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Paola Rogliani,1 Gian Marco Manzetti,1 Shima Gholamalishahi,1 Mario Cazzola,1 Luigino Calzetta2 1Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome, Italy; 2Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, Parma, ItalyCorrespondence: Paola Rogliani, Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, Rome, 00133, Italy, Email paola.rogliani@uniroma2.itAbstract: Mucus clearance is crucial for airway protection, and its dysfunction leads to chronic obstructive pulmonary disease (COPD) characterized by mucus hypersecretion (MHS) and impaired clearance. MUC5AC and MUC5B mucin proteins are key components of airway mucus, with MUC5AC being particularly responsive to environmental stimuli, making it a potential COPD biomarker. N-acetylcysteine (NAC) is a mucolytic agent with known effects on mucus viscosity and clearance, but its precise mechanisms in COPD remain unclear. This systematic review evaluated the impact of NAC on MHS in the airways, reporting significant inhibitory effects on MUC5AC and MUC5B gene and protein expression, as well as a reduction in the number of goblet cells. NAC has demonstrated efficacy in vitro and in animal models of MHS, including COPD models, but data on human bronchial tissue are lacking. This systematic review suggests that NAC acts as a mucolytic and a mucoregulator, directly inhibiting mucus secretion and goblet cell hyperplasia. Given the critical role of MHS in COPD progression, exacerbations, and mortality, these findings highlight the potential of NAC as a targeted therapy for hypersecretion COPD phenotypes. However, further studies are needed to confirm the results of this systematic review, even in human bronchial tissue, to provide translatable evidence in clinical settings. Understanding the intimate mechanism of NAC versus MHS regulation may pave the way for more effective treatments targeting airway mucus dysfunction in COPD, ultimately improving patient outcomes and reducing morbidity and mortality associated with chronic mucus hypersecretion.Keywords: COPD, mucus hypersecretion, N-acetylcysteine, systematic review

OBJECTIVE: Pilates is a popular system of exercise that is recommended for healthy individuals and patients with low back pain (LBP). The restoration of muscle function in lumbopelvic stability and pelvic floor muscles has been fostered by practices based on this strategy. Restoring or sustaining the motor control of the lumbar spine and proper body posture during each exercise is very important. The aim of this umbrella review (UR) of systematic reviews and narrative reviews is to detect the effects of exercise on patients with chronic low back pain (CLBP). MATERIALS AND METHODS: Records were published in December 2019 and identified from Web of Science, PubMed, and Scopus. Studies that addressed this topic were included. The protocol was registered on PROSPERO (246510). RESULTS: The Pilates method, using functional exercises, improves muscular strength and endurance. Eleven studies were included in the UR. Nine reviews for chronic LBP concluded that there were pain relief and functional progression from the Pilates-based exercise intervention in the short-term. There was strong evidence that Pilates exercise improved flexibility and dynamic balance and enhanced muscular endurance among healthy people in the short-term. CONCLUSIONS: Pilates exercise improved dynamic balance and flexibility also raised muscular endurance in people in the short time. There was some evidence that admits this exercise as effective in body fat reduction and increasing fat-free mass in the short-term. [ABSTRACT FROM AUTHOR]

Background. The aim of this study is to investigate the effect of of 12 weeks of water aerobic exercise and atrovastain drug on apolipoproteins changes A1, ANP, BNP and CRP in older men with cardiovascular disesaes. Methods. In this study, we chose 40 patients with cardiovascular disease that were divideded in to four groups. Experimental groups selected exercise 3 times per weeks during 3 months with the method ofwalking on the water and carnal swimming. Results. The results were expressed as the mean ± sd, and all statistical comparisons were made by means of a one-way ANOVA test, followed by Tukey’sPost-Hoc analysis. Conclusion. the effect of exercise and intervention taking Atorvastatin increased Apolipoproteins A1changes, but reducedANP, BNP, and CRP, followed by the reduction of disease cardio - vascular and improve cardiovascular function. [ABSTRACT FROM AUTHOR]

Introduction. Endothelial progenitor cells (EPCs) play a role in preventing endothelial dysfunction and increasing the angiogenesis process. Regular training increases these cells. Turmeric Curcumin has anti-inflammatory and anti-atherosclerotic properties. Animal, Materials and Methods. 49 Wistar rats were randomly assigned to control (C), Saline (S), curcumin (cur), moderate interval training (MIT), high interval training (HIT), MIT+curAndHIT+cur. The training groups trained 8 weeks,3 sessions per week and 40 minutes each session at 28 and 34 m / min. 48 hours after the last training, The gene expression of the CD34 and KDR was measured by Real-time PCR and CRP usesthe ELISA method. Findings. CD34 and KDR mRNA in cur, MIT and HIT groups showed a significant increase compared to C and Sgroups.The highest levels of CD34 and KDR mRNA were observed in HIT+curgroup. While the increase of CD3 mRNA in HIT group was greater than the cur and MIT groups(P = 0.0001). KDR showed a significant increase in MIT and HIT groups compared to C, S, cur and MIT+cur groups. Serum CRP means significantly decreased in all experimental groups compared to C and S groups. Discussion and Conclusion.The rate of increase in EPCs mRNA in response to aerobic training is dependent on training intensity. HIT training is likely to be more effective in the repair and development of coronary arteries. These findings can be useful for cell therapy and improve cardiovascular regeneration after injury and myocardial disorder, especially in elderly conditions. [ABSTRACT FROM AUTHOR]

Background. The objective of this study was to evaluate the reliability and validity of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires in the Italian setting in order to make this instrument available for the determination of lifestyle and hope level in the different domains of everyday life. Method. Before testing their psychometric properties, the original versions of the two questionnaires, lifestyle (Miller-Smith) and life expectancy (Schneider), were translated into the Italian language. We tested the instrument's psychometric properties on a sample of 18 patients over 60 years old with Alzheimer's disease in the Sapienza University of Rome teaching hospital, policlinico Umberto 1. Internal consistency was considered to assess the reliability of the results across items within the adopted scale by using Cronbach's α coefficient. Using Kolmogorov-Smirnov's test, the normality distribution was evaluated to guarantee the applicability of a parametric or non-parametric test. The software used to analyze data was SPSS version 26 for Windows. Results. According to the outcome of our statistical analysis, the lifestyle scale showed high overall internal consistency, and the Cronbach's α coefficient for the total 20-item scale was 0.80 in the Italian population. On the other hand, using the 12-item questionnaire about life expectancy resulted in a high overall internal consistency of 0.93, according to the Cronbach's alpha test. Conclusions. The outcome of our study shows that the Italian versions of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires demonstrated good psychometric properties and good characteristics of factorial validity for future epidemiological studies aimed at evaluating lifestyle and lifestyle expectancy in the Italian population and can as well be used in clinical practice and research. [ABSTRACT FROM AUTHOR]

Aim. To develop and test the effectiveness of an E-learning program for promoting physical activity (PA) and wellness among nurses. Background. Restrictions during the coronavirus (COVID-19) pandemic drastically changed many people's lives. Maintaining a healthy lifestyle is an everyday challenge faced by the general population. Nurses are one of the health care professionals who are typically well-educated in taking care of patients. There are studies that show that night shifts, extended shifts, and obesity have a correlation with the prevalence of acute low back pain among female nurses. PA is the key factor in the prevention and treatment of many chronic diseases, resulting in an improvement in the quality of Life. The impact of social media and technology on our lives is undeniable in the modern era. Design. This study will be a single-centre, single-blind, randomized controlled trial executed on an E-learning platform to provide the control and intervention groups with a distance learning program. Participants will be randomly assigned to either the control or intervention group. Participants in the control group will only sign up for module 1 of the PA modules, which only comprises information on PA and health promotion. On the other hand, the participants in the intervention group are expected to carry out 3 modules of exercises at home three days a week for a total duration of 8 weeks. The exercises will be performed at moderate intensity (5-6 on the Borg CR10 Scale). Ethical issues. This trial will comply with the declaration of Helsinki 1975, as revised in 2000. Informed written consent will be obtained from the participants. The Sapienza University of Rome, institutional ethics committee and review board approval will be requested for this study. Conclusion. Establishing an online PA program with good quality, such as a high level of convenience in access and use, simplified, easy to practice, and made available on social media, can minimize the difficulties faced previously in the implementation of an online PA program for nurses, and may enhance the health and wellbeing of many nurses in healthcare institutions. [ABSTRACT FROM AUTHOR]

Purpose. Hypokinesia is the fourth cause of endemic death in the world. The prevalence of obesity, caused by hypokinesia, in the world continues to increase and it is the main risk factor of chronic diseases. Our aim was to evaluate the effectiveness of curves program and High- Intensity Interval Training (HIIT) in healthy women. Methods. The study design is a non-randomized clinical trial. Eighty women with age between 30 to 40 years (who train 3/4 times a week) participated over a period of six months. They were allocated into a "Curves" program group (n = 40) and a "High-Intensity Interval Training" group (n = 40). BMI, body fat, the fat mass percentage was calculated by OMRON body fat 306 TM at baseline and the end of the intervention. Results. the results between high-intensity interval training and curves show that curves scores were significantly lower among Interval training. after 6 months the most impact was on "Abdomen loss "in Curves Group Mean(SD) = -4.48(1.70). According to the multivariate analysis, we can say that for all the dependent variables Weight loss -0.320 (<0.001), Trunk loss -0.376 (<0.001), Abdomen loss -0.276 (<0.001), Hip loss -0.302 (<0.001), Lower arm loss -0.248 (0.003) and Fat mass loss -0.153 (0.061) the curves group shows significant results in comparison with the high-intensity interval training group (p < 0.001) while the civil status is significantly associated with only "Upper arm loss" variable (ß = -0.357; p <0.001). Conclusions. This "Curves" program improved strength muscles, loss of fat and fat mass reduction more than High Intensity Interval Training. [ABSTRACT FROM AUTHOR]

The increasing global elderly population, projected to reach 20 % of individuals aged 65 and over by 2030, faces significant pulmonary challenges, including chronic obstructive pulmonary disease (COPD). Aging is associated with a natural decline in lung function and structural changes that exacerbate respiratory issues. COPD, characterized by chronic respiratory symptoms and airflow obstruction, presents a unique challenge in older patients due to the accelerated decline in lung function. Acetylcholine plays a pivotal role in airway dynamics through muscarinic acetylcholine receptors, particularly M 3 subtype, which mediates bronchoconstriction. The efficacy of long-acting muscarinic antagonists (LAMA) may differ in older adults, with evidence suggesting that these patients can respond favorably to LAMA treatment. This study utilized meta-analysis and meta-regression to explore the efficacy and safety of LAMA in treating COPD, while considering aging as a potential modifier. A meta-analysis of Phase III randomized controlled trials highlighted significant improvements in trough forced expiratory volume in the 1st second when LAMA were compared to placebo (PCB). Furthermore, the meta-regression revealed a trend suggesting older adults may experience enhanced benefits from LAMA therapy, particularly with once-daily regimens. Safety outcomes, including serious adverse events (SAE), cardiovascular SAE, and mortality, were not modulated by age when comparing LABA to PCB. Overall, these findings support the use of LAMA in elderly COPD patients and underscore the need for tailored treatment strategies to improve clinical outcomes in this vulnerable population., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The investigation of ensifentrine, an inhaled dual phosphodiesterase (PDE)3 and PDE4 inhibitor, for chronic obstructive pulmonary disease (COPD) maintenance therapy presents a significant clinical interest. Despite promising results from recent Phase III trials, a comprehensive synthesis of its therapeutic efficacy in COPD is lacking. This protocol outlines the first registered systematic review and meta-analysis in PROSPERO to assess the impact of ensifentrine on trough forced expiratory volume in the 1st second (FEV 1 ) and acute exacerbations of COPD. By conducting a rigorous literature search and employing solid methodologies, this endeavour aims to provide robust evidence on the real efficacy of ensifentrine. Anticipated outcomes include a significant improvement in trough FEV 1 and a reduction in AECOPD risk among ensifentrine-treated patients compared to controls, corroborating its bronchodilator and anti-inflammatory properties. The meta-analysis expects to reveal consistent results across different trials, enhancing confidence in the findings. Additionally, subgroup analyses may unveil factors influencing the efficacy of ensifentrine, guiding optimal therapeutic strategies. Overall, this protocol holds the potential to inform clinical practice and regulatory decisions, positioning ensifentrine as a valuable addition to COPD management., Competing Interests: No conflict of interest., (© 2024 The Authors. Published by Elsevier B.V.)

Background: Asthma and chronic obstructive pulmonary disease (COPD) are global health challenges leading to substantial morbidity and mortality. While existing guidelines emphasize evidence-based treatments, the potential therapeutic role of thermal water (TW) inhalation remains under-investigated., Methods: This systematic review followed PRISMA-P guidelines and sought to evaluate the impact of TW in asthma and COPD. A thorough literature search, performed up to May 2023, encompassed in vitro, in vivo, randomized controlled trial (RCT), non-RCT, and observational studies., Results: The review included 12 studies reporting different findings. In vitro studies suggested TW could enhance antioxidant capacity and cell proliferation. In a murine model of non-atopic asthma, TW inhalation reduced airway hyperresponsiveness and inflammation. RCTs in COPD patients indicated mixed effects, including improved quality of life, reduced airway oxidant stress, and enhanced exercise tolerance. Asthma patients exposed to water aerosols exhibited improved lung function and reduced airway inflammation. Non-RCTs showed improved lung function and antioxidant activity after TW therapy. Additionally, observational studies reported enhanced lung function and reduced airway inflammation., Conclusion: The current evidence suggests potential benefits of TW therapy in asthma and COPD. However, limited high-quality RCTs and concerns regarding occupational TW exposure necessitate further investigation. While TW therapy offers a non-invasive treatment, its therapeutic potential still needs definitive demonstration. Future research should therefore prioritize well-designed RCTs to thoroughly establish the efficacy and safety of TW as a potential therapeutic intervention for asthma and COPD.

Background: Engaging in physical activity could help improve the quality of life in patients with Alzheimer's disease. The objective of this study was to determine the association between the levels of physical activity and lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease in Iran and Italy., Methods: A total of 165 participants from Iran and Italy were enrolled in this cross-sectional study. In Iran, 85 patients participated in the study. In Italy, we enrolled 80 patients at the Sapienza University teaching hospital, Policlinico Umberto 1 in Rome. The inclusion criteria in this study include patients over 60 years old, non-smokers, and non-users of antidepressants and hypnotics., Results: The results of Tukey's post hoc test of the study conducted in Iran showed that the lifestyle of patients with moderate ( p = 0.001) and low ( p = 0.009) physical activity levels was significantly better than inactive patients. Life expectancy in patients with moderate physical activity levels was significantly higher than inactive patients ( p = 0.011). The quality of life was significantly better in patients with moderate ( p = 0.001) and low ( p = 0.002) physical activity levels than inactive patients. On the other hand, the findings of Tukey's post hoc test of the study in Italy showed that the quality of life in patients with low ( p = 0.001) and moderate physical activity levels ( p = 0.01) was significantly higher than inactive patients., Conclusions: A low to moderate level of physical activity could be associated with an improved lifestyle, life expectancy, and quality of life in patients with Alzheimer's disease compared to inactivity.

Background: Physical activity (PA) surveillance, policy, and research efforts need to be periodically appraised to gain insight into national and global capacities for PA promotion. The aim of this paper was to assess the status and trends in PA surveillance, policy, and research in 164 countries., Methods: We used data from the Global Observatory for Physical Activity (GoPA!) 2015 and 2020 surveys. Comprehensive searches were performed for each country to determine the level of development of their PA surveillance, policy, and research, and the findings were verified by the GoPA! Country Contacts. Trends were analyzed based on the data available for both survey years., Results: The global 5-year progress in all 3 indicators was modest, with most countries either improving or staying at the same level. PA surveillance, policy, and research improved or remained at a high level in 48.1%, 40.6%, and 42.1% of the countries, respectively. PA surveillance, policy, and research scores decreased or remained at a low level in 8.3%, 15.8%, and 28.6% of the countries, respectively. The highest capacity for PA promotion was found in Europe, the lowest in Africa and low- and lower-middle-income countries. Although a large percentage of the world's population benefit from at least some PA policy, surveillance, and research efforts in their countries, 49.6 million people are without PA surveillance, 629.4 million people are without PA policy, and 108.7 million live in countries without any PA research output. A total of 6.3 billion people or 88.2% of the world's population live in countries where PA promotion capacity should be significantly improved., Conclusion: Despite PA is essential for health, there are large inequalities between countries and world regions in their capacity to promote PA. Coordinated efforts are needed to reduce the inequalities and improve the global capacity for PA promotion.

Background: The aim of this study is to investigate the effect of of 12 weeks of water aerobic exercise and atrovastain drug on apolipoproteins changes A1, ANP, BNP and CRP in older men with cardiovascular disesaes., Methods: In this study, we chose 40 patients with cardiovascular disease that were divideded in to four groups. Experimental groups selected exercise 3 times per weeks during 3 months with the method ofwalking on the water and carnal swimming., Results: The results were expressed as the mean ± sd, and all statistical comparisons were made by means of a one-way ANOVA test, followed by Tukey'sPost-Hoc analysis., Conclusion: The effect of exercise and intervention taking Atorvastatin increased Apolipoproteins A1changes, but reducedANP, BNP, and CRP, followed by the reduction of disease cardiovascular and improve cardiovascular function.

Introduction: Endothelial progenitor cells (EPCs) play a role in preventing endothelial dysfunction and increasing the angiogenesis process. Regular training increases these cells. Turmeric Curcumin has anti-inflammatory and anti-atherosclerotic properties., Animal, Materials and Methods: 49 Wistar rats were randomly assigned to control (C), Saline (S), curcumin (cur), moderate interval training (MIT), high interval training (HIT), MIT+curAndHIT+cur. The training groups trained 8 weeks,3 sessions per week and 40 minutes each session at 28 and 34 m / min. 48 hours after the last training, The gene expression of the CD34 and KDR was measured by Real-time PCR and CRP usesthe ELISA method., Findings: CD34 and KDR mRNA in cur, MIT and HIT groups showed a significant increase compared to C and Sgroups.The highest levels of CD34 and KDR mRNA were observed in HIT+curgroup. While the increase of CD3 mRNA in HIT group was greater than the cur and MIT groups(P = 0.0001). KDR showed a significant increase in MIT and HIT groups compared to C, S, cur and MIT+cur groups. Serum CRP means significantly decreased in all experimental groups compared to C and S groups., Discussion and Conclusion: The rate of increase in EPCs mRNA in response to aerobic training is dependent on training intensity. HIT training is likely to be more effective in the repair and development of coronary arteries. These findings can be useful for cell therapy and improve cardiovascular regeneration after injury and myocardial disor-der, especially in elderly conditions.

Background: The objective of this study was to evaluate the relia-bility and validity of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires in the Italian setting in order to make this instrument available for the determination of lifestyle and hope level in the different domains of everyday life., Method: Before testing their psychometric properties, the original versions of the two questionnaires, lifestyle (Miller-Smith) and life expectancy (Schneider), were translated into the Italian language. We tested the instrument's psychometric properties on a sample of 18 patients over 60 years old with Alzheimer's disease in the Sapienza University of Rome teaching hospital, policlinico Umberto 1. Internal consistency was considered to assess the reliability of the results across items within the adopted scale by using Cronbach's α coefficient. Using Kolmogorov-Smirnov's test, the normality distribution was evaluated to guarantee the applicability of a parametric or non-parametric test. The software used to analyze data was SPSS version 26 for Windows., Results: According to the outcome of our statistical analysis, the lifestyle scale showed high overall internal consistency, and the Cron-bach's α coefficient for the total 20-item scale was 0.80 in the Italian population. On the other hand, using the 12-item questionnaire about life expectancy resulted in a high overall internal consistency of 0.93, according to the Cronbach's alpha test., Conclusions: The outcome of our study shows that the Italian versions of the lifestyle (Miller-Smith) and life expectancy (Schneider) questionnaires demonstrated good psychometric properties and good characteristics of factorial validity for future epidemiological studies aimed at evaluating lifestyle and lifestyle expectancy in the Italian population and can as well be used in clinical practice and research.

Aim: To develop and test the effectiveness of an E-learning program for promoting physical activity (PA) and wellness among nurses., Background: Restrictions during the coronavirus (COVID-19) pandemic drastically changed many people's lives. Maintaining a healthy lifestyle is an everyday challenge faced by the general popula-tion. Nurses are one of the health care professionals who are typically well-educated in taking care of patients. There are studies that show that night shifts, extended shifts, and obesity have a correlation with the prevalence of acute low back pain among female nurses. PA is the key factor in the prevention and treatment of many chronic diseases, resulting in an improvement in the quality of life. The impact of social media and technology on our lives is undeniable in the modern era., Design: This study will be a single-centre, single-blind, randomi-zed controlled trial executed on an E-learning platform to provide the control and intervention groups with a distance learning program. Par-ticipants will be randomly assigned to either the control or intervention group. Participants in the control group will only sign up for module 1 of the PA modules, which only comprises information on PA and health promotion. On the other hand, the participants in the intervention group are expected to carry out 3 modules of exercises at home three days a week for a total duration of 8 weeks. The exercises will be performed at moderate intensity (5-6 on the Borg CR10 Scale)., Ethical Issues: This trial will comply with the declaration of Helsinki 1975, as revised in 2000. Informed written consent will be obtained from the participants. The Sapienza University of Rome, institutional ethics committee and review board approval will be requested for this study., Conclusion: Establishing an online PA program with good quality, such as a high level of convenience in access and use, simplified, easy to practice, and made available on social media, can minimize the difficulties faced previously in the implementation of an online PA program for nurses, and may enhance the health and wellbeing of many nurses in healthcare institutions.

Several studies show the positive effects of new non-medical therapies known as complementary and alternative medicines (CAMs). In this context, the discipline of tai chi is obtaining a wider consensus because of its many beneficial effects both on the human body and mind. The aim of this study was to perform a systematic review of the scientific literature concerning the relationship between tai chi practice and wellness of health care workers (HCW) in their professional setting. The research was performed in September 2019, investigating the databases Cinahl, Scopus, Web of Science, and PubMed. Full-text articles, written in English language and published after 1995, were taken into account. No restrictions regarding the study design were applied. A quality assessment was developed using AMSTAR, Jadad, Newcastle-Ottawa Scale, INSA, and CASE REPORT scale. Six papers were finally included: Three clinical trials, one observational study, one systematic review, and one case report. The methodological quality of the included studies was judged as medium level. In conclusion, this systematic review suggests the potential impact of interventions such as tai chi as tools for reducing work-related stress among healthcare professionals. Further research will be needed in order to gain robust evidence of its efficacy.

Purpose: Hypokinesia is the fourth cause of endemic death in the world. The prevalence of obesity, caused by hypokinesia, in the world continues to increase and it is the main risk factor of chronic diseases. Our aim was to evaluate the effectiveness of curves program and High-Intensity Interval Training (HIIT) in healthy women., Methods: The study design is a non-randomized clinical trial. Eighty women with age between 30 to 40 years (who train 3/4 times a week) participated over a period of six months. They were allocated into a "Curves" program group (n = 40) and a "High-Intensity Interval Training" group (n = 40). BMI, body fat, the fat mass percentage was calculated by OMRON body fat 306 TM at baseline and the end of the intervention., Results: the results between high-intensity interval training and curves show that curves scores were significantly lower among Interval training. after 6 months the most impact was on "Abdomen loss "in Curves Group Mean(SD) = -4.48(1.70). According to the multivariate analysis, we can say that for all the dependent variables Weight loss -0.320 (<0.001), Trunk loss -0.376 (<0.001), Abdomen loss -0.276 (<0.001), Hip loss -0.302 (<0.001), Lower arm loss -0.248 (0.003) and Fat mass loss -0.153 (0.061) the curves group shows significant results in comparison with the high-intensity interval training group (p <0.001) while the civil status is significantly associated with only "Upper arm loss" variable (β = -0.357; p <0.001)., Conclusions: This "Curves" program improved strength muscles, loss of fat and fat mass reduction more than High Intensity Interval Training.