Delirium risk factors analysis post proximal femur fracture surgery in elderly.

BACKGROUND AND AIM: The increase in the average-age and in the percentage of elderly people implies an exponential increase in fractures of the proximal femur. A common consequence of hip fracture in elderly patients is delirium, characterized by cognitive confusion or a lethargic-type condition. Predisposing factors have been identified, but risk factors assessment useful for managing clinical intervention, has not received unanimous consent. This work aims to identify the potential risk factors for delirium in the elderly operated for hip fracture. METHODS: In this prospective observational study, we included 83 patients aged ≥65 years. Patients undergoing osteosynthesis of the femur and hip replacement for fractures were included. Patients already delusional in the pre-operative period were excluded. At the time, deadlines T0 (pre-operative), and T1,T3,T7 post-operative day, delirium, hematic parameters, blood transfusions, were assessed. RESULTS: Level of delirium was assessed obtaining 80% not delusional and 20% delusional. Glycemia and hemoglobin were not found to be risk factors, although they are known to influence cognitive status; we hypothesize they should be considered predisposing factors. Comorbidities such as atrial fibrillation and Chronic Obstructive Pulmonary Disease were found associated with delirium. The most advanced age, anxiolytic drugs, the use of benzodiazepine as anaesthetic, the time surgical waiting, were found significantly associated with delirium. CONCLUSIONS: Taken together, findings of this prospective observational study showed that environmental and metabolic risk factors might contribute to make elderly susceptible to develop postoperative delirium following hip surgery. Thus, these patients should be adequately assessed and monitored. (www.actabiomedica.it).

Garnet petrochronology reveals the lifetime and dynamics of phonolitic magma chambers at Somma-Vesuvius.

Somma-Vesuvius is one of the most iconic active volcanoes with historic and archeological records of numerous hazardous eruptions. Petrologic studies of eruptive products provide insights into the evolution of the magma reservoir before eruption. Here, we quantify the duration of shallow crustal storage and document the evolution of phonolitic magmas before major eruptions of Somma-Vesuvius. Garnet uranium-thorium petrochronology suggests progressively shorter pre-eruption residence times throughout the lifetime of the volcano. Residence times mirror the repose intervals between eruptions, implying that distinct phonolite magma batches were present throughout most of the volcano's evolution, thereby controlling the eruption dynamics by preventing the ascent of mafic magmas from longer-lived and deeper reservoirs. Frequent lower-energy eruptions during the recent history sample this deeper reservoir and suggest that future Plinian eruptions are unlikely without centuries of volcanic quiescence. Crystal residence times from other volcanoes reveal that long-lived deep-seated reservoirs and transient upper crustal magma chambers are common features of subvolcanic plumbing systems.

Long-term magmatic evolution reveals the beginning of a new caldera cycle at Campi Flegrei.

Understanding the mechanisms that control the accumulation of large silicic magma bodies in the upper crust is key to determining the potential of volcanoes to form caldera-forming eruptions. Located in one of the most populated regions on Earth, Camp Flegrei is an active and restless volcano that has produced two cataclysmic caldera-forming eruptions and numerous smaller eruptive events over the past 60,000 years. Here, we combine the results of an extensive petrological survey with a thermomechanical model to investigate how the magmatic system shifts from frequent, small eruptions to large caldera-forming events. Our data reveal that the most recent eruption of Monte Nuovo is characterized by highly differentiated magmas akin to those that fed the pre-caldera activity and the initial phases of the caldera-forming eruptions. We suggest that this eruption is an expression of a state shift in magma storage conditions, whereby substantial amounts of volatiles start to exsolve in the shallow reservoir. The presence of an exsolved gas phase has fundamental consequences for the physical properties of the reservoir and may indicate that a large magma body is currently accumulating underneath Campi Flegrei.