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Background: Drugs with anticholinergic properties are frequently prescribed to patients with cognitive impairment. The cholinergic system plays an important role in learning processes, memory, and emotions regulation. The aim of this research is to report use of anticholinergic drugs in a clinical population and to investigate the correlation between the use of anticholinergic drugs and the risk of presenting with more severe behavioral and psychological symptoms (BPSD)., Method: Patients with a diagnosis of subjective cognitive impairment, mild cognitive impairment (MCI) or dementia were recruited. Screening tests for cognitive impairment (MMSE) and functional status (ADL, IADL) were performed. BPSD were evaluated with the Neuropsychiatric Inventory (NPI). The anticholinergic burden was calculated using the ACB calculator. We compared patients at low risk of anticholinergic adverse effects (ACB < 3) versus patients at high risk (ACB ≥ 3). Chi-square test and Mann-Whitney test were used to compare the two groups. A multiple linear regression was performed to identify factors associated with higher NPI score and a logistic regression model was built to identify drug classes associated with ACB ≥ 3., Result: A total of 173 patients (mean age 74 ± 7, 74 men) were included in the study; 132 patients with ACB < 3 (low risk) versus 41 patients with ACB ≥3 (high risk) were compared. No statistically significant differences were found between the two groups in terms of demographics (age, sex) and anamnestic variables (education, marital status, family history of dementia, hypertension, diabetes, smoking, dyslipidemia, atrial fibrillation, coronary heart disease and use of alcohol). Significantly higher NPI scores were found in patients with ACB ≥ 3 (mean scores 47.3 ± 34.8 versus 25.5 ± 24.6, p  < 0.001). Patients with ACB ≥ 3 showed lower MMSE (18.5 ± 8.6 versus 22.4 ± 7, p  = 0.004) and more IADLs lost. In the multivariate regression analysis, after adjusting for age, sex, polypharmacy and IADLs lost, only the MMSE and the ACB scores were independent predictors of the NPI score. Being on antipsychotics, antidepressants and antidiabetic drugs was associated with increased risk of higher anticholinergic burden., Conclusion: In conclusion, the anticholinergic burden might play a significant role as a risk factor for developing more severe BPSD in patients with cognitive decline, independently from their degree of cognitive impairment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2025 Pistorio, Scotto di Tella, Canzanella, Merenda, Cuomo, Iacotucci, Carnovale, Bencivenga, Vargas, Manes, Cataldi, Rengo, Zanetti and Femminella.)

Background : Unexpected infections diagnosed after intraoperative cultures in aseptic revision hip arthroplasties are infrequent, but the features and outcomes of culture-positive cases are still poorly understood. A single-center retrospective study was conducted to assess the following: (1) the incidence, (2) the profile of the cases, and (3) the outcomes of the revision hips performed for presumed aseptic reasons that became septic after intraoperative cultures. Methods: Instances of first-time aseptic revision hips (a retrospective cohort study) in the hospital database were reviewed. The revisions with the isolation of two phenotypically identical microorganisms in the intraoperative cultures were selected. The profile (bacteria, pre-operative markers) and the outcomes of the revisions (survival rates, complications, reasons for re-revision) were assessed. Results: Out of 424 cases of presumed aseptic revision hip arthroplasty, 19 patients (4.48%) were classified as septic. Staphylococcus epidermidis (9, 47.37%) was the most frequent microorganism. In three patients (15.8%), C-reactive protein and erythrocyte sedimentation rate values were higher, and in only one case (5.26%), C-reactive protein values and the white blood cell count were elevated. An antibiotic therapy was administered in every case. At a mean follow-up of 3.72 ± 2.18 years, three patients (15.79%) experienced complications (dislocation, pain without loosening, chronic suppressive antibiotic therapy) and two patients (10.53%) required re-revision for septic relapse (same microorganisms). The survival rate of the cohort was 89.47% (95% CI: 64.08-97.26) at 2 and 4 years. Conclusions: Missed periprosthetic infections rarely occurred in presumed aseptic revision hips. However, the outcomes are fair, and septic relapses are not uncommon.

Objective: The purpose of this systematic review is to assess clinical and radiographic outcomes, complications rates, rates and reasons of re-revision of isolated femoral or tibial component revisions, comparing them with total knee revisions., Methods: A review of the published literature was performed using Medline, Embase and Cochrane libraries. The terms "isolate" and "revision" and "knee arthroplasty" or "knee replacement" were together used as MESH terms. Partial knee replacement, non-English literature, case reports and papers published before 2000 were excluded., Results: Out of 911 papers, six papers met the inclusion criteria. Mean MINORS scores achieved quite low values (13.33 and 13.67). No study encompassed revisions for septic loosening or infection. Total revisions performed for instability and wear achieved better clinical outcomes: in the other cases, partial and total revisions showed no differences in clinical outcomes. Both the cohorts showed similar radiographic features. Lesser bleeding and shorter operative times were observed in partial revisions compared to total revisions. The re-revision rates were similar in most of comparative studies: only one study noticed a significant difference in the failure rate between partial (25% at 3 years) and full (7% at 3.5 years) revisions., Conclusions: The poor quality of the studies precluded sound conclusions. Isolated tibial or femoral component revision is an option when the other component is well-fixed and positioned and in absence of chronic periprosthetic infection; nevertheless, it should be carefully evaluated when the reasons for revision are wear or instability., (The Author(s). Published by S. Karger AG, Basel.)

The impact of age and sex on femoral component choices in modular total hip arthroplasty (THA) is still unknown. A regional arthroplasty registry was interrogated about a modular stem in THA performed for primary osteoarthritis, with the aims to assess the influence of age and sex on stems sizes and neck choices. A total of 6830 THAs were included: all THAs had a modular stem (with 15 necks and 27 combinations per side). Patients were stratified by age in decades and sex. Necks were grouped according to the type of correction. The percentage of larger stem sizes increased in males and in elder patients ( p < 0.001). Standard necks were overrepresented in males aged 40-59 and underrepresented in males aged 70 or older ( p < 0.001). Half of the necks provided other corrections than standard or offset, especially in males aged 40-49 and females aged 70 or older ( p < 0.001). Offset necks were predominant in elder patients ( p < 0.001). Version-correcting necks were prevalent in younger males and older females ( p < 0.001). Varus necks were implanted in one-third of the cases. The four commonest necks showed age and sex specific patterns. In the registry, age and sex impacted stem size and neck choices in THA performed for primary osteoarthritis.

This study examines whether the perception of an object automatically activates the representation of the direction of use of that object. To this aim, we carried out two experiments. In Experiment 1, participants were asked to explicitly categorise objects as used either away from the body (AB, for example, a hammer) or towards the body (TB, for example, a toothbrush). In Experiment 2, participants were asked to judge whether the same objects were natural or manmade. In both experiments, they were asked to respond by moving a joystick backwards (i.e., TB) or frontwards (i.e., AB). Therefore, their response could either be congruent (i.e., backward response with TB objects, frontward response with AB objects) or incongruent (i.e., backward response with AB objects, frontward response with TB objects) with the direction of object use. Results from Experiment 1 showed that in the congruent condition, participants were faster in judging the direction of object use than those in the incongruent condition (congruency effect). Crucially, results from Experiment 2 showed the presence of a congruency effect even when the direction of object use was task-irrelevant. However, this effect was found only for TB objects. These results suggest that the perception of TB objects automatically activates the direction of object use with respect to the body, thus showing evidence of direct connection between perception and action. A specific role of the body might account for different action representation processes involved in TB and AB object-related actions.

This study aimed to explore the relationship between action execution and mental rotation modalities. To this end, pantomime gesture (i.e. the mime of the use of an object) was used as its execution relies on imagery processes. Specifically, we tried to clarify the role of visuo-spatial or motor and body-related mental imagery processes in pantomime gestures performed away (AB, e.g. drawing on a sheet) and towards the body (TB, e.g. brushing the teeth). We included an "actual use" condition in which participants were asked to use a toothbrush and make 3, 6, or 9 circular movements close to their mouth (as if they were brushing their teeth) or to use a pencil and make 3, 6, or 9 circular movements on a desk (as if they were drawing circles). Afterwards, participants were asked to pantomime the actual use of the same objects ("pantomime" condition). Finally, they were asked to mentally rotate three different stimuli: hands, faces, and abstract lines. Results showed that participants were faster in AB than TB pantomimes. Moreover, the more accurate and faster the mental rotation of body-related stimuli was, the more similar the temporal duration between both kinds of pantomimes and the actual use of the objects appeared. Instead, the temporal similarity between AB pantomimes and pencil actual use, as well as, the duration of AB pantomime and actual use, were associated with the ability to mentally rotate abstract lines. This was not true for TB movements. These results suggest that the execution of AB and TB pantomimes may involve different mental imagery modalities. Specifically, AB pantomimes would not only require to mentally manipulate images of body-parts in movement but also represent the spatial relations of the object with the external world.

Introduction: Late chronic periprosthetic infections (LCPIs) are worrisome complications of primary hip arthroplasties. The gold standard procedure is the 2-stage revision. 1-stage exchange is gaining popularity in order to reduce the invasivity of the former technique. A partial 2-stage exchange technique, retaining fixed components, may overcome some of the drawbacks of the previous techniques, allowing a much easier reconstruction step., Methods: 28 patients with a LCPI after a primary total hip arthroplasty underwent a first removal stage: the loosened component was removed (23 cups and 5 stems) and the fixed component, with no local signs of infection, was retained. An antibiotic hand molded spacer was positioned in 16 cases. After a mean time of 8 months and a tailored antimicrobial therapy, the spacer was removed and the implant was revised., Results: The mean follow-up was 5 years. The HHS score was 82.7. 4 cases failed (2 patients presenting a septic relapse after revision and 2 patients undergoing Girdlestone arthroplasty), achieving a survival rate of 83.4% at 5 years. 2 patients were unwilling to perform a further procedure and did not proceed to the second stage. All the other patients had no clinical, radiological, laboratory signs of septic relapse., Conclusions: The partial 2-stage approach seems a promising technique for LCPI in selected cases, with good infection control. It allows an easier revision by sparing the fixed components. Larger case series and longer follow-ups are needed to confirm the results and identify the limits of this approach.

For a total of 123 thoracolumbar traumatic lesions treated surgically in 101 patients over approximately 2 years (all monitored clinically and radiographically up to consolidation by follow-ups after from 6 to 26 months, mean 10 months) the technique used, complications and treatment are reported. The treatment procedure included: emergency surgery decompression, osteosynthesis, and fusion (posterior and possibly intersomatic); immediate recovery of function and loading; clinical and radiographic monitoring within 4-6 weeks, and possible anterior fusion in case of insufficient reconstruction of the anterior column. The complications observed out of 123 fractures were: collapse of the implant (4 cases), infection (5 cases), liquoral fistula (1 case), transitory paralysis of the abdominal muscles homolateral to the lombotomic incision (1 case), TVP (2 cases), bronchial pneumonia (2 cases), paralytic ileum (1 case). There was no sagittal deformity (secondary kyphosis) except for 5 cases of mechanical collapse that were resolved with a new operation. Neurologic deficit was caused by fracture in 49 patients (40% of the fractures or 48% of the patients). Six patients out of 30 affected with spinal cord lesion (20%) and 15 out of 19 affected with cone and/or cauda lesion (79%) improved. There was no progression of the neurologic findings after surgery. The authors conclude by proposing a protocol of posterior osteosynthesis for the use of a system in titanium made up of pedicle screws and hooks connected to a pair of cylindrical bars joined together.

The authors report a case of posterior inveterate sternoclavicular dislocation, which came to their observation after tangential resection of the clavicle. They discuss the surgical technique of reduction and stabilization and clinical results. CT scan was the method most-suited to evaluate dislocation of the clavicle.

Twenty-one patients affected with malignant fibrous histiocytoma localized in the limbs were treated by pre- and postoperative chemotherapy (neoadjuvant). Preoperatively methotrexate (i.v.), cisplatinum (i.a.), and adriamycin (i.v.) were administered. Postoperatively the same drugs (in patients who responded well) or with the addition of ifosfamide and VP 16 (in those who responded poorly) were administered. Twenty resections and 1 amputation followed. The response to chemotherapy was good in 7 patients, and poor in 14. At a mean follow-up of 6.3 years 15 patients were disease-free and 6 had relapses. These results appear to be comparable to those for 144 patients affected with osteosarcoma of the limbs treated at the same time with the same protocol. The percentage of good responses and pulmonary metastases was higher in cases of osteosarcoma. Pre- and postoperative chemotherapy increases the percentage of healing in malignant fibrous histiocytoma. The lower percentage of good responses and the different type of relapse as compared to osteosarcoma indicate that preoperatively chemotherapy different from that used for osteosarcoma should be conducted.

Intra-arterial (IA) and intravenous (IV) cisplatinum (CDP) were studied in a multiagent regimen of neoadjuvant chemotherapy for osteosarcoma of the extremities. Preoperatively two cycles of high-dose methotrexate (HDMTX) were administered, followed 5 days later by CDP and Adriamycin (ADM). MTX and ADM were administered IV, and CDP was delivered IA or IV. Postoperatively, good responders received 3 more cycles of the same drugs, while poor responders had a longer chemotherapy including ifosfamide. The rate of good histological response to chemotherapy was significantly higher in patients treated intraarterially (78% vs 46%: P < .004), while no significant differences in terms of disease-free survival were observed between patients who received CDP IA and patients who received CDP IV (55% vs 51%). In the IA group, however, there was only one local recurrence vs 5 in the IV group. The IA infusion of CDP is more active on the primary tumor than the IV infusion.

The Authors describe a case of isolated fracture of first dorsal left transvers apophysis observed in Orthopaedic Clinic of Parma University. It's an exceptional lesion: infact till now only six cases of this type of lesion are been presented in orthopaedic literature.

The Authors describe history, etiopatogenesis, clinic, therapy of omeral epicondilitis, very frequent affection. Physiotherapic aspects are studied by different methods. The indications are different compared to clinical aspect, pain modality, relapse eventuality. They conclude with personal considerations based on what observed in Orthopedic Clinica of Parma University.

After considering the anatomoclinical aspects of fractures of the distal third of the femur, the Authors analyse the classification of these fractures. Different types of fractures were reviewed and they discussed the best orthopaedic or surgical treatment needed. Surgical methods were studied regarding sopracondylar and intracondylar fractures, which present difficult problems of reduction, contention and consolidation. The 23 cases operated on in the last 2 years were discussed by the Authors.