[Prevention of low back pain diseases in a center for the disabled]. / Prevenzione delle patologie del rachide nelle operatrici di un centro di lungo-degenza per disabili.

Our unit of occupational medicine has been asked to solve the problem of an incrising percentage of workers affected by low-back pain in a clinic for patients with handicaps. The consequence of this affections caused frequently absences at work. We organized a course for training about correct methods for moving patient not self-sufficient. The 84 workers, all female (aged 30-45), had to sign on a card all the problems they found at work and their possible solutions according to them. Then we put the cards in a box and we red each one, signing on a blackboard the problems, using a red pen and the solutions proposed, in blue. Bed organization, turnation of patient, and the difficulties in the use of lifter were the principal problems, solved trought the training course made. Then we obtained a reduction in absence at work for low-back pain of about 40% after six months since the beginning of a course of posture exercises made in the same clinic one day a week after work.

[Risk perception in a group of dentists from Abruzzo]. / Percezione del rischio in un gruppo di odontoiatri Abruzzesi.

Dentist's office represents an area with high infectious risk both for workers and patients. With our study we tried to analyse the relationship between dentists and prevention. We studied 104 dentists who had to answer to a questionnaire composed by 25 questions on topics such as job management, risk perception, measures adopted for prevention and knowledge about normatives regarding safety at work. From the answers we can conclude that dentists know the risk present in their work and use correctly the individual preventive dispositives; make blood control to test hepatitis markers, in particular HCV. But only 68% made HBV vaccination. Many dentists,even if they know the way of transmission of HIV, avoid to cure positive patient.

Clinical phenotype and beta-cell autoimmunity in Italian patients with adult-onset diabetes.

OBJECTIVE: To characterize the phenotype of a large population of Italian patients with adult onset (> or =40 years) diabetes who were attending outpatient clinics and who were screened for glutamic acid decarboxylase 65 autoantibodies (GADA), protein tyrosine phosphatase IA-2 (IA-2A) and IA-2beta/phogrin (IA-2betaA). DESIGN AND METHODS: This was a cross-sectional study comprising a total of 881 patients, aged < or = 70 years, diagnosed with type 2 diabetes after the age of 40 years, and consecutively recruited in five clinics located in different geographic areas of Italy (Milan, Florence, Rome, Naples and Catania). Their mean disease duration was 8.1 (6.9; s.d.) years. GADA, IA-2A and IA-2betaA were measured with radiobinding assays with in vitro translated S-methionine-labelled glutamic acid decarboxylase 65 (GAD65) or IA-2 or IA-2beta. Anthropometric and clinical data were collected and compared amongst patients with or without autoantibodies. RESULTS: Sixty-three (7.1%) patients had one or more autoantibodies, 58 (6.6%) had GADA, 22 (2.5%) had IA-2A, six (0.7%) had IA-2betaA and 19 (2.15%) had two or more autoantibodies. IA-2A or IA-2betaA, in the absence of GADA, were found in only five patients. Autoantibody-positive patients were more often female (63.5 vs 36.5%; P < 0.009), had higher glycated haemoglobin (Hb A1c) (P < 0.001), lower body mass index (BMI; P < 0.0005) and waist/hip ratio (WHR; P < 0.01); female gender being the main contributor to BMI and WHR. We did not observe any differences in age at diagnosis or duration of disease with respect to the presence or absence of islet autoantibodies. The proportion of patients on insulin therapy was higher in patients with two or more antibodies, compared with those with one antibody only, and no antibodies (P for trend < 0.001), and among patients with GADA, in those with higher antibody titre (73.9% in those with > 10 units vs 42.0% in those with < or = 10 units; P < 0.007). CONCLUSIONS: Patients with adult onset diabetes characterized by autoimmunity to beta-cells showed a clinical phenotype with anthropometric features that differed from those classically observed in patients with type 2 diabetes. The number and titre of autoantibodies, which reflect the severity of autoimmunity and beta-cell impairment, amplified this difference. The usefulness of autoantibody screening in adult-onset diabetes is further emphasized by these findings.

Follow up study on the immune response to low frequency electromagnetic fields in men and women working in a museum.

Seven women and eight men, exposed to low frequency (50 Hz) electromagnetic fields (EMFs) in a museum for 20 hours a week, were investigated in the years 1999 and 2005. During the first study, the mean EMF exposure in the working place was 1.7 microT and 1.1 microT, respectively. In the first investigation, the EMF-exposed men showed reduced blood NK lymphocytes in relation to controls, while EMF-exposed women presented reduced PHA-stimulated IFN-gamma release from peripheral blood mononuclear cells (PBMC). In the year 2005, blood cytotoxic activity, state and trait anxiety (STAI I and II, respectively) and occupational stress were also investigated. The scores of STAI I and II of the control women were slightly higher than those of the control men. EMF-exposed men showed higher occupational stress but normal immune parameters. EMF-exposed women showed, in relation to controls, lower PHA-stimulated IFN-gamma release from PBMC and reduced blood cytotoxic activity/CD45+-CD16+-56+ NK lymphocytes (but not per ml of blood). One of the women exposed to EMF, who worked a night shift, showed marked lymphopenia with very low NK lymphocytes and reduced IFN-gamma release; these immune parameters returned to normal following a change of work site. This study suggests that low frequency EMFs affect the immune functions of women more than those of men. Moreover, the determination of immune parameters seems to be a useful marker of the health effects of exposure to EMFs.

"In vitro" effects of different arsenic compounds on PBMC (preliminary study).

Aim of this investigation was to compare the effects of 10(-4) M and 10(-7) M As compounds on spontaneous and PHA stimulated PBMC proliferation and IFN-gamma and TNF-alpha release. The inhibitory effect of the 10(-4) M As salts was in the following order: momo-methyl-arsinous acic (MMAs(III)) > sodium arsenite (As(III)) > tetraphenyl arsonium chloride (As(V)) > sodium arsenate (As(V)) > potassium- and sodium-esa-fluorum arsenate (As(V)) > dimethyl arsinic acid (DMAs(V)), while monomethyl-arsonic-acid (MMAs(V)) and arsenobetaine did not exert immune effects. 10(-7) M MMAs(III) stimulated the spontaneous PBMC proliferation, while As(III) and DMAs(V) enhanced the PHA stimulated PBMC proliferation. This study shows that the immune effects of As salts depends on speciation; moreover, the immunotoxicity of inorganic arsenic in part depends on the intracellular bio-synthesis of MMAs(III) from MMAs(V).

Assessing the presence of abnormal regulation of cortisol secretion by membrane hormone receptors: in vivo and in vitro studies in patients with functioning and non-functioning adrenal adenoma.

Regulation of cortisol secretion by aberrant hormone receptors may play a role in the pathogenesis of ACTH-independent Cushing's syndrome. In this study, the topic was evaluated by combining in vivo and in vitro approaches. Cortisol responses to various stimuli (standard meal, GnRH + TRH, cisapride, vasopressin, glucagon) were assessed in 6 patients with clinical or subclinical adrenal Cushing's syndrome, and non-functioning adrenal adenoma in two cases. Abnormal responses were observed in three patients with Cushing's syndrome; one patient showed a gastric inhibitory polypeptide (GIP)-dependent cortisol rise after meal, together with responses after GnRH and cisapride; the second patient showed an LH-dependent cortisol response to GnRH, and in the third cortisol rose after cisapride. The pattern of receptor expression performed by RT-PCR showed that while GIP-R was only expressed in tumor from the responsive patient, 5-hydroxytryptamine type 4 receptor and LH-R were also present in normal adrenal tissues and tissues from non-responsive patients. Interestingly, an activating mutation of Gsalpha gene was identified in one of these tumors. Therefore, cortisol responses to agents operating via Gs protein coupled receptors (in one case associated with Gsalpha mutation) were found in Cushing's patients, while these responses were absent in the others. The finding of receptor expression in normal and non-responsive tumors suggests that different mechanisms are probably involved in inducing in vivo cortisol responses.

[In vitro effects of hexavalent and tetravalent tellurium on immune functions]. / Effetti "in vitro" del tellurio esavalente e tetravalente su funzioni immunitarie.

The "in vitro" immune effects of K2TeO3xH2O (Te IV) and K2TeO4x2H2O (Te VI) on peripheral blood mononuclear cells (PBMC) was determined. Te(IV) inhibited PBMC proliferation and IFN-gamma, IL-5 and TNF-alpha release from PBMC more than Te (VI).

[Serum tryptase: marker of occupational anaphylaxis]. / Triptasi: marker dell'anafilassi occupazionale.

Tryptase is a protein released by mast cells, which is involved in the enhancement of inflammatory sequences in immune-mediated reactions. According with our experience, some patients having a reaction clinically classified as anaphylaxis, showed high levels of tryptase (> 20 ng/l) but also of serum specific IgE, showing the immune-mediated nature of the reactions. On the other hand workers without specific IgE and with low levels of tryptase probably had developed pseudoallergic (anaphylactoid) reactions. So, tryptase can be used as biomarker of occupational anaphylaxis and appear to be able to make out immune and nonimmune mediated reactions.

[Inflammation, bronchial hyperreactivity, and progression of asthma: a 5-year follow-up in grass sensitized farmers]. / Infiammazione, iperreattività bronchiale e progressione dell'asma: follow-up di 5 anni in contadini con asma allergico a graminacee.

We studied in a group of 53 asthmatic farmers the influence of various treatment regimens on progression of disease, during five years follow-up. Specific immuno-therapy (SIT) and steroid treated patients showed significantly lower ECP levels and higher methacholine PD20 FEV1 than untreated patients, during all years of the study. During the first two years, spring ECP increase was higher in SIT treated patients than in steroid ones, however no significant differences were found during the following years. Bronchial hyperreactivity showed same course, except for a significant higher PD20 FEV1 in steroid and SIT treated asthmatics, in respect to the steroid or SIT alone. We may conclude that ECP and bronchial reactivity are useful for asthma monitoring and SIT and inhalant steroids have additional effects on asthma.

Impaired estrogen-induced negative feedback on gonadotropin secretion in patients with gonadotropin-secreting and nonfunctioning pituitary adenomas.

BACKGROUND: Several in vitro studies suggest that gonadotropin-secreting pituitary adenomas (Gn-omas) and non functioning pituitary adenomas (NFPA) originate from gonadotroph cells. Patients with Gn-oma and NFPA frequently show abnormal gonadotropin response to TRH. The aim of the study was to investigate whether the estrogen-induced negative feedback is operating in either patients with Gn-oma or NFPA. MATERIALS AND METHODS: Serum gonadotropin levels were evaluated at 24 h after ethinylestradiol administration (1 mg per os; EE2 test) in seven patients with a diagnosis of Gn-oma, based on the presence of high follicle-stimulating hormone (FSH) and/or lutenising hormone (LH) levels with normal or high levels of sex steroids, in 22 patients with NFPA with normal or low levels of gonadotropin and sex steroids, and 30 sex- and age-matched healthy subjects. A normal response to EE2 test was arbitrarily defined as a serum LH and FSH decrease of at least 40 and 30% below basal levels. RESULTS: Among patients with Gn-oma, only one had a normal FSH inhibition and another, a normal LH inhibition. Among the 22 patients with NFPA, the EE2 test caused a normal FSH or LH reduction in 10 and 15, respectively, while a normal reduction of both FSH and LH was observed in nine. CONCLUSIONS: The study demonstrates that estrogen-induced negative feedback of gonadotropin secretion is disrupted in almost all patients with Gn-oma and in half of those with NFPA. This defective feedback is reminiscent of the resistance to thyroid hormones and glucocorticoids observed in patients with thyroid-stimulating hormone- (TSH-) and adrenocorticotropic hormone- (ACTH-)secreting adenomas, respectively.

Androgen secretion in ectopic ACTH syndrome and in Cushing's disease: modifications before and after surgery.

The role of ACTH in the control of adrenal androgen secretion is known, although the possible existence of other regulatory factors has been also suggested. While some data concerning Cushing's disease have been reported, only few studies concerned androgen levels in ectopic ACTH secretion. The aim of this study was to evaluate serum DHEA-S, androstenedione (A) and testosterone (T) levels in 36 women with ACTH-dependent Cushing's syndrome (30 with Cushing's disease and 6 with ectopic ACTH secretion) before and after surgery. Two men with ectopic ACTH production were also studied. In 30 women with Cushing's disease serum DHEA-S (9.6 +/- 0.9 micromol/l), A (15.2 +/- 1.2 nmol/l) and T (4.1 +/- 0.5 nmol/l) were higher than in controls (p < 0.01): elevated DHEA-S, A and T values were found in 8, 18 and 17 cases, respectively. After adenomectomy in 15 apparently cured patients DHEA-S, A and T levels were low at 1 - 3 months and at 6 - 12 months after surgery. At 18 - 24 months, DHEA-S remained low in spite of cortisol normalisation. In ectopic Cushing's syndrome, A levels were significantly higher (23.1 +/- 4.9 nmol/l) than in Cushing's disease (p < 0.05), while no differences were found in DHEA-S and T levels. Two patients had elevated DHEA-S values, 3 women had high T levels and 7 of the 8 patients had very high A concentration that was lowered in 3 operated cases. In conclusion, the pattern of adrenal androgen secretion is rather different in patients with pituitary or with ectopic Cushing's syndrome. While the frequency of DHEA-S and T alterations is similar, androstenedione secretion is greatly increased in the latter condition. It is suggested that in ACTH-secreting non-pituitary tumours, the production of a POMC-derived peptide, although unidentified, may lead to preferentially stimulated androstenedione secretion, without affecting other enzymatic pathways.

Effect of Thymomodulin on luteinizing hormone, prolactin and testosterone in male rats.

The effect of Thymomodulin (TMD), a calf thymus derivative, on luteinizing hormone, prolactin and testosterone was studied in male rats after acute and chronic treatment. The results showed that the stimulatory action on prolactin and testosterone secretion after acute (prolactin) or one month chronic (testosterone) treatments completely vanished during six month chronic administration. No effect was observed on luteinizing hormone after acute or chronic treatment.

Modifications of thymulin titers in patients affected with prolonged low or high zinc circulating levels are independent of patients' age.

UNLABELLED: Thymulin (FTS) is a thymic hormone, the bioactivity of which depends on zinc (Zn) incorporation in its molecule (FTS bioactive form: Zn-FTS). Many hormones (T3, GH, PRL, Gn-RH 6-endorphin) and Zn are able to increase thymus trophism and Zn-FTS circulating levels, even in old animals, suggesting that age dependent thymic involution is a reversible phenomenon. FTS circulating levels and thymus trophism are age-dependent. In fact, the decrease of Zn-FTS starts from the age of 10-20 years and proceeds progressively. In 19 uremic patients on hemodialysis (mean age +/- SD: 44.7+/-11.7, range 29-60 years) and 58 patients with prolactinoma (mean age 31+/-7; range 18-58) we found low Zn-FTS levels (expressed as scalar dilution in form of 1/log(2)): 1.5+/-0.5 and 2.1+/-0.7, respectively, vs normal age and sex matched controls: 2.9+/-0.4 and 3.6+/-0.3, respectively; p<0.01. On the contrary, in 41 acromegalic patients (mean age 43+/-12; range 20-63 years) Zn-FTS levels were elevated (4.5+/-0.7 vs controls: 2.8+/-0.3, p<0.01). In all these patients, age-related differences of Zn-FTS circulating levels were lost and Zn-FTS titers were homogeneously low or high according to Zn levels. In fact, in uremic patients and in patients with prolactinoma, Zn levels were low (79+/-26 microg/dl and 82+/-23 microg/dl, respectively, vs control levels: 114+/-12 microg/dl, p<0.01), while They were high in acromegalic patients (141+/-44 microg/dl vs control levels: 112+/-11 microg/dl, p<0.01). After ZnSO(4) administration (400 mg per os/day) for six months. Zn levels increased over the normal range, both in patients with uremia and in patients with prolactinoma (136+/-15 microg/dl and 138+/-18 microg/dl, respectively; p<0.01). Also Zn-FTS levels increased homogeneously independently of age (5.2+/-0.7 and 5.3+/-0.8, respectively); p<0.01, both vs basal and control values; PRL circulating levels did not change. In 20 patients affected with prolactinoma and in 10 acromegalic patients, Zn and Zn-FTS decreased to the normal range, 6, or 12 months after surgical or pharmacological normalization of high PRL and GH circulating levels. In these patients, age-related titers of Zn-FTS were found, such as in controls. IN CONCLUSION: (i) Reduced Zn-FTS levels in patients affected with uremia or prolactinoma and the increased Zn-FTS titers present in acromegalic patients are related to low and high Zn circulating levels, respectively, underlining the importance of Zn in regulating thymulin secretion. (ii) When spontaneous (or induced) hyper- or hypo-zincemia occurs, age-related differences of Zn-FTS titers are lost, suggesting that Zn may overcome the effect of age on thymic function.

Zinc and bromocriptine long-term administration in patients with prolactinomas: effects on prolactin and thymulin circulating levels.

Several studies have demonstrated zinc (Zn), prolactin (PRL) and thymulin (Zn-FTS) interplay: Zn inhibits, in a dose related manner, PRL release from lactotropes in vitro and stimulates thymulin synthesis in vivo both in humans and in animals. PRL receptors are present on thymic epithelial cells (TEC); PRL stimulates TEC trophism and activity. Little is known about the influence of PRL on Zn metabolism, though in prolactinomas we found reduced Zn and thymulin circulating levels. For this reason, we evaluated PRL, Zn, bioactive thymulin (Zn-FTS) and total thymulin (T-FTS: Zn-bound plus Zn-unbound form) serum levels in 58 patients with prolactinomas (PRL: 253 +/- 263 micrograms/L), Zn (82 +/- 23 micrograms/dl), Zn-FTS (2.2 +/- 0.20 log2(-1] and T-FTS (3.7 +/- 0.25 log2(-1] were significantly lower (p less than .01) than those found in age matched controls. Zn-unbound bioinactive thymulin form (FTS) levels were in the normal range. Bromocriptine administration (Brc) (2.5-5 mg p.o., b.i.d. for 9 months) to 20 patients with microprolactinomas lowered serum PRL levels (10.5 +/- 6.2 micrograms/L) and significantly increased (p less than .01) Zn (118.6 +/- 14.7 micrograms/dl), Zn-FTS (3.96 +/- 0.7 log2(-1)) and T-FTS (4.66 +/- 0.7 log2(1)) circulating levels. ZnSO4 administration (400 mg p.o. daily for 3 months) to 6 patients with microprolactinomas, significantly increased (p less than .01) Zn (136 +/- 18 micrograms/dl), Zn-FTS (4.5 +/- 0.5 log2(-1)) and T-FTS (5.6 +/- 0.9 log2(-1)) levels, while caused only a slight decrease in serum PRL concentrations (from 95 +/- 8 to 75 +/- 9 micrograms/L; p: NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Thymic endocrine activity in children with idiopathic growth-hormone deficiency.

Experimental and clinical evidences suggest that thymic endocrine function is modulated by the neuroendocrine network and in particular by growth hormone. The plasma of thymulin has been found reduced in congenital hypopituitarism and increased in acromegalic conditions when compared with the values observed in age-matched controls. In the present paper we have investigated in congenital GH-deficient children the effect of one year therapy with GH on the plasma level of thymulin, IGF-1 and plasma zinc; this last parameter has been checked because zinc is required for thymulin activity and modulates IGF-1 production. The basal thymulin and IGF-1 values are lower in GH deficient children than age-matched controls whereas zinc levels show a slight reduction. GH therapy induces a significant increment both of thymulin and IGF-1 levels and a slight increase of plasma zinc. A positive correlation has been found between zinc values and thymulin activity but not between GH and thymulin. Whether the recovery of thymulin production in GH deficient children by GH therapy is mediated by IGF-1 or by bioavailability of zinc ions remains to be established.

Prolactin, thymulin and zinc in chronic hemodialysis: effect of renal transplant.

The interrelationships between PRL, thymulin and Zn, were studied in 25 patients with chronic renal failure (CRF) undergoing kidney transplantation and immunosuppressed with cyclosporine A (CsA). The possible role of serum PRL levels in predicting allograft rejection was also investigated. Before the kidney transplant serum PRL levels were significantly higher than in normals (mean +/- SE, 28.3 +/- 7.1 vs 7.5 +/- 0.6 micrograms/l, p less than 0.001) and their response to TRH (200 micrograms iv) was impaired (mean delta % at peak, 45.4 +/- 9.5 vs + 641 +/- 47.5, p less than 0.001). After kidney transplantation a dramatic decrease in serum PRL concentrations was observed in all patients, followed by a slight upward trend in the following two weeks, while TRH test administered on 3rd, 7th and 14th day, induced a progressive increase in serum PRL responses (delta % at peak, 201 +/- 43.3, 220 +/- 37.1 and 305 +/- 15.5, respectively). No difference in serum PRL patterns was observed between patients with (8 cases) and without (17 cases) clinical features and kidney fine needle biopsies suggestive of rejection. Basal serum Zn levels of patients with CRF (18.1 +/- 0.6 mumol/l) were similar to those observed in normals (17.7 +/- 0.2 mumol/l) and without any correlation with serum PRL levels. A decrement in serum Zn was recorded during CsA infusion and on the first day after the surgery, followed by a slight and slow upward trend. Basal serum thymulin titers were low [2.92 +/- 0.18 (1/log2)], were further reduced after CsA infusion [1.68 +/- 0.15 (1/log2)] and returned to the pretransplant levels in the two weeks after grafting.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of oral zinc administration on prolactin and thymulin circulating levels in patients with chronic renal failure.

High serum PRL and low zinc (Zn) levels are common findings in patients with chronic renal failure (CRF); in such patients serum Zn concentrations have been reported to be inversely correlated to serum PRL levels. Moreover, Zn regulates both thymus growth and the biological activity of the thymic hormone thymulin, and PRL-thymic interrelationships have been described. To determine whether hypozincemia alters serum PRL and plasma thymulin concentrations in CRF, 9 men with CRF treated by chronic hemodialysis were given 400 mg/day Zn sulfate, orally (4.96 meq/day Zn), for 6 months. Before treatment, serum PRL levels were significantly higher (P less than 0.001) in these patients than in normal men [mean, 28.7 +/- 20.7 (+/-SD) vs. 7.5 +/- 3.7 micrograms/L], and their serum PRL response to TRH (200 micrograms, iv) was impaired (mean maximal percent increase, 38.2 +/- 10.9 vs. 641 +/- 335; P less than 0.001). The plasma Zn-bound bioactive thymulin titer (1.3 +/- 0.7 1/log2), total thymulin titer (Zn-bound plus Zn-unbound forms, 2.1 +/- 0.8 1/log2), and serum Zn (13.1 +/- 2.4 mumol/L) were lower (P less than 0.001) in men with CRF than in normal men. Zn therapy did not induce any significant change in basal and TRH-stimulated serum PRL levels, while serum Zn levels significantly increased, reaching the normal range after the first week of treatment (17.8 +/- 6.3 mumol/L). Plasma total thymulin increased rapidly, reaching normal levels after 1 week, but Zn-bound thymulin increased modestly during the first month of treatment and more after 3 and 6 months of treatment. There was no age-related difference in plasma thymulin levels during therapy. We conclude that oral Zn administration in patients with CRF significantly increases both total and Zn-bound thymulin, but does not modify basal and TRH-stimulated serum PRL levels. The observation that Zn supplementation markedly increased plasma thymulin levels in uremic patients suggests that Zn is a potent stimulus for thymic hormone synthesis, and it can reverse the age-related diminution of thymic activity in CRF patients.