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Background and aims: Race coefficients (RC) in equations to estimate glomerular filtration rate (GFR) have been highly questioned. We aimed to evaluate the performance of three equations, namely 2009 Chronic Kidney Disease Epidemiology Collaboration (2009 CKD-EPI), 2021 CKD-EPI, and European Kidney Function Consortium (EKFC) in self-reported Black and White Brazilians. Materials and methods: Our cross-sectional study compared estimated GFR (eGFR) with 51Cr-EDTA measured GFR (mGFR) in healthy adults, patients with type 2 diabetes mellitus with or without chronic kidney disease (CKD), and in non-diabetic individuals with CKD. The performance of these equations was assessed using Bland–Altman plots, Lin’s concordance correlation coefficient (CCC), bias, P30, and P15 accuracy. Results: Three hundred six White adults (aged 53 ± 17 years, 55% women, mean mGFR: 83 ± 32 mL/min/1.73 m2) and 48 Black participants (aged 53 ± 17 years, 58% women, mGFR: 90 ± 34 mL/min/1.73 m2) were included. No equation achieved the desirable P30 accuracy value of 90%, neither in White (2009 CKD-EPI:78%, 2021 CKD-EPI:76% and EKFC:77%, p= 0.368) nor in Black volunteers (respective values of 77%, 75%, and 77%; p= 0.882). The 2009 CKD-EPI showed the best performance in Black participants (bias: 4.04; CCC: 0.848), whereas the 2021 CKD-EPI performed better in Whites, with smaller bias (1.45), and better concordance correlation coefficient (0.790). The EKFC presented the worst performance. All equations underdiagnosed advanced CKD in White participants, but not in Black. Conclusions: The 2021 CKD-EPI does not outperform the 2009 CKD-EPI. Instead, it underestimated the occurrence of CKD in White participants. Thus, we do not recommend replacing the 2009 with the new 2021 CKD-EPI in the Brazilian population. Graphical abstract:

Background:Huntington's disease (HD) is still often defined by the onset of motor symptoms, inversely associated with the size of the CAG repeat expansion in the huntingtingene. Although the cause of HD is known, much remains unknown about mechanisms underlying clinical symptom development, disease progression, and specific clinical subtypes/endophenotypes. Objective:In the iMarkHD study, we aim to investigate four discrete molecular positron emission tomography (PET) tracers and magnetic resonance imaging (MRI) markers as biomarkers for disease and symptom progression. Methods:Following MRI optimization in five healthy volunteers (cohort 1), we aim to recruit 108 participants of whom 72 are people with HD (PwHD) and 36 healthy volunteers (cohort 2). Pending interim analysis, these numbers could increase to 96 PwHD and 48 healthy controls. Participants will complete a total of 10 study visits, consisting of a screening visit followed by a clinical and MRI visit and PET visits at baseline, year 1, and year 2. PET targets include the cannabinoid 1, histamine 3, and serotonin 2A receptors, and phosphodiesterase 10A, whereas MRI will be multimodal, including, but not limited to, the assessment of cerebral blood flow, functional connectivity, and brain iron. Results:Recruitment is currently active and started in September 2022. Conclusions:By combining PET and multi-modal MRI assessments we expect to provide a comprehensive examination of the molecular, functional, and structural framework of HD progression. As such, the iMarkHD study will provide a solid base for the identification of treatment targets and novel outcome measures for future clinical trials.

Compare the proportions of use of biological therapy, surgeries, and hospitalizations between adults and pediatric inflammatory bowel disease (IBD)—Crohn's disease (CD) and ulcerative colitis (UC)—patients.

The Divertor Tokamak Test (DTT) facility, currently under construction in Frascati (Italy), will be devoted to studying the main issues related to power exhaust in fusion facilities, under integrated physics and technical conditions relevant for ITER and DEMO. The additional heating system includes a neutral beam injector (NBI), providing fast deuterium neutrals (D0) with an energy of 510 keV and a maximum power of 10 MW. Due to size constraints and the peculiar multifocus aiming strategy adopted by DTT NBI, the device has required the development of novel concepts for particle beam steering. In this article, we describe the concept underlying the newly adopted spherical and Lemon hyperlens grids (SLHGs): multicurvature, lens-like electrostatic grids able to steer the beamlet array in the intended directions without shape deformation.

The main purpose of the divertor tokamak test (DTT) facility is to study alternative solutions to mitigate the issue of the power exhaust, under integrated physics and technical conditions relevant to ITER and DEMO. One of the most complex and innovative subsystems of the entire project is certainly the negative-ion-based neutral beam injector (NBI), meant to inject 10 MW of auxiliary power with a beam of 510 keV deuterium neutrals. This contribution describes the conceptual design of the beamline for the DTT NBI system, with a particular focus on the innovative technical solutions adopted to fulfill the requirements and maximize the performance. The DTT NBI is required to operate with high efficiency in several operating scenarios, covering a large range of beam energies, between 10% and 100% of the nominal value (510 keV). To reach this challenging goal, an innovative accelerator design, the spherical and lemon hyperlens grids (SLHGs), has been developed. The implementation of this design concept of the accelerator has recently become possible thanks to recent improvements in additive manufacturing (AM) technology. Another original aspect of the DTT NBI, compared to existing devices, regards the vacuum pumping system, which will be based on nonevaporable getter (NEG) pumps. This will represent the first application of the NEG technology to an NBI for the heating and current drive system of a fusion experiment, with a possible simplification of the overall construction, with respect to typical solutions based on cryogenic pumps. Other innovative solutions are the cylindrical sawtooth structure (CSS) for the neutralizer panels and the stray field shielding system (SFSS) with encapsulated neutralizer. This article provides an overview of the injector for DTT NBI with a particular focus on innovative technical solutions.

The challenge of reducing CO2emissions imposes on the countries the inclusion of renewable energies in their electricity matrix. Brazil needs to improve the participation of Wind, Solar, and Biomass in its system once its electricity generation is highly concentrated on hydro sources. Further, renewable, Electricity generation power plants are frequently associated with good impacts on carbon emission mitigation and job generation. In this paper, we sought to answer if there is a difference in the efficiency of electricity generation technologies’ capacity to induce regional socio-economic and environmental development. We used a data envelopment analysis (DEA) approach to measure the relative efficiency scores of Brazilian mesoregions that hold power plants regarding environmental and socio-economic dimensions. Results show that the mesoregions which contain nuclear, wind, and photovoltaic power plants (or a combination of these technologies) perform better than mesoregions that comprise biomass, gas, and coal thermal facilities. In addition, the results show that renewable energy facilities perform better than non-renewable facilities in direct job generation and GDP aggregation. This study contributes to the existing literature from a methodological perspective as we compare different renewable energy technologies in three dimensions (social, economic, and environmental) at a regional level.

Aim: Covid-19 pandemic and its relative containment measures have affected populations' quality of life and psychological well-being worldwide. The fear related to the pandemic and the imposed containment measures has acted as a trigger causing a global increase in negative mental health states. Thus, we aimed to explore the relationship between fear of covid-19 and mental health via QoL (the first and the second lockdown in Italy, 2020). Subject and methods: Through a quantitative cross-lagged path model research design, the study investigates people’s fear of Covid-19, quality of life, and negative mental states in a population of 444 Italian adults (Mean=40.7; Standard Deviation=16.9; 80% women), in the period between the first and the second waves of the pandemic. Results: Results show that participants’ Covid-19 fear decreased between waves, contributing to a decrease in negative mental states (stress, anxiety and depression), thus improving the perceived quality of life. Furthermore, quality of life emerged as able to buffer the impact of fear of Covid on people’s psychological distress in short and medium terms, confirming its central role in regulating mental distress. Conclusion: The study suggests important guidelines for developing interventions to support the populations’ well-being and mental health.

Many studies support the idea that sarcopenic obesity (SO) could be considered a potential risk factor for negative health outcomes. These results have been inconsistent, and no umbrella reviews exist regarding this topic. Several databases until November 2023 were searched for systematic reviews with meta‐analysis of observational studies (cross‐sectional, case–control and prospective). For each association, random‐effects summary effect sizes with correspondent 95% confidence intervals (CIs) were evaluated using the GRADE tool. Among the 213 papers initially screened, nine systematic reviews with meta‐analysis were included, for a total of 384 710 participants. In cross‐sectional and case–control studies, 30 different outcomes were analysed, and 18 were statistically significant. In any population addressed in cross‐sectional and case–control studies, compared with non‐SO, SO increased the prevalence of cognitive impairment (k= 3; odds ratio [OR] = 3.46; 95% CI: 2.24–5.32; high certainty of evidence), coronary artery disease (k= 2; OR = 2.48; 95% CI: 1.85–3.31) and dyslipidaemia (k= 3; OR = 2.50; 95% CI: 1.51–4.15). When compared with sarcopenia or obesity, the results were conflicting. In prospective studies, the association between SO—compared with non‐SO—and other negative outcomes was supported by low/very low certainty of evidence and limited to a few conditions. Besides, no comparison with sarcopenia or obesity was provided. Finally, only a few studies have considered muscle function/physical performance in the diagnostic workup. SO could be considered a risk factor only for a few conditions, with the literature mainly based on cross‐sectional and case–control studies. Future studies with clear definitions of SO are needed for quantifying the importance of SO—particularly when compared with the presence of only sarcopenia or obesity—and the weight of muscle function/physical performance in its definition.

Introduction: Cigarette smoke accounts for over 90,000 deaths each year in Italy. Tobacco dependence treatment guidelines suggest adopting an integrated pharmacological-behavioral model of intervention. Cytisine is a partial agonist of nicotinic receptors. Trials conducted to date have demonstrated its good efficacy in promoting smoking cessation. The cytisine scheme of treatment consists of 25 days of treatment. A 40-day regimen, with an escalating dose and an extended duration of the treatment, has been in use in many anti-smoking centers in Italy for several years, but to date there are no reports on the use of cytisine with this scheme.Methods: A retrospective, real-life, observational study was conducted between January 2016 and September 2022. The 300 patients who had received at least one dose of study medication were selected. Continuous variables were compared by the Wilcoxon-Mann–Whitney test. Univariate and multivariate logistic regression models were implemented for self-reported seven-day point prevalence for abstinence at three, six and 12 months.Results: The median age of the patients was 59 years, 57% were women. The median smoking exposure was 33.8 pack-years. Self-reported smoking abstinence at three, six and 12 months was 68.7%, 56.3% and 47.3% respectively. 84% completed the cytisine treatment, 31.3% reported adverse events and in 8.3% these led to dropping out of the treatment.Conclusion: Cytisine, administered with a novel therapeutic scheme in the real-life setting of a specialized anti-smoking center, significantly promotes smoking abstinence. However, more studies are needed to assess the tolerability and efficacy of this new regimen.

Copper acetate (also known as verdigris) is a bimetallic Cu(II) greenish pigment widely used in oil paintings. Since ancient times, this pigment has been known as a degradation-prone compound, especially when combined with lipidic binders. However, the degradation mechanism and the involved species have not yet been disclosed. In this article, we study verdigris interactions with linseed oil in painting mock-ups, stressing out the formation of copper-based complexes and proposing reaction routes. Such complex systems are studied by applying a complementary multispectroscopic approach: a combination of continuous-wave (CW) electron paramagnetic resonance (EPR), electron spin echo envelope modulation (ESEEM), and Raman and attenuated total reflection (ATR) Fourier transform infrared (FTIR) spectroscopies. Based on the experimental evidence, we propose the following mechanism: the neutral copper acetate shifts to a basic verdigris-promoting triglyceride hydrolysis, aided by the coordination of Cu(II) cations toward the carboxylic functions. The increased amount of free fatty acids in the mixtures triggers the formation of monomeric Cu(II) complexes. Afterward, the oil polymerization reaction occurs, and secondary oxidation species, containing OH groups in the alkyl chain, act as further ligands for copper nuclei. This is the first time, to the best of our knowledge, that a comprehensive view is proposed.

Objective:As reduced tissue vascularity is one of the mechanisms that prevent skin ulcers from healing, treatments that can improve local circulation could accelerate their clinical resolution. Given that kinesio-taping (KT) can improve tissue blood circulation and lymphatic drainage, we aimed to determine whether applying KT close to stage IV pressure ulcers (PUs) could improve their healing.Method:Older patients with stage IV sacral PUs, and impaired mobility and functional dependency who were consecutively admitted in a six-month period to the Home Care service of Galliera Hospital (Genoa, Italy) were screened for participation in this pilot clinical trial. Patients' PUs were divided into two treatment areas—in the experimental intervention, KT was applied close to a portion of the PU, while the contralateral portion of the same lesion was treated according to the standard protocol (‘control’). The surface reduction of both portions was measured every four days, for a total of five examinations (timepoints (T2–T6) after the baseline evaluation (T1).Results:A total of 12 patients (male=5, female=7; mean age 78.83±8.94 years) fulfilled the inclusion criteria and were enrolled in the study. At all timepoints (T2–T6), the mean percentage reduction was significantly greater in KT-treated areas than in control areas: T2=20.66% versus 6.17%, respectively; p<0.001; T3=37.33% versus 17.31%, respectively; p<0.001; T4=57.01% versus 30.06%, respectively; p<0.001; T5=69.04% versus 40.55%, respectively; p<0.001; and T6=80.34% versus 51.91%, respectively; p<0.001. Furthermore, from T3 onwards, a significantly higher number of KT-treated areas than control areas had halved in size, the maximum difference being recorded at T5 (10 versus two, respectively; p=0.002).Conclusion:From the findings of this pilot study, KT would seem to be an effective, rapid, low-cost therapy for advanced sacral PUs in older patients with impaired mobility and functional dependency. Declaration of interest: The authors have no conflicts of interest to declare.

Introduction: Heart failure (HF) is one of the most common cardiovascular disorders, and its prevalence is increased due to age, genetics, and lifestyle factors. Emerging evidence suggests that the Mediterranean Diet (Med Diet) is linked to lower all-cause mortality in patients with increased cardiovascular disease risk, such as those with HF. Objective: To conduct a systematic review and meta-analysis of observational studies into the relationship between the Med Diet on HF risk. Design: Several databases (PubMed, Scopus, Web of Science and Cochrane Library) until the 01stof May 2023 were searched. Our research was conducted based on the updated 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were reported as risk ratios (RRs) with their 95% confidence intervals (CIs) as results of multivariate or univariate analyses. Results: From the original 1206 studies collected, six observational prospective studies were included, with a total of 216,385 European participants without evidence of HF at baseline. Over a mean period of 11 years of follow-up, a 1-point increase in the Med Diet score was associated with a significantly lower risk of HF (RR = 0.940; 95% CI: 0.912–0.969, p&lt; 0.0001; I2= 42.9%). Categorised by sex, a higher adherence to Med Diet was associated with a significantly lower incidence of HF in women (RR = 0.942; 95% CI: 0.912-0.973, p= 0.001; I2= 41.8%), but not in men. The overall quality of included studies was good. Conclusions: Higher adherence to Med Diet across European countries is associated with lower risk of HF, particularly in women.

Fibroblast growth factor receptor (FGFR) alterations drive oncogenesis in multiple tumor types. Here we studied pemigatinib, a selective, potent, oral FGFR1–FGFR3 inhibitor, in the phase 2 FIGHT-207 basket study of FGFR-altered advanced solid tumors. Primary end points were objective response rate (ORR) in cohorts A (fusions/rearrangements, n= 49) and B (activating non-kinase domain mutations, n= 32). Secondary end points were progression-free survival, duration of response and overall survival in cohorts A and B, and safety. Exploratory end points included ORR of cohort C (kinase domain mutations, potentially pathogenic variants of unknown significance, n= 26) and analysis of co-alterations associated with resistance and response. ORRs for cohorts A, B and C were 26.5% (13/49), 9.4% (3/32) and 3.8% (1/26), respectively. Tumors with no approved FGFR inhibitors or those with alterations not previously confirmed to be sensitive to FGFR inhibition had objective responses. In cohorts A and B, the median progression-free survival was 4.5 and 3.7 months, median duration of response was 7.8 and 6.9 months and median overall survival was 17.5 and 11.4 months, respectively. Safety was consistent with previous reports. The most common any-grade treatment-emergent adverse events were hyperphosphatemia (84%) and stomatitis (53%). TP53co-mutations were associated with lack of response and BAP1alterations with higher response rates. FGFR1–FGFR3gatekeeper and molecular brake mutations led to acquired resistance. New therapeutic areas for FGFR inhibition and drug failure mechanisms were identified across tumor types. ClinicalTrials.gov identifier: NCT03822117.

Background: Cataracts may increase risk for falls but studies on this topic from low- and middle-income countries (LMICs) are scarce. Therefore, we examined the cross-sectional association between self-reported visual symptoms (suggesting cataract) and self-reported injurious falls in nationally representative samples of adults aged ≥ 65 years from five LMICs (China, Ghana, India, Mexico, and Russia). Methods: Data from the WHO Study on global AGEing and adult health (SAGE) were analysed. Self-reported information on past 12-month fall-related injury and cataract based on symptoms were collected. Multivariable logistic regression and meta-analyses were conducted to assess associations. Results: Data on 13,101 people aged ≥ 65 years were analysed [mean (SD) age 72.5 (11.3) years; 45.2% males]. The overall prevalence of self-reported fall-related injury and visual symptoms (suggesting cataract) were 4.9% and 29.4%, respectively. There was a positive association between self-reported visual symptoms (suggesting cataract) and fall-related injury (i.e., OR > 1) in all five countries but statistical significance was reached in three: China (OR = 1.60; 95% CI = 1.08–2.35), India (OR = 1.96; 95% CI = 1.15–3.35), and Russia (OR = 3.58; 95% CI = 2.06–6.24). The pooled OR including all five countries based on a meta-analysis was OR = 1.88 (95% CI = 1.32–2.68). Conclusions: Self-reported visual symptoms (suggesting cataract) were associated with higher odds for self-reported injurious falls among older adults in LMICs. Expanding availability of cataract surgery in LMICs may also have the additional benefit of reducing falls among older people.

ABSTRACTObjectivesAdequate hydration is essential for the maintenance of physiological functions. Older adults may not be able to maintain adequate hydration, which is often not recognized. Our aim was to investigate the prevalence, risk factors and clinical implications of dehydration in older adults.MethodsThis cross-sectional study included 964 older adults in one geriatric outpatient clinic in Turkey. Dehydration was defined as a calculated [1,86 × (Na+K)+1,15×glucose+urea +14] plasma osmolarity of ≥ 295 mOsm/L. Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. Predictors of dehydration were assessed using logistic regression analysis.ResultsMean age was 79.9 ± 7.7 years, (71.7% female). The prevalence of dehydration was 31%. Female patients, diabetes mellitus (DM), chronic renal failure (CKD), a higher risk of falling (based on Timed Up and Go test), probable sarcopenia, dependence based on basic and instrumental daily living activities (BADL and IADL) were more common in the dehydrated group (p < 0.05). After adjusting for age and gender, dependency on BADL and IADL, the risk of falling were still higher in the dehydrated group (p < 0.05). There were significant relationships between dehydration and risk of falling (OR 1.38, 95% CI 1.00–1.90; p < 0.05), after adjustment for age, gender, DM, CKD.ConclusionDehydration is common among older adults and is associated with a dependency, probable sarcopenia, and an increased risk of falling. Screening for dehydration and taking preventive measures may be beneficial in avoiding the negative consequences associated with dehydration.

IntroductionThe collaboration between palliative care and neurology has developed over the last 25 years and this study aimed to ascertain the collaboration between the specialties across Europe.MethodsThis online survey aimed to look at collaboration across Europe, using the links of the European Association for Palliative Care and the European Academy of Neurology.Results298 people completed the survey—178 from palliative care and 120 from neurology from over 20 countries across Europe. They reported that there was good collaboration in the care for people with amyotrophic lateral sclerosis and cerebral tumours but less for other progressive neurological diseases. The collaboration included joint meetings and clinics and telephone contacts. All felt that the collaboration was helpful, particularly for maintaining quality of life, physical symptom management, psychological support and complex decision making, including ethical issues.DiscussionThe study shows evidence for collaboration between palliative care and neurology, but with the need to develop this for all neurological illness, and there is a need for increased education of both areas.

Objective: We investigated the association between environmental concerns, health and mental health among Palestinians and whether optimism, pessimism and meaning in life mediate the association between these variables. Methods: Our study sample consisted of 504 participants who were selected using online tools. Findings: The results revealed that pessimism negatively correlated with optimism, mental health, physical health and meaning in life, while optimism positively correlated with mental health, physical health and meaning in life and negatively correlated with environmental concerns. Moreover, meaning in life correlated negatively with environmental concerns. Structural equation modelling (SEM) analysis showed that optimism, pessimism and meaning in life mediate the correlation between environmental concerns, health and mental health with a good fit for our model. Conclusion: In the case of Palestinian territories, environmental concerns and issues are driven mainly by politics affecting people’s health and mental well-being. Therefore, it is recommended to conduct similar studies to explore protective factors against environmental concerns in the Palestinian context, which will help develop appropriate interventions to enhance mental health in a society characterized by high stressors and prolonged trauma.

The use of solar energy to electrical power generation becomes an opportunity for socioeconomic improvement for regions affected by excessive solar radiation, as well as the Brazilian Northeast. This work proposes a new way of harnessing solar energy to generate electricity with a higher percentage of nationalization. A prototipe of a solid state thermoelectric generator is presented. The project considers two different natural sources to produce temperature difference. They are solar concentration for heating and geothermal heat exchanger for cooling. Boundary conditions based on the bibliographic review was produced artifitially. The system performance was analyzed in real time through a computerized acquisition system. The thermal behaviour was registered in a thermographic picture. The project resulted in the electric power generation of approximately 3Wdelivered to a resistive load of 4 Ω, under a temperature difference of approximately 60 °C. Comparated to a regular photovoltaic cells that produces 3,8Wat most, this propose can become an alternative to commertial systems. The novelty of this work is the combination of the thermoelectricity, solar heating and geothermal cooling technologies, necessariously.

Background. Reduced physical performance is predictive of deleterious outcomes in older adults. Data considering objective physical performance and incident depression are sparse. Objective. The objective of this study was to [...]

Objectives: Heart failure (HF) is a frequent chronic disease with disturbing symptoms and complex treatments, associated with depression and lower quality of life. Some studies have shown that spirituality and religiosity may be relevant in these patients. We aimed to systematically review the medical literature on spirituality and religiosity in patients with HF. Methods: Major databases for studies investigating the effect of spirituality and religiosity in people affected by HF were searched from inception until 26th April 2023. Studies with clear definition of spirituality or religiosity, validated diagnosis of HF, and reporting outcomes of interest (i.e., incidence of mortality, cardiovascular outcomes, and quality of life) were included. Results: Among 810 non-duplicate records, we screened the full texts of 25 works. After excluding 18 studies, we included 7 studies (3 observational and 4 interventional) comprising 1234 HF patients followed up over a median of 3 months. Definitions of spirituality and religiosity were heterogeneous among the studies. The intervention studies showed improvements in quality-of-life parameters, some cardiovascular outcomes, or mortality, and the observational studies showed significant associations with these outcomes. Conclusions: Despite the extreme heterogeneity of the populations included, of the definition of spirituality and religiosity, and of the interventions in the few studies that included it, all the studies reported some positive associations with the outcomes examined. Spirituality/religiosity is an aspect not generally taken into account in the usual practice of medicine and can potentially contribute to improving the conditions of patients with HF, a chronic disease with unfavorable prognosis.

We present an executive summary of a guideline for management of type 2 diabetes mellitus in primary care written by the European Geriatric Medicine Society, the European Diabetes Working Party for Older People with contributions from primary care practitioners and participation of a patient’s advocate. This consensus document relies where possible on evidence-based recommendations and expert opinions in the fields where evidences are lacking. The full text includes 4 parts: a general strategy based on comprehensive assessment to enhance quality and individualised care plan, treatments decision guidance, management of complications, and care in case of special conditions. Screening for frailty and cognitive impairment is recommended as well as a comprehensive assessment all health conditions are concerned, including end of life situations. The full text is available online at the following address: essential_steps_inprimary_care_in_older_people_with_diabetes_-_EuGMS-EDWPOP___3_.pdf.

•Clonal evolution on venetoclax selects for 8p deletion, which leads to increased venetoclax resistance in vitro.•Elevated Erk signaling and constitutively high BCR signaling are associated with venetoclax progression.

Background: Dynapenic abdominal obesity (DAO) (i.e., impairment in muscle strength and high waist circumference) is gaining interest, as it is associated with several important adverse health outcomes. However, the association between DAO and multimorbidity is largely unclear. Thus, the aim of the present study was to investigate the association between DAO at baseline and new onset multimorbidity over ten years of follow-up. Methods: People participating in the English Longitudinal Study of Ageing were included. DAO was defined as waist circumference > 102 cm in men and > 88 cm in women, and a concomitant presence of dynapenia (handgrip strength defined as &lt; 27 kg for men and &lt; 16 kg for women). Multimorbidity was defined as having two or more chronic conditions. The association between DAO and incident multimorbidity was assessed using a multivariable logistic regression analysis, reporting the data as odds ratios (ORs) and their 95% confidence intervals (CIs). Results: Overall, 3302 participants (mean age: 63.4 years, males: 50.3%) without multimorbidity at baseline were followed-up for ten years. After adjusting for several variables, compared to participants without dynapenia nor abdominal obesity, the presence of abdominal obesity (OR = 1.505; 95%CI: 1.272–1.780; p&lt; 0.0001) and DAO (OR = 1.671; 95%CI: 1.201–2.325; p= 0.002) significantly increased the risk of multimorbidity. Compared to no dynapenia nor abdominal obesity, DAO was associated with significantly higher risk for arthritis and diabetes. Conclusions: DAO was significantly associated with a higher risk of incident multimorbidity, over 10 years of follow-up. The results of our study suggest that addressing DAO can potentially decrease risk for multimorbidity.

The coronavirus pandemic has been sweeping the world for more than a year. As physical health begins to stabilize in the western world, an increasing concern is related to the impact of the virus and its containment measures on people’s mental health. This work aimed to explore the effect of demographic factors (age, gender, level of education, and socioeconomic status) and variables such as fear of COVID-19 and social support in predicting the quality of life and mental health of adults during the first wave of the pandemic in Italy. Through an online survey with 1087 Italian adults (M = 39.7, SD = 16.39; 74.4% women), gender and socioeconomic status emerged as crucial factors in determining differences regarding people’s responses and reactions to the pandemic. In addition, the results highlighted the importance of perceived social support and a moderate fear of COVID-19 in predicting people’s quality of life and mental health. The study suggests important guidelines for the development of interventions to support the population’s well-being and mental health.

This paper reports the proceedings of a virtual meeting convened by the European Interdisciplinary Council on Ageing (EICA), to discuss the involvement of infectious disorders in the pathogenesis of dementia and neurological disorders leading to dementia. We recap how our view of the infectious etiology of dementia has changed over the last 30 years in light of emerging evidence, and we present evidence in support of the implication of infection in dementia, notably Alzheimer’s disease (AD). The bacteria and viruses thought to be responsible for neuroinflammation and neurological damage are reviewed. We then review the genetic basis for neuroinflammation and dementia, highlighting the genes that are currently the focus of investigation as potential targets for therapy. Next, we describe the antimicrobial hypothesis of dementia, notably the intriguing possibility that amyloid beta may itself possess antimicrobial properties. We further describe the clinical relevance of the gut–brain axis in dementia, the mechanisms by which infection can move from the intestine to the brain, and recent findings regarding dysbiosis patterns in patients with AD. We review the involvement of specific pathogens in neurological disorders, i.e. SARS-CoV-2, human immunodeficiency virus (HIV), herpes simplex virus type 1 (HSV1), and influenza. Finally, we look at the role of vaccination to prevent dementia. In conclusion, there is a large body of evidence supporting the involvement of various infectious pathogens in the pathogenesis of dementia, but large-scale studies with long-term follow-up are needed to elucidate the role that infection may play, especially before subclinical or clinical disease is present.

Dopaminergic dysregulation is one of the leading hypotheses for the pathoetiology underlying psychotic disorders such as schizophrenia. Molecular imaging studies have shown increased striatal dopamine synthesis capacity (DSC) in schizophrenia and people in the prodrome of psychosis. However, it is unclear if genetic risk for psychosis is associated with altered DSC. To investigate this, we recruited healthy controls and two antipsychotic naive groups of individuals with copy number variants, one with a genetic deletion at chromosome 22q11.2, and the other with a duplication at the same locus, who are at increased and decreased risk for psychosis, respectively. Fifty-nine individuals (21 with 22q11.2 deletion, 12 with the reciprocal duplication and 26 healthy controls) received clinical measures and [18F]-DOPA PET imaging to index striatal Kicer. There was an inverse linear effect of copy number variant number on striatal Kicervalue (B= −1.2 × 10−3, SE = 2 × 10−4, p< 0.001), with controls showing levels intermediate between the two variant groups. Striatal Kicerwas significantly higher in the 22q11.2 deletion group compared to the healthy control (p< 0.001, Cohen’s d= 1.44) and 22q11.2 duplication (p< 0.001, Cohen’s d= 2) groups. Moreover, Kicerwas positively correlated with the severity of psychosis-risk symptoms (B= 730.5, SE = 310.2, p< 0.05) and increased over time in the subject who went on to develop psychosis, but was not associated with anxiety or depressive symptoms. Our findings suggest that genetic risk for psychosis is associated with dopaminergic dysfunction and identify dopamine synthesis as a potential target for treatment or prevention of psychosis in 22q11.2 deletion carriers.

Background: Only limited studies analyzed a possible relationship between frailty and infections. Our aim was to investigate the possible association between higher multidimensional prognostic index (MPI) values, a tool for evaluating multidimensional frailty, and the prevalence of infectious diseases, including antibiotics’ cost and the prevalence of MDR (multidrug resistance) pathogens. Methods: Older patients, affected by COVID-19, were enrolled in the hospital of Palermo over four months. Results: 112 participants (mean age 77.6, 55.4% males) were included. After adjusting for potential confounders, frailer participants had a higher odds of any positivity to pathogens (prevalence: 61.5%, odds ratio = 15.56, p&lt; 0.0001) compared to a prevalence of 8.6% in more robust, including MDR, and a higher costs in antibiotics. Conclusions: Higher MPI values, indicating frailer subjects, were associated with a higher prevalence of infections, particularly of MDR pathogens, and a consequent increase in antibiotics’ cost.

Inflammatory bowel diseases (IBD) are modern diseases, with incidence rising around the world. They are associated with perturbation of the intestinal microbiota, and with alteration and crossing of the mucus barrier by the commensal bacteria that feed on it. In the process of mucus catabolism and invasion by gut bacteria, carbohydrate-active enzymes (CAZymes) play a critical role since mucus is mainly made up by O- and N-glycans. Moreover, the occurrence of IBD seems to be associated with low-fiber diets. Conversely, supplementation with oligosaccharides, such as human milk oligosaccharides (HMOs), which are structurally similar to intestinal mucins and could thus compete with them towards bacterial mucus-degrading CAZymes, has been suggested to prevent inflammation. In this mini-review, we will establish the current state of knowledge regarding the identification and characterization of mucus-degrading enzymes from both cultured and uncultured species of gut commensals and enteropathogens, with a particular focus on the present technological opportunities available to further the discovery of mucus-degrading CAZymes within the entire gut microbiome, by coupling microfluidics with metagenomics and culturomics. Finally, we will discuss the challenges to overcome to better assess how CAZymes targeting specific functional oligosaccharides could be involved in the modulation of the mucus-driven cross-talk between gut bacteria and their host in the context of IBD.

Polypharmacy in older adults is associated with multiple negative consequences that may affect muscular function, independently from the presence of medical conditions. The aim of this systematic review and meta‐analysis was to investigate the association of sarcopenia with polypharmacy and higher number of medications. A systematic literature search of observational studies using PubMed, Web of Science, Scopus and Cochrane Library databases was conducted from inception until June 2022. To determine if sarcopenia is associated with a higher risk of polypharmacy and increased number of medications, a meta‐analysis using a random‐effects model was used to calculate the pooled effects (CRD42022337539). Twenty‐nine studies were included in the systematic review and meta‐analysis. Sarcopenia was associated with a higher prevalence of polypharmacy (odds ratio [OR]: 1.65, 95% confidence interval [CI] [1.23, 2.20], I2= 84%, P< 0.01) and higher number of medications (mean difference: 1.39, 95% CI [0.59, 2.19], I2= 95%, P< 0.01) compared with individuals without sarcopenia. Using meta‐regression, a high variance was observed due to different populations (i.e., community‐dwelling, nursing home residents, inpatients, outpatients) for both outcomes of polypharmacy (r= −0.338, SE = 0.1669, 95% CI [−0.67, −0.01], z= −2.03, P= 0.04) and number of medications (r= 0.589, SE = 0.2615, 95% CI [0.08, 1.10], z= 2.25, P= 0.02). This systematic review and meta‐analysis reported a significantly increased risk of polypharmacy and higher number of medications in people with sarcopenia compared with individuals without this condition. Future research should clarify whether the specificity and number of medications is a direct contributor in accelerating the progression of muscle wasting and dysfunction contributing to sarcopenia in older adults.

Premature ejaculation is a common male condition worldwide with prevalence estimates varying from 30% to 85%. Owing to the lack of a clear definition and a clear understanding of the potentially multifactorial pathophysiology, treatment remains challenging. The aim of this systematic review was to evaluate the non‐pharmacological treatment modalities for PE to inform clinical practice and patients.

Background and aim: We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. Methods: We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). Results and discussion: From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p&lt; 0.05), with 22 associations surviving the application of a more stringent p-value (p&lt; 10−6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551–2.124), and anxiety (OR = 1.498; 95% CI: 1.273–1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053–2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). Conclusions: UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

•Liquid biopsy is a new non-invasive tool for the early detection of cancer.•Literature so far is promising for some kinds of cancer, but supported by a very low level of evidence.•New high-quality evidence is urgently needed.

Gaussian Boson Sampling (GBS) is a recently developed paradigm of quantum computing consisting of sending a Gaussian state through a linear interferometer and then counting the number of photons in each output mode. When the system encodes a symmetric matrix, GBS can be viewed as a tool to sample subgraphs: the most sampled are those with a large number of perfect matchings, and thus are the densest ones. This property has been the foundation of the novel clustering approach we propose in this work, called GBS-based clustering, which relies solely on GBS, without the need of classical algorithms. The GBS-based clustering has been tested on several datasets and benchmarked with two well-known classical clustering algorithms. Results obtained by using a GBS simulator show that on average, our approach outperforms the two classical algorithms in two out of the three chosen metrics, proposing itself as a viable quantum-classical hybrid clustering option.

Background: Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown. Aims: Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs. Methods: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of &lt; 26 kg for men and &lt; 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted. Results: Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37–3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability. Conclusions: DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Vaccination, particularly against pneumococcus and influenza, is a low-cost primary prevention, useful to avoid hard complications, particularly among frail older people. In this pilot study, we aimed to assess the effect of a strategy for influenza and pneumococcal vaccination for outpatients mainly affected by cognitive or endocrinological conditions, evaluating what could stimulate or demotivate vaccination among older people. This study was conducted during the 2023–2024 influenza season at the outpatient clinics in Palermo, Italy. A total 76 patients were included. More than half of the patients could be considered as pre-frail and about 20% frail, according to a comprehensive geriatric evaluation. Among patients, 46.05% received only vaccination against pneumococcus, 28.95% both vaccinations, and 25.0% only against influenza. Compared with the previous seasons, a 19.5% increase of influenza and 90.2% of pneumococcal vaccine uptake was observed. Side effects of vaccination were the main reason of the previous rejection, namely 76.9% for influenza and 53.8% for anti-pneumococcal vaccination. In conclusion, our study indicates how a new vaccination strategy in different settings could be feasible. Proposing influenza and pneumococcal vaccination for frail older outpatients could be an effective instrument to improve immunization coverage that is still low among older people.

Background: Mild cognitive impairment (MCI) and sarcopenia are two common conditions in older people. It is not widely known if MCI could predict the onset of sarcopenia. Therefore, we aimed to investigate whether MCI could predict the occurrence of sarcopenia in a population of older adults. Methods: In the ELSA (English Longitudinal Study on Ageing), MCI was defined as the absence of dementia, preserved functional capacity and low performance in three objective cognitive tests. Sarcopenia was diagnosed as having low handgrip strength and low skeletal muscle mass index during follow-up. The longitudinal association between MCI at the baseline and incident sarcopenia was assessed using a multivariable logistic regression model, reporting the data as adjusted odds ratios (OR) and 95% confidence intervals (95%CI). Results: 3,106 participants (mean age of 63.1 years; 55.3% males) were included. People with MCI reported significantly lower mean handgrip strength values and Skeletal Mass Index (SMI), as well as a higher prevalence of obesity at baseline. At baseline, 729 people had MCI and during the ten years follow-up period, 12.1% of the initial population included had sarcopenia. On multivariate analysis, adjusted for 18 potential confounders, the presence of MCI (OR = 1.236; 95%CI: 1.090–1.596, p= 0.01) significantly predicted the onset of sarcopenia during follow-up. Conclusion: The presence of MCI at baseline was associated with a higher incidence of sarcopenia at ten-years follow-up, demonstrating a likely role of MCI as a predictor of the onset of sarcopenia in older people.

Radiofrequency Echographic Multi Spectrometry (REMS) is a radiation-free, portable technology, which can be used for the assessment and monitoring of osteoporosis at the lumbar spine and femoral neck and may facilitate wider access to axial BMD measurement compared with standard dual-energy x-ray absorptiometry (DXA).

Bone forming agents, also known as anabolic therapies, are essential in managing osteoporosis, particularly for patients at very high-risk of fractures. Identifying candidates who will benefit the most from these treatments is crucial. For example, this group might include individuals with severe osteoporosis, multiple vertebral fractures, a recent fragility fracture or those unresponsive to antiresorptive treatments. Definitions of patients with a very high fracture risk vary across nations, are often based on fracture history, bone mineral density (BMD), and/or fracture risk calculated by FRAX® or other algorithms. However, for very high-risk patients, anabolic agents such as teriparatide, abaloparatide, or romosozumab are commonly recommended as first-line therapies due to their ability to stimulate new bone formation and improve bone microarchitecture, offering significant benefits in rapid fracture reduction over antiresorptive therapies. The cost-effectiveness of these agents is a critical consideration for decision-makers. Despite their higher costs, their effectiveness in significantly reducing fracture risk and improving quality of life can justify the investment, especially when long-term savings from reduced fracture rates and associated healthcare costs are considered. Additionally, after completing a course of anabolic therapy, transitioning to antiresorptive agents like bisphosphonates or denosumab is crucial to maintain the gains in bone density and minimize subsequent fracture risks. This sequential treatment approach ensures sustained protection and optimal resource utilization. In summary, the effective use of bone forming agents in osteoporosis requires a comprehensive strategy that includes accurate patient identification, consideration of cost-effectiveness, and implementation of appropriate sequential treatments, ultimately maximizing patient outcomes and healthcare efficiency.