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Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. 150 subjects (mean age 64.85; 79 M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p< 0.05). In the exercise group we observed only minimal variations in the test scores. The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.

We studied the within-day determinations of some body composition (BC) parameters in clinically healthy elderly subjects with the aim of investigating their circadian rhythms (CR), which are known to vary in a circadian manner in clinically healthy young adults. The study involved six non-smoking, clinically healthy elderly males (mean age: 75±4 years; mean weight: 71.07±10.26 kg; mean height: 170±5 cm; mean BMI: 24±1 kg/m2). The BC parameters were determined by means of bioelectrical impedance analysis (BIA) at 2-hour intervals during the day and night, with the subjects lying horizontally in bed. The time-qualified BC estimates were analysed using the Cosinor method. The analysis revealed that the healthy elderly subjects had lost the CR of a number of the BC parameters, including fat body mass, cell body mass, extracellular body mass, total body water, extracellular body water, intracellular body water, and the Na and K exchangeable pools. However, they still retained the CR of body weight and lean body mass, with the expected nocturnal phase of oscillation. The abolition of the CR of the majority of BC parameters in the elderly suggests that human senescence is characterised by consistent changes in the daily rhythmic patterns of fat, water and electrolyte metabolism.

Na(+)-K+ cotransport in human erythrocytes from healthy subjects has been studied by means of 23Na-nuclear magnetic resonance (NMR) in the presence of the anionic paramagnetic shift reagent dysprosium (III) tripolyphosphate [Dy(PPP)2(7-)]. The intra- and extracellular 23Na-NMR signals were well separated, giving values of 6 +/- 1 mM for internal sodium concentration. Determination of the furosemide-sensitive Na+ efflux, in the presence of ouabain, was obtained by correlating the chemical shift variation of the external signal with changes in external Na+ concentration. For this purpose, calibration curves were generated. The values of the maximum efflux velocity (Vmax; 0.29-1 mmol.h-1.l cells-1) measured in 10 healthy adult male subjects were found to be within the range of values obtained by other authors. The NMR method proposed for the study of Na(+)-K+ cotransport is relatively simple and allows quick evaluation of cotransport Vmax values for a number of samples, being a good candidate for the study of this transport mechanism in the presence of different pathologies.

1. The aim of the present study was to evaluate whether metabolic factors are linked to the steady component and the pulsatile component of blood pressure, evaluated as mean arterial pressure and pulse pressure respectively, in a sex-specific manner. 2. A cohort of 299 subjects (152 males, 147 females; 25–80 years of age) was studied. Patients presenting congestive heart failure, coronary insufficiency, severe valvular heart disease, neurological accident in the last 6 months, renal or respiratory failure, cancer, diabetes mellitus or acute infectious disease were excluded. None of the women was taking oral contraceptives or oestrogen supplementation. All cardioactive drugs were withdrawn at least 2 weeks before the subjects entered the study. 3. Men presented higher mean arterial pressure (120 ± 15 compared with 115 ± 16 mmHg, P < 0.01) and lower pulse pressure values (63 ± 16 compared with 67 ± 18 mmHg, P < 0.05) than women. In men, no significant relation between mean arterial pressure and the tested variables was detected; multiple regression analysis demonstrated that age contributed independently to the model for pulse pressure with a multiple r2 of 0.10 (P < 0.01). In women, body mass index contributed independently to the model for mean arterial pressure, with a multiple of 0.12 (P < 0.005); age and, to a lesser extent, body mass index, glycaemia and triglyceridaemia persisted as independent determinants of pulse pressure at the multiple regression analysis, with a multiple r2 of 0.20 (P < 0.001). 4. Our findings suggest that metabolic risk factors are associated differently with pulse pressure and mean arterial pressure values in the two sexes.

The medical records of all women (297 cases)with breast cancer ≥ 70 years of age,presenting at our Institute from January 1980 toDecember 1989, were reviewed. Data from 226 elderlywomen was compared to that from 100 stage-matchedpatients ≤ 50 years of age, presenting duringthe same 10-year study interval. Conservative surgery wassignificantly more frequent in young patients (71.1%) comparedto elderly women (26.1%) and radical mastectomy accordingto Halsted was undertaken in 34.3% of theelderly group compared to 8.9% of young patients(p < 0.001). Since ‘incidental’ diagnosis was significantlymore frequent in the elderly group (59.9% versus6.0%) (p < 0.001), primary care physicians mayplay an important role in the early diagnosisof breast cancer in the majority of elderlywomen.

The outcomes of epidemiologic (Fram.) and clinical studies (SHEP) suggest the usefulness of therapeutic treatment in very old subjects with isolated systolic hypertension (ISH). The aim of this study was to evaluate the ability of Valsartan, antagonist of the AT1 receptor of Angiotensin II, not only in reducing blood pressure (SBP, DBP, PP) but also guaranteeing a good uniformity of action in the between-dose interval and reducing blood pressure variability in very old subjects with ISH. 10 very old, mean age 78 ± 3.7, 7 F and 3 M, with mild ISH at office blood pressure measurement according to W.H.O. criteria, were submitted to 24 hour ambulatory blood pressure monitoring (ABPM) with A&D TM 2421 device, at measurement intervals of 10' during day-time and 15' durind night-time, before and after 6 months of therapy with a single daily 80 mg. dose of Valsartan. The trough-peak ratio (T/P) as index of the duration-efficacy of antihypertensive therapy was evaluated and was regarded as favorable, according to F.D.A., if >0.50. The B.P. variability was assessed as standard deviation of the mean of blood pressure values over the 24-hour period. Exclusion criteria: secondary hypertension, coronary artery diseases, neoplasm, obesity. The statistical analysis was carried out with Students test for paired data. The results are shown in the table: TableSBP 24 h>SDSBP 24 hDBP 24 hSDDBP 24 hPPBase-line156.8 ± 1818.9 ± 5.275.8 ± 5.113.6 ± 2.879 ± 15.6Valsartan145 ± 18.416.3 ± 3.571.6 ± 5.810.7 ± 167.5 ± 8.8p0.023n.s.n.s.n.s.0.05V/P Ratio0.610.45 SBP = Systolic BP; DBP = Diastolic BP; PP = Pulse pressure; SD = Standard deviation; V/P = Trough-Peak Ratio. Valsartan, antagonist of AT1 receptors of the Angiotensin II, reduces meaningfully the SBP in the very old with ISH, without significant variations of DBP but with a clear reduction of PP, an important and negative prognostic factor for cardiovascular events. Moreover we have observed an homogeneous blood pressure control over a given between dose interval, as proved by the favorable T/P ratio for SBP and the non significant variation of blood pressure variability. So the Valsartan could it be a drug of first choice in therapeutic treatment of ISH in the very old.

Nowadays in clinical practice, the 24-hour Ambulatory Blood Pressure Monitoring (ABPM) is known to provide not only a more realistic value of the whole of the pressure overload, but also an analysis of the continuous Blood Pressure (BP) fluctuations from the mean values, which are shown to be independently related to the degree of organ damage and would seem to increase with age in hypertensive men and women. In a previous study, in accordance with international observations, we found a population of elderly patients with hypertension to have an increase of BP variability as compared to middle-age subjects. Based on these results our aim was to assess the behaviour of BP variability on a hypertensive population sample, subdivided in three groups of slightly different age, and well matched for sex. To this purpose wt selected 106 subjects as they came to our ambulatory (53 males or “M” and 53 females or “F”), who satisfied the WHO criteria for hypertension, and obtained three groups of similar size and statistically different (p = 0) mean ages: Group A 45.0 ± 5.21; Group B 56.3 ± 3.20; Group C 65.5 ± 3.53. All the subjects underwent a 24-hour ABPM performed with TAKEDA TM 2420-2021 device, set to take a reading every 10 minutes throughout the daytime “d” (7 AM-11 PM) and 15 minutes over the nighttime “n” (11 PM-7 AM). The statistical analysis on BP variability data, as expressed by Standard Deviation (SD) and Coefficient of Variation (CV) of the Sistolic (SBP) and Diastolic BP (DBP), was carried out with Students unpaired t-test and univariate regression analysis. We did not show any statistical difference between males and females belonging to the same age group, as regards to mean BP values and variability indexes. On the other hand we identified an increase of both the SBP and DBP fluctuations in older subjects (Group C), as compared to the younger (Group A) without sex-related differences, over the 24 hours. the daytime and nighttime. Then we matched the young adults (Group A) with the middle-age ones (Group B) and found an increase of SD (p = 0.004) and CV (p = 0.002) of the nighttime DBP, only in “B” females as compared to the younger. In men we saw no age-related change. Furthermore, when we compared female subjects of Group B and C we found in women BP variability increasing with age throughout the adult life, as regards the “n” DBP in the middle-age and to the 24-hour data after this period (F SD SBP 24hr “B” 21.5 ± 5.6 vs “C” 30.6 ± 9.3, p = 0.03; F CV SBP 24hr “B” 14.6 ± 4.3 vs “C” 19.9 ± 5.3, p = 0.05, F SD DBP 24hr “B” 15 ± 5.3 vs “C” 19.6 ± 1.7, p = 0.03; F CV DBP 24hr “B” 17.5 ± 6.4 vs “C” 23.2 ± 5.1, p = NS), whereas in men this seems to happen entirely over the early sixties (M SD SBP 24hr “B” 20.8 ± 5.2 vs “C” 32.9 ± 15.6, p = 0.02; M CV SBP 24hr “B” 13.8 ± 4 vs “C” 22 ± 12.1, p = 0.03; M SD DBP 24hr “B” 13.2 ± 3.4 vs “C” 18.8 ± 7.3, p = 0.02; M CV DBP 24hr “B” 15.2 ± 5.1 vs “C” 24.1 ± 12.5, p = 0.03) We shown a significant linear correlation between age and BP variability, influenced in women by factors unrelated to age.