Antonino Mulè

Balance is the ability to integrate vestibular, somatosensory, and visual inputs to maintain the body’s center of gravity within its stability limits. While chronic poor sleep habits are known to impair postural control, the acute effects of a single night of bad sleep remain controversial. This study aimed to determine whether one night of poor sleep would affect postural control, using objective sleep and balance assessments. Forty-eight subjects (age = 22.15 ± 0.47 years; BMI = 22.20 ± 0.34) performed the modified Clinical Test of Sensory Interaction in Balance (m-CTSIB), which evaluates the vestibular, proprioceptive, and visual components of balance through four distinct conditions. The tests were conducted at 9:00 AM and 6:00 PM on separate days. Participants wore an actigraph the night before each test, and based on National Sleep Foundation cut-offs, they were classified as Good Sleepers (GS), Intermediate Sleepers (IS), or Bad Sleepers (BS). In the evening session, BS exhibited significantly higher oscillation index values than both GS and IS (p = 0.01), indicating worse balance control. No significant differences were found between GS and IS. Poor sleep quality and quantity can significantly impair balance, particularly its vestibular component, in the evening. These findings enhance our understanding of the physiological relationship between sleep and balance, with implications for athletic training and fall prevention.

Purpose: The six-minute walk test (6MWT) is one of the most widely utilized submaximal tests to assess cardiorespiratory fitness in both healthy and clinical populations. The present study aims to provide 6MWT reference values for Italian adolescents (11–18 years) and to identify key variables influencing the six-minute walk distance (6MWD). Methods: Data were collected from 3276 Italian adolescents (48% males). Participants provided self-reported age, height, weight, and weekly practice of moderate-to-vigorous physical activity (MVPA). 6MWT was performed to assess participants’ cardiorespiratory fitness. Results: Average distances of 730.0 (IQR: 674.0–788.0) and 675.0 (IQR: 624.0–720.0) meters were walked in the 6MWT by male and female adolescents, respectively. Multiple linear regression models, used to investigate whether demographics, anthropometrics, and MVPA predicted the 6MWD, revealed statistically significant results in both males ( p < .001, F = 28.94, adjusted R ² = 0.11) and females ( p < .001, F = 23.00, adjusted R ² = 0.09). In male adolescents, MVPA and age positively predicted the 6MWD, whereas BMI negatively predicted the 6MWD. In female adolescents, MVPA positively predicted 6MWD, whereas age and BMI negatively predicted 6MWD. No interaction effects were found. Conclusion: The reference percentiles of distance walked, classified by sex and age, reported in the present study can be used as a practical tool to assess adolescents’ cardiorespiratory fitness. This study also highlights the importance of PA engagement in this population, as it was considerably associated with the average distance walked. Consequently, in addition to anthropometric and demographic variables, future studies should pay particular attention to the amount of MVPA practiced.

Sleep efficiency is a widely used indicator of sleep quality in actigraphy studies. Nevertheless, it is a composite metric integrating data derived from actigraphic recordings alongside information about bedtime and wake-up time, typically obtained from self-reported sleep logs. The aim of this report is to propose a novel sleep efficiency index, denoted as core sleep efficiency, that relies solely on actigraphic data and focuses on the quality of sleep after its onset. Using a database of actigraphic recordings obtained in 40 young subjects (22 ± 3 yrs, Mean±SD) and in 45 middle-aged subjects (63 ± 11 yrs, Mean±SD), we evaluated the interrelationship between the two metrics of sleep efficiency and investigated the extent of their correlation with other crucial actigraphic indicators of sleep quality, such as sleep onset latency, fragmentation index and mean activity score. We provided evidence suggesting that the novel index may be suitable for specifically assessing the quality of sleep once it has begun. We propose that the newly introduced core sleep efficiency has the potential to serve as a valuable adjunct to the classic sleep efficiency, thus enriching the parametric characterisation of sleep obtained through actigraphy.

University students are commonly described as having worsened sleep quality, especially when inactive and Evening-type (E-type) subjects. This study aimed to examine the interactions between physical activity and chronotype on sleep quality among a sample of active Sports Science university students. In November 2019, 433 participants (mean age: 19.7 ± 1.56 years; 70% males) completed the Pittsburgh Sleep Quality Index, the Godin-Shepard Leisure-Time Physical Activity Questionnaire (tertiles categorisation), and the Morningness-Eveningness Questionnaire. Females and E-type slept significantly worse than males and Neither-(N-types) and Morning-types (M-types), respectively. However, there were no significant differences in sleep quality based on physical activity levels. The three-way ANOVA revealed that sleep quality in N- and E-types appeared to be independent of physical activity, whereas M-types showed an improvement in sleep classification with increased physical activity. Moderation analysis indicated that physical activity significantly moderated the relationship between chronotypes and sleep quality. Specifically, M-types demonstrated a more pronounced improvement in sleep quality with increasing physical activity compared to the other chronotypes. In conclusion, M-type university students derived the greatest benefits from physical activity in improving sleep quality. Conversely, physical activity seemed to have a limited impact on sleep quality among active E-type university students.

Cystic lesions of the anterior head and neck region are a challenging and frequent finding on cytological smears. The scant amount of cellular material in cystic slides poses the greatest difficulty to interpretation, so that frequently they are diagnosed as inadequate or with minimal cellular component. Despite the majority of cystic lesions being benign, a minor portion consist of malignant cystic entities. In these latter cases, the evidence of very scant malignant cells can be misdiagnosed and/or underestimated, leading to a false negative diagnosis. Many papers have already described and detailed the range of possible benign and malignant cystic lesions in head and neck. In the current review we have focused on the less common entities that often lead to serious misinterpretation.

Autophagy dysregulation is commonplace in the pathogenesis of several invalidating diseases, such as musculoskeletal diseases. Polyamines, as spermidine and spermine, are small aliphatic cations essential for cell growth and differentiation, with multiple antioxidant, anti-inflammatory, and anti-apoptotic effects. Remarkably, they are emerging as natural autophagy regulators with strong anti-aging effects. Polyamine levels were significantly altered in the skeletal muscles of aged animals. Therefore, supplementation of spermine and spermidine may be important to prevent or treat muscle atrophy. Recent in vitro and in vivo experimental studies indicate that spermidine reverses dysfunctional autophagy and stimulates mitophagy in muscles and heart, preventing senescence. Physical exercise, as polyamines, regulates skeletal muscle mass inducing proper autophagy and mitophagy. This narrative review focuses on the latest evidence regarding the efficacy of polyamines and exercise as autophagy inducers, alone or coupled, in alleviating sarcopenia and aging-dependent musculoskeletal diseases. A comprehensive description of overall autophagic steps in muscle, polyamine metabolic pathways, and effects of the role of autophagy inducers played by both polyamines and exercise has been presented. Although literature shows few data in regard to this controversial topic, interesting effects on muscle atrophy in murine models have emerged when the two “autophagy-inducers” were combined. We hope these findings, with caution, can encourage researchers to continue investigating in this direction. In particular, if these novel insights could be confirmed in further in vivo and clinical studies, and the two synergic treatments could be optimized in terms of dose and duration, then polyamine supplementation and physical exercise might have a clinical potential in sarcopenia, and more importantly, implications for a healthy lifestyle in the elderly population.

Actigraphic parameters can provide indication of people’s sleep quality during their daily lives. However, there is a need for clear guidelines on the understanding of the different actigraphic parameters. The present study aims to propose a conceptual and theoretical framework for known actigraphic-derived parameters, which is able to describe the alternation between rest and wake phases during the nocturnal sleep, explaining their main characteristics and interrelations that can be replicated in future studies. Forty Sport Sciences students at the University of Milan (20 males; mean age ± SD, 22 ± 3 y) completed the validated Italian version of Morningness-Eveningness Questionnaire (MEQ) and wore an actigraph (Motion Watch 8®, Cambridge Neurotechnology, Cambridge, UK) for seven days. A framework was developed to depict the interactions between the actigraphic parameters and how they objectively describe sleep, according to which the parameters are organized into three different functional blocks related to different aspects of sleep. Correlations analyses were conducted to explore the relationships among the primary actigraphic parameters within and across the functional blocks. The proposed framework is a purely theoretical construct that provides a simple interpretation of known actigraphic parameters guiding researchers and practitioners in the use of these parameters either for research or clinical purposes.

The current study aimed to evaluate the Italian university students’ lifestyle during the COVID-19 pandemic, considering the degree courses, chronotype, and sex. Five-hundred thirty-three participants (21.46 ± 0.18 yrs, 335 females) filled out: Godin-Shephard Leisure Time Physical Activity Questionnaire (GSL-TPAQ), Pittsburgh Sleep Quality Index (PSQI), Mediterranean Diet Quality Index (KIDMED), Reduced Morningness-Eveningness Questionnaire (rMEQ) to assess physical activity, sleep, nutrition and chronotype. Use of electronic devices, smoking, and drinking habits were also evaluated. Sports science students were more active (60.92 ± 2.96), slept better (4.40 ± 0.15), showed greater Mediterranean diet adherence (5.98 ± 0.31), and smoked less (smokers: 14.5%) than nursing students (GSL-TPAQ: 38.62 ± 2.92, PSQI: 5.29 ± 0.18, KIDMED: 4.23 ± 0.33, smokers: 27.9%). They displayed a higher percentage of beer drinkers (40% vs. 28.7%) and lower use of electronic devices (5.92 ± 0.17 vs. 9.07 ± 1.17). Evening-type students showed worse sleep (5.96 ± 0.30) and lower Mediterranean diet adherence (4.32 ± 0.52) than Neither- (PSQI: 4.58 ± 0.13, KIDMED: 5.13 ± 0.28) and Morning-types (PSQI: 4.33 ± 0.33, KIDMED: 6.71 ± 0.64). Evening-types also showed a higher percentage of smokers (29.9%) and drinkers (beer: 53.3%, wine: 45.8%, alcohol: 40.2%) than Neither- (smokers: 20.3%, beer: 31.4%, wine: 31.4%, alcohol: 23.5%) and Morning-types (smokers: 8.9%, beer: 19.6%, wine: 19.6%, alcohol: 8.9%). Evening-type males used electronic devices longer (9.10 ± 3.05) than females (6.71 ± 0.41). Females showed fewer drinkers (beer: 26.6%, wine: 29.6%) than males (beer: 49.0%, wine: 38.9%). Maintaining a correct lifestyle even in this unusual condition is essential, in particular among the Evening-type students.

Balneotherapy and exercise are potential factors influencing sleep through several physiological pathways and relaxing effects. This review aims to assess whether balneotherapy can improve sleep quality in concomitance or not with exercise. The research was conducted on Medline, Scopus, PubMed, Web of Science, and Cochrane Library databases. The current review followed PRISMA reporting guidelines and involves twenty-one articles grouped into four sections based on the characteristics of the balneotherapy protocol: 1.a Balneotherapy–thermal water immersion alone (five studies); 1.b Balneotherapy–thermal water immersion with other spa treatments (six studies); 2.a Balneotherapy and physical exercise–balneotherapy and out-of-the-pool physical exercise (eight studies); 2.b Balneotherapy and physical exercise–balneotherapy and in-pool physical exercise (three studies). Apart from healthy or sub-healthy subjects, patients recruited in the studies were affected by fibromyalgia, ankylosing spondylitis, osteoarthritis, musculoskeletal pain, subacute supraspinatus tendinopathy, and mental disorders. Duration, number of sessions, and study protocols are very different from each other. Only one study objectively evaluated sleep, whereas the others used subjective sleep assessment methods. Eight studies considered sleep as a primary outcome and ten as secondary. Sixteen out of twenty-one studies described improvements in self-perceived sleep quality. Thus, balneotherapy associated with other spa treatments and physical exercise seems to be effective in improving self-perceived sleep quality. However, the miscellany of treatments makes it difficult to discern the isolated effects of balneotherapy and physical exercise. Future studies should consider using an objective sleep assessment method and describing the pathways and physiological mechanisms that could provoke sleep changes during balneotherapy treatments.