Italian version of the cornell musculoskeletal discomfort questionnaire (CMDQ-I): Translation, cultural adaptation and validation.

BACKGROUND: Almost 25%of workers in the European Union suffer from back pain, and 23%complain of muscle pain. Sixty-two percent of workers carry out repetitive operations with their hands or arms, 46%work in painful or tired positions and 35%carry or handle loads. OBJECTIVE: This study aimed to translate, culturally adapt and validate the Italian version of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ-I). METHODS: Translation and cultural adaptation procedures followed international guidelines. Participants were recruited from among the personnel components of the Italian Air Force, who were between 18 and 65 years old. Cronbach's alpha and the intraclass correlation coefficient (ICC) were calculated to assess internal consistency and stability, respectively. The CDMQ-I was administered together with the Visual Analogic Scale (VAS), and the validity was evaluated using Pearson's correlation coefficient. RESULTS: All CDMQ-I items were either identical or similar in meaning to the original version's items. The scale was administered twice with a retest after seven to 10 days to 66 participants. Cronbach's alpha was higher than 0.761, and the ICC ranged between 0.737 and 0.952. Pearson's correlation coefficient showed positive and significant correlations (p > 0.01). CONCLUSIONS: The study produced an Italian version of the CMDQ with good reliability and validity. This scale is a useful tool to investigate the frequency and intensity of musculoskeletal disorders in various categories of workers.

Sustained response to subcutaneous immunoglobulins in chronic ataxic neuropathy with anti-disialosyl IgM antibodies (CANDA): report of two cases and review of the literature.

INTRODUCTION: Chronic ataxic neuropathy with anti-disialosyl IgM antibodies (CANDA) is a rare disorder for which the pathological, neurophysiological, and therapeutic evidence remains anecdotal and controversial. METHODS: This report on CANDA focuses on the neurophysiological patterns and treatment responses shared by two cases. One patient underwent nerve ultrasound follow-up. A comprehensive review of the literature highlighted the diverse experiences with different treatment options. RESULTS: Response to different therapies was similar in both patients: intravenous immunoglobulins achieved a favorable response albeit with significant wearing-off fluctuations; treatment with subcutaneous immunoglobulins (SCIg) was an effective alternative leading to a clinical response for at least 2 years. Rituximab, which was trialed in both patients, was not continued long enough to determine its efficacy in modifying the disease course and/or modulating responsiveness to immunoglobulins. Steroids caused clinical worsening in both patients. CONCLUSIONS: Immunoglobulin therapy appeared as the most effective in the treatment of these two patients. SCIg provided an effective treatment option for the long-term management of CANDA.

Functional Improvement After Outpatient Cardiac Rehabilitation in Acute Coronary Syndrome Patients is Not Related to Improvement in Left Ventricular Ejection Fraction.

INTRODUCTION: Cardiac rehabilitation (CR) improves the functional capacity and the prognosis of patients with coronary artery disease. AIM: Our study was aimed at assessing the relationship between functional improvement (evaluated with 6-min Walk Test-6MWT) and the improvement in left ventricular ejection fraction (LVEF) after CR. METHODS: We collected data from 249 patients (age 66.79 ± 11.06 years; males 81.52%) with a recent history of Acute Coronary Syndrome that performed CR. The functional improvement after CR was expressed as the Δ between distance covered at the final versus the initial 6-min Walking Test (6-MWT), while LVEF was calculated with transthoracic echocardiogram at the beginning and at the end of the CR. RESULTS: Patients were divided accordingly to their pre-rehab LVEF (≥ 55% vs < 55%). With superimposable age and baseline 6MWT distance covered (434.58 vs 405.12 m, p = 0.08), the latter group presented higher Δ meter values at 6MWT (167.93 vs 193.97 m, p = 0.018). However, no statistically significant positive correlation between Δ meters and Δ LVEF was found. Moreover, linear regression analyses found that nor baseline LVEF nor Δ LVEF were significant determinants of Δ meters when considering the whole group, with age, basal 6MWT and peak CK-MB as additional covariates in the model. CONCLUSION: Although it could be expected that an increase in LVEF is related to the functional improvement after CR, no significant correlation was found in our population.

Cardiac Biomarkers Release in Preadolescent Athletes After an High Intensity Exercise.

INTRODUCTION: An elevation of cardiac troponins has been described in healthy athletes after endurance exercises. The clinical significance of this increase is unclear and the lack of awareness of this phenomenon may lead to inappropriate management of these subjects. AIM: We sought to determine wether an intensive cycling training could determine a biomarkers elevation. METHODS: We evaluated serum high sensitivity cardiac troponin T, NH(2)-terminal pro-brain natriuretic peptide, CK-MB and CK in 21 healthy male preadolescent athletes (age 9.2 ± 1.7 years) after an intensive cycling training prolonged until muscular exhaustion (mean duration 16'41″). During exercise heart rhythm and rate were monitored with Holter. RESULTS: 62% of the group had an elevation of cardiac biomarkers: specifically, 6 children had an increase in troponin levels; 3 of them had an elevation of pro-brain natriuretic peptides as well. Pro-brain natriuretic peptides resulted increased in 9 subjects. There was no relation between troponin elevation and heart rate, age or exercise duration; subjects with increased pro-brain natriuretic peptides had mean and maximal heart rates lower than children with normal natriuretic peptides levels. Other sports were performed in 50% of subjects with normal troponins and only in 17% of those with increased values. CONCLUSIONS: A short, high-intensity exercise caused an elevation of cardiac biomarkers in 62% of our subjects. The grade of training may influence the release of troponin and this increase is probably related to a temporary discrepancy between O2 delivery and consumption. Increases in natriuretic peptides levels are possibly expression of different adaptations to exercise.

Analysis of human ß-papillomavirus and Merkel cell polyomavirus infection in skin lesions and eyebrow hair bulbs from a cohort of patients with chronic lymphocytic leukaemia.

BACKGROUND: Research demonstrates an increased incidence of skin cancer in immunocompromised hosts, including patients with chronic lymphocytic leukaemia (CLL) and organ transplant recipients (OTRs). Active human ß-papillomavirus (ß-HPV) infection has been found in OTR skin lesions, suggesting its possible involvement in skin carcinogenesis. Merkel cell polyomavirus (MCPyV) has also been reported in cases of skin cancer. OBJECTIVES: To investigate the potential correlations between patient clinical features and skin cancer development, and the presence of ß-HPV and MCPyV DNA and protein markers in skin lesions and hair bulbs from patients with CLL. METHODS: The clinical features of 293 patients with CLL were analysed according to the presence or absence of skin lesions. ß-HPV and MCPyV infection was investigated in skin lesions and hair bulbs from the study cohort by both polymerase chain reaction (PCR) analysis and immunohistochemical screening. RESULTS: No significant correlations were observed between any of the analysed haematological parameters and the development of skin cancer. PCR analysis revealed the presence of ß-HPV and MCPyV DNA in skin lesions, and 83% of positivity for MCPyV DNA in hair bulbs, while systematic immunohistochemical analysis of all the lesions failed to detect any expression of the viral proteins ß-HPV E4, L1 or MCPyV LTAg. CONCLUSIONS: Overall, the data indicate that carriage of ß-HPV and MCPyV in the lesional skin and hair bulbs from patients with CLL without any evident reactivation at skin tumour sites most likely represents coincidental rather than causal infection. This contrasts with previous findings in relation to OTR-derived skin lesions.

[Forklifts: vibrations, drivers exposure, interventions to reduce risk]. / Carrelli elevatori: vibrazioni, esposizione dei conducenti, interventi di riduzione del rischio.

Whole-body vibrations may be a health risk to forklifts drivers. Thus, a research on the vibrations occurring on a high amount of forklifts (131) has been carried out in order to identify the characteristics of vibrations and the exposure of the drivers. Particular attention has been paid to the seats, to the travel speed and to the irregularities of the surface on which forklifts move: these factors can affect vibrations greatly. The paper closes with an overview of interventions to implement for reducing the risk.

Occurrence of priority and emerging organic compounds in fishes from the Rhone River (France).

The main objective of this study was to collect new data on the occurrence, levels of priority and emerging organic compounds in freshwater fish sampled in the Rhone River. The 34 studied contaminants included alkylphenols, bisphenol A, polybromodiphenylethers (PBDE), perfluorinated compounds, hexabromocyclododecanes (HBCD), hexachlorobenzene and hexachlorobutadiene (HCBD). About 50 fish samples (individual specimens or pooled fish) were collected from three sites located upstream and downstream of the Lyon metropolitan area in the Rhone River (France). Four species were caught at each site, namely: the barbel (Barbus barbus), the common bream (Abramis brama), the white bream (Blicca bjoerkna) and the chub (Squalius cephalus). Some contaminants were quantified in all the 32 fish samples analysed: 4-nonylphenol, α-HBCD, the six PBDE congeners (28, 47, 99, 100, 153, 154), perfluorooctanesulfonate (PFOS) and perfluorodecanoic acid. Twenty three of the 32 samples had a concentration of PFOS above the Environmental Quality Standards (EQS) (up to six times higher than the EQS), and all the 32 samples had concentrations of PBDE above the EQS (up to 4,000 times higher, with the sum of six PBDE varying from 4.5 to 182 ng/g dry weight). Clearly, the interest to consider PFOS and HBCD as new priority substances is confirmed. In contrast, the pertinence of a priority status for HCBD, which was never quantified in our study, might have to be reconsidered in the future.

Is PCBs concentration variability between and within freshwater fish species explained by their contamination pathways?

Many chemical, physiological, and trophic factors are known to affect bioaccumulation of polychlorinated biphenyls (PCBs) in biota. Understanding the primary factors affecting fish contamination is critical for predicting and assessing risks to upper-trophic level consumers, including humans. Here we identify PCB contamination pathways that could explain within- and between-species variability in fish concentration levels. Three freshwater river fish species (barbel, chub and bream) were sampled at three sites along the Rhone River (France) where fish consumption is partially prohibited because of PCB levels exceeding the European health-based benchmark. The trophic position was assessed using an innovative approach based on stable isotope analyses and Bayesian inference, which takes into account both isotope data variability and parameter uncertainty. The effect of foraging habitat on fish contamination was addressed using stable isotope mixing models. The fish trophic position and PCB concentrations were found to be unrelated while the exploitation of sediment detrital carbon as a food source appeared to be a critical factor affecting fish contamination. Fish length, PCB concentration of the sediment, and individual fish foraging habitat (exploitation of detrital versus planktonic carbon sources) explained 80% of within- and between-species variability observed in PCB concentrations. These results, obtained for species that have overlapping TPs and exploit different carbon sources, reveal that the important factor in fish PCB contamination is not only what fish consume, but also and essentially the feeding location.

Environmental conditions influence allometric patterns in the blow fly, Chrysomya albiceps.

The objective of this research was to study variations in allometry of body characters in females and males of two populations of blow flies, Chrysomya albiceps (Wiedemann) (Diptera: Calliphoridae), under different environmental conditions to establish patterns of morphological variation. Body size of both males and females in the experimental population was significantly higher than in the individuals of the natural population, indicating an important influence of food on body size. All genitalic and non-genitalic characters in males and females of the two populations showed a trend towards negative allometry rather than isometry. Allometric patterns were modified in both sexes and between populations. The data show generally larger allometric slopes in females than in males. We confirmed that the environmental conditions have an important effect on allometric patterns and body size.

Cryptic female choice via sperm dumping favours male copulatory courtship in a spider.

Males of many animals perform 'copulatory courtship' during copulation, but the possible reproductive significance of this behaviour has seldom been investigated. In some animals, including the spider Physocyclus globosus (Pholcidae), the female discards sperm during or immediately following some copulations. In this study, we determined which of several variables associated with copulation correlated with paternity success in P. globosus when two males mate with a single female. Then, by determining which of these variables also correlated with sperm dumping, we inferred which variables may affect paternity via the mechanism of sperm dumping. Male abdomen vibration (a copulatory courtship behaviour) and male genitalic squeezing both correlated with both paternity and sperm dumping; so, these traits may be favoured by biased sperm dumping. Biased sperm dumping may also be the mechanism by which possible cryptic female choice favours another male trait that was the subject of a previous study, responsiveness to female stridulation.

[Adequacy of personal hearing protection devices]. / Valutazione dell'adeguatezza dei dispositivi individuali di protezione uditiva.

At present, attenuation values reported on the hearing protection device (HPD) label are strongly overestimated due to an evaluation method inappropriate for the environments in which they have to be used: the workplaces. An alternative test protocol was validated and published as standard. It should be transposed in the regulatory and legislative scenario and then adopted by manufacturers. Meanwhile, derating schemes proposed by NIOSH may be applied for reducing the labelled attenuation data, in spite of their roughness. Moreover, attenuation values differ from subject to subject. Especially when exposure levels are high or hearing loss is worsening, it could thus be necessary to evaluate the attenuation provided by the hearing protector on each worker. To overcome this problem, the assessment of the hearing threshold levels on a subject with and without the HPD could be integrated into the annual audiometry program.

Ultrastructure of spermatozoa of Solifuges (Arachnida, Solifugae): possible characters for their phylogeny?

The ultrastructure of spermatozoa is a widely accepted source of characters for phylogenetic studies. In this study the fine structure of sperm cells of representatives of six different New and Old World families (Ammotrechidae, Daesiidae, Eremobatidae, Galeodidae, Karschiidae, Solpugidae) of solifuges (Arachnida, Solifugae) were investigated in order to reveal putative characters suitable for subsequent systematic and phylogenetic analyses. The spermatozoa of solifuges represent a relatively simple type of sperm cells. In general, their spermatozoa are roundish, oval shaped (Ammotrechidae, Daesiidae, Eremobatidae, Solpugidae) or plate-shaped (Karschiidae) with or without membrane protuberances and devoid of a flagellum. Only in Galeodidae, very conspicuous thin and elongated sperm cells occur. The spermatozoa either occur as single cells (Eremobatidae, Solpugidae) or in groups of loose knit cells (Ammotrechidae) or in highly ordered groups (Karschiidae). In contrast to the other families studied here, within the Galeodidae and in the genus Blossia (Daesiidae) sperm cells surrounded by a secretion sheath, clearly representing coenospermia, could be observed.

The anatomy and ultrastructure of the suctorial organ of Solifugae (Arachnida).

Solifugae possess an evertable, adhesive pedipalpal organ (suctorial organ) at the tip of the distal tarsus of each pedipalp that is unique among arachnids. When inverted inside the pedipalp, the suctorial organ is covered with two cuticular lips, a dorsal upper lip and a ventral lower lip, but it can be protruded rapidly in order to facilitate grasping prey or climbing on bushes or even climbing on smooth surfaces due to its remarkable adhesive properties. In this study, the suctorial organs of different species from old world families Galeodidae and Karschiidae and new world families Ammotrechidae and Eremobatidae were investigated by means of light microscopy, scanning and transmission electron microscopy. In all representatives, the suctorial organ is formed by an evertable, cuticular pad with a complex internal stabilizing structure. The procuticle of this pad consists of a lattice-like basal plate and numerous stalked structures connected to this basal plate. The shafts of the stalked structures are regularly organized and ramify apically. The surface of the suctorial organ is constituted of a very thin epicuticle overlaying the ramifying apices forming ridges and furrows on the ventral side of the suctorial organ.

Determination of chlorimuron and metsulfuron residues in two soils of Argentina using a rapid seed-bioassay.

The presence of chlorimuron ethyl and metsulfuron methyl in two soils was determined by a modified petri dish bioassay. Pregerminated seeds of maize and sunflower were placed in petri dishes containing 85 to 100 g of treated soil. Radicle root lengths were measured after 24 h. Chlorimuron had no effect on maize on the Balcarce soil, however 0.007 microg g(-1) decreased sunflower root length. Chlorimuron decreased maize and sunflower root length regardless application dose on the San Cayetano soil. Metsulfuron decreased maize root length at 0.04 microg g(-1) and sunflower at 0.021 microg g(-1) on the Balcarce soil. On the San Cayetano soil metsulfuron at 0.001 microg g(-1) decreased maize and sunflower root length. The phytotoxicity of chlorimuron and metsulfuron changed according to soil type and dose. Maize and sunflower were 1.3-1.5 and 1.3-1.8 times respectively more sensitive to chlorimuron on the San Cayetano soil than on the Balcarce soil. In the case of metsulfuron, maize was similarly sensitive on both soils but sunflower was 1.7-2.0 times more sensitive on the San Cayetano soil than on the Balcarce soil. Phytotoxicity increased as organic matter (OM) content decreased and/or when the soil pH and concentration increased.

[Congenital pseudarthrosis of the clavicle: 25 childhood cases]. / Pseudarthrose congénitale de la clavicule.

PURPOSE OF THE STUDY: Congenital pseudarthrosis of the clavicle is rare, only 200 cases having been reported. Based on 25 personal cases and an overview of the literature, we try to explain the etiology of this condition and the different kinds of treatment. MATERIAL AND METHODS: A retrospective analysis was performed on twenty-five children (16 females, 9 males, mean age at the end of the follow up - 11.5 yrs) from three different centers. We assessed the outcome of surgical and nonsurgical procedures, based on pain, functional ability, cosmetic results, and x-ray examination. RESULTS: A family background was noted in three children. The lesion always involved the right side. Twenty patients presented a bump over the middle third of the clavicle, thirteen a foreshortened shoulder girdle, three complained of discomfort. In two cases, palpation of the clavicular area was painful. No neurovascular compressive syndrome was reported. None of the patients complained of a decrease in the range of motion or in the strength of the upper limb. X-rays showed a middle third defect. In five cases we found abnormal first ribs. Seventeen patients underwent surgery, at a mean age of 6 years and 4 months. The procedure always included excision of the pseudarthrosis at both ends and internal fixation with a wire or a plate. In only eight cases a bone graft was used. Healing was achieved in fourteen patients. Three patients needed a second surgical procedure. In these 3 cases we had not used bone grafting. All patients had a normal range of shoulder motion, except a twelve year old girl who complained of discomfort of the right upper limb. The cosmetic result was good in eleven cases, one surgical wound was noted as hypertrophic, and one developed a keloid. An asymmetry of the trunk was still noted in seven cases. The x-rays showed symmetric clavicles in ten cases. Eight patients were treated conservatively. All of them had a normal range of motion of the shoulder, six had a good cosmetic result and two cases a poor one. DISCUSSION: According to Alldred, the anomaly results from the failed coalescence of the two primary ossification centers of the clavicle. The overview of the literature and our findings (in one case) confirm that the cartilage which covers both ends of the bone is made of growth cartilage. However, the true mechanism of the nonunion is still unknown. The three familial cases of our work suggest a possible genetic transmission of the disease. The diagnosis is based on the following criteria: right side lesion, found in infancy, without previous fracture, increasing size with growth, without major functional consequences, without neurofibromatosis or cleidocranial dysostosis symptom. X-rays or histologic examination will confirm the diagnosis showing the usual findings described above. Complications of the pseudarthrosis of the clavicle are rare and late. Conservative management appears to give good results as seen with our eight patients. However surgical treatment ensures symmetrical shoulder girdles and good function with few complications. Therefore, we recommend performing an excision of the cartilaginous caps, followed by an iliac bone graft and an internal fixation with wire. Surgical management will be preferred in symptomatic patients, in the case of major or increasing deformity, or on parental request.

Effects of 2,4-dichlorophenoxyacetic acid butyl ester on chick liver.

Fertilized hen eggs were externally treated with 3.1 mg 2,4-dichlorophenoxyacetic acid butyl ester (2,4-D ester) before starting incubation. Liver lipid composition, (14C)2,4-dichlorophenoxyacetic acid (14C-2,4-D) subcellular distribution and covalent binding to proteins and lipids of chicks hatched from these eggs were studied. Furthermore, catalase, glutathione S-transferase and glucose 6-phosphatase activities as well as reduced glutathione content were determined. The herbicide produced a significant decrease on the total lipids, specially on phospholipids, both in total liver and microsomes. (14C-2,4-D) subcellular distribution in liver demonstrated that the herbicide passed through the plasmatic membrane and it was present in all the studied fractions. Herbicide bound covalently to hepatic proteins and lipids, being the binding to proteins tenfold higher than to lipids. Because these results might be of potential relevance to the understanding of the 2,4-D toxicity, further studies on the mechanisms of these reactions are necessary. On the other hand, the microsomal and cytosolic glutathione S-transferases activities remained unchanged, even though in vitro studies 2,4-D ester caused a decrease of the enzyme activities with an I50 value of 0.2 mM. No significant change in reduced glutathione content between control and treated livers was observed. The catalase activity increased two-fold whereas glucose 6-phosphatase activity decreased 46% with respect to the corresponding control values. These results indicate that 2,4-D ester may have effects on the metabolism of xenobiotics.

Effects of 2,4-dichlorophenoxyacetic acid on Rhizobium sp. growth and characterization of its transport.

The herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) produced a deleterious effect on the growth of Rhizobium sp. M4, that was reversed by transferring the cells to a fresh control medium. The uptake of 2,4-D by Rhizobium sp. was not affected by chloramphenicol, indicating that it is constitutive rather than inducible. The mechanism of transport also appears to be energy independent, since uptake was not inhibited by azide or arsenate.

Effects of 2,4-dichlorophenoxyacetic acid on Rhizobium sp. membrane fluidity.

The effects of 1 mM 2,4-Dichlorophenoxyacetic acid on Rhizobium sp. in pure culture was studied. In a previous work it was demonstrated that this herbicide produces an alteration on the saturated to unsaturated phospholipid acyl chains ratio. In the present paper, it was found that this alteration produces a modification on the membrane fluidity in bacteria that had achieved the stationary phase. The same results were obtained when determinations were done in liposomes from sonicated lipids of treated bacteria, indicating that changes in phospholipid acyl chains may be the main cause of membrane fluidity alteration. In addition, it was determined that leucine transport as well as Ca(++)-ATPase activity (a membrane enzyme) was affected under the experimental conditions.

[Effects on hearing in exposure to impulsive and high frequency noise]. / Effetti uditivi in esposti a rumore impulsivo e ad alta frequenza.

Audiometric tests performed on 41 workers at a metal engineering factory producing tools for the wood manufacturing industry showed hearing loss at 6 kHz in 45.9% of the cases. A study was therefore carried out to check carefully the physical characteristics of the noise via statistical analysis and octave frequencies band analysis in real time. The measurements revealed higher noise levels at the high and medium high frequencies (3.15-6.3 Hz) both for impulsive and continuous noise. The results of the audiometric tests differed from those of a group of 50 workers employed in two different metal engineering factories, where the noise levels were similar but at medium-low frequencies, with no pure tones. In this group of subjects, hearing loss occurred at 6 kHz in 28% of the cases; the differences thus seemed to be related the particular physical characteristics of the noise levels measured in the first factory. The data are discussed against findings already reported in the literature, in relation to their prevention-related aspects and a more correct interpretation of the audiograms.