluation of benzene exposure in children living in Campania (Italy) by urinary trans,trans-muconic acid assay.

The urinary benzene metabolite trans,trans-muconic acid (MA) was determined in 144 children living in Campania (Italy): 92 from Naples (1,300,000 inhabitants), designated as an urban source, and compared to 52 from Pollica (300 inhabitants), considered a rural, background exposure for benzene. The children participating in the study were tested by an anonymous questionnaire about the possible sources of exposure to benzene. Quantifiable levels of MA were found in 63% of the urine samples analyzed. Setting the value of nondetectable urinary samples at 7 microg/L MA, a value that is one-half of the instrument detection limit of 14 microg/L, the mean urinary concentration levels were 98.7+/-81.0 microg/L and 48.4+/-71.7 microg/L in Naples and Pollica, respectively; adjustment of these values to creatinine clearance resulted in MA levels of 141.2+/-145.4 microg/L in Naples and 109.8+/-133.2 microg/L in Pollica. Passive smoke exposure did not significantly affect urinary MA levels, but proximity of the home to traffic increased urine MA content. Data show that MA can be utilized as a biomarker for exposure; however, a clear-cut association to benzene requires personal monitoring and control of dietary sorbic acid.

Alkyltins in farmed fish and shellfish.

A study to update dibutyltin (DBT) and tributyltin (TBT) residues in farmed fish and shellfish (Mytilus edulis) was carried out 4 years after the adopting of the restricting regulation of the antifouling uses of organotins in Italy. DBT and TBT were simultaneously extracted from farmed fish and shellfish (M. edulis) and from free living specimens, used as control, purchased from retail stores or fishermen in the province of Naples (Italy), and detected using a capillary gas chromatograph equipped with a flame photometric detector (GC-FPD). Dosable amounts of DBT were found in the 10% of the farmed fish analyzed, ranging from 1 to 26 micrograms kg-1 wet wt (mean 10 micrograms kg-1) and in the 23% of the free living fish at an average level of 2 micrograms kg-1 wet wt (range 1-4 micrograms kg-1 wet wt). TBT was detected in 85% of the farmed fish, in concentrations varying from 2 to 260 micrograms kg-1 wet wt (mean 28 micrograms kg-1 wet wt) and in 46% of the free living specimens (mean 39 micrograms kg-1 wet wt; range 1-93 micrograms kg-1). All the mussel samples analyzed were polluted by both DBT and TBT. In the farmed mussels the average amounts of DBT and TBT were, respectively, 4 and 2 micrograms kg-1 wet wt; in the free living they were 4 and 5 micrograms kg-1 wet wt, respectively. The results indicate that the DBT and TBT contamination is as highly diffuse in farmed as in free living fish and mussels on sale in retail markets in Naples province even if the levels of the contamination are meanly quite low.

Lead in human blood from children living in Campania, Italy.

Blood lead (PbB) levels were determined in children living in Campania (in Naples and in a rural zone in the district of Caserta). Atmospheric lead (PbA) concentration in these considered areas was monitored for 1 yr (1993-1994). The children tested were questioned about common sources of lead, other than atmospheric, relating to their living and dietary habits. The PbB levels in children living in Naples were, at the 50th percentile, 13.8 micrograms/dl in males and 13.7 micrograms/dl in females; in children living in the rural area the median PbB levels were 8.9 micrograms/dl in males and and 8.8 micrograms/dl in females. The annual mean values of atmospheric lead were 1.15 +/- 0.24 micrograms/m3 in Naples and 0.23 +/- 0.07 micrograms/m3 in the rural area. Significant and congruent mean differences between urban and rural sites were found in children's blood and concurrent air lead. Considering the PbB level of 10 micrograms/dl as the maximum level that is not associated any known adverse effect in children, the Neapolitan group can be considered at risk of chronic intoxication by lead.

Evaluation of the selenium content of the traditional Italian diet.

Food samples and ready-made meals from the traditional Italian-type diet were analysed for selenium content. The average Se content varied in food samples from 7 micrograms/kg w/w (fresh fruit) to 226 micrograms/kg w/w (fish). The highest average contents were obtained in the animal products and in legumes. Among ready-made foods the animal derived dishes were the richest in Se, representing 78% of the estimated total daily dietary intake of Se. The average daily dietary intake of selenium for Italian people is estimated to be 50.9 +/- 29.8 micrograms Se/day when results obtained on complete meals are used, while it is 45.0 +/- 30.8 micrograms Se/day when results on foods and statistical data on consumption are used.