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In Parkinson disease (PD), sarcopenia may represent the common downstream pathway that from motor and nonmotor symptoms leads to the progressive loss of resilience, frailty, and disability. Here we (1) assessed the prevalence of sarcopenia in older adults with PD using 3 different criteria, testing their agreement, and (2) evaluated the association between PD severity and sarcopenia.Cross-sectional, observation study.Geriatric day hospital.Older adults with idiopathic PD.Body composition was evaluated through dual energy x-ray absorptiometry. Handgrip strength and walking speed were measured. Sarcopenia was operationalized according to the Foundation for the National Institutes of Health, the European Working Group on Sarcopenia in Older Persons, and the International Working Group. Cohen k statistics was used to test the agreement among criteria.Among the 210 participants (mean age 73 years; 38% women), the prevalence of sarcopenia was 28.5%-40.7% in men and 17.5%-32.5% in women. The prevalence of severe sarcopenia was 16.8%-20.0% in men and 11.3%-18.8% in women. The agreement among criteria was poor. The highest agreement was obtained between the European Working Group on Sarcopenia in Older Persons (severe sarcopenia) and International Working Group criteria (k = 0.52 in men; k = 0.65 in women; P .01 for both). Finally, severe sarcopenia was associated with PD severity (odds ratio 2.30; 95% confidence interval 1.15-4.58).Sarcopenia is common in PD, with severe sarcopenia being diagnosed in 1 in every 5 patients with PD. We found a significant disagreement among the 3 criteria evaluated, in detecting sarcopenia more than in ruling it out. Finally, sarcopenia is associated with PD severity. Considering its massive prevalence, further studies should address the prognosis of sarcopenia in PD.

On February 20, 2020, a man living in the north of Italy was admitted to the emergency room with an atypical pneumonia that later proved to be COVID-19. This was the trigger of one of the most serious clusters of COVID-19 in the world, outside of China. Despite aggressive restraint and inhibition efforts, COVID-19 continues to increase, and the total number of infected patients in Italy is growing daily. After 6 weeks, the total number of patients reached 128,948 cases (April 5, 2020), with the higher case-fatality rate (15,887 deaths) dominated by old and very old patients. This sudden health emergency severely challenged the Italian Health System, in particular acute care hospitals and intensive care units. In 1 hospital, geriatric observation units were created, the experience of which can be extremely useful for European countries, the United States, and all countries that in the coming days will face a similar situation.

Summary Background & aims Cognitive impairment is a prevalent condition in older populations, independently associated with disability and mortality. Some studies have suggested a negative correlation between metabolic syndrome (MetS) and cognitive functioning, but results in older subjects are controversial. The aim of this study was to evaluate the association of cognitive performance with MetS in an older unselected population. Methods We evaluated the association of the Hodkinson Abbreviated Mental Test (AMT) score with MetS, as defined by the National Cholesterol Education Program's ATP-III criteria, in all 353 subjects aged 75+ living in Tuscania (Italy). Results MetS was positively associated with the AMT score in multivariable linear regression analysis, after adjusting (B = 0.45, 95% CI = 0.04–0.90; p = 0.03). When the same regression model was analyzed after stratifying for sex, such an association was significant in women (B = 0.76, 95% CI = 0.16–1.36; p = 0.01), but not in men. Also, when the regression model was analyzed in women, MetS was associated with better cognition (B = 1.41, 95% CI = 0.51–2.30; p Conclusions MetS is associated with better cognitive performance in community-dwelling elderly; such an association seems to depend upon the oldest female subjects.

A series of 2-semicarbazonomethyl-4,5-methylenedioxyphenylacetic acids (12-19) were synthesized and tested as anticonvulsant agents in DBA/2 mice against sound-induced seizures and the results compared to those previously reported for the corresponding methyl esters (4-11). The new compounds possess anticonvulsant properties lower than those of 4-11, but, in some instances, comparable to that of GYKI 52466, a well-known noncompetitive AMPA receptor antagonist.

Background New generation videoendoscopes potentially may visualize duodenal villi. This study compared endoscopic findings with this type of instrument to the histopathologic evaluation of duodenal villi. Methods A total of 191 patients underwent upper endoscopy for the purpose of obtaining duodenal biopsy specimens. The findings were assessed independently by 3 experienced observers by using a commercially available, high-resolution, high-magnifying (×2) videoendoscope. The duodenal villous profile was determined by endoscopic magnification and by endoscopic magnification after filling the duodenum with water. With both endoscopic magnification and endoscopic magnification after filling the duodenum with water, villous patterns were scored as the following: definitely present, partially present, or definitely absent. Villous patterns also were histopathologically scored as the following: normal, partial villous pattern, or total villous atrophy. Results Interobserver variability was excellent (κ=0.93). The concordance between either endoscopic magnification or endoscopic magnification after filling the duodenum with water and histology was 100% for presence/absence of villi. The sensitivity, the specificity, and the positive and negative predictive values of endoscopic magnification for detection of any villous abnormality were 95%, 99%, 95%, and 99%, respectively; the respective values of endoscopic magnification after filling the duodenum with water were 95%, 98%, 92%, and 99%. Conclusions High-resolution magnifying upper endoscopy can reliably predict the presence or the absence of duodenal villi.

The use of high-dose magnesium infusions in critically ill and surgical patients is increasing. This practice is associated with considerable risk of toxicity, as no reliable criteria are currently available to detect significant intracellular magnesium depletion. We have evaluated, before and after surgery, 33 elderly patients with hip fracture, by 24-h Holter ECG monitoring, Doppler echocardiography and serum chemistry; lymphocyte magnesium was measured using atomic absorption spectrophotometry. The severity of ventricular arrhythmias increased, and serum and mononuclear magnesium concentrations decreased significantly after surgery. Decreases in either serum magnesium concentrations > 0.125 mmol litre-1 or cellular magnesium > 6 nmol mg-1, but not serum or lymphocyte absolute magnesium concentrations, were associated with postoperative development of repetitive arrhythmias. Variations in serum magnesium concentrations correlated with intracellular decreases, and yielded good accuracy in predicting the postoperative worsening of arrhythmias. Thus perioperative differences in serum magnesium concentrations reflected intracellular variations and allowed us to identify patients with clinically relevant cellular magnesium depletion.

Background Posture, gait and balance problems are very disabling symptoms in Parkinson’s disease (PD). Gait cycle in PD shows increased stride-to-stride variability because of the reduction of gait automaticity and asymmetry of lower limbs function. These feature predispose to freezing of gait (FOG) and recurrent falls. Aim of the study was to evaluate how the modulation of asymmetry through physiotherapy might improve gait and FOG preventing falls. Methods Twenty-eight PD patients entered the study and were evaluated at baseline and after three months of rehabilitative program (performed twice a week) by means of the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III), Gait and Falls Questionnaire (GFQ), Tinetti balance and gait scale, Short Physical Performance Battery (SPPB), European Quality of Life questionnaire (EQ-5D). Patients were randomly assigned to (1) physiotherapy for worst side improvement (WSI), (2) physiotherapy for best side improvement (BSI), and (3) standard physical therapy (SPT). Patients were unaware of study’s aim and evaluations were carried out by blinded physiotherapist and doctor. Results After three months, all three groups showed a significant improvement at the Tinetti and SPPB scores. The magnitude of change (end of treatment compared to baseline) was analyzed among groups: BSI led to a greater improvement than SPT in terms of UPDRS-III ( p = 0.01), Tinetti total score ( p = 0.05) and Tinetti gait subscore ( p = 0.01). No other significant differences arose. Conclusions Our study confirms the usefulness of physical therapy in the treatment of PD and, more importantly, suggests that specific intervention tailored on individual feature (e.g. asymmetry of motor condition) might be even more effective than standard rehabilitative programs. The impact of such approach on the benefit duration and rate of falls should be prospectively assessed by future trials.

Background. Since its introduction in 1974 ES has become the treatment of choice for CBDS in cholecystectomized and elderly patients unfit for surgery.With further experience, ES has been widely applied also in young and fit patients. Recently, three significant factors for late complications after ES for CBDS were identified (Pereira-Lima 1998): 1) peripapillary diverticulum (recurrence of CBDS); 2) gallbladder in situ (recurrence of biliary symptoms); 3) common bile duct (CBD) diameter ≥ 15 mm (recurrence of CBDS and/or biliary symptoms). Aim of this study was to evaluate the long-term clinical outcome of ES for CBDS, and identify patients at risk for recurrence in a selected group with a follow-up of at least 5-years. Materials and methods. 529 patients (296 females, 233 males, mean age 62 years range 9-88) that underwent successful ES+CBDS extraction between april 1983 and december 1993 were included in the study. Followup data were obtained from our patient records, by mail, telephone call, interview, or ERCP when indicated. The following parameters have been included in statistical analyses: sex, age, gallbladder status, previous biliary tract surgery, prior gastrectomy, clinical presentation, ES-related complications, precut, stone size, number of stones, CBD diameter, duodenal diverticulum, infundibular fistula and liver function tests. Asymptomatic patients with follow-up