The Ventricular System Enlarges Abnormally in the Seventies, Earlier in Men, and First in the Frontal Horn: A Study Based on More Than 3,000 Scans

Objectives: To detect on computed tomography (CT) brain scans the trajectories of normal and abnormal ventricular enlargement during aging. Methods: For each 1-year age cohort, we assessed in 3,193 axial CT scans the Evans’ index (EI) in the anterior frontal horns and the parieto-occipital (POR) and temporal ratio (TR) in the posterior and inferior horns. Cut-off values for abnormal enlargement were based on previous clinical studies. Results: The mean age associated with normal linear measures was 71 years. Values for all three measures increased with age, showing a linear relationship below—but not above—each cut-off value. The mean age of participants with abnormal enlargement on CT progressed from 79 years for EI to 83 years for POR to 87 years for TR. These results suggested that ventricular dilatation progresses in an age–location relationship. First comes enlargement of the frontal horns (13.8% of scans), followed by the parieto-occipital horns (15.1% of scans) and then temporal horn enlargement (6.8% of scans). Scans from men displayed abnormal values earlier than scans from women (on average 6 years). Risk increased 5.1% annually for abnormal EI, 9.0% for abnormal POR, and 11% for abnormal TR (all p < 0.001). The most frequent agreement between categories (normal–abnormal) for values of neuroimaging measures was identified for POR–TR. Conclusion: The results of this large radiological study suggest that the ventricular system enlarges progressively during aging, and in a subset of patients follows an abnormal consecutive geometric dilatation, influenced by age and sex

Adherence to antibiotic treatment guidelines and outcomes in the hospitalized elderly with different types of pneumonia

Background: Few studies evaluated the clinical outcomes of Community Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP) and Health Care-Associated Pneumonia (HCAP) in relation to the adherence of antibiotic treatment to the guidelines of the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) in hospitalized elderly people (65 years or older). Methods: Data were obtained from REPOSI, a prospective registry held in 87 Italian internal medicine and geriatric wards. Patients with a diagnosis of pneumonia (ICD-9 480-487) or prescribed with an antibiotic for pneumonia as indication were selected. The empirical antibiotic regimen was defined to be adherent to guidelines if concordant with the treatment regimens recommended by IDSA/ATS for CAP, HAP, and HCAP. Outcomes were assessed by logistic regression models. Results: A diagnosis of pneumonia was made in 317 patients. Only 38.8% of them received an empirical antibiotic regimen that was adherent to guidelines. However, no significant association was found between adherence to guidelines and outcomes. Having HAP, older age, and higher CIRS severity index were the main factors associated with in-hospital mortality. Conclusions: The adherence to antibiotic treatment guidelines was poor, particularly for HAP and HCAP, suggesting the need for more adherence to the optimal management of antibiotics in the elderly with pneumonia

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Detection of brominated plastics from e-waste by short-wave infrared spectroscopy

In this work, the application of Short-Wave Infrared (SWIR: 1000–2500 nm) spectroscopy was evaluated to identify plastic waste containing brominated flame retardants (BFRs) using two different technologies: a portable spectroradiometer, providing spectra of single spots, and a hy-perspectral imaging (HSI) platform, acquiring spectral images. X-ray Fluorescence (XRF) analysis was preliminarily performed on plastic scraps to analyze their bromine content. Chemometric methods were then applied to identify brominated plastics and polymer types. Principal Component Analysis (PCA) was carried out to explore collected data and define the best preprocessing strate-gies, followed by Partial Least Squares—Discriminant Analysis (PLS-DA), used as a classification method. Plastic fragments were classified into “High Br content” (Br > 2000 mg/kg) and “Low Br content” (Br < 2000 mg/kg). The identified polymers were acrylonitrile butadiene styrene (ABS) and polystyrene (PS). Correct recognition of 89–90%, independently from the applied technique, was achieved for brominated plastics, whereas a correct recognition ranging from 81 to 89% for polymer type was reached. The study demonstrated as a systematic utilization of both the approaches at the industrial level and/or at laboratory scale for quality control can be envisaged especially considering their ease of use and the short detection response

EFFECT OF AGING ON CIRCADIAN-RHYTHM OF ATRIAL-NATRIURETIC-PEPTIDE, PLASMA-RENIN ACTIVITY, AND PLASMA-ALDOSTERONE

Atrial natriuretic peptide (ANP) shows a nychtohemeral fluctuation and an age-related trend. The aim of this study was to explore the circadian rhythm of ANP as a function of age. Circadian rhythms of plasma renin activity (PRA), aldosterone (PA), and cortisol (PC) were explored as well. Twenty clinically healthy subjects, 10 young (20-25 yrs) and 10 elderly (65-75 yrs), were investigated, while recumbent, after synchronization to light-dark regimen and meal timing. Blood samples for RIA tests were collected six times during the 24-hr span. The chronobiologic analysis in young subjects demonstrated a significant circadian rhythm for all the investigated variables with an acrophase-timing located at 16.48 for ANP, 4.44 for PRA, 5.32 for PA, and 7.12 for PC. In elderly subjects we documented an important increase of 24-hr mean plasma levels but not a statistically significant circadian rhythm for ANP, and a decrease in mean value of PRA which maintained, however, a significant periodic 24-hr oscillation in parallel with PA and PC. The results in young subjects reinforce the concept that ANP plays physiologically an inhibitory role on the phasic secretion of renin. The lack of the circadian rhythm for ANP along with the divergent changes in ANP and PRA 24-hr mean concentration of elderly subjects both suggest that ANP exerts with advancing age only a counter regulatory role on the tonic rather than the phasic release of renin

The circadian rhythm of atrial natriuretic peptide, vasoactive intestinal peptide, beta-endorphin and cortisol in healthy young and elderly subjects.

Atrial natriuretic peptide, vasoactive intestinal peptide, beta-endorphin and cortisol are humoral variables characterized by a 24-h periodicity. We evaluated the circadian rhythm of these peptides and hormones in healthy subjects who were young (between 20-25 years) or elderly (between 65-75 years). All were on controlled diets. Blood samples were collected six times during a 24-h period (at 06.00, 08.00, 12.00, 18.00, 20.00 and 24.00 h) beginning 8-h after start of recumbency. The time-related data were analysed by the Cosinor method in order to validate the circadian rhythm and to quantify rhythmometric parameters which included the midline estimate of rhythm (mesor). In contrast to the young subjects, Cosinor analysis failed to reveal a significant circadian rhythm in elderly subjects, for plasma cortisol. In elderly subjects oscillation (mesor) of atrial nutriuretic peptide was higher, while that of vasoactive intestinal peptide and beta-endorphins was lower. The results suggest changes in the physiological secretion of these three peptides in healthy elderly subjects

Temporal interrelationships between circadian rhythms of vasoactive intestinal peptide and T lymphocyte subpopulations.

Recent investigations documented an immunosuppressive action of VIP. Previous studies demonstrated that T lymphocytes exhibit a circadian rhythm (CR). This investigation was, thus, performed with the aim of detecting the relationships intercurrent between the 24-h patterns of VIP and T lymphocyte subsets. The hypothesis was formulated that circulating VIP may play a role in controlling the CR of T cells. The research was carried out on 10 clinically healthy subjects, tested six times during the 24-h span by assaying circulating levels of VIP and total T (OKT3), T helper (OKT4), and T suppressor/cytotoxic (OKT8) lymphocytes. Time data series were analyzed by Cosinor method. All investigated variables were seen to be characterized by a statistically significant CR. While the acrophase of VIP CR was found to be located at 18.20, the crest of OKT3, OKT4, OKT8 CR was seen to occur at 03.04, 02.16 and 02.56, respectively. The phase shift was found to be significant, suggesting that VIP and T lymphocytes physiologically fluctuate with a phase angle during their nyctohemeral cyclicity. The finding can be regarded as an indirect evidence of a negative VIPergic chronoregulation of CR of T lymphocytes