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Key summary points: Aim: Our aim was to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians. Findings: By grouping the participants according to BMI categories, overweight and obese participants showed lower functional capability, higher risk of falling but better Mini-Mental State Examination (MMSE) performance than participants with normal weight or underweight. Message: This cross-sectional survey supports the hypothesis that adiposity could affect the cognitive state of people reaching the old age. Purpose: The study of the relationship between body weight and health in old age has attracted increasing interest. The aim of the present study is to investigate the association of body mass index (BMI) with functional and cognitive status in a group of nonagenarians. Methods: We analyzed 475 participants (348 women, 127 men; median age 92 years) from the Mugello study. Participants were evaluated through laboratory, instrumental examinations and questionnaires. Results: By grouping the participants according to BMI categories, a better perception of health and nutritional status and a lower prevalence of sarcopenia (p < 0.05) were observed in participants with overweight and obesity compared to participants with normal weight or underweight. Concerning functional and cognitive measures, overweight and obese participants showed significantly worse performance on short physical performance battery and timed up and go tests and better performance on the mini-mental state examination (MMSE). As regards the other tests performed, no statistically significant differences were observed. In a multivariate logistic regression analysis adjusted for possible confounding factors, participants with BMI ≥ 30 kg/m2 showed lower probability to achieve poor performance on the MMSE (OR 0.42; 95% CI 0.19–0.94; p = 0.035). Conclusion: Our results support the hypothesis that in nonagenarians, a higher BMI is associated with better cognitive ability. Further studies are needed to explore the mechanisms underlying this association. [ABSTRACT FROM AUTHOR]

Prostaglandins are a complex set of biochemical compounds within the body that perform an equally complex array of functions. Two prostaglandins, prostaglandin E2 (PGE2) and prostacyclin (also called prostaglandin I2 or PGI2), have been found to dilate blood vessels. In patients with angina pectoris, the chest pain which results from intermittent oxygen deprivation of the heart muscle, little or no PGI2 or PGE2 can be found. Since normal individuals can increase the production of PGE2 and PGI2 in response to sympathetic stimulation, a test was performed on angina patients under similar conditions. For this test, the stimulation of the sympathetic nervous system, which modulates the body's response to potentially serious or threatening situations, came in the form of immersing the patient's foot in ice water (appropriately called a cold pressor test). The 23 control subjects all responded to the sympathetic stimulation with increased production of PGI2 and PGE2, and a concomitant decrease in the resistance of the coronary arteries to blood flow. In contrast, little or no increase in prostaglandin production could be detected among the 26 patients with angina. Somewhat paradoxically, among the anginal patients, the resistance of the coronary arteries to blood flow actually increased in response to the cold pressor test. It seems clear that prostaglandins play an important role in the response of the heart's circulation to sympathetic stimulation, whether it is in the form of a bucket of cold water or the stresses of everyday life. And, it is equally clear that an abnormal prostaglandin response is part of the inadequate physiological responses that occur in patients with angina. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Background Since the first outbreak of a respiratory illness caused by H1N1 virus in Mexico, several reports have described the need of intensive care or extracorporeal membrane oxygenation (ECMO) assistance in young and often healthy patients. Here we describe our experience in H1N1-induced ARDS using both ventilation strategy and ECMO assistance. Methods Following Italian Ministry of Health instructions, an Emergency Service was established at the Careggi Teaching Hospital (Florence, Italy) for the novel pandemic influenza. From Sept 09 to Jan 10, all patients admitted to our Intensive Care Unit (ICU) of the Emergency Department with ARDS due to H1N1 infection were studied. All ECMO treatments were veno-venous. H1N1 infection was confirmed by PCR assayed on pharyngeal swab, subglottic aspiration and bronchoalveolar lavage. Lung pathology was evaluated daily by lung ultrasound (LUS) examination. Results A total of 12 patients were studied: 7 underwent ECMO treatment, and 5 responded to protective mechanical ventilation. Two patients had co-infection by Legionella Pneumophila. One woman was pregnant. In our series, PCR from bronchoalveolar lavage had a 100% sensitivity compared to 75% from pharyngeal swab samples. The routine use of LUS limited the number of chest X-ray examinations and decreased transportation to radiology for CT-scan, increasing patient safety and avoiding the transitory disconnection from ventilator. No major complications occurred during ECMO treatments. In three cases, bleeding from vascular access sites due to heparin infusion required blood transfusions. Overall mortality rate was 8.3%. Conclusions In our experience, early ECMO assistance resulted safe and feasible, considering the life threatening condition, in H1N1-induced ARDS. Lung ultrasound is an effective mean for daily assessment of ARDS patients.

Abstract Background Epidemiological studies showed that physical exercise, specifically moderate lifelong training, is protective against cardiovascular morbidity and mortality. Most experimental work has focused into the effects and molecular mechanisms underlying intense, rather than mild exercise, by exploring the acute effect of training. Our study aims at investigating the cardioprotective effect of mild chronic exercise training and the gene expression profile changes at 48 hrs after the exercise cessation. Rats were trained at mild intensity on a treadmill: 25 m/min, 10%incline, 1 h/day, 3 days/week, 10 weeks; about 60% of the maximum aerobic power. By Affymetrix technology, we investigated the gene expression profile induced by exercise training in the left ventricle (LV) of trained (n = 10) and control (n = 10) rats. Cardioprotection was investigated by ischemia/reperfusion experiments (n = 10 trained vs. n = 10 control rats). Results Mild exercise did not induce cardiac hypertrophy and was cardioprotective as demonstrated by the decreased infarct size (p = 0.02) after ischemia/reperfusion experiments in trained with respect to control rats. Ten genes and 2 gene sets (two pathways) resulted altered in LV of exercised animals with respect to controls. We validated by real-time PCR the increased expression of four genes: similar to C11orf17 protein (RGD1306959), caveolin 3, enolase 3, and hypoxia inducible factor 1 alpha. Moreover, caveolin 3 protein levels were higher in exercised than control rats by immunohistochemistry and Western Blot analysis. Interestingly, the predicted gene similar to C11orf17 protein (RGD1306959) was significantly increased by exercise. This gene has a high homology with the human C11orf17 (alias: protein kinase-A interacting protein 1 or breast cancer associated gene 3). This is the first evidence that this gene is involved in the response to the exercise training. Conclusion Our data indicated that few, but significant, genes characterize the gene expression profile of the rat LV, when examined 48 hrs since the last training section and that mild exercise training determines cardioprotection without the induction of hypertrophy.