Low-Dose Occupational Exposure to Nickel and Thyroid Hormones.

INTRODUCTION: The aim of this study was to evaluate the effects of a low-dose exposure to nickel, as it is present in urban air, on thyroid hormones and on thyrotropin in outdoor workers exposed to urban pollutants. MATERIALS AND METHODS: A total of 164 outdoor workers were studied and divided by sex and smoking habit. Each worker underwent measurement of urinary nickel and of blood triiodothyronine, L-thyroxine, and thyrotropin levels. The statistical analysis was performed. RESULTS: Statistical analysis shows a significant and positive correlation between urinary nickel and L-thyroxine, both in total sample and in males. DISCUSSION AND CONCLUSION: The study suggests that occupational exposure to a low dose of nickel may affect thyroid function in municipal police workers. These data may provide information on other categories of outdoor workers with similar exposure.

Urinary Nickel and Progesterone in Workers Exposed to Urban Pollutants.

OBJECTIVE: The aim of this study is to evaluate whether the exposure to a low dose of nickel could determinate a variation in levels of progesterone in outdoor workers. MATERIALS AND METHODS: Two hundred sixty one subjects were divided by sex, task, age, seniority, and cigarette smoking habit. For each workers was evaluated the dose of blood progesterone and urinary nickel.The statistical analysis was performed. RESULTS: The Pearson correlation showed a statistically significant correlation between urinary nickel levels and progesterone. The multiple linear regression showed a significant correlation between progesterone and urinary nickel in the total sample and in the subgroups of smokers and workers with tasks of traffic direction. CONCLUSIONS: The results of our study suggest that occupational exposure to low doses of nickel present in urban pollution may influence to progesterone levels in outdoor workers.

Small renal masses managed with active surveillance: predictors of tumor growth rate after long-term follow-up.

BACKGROUND: The purpose of the study was to evaluate the relationships between the patients' clinical characteristics and the growth pattern of SRMs, and to investigate the predictive factors of tumor growth rates in patients initially managed with AS. MATERIALS AND METHODS: We retrospectively reviewed data from our prospectively collected database of 70 patients diagnosed with 72 SRMs between 1996 and 2013. Clinical and demographic data, and linear and volumetric growth rates were recorded for each patient. A Pearson correlation test was used to evaluate initial tumor size and linear or volumetric growth rate. Logistic regression models were used to evaluate the predictive factors affecting tumor growth kinetics. RESULTS: The mean age was 76 ± 6.8 years, and 47 (67.1%) of patients were male. The mean (± SD) and the median (interquartile range [IQR]) tumor size at presentation were 2.1 ± 1.3 and 2.7 (1.8-3.7) cm, respectively. The mean (± SD) and the median (IQR) linear growth rate were 0.5 ± 0.3 and 0.6 (0.4-1.5) cm per year, respectively. Patients treated with delayed surgery experienced a significantly greater mean linear growth rate (1.4 vs. 0.3 cm per year) than those observed in the AS group (P < .001). Male sex (HR, 1.70; P = .04) and symptomatic presentation (HR, 1.85; P = .02) were found to be significant predictors of tumor growth rates during AS. Conversely, age, Charlson Comorbidity Index, and initial tumor size failed to predict growth kinetics. CONCLUSION: Male sex and symptomatic presentation are associated with faster growth rates in patients managed with AS after long-term follow-up.

Small renal masses initially managed using active surveillance: results from a retrospective study with long-term follow-up.

BACKGROUND: The purpose of this study was to provide outcomes of patients managed using active surveillance (AS) for small renal masses (SRMs). PATIENTS AND METHODS: We retrospectively reviewed data of 62 patients diagnosed with 64 contrast enhancing SRMs suspicious for renal cell carcinoma. We evaluated the differences between patients who remained on AS and those who underwent delayed surgical intervention. RESULTS: The mean age of patients was 75 years and the mean follow-up was 91.5 months. The median tumor size and the median estimated tumor volume were 2.6 cm and 8.7 cm(3), respectively. The median linear growth rate and the median volumetric growth rate were 0.7 cm/y and 8.8 cm(3)/y, respectively. The mean linear and volumetric growth rates of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.9 vs. 0.4 cm/y and 16.1 vs. 4.6 cm(3)/y, respectively; P < .001). CONCLUSION: Most SRMs show an indolent course, with low metastatic potential. Faster linear and volumetric growth rates could be the expression of malignant disease, thus suggesting the need for a delayed surgical intervention. AS is a reasonable option for the management of SRMs in properly selected patients with low life expectancy.

Surveillance for small renal masses: retrospective analysis of a cohort of 42 patients with long-term follow-up.

PURPOSE: To provide our experience with active surveillance in patients incidentally diagnosed with small renal masses and show the results of long-term follow-up. PATIENTS AND METHODS: We retrospectively evaluated a cohort of 42 patients diagnosed with small renal mass (≤ 4 cm in diameter). All patients had clinical and radiological follow-up every 6 months. We evaluated the differences between patients who remained on surveillance and those who underwent surgical delayed intervention and the correlations between clinical variables and size growth rate. RESULTS: The mean patients' age was 75 years (66-90); the mean follow-up was 69.4 months (range 35-168). The median initial tumor size at presentation was 2.5 cm (range 1-4.3), and the median estimated tumor volume was 8.6 cm(3) (range 1.7-42.3). The median growth rate of the cohort was 0.8 cm/year (range 0.2-2.9), and the median volumetric growth rate was 9.1 cm(3)/year (range 0-19.6). Death for metastatic disease occurred in 2 patients died due to metastatic disease (4.7 %). No correlation was found between initial tumor size and size growth rate. The mean growth rate of the group of patients who underwent surgery was higher than in those who remained on surveillance (1.8 vs. 0.4 cm/year; P < 0.001). CONCLUSIONS: The most of small renal masses initially managed by surveillance will grow slowly and will have a low metastatic potential. Tumor size at diagnosis is not able to predict the natural history of renal masses, even if malignant disease may have a higher growth rate. In elderly patients with relevant co-morbidities, surveillance can be a reasonable option alternative to surgery.

Arthroscopic autologous chondrocyte implantation in osteochondral lesions of the talus: mid-term T2-mapping MRI evaluation.

PURPOSE: Autologous chondrocyte implantation (ACI) in the ankle has become an established procedure to treat osteochondral lesions. However, a non-invasive method able to provide information on the nature of the repair tissue is needed. Recently, MRI T2 mapping was identified as a method capable of qualitatively characterizing articular cartilage. The aim of this study was to evaluate the mid-term results of a series of patients arthroscopically treated by ACI and investigate the nature of the repair tissue by MRI T2 mapping. METHODS: Twenty patients, aged 35 ± 8 years, with an osteochondral lesion of the talus, underwent ACI and were evaluated at 5 ± 1 years' follow-up clinically (AOFAS score) and by the MRI T2-mapping sequence. MRI images were acquired using a protocol proposed by the International Cartilage Repair Society, evaluated by the MOCART score and completed by the T2-mapping sequence. Healthy volunteers, mean age 29 ± 6 years, were enrolled, and their T2 map values were used as a control. Their MRI results were then correlated with the clinical score. RESULTS: The AOFAS score increased from 59 ± 16 pre-operatively to 84 ± 18 at follow-up (P < 0.0005). Patients with more than 4 years' follow-up were found to have the most satisfactory results. On the basis of the controls, healthy hyaline cartilage tissue showed a T2 map value of 35-45 ms. A mean T2 map value compatible with normal hyaline cartilage was found in all the cases treated, covering a mean percentage of 69% ± 22 of the repaired lesion area. CONCLUSIONS: ACI was able to provide durable results that improved over time. Because of its ability to detect cartilage quality, the MRI T2-mapping sequence integrated with the Mocart score is a valid, non-invasive technique in evaluating the nature of the repair tissue in the ankle joint. LEVEL OF EVIDENCE: Therapeutic study, Level IV.

An unusual cause of external snapping hip.

The external snapping hip syndrome is a condition characterized by palpable or audible snap on the lateral region of the hip occurring during movements and sometimes associated with pain. It is typical of young adults and athletes and can be favored by the abnormal sliding of the iliotibial band or of the gluteus maximus muscle over the greater trochanter. We present a case of external snapping hip syndrome occurring in a young woman secondary to a dysmorphic sickle-shaped myotendinous junction of the gluteus maximus muscle. Diagnosis was allowed by an integrated clinical and radiological approach, based on dynamic ultrasound and magnetic resonance imaging (MRI).

Hemopoietic system in traffic police exposed to urban stressors.

The aim of the study is to evaluate if occupational exposure to urban stressors could cause alterations in red blood cells (RBC), hemoglobin (HGB), hematocrit (HCT), mean cell volume (MCV), mean cell hemoglobin (MCH), mean corpuscular hemoglobin concentrations (MCHC) in traffic police compared to a control group. 694 subjects were included in the study: 347 traffic police and 347 controls matched by sex, age and length of service after excluding the subjects with the principal confounding factors. The levels of RBC, HGB, HCT were significantly higher in male (respectively p<0.001, p<0.05, p<0.01) and in female (respectively p<0.05, p<0.001, p<0.01) traffic police than in controls. The authors hypothesise that occupational exposure to urban stressors in traffic police can alter hemopoietic system.

Plasma 17-alpha-OH-progesterone in male workers exposed to traffic pollutants.

The aim of the study is to evaluate if the occupational exposure to urban pollutants could cause alterations on 17-alfa-hydroxy-progesterone plasma levels and related diseases in male traffic policemen. 17-alpha-OH-P is synthesized in Leydig cells and in adrenals; it influences spermiogenesis, acrosoma reaction, testosterone biosynthesis, blocking of gonadotropin secretion; it regulates learning, memory and sleep. After excluding principal confounding factors, i.e., rotating or night shifts, exposure to solvents, paints and pesticides during time-off and smoking, traffic policemen were matched with controls by age, working life and drinking habit. Finally, 112 traffic policemen and 112 controls were included in the study. In traffic policemen 17-alpha-OH-P mean values were significantly higher vs. controls. The distribution of 17-alpha-OH-P values in both groups was significant. An increased frequency of fertility disorders referred to the questionnaire items were found in traffic policemen vs. controls, but the difference was not significant. The occupational exposure to low doses of chemical urban stressor, interacting with and adding to the psychosocial ones, could alter plasma 17-alpha-OH-P concentrations in traffic policemen vs. controls. 17-alpha-OH-P could be used as an early biological marker, even before the onset of the reproductive and mental health diseases.

Plasma dopamine in workers exposed to urban stressor.

The aim of this study is to evaluate if the occupational exposure to urban stressor could cause alterations in dopamine (DA) plasma levels and related diseases in traffic police officers compared to a control group. After excluding subjects with principal confounding factors, 306 traffic police officers (139 female and 167 male) and 301 controls (134 female and 167 male) were included in the study. In traffic police officers, mean DA values were significantly higher compared with controls (P = 0.006 and P = 0.000 in male and female, respectively). The distribution of DA values in traffic police officers and controls was significant (P = 0.000 and P = 0.000 in male and female, respectively). The number of male traffic police officers with a positive response to the questionnaire's items concerning anxiety, depression and panic attacks was higher than controls, though not significant (7.2% traffic police officers versus 4.2% controls). This difference was also not significant in female traffic police officers compared with controls. According to our previous researches on other neuro-immune-endocrine parameters, DA could be used as an early biological marker, valuable for the group to be employed in occupational sets, even before the onset of pathology.

Prolactin levels in workers exposed to chemical, physical and psycho-social urban stressors.

The aim of this study was to evaluate whether traffic police officers exposed to chemical, physical and psycho-social stressors, are at risk for alterations in plasma levels of prolactin (PRL) compared to a control group. Plasma PRL levels were evaluated in 92 male and 51 female, non-smoker, traffic police officers exposed to urban stressors and in 92 male and 51 female controls, matched by sex, age and working life (mean, SD and distribution), after excluding workers with the principal extra-occupational confounding factors. Mean PRL levels were significantly higher than controls in non-smoker, male and female traffic police officers (respectively, p=0.000 and p=0.013). The number of non-smoker, male and female traffic police officers with PRL values outside the upper normal limit for our laboratory was higher than, but not significantly different from controls. Mean PRL levels were not significantly higher than controls in smoker, male and female traffic police officers. The number of smoker, male and female traffic police officers with PRL values outside the normal limit for our laboratory was not significantly different from controls. The results suggest that exposure to urban chemical and physical stressors, interacting with psychosocial factors, may have an influence on PRL levels in traffic police officers. The level of plasma PRL might be a useful early biological marker for workers exposed to urban stressors.

Exposure to urban stressor and effects on luteinizing hormone (LH) in female outdoor workers.

There are few studies in literature about exposure to urban pollutants and effects on female reproductive health. The aim of the study was to evaluate if the occupational exposure to chemical urban stressor could cause luteinizing hormone (LH) plasma levels alterations in female traffic police compared to a control group. One hundred and eighty subjects were included in the study, subdivided into three different groups according to the day of the menstrual cycle (7th, 14th, 21st) in which a blood sample was taken. In follicular and lutheal phase of ovarian cycle, the LH mean levels were significantly higher in traffic police vs. controls. The distribution of LH values in traffic police and controls was significant in follicular, and lutheal phase. In ovulatory phase, LH mean levels were lower but not significant in traffic police compared to controls. An increase was found concerning mental health disorders referred to the questionnaire items in traffic police vs. controls, although the difference was not significant. Our results suggest that occupational exposure to urban stressor in female traffic police, may alter LH plasma concentrations. LH may be used in occupational set as an early biomarker of exposure to urban stressor.

Immune parameters in female workers exposed to urban pollutants.

Urban outside workers, such as traffic police, are daily exposed to air pollutants and psychosocial stressors: for these workers, the working environment corresponds to the living environment of the general population. Studies in the literature have shown that immune parameters could be affected by chronic exposure to various chemical pollutants. The aim of this study is to evaluate whether occupational exposure to urban pollutants can cause alterations in NK, IL-2, IFN-gamma and C3 plasma levels in female traffic police compared to a control group. After excluding subjects with the principal confounding factors, 86 female traffic police and 87 controls were matched by age, years of police work and habitual alcohol consumption. The distribution of NK values in female traffic police and controls was significantly different (p=0.000); NK values above the upper limit of the normal laboratory range were observed in 23 female traffic police and in 2 controls (p=0.000). IL-2 mean levels were higher in traffic police compared to controls, but the difference was not significant. The mean and the distribution of IFN-gamma values in female traffic police and controls were not different. C3 mean levels were higher in female traffic police versus controls, but the difference was not significant. Considering that the subjects with the principal confounding factors were excluded from the study and that female traffic police and controls were matched by the above-mentioned variables, our results suggest that chronic occupational exposure to low doses of chemical stressors, which may interact with and add to psychosocial ones, can affect both innate and adaptative immunity.

Exposure to traffic pollutants and effects on 17-beta-estradiol (E2) in female workers.

OBJECTIVE: The aim of the study is to evaluate whether the occupational exposure to urban pollutants including endocrine disruptors (EDs) could cause alterations in plasma 17-beta-estradiol (E2) levels and related diseases (adverse pregnancy outcome and mental health disorders) in female traffic police compared to a control group. METHODS: After excluding the subjects with the principal confounding factors, traffic police and controls were matched by age, years of police work, age of menarche, menstrual cycle day, body mass index (BMI), drinking habit, cigarette smoking habit, habitual intake of soy or liquorice in diet and habitual consumption of Italian coffee. Thirty-seven traffic police and 31 controls (seventh day; follicular phase of the ovarian cycle); 38 traffic police and 42 controls (14th day; ovulatory phase of the ovarian cycle); and 25 traffic police and 28 controls (21st day; lutheal phase of the ovarian cycle) were included in the study and then matched for the above-mentioned variables. RESULTS: In follicular and in lutheal phases, mean E2 levels were significantly lower in traffic police compared to controls. The distribution of E2 values in traffic police and controls was significant in follicular, ovulatory and lutheal phases. In ovulatory phase, mean E2 levels were lower but not significant in traffic police compared to controls. An increase was found concerning mental health disorders referred to in the questionnaire items in traffic police compared to controls, although the difference was not significant. CONCLUSIONS: Considering that the potential confounding effect of extraneous factors was controlled for by restricting the study population and by matching traffic police and controls on the above-mentioned variables, our results suggest that occupational exposure to urban pollutants, EDs included, might alter E2 plasma concentrations. E2 could be used in occupational set as an early biomarker of exposure to urban pollutants, valuable for the group, even before the onset of the related pathologies (adverse pregnancy outcome and mental health disorders).

Assessment of subjective stress in video display terminal workers.

Stress assessment in the workplace has been focused on its environmental, psychological and biological aspects. We carried out an evaluation of the subjective components of stress in a working population of 60 subjects employed in a large Public Service, 30 Video Display Terminal (VDT) workers (15 men and 15 woman) and 30 office-workers not assigned to VDT (15 men and 15 woman), by using the "Rapid Stress Assessment Scale": a short questionnaire of easy administration in work environment. VDT workers of both sexes showed higher total stress score vs. office workers (respectively p<0.05, p<0.05). Gender differences were present: female VDT workers showed higher scores of clusters anxiety (p<0.001) and aggressiveness (p<0.05); male VDT workers' score were significantly higher in somatization (p<0.05) and aggressiveness cluster. Our results showed that in VDT workers are experienced greater subjective response to stress than "office workers" and confirm the gender differences in stress experiencing.

Effects on androstenedione in male workers exposed to urban stressors.

The aim of this study is to evaluate whether occupational exposure to urban stressors could cause alterations in androstenedione plasma levels in male traffic policemen compared to a control group. After excluding the principal confounding factors, traffic policemen were matched with controls by age, working life, body mass index (BMI), drinking habit, and habitual soy intake in diet. One hundred and ten traffic policemen and 110 controls were included in the study. In male traffic policemen, mean androstenedione values were significantly lower compared to controls. The distribution of androstenedione values in traffic policemen and in controls was significant. Our results suggest that the occupational exposure to chemical urban stressors, interacting with and adding to the psychosocial ones, could alter androstenedione plasma concentrations in traffic policemen compared to a control group. According to our previous research, androstenedione could be used as an early biological marker, valuable for the group to be employed in occupational settings, even before the onset of the endocrine reproductive health diseases.

Plasma IL-2, NK, IFN-γ, and C3 in male workers exposed to traffic pollutants.

The aim of the study is to evaluate if the occupational exposure to urban stressors could cause alterations in interleukin-2 (IL-2), NK, interferon-γ (IFN-γ) and C3 plasma levels in male traffic police officers compared to controls. After excluding the principal confounding factors, 108 traffic police officers were matched with 108 controls by age, working life, habitual consumption of alcohol and spirits. IL-2 mean levels were significantly higher in traffic police officers compared to controls (p=0.04). The distribution of IL-2 values in traffic police officers and in controls was significant (p=0.01). The distribution of NK value percentage in traffic police officers and in controls was significant (p=0.000). IFN-γ and C3 mean levels were not significant in traffic police officers compared to controls. Our results suggest that the occupational chronic exposure to low doses of urban stressors could affect NK and IL-2 plasma concentrations in traffic police officers of male sex.