Carolina Mensi

Comparison of RT‐PCR with other diagnostic assays for rapid detection of influenza viruses

To compare the effectiveness of reverse transcription‐polymerase chain reaction (RT‐PCR), shell vial culture and cytospin assay as laboratory techniques for rapid diagnosis of influenza infections, a retrospective study was carried out on 270 aliquots of oropharyngeal swabs collected from October 1993 to March 1996 and already characterized by standard isolation procedures, and a prospective study in which 65 clinical samples taken from patients with influenza‐like syndrome between October 1996 and March 1997 were tested. In the retrospective study, using conventional isolation as the gold standard, the sensitivity of RT‐PCR and cytospin assay for virus A was 100% (95% confidence interval (CI), 89.1–100) and for virus B it was 100% (95% CI, 56.1–100) compared with 77.5% (95% CI, 61.1–88.6) and 71.4% (95% CI, 30.3–94.9) for shell vial culture. The specificity of all the three assays was 100% (95% CI, 98.0–100) for virus A and 100% (95% CI, 98.2–100) for virus B. In the prospective study the sensitivity of RT‐PCR was greater than that of the other tests considered, both rapid and standard. It is suggested that RT‐PCR should be employed in combination with conventional culture techniques in routine diagnosis of influenza infections in order to obtain results more rapidly and to improve virus detection even in circumstances in which standard isolation could be problematic. J. Med. Virol. 56: 168–173, 1998.

Safety and Immunogenicity of a Conjugate Vaccine against Haemophilus influenzae Type b in Splenectomized and Nonsplenectomized Patients with Cooley Anemia

Patients with thalassemia are at increased risk for infections, especially after undergoing splenectomy. Vaccinations and antimicrobial prophylaxis are recommended in these patients, but the optimal immunization schedule for Haemophilus influenzae type b (Hib) vaccine is unknown. The immunogenicity of a conjugate Hib vaccine was investigated in 57 patients with thalassemia, 32 of whom had undergone splenectomy. Anti-capsular antibodies to Hib (anti-polyribosylribitol phosphate) were measured before vaccination and 2, 6, 12, 24, and 36 months after vaccination. Immunization was well tolerated. All patients achieved protective (>1 microg/mL) antibody levels. Antibody titers declined after the initial postvaccination increase, becoming undetectable in 4 patients and decreasing to concentrations of 0.15-1 microg/mL in another 2 patients when tested 2-3 years after vaccination. Hib conjugate vaccine is safe and immunogenic in patients with thalassemia major; however, additional studies are needed to assess the need and timing of booster vaccination to maintain long-term immunity.

Pericardial mesothelioma and asbestos exposure

Pericardial mesothelioma (PM) accounts for 0.7% of all malignant mesotheliomas. Although asbestos exposure is a recognized etiological factor for pleural and peritoneal mesotheliomas, its role in the development of PM is controversial. The aim of this study is to describe the characteristics of PM cases occurred in Lombardy, a highly industrialized Region of Northern Italy. From the Lombardy Mesothelioma Registry we selected the incident cases of PM registered in the Lombardy Region between 2000 and 2009 and we abstracted clinical characteristics and history of asbestos exposure. We identified 8 cases (6 men and 2 women), with a median age at diagnosis of 55.5 years, representing 0.3% of all mesothelioma cases (n = 3059). The age-standardized incidence rate was 0.09 per million/year. Occupational exposure to asbestos was documented in 5 of the 7 cases for which we obtained an interview. Our findings support the role of asbestos in the pathogenesis of PM.

Sinonasal cancer and occupational exposure in a population-based registry.

We examined occupational exposures among subjects with sinonasal cancer (SNC) recorded in a population-based registry in the Lombardy Region, the most populated and industrialized Italian region. The registry collects complete clinical information and exposure to carcinogens regarding all SNC cases occurring in the population of the region. In the period 2008–2011, we recorded 210 SNC cases (137 men, 73 women). The most frequent occupational exposures were to wood (44 cases, 21.0%) and leather dust (29 cases, 13.8%), especially among men: 39 cases (28.5%) to wood and 23 cases (16.8%) to leather dust. Exposure to other agents was infrequent (<2%). Among 62 subjects with adenocarcinoma, 50% had been exposed to wood dust and 30.7% to leather dust. The proportions were around 10% in subjects with squamous cell carcinoma and about 20% for tumors with another histology. The age-standardized rates (×100,000 person-years) were 0.7 in men and 0.3 in women. Complete collection of cases and their occupational history through a specialized cancer registry is fundamental to accurately monitor SNC occurrence in a population and to uncover exposure to carcinogens in different industrial sectors, even those not considered as posing a high risk of SNC, and also in extraoccupational settings.

Plasmatic extracellular vesicle microRNAs in malignant pleural mesothelioma and Asbestos-Exposed subjects suggest a 2-miRNA signature as potential biomarker of disease

Background Malignant Pleural Mesothelioma (MPM) is an aggressive cancer mainly caused by asbestos exposure and refractory to current therapies. Specific diagnostic markers for early MPM diagnosis are needed. Changes in miRNA expression have been implicated in several diseases and cancers, including MPM. We examined if a specific miRNA signature in plasmatic extracellular vesicles (EV) may help to discriminate between malignant pleural mesothelioma patients (MPM) and subjects with Past Asbestos Exposure (PAE). Methodology/Principal findings We investigated 23 MPM patients and 19 cancer-free subjects with past asbestos exposure (PAE). We screened 754 miRNAs in plasmatic EVs by OpenArray and found 55 differential miRNAs using logistic regression models adjusted for age, sex, BMI, and smoking. Among the top-20 differential miRNAs chosen for validation by Real time PCR, 16 were confirmed. Using receiver operating characteristic (ROC) curve analysis, the most discriminating miRNA combination was given by miR-103a-3p + miR-30e-3p, which generated an AUC of 0.942 (95% CI 0.87–1.00), with a sensitivity of 95.5% and a specificity of 80.0%. Using multivariate Cox regression analysis including gender, age, BMI and smoking we found a Hazard Ratio for miR-103a-3p above the median of 0.37 (95%CI 0.13–1.13) and of 0.51 (95%CI 0.17–1.52) for miR-30e-3p. Conclusions This study suggests EV-associated miR-103a-3p and miR-30e-3p are able to discriminate MPM from PAE subjects. Larger and prospective studies are needed to confirm these two-miRNA signature alone or in combination with other biomarkers as diagnostic tools for MPM.

Italian influenza surveillance network: Results of the first year of activity

The spread of influenza is of major public health concern. Community based clinical morbidity data constitute an excellent predictor of when the peak of influenza virus activity will be reached. Surveillance programmes exist in many countries [1, 2]. A voluntary system for the surveillance of acute respiratory infection (ARI) and influenza was established in Italy in 1996. The surveillance is based on a sentinel network of general practitioners (GPs) and pediatricians (Ps) for the collection of clinical data and a network of virological laboratories. The physicians report to the Istituto di Virologia on a weekly basis.

O32-4 Spatial analysis of mesothelioma incidence and tracing of past asbestos exposure in italy

Introduction Due to the strong causal association with asbestos fibres, the distribution of incident malignant mesothelioma (MM) cases over time and space likely reflect different kinds of asbestos exposures occurring in the past, as previously demonstrated in several studies. Starting from the data of a disease-specific national registry, namely the Italian mesothelioma registry (ReNaM), a geographic cluster analysis was integrated with information about exposure, either occupational or non occupational, in order to trace patterns of asbestos exposure in Italy. Methods A total of 15,322 incident cases of all-site MM, recorded by ReNaM in the period 1993 to 2008 were analysed, corresponding to 11,852 occupational, residential and familial histories reconstructed by interview. Observed cases were mapped based on the municipality of residence at diagnosis and age-specific rates of the area where municipality was located was used to calculate expected cases. A Bayesian hierarchical model was applied to identify municipality clusters and each cluster was characterised by type and source of asbestos exposure of cases. Results Thirty-two clusters of MM were mapped. Asbestos manufacturing industries and shipbuilding and repair facilities were the more common sources of asbestos exposure, but other activity sectors, such as non-asbestos textile, metal engineering and construction had a relevant contribution in some clusters. Environmental asbestos exposure was detected more frequently in clusters with an asbestos cement industry or a natural source of asbestos-like fibres. Differences by gender among clusters were attributable to environmental fraction but also to high female employment in selected activity sectors, such as textile industry. Discussion This study while indirectly confirming the role of specific natural or industrial sources of asbestos exposure for mesothelioma risk, highlights the great public health implications of spatial tracing of asbestos exposure for risk prevention, health surveillance and welfare policies.

Incidence of malignant mesothelioma and asbestos exposure in the Lombardy region, Italy, 2000–07

Objectives The Lombardy Mesothelioma Registry (RML) was established in 2000 in the most populated (9 100 000 residents) and industrialised region of Italy. We evaluated the trend of malignant mesothelioma (MM) in 2000-07 and the sources of asbestos exposure collected from the patient/next-of-kin by a standardised questionnaire. Methods We calculated age-standardised rates (standard: Europe) and analysed the number of cases/year using Poisson regression. We evaluated asbestos exposure profile (occupational, non-occupational, unlikely/unknown) using multinomial logistic regression. Results We recorded 2462 verified MM cases (1574 men, 888 women). The age-standardised rates (×100 000/year) were 3.6 (men) and 1.4 (women). In both genders, we found a 3.0% increase of MM cases/year (p=0.001). Interview was obtained in 2333 cases (94.7%) and directly from patients in 1282. Occupational exposure was found for 1124 (71.4%) men and 322 (36.3%) women. Non-occupational asbestos exposure was more frequent among women (No. 118, 13.3%) than in men (No. 51, 3.2%). We did not find evidence of exposure to asbestos in 399 men (25.3%) and 448 women (50.4%). The exposure profile did not vary over years (p=0.49). Direct interviews were more likely to identify asbestos exposure (p<0.001). These patterns were confirmed by multiple regression. Conclusions The MM burden in Lombardy (among the highest in Italy), are increasing. This increase is real and not due to ascertainment bias. Asbestos exposure was mainly occupational and more frequent among men; we found no variation of the exposure profiles over time. This work was supported by Regione Lombardia Conv. 14013/RU01/06/2010

Porcelain Factory Worker With Asbestos-related Mesothelioma

The LMR collects all in-cident cases of malignant mesothelioma of thepleura, peritoneum, pericardium, and tunica vagi-nalis of testis that have been diagnosed in peopleresiding in the Lombardy region (a region with anestimated total population of 9.1 million) in thenorth of Italy.Cases are actively reported to the LMR by themain services including pathology, pneumology,surgery, and oncology departments of each re-gional hospital. For each case the disease his-tory, radiological and histological reports, andclinical records were collected. Asbestos expo-sure history was obtained from patients (or his/her next to kin) through a standardized ques-tionnaire administered by trained interviewers.All records were reviewed by a panel composedof a pneumologist, oncologist, pathologist, oc-cupational health physician, industrial hygienistand epidemiologist.