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The aim of this study was to explore the relationship between 25-hydroxyvitamin D (25[OH]D) serum concentrations and body fat distribution in a sample of postmenopausal women.We enrolled sixty-two postmenopausal women; 25(OH)D serum concentrations, serum intact parathyroid hormone, blood analyses, and anthropometric measurements were carried out. Body fat composition was evaluated by dual-energy X-ray absorptiometry. Insulin resistance was estimated by homeostatic model assessment of insulin resistance (HOMA-IR) calculation.Low levels of vitamin D (30 ng/mL) were found in 77.4% of the population studied. There was a correlation (P 0.0001) between 25(OH)D and waist circumference (r = -0.543), android fat to gynoid fat (A/G) ratio (r = -0.554), high-density lipoprotein cholesterol (r = 0.498), and HOMA-IR (r = -0.520). A/G fat ratio (B = -34.90; 95% confidence interval [-55.30, -14.1]; P = 0.019), HOMA-IR (B = -3.17; 95% confidence interval [-5.99, -0.351]; P = 0.028), and high-density lipoprotein cholesterol (B = 0.361; 95% confidence interval [0.033, 0.698]; P = 0.032), were found to be independent predictors of lower 25(OH)D by multilogistic regression analysis. Except for waist circumference, both these results were maintained when correlations were adjusted for age, onset of menopause, serum intact parathyroid hormone, and medications, and when body mass index was added as covariate.Vitamin D deficiency and insufficiency are common conditions. A/G ratio appeared to be associated with 25(OH)D concentrations and it is well-known that the android disposition of body fat is more closely associated with the onset of metabolic syndrome. Longitudinal studies are needed to better characterize the direction and the causal links of this association.

Recent research efforts examining the effects on the brain of listening to music have discovered that music, with specific characteristics, is able to improve cognitive and learning capacity. Recent studies have demonstrated that music, in particular some musical compositions (such as those of W. A. Mozart and J. S. Bach), has a notable role not only in cognitive disturbances, but also in the treatment of several syndromes and diseases, either by rehabilitating or by stimulating cerebral synaptic plasticity. The Mozart Effect was described for the first time in 1993. Subsequently, other studies with similar designs were made. This review summarizes the recent scientific literature on the Mozart Effect. More studies are needed, in order to define specific protocols in which music helps clinicians in recuperating patients and in improving their quality of life.

The study suggests that Mozart therapy could be a valid alternative to the common sound therapy methods in tinnitus patients.The aim of the study was to evaluate the presence of the Mozart effect as indexed by a variation in tinnitus intensity and tolerability.Sixty-two individuals aged between 22 and 78 years, reporting tinnitus for at least 1 year, were enrolled for the study. All patients attended a 1 h cognitive behavioral counseling session and listened to Mozart's sonata k448 for 1 h per day for a month. Afterwards patients listened to Beethoven's Für Elise sonata for 1 h per day for a month. To evaluate the general stress level, the impact of tinnitus on patients' quality of life, and the intensity of tinnitus, patients were invited to participate in three tests: the Measure du Stress Psychologique (MSP) questionnaire, the Tinnitus Handicap Inventory (THI), and a 0 to 10 visual analog scale (VAS).For all the parameters investigated, MSP, THI, and intensity, there was a general significant improvement between the pre- and post-listening evaluation. A significant improvement, as regards THI and intensity, could already be appreciated after a single exposure to Mozart's sonata.

LRTI are among the most common diseases in developed countries, including chronic obstructive pulmonary disease (COPD), one of the most frequent conditions. Their treatment in general practice is often unsuccessful and this increases hospital admissions. We know, bacterial infections in the elderly show a higher morbidity and mortality, either for more severe symptoms, than in younger adults, or because the causing agent often remains unknown. The need for a quick initiation of ABT often requires to chose on empirical grounds. To date there are no official guidelines for empirical ABT of COPD exacerbations, but only heterogeneous and often conflicting recommendations exist. The aim of our study was to identify a tool to guide the choice of the most effective empirical ABT when symptoms are acute and bacteriological tests cannot be performed. We used an ANN to study 117 patients aged between 55 and 97 years (mean 81.5 ± 8.7 years) (± S.D.), admitted with a diagnosis of pneumonia, COPD exacerbation or pneumonia with respiratory failure. We registered symptoms at onset and some individual variables such as age, sex, risk factors, comorbidity, current drug therapies. Then the ANN was applied to choose ABT in 20 patients versus 20 subjects whose therapy was chosen by the physicians, comparing these groups for therapy's efficacy, mean durations of therapy and hospitalization (H). In the learning phase, the ANN could predict the resolution index 99.05% of the time (i.e., 104 times) with a ± S.D. = 0.23. After the training, during the test phase, the network predicted the resolution index 91.67% of the time (i.e., 11 times) with a ± S.D. = 0.54, thus proving the validity of the relations identified during the learning phase. Preliminary results of the application of our tool, show the ANN allowed us to greatly reduce the duration of the ABT and subsequently of the H. Based on preliminary results, we assume that the use of ANN can make a valuable contribution in the choice of empirical ABT in the course of acute lung diseases in elderly.

Chronic obstructive pulmonary disease (COPD) is an alteration in which ventilatory function, exercise capacity and health status of patients progressively decline and it is characterized by an increase of inflammatory cytokines such as TNF-α, LTB4, IL-8, etc. In this study we considered twenty patients (15 males and 5 females; mean age: 72.8 ± 6.3) with stable COPD. All patients were performed evaluation of psychological stress at enrollment and were treated with leukotriene receptor antagonists (montelukast tablets) 10mg/day for 12 months. After 12 months we observed a significant decrease of serum levels of LTB4, IL-8 and also a decrease of the number of outpatient clinic visits, of the number of hospitalizations and of the duration of hospitalization.

The cardiovascular pathologies are the most common causes of death in the elderly patient. To single out the main risk factors in order to effectively prevent the onset of the disease, the authors experimented a special computerized tool, the neural network, that works out a mathematical relation that can obtain certain data (defined as output) as a function of other data (defined as input). Data were processed from a sample of 276 subjects of both sexes aged 26-69 years old. The output data were: high/low cholesterolemia, HDL cholesterol, triglyceridemia with respect to an established cut-off; the input data were: sex, age, build, weight, married/single, number of children, number of cigarettes smoked/day, amount of wine and number of cups of coffee. We conclude that: (i) a relationship exists, deduced from a neural network, between a set of input variables and a dichotomous output variable; (ii) this relationship can be expressed as a mathematical function; (iii) a neural network, having learned the data on a sufficiently large population, can provide valid predictive data for a single individual with a high probability (up to 93.33%) that the response it gives is correct. In this study, such a result is found for two of the three cardiovascular risk indicators considered (cholesterol and triglycerides); (iv) the repetition of the neural network analysis of the cases in question after a "pruning" operation provided a somewhat less good performance; (v) a statistical analysis conducted on those same cases has confirmed the existence of a strong relationship between the input and the output variables. Therefore the neural network is a valid instrument for providing predictive in a single subject on cardiovascular pathology risks.

Two clinical cases are reported that have in common the electrocardiographic detection of a third degree atrioventricular block (AVB), which occurred in the first case in a man of 78 years, hospitalized in our unit after an accidental fall with an ensuing head trauma, and in the second case, in a woman of 67 years, after cataract surgery on her left eye. The complete or third degree AVB is a bradyarrhythmia characterized by the absence of paroxystic or permanent atrioventricular conduction. Several studies conducted on subjects between the ages of 60 and 85 pointed out that the incidence of AVB-type bradyarrhythmias of a degree greater than the first is extremely rare, i.e., it is close to zero. It is, however, necessary to make an early diagnosis of the AVB, as in many cases it may complicate the patient's clinical progress and may often lead to sudden death. Clinical and experimental observations have shown that electrocardiographic alterations and arrhythmias are frequent complications of cerebral accidents such as head traumas, or of ophthalmic surgery. It is therefore necessary, especially in elderly patients in whom bradyarrhythmias are characterized by the presence of widespread histological alterations of the conduction system, to perform a 24-h monitoring of all adverse events that may lead to an AVB.

Fahr’s disease (FD) is a neurodegenerative disease whose aetiology is unknown, characterized by neuropsychiatric and motor problems associated with symmetrical, bilateral calcification of the basal ganglia. A drop in the metabolism and cerebral flow is deemed to be responsible for the onset of psychiatric and motor problems, cognitive deficit, painful symptoms and altered state of consciousness. The term Fahr’s syndrome (FS) is used when an etiological cause responsible for calcification can be identified. Fahr’s syndrome is associated with extremely diverse clinical conditions: calcium/phosphate metabolism disorders (hypo-hyperparathyroidism, pseudo-hypoparathyroidism), systemic lupus erythematosus, encephalitis and neoplasms [1]. Here, we describe clinical and radiological findings of a case of FS associated with micromolecular myeloma and hypothesize that bone remodelling could encourage the depositing of calcium at an intracerebral level as a result of an increase in the levels of alkaline phosphatase (ALP) and alteration of calcium levels. In January 2013, an 82-year-old woman was admitted to our hospital. The patient’s medical records showed a condition of severe osteoporosis with multiple collapsed vertebrae, dysphagia and rapidly ingravescent cognitive impairment over the last 18 months. No motor problems or psychiatric disturbances were reported. An acute onset of drowsiness made it necessary to hospitalize the patient, who appeared to be in generally serious conditions (Glasgow coma score (GCS) 10/15), and prompted us to perform a brain CT. The brain CT scan was negative regarding focal densitometric alterations and localized accumulation of blood, but showed dystrophic calcification of the dentate nuclei with bilateral occipital cortical calcification at the level of the calcarine cortex, as seen in FD (Fig. 1). Blood chemistry analysis also showed: kidney failure (GFR 13 ml/min); anaemia (Hb 9.5 g/dl; n.v. 12–16 g/dl); hypercalcaemia (13.3 mg/dl; n.v. 8.40–10 mg/dl) and hyperphosphatemia (5.9 mg/dl; n.v. 2.8–4.6 mg/dl); increase of ALP (123 U/l; n.v. 35–104 U/l) and inflammatory markers (VES 69 mm/h; n.v. 0–35 mm/h; PCR 18,600 lg/l; n.v. \5,000 lg/l). Protein electrophoresis test showed hypoalbuminemia (33.8 g/l; n.v. 40.2–47.6 g/l), increase of acute phase proteins and hypogammaglobulinemia (8 % n.v. 11.1–18.8 %). Alterations of the calcium and phosphate metabolism are the most common cause of FS. In our patient, the concomitance of calcification of the basal ganglia and hypercalcaemia led us to suspect a condition of secondary FS and hyperparathyroidism, but subsequent serum assays for parathormone (PTH) (40.7 pg/ml; n.v.15–65 pg/ml) and vitamin D (31 ng/ml; n.v. [30 ng/ml) were normal in both cases. During the clinical course, the patient was less drowsy and suffered extremely painful symptoms, visual analogue scale (VAS) 10/10; worsening renal function was also noted. Even though drowsiness and painful symptoms could be attributed to cerebral calcification, was ingravescent kidney failure simply a concomitant pathological condition or was there a link among the clinical picture, calcification of basal ganglia and renal dysfunction? A 24-h urine collection showed significant proteinuria (2,777 mg/ 24 h; n.v. 40–150 mg/24). The finding of proteinuria in the N. Gueli W. Verrusio (&) V. M. Magro M. Zaccone M. Cacciafesta Department of Anesthesiological, Cardiovascular, Respiratory, Nephrological, and Geriatric Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy e-mail: walter.verrusio@uniroma1.it

Recent studies have thrown doubt on the true effectiveness of anti-depressants in light and moderate depression. The aim of this study is to evaluate the impact of physical training and music therapy on a sample group of subjects affected by light to moderate depression versus subjects treated with pharmacological therapy only.Randomized controlled study. Patients were randomized into two groups. Subjects in the pharmacotherapy group received a therapy with antidepressant drugs; the exercise/music therapy group was assigned to receive physical exercise training combined with listening to music. The effects of interventions were assessed by differences in changes in mood state between the two groups.Medically eligible patients were screened with the Hamilton Anxiety Scale and with the Geriatric Depression Scale. We used plasmatic cytokine dosage as a stress marker.We recruited 24 subjects (mean age: 75.5 ± 7.4, 11 M/13 F). In the pharmacotherapy group there was a significant improvement in anxiety only (p0.05) at 6-months. In the exercise/music therapy was a reduction in anxiety and in depression at 3-months and at 6-months (p0.05). We noted an average reduction of the level of TNF-a from 57.67 (± 39.37) pg/ml to 35.80 (± 26.18) pg/ml.Our training may potentially play a role in the treatment of subjects with mild to moderate depression. Further research should be carried out to obtain more evidence on effects of physical training and music therapy in depressed subjects.

Besides increasing calcium absorption in the bowel and promoting the normal formation and mineralization of bone, vitamin D exerts relevant pleiotropic effects in different tissues. Serum levels of vitamin D show correlation with the risk of infections, cardiovascular diseases, cancer and autoimmune disorders. The possible therapeutic role of vitamin D in different kind of diseases: inflammatory, immunologic, infectious and neoplastic ones, explains the growing interest in this vitamin due to its pleiotropic effects, and makes it a candidate to become a potential drug in the next future.

Objectives the possible therapeutic role of vitamin D in different kind of diseases explains the growing interest in this vitamin due to its pleiotropic effects. This short report shows preliminary results of prevalence of hypovitaminosis D in a group of patients and proposes a oral supplement therapy effective in correcting hypovitaminosis in a short time, without side effects.

Two clinical cases are reported that have in common the electrocardiographic detection of a third degree atrioventricular block (AVB), which occurred in the first case in a man of 78 years, hospitalized in our unit after an accidental fall with an ensuing head trauma, and in the second case, in a woman of 67 years, after cataract surgery on her left eye. The complete or third degree AVB is a bradyarrhythmia characterized by the absence of paroxystic or permanent atrioventricular conduction. Several studies conducted on subjects between the ages of 60 and 85 pointed out that the incidence of AVB-type bradyarrhythmias of a degree greater than the first is extremely rare, i.e., it is close to zero. It is, however, necessary to make an early diagnosis of the AVB, as in many cases it may complicate the patient's clinical progress and may often lead to sudden death. Clinical and experimental observations have shown that electrocardiographic alterations and arrhythmias are frequent complications of cerebral accidents such as head traumas, or of ophthalmic surgery. It is therefore necessary, especially in elderly patients in whom bradyarrhythmias are characterized by the presence of widespread histological alterations of the conduction system, to perform a 24-h monitoring of all adverse events that may lead to an AVB.

The ability of trimetazidine (2,3,4, trimethoxybenzylpiperazine dihydrochloride, TMZ) to protect the myocardium against anthracycline (ANT)-induced cardiotoxicity during chemotherapy has been evaluated in female patients with breast cancer. A clinical trial was conducted in 61 patients subdivided into three groups: group 1 (n = 15, G1) treated with standard ANT protocol and cardioprotection by dexrazoxane (DEX) plus TMZ (60 mg, daily dose); group 2 (n = 22, G2) treated with ANT and cardioprotection by TMZ only; and group 3 (n = 24, G3) scheduled to receive ANT therapy and DEX. All the patients submitted to an echocardiographic evaluation of diastolic function (E wave velocity, A wave velocity, isovolumetric relaxation time [IVRT], deceleration time [DT]) at enrollment (TO), at T1 time, at T2 time, and at T3 time. After a 12- month follow-up period, the patients showed a good conservation of diastolic function both in G1 and G2 groups. No statistically significant difference was observed in E wave and A wave velocity and E/A ratio after ANT treatment. TMZ produced a cardioprotective effect, compa rable to DEX protection, against subacute and chronic subclinical cardiotoxicity with no signif icant changes in diastolic function after 1 year of follow-up.

For the past thirty years, many countries, especially the USA, have been performing clinical and laboratory studies to establish the most prominent disease risk factors, in particular those involved in cardiovascular diseases. The main aim of these studies is to reduce disease related risks by intervening at an early age.We studied 305 patients, 198 males and 107 females, all employees in Rome, mean age 40.8 years (+/- 8.22), enrolled from September 1988 to December 1989. We measured the main anthropometric parameters and performed otolaryngologic and ocular examination, a telecardiogram and an EKG; the following analyses were performed: hemochrome, ESR uric acid, azotemia, glycemia, AST, ALT, gamma GT, bilirubinemia, proteic electrophoresis, triglyceridemia, total cholesterolemia, HDL cholesterolemia, creatinine, urine examination, Pap-Test for women. Lifestyle habits that might be considered cardiovascular disease risk factors were considered and hygienic eating habits were suggested. Seven years later, in 1997, 100 of these patients were randomly selected (51 man and 49 women) and underwent the same clinical and laboratory tests as before.The results suggest a deep correlation between lifestyles and the increase of some cardiovascular risk factors.The authors believe that this study can be of some help in guiding future preventive medicine interventions that may be carried out on this population sample.

The Authors describe the case of a 58-year-old woman affected by erythematous telangiectasis lesions on the antero-lateral surface of the right hip during papillary serous cystoadenocarcinoma of the right ovary. The diagnosis, based on clinical and histological findings, was unilateral naevoid telangiectasia. After a review of literature the Authors assume a possible role of the oestrogens in the pathogenesis of such infrequent disease.

Atherosclerosis appears already in the first years of life. Several factors may accelerate the age of onset and the gravity of its symptoms. Particular importance is attributed to lipid metabolism in youth. Ther Authors studied the rates of cholesterol, HDL, LDL, triglycerides, apolipoproteins AI and B100, lipoprotein a and several anamnestic and anthropometric parameters in a group of 103 young people of Rome, between 16 and 19 years of age. They processed these data statistically and compared them with those of a similar American group. The results showed a tendency to fatness in the Italian sample, and to dyslipidosis in the American group. Besides, the subjects who had been breast-fed presented higher blood levels of cholesterol and apolipoprotein B100.

A case is reported of a 14-year old male MZ twin pair, with only one partner affected by situs viscerum inversus, whereby the condition is termed situs viscerum specularis. The high degree of mirror imaging is seen as an abnormal variation of the biological time of the cleavage giving rise to MZ twinning. Electrocardiographic findings are presented and the biological implications of the condition are discussed.