Kodamaea ohmeri Leg Skin Ulcer Infection in an Immunocompetent Patient: A Case Report.

INTRODUCTION: Kodamaea ohmeri is an emerging fungus recognised as an important pathogen in immunocompromised hosts, responsible for life-threatening infections. CASE PRESENTATION: We describe a case of a 69-year-old immunocompetent man with a long history of leg skin ulcers infected by K. ohmeri. This is the first case of leg wounds infected by K. ohmeri in an immunocompetent patient. The infection was successfully treated with voriconazole 200 mg daily. CONCLUSION: Though rare, K. ohmeri should be considered in patients with skin ulcers that are poorly responsive to medical treatment, even if not immunocompromised.

Effect of Macronutrients or Micronutrients Supplementation on Nutritional Status, Physical Functional Capacity and Quality of Life in Patients with COPD: A Systematic Review and Meta-Analysis.

Given the importance that a correct and balanced nutrition has on patients with chronic obstructive pulmonary disease (COPD), supplementation of macro and micronutrients has been proposed, but the results of previous meta-analyses are contrasting. We performed an update of the latest evidence through a systematic review and meta-analysis of studies to assess the role of nutritional supplements in improving nutritional status, pulmonary function, physical performance, and quality of life of these patients.We included randomized controlled trials (RCTs) published between 01-01-2010 and 11-01-2023 evaluating the effectiveness of nutritional support in patients affected by stable COPD with an intervention of at least 2 weeks. Primary outcomes were changes in body mass index (BMI) and fat free mass index (FFMI). Secondary outcomes were exercise tolerance (6-min walking test, 6MWT), quality of life (St George's Respiratory Questionnaire, SGRQ) and respiratory function (FEV1). According with supplements type (macronutrients or micronutrients), we calculated the pooled adjusted mean difference (MD) and 95% confidence intervals (95%CIs) of the selected outcomes, using random-effects models in presence of high heterogeneity (I2>50%) or fixed-effects models otherwise. The risk of publication bias was evaluated with the trim and fill method.From 967 articles, 20 RCTs were included. Macronutrients supplementation improved BMI (MD 1.0 kg/m2, 95%CI 0.21-1.79), FFMI (MD 0.77 Kg/m2, 95%CI 0.48-1.06), 6MQT (MD 68.39 m, 95%CI 40.07-96.71), and SGRQ (MD -5.14, 95% CI -7.31-2.97), while it does not ameliorate respiratory function (MD 0.26% 95%CI -1.87-2.40). Micronutrients supplementation alone did not improve any of the considered outcomes.

Is Citicoline Effective in Preventing and Slowing Down Dementia?-A Systematic Review and a Meta-Analysis.

BACKGROUND: Cognitive impairment is a staggering personal and societal burden; accordingly, there is a strong interest in potential strategies for its prevention and treatment. Nutritional supplements have been extensively investigated, and citicoline seems to be a promising agent; its role in clinical practice, however, has not been established. We systematically reviewed studies on the effect of citicoline on cognitive performance. METHODS: We searched the PubMed and Cochrane Library databases for articles published between 2010 and 2022. Relevant information was extracted and presented following the PRISMA recommendations. Data were pooled using the inverse-variance method with random effects models. RESULTS: We selected seven studies including patients with mild cognitive impairment, Alzheimer's disease or post-stroke dementia. All the studies showed a positive effect of citicoline on cognitive functions. Six studies could be included in the meta-analysis. Overall, citicoline improved cognitive status, with pooled standardized mean differences ranging from 0.56 (95% CI: 0.37-0.75) to 1.57 (95% CI: 0.77-2.37) in different sensitivity analyses. The overall quality of the studies was poor. DISCUSSION: Available data indicate that citicoline has positive effects on cognitive function. The general quality of the studies, however, is poor with significant risk of bias in favor of the intervention. Other: PubMed and the Cochrane Library.

Association of age with emergency department visits and hospital admissions: A nationwide study.

AIM: Older adults are frequently stigmatized for improper emergency department (ED) visits and hospitalizations. In this study, we aimed to investigate the relationship between age and appropriateness of ED visits, and the mismatching between ED clinical severity and hospitalizations. METHODS: We carried out a nationwide assessment of Italian Informative System for the Emergency and Urgency data from 1 January 2015 to 31 December 2015 including patients admitted to all the Italian EDs for any reason. Appropriateness of ED visits was defined as a yellow/red/black color code (potentially life-threatening/dead patients), whereas clinical severity/hospitalization mismatching was defined as hospital admission after validated ED green/white codes. Analyses dedicated to people aged ≥75 years were carried out. RESULTS: There were 20 400 071 ED visits (3 444 091 aged ≥75 years), which increased with age, up to >650/1000 inhabitants aged ≥90 years. The appropriateness of ED visits increased with age, from 6.3% in the 5-9 years age group to 44.2% in the 95-99 years age group. Clinical severity/hospitalization mismatching decreased with age, from 62.9% in the 30-34 years age group to 27.7% in the 95-99 years age group. At ED presentation, 21.6% of patients aged ≥75 years complained of non-specific symptoms, and hospital discharge diagnoses frequently differed from the ED admission diagnoses; 11.4% died during hospitalization and 8.8% were discharged to long-term care facilities. CONCLUSIONS: The request for ED care and the admission to acute care ward are commonly appropriate for older patients. Clinical presentation at ED admission is frequently atypical. Health care systems should aim at improving outpatients' management to reduce the ED care need, but also at optimizing in-hospital strategies and pathways for older adults. Geriatr Gerontol Int 2022; 22: 917-923.

Attention, Praxis, and Reasoning Are Associated with Risk of Undernutrition in Older People with Cognitive Impairment.

BACKGROUND: Dementia is a risk factor for undernutrition. However, it is not clear if specific cognitive deficits have a higher risk of undernutrition and how much appetite/nutritional problems and caregiver stress mediate this association. OBJECTIVE: To evaluate the relationship between nutritional status and severity of global and function-specific scores of cognitive dysfunctions, and to which extent this association is mediated by appetite/nutritional problems and caregiver stress. METHODS: Cross-sectional analysis of the ReGAl study data, including 761 older adults attending a Memory Clinic. Nutritional status was evaluated with Mini Nutritional Assessment (MNA). The relationship between scores at neuro-cognitive tests and risk of undernutrition was evaluated using logistic regression models adjusted for potential confounders. To allow comparison between different tests, all scores were standardized. Mediation analysis was used to evaluate how much appetite/nutritional problems and caregiver stress mediate this association. RESULTS: Mean age was 77 years (SD: 9), 37.3% were women. Exploring different cognitive domains, a stronger association was documented for attentive matrices (OR:0.49, 95% CI: 0.34-0.72), the figure copy test (OR:0.63, 95% CI: 0.45-0.88), and the verbal judgement test (OR:0.61, 95% CI: 0.42-0.91). The proportion of the effect of cognition (MMSE) on nutritional status mediated by caregiver distress was 9.5% (95% CI: 0.002-0.27), the proportion mediated by appetite/nutritional problems was 11% (95% CI: -4.8-3.18). CONCLUSION: Risk of undernutrition is associated to cognitive decline; a stronger association was observed for attention, praxis, and reasoning. Caregiver distress is a mediator of this association. This information should be considered in the management plans of this population.

Bone Quality as Measured by Trabecular Bone Score in Normocalcemic Primary Hyperparathyroidism.

OBJECTIVE: The impact of normocalcemic hyperparathyroidism (NHPT) on bone quality remains largely unexplored. We aimed to investigate the usefulness of trabecular bone score (TBS) assessment in NHPT and the accuracy of TBS in predicting vertebral fractures (VFs) in NHPT. METHODS: In this multicentric cross-sectional study, we assessed the TBS in 47 subjects with NHPT, 41 with primary hyperparathyroidism (PHPT), and 39 age- and sex-matched control subjects. RESULTS: TBS values did not differ among the 3 groups. The prevalence of low TBS (TBS < 1.2) was 23.4% in NHPT, 26.8% in PHPT, and 15.4% in controls, without statistically significant differences between groups. However, we found a lower lumbar spine Z-score adjusted for TBS (LS Z-score∗TBS) in PHPT participants when compared with controls (-0.48 ± 1.06 vs 0.07 ± 0.93, P = .017). In NHPT group, LS Z-score∗TBS did not detect patients with overall VFs (threshold, -0.15; area under the curve, 0.45; 95% CI, 0.253-0.648; accuracy, 55.3%). Instead, it was useful for moderate-severe VFs (threshold, 0.55; area under the curve, 0.81; 95% CI, 0.62-0.996; accuracy, 83%). In PHPT subjects also, TBS did not predict VFs. CONCLUSION: In NHPT, TBS is not reduced. When adjusted for TBS, the LS Z-score might predict moderate-to-severe VFs.

Use of Plant-Derived Natural Products in Sleep Disturbances.

Sleep disorders have a high prevalence both in the general population and especially in specific populations such older adults and oncologic patients. Impacting on quality of life, they often translate in drug prescription, with consequent increased risk of drug-drug interactions and adverse drug reactions. In the last years several products derived from plants have been developed with the aim of treating insomnia with lower risk of side effects. Despite several studies have been performed with this aim, the available evidence is inconclusive, and reviews summarizing the most recent evidences on the effectiveness of plant-derived products in treating insomnia are lacking.This narrative review aims at summarizing the evidences of the mechanism of action, effectiveness and safety of the most commonly used plant-derived products for the treatment of sleep disorders (Valerian, Lemon balm, Passionflower, Chamomile, Hops, and Jujube).

Management of heart failure: an Italian national survey on fellows/specialists in geriatrics.

BACKGROUND: Heart failure (HF) is often managed by geriatricians. Few data are available on their knowledge and attitudes about this condition. AIMS: To compare perceptions and knowledge on HF of specialists/fellows in geriatrics working in Italy. METHODS: This nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in May-June 2019 enrolled 283 specialists/fellows in geriatrics in Italy. Results were stratified by qualification (specialist/fellow) and performance (lower/higher quartile of correct answers). RESULTS: About half (55.5%) of the participants worked in acute care wards, 190 were residents, and 93 specialists. The overall proportion of correct answers was 70.8%, with no differences between specialists and fellows. There was a poor knowledge, with no differences between groups, about the target doses of ACE-inhibitors (36% of correct answers), the pharmacological treatment of HF with preserved ejection fraction (HFpEF) (37% of correct answers), and the inotropes indicated in acute HF (35% of correct answers). Compared to specialists, fellows performed better on indication (88% vs 76%, P = 0.019) and mechanism of action (93% vs 84%, P = 0.023) of sacubitril/valsartan, and on therapeutic indications of patients with atrial fibrillation (92% vs 75%, P < 0.001). CONCLUSIONS: Globally, there was a good knowledge of the latest guidelines on the diagnosis and management of HF. However, for some important topics, such as HFpEF, that is the most common HF manifestation in older adults, the observed performance was relatively poor, indicating the need for focused educational campaigns.

Clinical, Biochemical, and Radiological Profile of Normocalcemic Primary Hyperparathyroidism.

CONTEXT: The clinical and radiological aspects of normocalcemic hyperparathyroidism (NHPT) are confounded by the differing methods used to rule out secondary hyperparathyroidism and by the small sample size. OBJECTIVE: To assess the clinical, biochemical, and radiological profile of NHPT compared with primary hyperparathyroidism (PHPT) and control subjects. DESIGN: Multicentric cross-sectional study. SETTING: Outpatient clinic. PATIENTS: 47 NHPT, 41 PHPT, and 39 age- and sex-matched control subjects. MAIN OUTCOME MEASURES: Calcium metabolism and bone turnover markers (BTMs). Lumbar spine, total hip, femoral neck, one-third distal radius bone mineral density (BMD). Morphometric vertebral fracture (VF) assessed by dual-energy X-ray absorptiometry. RESULTS: NHPT patients had significantly higher parathyroid hormone, 25(OH)-vitamin D levels and lower calcium × phosphorus product than controls (P < .001). Compared with PHPT, the NHPT group had significantly higher 25(OH) vitamin D levels (P = .016). NHPT had BTM levels similar to controls and PHPT. NHPT, PHPT, and controls have similar lumbar spine and femoral neck BMD. NHPT and controls had a similar radial BMD, while patients with PHPT had a lower radial BMD than both patients with NHPT (P = .031) and controls (P < .05). Using the control group as the reference, after adjustment for interacting factors, there was no increase in risk of moderate-severe VF in NHPT (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.25-4.55), while PHPT had an increased risk (OR 3.81,95% CI 1.15-15.12). Seventy-nine percent of NHPT and 59% of PHPT patients fulfilled the criteria for asymptomatic hyperparathyroidism. CONCLUSIONS: The biochemical phenotype of NHPT is intermediate between PHPT and controls. In contrast, the bone phenotype resembles controls with normal bone turnover, no significant BMD impairment, and no increased risk of VF.

Association between PUFA intake and serum concentration and mortality in older adults: A cohort study.

BACKGROUND & AIMS: PUFA intake is associated with reduced cardiovascular and all-cause mortality in the general population; however, evidence about this association in older adults is controversial. The objective of this study was to evaluate the relationship between PUFA intake and serum concentration, and the association of these variables with all-cause and cardiovascular mortality. METHODS: in this cohort study, we selected 927 community dwelling adults aged ≥65 years enrolled in the InCHIANTI study from 1998 to 2000 and followed-up for 9 years. The association between PUFA intake and serum concentration was evaluated using scatterplot and Pearson correlation test; all-cause and cardiovascular mortality was analyzed using the Kaplan-Meier method and Cox regressions adjusted for potential confounders. RESULTS: mean age of the population was 75 years (SD 7.3), 55% were women. There was no association between overall PUFAs, linolenic and linoleic acid intake and their serum concentration. There was no association between quartiles (Q) of PUFA intake and all-cause mortality: compared to Q1 of PUFA intake, the adjusted HR (95% CI) for overall mortality were: 1.05 (0.74-1.50) in Q2, 1.10 (0.76-1.58) in Q3, and 0.98 (0.68-1.41) in Q4; this lack of association was confirmed for cardiovascular mortality. Compared to Q1, participants in the fourth quartile of PUFA serum concentration had lower risk of all-cause mortality (adjusted HR [95%CI]: Q2 1.10 [0.79-1.53], Q3 0.84 [0.60-1.19], Q4 0.66 [0.44-0.995]), no association was found for cardiovascular mortality. CONCLUSIONS: In our sample of community-dwelling older adults, PUFA intake is not associated with PUFA serum concentration. Interventions to modulate PUFA concentration based on dietary intake may not be effective in preventing mortality in this population.

Cardiovascular autonomic neuropathy as a cause of fatigue in chronic hypoparathyroidism.

PURPOSE: Hypoparathyroidism (hypoPT) results in an impairment of quality of life (QoL), an increase in fatigue and a higher risk of mortality. Cardiovascular autonomic neuropathy (CAN) is an impairment of the cardiovascular autonomic system and is associated with increased mortality and fatigability. Patients with hypoPT show an increased risk of CAN. However, no previous studies have investigated the association between CAN and QoL in hypoPT. To test whether CAN is associated with fatigue and impaired QOL in hypoPT patients. METHODS: We enrolled 48 subjects with postsurgical hypoPT treated with calcium and calcitriol and 38 healthy subjects who underwent thyroidectomy. Subjects completed the RAND 36-Item Short Form (SF-36) Health Survey, evaluating physical (PCS) and mental (MCS) health, and fatigue score. CAN was assessed using cardiovascular autonomic reflex tests (CARTs). Participants were considered to have "early CAN" (EC) if they had one abnormal CART and "definite CAN" (DC) with two or more abnormal CARTs. RESULTS: Compared with controls, hypoPT population had lower fatigue scores (44.5 IQRː9 vs 38.5 IQRː12.3, P = 0.031). In the hypoPT group, only participants with DC had a lower fatigue score than subjects without CAN (DC: ß: -9.55, P = 0.005) after adjusting for age, duration of disease, calcium concentration, TSH, calcitriol and calcium supplementation. No differences were found in the PCS and MCS scores in the hypoPT group. CONCLUSIONS: CAN may explain fatigue, a common complaint of postsurgical hypoPT patients. Further larger and prospective investigations are needed to confirm our findings.

Nutritional status is associated with physical function and disability in older adults with chronic heart failure.

BACKGROUND: The association between nutritional status (NS) and physical performance and disability in older adults with chronic heart failure (CHF) is not well established. We aimed at evaluating whether NS, estimated using the Mini Nutritional Assessment (MNA), is associated with gait speed (GS) and disability (ADL/IADL impairment) in this population and to assess whether energy intake (EI) and appendicular skeletal muscle mass index (ASMMI) influence this relationship. METHODS: In this cross-sectional study we enrolled 88 older adults admitted to a cardiology outpatient clinic for CHF. MNA was analyzed both as continuous and categorical variable (risk of malnutrition [RM]/well-nourished [WN]). The association between NS and GS and disability was assessed using linear and logistic regression models, respectively, crude, adjusted firstly for age, sex, ejection fraction, and mood status, and then for EI and ASMMI. RESULTS: Mean age was 77.8 years, 73% were men. MNA score was positively associated with GS: ß adjusted = 0.022, P = 0.035; the coefficient was unaffected by adjustment for EI and ASMMI (ß = 0.022, P = 0.052). Compared to WN, RM participants had a lower gait speed (0.82 vs 0.99 m/s, P = 0.006); the difference was attenuated after adjustment for potential confounders (ß - = 0.138, P = 0.055). MNA score was inversely associated with ADL impairment (Adjusted OR: 0.80, 95%CI 0.64-0.98), but not with IADL impairment (Adjusted OR: 0.94, 95%CI 0.78-1.13). CONCLUSION: Reduced MNA score is associated with poorer physical function and ADL impairment in older adults affected by CHF, independently of EI and ASMMI. Routinely evaluation of NS should be performed in this population.

A Novel Interplay Between Irisin and PTH: From Basic Studies to Clinical Evidence in Hyperparathyroidism.

CONTEXT: Irisin is a hormonelike molecule that is cleaved and secreted by an unknown protease from fibronectin type III domain-containing protein 5 (FNDC5). It ameliorates bone status and muscle atrophy and influences energy homeostasis. PTH exerts several metabolic effects that may interact with the effects of irisin. OBJECTIVES: To test the hypothesis that irisin and PTH mutually affect their biological action, we evaluated FNDC5 mRNA and protein expression in myotubes treated with PTH (1-34) and parathyroid hormone receptor (PTH-r) mRNA expression in osteoblasts treated with r-irisin. To confirm the in vivo impact of PTH on irisin, we compared irisin serum concentrations in postmenopausal women with primary hyperparathyroidism (PHPT) and control subjects. DESIGN AND INTERVENTION: C2C12 myotubes were treated with short-term and continuous 10-10 M teriparatide and MC3T3-E1 osteoblasts with 100 ng/mL r-irisin for 8 hours. In a cross-sectional open-label trial, we enrolled 26 postmenopausal women with PHPT and 31 age-/body mass index (BMI)‒matched control subjects without impairment of calcium/phosphate metabolism. RESULTS: Teriparatide treatment on myotubes significantly downregulated FNDC5 expression by acting through its own receptor, which in turn activated Erk11/2 phosphorylation. r-Irisin led to a 50% downregulation of PTH-r mRNA expression compared with untreated cells (P < 0.001). Irisin was significantly lower in the PHPT group than in age-/BMI-matched controls (4.5 ± 1.1 vs 12 ± 5.2 µg/mL; P < 0.001). No significant correlation between irisin and bone mineral density or PTH was recorded in the PHPT group. CONCLUSION: Preclinical findings suggest the existence of an interplay between PTH and irisin metabolism that seems to be confirmed by the significant reduction of irisin concentration in postmenopausal women with PHPT.

Nutritional Status and Functional Outcomes in Older Adults Admitted to Geriatric Rehabilitations: The SAFARI Study.

Objective: Evidence about the role of nutritional status (NS) on functional outcomes (FO) after rehabilitation in older adults is scarce. Our aim was to analyze the association between NS and FO in older adults admitted to geriatric rehabilitation units. Methods: The Sarcopenia And Function in Aging Rehabilitation (SAFARI) multicenter study enrolled patients aged ≥65 years admitted to geriatric rehabilitation units in Italy and Spain. FO were absolute and relative functional gain (AFG-RFG) in Barthel Index (BI) at 1 and 3 months after admission. The association between NS (Mini Nutritional Assessment-Short Form) and FO was explored using linear regression and mixed models, adjusted for potential confounders. Analyses were then stratified for diagnosis at admission. Results: We included 415 patients (mean age 81.4 years [SD: 7.7]; 67% female; 9.4% malnourished [MN], 42.7% at risk of malnutrition [RM], and 48% well nourished [WN]). Admission diagnoses were hip fracture (39.5%), elective orthopedic surgery (EOS) (29.5%), and stroke (31%). In an adjusted linear mixed model, MN and RM participants had lower BI compared to WN (MN: ß: -8.47, p = 0.023; RM: ß: -5.22, p = 0.031), and differences between groups remained stable over time. After stratification for admission diagnosis, only MN patients admitted after EOS had worse FO, both at 30 days (AFG: ß adjusted: -13.54, p < 0.001; RFG: ß: -32, p < 0.001) and 3 months (AFG: ß adjusted: -17.79, p < 0.001; RFG: ß: -26.77, p = 0.002). Conclusions: In our sample, poor NS is associated with worse BI in older adults admitted to geriatric rehabilitation units; in patients undergoing EOS, MN is associated with worse FO. Our results documented for the first time the importance of assessing nutritional status before EOS.

Use of voltammetric analysis for fast and objective discrimination of the etiology, evolution, and bacterial infection of lower limb ulcers.

The timely recognition of leg ulcers (LU) etiology and infection is pivotal to optimize management and accelerate healing. The objective of this proof-of-concept study was to test the diagnostic performance of voltammetric analysis (VA) on ulcer exudate to identify LU etiology, infection, and predict clinical course. We enrolled 25 patients aged ≥60 years, affected by 42 venous/arterial LU. Clinical examination (Leg Ulcer Measurement Tool score, LUMT), swab culture, and VA were performed at baseline and 30 days. The ability of VA to predict outcomes was tested using partial least square-discrimination analysis. Mean age was 75 years (SD 11.1), 9/25 were male. The accuracy, sensitivity, and specificity vs. etiology were 97.4, 100%, and 94.1%, respectively; the corresponding figures were 95.2%, 100%, 88.9%, for infection and 94%, 84.6%, 100% for predicted objective LUMT worsening. VA is a promising diagnostic/prognostic tool for management of LU that may allow a more timely targeted therapy.

Voltammetric analysis for fast and inexpensive diagnosis of urinary tract infection: a diagnostic study.

BACKGROUND: Dipstick test is widely used to support the diagnosis of urinary tract infections (UTI). It is effective in ruling out UTI, but urine culture is needed for diagnosis confirmation. In this study we compared the accuracy of voltammetric analysis (VA) with that of DT to detect UTI (diagnosed using urine culture), and its usefulness as a second-stage test in people with positive DT. METHODS: 142 patients were enrolled with no exclusion criteria. VA was performed using the BIONOTE device. Partial Least Square Discrimination Analysis was used to predict UTI based on VA data; diagnostic performance was evaluated using sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), positive and negative likelihood ratios (LR), accuracy, diagnostic odds ratio (DOR). RESULTS: Mean age was 76.6 years (SD 12.6), 57% were male. VA had a better overall performance respect to DT in detecting UTI with accuracy 81.7% vs 75.9%, specificity 90.8% vs 82.5%, PPV 75% vs 61.4%, positive LR 6.68 vs 3.5, DOR 17.7 vs 7.47; sensibility, NPV and negative LR of the two tests were similar. VA had an accuracy of 82.4% in discriminating bacterial from fungal infections. When added as a second-stage test, VA identified 9 of the 17 false positive patients, with a net specificity of 91.7%, sensitivity 54%, PPV 75% and NPV 81%. CONCLUSIONS: VA is a quick and easy method that may be used as a second stage after DT to reduce the number of urine culture and of inappropriate antibiotic prescriptions.

Association Between Sodium Excretion and Cardiovascular Disease and Mortality in the Elderly: A Cohort Study.

OBJECTIVE: High dietary sodium intake is a risk factor for cardiovascular events and death. Recently, a J-shaped correlation between sodium intake and adverse outcomes has been shown. The evidence on the association between sodium intake and cardiovascular outcomes in the elderly is scant. The objective of this study was to evaluate the correlation between sodium intake and cardiovascular events and mortality in an elderly population, taking into account frailty status. DESIGN: Cohort study of community dwelling older people enrolled in the InCHIANTI (Invecchiare in Chianti - Aging in the Chianti) study from 1998 to 2000 and followed-up for 9 years. SETTING: Two communities in Tuscany, Italy. PARTICIPANTS: A total of 920 participants 65 years of age and older, with 24-hour urinary sodium excretion data. MEASUREMENTS: Nine-year mortality and incident cardiovascular events were analyzed using Cox and nonlinear log-binomial models, stratified by frailty status. Sensitivity analysis in participants without hypertension and cardiovascular diseases was performed. RESULTS: Mean age of the population was 74.5 years (standard deviation 6.99); 55.4% were women. There was a bi-modal association between sodium excretion and mortality, with risk increasing only below sodium excretion of 6.25 g/d [hazard ratio (HR) 1.29, 95% confidence interval (CI) 1.20-1.38], confirmed in the adjusted model (HR 1.12, 95% CI 1.04-1.22). These results were confirmed in participants without cardiovascular diseases. After stratification for frailty phenotype, the association was stronger in frail participants (adjusted HR 1.23, 95% CI 1.02-1.50 vs HR 1.11, 95% CI 1.01-1.22 in robust participants). There was no association between 24-hour sodium excretion and 9-year incidence of cardiovascular diseases (adjusted risk ratio 0.96, 95% CI 0.90-1.02). CONCLUSIONS: Reduced sodium excretion is associated with increased mortality in a sample of community-dwelling older people, especially among the frail participants. High levels of sodium excretion are not associated with adverse outcomes in this population; therefore, sodium restriction might not be beneficial in older people.

Hemoglobin Concentration Influences N-Terminal Pro B-Type Natriuretic Peptide Levels in Hospitalized Older Adults with and without Heart Failure.

OBJECTIVES: To investigate the relationship between hemoglobin and N-terminal pro B-type natriuretic peptide (NT-proBNP) concentration in hospitalized older adults with or without a diagnosis of heart failure (HF). DESIGN: Cross-sectional study based on retrospective hospital records review. SETTING: Geriatric acute care ward. PARTICIPANTS: Individuals aged 65 and older (N = 226; mean age 81.1), with (n = 104) and without (n = 122) a diagnosis of HF. MEASUREMENTS: Information was collected on demographic characteristics, comorbidities, and laboratory and echocardiographic data. The relationship between hemoglobin and NT-proBNP was evaluated using linear regression models adjusted for potential confounders. RESULTS: A negative association was found between NT-proBNP and hemoglobin (ß = -0.226, P < .001). The regression coefficient was -0.114 (P = .04) in the subsample with HF and -0.191 (P < .001) in the subsample without HF. After adjustment for potential confounders, the inverse association between hemoglobin and NT-proBNP was confirmed in the whole sample (ß = -0.182, P < .001), in those with HF (ß = -0.136, P = .007), and in those without HF (ß = -0.165, P = .003). CONCLUSION: Hemoglobin concentration should be taken into account in the interpretation of NT-proBNP in hospitalized older adults, especially those without HF.

Curcumin and treatment of melanoma: The potential role of microRNAs.

Melanoma is the most aggressive type of skin cancer and is characterized by poor prognosis in its advanced stages because treatments are poorly effective and burdened with severe adverse effects. MicroRNAs (miRNAs) are small non-coding RNAs that are implicated in several cellular processes; they are categorized as oncogenic and tumor suppressor miRNAs. Several miRNAs are implicated in the pathogenesis and progression of melanoma, such as the tumor suppressor miR-let7b that targets cyclin D and regulates cell cycle. Curcumin is a natural compound derived from Curcuma longa L. (turmeric) with anti-cancer properties, documented also in melanoma, and is well tolerated in humans. Pharmacological activity of curcumin is mediated by modulation of several pathways, such as JAK-2/STAT3, thus inhibiting melanoma cell migration and invasion and enhancing apoptosis of these cells. The low oral bioavailability of curcumin has led to the development of curcumin analogues, such as EF24, with greater anti-tumor efficacy and metabolic stability. Potential anti-cancer activity of curcumin and its analogues is also mediated by modulation of miRNAs such as miR21, that is implicated in cell cycle regulation and apoptosis through down-regulation of PTEN and PDCD4 proteins. Curcumin has a potential role in the treatment of melanoma, though further studies are necessary to explore its clinical efficacy.