"Delirium Day": A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool

Background: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy. Methods: This is a point prevalence study (called "Delirium Day") including 1867 older patients (aged 65 years or more) across 108 acute and 12 rehabilitation wards in Italian hospitals. Delirium was assessed on the same day in all patients using the 4AT, a validated and briefly administered tool which does not require training. We also collected data regarding motoric subtypes of delirium, functional and nutritional status, dementia, comorbidity, medications, feeding tubes, peripheral venous and urinary catheters, and physical restraints. Results: The mean sample age was 82.0 \ub1 7.5 years (58 % female). Overall, 429 patients (22.9 %) had delirium. Hypoactive was the commonest subtype (132/344 patients, 38.5 %), followed by mixed, hyperactive, and nonmotoric delirium. The prevalence was highest in Neurology (28.5 %) and Geriatrics (24.7 %), lowest in Rehabilitation (14.0 %), and intermediate in Orthopedic (20.6 %) and Internal Medicine wards (21.4 %). In a multivariable logistic regression, age (odds ratio [OR] 1.03, 95 % confidence interval [CI] 1.01-1.05), Activities of Daily Living dependence (OR 1.19, 95 % CI 1.12-1.27), dementia (OR 3.25, 95 % CI 2.41-4.38), malnutrition (OR 2.01, 95 % CI 1.29-3.14), and use of antipsychotics (OR 2.03, 95 % CI 1.45-2.82), feeding tubes (OR 2.51, 95 % CI 1.11-5.66), peripheral venous catheters (OR 1.41, 95 % CI 1.06-1.87), urinary catheters (OR 1.73, 95 % CI 1.30-2.29), and physical restraints (OR 1.84, 95 % CI 1.40-2.40) were associated with delirium. Admission to Neurology wards was also associated with delirium (OR 2.00, 95 % CI 1.29-3.14), while admission to other settings was not. Conclusions: Delirium occurred in more than one out of five patients in acute and rehabilitation hospital wards. Prevalence was highest in Neurology and lowest in Rehabilitation divisions. The "Delirium Day" project might become a useful method to assess delirium across hospital settings and a benchmarking platform for future surveys

Profili molecolari predittivi del potenziale metastatico del carcinoma uroteliale della vescica di stadio pt1 o superiore

Introduction: Recent data from genomic analysis of bladder tumors have identified subgroups with different aggressiveness patterns and chemotherapy response profiles. The aim of our study was to identify molecular markers that can be used in clinical practice, to predict the evolution of these tumors in order to personalize their management.Materials and Methods: DNAs extracted from 54 solid tumors and 50 urine samples from patients with bladder cancer were hybridized on the BCA-oligo CGH (Comparative Genome Hybridization) chip. TMAs (Tissue Micro Array) from 140 paraffine-embedded tissues of primary and metastatic tumors, were analyzed in immunohistochemistry with antibodies directed against proteins involved in DNA stability, cell proliferation and the definition of basal or luminal subgroup. Correlations with clinical data were sought at all levels of analysis.Results: The number of chromosomal alterations increased significantly with the tumor stage. In addition, the distribution of these alterations was consistent between the DNAs extracted from tumor tissue and those from urinary samples. If no immunohistochemical marker differentiated between metastatic and non-metastatic patients, similar labeling patterns were observed between primary tumors and metastases. Notably, the presence of lymphatic emboli was predictive of metastatic status.Conclusion: The use in clinical practice of the BCA-oligo chip to predict a progression of a bladder tumor to a higher stage or grade may be considered. This analysis is feasible on urine sample. The systematic search for lymphatic emboli on primary tumors can be used in clinical practice to predict a metastatic evolution.Introduction: Les données des analyses génomiques des tumeurs de vessie ont défini des sous-groupes qui présentent une agressivité et une réponse à la chimiothérapie différents. Notre but était d’identifier des marqueurs moléculaires prédictifs de l'évolution tumorale.Matériels et méthodes: Les ADNs de 54 tumeur solides et de 50 échantillons d’ urines de patients avec une tumeur de vessie ont été hybridés sur la puce CGH (Comparative Genomic Hybridization) BCA-oligo. Des TMAs (Tissue Micro Array) de 140 tissus paraffinés de tumeurs primitives et métastatiques, ont été analysés en immunohistochimie pour les marqueurs impliqués dans: stabilité de l’ADN, prolifération cellulaire et définition de sous-groupe basal ou luminal. Des corrélations avec les données cliniques ont été recherchées à tous les niveaux d’analyse.Résultats: Le nombre d'altérations chromosomiques augmentait significativement avec le stade tumoral. La distribution de ces altérations était cohérente entre les ADNs extraits de tissu tumoral et de prélèvements urinaires. Si aucun marqueur immunohistochimique ne permettait de différencier les patients métastatiques ou non, des profils de marquage similaires ont été observés entre tumeurs primitives et métastases. La présence d'emboles tumoraux lymphatiques était prédictive du statut métastatique. Conclusion: l’utilisation dans la pratique clinique de la puce BCA-oligo pour prédire une évolution d'une tumeur de vessie vers un stade ou un grade plus élevé peut être envisagée, et réalisée sur un simple prélèvement urinaire. La recherche systématique d’emboles lymphatiques sur tumeurs primitives peut être utilisée pour prédire une évolution métastatique

Synthesis and characterization of PMMA-based superhydrophobic surfaces

Recently, superhydrophobic surfaces are gaining much interest because they may be employed in a series of applications, spanning from the realization of self-cleaning surfaces to microfluidics to special water-impermeable tissues allowing perspiration. It is well-known that superhydrophobicity strictly depends on the combination of superficial micro- and nano-structures. Then, key factors in the process of surface synthesis are the parameters which will define the surface conformation. In this work, we deal with the fabrication of polymer-based superhydrophobic surfaces. We developed a new method to have a good control of the structure of the synthesised surface. A high stability of the superhydrophobic character during time was obtained. Moreover, the synthesis process is green and easily transferable to industry for large production