Among indoor sources linked to combustion processes, relatively less attention has been paid to incense burning over liturgical celebrations in the churches. Therefore, a real-time monitoring campaign was carried out in 2023 from February 2nd to April 10th inside a naturally ventilated Italian church where the size distribution of airborne particles and the concentrations of total volatile organic compounds (TVOCs), benzene, toluene and carbon dioxide (CO2) were continuously monitored. Moreover, tailored experimental sessions burning four different typologies of incense were carried out inside a large-scale test chamber under controlled microenvironmental conditions (temperature, relative humidity and air exchange rate) miming priest actions during the liturgical celebrations. Investigations inside the church highlighted a significant increment of PM10 (max value: 203 mu g/m3), PM2.5 (max value: 171 mu g/m3), PM1 (max value: 108 mu g/m3),TVOCs (max value: 3.9 ppm) and Benzene (maxvalue: 5.86 mu g/m3) concentrations during liturgical celebrations and in correspondence of incense use. These peak concentrations were significantly higher than the limit values established by recent WHO air quality guidelines (AQGs) for outdoor. Moreover, the combustion tests highlighted that the qualitative and quantitative differences in pollutants concentrations emitted by incense combustion were linked to the intrinsic variability of combustions performance rather than to the typologies of incense and charcoal used.

Since people spend most of their time in indoor environments, they are continuously exposed to various contaminants that threaten human health. The air quality in these settings is therefore a crucial factor in maintaining health safety. In order to reduce the concentration of indoor air pollutants and improve air quality, photocatalytic oxidation has drawn the attention of researchers. This study aims to provide a comprehensive view of the nanomaterials used in the photocatalytic oxidation of the most common pollutants in indoor environments. The effects of various parameters like humidity, airflow, deposition time, and light intensity were also evaluated, as they can significantly influence photocatalytic reactions. The most common nanomaterials used in photocatalysis are TiO2-based and, in this study, they were classified and examined based on their morphology. TiO2 doping with metals and non-metals has demonstrated an enhancement of its adsorption properties and photocatalytic efficiency for the removal of several pollutants. The role of carbon-based nanomaterials in photocatalysis was also evaluated due to their adsorption capabilities towards various pollutants. In addition, other less common photocatalysts such as ZnO, MnO2, WO3, CeO2, and CdS also exhibited high photocatalytic activity for pollutant degradation. Applications of these photocatalysts in air purifiers, paints, and building materials e.g., concrete, glass, and wallpapers, lead to efficient reduction of pollutants in indoor settings.

After the onset of the global COVID-19 pandemic, the deep connections between environmental factors and the transmission of airborne infectious diseases (including COVID-19) has become an area of relevant scientific and social interest. Indoor environments, where we spend a significant part of our daily lives, play a crucial role in shaping the dynamics of disease spread. The mitigation of infection risk related to poor indoor air quality and its link with the transmission of airborne diseases has emerged as a focal point for research and intervention strategies. This paper presents the results of a specific collaborative project in this field, focused on the utilization of Internet of Things (IoT) devices for comprehensive indoor environmental monitoring and infectious risk forecasting. In the frame of developing effective countermeasures for COVID-19 and future pandemic preparedness, our primary goal was to develop a predictive model for infection risk in indoor environments. Parameters such as humidity, temperature, CO2, and particulate matter concentrations (namely PM10 and PM2.5), have been assessed and modelled as indicators of indoor air quality, with these measures having been combined to generate a predictive algorithm specifically able to provide information about the transmission dynamics of COVID-19 and airborne infectious diseases within indoor spaces. This newly-developed Algorithm for the Prediction of Risk of Infections (APRI) relies on rigorous analyses and established different risk thresholds based on temperature, humidity, and CO2 levels. The model showed significant associations between environmental factors, such as temperature, CO2 levels, humidity, and particulate matter concentrations. A pivotal role of PM10 and PM2.5 in shaping air quality in indoor environments has been highlighted, as low PM concentrations corresponded in our predictive model to a minimal risk of airborne infectious diseases, while medium or high PM levels were associated with variations in temperature, humidity, and CO2 levels, thus corresponding to an elevated risk of infection, particularly in the frame of highly diffusive diseases like COVID-19.

In the wake of the COVID-19 pandemic, the surveillance and safety measures of indoor Cultural Heritage sites have become a paramount concern due to the unique challenges posed by their enclosed environments and high visitor volumes. This communication explores the integration of Artificial Intelligence (AI) in enhancing epidemiological surveillance and health safety protocols in these culturally significant spaces. AI technologies, including machine learning algorithms and Internet of Things (IoT) sensors, have shown promising potential in monitoring air quality, detecting pathogens, and managing crowd dynamics to mitigate the spread of infectious diseases. We review various applications of AI that have been employed to address both direct health risks and indirect impacts such as visitor experience and preservation practices. Additionally, this paper discusses the challenges and limitations of AI deployment, such as ethical considerations, privacy issues, and financial constraints. By harnessing AI, Cultural Heritage sites can not only improve their resilience against future pandemics but also ensure the safety and well-being of visitors and staff, thus preserving these treasured sites for future generations. This exploration into AI’s role in post-COVID surveillance at Cultural Heritage sites opens new frontiers in combining technology with traditional conservation and public health efforts, providing a blueprint for enhanced safety and operational efficiency in response to global health challenges.

OBJECTIVE To review the evidence on the association between maternal exposure to ultra-processed food (UPF) categories, UPF diet items, and overall diet quality, as assessed by recognized dietary indices, and neurodevelopmental outcomes in offspring. METHODS PubMed, MEDLINE, EMBASE, Scopus, Ovid, and Scholar databases were searched for original articles on female gestational exposure to UPF categories, individual elements of the UPF diet, or indices of diet quality, in relation to outcomes regarding their offspring's neurocognitive development, according to neuropsychometric and behavioral scales, anthropometric/psychomotor indices, and symptoms/diagnosis of neurodevelopmental disorders (NDDs). RESULTS Fourteen articles were selected and underwent the quantitative analysis. Six of these examined diet quality, and eight exposure to UPF categories or specific UPF foods. The maternal population was adult (18+). Child cognitive development was negatively impacted by a diet featuring many processed foods, saturated fats, and sugars. Conversely, a Med-diet led to better neurodevelopment, particularly verbal intelligence and executive functions, in middle childhood. DISCUSSION A maternal diet with many UPFs, saturated fats, and total sugars (especially those added or hidden in packaged carbonated beverages) can adversely affect a child's cognitive development. Knowledge needs to be further extended and managed from a prevention perspective in light of the well-known negative effects of UPFs on human health in all age groups.

Background: The rising diffusion of vascular resections during complex pancreatectomy for malignancy, for both oncological and technical matters, brought with it the use of vascular shunts, either temporary or definitive, to prevent bowel congestion and liver ischemia. This study aimed to systematically review the literature on the technical feasibility of vascular shunts during advanced pancreatic surgery, analyzing intraoperative and postoperative outcomes. Methods: A systematic literature search was performed on PubMed, Scopus, Web of Science, and the Cochrane Library Central, according to PRISMA guidelines. Studies published before 2006 were excluded, considering the lack of a standardized definition of locally advanced pancreatic cancer. The main outcomes evaluated were the overall complication rate and shunt patency. Results: Among 789 papers retrieved from the database search, only five fulfilled the inclusion criteria and were included in the review, amounting to a total of 145 patients undergoing a shunt creation at the time of pancreatectomy. Pancreatic adenocarcinoma (PDAC) was found to be the most common diagnosis and pancreaticoduodenectomy was the main surgical procedure, accounting for 88% and 83% of the overall cohort, respectively. The distal splenorenal shunt was the most performed. Overall, 44 out of 145 patients (30%) experienced postoperative complications; the long-term patency of definitive shunts was 83% (110 out of 120 patients). Conclusions: An increasing number of patients with borderline resectable or locally advanced PDAC are becoming amenable to resection and shunt creation may facilitate vascular resection with clear margins, becoming a valid tool of modern pancreatic surgery.

BACKGROUND:The incidence of non-melanoma skin cancers (NMSCs) increased over last decades, probably due to environmental concerns or to the increase of frail patients with age related comorbidities. Currently, the relationship of increasing global skin cancer rates with increased ultraviolet radiations (UVRs) resulting from stratospheric ozone depletion, global warming, and air pollution from fossil-fuel combustion. AIMS:We conducted a retrospective epidemiological study including 546 NMSC patients managed at the Dermatology Unit of the Tor Vergata Hospital to highlight different trends of sun exposure or different comorbidities. METHODS:Descriptive and inferential statistical analyses were performed to evidence differences between continous variable and Spearman rank test for dicotomical variables. Charlson Comorbidity Index was calculated to obtain the 10-years survival rate in order to identify the mean comorbidity burden of our patients. RESULTS:Considering patients with comorbidities (73.81%), actinic keratoses (AKs) was the most frequent lesion. In patients with a history of previous melanoma, basal cell carcinoma (BCC) was predominant (ANOVA test, p < 0.05) with a statistically significant correlation (rho = 0.453; p < 0.01). Squamous cell carcinoma (SCC) showed a higher rate in arterial hypertension patients, followed by the chronic heart failure and hematologic neoplasms (60%, 29.7% and 32.1%, respectively) groups. Men were more affected than women, representing 61.54% of patients. Chronic sun exposure is directly correlated with SCC rho = 0.561; p < 0.01), whereas BCC correlated with a history of sunburns (rho = 0.312; p < 0.05). CONCLUSIONS:History of photo-exposition had an important role on NMSC development especially for work or recreational reasons. Sex, age, and presence of comorbidities influenced different NMSC types. BCC was more frequent in younger patients, associated with melanoma and sunburns. The presence of SCC is associated with older patients and the hypertension group. AKs were diagnosed predominantly in oldest men, with a chronic sun-exposure history, and hematologic neoplasms group.

The endeavor to maintain and enhance the indoor air quality (IAQ) in historical buildings transcends the traditional boundaries of cultural heritage preservation, emerging as a pivotal public health concern [...]

BACKGROUND:Coronary artery disease (CAD) prevention in shift workers (SWs) poses a significant challenge worldwide, as CAD remains a major cause of mortality and disability. In the past, SWs were found at higher risk of CAD than non-s SWs. Nevertheless, the pathogenic mechanism between shift work and CAD to date is unclear. This systematic review aims to enhance understanding of the risk of CAD occurrence in SWs. METHODS:A systematic literature review was conducted from January 2013 to December 2023. MEDLINE/Pubmed databases were used initially, and additional relevant studies were searched from references. Shift work was defined as any schedule outside traditional shifts, including the night shift. RESULTS:Fifteen pertinent papers were categorized into risk assessment or risk management. Findings demonstrated an increased risk of CAD among SWs compared to non-SWs, with an increased CAD risk observed for both shift work and night shift work. DISCUSSION:Duration-response associations indicate that greater shift exposure is linked to higher CAD risk. SWs incur an increased risk of CAD through the atherosclerotic process. As shift work duration increases as the risk of atherosclerosis is higher, workers demonstrate a higher prevalence and severity of coronary artery plaques. CONCLUSIONS:The evidence-based results underscore the increased risk of CAD in SWs and are sufficient for proposing guidelines aimed at reducing the risk of CAD in SWs and at managing people with CAD in return to work characterized by disrupted circadian rhythms.

Background and objectivesThe Mediterranean Diet (MD) has been recognized for its benefits for human health and sustainability for the planet, but it has considered not easy to reproduce in other populations. The United Nations Educational, Scientific and Cultural Organization (UNESCO) Chair on Health Education and Sustainable Development is fostering a research project (Planeterranea), aiming to identify a healthy dietary pattern based on local foods with the same MD features. The aim of our study is to develop a MD-based food pyramid for Asian populations.MethodsAsia was stratified into six areas according to pedo-climatic conditions. For each region a comprehensive scoping review of local crops and typical foods was conducted on several databases such as the US Department of Agriculture (USDA)'s database, the Food and Agriculture Organization of the United Nations (FAO) website, and PubMed, focusing on both plant-based and animal-based foods. Narrative review was then conducted on the identified foods to determine their nutritional composition and planetary health impact. Finally, the collected information was used to build up the Asian food pyramid with details for each respective region.ResultsWe proposed a food pyramid for Asian countries, guaranteeing the same nutritional intake and health benefits as MD, by considering dietary habits and typical foods of this population. From the bottom to the top, Asian fruits and vegetables present similar nutritional profile as those in MD. Whole grains (barley) may represent valid alternative to white rice. Sesame oil represents a source of unsaturated fats and an alternative to olive oil. Legumes (soybean), edible insects, mushrooms and algae, guarantee an adequate intake of plant-based proteins with a complete amino-acid profile and a low environmental impact with respect to animal-based ones.ConclusionsThis work is a new insight of healthy and sustainable local food system based on MD principles for the Asian population.

Introduction We present an unusual case of a 28-year-old rheumatologic male patient who developed eosinophilia while he was on etanercept therapy first and then on golimumab.Case Representation Although eosinophilia is rarely reported in the literature as a side-effect of various Tumor Necrosis Factor-alpha [TNF-alpha] antagonists, it represents a riddle about the future treatments of these patients since the persistence of therapy might lead to the onset of dermatologic or visceral eosinophilic complications in such patients.Conclusion Furthermore, the pathogenesis of eosinophilia is still unknown, and all the proposed hypotheses do not explain the eosinophilic proliferation in certain subjects.

Phase I clinical trials represent a critical point in drug development because the investigational medicinal product is being tested in humans for the first time. For this reason, it is essential to evaluate and identify the Maximum Tolerated Dose (MTD) and the safety of the new compound. To mitigate the possible risks associated with drug administration and treatment, the European Competent Authority issued various guidelines to provide provisions and harmonize risk management processes. In the UK and Italy, particular attention should be paid to the Medicines & Healthcare Products Regulatory Agency (MHRA) phase I accreditation scheme and the specific rules set by the Italian Drug Authority through the AIFA Determination no. 809/2015. Both reference documents are based on the concept of quality risk management while conducting phase I clinical studies. Moreover, the AIFA determination outlines specific requirements for those sites that want to conduct non-profit phase I clinical trials. Indeed, the document reports peculiar activities to the “Clinical Trial Quality Team”, which is a team that should support the clinical site researchers in designing, starting, performing, and closing non-profit phase I studies. In this paper, we provide a general overview of the main European guidelines concerning the management of risks during phase I trials, focusing on the main peculiarities of the schemes and rules set by the MHRA and AIFA.

The era of climate change has introduced unprecedented challenges for global public health, especially visible through the lens of infectious diseases [...]

Osteoporosis is the most common bone disease, characterized by decreased bone mineral density (BMD) and often associated to decreased muscle mass and function. Metal exposure plays a role in the pathophysiology of osteoporosis and affects also muscle quality. The aim of this study was to assess the association between metal levels in bone and muscle samples and the degeneration of these tissues. A total of 58 subjects (30 male and 28 female) was enrolled and classified in osteoporotic (OP, n = 8), osteopenic (Ope, n = 30) and healthy (CTR, n = 20) subjects, according to BMD measures. Femoral head bone samples and vastus lateralis muscle samples were collected during hip arthroplasty surgeries. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) analysis showed increased levels of Al, Cd and Pb in OP and Ope bone tissue compared to CTR subjects (p = 0.04, p = 0.005 and p = 0.01, respectively). Whereas, increased levels of Co, Cd and Pb were measured in OP and Ope muscle tissues, compared to CTRs (p < 0.001, p = 0.02 and p = 0.01, respectively). In addition, Al, Cd and Pb levels in bone and Cd and Co levels in muscle were negatively correlated with BMD. A negative association among Co, Cd, Cr and Hg levels and muscle fibers diameter was also observed in muscle tissues. This study assessed that metal exposure can affects bone and muscle tissue quality and may contribute to the onset and progression of musculoskeletal diseases such as osteoporosis. Therefore, it is important to implement metal exposure assessment and their impact on disease development, in order to manage and prevent metal accumulation effects on bone and muscle quality.

Abstract Background Elderly cancer patients are at higher risk of developing cachexia and adverse events due to antineoplastic treatments. Comprehensive Geriatric assessment (CGA) is used to evaluate the health status of elderly to identify impairments/frailty and better assess the risk/benefit ratio of therapeutic decisions. Malnutrition is an independent risk factor that further influences patients’ outcomes and should be systematically screened at hospital admission. The G8 screening tool allows to identify patients who might benefit from CGA and could help clinicians to evaluate nutritional and health status in elderly cancer patients. The Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) are other standardized nutritional screening tests too. The aim of the study was to demonstrate that the use of a single tool is not enough to assay the real nutritional status of cancer patients. Methods The study involved 533 patients (282 men and 251 women) affected by solid tumor and aged ≥ 70 years old. Patients underwent CGA and MNA to quantify the risk of frailty and malnutrition. Anthropometric assessments, serum levels of albumin, the activities of daily living (ADLs) and Instrumental Activities of Daily Living (IADLs), as well as the rating scale of mental status SPMSQ (Short Portable Mental Status Questionnaire), were also performed. Results. Less than the half of patients had a G8 score and MNA that excluded malnutrition, whereas the most enrolled patients were at high risk for frailty and malnutrition. Anthropometric parameters and serum albumin levels alone were not able to detect malnutrition in all patients, while the association of GNRI with G8, MNA, and CGA scores allowed to specifically determine health risk in 95% of malnourished patients. Conclusions. The malnutrition risk could not be assessed by using a single score. The association of multiple information is required to define malnutrition’s risk among elderly people.

Background: Prevention of latent tuberculosis infection (LTBI) in healthcare workers (HCWs) to ensure the “Right to Occupational Safety” is a special challenge globally, as HCWs have a higher risk of acquiring the infection in hospital settings because of frequent close exposure to patients suffering from tuberculosis (TB). Methods: Aretrospective study was performed with the aim of assessing the prevalence of LTBI related to demographical and occupational risk factors among HCWs employed in a large hospital in Italy. The study involved 1461 HCWs screened for LTBI by Mantoux tuberculin skin test (TST) and then confirmed with Interferon Gamma Release Assay (IGRA) test in case of positivity. Immunosuppressed and BGC-vaccinated workers were tested directly with IGRA. Results: LTBI was diagnosed in 4.1% of the HCWs and the prevalence resulted lower than other studies conducted in low TB incidence countries. The variables significantly linked with higher frequency of the infection were: age ≥40 years (OR = 3.14; 95% CI: 1.13–8.74; p < 0.05), length of service ≥15 years (OR = 4.11; 95% CI: 1.48–11.43; p < 0.05) and not being trained on TB prevention (OR = 3.46; 95% CI: 1.85–6.46; p < 0.05). Not trained HCWs presented a higher risk of LTBI also after adjustment for age and length of service, compared to trained HCWs. Conclusions: screening of HCWs for LTBI should be always considered in routinely occupational surveillance in order to early diagnose the infection and prevent its progression. Safety policies in hospital settings centered on workers’ training on TB prevention is crucial to minimize LTBI occurrence in HCWs.

Background The formation of the NOD-, LRR-, and pyrin-containing 3 (NLRP3) inflammasome plays a critical role in the initiation of the inflammatory reaction induced by the monosodium urate (MSU) crystals in an acute gout flare. Once assembled, the NLRP3 inflammasome converts pro-interleukin-1β into its active form and initiates IL-1β-dependent inflammation. NLRP3 activation, therefore, occurs upstream of IL-1β, the pivotal cytokine in gouty inflammation and the causative agent mediating symptoms of acute gout flares, including joint pain.Monoclonal antibodies against IL-1β can decrease inflammation and gout flares by neutralizing cicrulating IL-1β and shutting down the IL-1β-mediated inflammatory cascade. However, they must be injected and are associated with immune suppression and increased risk of infection. There remains an unmet need for an orally administered treatment for acute gout flare to safely reduce IL-1β-mediated inflammatory pain without the risk of immunosuppression.In an initial dose-range finding study, PODAGRA I, we reported preliminary evidence of efficacy and safety in this setting with dapansutrile, an orally administered specific inhibitor of the NLRP3 inflammasome. Objectives PODAGRA II study is designed to further evaluate the effects of dapansutrile on reducing joint pain and IL-1β-dependent inflammation during acute gout flare. Methods The study (NCT05658575/EudraCT 2019-002717-19) is a multicenter, placebo-controlled, prospective, randomized, double-blind trial conducted in the Netherlands, Spain, France, and the USA. A total of 300 patients with acute symptomatic gout flare are being randomized centrally to receive either dapansutrile (2000 mg loading dose followed by 1000 mg BID) or matching placebo tablets for 7 days (2:1 ratio dapansutrile: placebo). The study is designed to determine the superiority of dapansutrile compared to placebo on the symptoms and signs of an acute gout flare.The primary endpoint is the subject-reported pain intensity score in the target joint (evaluated on a 100-mm visual analogue scale) at 72 hours. Secondary endpoints include patient- and investigator-assessment of response to treatment and the investigator-assessed scores for joint tenderness, swelling, erythema, warmth, and range of motion. A subject-assessed quality-of-life questionnaire will be collected, and biomarkers associated with acute gout inflammation (IL-1 β, IL-6 and CRP) will be evaluated.In order to demonstrate both statistical and clinical significance, approximately 170 and 85 evaluable subjects are needed in the dapansutrile and placebo arms, respectively. This assumes a one-sided significance level of α = 0.025, 85% power (1-β), a standard deviation of 25 points, an expected mean difference (Δ=10 points) plus an additional clinical significance of (δ=10 points). To account for dropouts and non-evaluable subjects, up to 200 subjects in the dapansutrile arm, and up to 100 in the placebo arm will be randomized. Results The trial has launched and is currently enrolling subjects. Conclusion There is a need for an orally administered, safe, and well-tolerated treatment for acute gout flares. PODAGRA II will be the first placebo-controlled, adequately powered, large, multi-center study with an oral NLRP3-specific inhibitor. As gout is a prototypical disease of NLRP3 activation, this trial will provide important new data on NLRP3 inhibition leading to a reduction in joint pain and associated inflammatory biomarkers in acute gout flare. Reference [1]Klück V, Jansen TLTA, Janssen M, et al. Dapansutrile, an oral selective NLRP3 inflammasome inhibitor, for treatment of gout flares: an open-label, dose-adaptive, proof-of-concept, phase 2a trial. Lancet Rheumatol. 2020 May;2(5) Acknowledgements: NIL. Disclosure of Interests Tim Jansen Consultant of: AstraZeneca, Abbvie, Olatec Therapeutics, Grant/research support from: Olatec Therapeutics, Phil Piscitelli Shareholder of: Olatec Therapeutics, Employee of: Olatec Therapeutics, Cynthia Barrow Shareholder of: Olatec Therapeutics, Employee of: Olatec Therapeutics, Kip Vought Shareholder of: Olatec Therapeutics, Consultant of: Olatec Therapeutics, Amy Poshusta Shareholder of: Olatec Therapeutics, Consultant of: Olatec Therapeutics, Heather Kapushoc Consultant of: Olatec Therapeutics, Andrea Leonard-Segal Consultant of: Olatec Therapeutics, Mustafa Noor Shareholder of: Olatec Therapeutics, Employee of: Olatec Therapeutics, Damaris Skouras Shareholder of: Olatec Therapeutics, Employee of: Olatec Therapeutics, Charles Dinarello Speakers bureau: Novartis, Amgen, Kinikisa, Paid instructor for: Novartis, Amgen, Kiniksa, Olatec, Consultant of: Olatec, Grant/research support from: Olatec, Naomi Schlesinger Consultant of: Novartis, Horizon, LG Chem, ANI, Protalix. Olatec Therapeutics.Group SizePower (%)DapansutrilePlaceboStudy Size8015075225851708525590200100300Group SizeStd deviation at 85% powerDapansutrilePlaceboStudy Size2011055165251708525530244122366