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Manna M, Mazzola P. Role of sociodemographic characteristics on the progression of multimorbidity over time: a longitudinal approach using the Clinical Practice Research Datalink of England. Evid Based Nurs 2024:ebnurs-2024-103952. [PMID: 38594077 DOI: 10.1136/ebnurs-2024-103952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Martina Manna
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Morandi A, Zambon A, Crippa M, Re M, Riva L, Lombardi F, Mazzola P, Scaccabarozzi G, Bellelli G. Predicting 60-Day Mortality in a Home-Care Service: Development of a New Inter-RAI 49-Frailty Index in Patients with Chronic Disease and without a Cancer Diagnosis. J Am Med Dir Assoc 2024; 25:521-525.e6. [PMID: 38081326 DOI: 10.1016/j.jamda.2023.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE Frailty Index (FI) is used to define the level of frailty in various clinical settings. Fifteen- and 26-item FIs have been demonstrated to predict 1-year mortality and intensity of care in home care (HC) and palliative home care (PHC). The objective of this study was to develop a new FI to predict the 60-day risk of death or transition to a PHC service after the initiation of an HC service in patients with chronic disease and without a cancer diagnosis. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients 18 years and older followed in an HC service of a "Frailty Department-Local Palliative Care Network" from January 1, 2017, to October 31, 2021. METHODS A 49-item FI (FI-49) was developed selecting variables within the standardized international Residential Assessment Instrument assessments (interRAI-HC) and compared to existing FIs with 15 and 26 variables. RESULTS A total of 2099 patients were included in the study with a median age of 80.0 years (IQR: 72.0-86.0) and a predominantly female population (62.4%). Among these patients, 8% died or were transferred to PHC within the 60-day follow-up. The FI-49 demonstrated a higher ability to predict 60-day mortality (C index 0.8165, 95% CI 0.7848-0.8481) compared to the 26- and 15-item FI. An FI-49 cutoff of 0.33 was also selected to provide clinicians with a more practical approach (C-index of 0.7044, 95% CI 0.6796-0.7292). CONCLUSION AND IMPLICATION The FI-49 is a good predictor of short-term mortality or transition to palliative care among older patients referred to an HC service. The automatic calculation of this tool could facilitate more appropriate care planning and the correct allocation of healthcare resources, especially considering the rapid ageing of the population.
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Affiliation(s)
- Alessandro Morandi
- Intermediate Care and Rehabilitazion, Azienda Speciale Cremona Solidale, Cremona, Italy; REFiT Bcn research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Catalonia, Spain.
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano Bicocca, Milan, Italy; Biostatistics Unit, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | | | - Massimo Re
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Luca Riva
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Fabio Lombardi
- Frailty Department, Local Network of Palliative Care, ASST, Lecco, Italy
| | - Paolo Mazzola
- Acute Geriatric Unit, IRCCS Foundation San Gerardo, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Giuseppe Bellelli
- Acute Geriatric Unit, IRCCS Foundation San Gerardo, Monza, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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Mazzola P, Zanetti M, Ferraguzzi G, Villa ML, Sandrini MC, Fumagalli M, Volpi M, Caggiu G, Monzio Compagnoni M, Mecocci P, Bellelli G. Shifting the Paradigm of Nursing Home Care for People with Dementia: The Italian Experience of Il Paese Ritrovato and the Impact of SARS-CoV-2. J Alzheimers Dis 2024; 97:741-752. [PMID: 38143344 DOI: 10.3233/jad-230229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND Il Paese Ritrovato is an Italian nursing home founded in 2018, it is based on the Alzheimer village model and admits people with mild-to-moderate dementia. OBJECTIVE Describe the impact of the SARS-CoV-2 pandemic on people living at Il Paese Ritrovato through a Comprehensive Geriatric Assessment (CGA) regularly administered prior to and during the pandemic. METHODS We explored the effects of a person-centered approach. We assessed 64 subjects (enrolled and followed between June 2018 and December 2020), who underwent at least 18 months of observation prior to the pandemic. Each subject was evaluated using a CGA on admission time (T0) and at defined time-points: T6, T12, T18. One last CGA evaluation was performed during the SARS-CoV-2 pandemic (TCovid-19). Temporal trends during T0-T18, and differences between T18 and TCovid-19 were calculated. RESULTS The mean age was 82 years with a prevalence for females (77.0%) and Alzheimer's disease diagnosis (60%). Psychiatric and behavioral disorders were the most common conditions (80%). We utilized a nonpharmacological approach aimed at promoting the residents' overall wellbeing and observed satisfactory performance during the first 18 months. In comparison with the pre-pandemic period, TCovid-19 enlightened +11.7% use of antidepressants and a decline of Mini-Mental State Examination mean values (not statistically significant), while engagement in activities dropped. CONCLUSIONS The pandemic may have disrupted the existing model of care, but at the same time, it confirmed that the Il Paese Ritrovato approach, which encompasses symptoms improvement and multicomponent support, is in fact beneficial.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
| | | | - Gaia Ferraguzzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | | | | | | | | | - Giulia Caggiu
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Matteo Monzio Compagnoni
- Department of Statistics and Quantitative Methods, Università degli Studi di Milano-Bicocca, Milano, Italy
| | - Patrizia Mecocci
- Department of Biomedical Sciences for Health, Università di Perugia, Perugia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Acute Geriatrics Unit, Monza, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
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Spedale V, Mazzola P. Managing multimorbidity in midlife may reduce the risk of developing dementia as we age. Evid Based Nurs 2023:ebnurs-2023-103779. [PMID: 37973209 DOI: 10.1136/ebnurs-2023-103779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Valentina Spedale
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Sidoli C, Bruni AA, Beretta S, Mazzola P, Bellelli G. Guillain-Barré syndrome AMSAN variant in a 90-year-old woman after COVID-19: a case report. BMC Geriatr 2023; 23:114. [PMID: 36859256 PMCID: PMC9975860 DOI: 10.1186/s12877-023-03833-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS. CASE PRESENTATION We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home. CONCLUSIONS To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.
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Affiliation(s)
- Chiara Sidoli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
| | | | - Simone Beretta
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Neurology Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy.
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy.
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy.
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
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Mazzola P, Spedale V. Commentary: Risk factors for complications in elderly patients aged 85 years and over undergoing endoscopic biliary stone removal. Front Surg 2023; 10:1139745. [PMID: 36925506 PMCID: PMC10011687 DOI: 10.3389/fsurg.2023.1139745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/01/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Università Degli Studi di Milano-Bicocca, Monza, MB, Italy.,Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, MB, Italy
| | - Valentina Spedale
- School of Medicine and Surgery, Università Degli Studi di Milano-Bicocca, Monza, MB, Italy.,Nurse Educator Undergraduate Nursing Degree, Fondazione IRCCS San Gerardo dei Tintori, Monza, MB, Italy
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Mazzola P, Spedale V. Staff training and the use of rapid, accurate and user-friendly tools for delirium screening could improve the diagnosis of delirium in the elderly referred to the emergency department. Evid Based Nurs 2023; 26:13. [PMID: 36002227 DOI: 10.1136/ebnurs-2022-103543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Universita degli Studi di Milano-Bicocca, Monza, Italy .,Acute Geriatrics Unit, ASST di Monza, Monza, Italy
| | - Valentina Spedale
- School of Medicine and Surgery, Universita degli Studi di Milano-Bicocca, Monza, Italy
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Mazzola P, Ferraguzzi G, Zanetti M, Bellelli G. AN INNOVATIVE MODEL OF CARE FOR SUBJECTS WITH DEMENTIA IN ITALY—IL PAESE RITROVATO—THROUGH THE SARS-COV-2 PANDEMIC. Innov Aging 2022. [PMCID: PMC9766643 DOI: 10.1093/geroni/igac059.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
“Il Paese Ritrovato” is an innovative long-term facility dedicated to subjects with mild-to-moderate Alzheimer’s disease or other dementias, located in Monza (Lombardia, Italy).By living in a village that resembles a community neighborhood, it aims at people’s wellbeing and represents a shift in the paradigm of traditional nursing home care, allowing the guests to visit the hair stylist, the supermarket, and various activities according to their personal habits, always supported by trained professionals.We performed a retrospective cohort study on 60 subjects, comparing their characteristics before and during the SARS-CoV-2 pandemic, from June 2018 to December 2020. We collected demographic information, cognition, comorbidity, functional status, engagement in the activities through Popularity Index (PI) and Engagement Social Index (ISE), and use of psychoactive medications.The follow-up is performed every 6 months from admission: T0, T6, T12, and T18 are the time-points. The assessment performed during the pandemic is called Tcovid.Compared to a relative stability in cognition before the pandemic, the assessment at Tcovid showed an accelerated worsening of MMSE and CDR scales. We observed an increase in the prescription of antipsychotics (+5%), antidepressants (+11.7%), and benzodiazepines (+1.7%). As expected, engagement in activities dropped (lower PI and ISE). Functional status gradually worsened during the follow-up, according to the natural progression of dementias, but Tcovid slightly accelerated this process and overall worsened the balance performances.Although we are currently unable to quantify the negative effect of this reorganization, future studies need to address the real impact of pandemic on the guests’ performances.
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Affiliation(s)
- Paolo Mazzola
- Università degli Studi di Milano-Bicocca, Monza, Lombardia, Italy
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Spedale V, Finco T, Mazzola P. Intensive multidisciplinary rehabilitation programmes for older people with hip fractures may be beneficial but more research is needed. Evid Based Nurs 2022; 25:ebnurs-2022-103522. [PMID: 35346978 DOI: 10.1136/ebnurs-2022-103522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Valentina Spedale
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Tommaso Finco
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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Grasselli C, Bombelli S, Eriani S, Domenici G, Galluccio R, Tropeano C, De Marco S, Bolognesi MM, Torsello B, Bianchi C, Antolini L, Rossi F, Mazzola P, Leoni V, Bellelli G, Perego RA. DNA damage in circulating hematopoietic progenitor stem cells as promising biological sensor of frailty. J Gerontol A Biol Sci Med Sci 2022; 77:1279-1286. [PMID: 35137086 PMCID: PMC9255693 DOI: 10.1093/gerona/glac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 12/02/2022] Open
Abstract
Frailty is an age-related syndrome that exposes individuals to increased vulnerability. Although it is potentially reversible, in most cases it leads to negative outcomes, including mortality. The different methods proposed identify frailty after the onset of clinical manifestations. An early diagnosis might make it possible to manage the frailty progression better. The frailty pathophysiology is still unclear although mechanisms, in particular, those linked to inflammation and immunosenescence, have been investigated. A common feature of several clinical aspects involved in senescent organisms is the increase of oxidative stress, described as one of the major causes of deoxyribonucleic acid (DNA) damage accumulation in aged cells including the adult stem cell compartment. Likely, this accumulation is implicated in frailty status. The oxidative status of our frail, pre-frail, and non-frail population was characterized. In addition, the DNA damage in hematopoietic cells was evidenced by analyzing the peripheral blood mononuclear cell and their T lymphocyte, monocyte, circulating hematopoietic progenitor stem cell (cHPSC) subpopulations. The phosphorylation of C-terminal of histone H2AX at amino acid Ser 139 (γ-H2AX), which occurs at the DNA double-strand break focus, was evaluated. In our frail population, increased oxidative stress and a high level of DNA damage in cHPSC were found. This study may have potential implications because the increment of DNA damage in cHPSC could be suggestive of an organism impairment preceding the evident frailty. In addition, it may open the possibility for attenuation of frailty progression throughout specific drugs acting on preventing DNA damage or removing damaged cells
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Affiliation(s)
- Chiara Grasselli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Silvia Bombelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Stefano Eriani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Domenici
- Acute Geriatric Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Riccardo Galluccio
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Chiara Tropeano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Laboratory of Clinical Chemistry, Hospital of Desio, ASST-Brianza, Desio, Italy
| | - Sofia De Marco
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Barbara Torsello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Cristina Bianchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Fabio Rossi
- Immunotransfusional Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Valerio Leoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Laboratory of Clinical Chemistry, Hospital of Desio, ASST-Brianza, Desio, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Roberto A Perego
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Mazzola P, Zambon A, Bellelli G. Delirium Duration Predicts 1-Month And 6-Month Mortality In Septic Patients From an Acute Geriatrics Unit. Innov Aging 2021. [PMCID: PMC8681918 DOI: 10.1093/geroni/igab046.3685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is important to understand the effects of the COVID-19 pandemic not only on individuals’ daily lives, but also their close partners. Current literature suggests that the COVID-19 pandemic has impacted older adults’ lives in several ways, including the frequency of social interactions and change in various life habits (Lesbrasseur et al., 2021). Data from 42 middle-aged and older, long-term married or cohabitating dyads were collected as part of an ongoing study of everyday cognition and functioning among couples. Participant age ranged from 40-85+, and couples were partnered for 9-60+ years. During this study, COVID-19 pandemic impact was assessed using six items (1 = No change to 4 = Severe change) examining daily routines, medical and mental health access, social contacts, and pandemic and family-related stress; reports ranged from six to 19. On average, women reported significantly higher COVID-19 pandemic impact compared to men. For both partners, the greatest disruptions reported related to routines and social contacts. Further analysis examined COVID-19 pandemic impact in dyads. For eight dyads, both partners reported relatively lower COVID-19 impact (6-11), whereas for six dyads, both partners reported higher impact scores (14-19). Discussion focuses on within-dyad and between-dyad differences related to perceptions of the pandemic’s impact.
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Affiliation(s)
- Paolo Mazzola
- Università degli Studi di Milano-Bicocca, Monza, Lombardia, Italy
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Rebora P, Focà E, Salvatori A, Zucchelli A, Ceravolo I, Ornago AM, Finazzi A, Arsuffi S, Bonfanti P, Citerio G, Mazzola P, Ecarnot F, Valsecchi MG, Marengoni A, Bellelli G. The effect of frailty on in-hospital and medium-term mortality of patients with COronaVIrus Disease-19: the FRACOVID study. Panminerva Med 2021; 64:24-30. [PMID: 34761887 DOI: 10.23736/s0031-0808.21.04506-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Older persons hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middleaged and older adults with COVID-19 during the first two pandemic waves. METHODS Observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry. RESULTS In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR= 1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50). CONCLUSIONS Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.
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Affiliation(s)
- Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Emanuele Focà
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Brescia Spedali Civili Hospital, Brescia, Italy
| | - Andrea Salvatori
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Isabella Ceravolo
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alice M Ornago
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Alberto Finazzi
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Stefania Arsuffi
- Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besançon, EA3920, University of Franche-Comté, Besançon, France
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano - Bicocca, Monza, Italy - .,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
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13
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Gamberale R, D'Orlando C, Brunelli S, Meneveri R, Mazzola P, Foti G, Bellani G, Zatti G, Munegato D, Volpato S, Zurlo A, Caruso G, Andreano A, Valsecchi MG, Bellelli G. Study protocol: understanding the pathophysiologic mechanisms underlying delirium in older people undergoing hip fracture surgery. BMC Geriatr 2021; 21:633. [PMID: 34736422 PMCID: PMC8567587 DOI: 10.1186/s12877-021-02584-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative delirium (POD) is a common complication of older people undergoing hip fracture surgery, which negatively affects clinical- and healthcare-related outcomes. Unfortunately, POD pathophysiology is still largely unknown, despite previous studies showing that neuroinflammation, neuroendocrine dysfunction, increased reactive oxidative stress (ROS), and endothelial dysfunctions may be involved. There is also evidence that many of the pathophysiological mechanisms which are involved in delirium are involved in sarcopenia too. This article describes the protocol of a pilot study to evaluate the feasibility of a larger one that will explore the pathophysiological mechanisms correlating POD with sarcopenia. We will analyse whether various biomarkers reflecting neuroinflammation, ROS, neuroendocrine disorders, and microvasculature lesions will be simultaneously expressed in in the blood, cerebrospinal fluid (CSF), and muscles of patients developing POD. METHODS Two centres will be involved in this study, each recruiting a convenient sample of ten older patients with hip fracture. All of them will undergo a baseline Comprehensive Geriatric Assessment, which will be used to construct a Rockwood-based Frailty Index (FI). Blood samples will be collected for each patient on the day of surgery and 1 day before. Additionally, CSF and muscle fragments will be taken and given to a biologist for subsequent analyses. The presence of POD will be assessed in each patient every morning until hospital discharge using the 4AT. Delirium subtypes and severity will be assessed using the Delirium Motor Subtype Scale-4 and the Delirium-O-Meter, respectively. We will also evaluate the patient's functional status at discharge, using the Cumulated Ambulation Score. DISCUSSION This study will be the first to correlate biomarkers of blood, CSF, and muscle in older patients with hip fracture.
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Affiliation(s)
- R Gamberale
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - C D'Orlando
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - S Brunelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - R Meneveri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - P Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - G Zatti
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - D Munegato
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy
| | - S Volpato
- Orthogeriatric Unit, Arcispedale S. Anna, University of Ferrara, Ferrara, Italy
| | - A Zurlo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - G Caruso
- Department of Biomedical and Surgical Specialist Sciences, University of Ferrara, Ferrara, Italy
| | - A Andreano
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - M G Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Acute Geriatric Unit, San Gerardo Hospital, Monza, Italy.
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14
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Gandossi CM, Zambon A, Oliveri G, Codognola M, Szabo H, Cazzulani I, Ferrara MC, Mottadelli C, Galeazzi M, Amoroso I, Zarcone C, Principato G, Corsi M, Mazzola P, Zatti G, Foti G, Bellelli G. Frailty, post-operative delirium and functional status at discharge in patients with hip fracture. Int J Geriatr Psychiatry 2021; 36:1524-1530. [PMID: 33908103 PMCID: PMC8518900 DOI: 10.1002/gps.5561] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/17/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To explore the effect of frailty, alone and in combination with post-operative delirium (POD), on the risk of poor function at discharge in patients with hip fracture (HF). METHODS This is a prospective cohort study of patients with HF admitted to an Orthogeriatric Unit (OGU) between October 1, 2011 and March 15, 2019. POD was assessed using the 4AT and the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5-edition criteria. A 22-items Frailty Index (FI) was created using the data collected on admission. The outcome measure was the Cumulated Ambulation Score (CAS) score at discharge. A log-binomial regression model was used to assess the effect of frailty and POD on CAS. RESULTS A total of 988 patients (median age = 84.9 years, Interquartile range = 80.6-89.2) were included: 360 patients (36.4%) were frail and 411 (42%) developed POD. Poor functional status at discharge (CAS score ≤2) was more common in frail than non-frail patients (68.3% vs. 53.8%, p < 0.001) In a regression adjusted for confounders, frailty alone (Relative Risk, RR = 1.33, 95% Confidence Intervals, CI = 1.14-1.55) and POD alone (RR 1.38, 95% CI = 1.2-1.59) were associated with poor functional status at discharge; when combined, frailty and POD had an interaction, yielding a mild increase in the risk of poor outcome (RR 1.47, 95% CI = 1.28-1.69). CONCLUSIONS In older patients undergoing HF surgery, frailty, POD and their combination, are associated with poor functional status at discharge.
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Affiliation(s)
| | - Antonella Zambon
- Department of Statistics and Quantitative MethodsUnit of BiostatisticsEpidemiology and Public HealthUniversity of Milano‐ BicoccaMilanItaly
| | | | | | - Hajnalka Szabo
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Ilaria Cazzulani
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | | | | | - Isabella Amoroso
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | - Cristina Zarcone
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly
| | | | - Maurizio Corsi
- Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Paolo Mazzola
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
| | - Giovanni Zatti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Orthopedic DepartmentSan Gerardo HospitalMonzaItaly
| | - Giuseppe Foti
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Department of Anesthesia and Intensive CareSan Gerardo HospitalMonzaItaly
| | - Giuseppe Bellelli
- School of Medicine and SurgeryMilano‐Bicocca UniversityMonzaItaly,Acute Geriatric and Orthogeriatric UnitSan Gerardo HospitalMonzaItaly
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15
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Mazzola P, Tassistro E, Di Santo S, Rossi E, Andreano A, Valsecchi MG, Cherubini A, Marengoni A, Mossello E, Bo M, Inzitari M, Di Bari M, Udina C, Latronico N, Paolillo C, Morandi A, Bellelli G. The relationship between frailty and delirium: insights from the 2017 Delirium Day study. Age Ageing 2021; 50:1593-1599. [PMID: 33792656 DOI: 10.1093/ageing/afab042] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND although frailty and delirium are among the most frequent and burdensome geriatric syndromes, little is known about their association and impact on short-term mortality. OBJECTIVE to examine, in hospitalized older persons, whether frailty is associated with delirium, and whether these two conditions, alone or in combination, affect these patients' 30-day survival. DESIGN observational study nested in the Delirium Day project, with 30-day follow-up. SETTING acute medical wards (n = 118) and rehabilitation wards (n = 46) in Italy. SUBJECTS a total of 2,065 individuals aged 65+ years hospitalized in acute medical (1,484 patients, 71.9%) or rehabilitation (581 patients, 28.1%) wards. METHODS a 25-item Frailty Index (FI) was created. Delirium was assessed using the 4AT test. Vital status was ascertained at 30 days. RESULTS overall, 469 (22.7%) patients experienced delirium on the index day and 82 (4.0%) died during follow-up. After adjustment for potential confounders, each FI score increase of 0.1 significantly increased the odds of delirium (odds ratio, OR: 1.66 [95% CI: 1.45-1.90]), with no difference between the acute (OR: 1.65 [95% CI: 1.41-1.93]) and rehabilitation ward patients (OR: 1.71 [95% CI: 1.27-2.30]). The risk of dying during follow-up also increased significantly for every FI increase of 0.1 in the overall population (OR: 1.65 [95% CI: 1.33-2.05]) and in the acute medical ward patients (OR: 1.61 [95% CI: 1.28-2.04]), but not in the rehabilitation patients. Delirium was not significantly associated with 30-day mortality in either hospital setting. CONCLUSIONS in hospitalized older patients, frailty is associated with delirium and with an increased risk of short-term mortality.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Elena Tassistro
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Simona Di Santo
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Foundation S Lucia, Rome, Italy
| | - Emanuela Rossi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Anita Andreano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging (B4 center), University of Milano-Bicocca, Monza, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica, Centro di ricerca per l’invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Alessandra Marengoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Enrico Mossello
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mario Bo
- Section of Geriatrics, Città della Salute e della Scienza-Molinette, Turin, Italy
| | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Università Autònoma di Barcelona, Catalonia, Spain
| | - Mauro Di Bari
- Research Unit of Medicine of Ageing, Department of Experimental and Clinical Medicine, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Cristina Udina
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Università Autònoma di Barcelona, Catalonia, Spain
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Ciro Paolillo
- UOC Pronto Soccorso, Spedali Civili University Hospital, Brescia, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, “Fondazione Camplani” Hospital, Cremona, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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16
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Abstract
Delirium is an acute neuropsychiatric syndrome and one of the most common presenting symptoms of acute medical illnesses in older people. Delirium can be triggered by a single cause, but in most cases, it is multifactorial as it depends on the interaction between predisposing and precipitating factors. Delirium is highly prevalent in older patients across various settings of care and correlates with an increased risk of adverse clinical outcomes. Several pathophysiological mechanisms may contribute to its onset, including neurotransmitter imbalance, neuroinflammation, altered brain metabolism, and impaired neuronal network connectivity. Several screening and diagnostic tools for delirium exist, but they are unfortunately underutilized. Additionally, the diagnosis of delirium superimposed on dementia poses a formidable challenge – especially if dementia is severe. Non-pharmacological approaches for the prevention and multidomain interventions for the treatment of delirium are recommended, given that there is currently no robust evidence of drugs that can prevent or resolve delirium. This article aims to review the current understanding about delirium in older people. To achieve this goal, we will describe the epidemiology and outcomes of the syndrome, the pathophysiological mechanisms that are supposed to be involved, the most commonly used tools for screening and diagnosis, and prevention strategies and treatments recommended. This review is intended as a brief guide for clinicians in hospital wards to improve their knowledge and practice. At the end of the article, we propose an approach to improve the quality of care provided to older patients throughout a systematic detection of delirium.
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Affiliation(s)
- Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Justin S Brathwaite
- Department of Emergency Medicine, Boston University, Boston, MA, United States
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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17
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Coppadoro A, Benini A, Fruscio R, Verga L, Mazzola P, Bellelli G, Carbone M, Mulinacci G, Soria A, Noè B, Beck E, Di Sciacca R, Ippolito D, Citerio G, Valsecchi MG, Biondi A, Pesci A, Bonfanti P, Gaudesi D, Bellani G, Foti G. Helmet CPAP to treat hypoxic pneumonia outside the ICU: an observational study during the COVID-19 outbreak. Crit Care 2021; 25:80. [PMID: 33627169 PMCID: PMC7903369 DOI: 10.1186/s13054-021-03502-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/10/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Respiratory failure due to COVID-19 pneumonia is associated with high mortality and may overwhelm health care systems, due to the surge of patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment. Helmet is an effective interface to provide continuous positive airway pressure (CPAP) noninvasively. We report data about the usefulness of helmet CPAP during pandemic, either as treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI). METHODS In this observational study we collected data regarding patients failing standard oxygen therapy (i.e., non-rebreathing mask) due to COVID-19 pneumonia treated with a free flow helmet CPAP system. Patients' data were recorded before, at initiation of CPAP treatment and once a day, thereafter. CPAP failure was defined as a composite outcome of intubation or death. RESULTS A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP treatment was successful in 69% of the full treatment and 28% of the DNI patients (P < 0.001). With helmet CPAP, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P < 0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P < 0.001). C-reactive protein, time to oxygen mask failure, age, PaO2/FiO2 during CPAP, number of comorbidities were independently associated with CPAP failure. Helmet CPAP was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards. CONCLUSIONS Helmet CPAP treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP as rescue therapy to improve survival. TRIAL REGISTRATION NCT04424992.
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Affiliation(s)
- Andrea Coppadoro
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Annalisa Benini
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Robert Fruscio
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Luisa Verga
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Paolo Mazzola
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giuseppe Bellelli
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Marco Carbone
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giacomo Mulinacci
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Alessandro Soria
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Beatrice Noè
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Eduardo Beck
- grid.413643.70000 0004 1760 8047ASST Monza, Desio Hospital, Desio, Italy
| | - Riccardo Di Sciacca
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Davide Ippolito
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
| | - Giuseppe Citerio
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Maria Grazia Valsecchi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Andrea Biondi
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Alberto Pesci
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Paolo Bonfanti
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Davide Gaudesi
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giacomo Bellani
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
| | - Giuseppe Foti
- grid.415025.70000 0004 1756 8604ASST Monza, San Gerardo Hospital, Monza, Italy
- grid.7563.70000 0001 2174 1754Department of Medicine and Surgery, University of Milan-Bicocca, Via Cadore 48, Monza, MB Italy
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18
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Mazzola P. Depression and social isolation are associated with loneliness among seniors with mild-to-moderate dementia-findings from the IDEAL cohort study. Evid Based Nurs 2020; 25:17. [PMID: 33361388 DOI: 10.1136/ebnurs-2020-103387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Università degli Studi di Milano-Bicocca, Monza, Italy .,Acute Geriatrics Unit, ASST di Monza, Monza, Italy
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19
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Rebora P, Rozzini R, Bianchetti A, Blangiardo P, Marchegiani A, Piazzoli A, Mazzeo F, Cesaroni G, Chizzoli A, Guerini F, Bonfanti P, Morandi A, Faraci B, Gentile S, Bna C, Savelli G, Citerio G, Valsecchi MG, Mazzola P, Bellelli G. Delirium in Patients with SARS-CoV-2 Infection: A Multicenter Study. J Am Geriatr Soc 2020; 69:293-299. [PMID: 33411332 PMCID: PMC7753490 DOI: 10.1111/jgs.16969] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN Multicenter observational cohort study. SETTINGS Acute medical units in four Italian hospitals. PARTICIPANTS A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.
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Affiliation(s)
- Paola Rebora
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Renzo Rozzini
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Angelo Bianchetti
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy
| | - Paolo Blangiardo
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Alice Marchegiani
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Andrea Piazzoli
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Francesca Mazzeo
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giulia Cesaroni
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Anita Chizzoli
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy.,Department of Clinical and Experimental Sciences, Geriatric School, University of Brescia, Brescia, Italy
| | - Fabio Guerini
- Medicine and Rehabilitation Department, Istituto Clinico S. Anna Hospital, Brescia, Italy
| | - Paolo Bonfanti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Infectious Diseases Unit, San Gerardo Hospital, Monza, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy.,Parc Sanitari Pere Virgili and Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Bianca Faraci
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy
| | - Simona Gentile
- Department of Rehabilitation and Aged Care, "Fondazione Camplani" Hospital, Cremona, Italy
| | - Claudio Bna
- Department of Radiology and Medical Imaging, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giordano Savelli
- Department of Radiology and Medical Imaging, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Maria Grazia Valsecchi
- Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.,Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
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Bombelli S, Meregalli C, Grasselli C, Bolognesi MM, Bruno A, Eriani S, Torsello B, De Marco S, Bernasconi DP, Zucchini N, Mazzola P, Bianchi C, Grasso M, Albini A, Cattoretti G, Perego RA. PKH high/CD133+/CD24- Renal Stem-Like Cells Isolated from Human Nephrospheres Exhibit In Vitro Multipotency. Cells 2020; 9:cells9081805. [PMID: 32751333 PMCID: PMC7465083 DOI: 10.3390/cells9081805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 12/17/2022] Open
Abstract
The mechanism upon which human kidneys undergo regeneration is debated, though different lineage-tracing mouse models have tried to explain the cellular types and the mechanisms involved. Different sources of human renal progenitors have been proposed, but it is difficult to argue whether these populations have the same capacities that have been described in mice. Using the nephrosphere (NS) model, we isolated the quiescent population of adult human renal stem-like PKHhigh/CD133+/CD24− cells (RSC). The aim of this study was to deepen the RSC in vitro multipotency capacity. RSC, not expressing endothelial markers, generated secondary nephrospheres containing CD31+/vWf+ cells and cytokeratin positive cells, indicating the coexistence of endothelial and epithelial commitment. RSC cultured on decellularized human renal scaffolds generated endothelial structures together with the proximal and distal tubular structures. CD31+ endothelial committed progenitors sorted from nephrospheres generated spheroids with endothelial-like sprouts in Matrigel. We also demonstrated the double commitment toward endothelial and epithelial lineages of single RSC. The ability of the plastic RSC population to recapitulate the development of tubular epithelial and endothelial renal lineages makes these cells a good tool for the creation of organoids with translational relevance for studying the parenchymal and endothelial cell interactions and developing new therapeutic strategies.
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Affiliation(s)
- Silvia Bombelli
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
- Correspondence: (R.A.P.); (S.B.); Tel.: +39-02-6448-8303 (R.A.P.); +39-02-6448-8326 (S.B.)
| | - Chiara Meregalli
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Chiara Grasselli
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Maddalena M. Bolognesi
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | | | - Stefano Eriani
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Barbara Torsello
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Sofia De Marco
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Davide P. Bernasconi
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Nicola Zucchini
- Pathology Unit, ASST Monza, San Gerardo Hospital Via G.B. Pergolesi 33, 20900 Monza, Italy;
| | - Paolo Mazzola
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
- Geriatric Unit, ASST Monza, San Gerardo Hospital Via G.B. Pergolesi 33, 20900 Monza, Italy
| | - Cristina Bianchi
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
| | - Marco Grasso
- Urology Unit, ASST Monza, San Gerardo Hospital Via G.B. Pergolesi 33, 20900 Monza, Italy;
| | - Adriana Albini
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
- IRCCS MultiMedica, 20138 Milan, Italy;
| | - Giorgio Cattoretti
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
- Pathology Unit, ASST Monza, San Gerardo Hospital Via G.B. Pergolesi 33, 20900 Monza, Italy;
| | - Roberto A. Perego
- School of Medicine and Surgery, Milano-Bicocca University, Via Cadore 48, 20900 Monza, Italy; (C.M.); (C.G.); (M.M.B.); (S.E.); (B.T.); (S.D.M.); (D.P.B.); (P.M.); (C.B.); (A.A.); (G.C.)
- Correspondence: (R.A.P.); (S.B.); Tel.: +39-02-6448-8303 (R.A.P.); +39-02-6448-8326 (S.B.)
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Maiuri G, Luca FF, Andrea A, Giovanni S, Rossella N, Castegnaro E, De Rosa S, Sechi RB, Benvenuti E, Del Lungo I, Giardini S, Giulietti C, Mauro DB, Eleonora B, Roberto F, Paolo B, DuranteMangoni E, Testoni M, Fabio DS, Loredana S, Valeria S, Fabiano M, Annabella DG, Salvatore DC, Martina P, Greco A, Grazia D, Daniele S, Gianluca R, Renzo G, Sergio M, Morena B, Vitali M, Marina P, Paolo DC, Irene F, Cristina S, Alessandra F, Orlandini F, La Regina M, Desirée A, Mirella F, Marco F, Mario B, Paola P, Giuliana B, Riccardo B, Michela T, Eleonora C, Padulo F, Cristina M, Dario R, Giancarla M, Guido R, Elena M, Prete C, Marileda N, Federica S, Igor B, Nicole B, Elena R, Paolillo C, Riccardi A, Claudia B, Barbara R, Francesca M, Silvia V, Chiara C, Ilaria DL, Oliver B, Mauro C, Eleonora M, Giuseppe P, Rosaria T, Maria C, Davide D, Stefania C, Marco C, Massimo P, Bertoletti E, Luca S, Martina DF, Paola V, Lia S, Sandro C, Valentina DS, Erminia B, Paola C, Romina R, Minisola S, D'Amico F, Luciano C, Pasquale A, Ilaria L, Francesca C, Guglielmo S, Marco E, Sara R, Paola A, Claudio A, Francesco R, Caronzolo F, Alessandro C, Simona M, Lara F, Paola R, Simonetta C, Antonella C, Generoso U, Fernando G, Giuliano C, Emanuela S, Grippa A, Mariolina S, Alessandro D, Chiara P, Giulia L, Alessandro G, Famularo S, Sandini M, Pinotti E, Gianotti L, Antonella B, Lombardo G, Giulia P, Sante G, Rossi A, Rubele S, Sant S, Marco V, Danila C, Fabio R, Bandirali MP, Nicoletta C, Pipicella T, Laura B, Paolo T, Luciano T, Leonello A, Margherita S, Stefania DN, Pierluigi DS, Laura R, Fabiana T, Giovanna C, Antonino S, Antonino A, Felice C, Giuseppe B, Danilo F, Giovanna DB, Francesco L, Salini S, Angela BM, De Filippi F, Giorgetta C, Francesco C, Giovanni G, Paola C, Gerardo B, Silvio R, Letizia S, Sabrina P, Davide B, Rosaria RM, Maria DA, Raffaele P, Valeria PG, Palmieri VO, Palasciano G, Belfiore A, Portincasa P, Carlo S, Vincenzo S, Alessia D, Valiani V, Carolina B, Tiziana C, Daniela L, Giuseppe M, Francesca C, Giordano C, Roberto S, Paola T, Ugo P, Federica R, Giacomo P, Castellano M, Anna G, Domenico C, Elisa C, Federica C, Antonietta CM, Luigi M, Fabio L, Salvatore B, Giuseppe M, Gelosa G, Viviana AT, Piras V, Giorgio B, Andrea C, Alessandra B, Coen D, Magliola R, Milanesio D, Muzzulini CL, Paolo F, Marinella T, Sofia CM, Marta B, March A, Siano P, Capo G, Napoletano R, Cecilia P, Mancini C, Del Buono C, De Bartolomeo G, Addolorata M, Carmen C, Roberto C, Nitti MT, Giovanni VA, Moschettini G, Franco M, Daniela R, D'Amico G, Mirella P, Endrizzi C, Trotta L, Ciarambino T, Orazio Z, Felici A, Emanuela T, Marta S, Thomas F, Giacomo T, Ignazio DF, Andrea B, Giuseppe O, Emanuela F, Serena A, Elena D, Pavan S, Anna C, Serena B, Erika N, Roberto S, Elena S, Manuela P, Francesca A, Angelo T, Piazzani F, Lunelli A, Dimori S, Margotta A, Soglia T, Postacchini D, Brunelli R, Santini S, Francavilla M, Macchiati I, Sorvillo F, Giuli C, Mecocci P, Longo A, Perticone F, Addesi D, Rosa PC, Bencardino G, Falbo T, Grillo N, Marco F, Mirella F, Fantò F, Isaia G, Pezzilli S, Bergamo D, Furno E, Rrodhe S, Lucarini S, Dijk B, Dall'Acqua F, Cappelletto F, Calvani D, Becheri D, Giuseppe M, Costanza M, Vito A, Francesca B, Magherini L, Novella M, Franca B, Lucia Gambardella PM, Valente C, Ilaria B, Alice F, Bo M, Porrino P, Ceci G, Giuliana B, Michela T, Eleonora C, Ettore E, Camellini C, Servello A, Grassi A, Rozzini R, Tironi S, Grassi MG, Troisi E, Carlo C, Simona Gabriella DS, Flaminia F, Federica R, Beatrice P, Sofia T, Gabutto A, Quazzo L, Rosatello A, Suraci D, Tagliabue B, Perrone C, Ferrara L, Castagna A, Tremolada ML, Giuseppe C, Stefano B, Davide O, Piano S, Serviddio G, Lo Buglio A, Gurrera T, Merlo V, Rovai C, Cotroneo AM, Carlucci R, Abbaldo A, Monzani F, Qasem AA, Bini G, Tafuto S, Galli G, Bruni AC, Mancuso G, Mancuso G, Calipari D, Giuseppe Massimiliano DL, Bernardini B, Corsini C, Michele C, Sara DF, Cagnin A, Fragiacomo F, Pompanin S, Piero A, Marco C, Zurlo A, Guerra G, Pala M, Menozzi L, Gatti CD, Magon S, Roberto M, Alfredo DG, Fabio F, Ruana T, Elisa M, Benedetta B, Christian M, Marco P, Massimo G, Di Francesco V, Faccioli S, Pellizzari L, Giorgia F, Barbagallo G, Lunardelli ML, Martini E, Ferrari E, Macchiarulo M, Corneli M, Bacci M, Battaglia G, Anastasio L, Lo Storto MS, Seresin C, Simonato M, Loreggian M, Cestonaro F, Durando M, Latella R, Mazzoleni M, Russo G, Ponte M, Valchera A, Salustri G, Petritola D, Costa A, Sinforiani E, Cotta MR, Piano S, Pizio RN, Cester A, Formilan M, Pietro B, Carbone P, Cazzaniga I, Appollonio I, Cereda D, Stabile A, Xhani R, Acampora R, Tremolizzo L, Federico P, Antonio C, Valerio P, Cesare B, Zhirajr M, Giovanni V, Maria A, Mariaelena S, Bottacchi E, Bucciantini E, Di Giovanni M, Franchi F, Lucchetti L, Mariani C, Grande G, Rapazzini P, Marco M, Romanelli G, Marengoni A, Franco N, Alessio M, Stefano B, Nicola L, Laura P, Nazario P, Carlo C, Chiara G, Soccorso P, Andrea S, Luca B, Francesca S, Roberto A, Marco F, Anna C, Francesco C, Anna C, Fugazza L, Guerrini C, De Paduanis G, Iallonardo L, Palumbo P, Zuliani G, Ortolani B, Capatti E, Soavi C, Bianchi L, Francesconi D, Miselli A, Gloria B, Tommaso R, Chiara P, Agata MM, Marco D, Luca M, Gianluca G, Suardi T, Mazzone A, Zaccarini C, Manuela R, Mirra G, Muti E, Bottura R, Gianpaolo M, Secreto P, Bisio E, Cecchettani M, Naldi T, Pallavicino A, Pugliese M, Iozzo RC, Grassi G, Michele B, Raffaella D, Fosca QT, Giorgio GC, Giovanni P, Ernesto C, Soccorso P, Mannironi A, Giorli E, Oberti S, Fierro B, Piccoli T, Giacalone F, Mandas A, Serchisu L, Costaggiu D, Pinna E, Orrù F, Mannai M, Cordioli Z, Pelizzari L, Turcato E, Arduini P, Cacace C, Chiloiro R, Cimino R, Ruberto C, Giovanni R, Pietro G, Laura G, Alberto C, Pietro G, Carmen R, Santo PD, Andriolli A, Burattin G, Rossi L, Andreolli Antonino CG, Giuseppe C, Tezza F, Maddalena P, Laura S, Crippa P, Aloisio P, Di Monda T, Malighetti A, Galbassini G, Salutis D, Ivaldi C, Russo AM, Bennati E, Pino E, Zavarise G, Pesci A, Suigo G, Faverio P, Andrea G, Sabrina P, Zanasi M, Moniello G, Rostagno C, Cartei A, Polidori G, Ungar A, Melis MR, Martellini E, Enrico M, Monica T, Antonella G, Giovanna L, Migliorini M, Caramelli F, Battiston B, Berardino M, Cavallo S, Alessandro M, Anna S, Lombardi B, D'Ippolito P, Furini A, Villani D, Clara R, Guarneri M, Paolucci S, Bassi A, Coiro P, De Angelis D, Morone G, Venturiero V, Palleschi L, Raganato P, Di Niro G, Rosa CA, Loredana B, Imoscopi A, Isaia G, Tibaldi V, Bottignole G G, Calvi E, Clementi C, Zanocchi M, Agosta L, Nortarelli A, Provenzano G, Mari D, Romano FY, Rosini F, Mansi M, Rossi S, Geriatria AR, Inzaghi L, Bonini G, Rossi P, Potena A, Lichii M, Candiani T, Grimaldi W, Bertani E, Alessandra P, Calogero P, Pinto D, Bernardi R, Nicolino F, Galetti C, Gianstefani A, Giulia C, Lorenzo M, Odetti P, Monacelli F, Prefumo M, Fiammetta M, Canepa M, Minaglia C, Paolisso G, Rizzo MR, Prestano R, Dalise AM, Barra D, Bosco LD, Asprinio V, Dallape L, Perina E, Incalzi RA, Bartoli IR, Pluderi A, Maina A, Pecoraro E, Sciarra M, Prudente A, Paola M, Francesca M, Manuel V, Luisella C, Maria PL, Tina S, Benini L, Levato F, Mhiuta V, Alius F, Davidoaia D, Giardini V, Garancini M, Bellamoli C, Terranova L, Bozzini C, Tosoni P, Provoli E, Cascone L, Dioli A, Ferrarin G, Gabutto A, Bucci A, Bua G, Fenu S, Bianchi G, Casella S, Romano V, Maurizio P, Mascherona I, Belotti G, Cavaliere S, Cuni E, Merciuc N, Oberti R, Veneziani S, Capoferri E, De Bernardi E, Colombo K, Bravi M, Nicoletta N, D'Arcangelo P, Montenegro N, Galli G, Montanari R, Lamanna P, Gasperini B, Isabella M, Stefania D, Gaia A, Filippo C, Palamà C, Di Emidio C, Scarpini E, Arighi A, Fumagalli G, Basilico P, De Amicis Margherita M, Marta M, Diletta M, D'Amico F, Granata A, Rostagno C, Ranalli C, Cammilli A, Cavallini MC, Tricca M, Natella D, Gabbani L, Tesi F, Martella L, Gurrera T, Imbrici R, Guerrini G, Scotuzzi AM, Sozzi F, Valenti L, Chiarello A, Monia M, Pilotto A, Prete C, Senesi B, Meta AC, Pendenza E, Monzani F, Pasqualetti G, Polini A, Tognini S, Ballino E, Cherubini A, Dell'Aquila G, Gasparrini PM, Marotti E, Migale M, Scrimieri A, Falsetti L, Salvi A, Toigo G, Ceschia G, Rosso A, Tongiorgi C, Scarpa C, Maurizio P, De Dominicis L, Pucci E, Renzi S, Cartechini E, Tomassini PF, Del Gobbo M, Ugenti F, Romeo P, Nardelli A, Lauretani F, Visioli S, Montanari I, Ermini F, Giordano A, Pigato G, Simeone E, Barbujani M, Giampieri M, Amoruso R, Piccinini M, Ferrari C, Gambetti C, Sfrappini M, Semeraro L, Striuli R, Mariani C, Pelliccioni G, Marinelli D, Fabi K, Rossi T, Pesallaccia M, Sabbatini D, Gobbi B, Cerqua R, Tagliani G, Schlauser E, Caser L, Caramello E, Sandigliano F, Rosso G, Ferrari A, Bendini C, Luisa DM, Casella M, Prampolini R, Scevola M, Vitale E, Roberto B, Carlo F, Sergio F, Alberto S, Daniela Z, Giulia B, Serena G, Michele B, Maugeri D, Sorace R, Anzaldi M, De Gesu R, Morrone G, Davolio F, Fabbo A, Palmieri M, Barbagallo G, Zoli M, Forti P, Pirazzoli L, Fabbri E, Terenzi L, Bergolari F, Wenter C, Ruffini I, Insam M, Abraham E, Kirchlechner C, Cucinotta D, Antonino L, Basile G, Grazia AM, Parise P, Boccali A, Amici S, Gambacorta M, Ferrari A, Lasagni A, Lovati R, Giovinazzo F, Kimak E, Zappa P, Medici F, Lo Castro M, Mauro F, De Luca A, Sancesario G, Martorana A, Scaricamazza B, Toniolo S, Di Lorenzo F, Liguori C, Lasco A, Basile G, Vita N, Giomi M, Dimori S, Forte F, Padovani A, Rozzini L, Ceraso A, Salvatore C, Padovani A, Cottino M, Vitali S, Marelli E, Tripi G, Miceli S, Urso G, Grioni G, Vezzadini G, Misaggi G, Forlani C, Avanzi S, Serena S, Claudia C, Marilena V, Alberto L, Diego G, Alessandro G, Iemolo F, Giordano A, Sanzaro E, D'Asta G, Proietto M, Carnemolla A, Razza G, Spadaro D, Bertolotti M, Mussi C, Neviani F, Roberto C, Valentina G, Linda M, Francesca V, Tarozzi A, Balestri F, Monica T, Mannarino G, Tesi F, Bigolari M, Natale A, Grassi S, Bottaro C, Stefanelli S, Bovone U, Tortorolo U, Quadri R, Leone G, Ponzetto M, Frasson P, Annoni G, Bellelli G, Bruni A, Confalonieri R, Corsi M, Moretti D, Teruzzi F, Umidi S, Mazzola P, Perego S, Persico I, Olivieri G, Bonfanti A, Hajnalka S, Galeazzi M, Massariello F, Anzuini A, Caffarra P, Barocco F, Spallazzi M, Paolo CG, Simonetta M, Andrea A, Chioatto P, Bortolamei S, Soattin L, Ruotolo G, Beneamino B, Pietro G, Giuseppe B, Carmen R, Castagna A, Bertazzoli M, Rota E, Adobati A, Scarpa A, Granziera S, Zuccher P, Fabbro AD, Zara D, Lo Nigro A, Franchetti L, Toniolo M, Marcuzzo C, Piano S, Rollone M, Guerriero F, Sgarlata C, Massè A, Berardino M, Cavallo S, Anna S, Zatti G, Piatti M, Graci J, Benati G, Boschi F, Biondi M, Fiumi N, Erika T, Locatelli SM, Mauri S, Beretta M, Margheritis L, Desideri G, Liberatore E, Carucci AC, Bonino P, Caput M, Antonietti MP, Polistena G, De la Pierre F, Mari M, Massignani P, Tombesi F, Selvaggio F, Verbo B, Bodoni P, Marchionni N, Mossello E, Cavallini MC, Sabatini T, Mussio E, Magni E, Bianchetti A, Crucitti A, Titoldini G, Cossu B, Fascendini S, Licini C, Tomasoni A, Calderazzo M, Daniela T, Valentina L, Ferrari A, Prampolini R, Melotti RM, Lilli A, Buda S, Adversi M, Noro G, Turco R, Ubezio MC, Mantovani AR, Viola MC, Serrati C, Pretta S, Infante M, Gentile S, Morandi A, D'Ambrosio V, Mazzanti P, Brambilla C, Sportelli S, Platto C, Faraci B, Quattrocchi D, Pernigotti LM, Pisu C, Sicuro F, Oliverio M, Del Grosso LL, Zagnoni P, Ghiglia S, Mosca M, Corazzin I, Deola M, Biagini CA, Bencini F, Cantini C, Tonon E, Pierinelli S, Onofrj M, Thomas A, Filomena B, Bonanni L, Gabriella C, Comi G, Magnani G, Santangelo R, Mazzeo S, Giuseppe M, Francesca C, Giordano C, Roberto S, Barbieri C, Giroldi L, Davolio F, Bandini F, Masina M, Malservisi S, Cicognani A, Ricca L, Ricca L, Piccininni M, Ferrari C, Gambetti C, Tassinari T, Brogi D, Sugo A, Alessandra F, Sonia M, Valerio V, Andrea UC, Enrico C, Vera RF, Assunta S, Gianmaria Z, Mauro P, Pietro B, Roberto M, Salvatore C, Barone A, Razzano M, Giuseppe I, Angela B, Francesco S, Valeria D, Federico G, Lucia P, Antonella V, Elisabetta DC, Cristina R, Nadia C, Maria S, Luciano A, Chiara C, Bini P, Pignata M, Enrico B, Maria V, Giovanni C, Giorgio C, Andrea T, Marco M, Anna C, Piera R, Alberto Z, Ceccon A, Magrin L, Marin S, Barbara S, Marco M, Laura G, Matteo M, Marco P, Caterina PM, Carla R, Federica G, Clara T, Melania C, Giampaolo B, Stefano G, Valeria G, Lucia M, Giovambattista D, Ester L, Cecilia CA, Maurizio T, Alessandra F, Vera RF, Nadia B, Grillo A, Arenare F, Tonino M, David K, Giorgio VP, Ubaldo B, Vincenzo S, Stefano M, Marino F, Busonera Flavio MT, Paolo A, Monica M, Francesco B. Understanding Factors Associated With Psychomotor Subtypes of Delirium in Older Inpatients With Dementia. J Am Med Dir Assoc 2020; 21:486-492.e7. [DOI: 10.1016/j.jamda.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022]
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Bellelli PG, Biotto M, Morandi A, Meagher D, Cesari M, Mazzola P, Annoni G, Zambon A. The relationship among frailty, delirium and attentional tests to detect delirium: a cohort study. Eur J Intern Med 2019; 70:33-38. [PMID: 31761505 DOI: 10.1016/j.ejim.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/09/2019] [Accepted: 09/12/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Few studies explored if frailty predisposes to delirium in hospitalized older patients. The aims of this study were to evaluate if frailty: 1) is independently associated with delirium, and 2) affects the patient's performance in three tests of attention used to detect delirium. METHODS Data are from a prospective cohort study of patients admitted to an Acute Geriatric Unit (AGU). Frailty was operationalized using the health deficit accumulation model (38-item Frailty Index). Delirium was screened using the 4AT, and the diagnosis confirmed with the DSM-5th criteria. During the first 7 days from the hospital admission, patients also underwent a double-blind assessment of attention using three ad hoc tests (i.e., Months of the year backwards, MOTYB; Days of the week backwards, DOWB; and Count backwards from 20 to 1, CB). RESULTS Eighty-nine patients were included (mean age 83.1 years, standard deviation 6.0). Forty-two (47.19%) patients were frail, and 37 (41.7%) had delirium. The likelihood of delirium was significantly higher in frail compared to the non-frail patients; it was also inversely associated with the three attention tests. Using the MOTYB test, the ability to discriminate delirium was similar in patients with (Area Under the Receiving Operator Characteristic [AUROC] 0.88, 95% Confidence Interval [CI] 0.82-0.92) and without frailty (AUROC 0.93, 95%CI 0.90-0.95) whilst was markedly different between the same groups using either DOWB and CB. CONCLUSIONS Frailty is associated with delirium in hospitalized older patients and can influence the patient's performances at attentional tests that are commonly used to screen delirium.
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Affiliation(s)
- Prof Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Acute Geriatric Unit, San Gerardo hospital, Monza, Italy..
| | - Martina Biotto
- Geriatric Unit, Fondazione IRCCS Ca 'Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milano, Milan, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care Hospital Ancelle, Cremona, Italy
| | - David Meagher
- Cognitive Impairment Research Group (CIRG). Graduate-Entry Medical School University of Limerick, Limerick, Ireland
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca 'Granda-Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, University of Milano, Milan, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Giorgio Annoni
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900 Monza, Acute Geriatric Unit, San Gerardo hospital, Monza, Italy
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
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Mazzola P, Bombelli S, Grasselli C, Bolognesi M, Antolini L, Cattoretti G, Annoni G, Perego R. CORRELATION BETWEEN FRAILTY AND DNA DAMAGE IN HEMATOPOIETIC STEM CELLS: A PILOT STUDY. Innov Aging 2019. [PMCID: PMC6844818 DOI: 10.1093/geroni/igz038.333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Frailty is an age-related syndrome characterized by a progressive impairment of multiple physiological systems and leading to poor clinical and functional outcomes. Our aim was to explore the DNA damage, as an effect of increased oxidative stress related to frailty, on peripheral blood mononuclear cells (PBMC) and circulating hematopoietic stem cells (cHSC). According to Fried’s operating definition of frailty, we enrolled three groups of subjects: frail seniors (age >65 years, n=19), fit seniors (>65 years, n= 16) and young controls (age 25-35 years, n=19). We carried out a comprehensive assessment and obtained 3 vials of whole blood for cells and plasma separation. We separated PBMC by Ficoll-Paque and stained with specific conjugated antibodies leucocyte lineage and HSC. We evaluated DNA damage by FACS detection of γ-H2AX in the total PBMC and cHSC subpopulation. We observed an increased percentage of cells, although not significant, with DNA damage in PBMC from frail seniors (0.70%) compared to fit seniors (0.37%) and young controls (0.13%). The percentage of cells with DNA damage in cHSC of frail seniors (2.97%) was higher compared to fit seniors (1.66%, not significant) and young controls (0.46%, statistically significant). Moreover, cHSC present the statistically higher amount of DNA damage, measured as fluorescence intensity, compared to fit seniors and young controls. cHSC from frail seniors show the highest total DNA damage, compared to fit seniors and young controls. This is probably linked to an increase of oxidative stress related to frailty, which we are going to analyze in the near future.
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Affiliation(s)
- Paolo Mazzola
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
| | - Silvia Bombelli
- University of Milano-Bicocca, Department of Medicine and Surgery, Monza, Italy
| | - Chiara Grasselli
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
| | | | - Laura Antolini
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
| | - Giorgio Cattoretti
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
| | - Giorgio Annoni
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
| | - Roberto Perego
- University of Milano-bicocca, School of medicine and surgery, Monza, Italy
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24
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Carlotta F, Raffaella R, Ilaria A, Alessandro N, Mannuccio MP, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Caterina C, Biolo G, Zanetti M, Guadagni M, Zaccari M, Chiuch M, Zaccari M, Vanoli M, Grignani G, Pulixi EA, Bernardi M, Bassi SL, Santi L, Zaccherini G, Lupattelli G, Mannarino E, Bianconi V, Paciullo F, Alcidi R, Nuti R, Valenti R, Ruvio M, Cappelli S, Palazzuoli A, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Cocita F, Beneduce V, Plances L, Corrao S, Natoli G, Mularo S, Raspanti M, Cavallaro F, Zoli M, Lazzari I, Brunori M, Fabbri E, Magalotti D, Arnò R, Pasini FL, Capecchi PL, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Maira D, Di Stefano V, Fabio G, Seghezzi S, Mancarella M, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Conti F, Bonini G, Ottolini BB, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Murialdo G, Marra A, Cattaneo F, Pontremoli R, Beccati V, Nobili G, Secchi MB, Ghelfi D, Anastasio L, Sofia L, Carbone M, Cipollone F, Guagnano MT, Valeriani E, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Pes C, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Zuccalà G, D’Aurizio G, Romanelli G, Marengoni A, Zucchelli A, Manzoni F, Volpini A, Picardi A, Gentilucci UV, Gallo P, Dell’Unto C, Annoni G, Corsi M, Bellelli G, Zazzetta S, Mazzola P, Szabo H, Bonfanti A, Arturi F, Succurro E, Rubino M, Tassone B, Sesti G, Interna M, Serra MG, Bleve MA, Gasbarrone L, Sajeva MR, Brucato A, Ghidoni S, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Cosi E, Scarinzi P, Amabile A, Omenetto E, Prandini T, Manfredini R, Fabbian F, Boari B, Giorgi AD, Tiseo R, De Giorgio R, Paolisso G, Rizzo MR, Borghi C, Strocchi E, Ianniello E, Soldati M, Sabbà C, Vella FS, Suppressa P, Schilardi A, Loparco F, De Vincenzo GM, Comitangelo A, Amoruso E, Fenoglio L, Falcetta A, Bracco C, Fracanzani AL, Fargion S, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Ferrari B, Colombo G, Agosti P, Monzani V, Savojardo V, Folli C, Ceriani G, Salerno F, Pallini G, Dallegri F, Ottonello L, Liberale L, Caserza L, Salam K, Liberato NL, Tognin T, Bianchi GB, Giaquinto S, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Spazzini E, Ferrandina C, Montrucchio G, Petitti P, Peasso P, Favale E, Poletto C, Salmi R, Gaudenzi P, Violi F, Perri L, Landolfi R, Montalto M, Mirijello A, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Dondi G, Pellegrini E, Carulli L, Galassi M, Grassi Y, Perticone F, Perticone M, Battaglia R, FIlice M, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Gabrielli A, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Marigliano B, Pipita ME, Castellino P, Zanoli L, Pignataro S, Gennaro A, Blanco J, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Cittadini A, Vigorito C, Arcopinto M, Salzano A, Bobbio E, Marra AM, Sirico D, Moreo G, Gasparini F, Prolo S, Pina G, Ballestrero A, Ferrando F, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Scattolin G, Martinelli S, Turrin M, Sechi L, Catena C, Colussi G, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Del Giacco S, Firinu D, Losa F, Paoletti G, Costanzo G, Montalto G, Licata A, Malerba V, Montalto FA, Lasco A, Basile G, Catalano A, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, La Malfa L, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Lauretani F, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Pirisi M, Fra GP, Sola D, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Tedeschi A, Trotta L, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Cattaneo M, Napoli F. Prevalence of use and appropriateness of antidepressants prescription in acutely hospitalized elderly patients. Eur J Intern Med 2019; 68:e7-e11. [PMID: 31405773 DOI: 10.1016/j.ejim.2019.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/25/2019] [Indexed: 11/29/2022]
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Pincelli AI, Perotti M, Massariello F, Gatti A, Calella D, Cimino V, Haas J, Bellelli G, Mazzola P, Annoni G. A Rare Diagnosis After the Fall of a 96-Year-Old Woman: Doege-Potter Syndrome. Curr Aging Sci 2018; 11:195-200. [PMID: 30520387 PMCID: PMC6388424 DOI: 10.2174/1874609812666181205142247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 10/13/2018] [Accepted: 10/23/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Doege-Potter Syndrome (DPS) is a rare but life-threatening paraneoplastic syndrome, characterized by Non-Islet Cell Tumor-Induced Hypoglycemia (NICTH) secondary to a Solitary Fibrous Tumor (SFT), which secretes an incompletely processed form of Insulin-like Growth Factor 2 (IGF-2). RESULTS A 96-year-old woman was admitted with head trauma due to an accidental fall. During her hospital stay she experienced frequent hypoglycemic episodes. Multiple injections of 33% dextrose and continuous infusion with 10% dextrose were required to maintain normal blood glucose levels. Biochemical analyses revealed hypoinsulinemic hypoglycemia, low C-peptide levels, suppressed insulin-like growth factor-1, normal insulin-like growth factor-2, and an elevated IGF-2:IGF-1 ratio, all consistent with IGF-2 secretion by a non-islet cell tumor. A contrast-enhanced chest and abdominal CT scans showed a single large pleural mass in the left lower hemithorax measuring 15x14 cm without secondary lesions. Histological analysis of biopsied specimens suggested a solitary fibrous pleural tumor; accordingly, a diagnosis of Doege-Potter syndrome was considered. Due to extensive tumor burden and the advanced age of the patient, supportive and non-invasive management was chosen. Dexamethasone therapy was started, and while receiving this therapy she was able to discontinue glucose infusion and successfully maintain euglycemia. DISCUSSION In the elderly, a sudden and unexplained fall can be the expression of severe hypoglycemia, usually as a complication of insulin therapy or of oral hypoglycemic agents administered to patients with diabetes. However, in patients without diabetes, other causes should be investigated, and the hypothesis of neoplastic diseases should be considered. CONCLUSION In this case report we describe an uncommon cause of paraneoplastic hypoglycemia occurring in the oldest patient with a non-islet cell tumor reported thus far.
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Affiliation(s)
- Angela Ida Pincelli
- San Gerardo Hospital ASST Monza, Division of Internal Medicine, Monza, Italy
| | - Mario Perotti
- San Gerardo Hospital ASST Monza, Division of Internal Medicine, Monza, Italy
| | | | - Antonella Gatti
- University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy
| | - Damiano Calella
- San Gerardo Hospital ASST Monza, Division of Internal Medicine, Monza, Italy
| | - Vincenzo Cimino
- San Gerardo Hospital ASST Monza, Division of Internal Medicine, Monza, Italy
| | | | - Giuseppe Bellelli
- University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy.,Acute Geriatrics Unit, Monza (MB), Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milano (MI), Italy
| | - Paolo Mazzola
- University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milano (MI), Italy
| | - Giorgio Annoni
- University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB), Italy.,Acute Geriatrics Unit, Monza (MB), Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milano (MI), Italy
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26
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Ho L, Zhao D, Ono K, Ruan K, Mogno I, Tsuji M, Carry E, Brathwaite J, Sims S, Frolinger T, Westfall S, Mazzola P, Wu Q, Hao K, Lloyd TE, Simon JE, Faith J, Pasinetti GM. Heterogeneity in gut microbiota drive polyphenol metabolism that influences α-synuclein misfolding and toxicity. J Nutr Biochem 2018; 64:170-181. [PMID: 30530257 DOI: 10.1016/j.jnutbio.2018.10.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022]
Abstract
The intestinal microbiota actively converts dietary flavanols into phenolic acids, some of which are bioavailable in vivo and may promote resilience to select neurological disorders by interfering with key pathologic mechanisms. Since every person harbors a unique set of gut bacteria, we investigated the influence of the gut microbiota's interpersonal heterogeneity on the production and bioavailability of flavonoid metabolites that may interfere with the misfolding of alpha (α)-synuclein, a process that plays a central role in Parkinson's disease and other α-synucleinopathies. We generated two experimental groups of humanized gnotobiotic mice with compositionally diverse gut bacteria and orally treated the mice with a flavanol-rich preparation (FRP). The two gnotobiotic mouse groups exhibited distinct differences in the generation and bioavailability of FRP-derived microbial phenolic acid metabolites that have bioactivity towards interfering with α-synuclein misfolding or inflammation. We also demonstrated that these bioactive phenolic acids are effective in modulating the development and progression of motor dysfunction in a Drosophila model of α-synucleinopathy. Lastly, through in vitro bacterial fermentation studies, we identified select bacteria that are capable of supporting the generation of these bioavailable and bioactive phenolic acids. Outcomes from our studies provide a better understanding of how interpersonal heterogeneity in the gut microbiota differentially modulates the efficacy of dietary flavanols to protect against select pathologic mechanisms. Collectively, our findings provide the basis for future developments of probiotic, prebiotic, or synbiotic approaches for modulating the onset and/or progression of α-synucleinopathies and other neurological disorders involving protein misfolding and/or inflammation.
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Affiliation(s)
- Lap Ho
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA 10468
| | - Danyue Zhao
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA 08901
| | - Kenjiro Ono
- Department of Internal Medicine, Division of Neurology, Showa University School of Medicine, Tokyo, Japan
| | - Kai Ruan
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, USA, MD 21205
| | - Ilaria Mogno
- Precision Immunology Institute and Department of Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Mayumi Tsuji
- Department of Pharmacology, Showa University School of Medicine, Tokyo, Japan
| | - Eileen Carry
- Department of Medicinal Chemistry, Ernest Mario School of Pharmacy, Piscataway, NJ, USA 08854
| | - Justin Brathwaite
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Steven Sims
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Tal Frolinger
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Susan Westfall
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Paolo Mazzola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Qingli Wu
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA 08901
| | - Ke Hao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029; Icahn Institute of Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Thomas E Lloyd
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, USA, MD 21205; Solomon H. Snyder Department of Neuroscience, Johns Hopkins School of Medicine, Baltimore, USA, MD 21205
| | - James E Simon
- New Use Agriculture and Natural Plant Products Program, Department of Plant Biology, Rutgers University, New Brunswick, NJ, USA 08901
| | - Jeremiah Faith
- Precision Immunology Institute and Department of Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029
| | - Giulio M Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, New York, USA 10029; Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA 10468.
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Mazzola P, Merla L, Guerini V, Cappuccio M, Bellelli G, Annoni G. COGNITIVE PERFORMANCES AND REHABILITATION OUTCOMES: FOCUS ON PATIENTS WITH COGNITIVE IMPAIRMENT. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - L Merla
- Fondazione IPS Cardinal Gusmini
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Persico I, Cesari M, Morandi A, Haas J, Mazzola P, Zambon A, Annoni G, Bellelli G. Frailty and Delirium in Older Adults: A Systematic Review and Meta-Analysis of the Literature. J Am Geriatr Soc 2018; 66:2022-2030. [PMID: 30238970 DOI: 10.1111/jgs.15503] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To evaluate the relationship between frailty and delirium. DESIGN Systematic review and meta-analysis. SETTING MEDLINE, EMBASE, PubMed, Scopus, Web of Science, and Google Scholar databases were searched for articles on frailty and delirium published on or before October 31, 2017. PARTICIPANTS Individuals aged 65 and older. MEASUREMENTS Two authors independently reviewed all English-language citations, extracted relevant data, and assessed studies for potential bias. Articles involving pediatric or neurosurgical populations, alcohol or substance abuse, psychiatric illness, head trauma, or stroke, as well as review articles, letters, and case reports were excluded. Studies underwent qualitative or quantitative analysis according to specified criteria. Using a random-effects or fixed-effects model, relative risk (RR) was calculated for the effect of frailty as a predictor of subsequent delirium. Heterogeneity was tested using Q and I2 statistics. RESULTS We identified 1,626 articles from our initial search, of which 20 fulfilled the selection criteria (N=5,541 participants, mean age 77.8). Eight studies were eligible for meta-analysis, showing a significant association between Q2 frailty and subsequent delirium (RR = 2.19, 95% confidence interval = 1.65-2.91). There was low variability among studies in the measures of association between frailty and delirium (I2 2.24, p-value Q-statistic = .41) but high heterogeneity in the methods used to assess the two conditions. CONCLUSION This systematic review and meta-analysis supports the existence of an independent relationship between frailty and delirium, although there is notable methodological heterogeneity between the methods used to assess the 2 conditions. Future studies are needed to better delineate the dynamics between these syndromes.
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Affiliation(s)
- Ilaria Persico
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione IRCCS Ca 'Granda-Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milano, Milan, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care Unit, Ancelle della Carità Hospital, Cremona, Italy
| | - Justin Haas
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Paolo Mazzola
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy
| | - Antonella Zambon
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milano, Italy
| | - Giorgio Annoni
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.,Acute Geriatric Unit San Gerardo Hospital, Monza, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, Milano-Bicocca University, Monza, Italy.,Acute Geriatric Unit San Gerardo Hospital, Monza, Italy
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Bellelli G, Carnevali L, Corsi M, Morandi A, Zambon A, Mazzola P, Galeazzi M, Bonfanti A, Massariello F, Szabo H, Oliveri G, Haas J, d'Oro LC, Annoni G. The impact of psychomotor subtypes and duration of delirium on 6-month mortality in hip-fractured elderly patients. Int J Geriatr Psychiatry 2018; 33:1229-1235. [PMID: 29851194 DOI: 10.1002/gps.4914] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/19/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Studies exploring the incidence and impact of the psychomotor subtypes of postoperative delirium (POD) on the survival of hip fracture patients are few, and results are inconsistent. We sought to assess the incidence of POD subtypes and their impact, in addition to delirium duration, on 6-month mortality in older patients after hip-fracture surgery. METHODS This is a prospective study involving 571 individuals admitted to an Orthogeriatric Unit within a 5-year period with a diagnosis of hip fracture. Survival status was assessed 6 months after posthip fracture surgery. Postoperative delirium was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. Postoperative delirium subtypes were classified according to Lipowski's criteria. Cox regressions were used to evaluate the associations between POD subtypes, POD duration, and 6-month mortality, adjusting for covariates. RESULTS The incidence of psychomotor POD subtypes was hypoactive 57 (10.0%), hyperactive 84 (14.7%), and mixed 79 (13.8%). Six-month mortality rates were 8.3%, 10.7%, 36.8%, and 29.1% in the no-delirium, hyperactive, hypoactive, and mixed-delirium subgroups, respectively. In adjusted models, the hypoactive subgroup (Hazard Ratio, HR = 3.14, 95% Confidence Intervals, CI, 1.63-6.04) and mixed subgroup (HR = 2.89, 95% CI, 1.49-5.62) showed high mortality rates and a significantly increased risk of mortality associated with POD duration as well. CONCLUSIONS Hyperactive delirium was the most common POD psychomotor subtype, but hypoactive and mixed POD were associated with 6-month mortality risk. Moreover, the risk of death 6 months after surgery increased for both subgroups (hypoactive and mixed) with increasing duration of POD.
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Affiliation(s)
- Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, S. Gerardo Hospital, Monza, Italy
- Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
| | | | - Maurizio Corsi
- Acute Geriatric Unit, S. Gerardo Hospital, Monza, Italy
- Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
| | - Alessandro Morandi
- Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
| | - Marianna Galeazzi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Hajnalka Szabo
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giulia Oliveri
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Justin Haas
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | | | - Giorgio Annoni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Acute Geriatric Unit, S. Gerardo Hospital, Monza, Italy
- Milan Center for Neuroscience (Neuro-Mi), Milan, Italy
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Mazzola P, Floris P, Picone D, Anzuini A, Tsiantouli E, Haas J, Bellelli G, De Filippi F, Annoni G. Functional and clinical outcomes of patients aged younger and older than 85 years after rehabilitation post-hip fracture surgery in a co-managed orthogeriatric unit. Geriatr Gerontol Int 2018; 18:1194-1199. [DOI: 10.1111/ggi.13440] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Affiliation(s)
- Paolo Mazzola
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
| | - Patrizia Floris
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Acute Geriatrics Unit, Department of Medicine; Sondrio Hospital, ASST of Valtellina and Alto Lario; Sondrio Italy
| | - Domenico Picone
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
| | - Alessandra Anzuini
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
| | - Eleni Tsiantouli
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Department of Bone Diseases; Geneva University Hospital; Geneva Switzerland
| | - Justin Haas
- Neuroscience and Mental Health Institute, University of Alberta; Edmonton Canada
| | - Giuseppe Bellelli
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
| | - Francesco De Filippi
- Acute Geriatrics Unit, Department of Medicine; Sondrio Hospital, ASST of Valtellina and Alto Lario; Sondrio Italy
| | - Giorgio Annoni
- Acute Geriatrics Unit; School of Medicine and Surgery, University of Milano-Bicocca; Monza Italy
- Clinical Neurosciences Research Area; NeuroMI - Milan Center for Neuroscience; Milan Italy
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31
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Casati M, Ferri E, Gussago C, Mazzola P, Abbate C, Bellelli G, Mari D, Cesari M, Arosio B. Increased expression of TREM2 in peripheral cells from mild cognitive impairment patients who progress into Alzheimer's disease. Eur J Neurol 2018; 25:805-810. [PMID: 29377401 DOI: 10.1111/ene.13583] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/19/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Neuroinflammation plays a role in the aetiopathogenesis of Alzheimer's disease (AD). Triggering receptor expressed on myeloid cells 2 (TREM2), a cell surface receptor of the immunoglobulin superfamily, seems to have protective anti-inflammatory activity in AD. METHODS Triggering receptor expressed on myeloid cells 2 expression was analysed in peripheral blood mononuclear cells from healthy subjects (CT) and from patients with either AD or mild cognitive impairment (MCI). MCI patients were re-evaluated at a 2-year follow-up to investigate their progression to AD (MCI-AD) or lack thereof (MCI-MCI). RESULTS Triggering receptor expressed on myeloid cells 2 gene expression was higher in AD than CT patients, but was highest in MCI. At recruitment TREM2 levels were higher in MCI-AD than in MCI-MCI, and in MCI-AD were higher initially than at follow-up. TREM2 displayed a moderate degree of sensitivity and specificity for identifying MCI-AD in all MCI patients. Our data showed higher TREM2 levels in allele ε4 of apolipoprotein E (ApoE ε4) carriers than non-carriers in MCI and particularly in MCI-AD. CONCLUSIONS These data seem to confirm the protective role of TREM2 in the pre-clinical stage of AD. Upregulation of TREM2 in MCI-AD could be a mechanism to counteract the activation of neuroinflammatory processes. It is possible that TREM2 and ApoE ε4 interact synergistically in the pre-clinical stage of AD. Therefore, TREM2 may be useful as an early peripheral biomarker for the development of AD.
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Affiliation(s)
- M Casati
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Nutritional Sciences, University of Milan, Milan, Italy
| | - E Ferri
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - C Gussago
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy.,NeuroMI Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
| | - C Abbate
- Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - G Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy.,NeuroMI Milan Center for Neuroscience, Clinical Neurosciences research area, Milano, Italy
| | - D Mari
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - M Cesari
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - B Arosio
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione Ca' Granda, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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32
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Galeazzi M, Mazzola P, Valcarcel B, Bellelli G, Dinelli M, Pasinetti GM, Annoni G. Endoscopic retrograde cholangiopancreatography in the elderly: results of a retrospective study and a geriatricians' point of view. BMC Gastroenterol 2018. [PMID: 29540171 PMCID: PMC5853060 DOI: 10.1186/s12876-018-0764-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of biliary tract pathology is growing with an age-related trend, and progresses as the population ages. Endoscopic Retrograde Cholangiopancreatography (ERCP) represents the gold standard for treatment in these cases, but evidence about its safety in the elderly is still debated. Methods We retrospectively analyzed the clinical records of all patients aged ≥65 undergoing ERCP between July 2013 and July 2015. Of 387 ERCP cases, 363 (~ 94%) were completed entirely. The mean age of the study population (n = 363) was 79.9 years old (range 70–95), with 190 subjects aged 70–79 and 173 older than 80. We recorded demographics, Charlson Comorbidity index (CCI), American Society of Anesthesiologists (ASA) physical status classification score, indication for the use of the ERCP procedure, and clinical outcomes. Then, we tested all variables to identify the potential risk factors for complications associated with the procedure. Results The older group (those ≥80 years old) showed significantly more patients with ASA Classes III-IV than the younger one (those ≤79 years old). Interestingly, the CCI was higher in the younger group (p = 0.009). The overall complication rate was 17.3% without inter-group differences. Older age, sex, CCI and intra-ERCP procedures were not related to a higher risk of complications, and the multivariate regression did not identify any of the considered variables to be an independent risk factor for complications. Conclusion ERCP appears as safe in the patients aged 80 years and older, as it is in those aged 70–79 years old in our study, however, a selection bias may affect these findings. A study including a comprehensive geriatric assessment will contribute to shedding light on this issue.
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Affiliation(s)
- Marianna Galeazzi
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy
| | - Paolo Mazzola
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy. .,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.
| | | | - Giuseppe Bellelli
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.,San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
| | - Marco Dinelli
- San Gerardo Hospital ASST Monza, Endoscopy Unit, Monza, MB, Italy
| | - Giulio Maria Pasinetti
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Giorgio Annoni
- University of Milano-Bicocca, School of Medicine and Surgery, U8 Building, Floor 4, Lab 4045, Via Cadore, 48 - 20900, Monza, MB, Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.,San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
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33
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Mazzola P. Prolonged hospital stay before hip fracture surgery in the elderly: a single parameter but multiple roles. Int Orthop 2017; 42:447-448. [PMID: 29164287 DOI: 10.1007/s00264-017-3689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/06/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Paolo Mazzola
- University of Milano-Bicocca, School of Medicine and Surgery, Via Cadore, 48 - U8 Building, Floor 4, Lab 4045, 20900, Monza, MB, Italy.
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences research area, Milan, MI, Italy.
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34
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Ho L, Ono K, Tsuji M, Mazzola P, Singh R, Pasinetti GM. Protective roles of intestinal microbiota derived short chain fatty acids in Alzheimer's disease-type beta-amyloid neuropathological mechanisms. Expert Rev Neurother 2017; 18:83-90. [PMID: 29095058 DOI: 10.1080/14737175.2018.1400909] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Dietary fibers are metabolized by gastrointestinal (GI) bacteria into short-chain fatty acids (SCFAs). We investigated the potential role of these SCFAs in β-amyloid (Aβ) mediated pathological processes that play key roles in Alzheimer's disease (AD) pathogenesis. RESEARCH DESIGN AND METHODS Multiple complementary assays were used to investigate individual SCFAs for their dose-responsive effects in interfering with the assembly of Aβß1-40 and Aβ1-42 peptides into soluble neurotoxic Aβ aggregates. RESULTS We found that several select SCFAs are capable of potently inhibiting Aβ aggregations, in vitro. CONCLUSION Our studies support the hypothesis that intestinal microbiota may help protect against AD, in part, by supporting the generation of select SCFAs, which interfere with the formation of toxic soluble Aβ aggregates.
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Affiliation(s)
- Lap Ho
- a Department of Neurology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Kenjiro Ono
- b Department of Neurology , Showa University School of Medicine , Tokyo , Japan
| | - Mayumi Tsuji
- c Department of Pharmacology , Showa University School of Medicine , Tokyo , Japan
| | - Paolo Mazzola
- d Department of Medicine , Center for Neuroscience, University of Milano-Bicocca , Monza , Italy
| | - Risham Singh
- a Department of Neurology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Giulio M Pasinetti
- a Department of Neurology , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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35
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Mazzola P. Functional status and early surgery in elderly patients with hip fracture. Hong Kong Med J 2017; 23:542. [PMID: 29026054 DOI: 10.12809/hkmj176916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- P Mazzola
- University of Milano-Bicocca, School of Medicine and Surgery, Monza (MB); NeuroMI - Milan Center for Neuroscience, Clinical Neuroscience Research Area, Milano (MI), Italy
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36
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Mazzola P, Carissimi F, Floris P, Pittella F, Galeazzi M, Moretti D, Bellelli G, Dinelli M, Annoni G. Megaesophagus in an elderly man with achalasia: a "not so benign" condition. Aging Clin Exp Res 2017; 29:809-814. [PMID: 27714664 DOI: 10.1007/s40520-016-0633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Paolo Mazzola
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy.
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy.
| | | | - Patrizia Floris
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Francesca Pittella
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Marianna Galeazzi
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
| | - Daniela Moretti
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giuseppe Bellelli
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Marco Dinelli
- Endoscopy Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giorgio Annoni
- Acute Geriatrics Unit, School of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi, 33, 20900, Monza, MB, Italy
- Clinical Neurosciences Research Area, NeuroMI - Milan Center for Neuroscience, 20126, Milan, MI, Italy
- Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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37
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Carnevali L, Mazzola P, Corsi M, Bellelli G, Annoni G. DELIRIUM MOTOR SUBTYPES AND ONE-YEAR MORTALITY AFTER HIP FRACTURE SURGERY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- L. Carnevali
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
| | - P. Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
- NeuroMI - Milan Center for Neuroscience, Milano, MI, Italy,
| | - M. Corsi
- San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
| | - G. Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
- NeuroMI - Milan Center for Neuroscience, Milano, MI, Italy,
- San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
| | - G. Annoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
- NeuroMI - Milan Center for Neuroscience, Milano, MI, Italy,
- San Gerardo Hospital ASST Monza, Acute Geriatrics Unit, Monza, MB, Italy
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Mazzola P, Floris P, De Filippi F. REHABILITATION OUTCOMES OF THE OLDEST-OLD PATIENTS AFTER HIP FRACTURE SURGERY: A PROSPECTIVE STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P. Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
- NeuroMI - Milan Center for Neuroscience, Milano, MI, Italy,
| | - P. Floris
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, MB, Italy,
- Regional Hospital of Valtellina and Valchiavenna, Department of Medicine, Geriatric Rehabilitation and Sub-acute Care Unit, Sondrio, SO, Italy
| | - F. De Filippi
- Regional Hospital of Valtellina and Valchiavenna, Department of Medicine, Geriatric Rehabilitation and Sub-acute Care Unit, Sondrio, SO, Italy
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39
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Mazzola P, Picone D. Healing as a Team. J Am Geriatr Soc 2017; 65:1627. [PMID: 28323329 DOI: 10.1111/jgs.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, Acute Geriatrics Unit, University of Milano-Bicocca, Monza (MB), Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milano (MI), Italy
| | - Domenico Picone
- School of Medicine and Surgery, Acute Geriatrics Unit, University of Milano-Bicocca, Monza (MB), Italy.,NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milano (MI), Italy
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40
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Mazzola P, Ward L, Zazzetta S, Broggini V, Anzuini A, Valcarcel B, Brathwaite JS, Pasinetti GM, Bellelli G, Annoni G. Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults. J Am Geriatr Soc 2017; 65:1222-1228. [PMID: 28263371 DOI: 10.1111/jgs.14764] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/01/2016] [Accepted: 11/07/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery. DESIGN Prospective observational cohort study. SETTING Italian orthogeriatric unit. PARTICIPANTS Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415). MEASUREMENTS Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome). RESULTS Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium. CONCLUSION This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium.
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Affiliation(s)
- Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy
| | - Libby Ward
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sara Zazzetta
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Valentina Broggini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandra Anzuini
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Breanna Valcarcel
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Justin S Brathwaite
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Giulio M Pasinetti
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Geriatric Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
| | - Giorgio Annoni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, Monza, Italy.,Acute Geriatrics Unit, San Gerardo Hospital ASST Monza, Monza, Italy
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41
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Corrao G, Rea F, Merlino L, Mazzola P, Annoni F, Annoni G. Management, prognosis and predictors of unfavourable outcomes in patients newly hospitalized for transient ischemic attack: a real-world investigation from Italy. BMC Neurol 2017; 17:12. [PMID: 28103824 PMCID: PMC5248532 DOI: 10.1186/s12883-017-0796-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/11/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Understanding the gap between evidence-based recommendations and real-world management is important to inform priority setting and health service planning. METHODS The 7,776 residents in the Italian Lombardy Region who were newly hospitalized for transient ischemic attack (TIA) during 2008-2009 entered into the cohort and were followed until 2012. Exposure to medical care including selected drugs, diagnostic procedures and laboratory tests was recorded. A composite outcome was employed taking into account all-cause death and hospitalization for stroke and acute myocardial infarction. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. RESULTS During the first year after discharge, 8.6, 49.7 and 48.5% of patients did not use any drugs, diagnostic procedures and laboratory tests respectively. Patients exposed to medical care had 59% reduced risk (95% CI, 50 to 66%) with respect to those who did not use any of these services. CONCLUSIONS Although the Italian National Health System supplies universal coverage for healthcare, several TIA patients receive suboptimal care. Systematic improvements are necessary in order to improve patient outcomes.
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Affiliation(s)
- Giovanni Corrao
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Federico Rea
- Laboratory of Healthcare Research & Pharmacoepidemiology, Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy
| | - Paolo Mazzola
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federico Annoni
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Giorgio Annoni
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Geriatric Unit, San Gerardo University Hospital, Monza, Italy
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42
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Asselineau D, Benlhassan K, Arosio B, Mari D, Ferri E, Casati M, Gussago C, Tedone E, Annoni G, Mazzola P, Piette F, Belmin J, Pariel S, Bornand A, Beaudeux JL, Doulazmi M, Mariani J, Bray DH. Interleukin-10 Production in Response to Amyloid-β Differs between Slow and Fast Decliners in Patients with Alzheimer's Disease. J Alzheimers Dis 2016; 46:837-42. [PMID: 26402623 DOI: 10.3233/jad-142832] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We investigated IL-10 and IL-6 production in amyloid-β (Aβ) stimulated peripheral blood mononuclear cells (PBMCs) in twenty Alzheimer's disease (AD) patients with slow progression, eleven with fast progression, and twenty age-matched controls. Promoter polymorphisms in IL-10 (position -592, -819, -1082), IL-6 (-174), transforming growth factor-β1 (TGF-β1) (-10, -25), interferon-γ (IFN-γ) (-874), and tumor necrosis factor-α (TNF-α) (-308) genes were analyzed. IL-10 production after Aβ stimulation was high in PBMCs from slow decliners and almost completely abrogated in fast decliners. Association between AA IFN-γ low-producing genotype and fast progression was demonstrated. Investigations in a larger sample will clarify these findings.
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Affiliation(s)
- Delphine Asselineau
- ImmunoClin Ltd, London, UK.,UPMC University Paris 06, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France.,CNRS, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France
| | | | - Beatrice Arosio
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniela Mari
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy.,Geriatric Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Evelyn Ferri
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Martina Casati
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Cristina Gussago
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Enzo Tedone
- Geriatric Unit, Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giorgio Annoni
- Geriatric Clinic, Department of Health Science, Milan Center for Neuroscience, University Study of Milano-Bicocca, Milan, Italy
| | - Paolo Mazzola
- Geriatric Clinic, Department of Health Science, Milan Center for Neuroscience, University Study of Milano-Bicocca, Milan, Italy
| | - Francois Piette
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Joel Belmin
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Sylvie Pariel
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Anne Bornand
- AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Jean-Louis Beaudeux
- UMR-S 1139 "Pathophysiology and pharmacotoxicology of human placenta", Faculty of Pharmacy, Paris Descartes, Paris, France.,Department of Medical Biochemistry, Necker Hospital, AP-HP, Paris, France
| | - Mohamed Doulazmi
- UPMC University Paris 06, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France.,CNRS, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France.,AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
| | - Jean Mariani
- UPMC University Paris 06, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France.,CNRS, UMR 8256 Biological Adaptation and Ageing (B2A) Team Brain Development, Repair and Aging (BDRA), Paris, France.,AP-HP, DHU FAST GH Pitie-Salpêtrière-Charles Foix, Paris, France
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Zhao W, Ho L, Wang J, Bi W, Yemul S, Ward L, Freire D, Mazzola P, Brathwaite J, Mezei M, Sanchez R, Elder GA, Pasinetti GM. In Silico Modeling of Novel Drug Ligands for Treatment of Concussion Associated Tauopathy. J Cell Biochem 2016; 117:2241-8. [PMID: 26910498 DOI: 10.1002/jcb.25521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/19/2016] [Indexed: 11/07/2022]
Abstract
The objective of this study was to develop an in silico screening model for characterization of potential novel ligands from commercial drug libraries able to functionally activate certain olfactory receptors (ORs), which are members of the class A rhodopsin-like family of G protein couple receptors (GPCRs), in the brain of murine models of concussion. We previously found that concussions may significantly influence expression of certain ORs, for example, OR4M1 in subjects with a history of concussion/traumatic brain injury (TBI). In this study, we built a 3-D OR4M1 model and used it in in silico screening of potential novel ligands from commercial drug libraries. We report that in vitro activation of OR4M1 with the commercially available ZINC library compound 10915775 led to a significant attenuation of abnormal tau phosphorylation in embryonic cortico-hippocampal neuronal cultures derived from NSE-OR4M1 transgenic mice, possibly through modulation of the JNK signaling pathway. The attenuation of abnormal tau phosphorylation was rather selective since ZINC10915775 significantly decreased tau phosphorylation on tau Ser202/T205 (AT8 epitope) and tau Thr212/Ser214 (AT100 epitope), but not on tau Ser396/404 (PHF-1 epitope). Moreover, no response of ZINC10915775 was found in control hippocampal neuronal cultures derived from wild type littermates. Our in silico model provides novel means to pharmacologically modulate select ubiquitously expressed ORs in the brain through high affinity ligand activation to prevent and eventually to treat concussion induced down regulation of ORs and subsequent cascade of tau pathology. J. Cell. Biochem. 117: 2241-2248, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Wei Zhao
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.,Geriatric Research Education Clinical Center at James J. Peters VA Medical Center, Bronx, New York
| | - Lap Ho
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Jun Wang
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.,Geriatric Research Education Clinical Center at James J. Peters VA Medical Center, Bronx, New York
| | - Weina Bi
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Shrishailam Yemul
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Libby Ward
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Daniel Freire
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Paolo Mazzola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.,School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Justin Brathwaite
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York
| | - Mihaly Mezei
- Department of Structural and Chemical Biology, Icahn School of Medicine at Mount Sinai, New York.,Experimental Therapeutics Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Roberto Sanchez
- Department of Structural and Chemical Biology, Icahn School of Medicine at Mount Sinai, New York.,Experimental Therapeutics Institute, Icahn School of Medicine at Mount Sinai, New York
| | - Gregory A Elder
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
| | - Giulio Maria Pasinetti
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York.,Geriatric Research Education Clinical Center at James J. Peters VA Medical Center, Bronx, New York.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York
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Mazzola P, Rea F, Merlino L, Bellelli G, Dubner L, Corrao G, Pasinetti GM, Annoni G. Hip Fracture Surgery and Survival in Centenarians. J Gerontol A Biol Sci Med Sci 2016; 71:1514-1518. [DOI: 10.1093/gerona/glw016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 01/19/2016] [Indexed: 12/11/2022] Open
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Mazzola P, Picone D, Anzuini A, Corsi M, Bellelli G, Annoni G. Takotsubo cardiomyopathy in an 81-year-old woman after injection of bone cement during hemiarthroplasty: An orthogeriatric case report. Int J Surg Case Rep 2015; 18:37-41. [PMID: 26688511 PMCID: PMC4701876 DOI: 10.1016/j.ijscr.2015.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Takotsubo cardiomyopathy is a syndrome characterized by transient cardiac ischemia-like symptoms, such as chest pain, increase of myocardial necrosis markers, electrocardiographic changes, and temporary left ventricular apical ballooning without significant coronary artery disease, often triggered by a particularly stressful situation. The association between Takotsubo and hip fracture surgery has been rarely reported in the literature. PRESENTATION OF CASE An 81-year-old woman was hospitalized with a diagnosis of right femoral neck fracture. During the surgical procedure, she displayed acute coronary symptoms a few minutes after the injection of bone cement, in the absence of coronary lesions. Due to the time relationship, bone cement implantation syndrome - not uncommon to observe - was considered in the differential diagnosis. However, the instrumental findings and the transient nature of the abnormalities guided us toward a diagnosis of Takotsubo. The treatment with Levosimendan, Amiodarone, and Metoprolol allowed gradual and satisfactory recovery of the cardiac function within a few days. The follow-up performed two and six months after surgery revealed complete cardiac recovery, and ability to walk at home comparable to the pre-fracture situation. DISCUSSION Takotsubo cardiomyopathy is more common in women during the postmenopausal phase, especially if undergoing stressful physical or emotional stimuli. In this case, the sequence of hip fracture, pain, hospitalization, and surgery could easily be intended as a strong stressful event with high physical/psychological burden. CONCLUSION Despite the good prognosis associated with early recognition, Takotsubo represents a life-threatening adverse event. Considering its possible pathogenesis, a "gentle care" approach and the optimization of pain control must be pursued in elderly subjects with hip fracture, aiming at reducing the stress of the hospitalization and related procedures.
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Affiliation(s)
- Paolo Mazzola
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy.
| | - Domenico Picone
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Alessandra Anzuini
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Maurizio Corsi
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy
| | - Giuseppe Bellelli
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy
| | - Giorgio Annoni
- Department of Medicine and Surgery, University of Milano-Bicocca and Geriatric Clinic, San Gerardo University Hospital, 20900 Monza-MB, Italy; NeuroMI-Milan Center for Neuroscience, Clinical Neurosciences Research Area, 20126 Milano-MI, Italy
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Abstract
Delirium is the clinical expression of an acute cerebral dysfunction caused by various noxious insults. Its prevalence is very high in the elderly, especially in the hospital setting, and in geriatric patients it can be the clinical manifestation of almost every acute disease. Delirium is associated to a number of adverse clinical and functional outcomes, to a higher risk of cognitive decline, institutionalization, and short- and long-term mortality. It is thus necessary to increase the attention on this issue: in fact, it is clearly demonstrated that delirium can be prevented in a large proportion of cases. Delirium is not only a marker of patient vulnerability and clinical instability, but also an index of the quality of care and the efficiency of its organization. By systematically assessing the presence of delirium during the whole length of hospital stay, physicians may closely monitor the patient’s clinical status. The aims of this review are to review the current clinical practice in delirium, focusing particularly on elderly individuals. The topics covered include epidemiology and outcomes, causes, clinical features and diagnosis, prevention and treatment. Finally, implications for clinical practice are discussed.
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Bellelli G, Mazzone A, Morandi A, Latronico N, Perego S, Zazzetta S, Mazzola P, Annoni G. The Effect of an Impaired Arousal on Short- and Long-Term Mortality of Elderly Patients Admitted to an Acute Geriatric Unit. J Am Med Dir Assoc 2015; 17:214-9. [PMID: 26585091 DOI: 10.1016/j.jamda.2015.10.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Impaired arousal is associated with negative outcomes in intensive care units, but studies in acute medical wards are scanty. The study aim was to evaluate the association between impaired arousal, as measured using an ultrabrief screen, and risk of both 1- and 6-month mortality and discharge to nursing home (NH) or hospice. DESIGN Prospective cohort study with 6-month follow-up. SETTING An acute geriatric unit (AGU) of a university-based hospital in Northern Italy. PARTICIPANTS All patients aged 65 years or older, admitted to the AGU between September 2012 and February 2015. MEASUREMENTS The modified Richmond Agitation Sedation Scale (m-RASS) was used to assess patients' arousal; a score of 0 denotes normal arousal, scores ranging from +1 to +4 denote increased arousal, and scores ranging from -1 to -5 denote decreased levels. The association of m-RASS scores with 6-month mortality was assessed by a Kaplan-Meier analysis. The impact of impaired arousal, defined by the m-RASS as anything other than "awake and alert," was determined using Cox proportional hazard regression for 1- and 6-month mortality after admission and logistic regressions were used for discharge to NH or hospice. The models were adjusted for age, sex, dementia, Sequential Organ Failure Assessment score, and disability. RESULTS Patients (n = 2477) had a mean age of 84 years, and were predominantly women (59.8%). Impaired arousal on admission was present in 644 (25.9%) patients: 33 (1.3%) were comatose (m-RASS = -5), 56 (2.3%) awakened to pain only (m-RASS = -4), 43 (1.7%) were very drowsy (m-RASS = -3), 93 (3.8%) drowsy (m-RASS = -2), and 212 (8.6%) were slightly drowsy (m-RASS = -1), but there were also 110 (4.4%) patients with restlessness, 75 (3.0%) with agitation, 17 (0.7%) with severe agitation, and 3 (0.1%) with combative behavior. Globally, 337 patients died within 1 month and 689 patients within 6 months. After adjustment for covariates, patients with impaired arousal had a significantly higher chance of having died at 1-month (adjusted hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.22-2.03) and 6-month follow-up (adjusted HR 1.31, 95% CI 1.10-1.57). Those with impaired arousal were more likely to be discharged to a new NH (odds ratio [OR] 1.75, 95% CI 1.19-2.57) or to hospice (OR 1.96, 95% CI 1.18-3.23) than those without impaired arousal. CONCLUSIONS An abnormal arousal level is an independent predictor of increased risk of 1- and 6-month mortality and of discharge to a new NH or hospice. The assessment of arousal with m-RASS should be routinely performed on all older patients on admission to acute hospital wards to screen potentially critical conditions.
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Affiliation(s)
- Giuseppe Bellelli
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy; Geriatric Research Group, Brescia, Italy.
| | - Andrea Mazzone
- Department of Rehabilitation, Redaelli Geriatric Institute, Milan, Italy
| | - Alessandro Morandi
- Geriatric Research Group, Brescia, Italy; Department of Rehabilitation and Aged Care "Fondazione Camplani" Hospital, Cremona, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Sabrina Perego
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Sara Zazzetta
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Paolo Mazzola
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy
| | - Giorgio Annoni
- Department of Health Sciences, University of Milano-Bicocca, Monza, Italy; Geriatric Unit, S. Gerardo Hospital, Monza, Italy
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Mazzola P, Rimoldi SML, Rossi P, Noale M, Rea F, Facchini C, Maggi S, Corrao G, Annoni G. Aging in Italy: The Need for New Welfare Strategies in an Old Country. Gerontologist 2015; 56:383-90. [PMID: 26553737 DOI: 10.1093/geront/gnv152] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Italy, a Southern European country with 60.8 million inhabitants, has the largest proportion of elderly citizens (aged ≥65) in Europe of 21.4%. The aging of the population is due to a number of reasons, such as baby boomers growing old, an increase in longevity, and low birth rate. Although international migration has increased in recent years, the addition of a foreign segment of the population has neither compensated for nor significantly curtailed the aging phenomenon. The impact of aging on the economic sustainability concerns the progressive reduction of the workforce, high incidence of pension spending in the overall resources allocated to welfare, recent reform of the pension system, and the growing issue of "non-self-sufficiency" in the elderly. Despite limited financial measures dedicated to research, Italy is conducting important studies on aging, both at the national and international level. Physicians and researchers in the field of geriatrics and gerontology are not only promoting quality of life in the elderly, and healthy-active aging, but also contributing to economic stability and social organization. Finally, nutritional and lifestyle habits-and their role in preventing chronic diseases-are the focus of the current international event EXPO 2015, with many sections dedicated to the elderly.
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Affiliation(s)
- Paolo Mazzola
- Department of Medicine and Surgery, University of Milano-Bicocca, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy. Clinical Neurosciences Research Area, NeuroMI-Milan Center for Neuroscience, Milano, Italy.
| | | | - Paolo Rossi
- Department of Sociology and Social Research, University of Milano-Bicocca, Italy
| | - Marianna Noale
- Institute of Neuroscience, Aging Branch, National Research Council-CNR, Padova, Italy
| | - Federico Rea
- Biostatistics, Epidemiology and Public Health Unit, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Italy
| | - Carla Facchini
- Department of Sociology and Social Research, University of Milano-Bicocca, Italy
| | - Stefania Maggi
- Institute of Neuroscience, Aging Branch, National Research Council-CNR, Padova, Italy
| | - Giovanni Corrao
- Biostatistics, Epidemiology and Public Health Unit, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Italy
| | - Giorgio Annoni
- Department of Medicine and Surgery, University of Milano-Bicocca, and Geriatric Clinic, San Gerardo Hospital, Monza, Italy. Clinical Neurosciences Research Area, NeuroMI-Milan Center for Neuroscience, Milano, Italy
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Mazzola P, Anzuini A, Picone D, De Filippi F, Dubner L, Bellelli G, Zatti G, Pasinetti GM, Annoni G. Simultaneous bilateral femoral neck fracture and end-stage renal disease in a 76-year-old woman: a case report. Aging Clin Exp Res 2015; 27:555-9. [PMID: 25576255 DOI: 10.1007/s40520-014-0312-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/29/2014] [Indexed: 11/30/2022]
Abstract
Hip fracture is a common occurrence in the elderly. Due to the growing demand for the specific care of these patients, we established the Orthogeriatric Unit (OGU) at San Gerardo University Hospital (Italy) in 2007. However, simultaneous bilateral femoral neck fractures among the geriatric population (those aged ≥65 years) are rarely reported in the literature. Reporting the rare case of a frail 76-year-old woman admitted with bilateral hip fracture and end-stage renal disease, we explain the important role played by the OGU and its flexible multidisciplinary approach for providing comprehensive care to patients with multimorbidity and clinical complexity. The team of geriatricians, orthopedic surgeons, anesthesiologists, and, in this case, a nephrologist, helped in the careful planning and timing of the single-step surgical repair, decided the appropriate type of anesthesia, and optimized outcomes. After a prompt evaluation of the patient, the OGU approach can achieve clinical stabilization prior to intervention. Along with a strict follow-up in the postoperative phase, this could result in a significant reduction of complications and mortality rates and an early start to a tailored rehabilitation process. We strongly suggest employing facilities with multidisciplinary teams for cases involving complex patients at short-term high risk for poor clinical outcomes. Indeed, the usual single-specialist model of care is gradually being abandoned worldwide.
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Affiliation(s)
- Paolo Mazzola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA,
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Wang J, Freire D, Knable L, Zhao W, Gong B, Mazzola P, Ho L, Levine S, Pasinetti GM. Childhood and adolescent obesity and long-term cognitive consequences during aging. J Comp Neurol 2015; 523:1587. [PMID: 26109420 DOI: 10.1002/cne.23799] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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