Mauro Cacciafesta

Exaggerated morning blood pressure surge and cardiovascular events. A 5-year longitudinal study in normotensive and well-controlled hypertensive elderly

Cardiovascular events (CE) occur most frequently in the morning hours in hypertensive subjects. We studied the association between the morning blood pressure (BP) surge and CE in prognosis of 10 normotensive and 32 well-controlled hypertensive elderly, in whom ambulatory BP monitoring was performed and who were followed prospectively for 5 years. The morning surge (MS) of BP was calculated as mean systolic BP during 2h after awakening--mean systolic BP during 1h that included the lowest sleep BP. During an average of 60 months, five CE occurred. When the patients were divided into two groups according to MS, those in the top terzile (MS group; MS> or =34 mmHg, n=14) had a higher prevalence of CE (5 versus 0, p=0.001) during the follow-up period, than the others (non-MS group; MS<34 mmHg, n=28). The logistic regression analysis showed the MS sleep-trough surge as predictive variable of CE (odds ratio, OR=0.794, p=0.022). In conclusion, in older normotensives and well-controlled hypertensives, a higher BP MS is associated with vascular risk independently of clinical and ambulatory BP. Reduction of the MS could thus be a therapeutic target for preventing vascular events also in non-hypertensive patients.

Effects of carvedilol on heart rate and blood pressure variability in subjects with chronic heart failure

In this study we observed that carvedilol administration to patients with heart failure improves hemodynamic function, baroreflex sensitivity, and heart rate variability. These findings contribute to improvement in survival in such patients.

Influence of Aging and Other Cardiovascular Risk Factors on Baroreflex Sensitivity

OBJECTIVES: To examine the influence of known cardiovascular risk factors (cholesterol, blood glucose levels, arterial pressures, heart rate, and aging) on baroreflex sensitivity.

Exercise training and music therapy in elderly with depressive syndrome: A pilot study

OBJECTIVE 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. DESIGN AND SETTING 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. MAIN OUTCOME MEASURES 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. RESULTS 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 (p<0.05) at 6-months. In the exercise/music therapy was a reduction in anxiety and in depression at 3-months and at 6-months (p<0.05). 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. CONCLUSIONS 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.

New frontiers of cognitive rehabilitation in geriatric age: the Mozart Effect (ME)

The ME was described for the first time in 1993. Subsequently other studies with similar designs were performed. The present study, therefore, proposes: (i) to verify the existence of the benefits of exposure to music in elderly subjects with mild cognitive impairment (MCI), (ii) to explore whether it is possible to find any lasting improvement after training, conducted for a long period of time, with such musical pieces, in the measurable cognitive performances. The study we conducted showed that the ME is present in geriatric patients with MCI; the influence on spatial-temporal abilities remains constant in time if the stimulation is maintained. The continuation of our study will consist of increasing the number of individuals examined and in having them listen to music during the study of ECG rhythms and during the acquisition of cerebral functional magnetic resonance imaging (fMRI), and, at the same time, testing them by neuropsychometric methods.

Role of 99mTc-Sestamibi scintimammography by SPEM camera in the management of breast cancer in the elderly

The incidence of breast cancer in the elderly is 10 fold higher than in the population younger than 65 years. Moreover, in this segment of the population there are not defined clear practice guidelines regarding patient management. X-ray mammography, the most widely used diagnostic technique, is often inadequate to differentiate benign from malignant lesions.99m Tc Sestamibi scintimammography plays an important role as complement to mammography; in fact it is a very sensitive and specific method for breast cancer detection, when cancers > 1 cm diameter are considered. However, sensitivity values fall to 50–60% in the case of small tumors (T1a and T1b). In this study we present the results of a new Small Field Of View (SFOV) Gamma Camera with very high spatial resolution that allows the first Single Photon Emission Mammography (SPEM). Eighteen patients aged 71 ± 6 years with mammographically detected breast lesions were submitted to a Prone Scinti Mammography (PSM) by conventional Gamma Camera and to a SPEM on craniocaudal view. A final diagnosis was reached by histopathology. SPEM correctly diagnosed 15 of 16 cancers, while PSM was not able to recognize 5 malignant lesions with subcentimeter size. Both the techniques provided normal findings in the case of benign lesions. The 99mTc Sestamibi scintimammography, particularly when performed by SPEM camera, is a sensitive, specific, and non invasive method to define the nature of radiologically described breast masses and would be very useful as a complement to X-ray mammography in screening programs for breast cancer.

Vitamin D: drug of the future. A new therapeutic approach

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.

Role of aging in malnutrition and in restitution of nutritional parameters by tube feeding

Aging and malnutrition are connected by social and pathological factors; many studies show that 60-80% of hospitalized elderly patients are malnourished. The aim of this study was to establish a correlation between age and nutritional parameters in malnourished, hospitalized, elderly patients before and after restitution by tube feeding (using Clintec chemicals) for 45 days, with a mean caloric contribution of 2670 +/- 235 Kcal/day. Twenty-three patients were examined, matched for age (80.59 + 8.35 years) and sex (11 females and 12 males). Patients affected by malignant, chronic or acute diseases that could directly increase cytokine production (TNF-alpha, IL-1, etc.) were excluded. Anthropometric measurements were carried out always by the same operator using a fiberglass tape measure and a Harpenden skinfold caliper. Statistical analysis was carried out by ANOVA test and linear regression analysis. The main observations before and after tube feeding were the following: (i) Significant increases were found in serum albumin, triglyceride and cholesterol levels, whereas slightly increasing tendencies occurred, without reaching statistical significance, in serum transferrin levels, in triceps skinfold (TSF) and mid arm muscle circumference (MAMC) values. In malnourished patients close correlations were found between the age and serum albumin (r = 0.486; p = 0.022), as well as between age and MAMC (r = 0.576; p = 0.005), however, these correlations disappeared after tube feeding. These data show that age itself does not represent an important impediment for nutritional restitution; the possibilities of the latter appear to be dependent on the self-sufficiency and cognitive faculty of the patient, as measured by the activity of daily living (ADL), instrumental activity of daily living (IADL) and mini mental state evaluation (MMSE) scores (p < 0.005).

Montelukast therapy and psychological distress in chronic obstructive pulmonary disease (COPD): a preliminary report.

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.

Circadian Blood Pressure Pattern and Cognitive Function in Newly Diagnosed Older Hypertensives

Hypertensive subjects can be subdivided in two groups, dippers and non-dippers, according to the presence or the lack of a nocturnal fall of blood pressure (BP) of over 10%. Several studies have investigated cardiovascular and cerebrovascular organ damage in the two groups with discordant results, but fewer of them analysed the relationship between circadian BP pattern and cognitive function, and none in the early phases of hypertension. To this purpose, we selected 40 older hypertensives, 23 dippers and 17 non-dippers, with newly diagnosed hypertension, never treated, who underwent to 24-h ambulatory BP monitoring (ABPM), Mini-Mental State Examination (MMSE) and recording of event-related potentials (ERPs). No significant differences between dippers and non-dippers were found in the MMSE scores and P300 latency values, as we expected, and not even in N2 wave latency values, showing that the non-dipping pattern is not associated with lower cognitive function in the early phases of hypertension.