OBJECTIVE: To investigate the changes of visceral fat, as compared with total and subcutaneous adipose tissue (AT) in obese patients operated with laparascopic adjustable silicone gastric banding (LAP-BAND). SUBJECTS: Six premenopausal morbid obese (body mass index range: 41.4 ± 44.2 kgam 2 ) women, aged 38 ± 42 y, operated with LAP-BAND, evaluated before, 8 weeks after, and 24 weeks after surgery. MEASUREMENTS: Fat distribution was analysed by total body multi-slices MRI. Total AT, gluteo-femoral subcutaneous AT, abdominal subcutaneous AT, and abdominal visceral AT volumes were measured. FM was calculated from MRI-determined total AT volume and AT density. RESULTS: A weight loss of 9.9AE AE3.8 kg was observed in the ®rst 8 weeks after LAP-BAND (0 ± 8 weeks), and a further weight loss of 7.1AE AE4.9 kg in the subsequent 16 weeks (8 ± 24 weeks). Total AT showed a statistically signi®cant reduction of 6.2AE AE4.0 l in 0 ± 8 weeks and a further signi®cant reduction of 7.7AE AE3.9 l in 8 ± 24 weeks (P`0.01 from baseline). A similar trend was observed for both abdominal and gluteo-femoral subcutaneous AT. Visceral AT showed a statistically signi®cant reduction of 1.0AE AE0.9 l in the 0 ± 8 weeks (P`0.05) and a further non-signi®cant reduction of 0.6AE AE0.7 l in 8 ± 24 weeks (P`0.05 from baseline). In 0 ± 8 weeks, the relative reduction of visceral AT was higher than the relative reduction of both total AT and gluteo-femoral subcutaneous AT. A highly signi®cant correlation was observed between the reduction of total AT and the reduction of both abdominal and gluteo-femoral subcutaneous AT. By contrast, in 0 ± 8 weeks, the reduction of total AT and the reduction of visceral AT were not correlated. In a subsequent analysis, both observations collected in the ®rst 8 weeks after LAP-BAND and observations collected in the last 16 weeks are simultaneously considered, leading to a total of 12 time periods (two time periods for each individual patient). In order to identify factors associated with preferential visceral fat reduction, we calculated for each of the 12 time periods the difference between the percentage changes of visceral AT and the percentage changes of total AT. The relationship between this difference and several other variables were investigated by simple correlation analysis. The only variables found to be associated were the initial visceral AT volume, the absolute level of weight loss (kg) per week of observation, and the relative level of weight loss (%) per week of observation. CONCLUSION: In the phase of rapid weight loss following LAP-BAND, a preferential mobilization of visceral fat, as compared with total and subcutaneous AT, can occur. However, this preferential visceral fat reduction occurs only in those patients presenting higher levels of visceral fat deposition at baseline and higher levels of weight loss.

Bioelectrical impedance analysis (BIA) is a noninvasive method recently introduced for body fluid evaluation in healthy subjects. The purpose of this paper is to verify the reliability of bioelectrical measurements in extracellular water (ECW) prediction in healthy subjects and in fluid retention states. We studied 40 subjects (19 males and 21 females) aged 21-81 years; 22 were healthy subjects, 12 were affected by chronic heart failure, and 6 by chronic renal failure. In all subjects resistance (R) and reactance (Xc) at 1 and 50 kHz corrected for height were compared with ECW measured by the bromide dilution method. Our results suggested a different behavior of the current in fluid-retention states with respect to healthy subjects. ECW was best predicted by resistance at 1 kHz corrected for height, group (considered as dummy variable), weight and gender (R² = 0.89, p < 0.001, SEE = 1.7 liters). The bioelectrical impedance analysis at 50 kHz explained the 89% of ECW variability when resistance and reactance corrected for height are considered with gender group and weight (R² = 0.89, p < 0.001, SEE = 1.7 liters). In conclusion, the bioelectrical method at 1 kHz can be considered sufficiently accurate in ECW prediction in healthy subjects and in fluid retention states. Also, the bioelectrical impedance analysis at 50 kHz is useful for predicting ECW, but his role must be further investigated.

Background: In the literature there are several body impedance analysis (BIA) prediction equations generally determined in younger populations and their accuracy in the elderly has not been adequately confirmed. Objective: We verified the reliability of the BIA method in a body composition study in the elderly. Methods: To assess the accuracy of bioelectrical impedance analysis we compared this method with dual photon absorptiometry (DPA), assumed as a gold standard; body composition was predicted by seven BIA prediction equations in 24 healthy elderly individuals. Results: The best equation in fat-free mass (FFM) estimation is the RJL System formula (published by Segal in 1988); nevertheless, the wide range of the error in FFM estimating may limit its clinical application. The FFM hydration variability seems to be the principal variable which explains the error in FFM estimation by BIA prediction equations. Conclusion: These findings indicate that the use of BIA equations is not interchangeable, when FFM is calculated in an elderly population, and more validation studies are necessary in this age group to evaluate the clinical application of this method.

In burn patients, variability in heart rate is associated with a significant part of postburn hypermetabolism variability. Therefore, heart rate may be considered a useful variable to be used for the evaluation of the energy requirements of severely burned patients.

Introduction A new national survey has been carried out by the Italian Centers for Cognitive Disorders and Dementias (CCDDs). The aim of this new national survey is to provide a comprehensive description of the characteristics, organizational aspects of the CCDDs, and experiences during the COVID-19 pandemic. Methods A list of all national CCDDs was requested from the delegates of each Italian region. The online questionnaire is divided in two main sections: a profile section, containing information on location and accessibility, and a data collection form covering organization, services, treatments, activities, and any service interruptions caused by the COVID-19 outbreak. Results In total, 511 out of 534 (96%) facilities completed the profile section, while 450 out of 534 (84%) CCDDs also completed the data collection form. Almost half of the CCDDs (55.1%) operated for 3 or fewer days a week. About one-third of the facilities had at least two professional figures among neurologists, geriatricians and psychiatrists. In 2020, only a third of facilities were open all the time, but in 2021, two-thirds of the facilities were open. Conclusion This paper provides an update on the current status of CCDDs in Italy, which still shows considerable heterogeneity. The survey revealed a modest improvement in the functioning of CCDDs, although substantial efforts are still required to ensure the diagnosis and care of patients with dementia.

No abstract