Dietary intervention and prevention of cognitive-related outcomes in healthy older adults without cognitive dysfunction

In the last decade, the association between diet and cognitive function/dementia has been largely investigated in observational studies, while there was a lack of evidence from randomized clinical trials (RCTs) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults. In the present article, we reviewed RCTs published in the last three years (2014-2016) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged over 60 years using different levels of investigation (i.e., dietary pattern changes/ medical food/nutraceutical supplementation/multidomain approach and dietary macro-and micronutrient approaches). From the included RCTs, there was moderate evidence that intervention through dietary pattern changes, medical food/nutraceutical supplementation, and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers. Moreover, there was high evidence that protein supplementation improved specific cognitive domains. For fatty acid supplementation, mainly long-chain polyunsaturated fatty acids, there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains, MRI findings, and/or cognitive-related biomarkers also in selected subgroups of older subjects although some results were conflicting. Moreover, there was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and/or MRI findings. Finally, there was only low evidence suggesting efficacy of intervention with homocysteine-related vitamins in improving cognitive functions, dementia incidence, or cognitive-related biomarkers in cognitively healthy older subjects

Dietary patterns, foods, and food groups : relation to late-life cognitive disorders

The limited efficacy of disease-modifying therapeutic strategies for mild cognitive impairment (MCI) and Alzheimer\u2019s dementia (AD) underscores the need for preventive measures to reduce the burden of late-life cognitive impairment. The aim of the present review article was to investigate the relationship among dietary patterns, foods, and food groups and late-life cognitive disorders considering the results of observational studies published in the last three years (2014-2016). In the last decade, the association between diet and cognitive function or dementia has been largely investigated. However, more recently, the National Institute on Aging-Alzheimer\u2019s Association guidelines for AD and cognitive decline due to AD pathology introduced some evidence suggesting a direct relation between diet and changes in the brain structure and activity. Several studies focused on the role of the dietary patterns on late-life cognition, with accumulating evidence that combinations of foods and nutrients into certain patterns may act synergistically to provide stronger health effects than those conferred by their individual dietary components. In particular, higher adherence to a Mediterranean-type diet was associated with decreased cognitive decline, although the Mediterranean diet (MeDi) combines several foods, micronutrients, and macronutrients already separately proposed as potential protective factors against dementia and MCI. Moreover, also other emerging healthy dietary patterns such as the Dietary Approach to Stop Hypertension (DASH) and the Mediterranean-DASH diet Intervention for Neurodegenerative Delay (MIND) diets were associated with slower rates of cognitive decline and significant reduction in AD rate. Furthermore, some foods or food groups traditionally considered harmful such as eggs and red meat have been partially rehabilitated, while there is still a negative correlation of cognitive functions with added sugars and trans fatty acids, nutrients also increasing the cardiovascular risk. This would suggest a genesis for the same damage for aging brain

Nutritional interventions in patients with Alzheimer’s disease and other late-life cognitive disorders

Given the impact of nutrition on neuroprotection largely investigated in observational studies, in the present article, we reviewed evidence from randomized clinical trials (RCTs) published in the last three years (2014-2016) exploring nutritional intervention efficacy in slowing cognitive impairment progression and achieving cognitive-related outcomes in patients aged 60 years and older with mild cognitive impairment (MCI), preclinical Alzheimer\u2019s disease (AD), prodromal AD, AD, unspecified dementia, and vascular dementia using different levels of investigation (i.e., medical food/nutraceutical supplementation/multidomain approach and dietary food/macro-and micronutrient approaches). From the reviewed RCTs, there was emerging evidence that nutritional intervention through medical food/nutraceutical supplementation (Fortasyn Connect\uae and another similar nutraceutical formulation) and multidomain approach improved magnetic resonance imaging findings and other cognitive-related biomarkers, but without clear effect on cognition in mild AD and MCI. Moreover, there was some evidence of a positive effect of antioxidant-rich foods (nuts) in improving specific cognitive domains and cognitive-related outcomes in MCI and mild-to-moderate dementia, but only in small samples. There was also convincing evidence for fatty acid supplementation, mainly n-3 polyunsaturated fatty acids (PUFAs), in improving specific cognitive domains and/or cognitive-related biomarkers in MCI and AD. Furthermore, antioxidant vitamin and trace element supplementations improved only cognitive-related outcomes and biomarkers, without effect on cognitive function in AD and MCI patients. Finally, high-dose B vitamin supplementation in AD and MCI patients improved cognitive outcomes but only in the subjects with a high baseline plasma n-3 PUFA, while folic acid supplementation had positive impact on specific cognitive domains

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Fenomeni diffusivo-dispersivi in alvei meandriformi: modellazione numerica

Si presenta un modello matematico bidimensionale per la ricostruzione dell’idrodinamica e dei fenomeni di trasporto di scalari passivi in alvei meandriformi, che tiene conto delle indagini recenti, sperimentali e teoriche, sulle correnti secondarie in curva. Le equazioni classiche alle acque basse, puramente convettive, sono arricchite con i termini diffusivi e dispersivi inerenti sia il trasporto di uno scalare passivo, sia la ridistribuzione di quantità di moto dovuta alla curvatura locale. L’integrazione numerica è effettuata utilizzando un metodo LDG (Local Discontinuous Galerkin) di alto ordine. La convalida del metodo proposto viene effettuata utilizzando due casi-test di laboratorio, riferiti rispettivamente a condizioni stazionarie e non stazionarie

A mathematical model for dam-break over movable bed

A four equation, one dimensional, shallow water mathematical model, suitable for the numerical simulation of dam break flow on mobile bed, is presented. Two different numerical codes, both based on the same mathematical model but on different numerical schemes, are developed: a Beam Warming, three-point backward implicit, finite difference method and a Godunov-type, high resolution, explicit finite volume method. These schemes are shown to be adequate solutions to accuracy and stability problems due to the discontinuities of the solution, the strongly time varying character of the flow, the dry/wet bed propagation phenomena and the rapid modification of the bed elevation. Numerical results for dam break flow over dry bed are compared with recent laboratory results. The maximum scour size dam is well predicted, and the hydraulic jump, induced by the strong erosion at the dam location, is reproduced. Investigation is extended to wet bed propagation, for significant values of depth ratios

Modellazione numerica bidimensionale alle acque basse del deflusso in presenza di ostacoli isolati o aggregati

Il lavoro consiste nell’applicazione di un codice di calcolo autoprodotto ai volumi finiti, idoneo ad integrare numericamente le equazioni bidimensionali alle acque basse, a casi in cui un’onda di sommersione investa ostacoli isolati o aggregati che modifichino significativamente il campo di moto. Il codice di calcolo è del tipo di Godunov, esplicito, ai volumi finiti, accurato al secondo ordine nello spazio e nel tempo. Il solutore approssimato di Riemann utilizzato è quello di Harten, Lax e van Leer. Vengono studiati casi tipo nei quali un’onda a fronte ripido investe ostacoli isolati a pianta quadrata, con lati paralleli o disposti a 45° rispetto al fronte incidente. Si evidenziano la diffrazione provocata dagli ostacoli, il ruolo delle pareti laterali nella riflessione delle ondulazioni, le principali caratteristiche delle ondulazioni stesse. Vengono inoltre simulate alcune tipi-che onde di sommersione che investono gruppi di ostacoli che possano schematicamente rappresentare aggregazioni di edifici. I risultati delle simulazioni vengono confrontati con risultati sperimentali di laboratorio ottenuti presso l’Enel.Hydro di Milano

CROLLO DIGA IN CORRISPONDENZA DI BRUSCHE VARIAZIONI DI LARGHEZZA

Si affronta il classico problema di Stoker, rivisitandolo per analizzare il comportamento del sistema fisico quando nella sezione dello sbarramento esista un brusco restringimento o allargamento dell’alveo, supposto per semplicità rettangolare e piatto