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Introduction: Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium., Methods: The analyses were conducted employing the cross-sectional "Delirium Day" initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses., Results: A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09-2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001]., Discussion and Conclusion: Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium., (© 2021. The Author(s).)

Early brain injury (EBI), delayed cerebral vasospasm (DCVS), and delayed cerebral ischemia (DCI) are common complications of subarachnoid hemorrhage (SAH). Inflammatory processes in the cerebrospinal fluid (CSF) are one of the causes for such complications. Our aim to study the effects of an IL-6 receptor antagonist (Tocilizumab) examines the occurrence of DCVS, neuronal cell death, and microclot formation in an acute SAH rabbit model. Twenty-nine New Zealand white rabbits were randomized into one of three groups as the SAH, SAH + Tocilizumab, and sham groups. In SAH groups, hemorrhage was induced by extracranial-intracranial arterial blood shunting from the subclavian artery into the cisterna magna under intracranial pressure (ICP) monitoring. In the second group, Tocilizumab was given once intravenously 1 h after SAH induction. Digital subtraction angiography was performed, and CSF and blood were sampled before and after (day 3) SAH induction. IL-6 plasma and CSF levels were measured. TUNEL, FJB, NeuN, and caspase-3 immunostaining were used to assess cell apoptosis, neurodegeneration, and neuronal cell death, respectively. Microclot formation was detected by fibrinogen immunostaining. Between baseline and follow-up, there was a significant reduction of angiographic DCVS (p < 0.0001) in the Tocilizumab compared with the SAH group. Tocilizumab treatment resulted in decreased neuronal cell death in the hippocampus (p = 0.006), basal cortex (p = 0.001), and decreased microclot formation (p = 0.02). Tocilizumab reduced DCVS, neuronal cell death, and microclot formation in a rabbit SAH model, and could be a potential treatment to prevent DCVS and DCI in SAH patients., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)

The aim of this study was to assess whether adherence to a restricted-calorie, Mediterranean-type diet improves endothelial dysfunction and markers of oxidative stress in patients with metabolic syndrome. A moderately low-calorie (600 calories/day negative energy balance), low-fat, high-carbohydrate diet (<30% energy from fat, <10% from saturated fat and 55% from carbohydrate) was prescribed to 53 outpatients with the metabolic syndrome. Participants were divided into two groups according to body weight loss > or < 5% after 6 months. Group A (n = 23) showed a remarkable decrease in body weight (-6.8%), body-mass-index (-4.6%), waist circumference (-4.8%), HOMA-IR (-27.2%), plasma glucose, glycosylated haemoglobin, total and LDL-cholesterol, blood pressure, serum NOX2 (the catalytic core of NADPH oxidase) (-22.2%) and urinary8-isoprostanes (-39.0%) and an increase of serum NOx (Nitrite/Nitrate) (+116.8%) and adiponectine (+125.5%) as compared with those in group B (n = 30). A statistically significant increase in brachial artery flow-mediated dilatation was observed in group A (+24.7%; p < 0.001), while no changes were present in group B. Variations of flow-mediated dilatation were statistically and negatively correlated with changes of serum NOX2 levels (p = 0.04), body-mass-index (p < 0.01), waist circumference (0.01), glycosylated haemoglobin (p < 0.01), LDL-cholesterol (p < 0.01) and triglycerides (p < 0.05) and positively correlated with changes of serum NOx (p < 0.001) and adiponectin (p = 0.01). The results show that moderate weight loss is able to improve endothelial dysfunction in patients with the metabolic syndrome. The coexistent decrease of NOX2 activation suggests a role for oxidative stress in eliciting artery dysfunction.

Background and Aims: Several publications and guidelines stress the efficacy and safety of opioid-based therapy for cancer and non-cancer pain management. The first point of the World Health Organization (WHO) guidelines recommends that, if possible, analgesics should be given by mouth. This advice fully matches the European Society for Medical Oncology (ESMO) guidelines, which advise that opioids should be titrated to take effect as rapidly as possible. The European Association for Palliative Care (EAPC) guidelines specify that transdermal fentanyl should be administered only in patients with stable analgesic requirements. The aim of this study was to assess the efficacy and influence on the quality of life of controlled- release (CR) oxycodone in patients who had obtained no or only partial pain relief after transdermal (TTD)-based opioid therapy., Methods: Forty-one consecutive patients experiencing persistent cancer and non-cancer related pain and in treatment with transdermal- based opioid therapy for at least 5 days were enrolled in this open-label, multicenter observational study. All patients were switched from transdermal to oral opioid therapy with oxycodone CR for 21 days. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 (0=no pain, 10=maximum severity). Patients were asked to rate their perceptions on efficacy and pain interference on the quality of life on an NRS from 0 to 10 (0=no interference, 10=maximum interference)., Results: After 3 days with oxycodone CR, pain intensity decreased by 38.83% (p<0.001) and maintained a significant decrease throughout the period (T0-T7: -59.71%, p<0.001; T0-T21: -65.75%, p<0.001). The average daily dose of oxycodone CR increased from 68.75 mg at baseline to 72.39 mg after 7 days and was maintained stable until the study ended. At T0, 56.10% of patients suffered from severe pain (NRS 7- 10); this percentage had decreased to 2.56% at the end of the study. About 7% of patients considered transdermal therapy effective at baseline; after 21 days, 72.22% and 19.44% of patients considered it effective and very effective, respectively. Quality of life improved significantly during the 21 days with the oral treatment (p<0.001)., Conclusions: Switching from transdermal opioid to oxycodone CR treatment is effective and leads to patients' improved satisfaction and quality of life.