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Occupational health is a major problem in modern work environments. Physical activity breaks (PABs), short exercise periods delivered during working hours, incorporating exergames or outdoor activities, have emerged as a novel approach that could be used to improve work efficiency and workplace wellbeing. Therefore, this study aimed to investigate the impact of PABs on attention levels and executive functions in healthcare workers. A total of 27 healthcare workers (M = 14, W = 13; 49.55 ± 12.46 years), after 4 h of work, randomly performed one of three 10 min conditions weekly in a counterbalanced order: No Physical Activity Break (NPAB); Outdoor Physical Activity Break (OPAB); Physical Activity Break with Exergame (PABEx). After the conditions, executive functions and selective attention were assessed by the Stroop Color and Word Test (SCWT), and the Trail Making A,B test (TMT A,B), respectively. Significant differences between OPAB and NPAB as well as between PABEx and NPAB in the TMT-A test χ2(2) = 44.66 (p < 0.001) and TMT-B test χ2(2) = 48.67 (p < 0.001) were found, respectively. TMT-A and SCWT interference/time scores of the PABEx and OPAB conditions were significantly lower than those of NPAB (p < 0.001). In the SCWT interference/error score, no significant difference was found between the PABEx and NPAB (p > 0.05), but the score was statistically lower in the OPAB condition than PABEx (p = 0.001) and PABEx condition compared to OPAB for TMT-A (p = 0.001). Findings showed that the OPAB and PABEx conditions are effective in improving selective attention and executive functions in healthcare workers. Employers can foster a healthier and more productive workforce by promoting a culture of movement and prioritizing employee health, which in turn can enhance patient care outcomes. [ABSTRACT FROM AUTHOR]

Outdoor exercise is beneficial for psychophysical well-being. Limited studies have compared outdoor and virtual reality (VR) indoor physical activities, especially in coastal settings. Therefore, this study aimed to assess the impact of outdoor coastal walking and indoor walking in a VR simulation with a similar environment on physiological and psychological variables in healthy adults. A total of 26 subjects (14 M and 12 F, age 25.2 ± 2.5 years) voluntarily participated in this crossover randomized controlled and counterbalanced study and were allocated under three conditions: VR indoor walking (INVR), outdoor walking (OUT) and standard indoor walking (IN). IN and INVR conditions were performed on a treadmill (speed 4.5 km/h) and the OUT was performed on a seaside pedestrian road. The same outdoor environment was displayed in the visor during the INVR. Heart rate (HRmean/max), physical activity enjoyment (PACES-It) and state of mindfulness for physical activity (SMS-PA) were assessed at the end of each condition. The OUT condition showed significantly greater PACES-It scores and HRmean than IN and INVR (p < 0.001) and greater SMS-PA scores and HRmax than IN (p < 0.01 and p < 0.05, respectively). No significant differences were found between OUT and INVR regarding HRmax and SMS-PA scores (p > 0.05). Findings suggest that physical activity in an immersive technology may lead to physiological loads comparable to the outdoor environment. OUT is more enjoyable than IN and INVR but exhibits a mindfulness response comparable to INVR. Therefore, INVR could be an alternative to OUT for those who cannot engage in outdoor activities for various reasons. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the effects of adopting a specific and prolonged posture on cyclists. This study aimed to evaluate the upright spine in a sample of recreational cyclists and compare it with a sample of non-cyclists, though still athletes, through a 3D scanning method. Methods: Forty-eight participants were enrolled in this observational study. The sample consisted of 25 cyclists for the cycling group and 23 non-cyclist athletes for the control group. The Spine3D device (Sensor Medica, Guidonia Montecelio, Rome, Italy) was used to evaluate the spine of the participants in both groups. Results: The results showed significantly greater spine inclination in the cycling group compared to the control group (p < 0.01). Furthermore, there was a significant decrease in lumbar lordosis in the cycling group compared to the control group (p < 0.01). Conclusions: This case–control study raises the possibility that the onset of lower back pain in cyclists may be due to a reduction in lumbar lordosis. Furthermore, this study demonstrated that the Spine3D device can be used in sports to monitor the spine of athletes to prevent and reduce musculoskeletal deficits. [ABSTRACT FROM AUTHOR]

Physical activity (PA), which includes exercise, can reduce the risk of developing various non-communicable diseases, including neurodegenerative diseases (NDs), and mitigate their adverse effects. However, the mechanisms underlying this ability are not yet fully understood. Among several possible mechanisms proposed, such as the stimulation of brain-derived neurotrophic factor (BDNF), endothelial nitric oxide synthase (eNOS), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), and nerve growth factor (NGF), the possible involvement of particular vesicular structures enclosed in lipid membranes known as extracellular vesicles (EVs) has recently been investigated. These EVs would appear to exert a paracrine and systemic action through their ability to carry various molecules, particularly so-called microRNAs (miRNAs), performing a function as mediators of intercellular communication. Interestingly, EVs and miRNAs are differentially expressed following PA, but evidence on how different exercise parameters may differentially affect EVs and the miRNAs they carry is still scarce. In this review we summarized the current human findings on the effects of PA and different exercise parameters exerted on EVs and their cargo, focusing on miRNAs molecules, and discussing how this may represent one of the biological mechanisms through which exercise contributes to preventing and slowing NDs. [ABSTRACT FROM AUTHOR]

Plyometric exercise is a major tool for improving explosive actions. This study aimed to compare the efficacy of a vertical and horizontal plyometric training program on stretch-shortening performance variables in adolescent soccer players. Thirty-two male soccer players (aged 12.09 ± 0.89 years, with soccer experience 5.37 ± 1.58 years) were divided into horizontal plyometric, vertical plyometric, or control groups. The horizontal and vertical plyometric groups participated in a 6-week training program that was performed twice per week, with a 48-h interval, in conjunction with regular soccer training. The control group participated only in regular soccer training. Vertical jump height, reactive strength index, leg stiffness, ground contact time, standing long jump distance, agility, and 10 and 20 m sprint performances were tested as stretch-shortening performance variables of the participants. Stretch-shortening performance variables were assessed before and after completion of the training program. The results showed that either horizontal or vertical plyometric training had no effect on VJH, RSI, GCT, or Kleg performance (F = 2.14, 1.32, 0.66, 1.03; p > 0.05). Furthermore, there was no effect on SLJ, 10 m sprint, 20 m sprint, or agility performance (F = 2.06, 0.14, 0.06, 0.27; p > 0.05). A 6-week horizontal or vertical plyometric intervention was found to be insufficient to elicit stretch-shortening performance enhancement in adolescent male soccer players. Although there was no performance change in any group, it was observed that the players enjoyed plyometric training. Therefore, coaches could safely use plyometric exercises to design enjoyable training programs. [ABSTRACT FROM AUTHOR]

Active healthy ageing (AHA) is a goal that several world organisations promote and is essential for modern societies where the average age is increasing. Physical activity (PA), including exercise, is a central aspect of achieving this goal, even though a high percentage of the population has high levels of sedentariness and low levels of PA. Therefore, this narrative review aimed to summarise and critically evaluate the existing literature that investigates technology-induced changes in PA levels and the possibility that these may produce active lifestyles, promoting AHA; this is unclear in the apparently healthy older adult population. Training protocols delivered via a website, similar to mobile applications, seem capable of increasing not only physical fitness but also PA levels, at least in the short term. Wearable active tracker devices (WATs), alone or together with websites, can lead to an increase in step count and average daily moderate PA in outdoor environments, as well as in specifically designed applications. Technology that can offer virtual physical games is an effective strategy to promote PA by overcoming certain barriers that may limit its practice in apparently healthy older adults. Currently, information and communication technologies (ICTs), and more generally new digital technologies, show great potential in increasing PA levels and reducing sedentary levels, at least in the short term. The heterogeneity of the proposed interventions and the frequent lack of follow-ups do not allow us to evaluate the effectiveness in the long term, which is crucial for the AHA process. [ABSTRACT FROM AUTHOR]

Research has shown that higher levels of physical activity are associated with better cognitive performance in children. However, the benefits of physical activity on academic achievement and specifically on mathematics performance need to be further explored. Therefore, this study aimed to investigate the effects of a complex physical activity (CPA) intervention program, including cognitive involvement, on children's mathematics performance. The participants were 128 children (aged 12–13 years) attending third grade in three middle schools. They were randomly allocated into a CPA intervention (n = 64) or a waitlist control group (n = 64), the latter of which was given a regular and easy-to-perform activity program. At baseline and after the intervention, students' physical fitness was measured using a battery of standardized motor tests (20 m shuttle run test, curl-up test, push-up test, and sit and reach test). In addition, the AC-MT 11-14 test was administered to allow a standardized and comprehensive assessment of arithmetic problem-solving and arithmetic reasoning abilities. In comparison to the control, the intervention group showed significant improvements (p < 0.001) in comprehension and production (d = 1.88), arithmetic reasoning (d = 2.50), and problem solving (d = 1.32), as well as in 20 m shuttle run test (d = 1.81), push-up test (d = 1.88), curl-up (d = 3.52), and sit and reach (d = 2.52). No significant changes were found in the control group. In conclusion, findings showed that a 12-week CPA intervention program can improve mathematical performance in children in the third grade of middle school. CPA intervention may be an effective method to improve academic performance and avoid student failure. [ABSTRACT FROM AUTHOR]

Background: Paralympic powerlifting (PP) is one of the sports modalities that uses strength training with high loads, causing various physiological responses resulting from hemodynamic adaptations. Objective: To evaluate hemodynamic responses after traditional (TT) and eccentric (ET) training sessions in PP athletes. Methods: Twelve national-level PP athletes, aged: (Mean ± SD) 30.8 ± 10.05 years; 70.0 ± 16.1 kg. In the intervention, five sets of five repetitions (5 × 5) of the bench press at 80% of 1 repetition maximum (1RM) were used; in the TT and in the ET, 5 × 5 of the bench press with a load in the eccentric phase of 110% and that in the concentric phase of 80% of 1RM were used. Results: Compared to baseline, heart rate was significantly elevated at various times in the ET, between before and 20 min after (p = 0.023), and 40 min after (p = 0.035), but decreased to baseline in 24 h (p = 0.043, η2p = 0.395). In addition, the product pressure rate in the ET had a decrease between the moments before and 60 min after (p = 0.042), and before and 24 h after (p = 0.043). A high effect on myocardial oxygen volume in ET at 24 h was found (p = 0.018; η2p = 0.393). Conclusions: One session of traditional and eccentric training methods can be effective in causing significant changes in the cardiovascular system in PP athletes. [ABSTRACT FROM AUTHOR]

The purpose of this study was (i) to compare two groups (players with more vs. less match play time) regarding body composition, vertical and horizontal jumping performance, and aerobic capacity; and (ii) to test the relationships between physical fitness and play time. This study followed a case-control design in which the outcome was playtime, and the causal attribute was physical fitness. Sixty-six youth male soccer players from under-16 (n = 21), under-17 (n = 19), under-18 (n = 12), and under-19 (n = 14) age groups were monitored for match play time during five months of observation. Inclusion criteria consisted of (1) no absence of more than a week due to injury or other conditions during the five months of observation and (2) physical assessments having been done simultaneously with those of the other players (at the beginning of the season). The exclusion criteria were (1) not participating in one week or more of training sessions, and (2) not participating in the physical fitness assessments. At the beginning of the season, players were assessed for anthropometry (height, body mass, skinfolds), countermovement jump, triple hop bilateral and unilateral jump, and aerobic capacity using the Yo-Yo Intermittent Recovery Test, level 2 (YYIRT). The group that played more time had significantly greater YYIRT results (+28.2%; p = 0.009; Cohen's d = 0.664). No other significant differences were found between those who played more and fewer minutes. Moderate and significant linear positive correlations were found between YYIRT and play time in the under-19 group (r = 0.423; p = 0.031) and overall (r = 0.401; p < 0.001). In the case of the under-17 group, moderate and significant linear positive correlations were found between TSA and play time (r = 0.473; p = 0.041). This suggests that aerobic and anaerobic capacity is related to play time while jumping performance and fat mass seem not to play an essential role in play time. [ABSTRACT FROM AUTHOR]

The aim of this work was to assess the level of microbial contamination and resistance of bacteria isolated from a highthroughput heavy pig slaughterhouse (approx. 4600 pigs/day) towards antimicrobials considered as critical for human, veterinary or both chemotherapies. Samples, pre-operative and operative, were obtained in 4 different surveys. These comprised environmental sampling, i.e. air (ntotal = 192) and surfaces (ntotal = 32), in four different locations. Moreover, a total of 40 carcasses were sampled in two different moments of slaughtering following Reg. (CE) 2073/2005. Overall, 60 different colonies were randomly selected from VRBGA plates belonging to 20 species, 15 genera and 10 families being Enterobacteriaceae, Moraxellaceae and Pseudomonadaceae the most represented ones. Thirty-seven isolates presented resistance to at least one molecule and seventeen were classified as multi-drug resistant. Enterobacteriaceae, particularly E. coli, displayed high MIC values towards trimethoprim, ampicillin, tetracycline and sulphametoxazole with MICmax of 16, 32, 32 and 512 mg/L, respectively. Moreover, isolated Pseudomonas spp. showed high MIC values in critical antibiotics such as ampicillin and azithromycin with MICmax of 32 and 64 mg/L, respectively. Additionally, in vitro biofilm formation assays demonstrated that fifteen of these isolates can be classified as strong biofilm formers. Results demonstrated that a high diversity of bacteria containing antibiotic resistant and multiresistant species is present in the sampled abattoir. Considering these findings, it could be hypothesised that the processing environment could be a potential diffusion determinant of antibiotic resistant bacteria through the food chain and operators. [ABSTRACT FROM AUTHOR]

Background: Few studies explored the role of hypothermic machine perfusion (HMP) in the sub‐group of non‐standard renal grafts with a biopsy‐proven advanced histological impairment. This study aimed to investigate the role of HMP in grafts with a Karpinski Score >3 in terms of the need for dialysis, creatinine reduction ratio at day‐7 (CRR7), and 3‐year graft survival. Methods: Twenty‐three perfused grafts with Karpinski Score >3 evaluated between November 2017 and December 2018 were retrospectively analyzed and compared with a control group of 32 non‐perfused grafts transplanted between January 2014 and October 2017. Results: After transplantation, perfused grafts had fewer cases requiring dialysis (8.7% vs. 34.4%; p = 0.051), a better reduction in serum creatinine (median at 7 days: 2.2 vs. 4.3 mg/dl; p = 0.045), and shorter length of hospital stay (median 11 vs. 15 days; p = 0.01). Three‐year death‐censored graft survival was better in the perfused cases (91.3% vs. 77.0%; p = 0.16). In perfused grafts, initial renal resistance (RR) had the best predictive value for renal function recovery after the first week, as defined by CRR7 ≤ 70% (AUC = 0.83; p = 0.02). A cut‐off value of 0.5 mm Hg/ml/min showed a sensitivity of 82.4%, a specificity of 83.3%, and diagnostic odds ratio = 23.4. After dividing the entire population into a Low‐RR (n = 8) and a High‐RR Group (n = 15), more cases with CRR7 ≤ 70% were reported in the latter group (86.7 vs. 13.3%; p = 0.03). Conclusion: HMP yielded promising results in kidneys with Karpinski Score >3. Initial RR should be of interest in selecting non‐standard organs for single kidney transplantation even in impaired histology. [ABSTRACT FROM AUTHOR]

Increasing evidence supports the importance of the gut microbiota (GM) in regulating multiple functions related to host physical health and, more recently, through the gut–brain axis (GBA), mental health. Similarly, the literature on the impact of physical activity (PA), including exercise, on GM and GBA is growing. Therefore, this narrative review summarizes and critically appraises the existing literature that delves into the benefits or adverse effects produced by PA on physical and mental health status through modifications of the GM, highlighting differences and similarities between preclinical and human studies. The same exercise in animal models, whether performed voluntarily or forced, has different effects on the GM, just as, in humans, intense endurance exercise can have a negative influence. In humans and animals, only aerobic PA seems able to modify the composition of the GM, whereas cardiovascular fitness appears related to specific microbial taxa or metabolites that promote a state of physical health. The PA favors bacterial strains that can promote physical performance and that can induce beneficial changes in the brain. Currently, it seems useful to prioritize aerobic activities at a moderate and not prolonged intensity. There may be greater benefits if PA is undertaken from a young age and the effects on the GM seem to gradually disappear when the activity is stopped. The PA produces modifications in the GM that can mediate and induce mental health benefits. [ABSTRACT FROM AUTHOR]

Simple Summary: To date, the influence that physical activity (PA)/physical exercise (PE) can exert on the human gut microbiota (GM) is still poorly understood. Several issues arise in structuring research in this area, starting from the association between PA/PE and diet. Indeed, the diet of an individual is a key factor for the composition of the GM and those who regularly practice PA/PE, generally, have dietary patterns favorable to the creation of an ideal environment for the proliferation of a GM capable of contributing to the host's health. It is therefore difficult to establish with certainty whether the effects generated on the GM are due to a PA protocol, the type of diet followed, or to both. In addition, most of the available studies use animal models to investigate a possible correlation between PA/PE and changes in the GM, which may be not necessarily applied to humans. Evidence suggests that aerobic PA/PE seems capable of producing significant changes in GM; training parameters, likewise, can differentially influence the GM in young or elderly people and these changes appear to be transient and reversible. Several studies have been conducted to find at least an association between physical activity (PA)/ physical exercise (PE) and the possibility to modulate the gut microbiome (GM). However, the specific effects produced on the human GM by different types of PA/PE, different training modalities, and their age-related effects are not yet fully understood. Therefore, this systematic review aims to evaluate and summarize the current scientific evidence investigating the bi-directional relationship between PA/PE and the human GM, with a specific focus on the different types/variables of PA/PE and age-related effects, in healthy and unhealthy people. A systematic search was conducted across four databases (Web of Science, Medline (PubMed), Google Scholar, and Cochrane Library). Information was extracted using the populations, exposure, intervention, comparison, outcomes (PICOS) format. The Oxford Quality Scoring System Scale, the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool, and the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies were used as a qualitative measure of the review. The protocol was registered in PROSPERO (code: CRD42022302725). The following data items were extracted: author, year of publication, study design, number and age of participants, type of PA/PE carried out, protocol/workload and diet assessment, duration of intervention, measurement tools used, and main outcomes. Two team authors reviewed 694 abstracts for inclusion and at the end of the screening process, only 76 full texts were analyzed. Lastly, only 25 research articles met the eligibility criteria. The synthesis of these findings suggests that GM diversity is associated with aerobic exercise contrary to resistance training; abundance of Prevotella genus seems to be correlated with training duration; no significant change in GM richness and diversity are detected when exercising according to the minimum dose recommended by the World Health Organizations; intense and prolonged PE can induce a higher abundance of pro-inflammatory bacteria; PA does not lead to significant GM α/β-diversity in elderly people (60+ years). The heterogeneity of the training parameters used in the studies, diet control, and different sequencing methods are the main confounders. Thus, this systematic review can provide an in-depth overview of the relationship between PA/PE and the human intestinal microbiota and, at the same time, provide indications from the athletic and health perspective. [ABSTRACT FROM AUTHOR]

Solid organ transplant patients are at a higher risk for poor CoronaVirus Disease‐2019 (COVID‐19)‐related outcomes and have been included as a priority group in the vaccination strategy worldwide. We assessed the safety and efficacy of a two‐dose vaccination cycle with mRNA‐based COVID‐19 vaccine (BNT162b2) among 82 kidney transplant outpatients followed in our center in Rome, Italy. After a median of 43 post‐vaccine days, a SARS‐CoV‐2 anti‐Spike seroprevalence of 52.4% (n = 43/82) was observed. No impact of the vaccination on antibody‐mediated rejection or graft function was observed, and no significant safety concerns were reported. Moreover, no de novo HLA‐donor‐specific antibodies (DSA) were detected during the follow‐up period. Only one patient with pre‐vaccination HLA‐DSA did not experience an increased intensity of the existing HLA‐DSA. During the follow‐up, only one infection (mild COVID‐19) was observed in a patient after receiving the first vaccine dose. According to the multivariable logistic regression analysis, lack of seroconversion after two‐dose vaccination independently associated with patient age ≥60 years (OR = 4.50; P =.02) and use of anti‐metabolite as an immunosuppressant drug (OR = 5.26; P =.004). Among younger patients not taking anti‐metabolites, the seroconversion rate was high (92.9%). Further larger studies are needed to assess the best COVID‐19 vaccination strategy in transplanted patients. [ABSTRACT FROM AUTHOR]

Several studies have shown a relevant presence of anxiety feelings among renal transplant patients. This study examines the impact of transplant-related stress and social support on anxiety. Two hypotheses were examined: H1: High transplant-related stressors and low social support are related to high anxiety (additive hypothesis); H2: Social support moderates the detrimental impact of transplant-related stressors on anxiety (buffer hypothesis). One hundred and four kidney transplant recipients (54% male), with a mean age of 50.8 (SD = 12.6), volunteered to participate in a cross-sectional study that included a face-to-face interview and several self-administered scales. Hierarchical regression analyses indicated that higher transplant-related stressors are associated with higher levels of anxiety (F change(2, 92) = 17.4,p < .001, ∆R2 = 24%), but, contrary to our prediction, social support was not directly related with anxiety. However, social support has a moderating effect on the relationship between high transplant-related stressors and anxiety (F change(1, 91) = 5.2,p < .05, ∆R2 = 3%). The results are consistent with the hypothesis that social support has a buffering role on the patients’ distress following renal transplantation and suggest that their psychological well-being could benefit from enhancing the perception of social support in post-operative care. [ABSTRACT FROM PUBLISHER]

Tumor thrombus in the inferior vena cava (IVC) occurs in 4-10% of patients with renal cell carcinoma (RCC) and poses a challenge for the surgical team. Because there is no systemic therapy available to significantly reduce tumor burden, surgical intervention is the only treatment. However, the surgical approach is associated with significant morbidity and mortality. When the thrombus extends above the diaphragm, the use of cardiopulmonary bypass (CPB) and accompanying deep hypothermic circulatory arrest (DHCA) has usually been advocated. However, complications inherent to CPB and DHCA, such as coagulopathy and central nervous system complications, have led us to search for an alternative surgical approach to these tumors. The purpose of this study is to describe the surgical technique used in five patients with large RCC with tumor thrombus extending into the supradiaphragmatic IVC and Right atrium (RA), Right atrium, who underwent extensive resection without CPB and DHCA. [ABSTRACT FROM AUTHOR]

The decline of allograft kidney function in the long term remains a significant issue in renal transplantation, with drug nephrotoxicity and cardiovascular complications as important risk factors. Our study aimed to evaluate the estimated glomerular filtration rate (eGFR) trend and metabolic cardiovascular risk factors over 10 years in a cohort of kidney transplant (KT) recipients converted from twice-daily (TD) tacrolimus (Tac) to once-daily (OD)-Tac. We enrolled 55 consecutive KT recipients who had been at the outpatient clinic between 2009 and 2011. Thirty-seven reached the 10-year follow-up. We compared the observed eGFR with the expected eGFR trend described in KT-recipients and monitored blood pressure and metabolic cardiovascular risk factors. The observed eGFR remained stable throughout the complete follow-up (P =.188). The observed decline of eGFR was significantly lower compared with the expected decline for KT patients (P <.001). The blood pressure was maintained within target values. The monitoring of plasma glucose levels demonstrated the stability of median values (P =.686), as well as cholesterol level (P =.250), high-density lipoprotein (HDL) cholesterol (P =.294), and triglycerides (P =.592) throughout the follow-up. The monitoring of tacrolimus plasma level demonstrated that median trough levels remained constant (median values 4.4-5.5 ng/mL) throughout the entire follow-up period (P =.149). We suggest that the reasonable control of metabolic risk factors for cardiovascular disease over long-term follow-up may significantly contribute to the preservation of eGFR compared with the decline expected in KT recipients. [ABSTRACT FROM AUTHOR]

Background: Despite the benefits of physical activity (PA), Italy ranks low in leisure-time PA among European countries. Integrating virtual (VR)/enhanced (ER) reality with exercise equipment could boost PA engagement. Limited studies have explored how VR/ER-integrated cycling activity, compared to outdoor settings, influences PA among university students. Therefore, this study aimed to evaluate the acute effects of a brief cycling session outdoors and indoors on psychological and physiological outcomes, and secondly, investigate the potential of VR/ER-mediated nature experiences as a tool to promote green exercise. Methods: In February 2024, thirty-one subjects (20 M and 11 F; age 24.3 ± 3.2 years; BMI 23.5 ± 3.6 kg/m 2 ) were involved in this randomized crossover-controlled trial, where they were assigned to three different conditions: ER cycling (ERC), VR cycling (VRC), and outdoor cycling (OUTC). Heart rate (HR), Physical Activity Enjoyment (PACE), Intrinsic Motivation Inventory (IMI), and Intention to Perform Green Exercise (INT-GE) were assessed at the end of each condition. Results: The OUTC condition showed significantly greater PACE, IMI, and INT-GE than ERC/VRC ( p < 0.001), lower HR mean than ERC/VRC ( p < 0.001 and p < 0.05, respectively), and lower HRmax than ERC ( p < 0.05). Conclusions: VRC and ERC enhanced engagement and physiological responses during indoor cycling, but outdoor cycling offered superior benefits in motivation, enjoyment, and future engagement intentions. No significant differences were found between VRC and ERC in promoting intentions for outdoor activities, suggesting both technologies could be equally effective.

Outdoor exercise is beneficial for psychophysical well-being. Limited studies have compared outdoor and virtual reality (VR) indoor physical activities, especially in coastal settings. Therefore, this study aimed to assess the impact of outdoor coastal walking and indoor walking in a VR simulation with a similar environment on physiological and psychological variables in healthy adults. A total of 26 subjects (14 M and 12 F, age 25.2 ± 2.5 years) voluntarily participated in this crossover randomized controlled and counterbalanced study and were allocated under three conditions: VR indoor walking (INVR), outdoor walking (OUT) and standard indoor walking (IN). IN and INVR conditions were performed on a treadmill (speed 4.5 km/h) and the OUT was performed on a seaside pedestrian road. The same outdoor environment was displayed in the visor during the INVR. Heart rate (HR mean/max ), physical activity enjoyment (PACES-It) and state of mindfulness for physical activity (SMS-PA) were assessed at the end of each condition. The OUT condition showed significantly greater PACES-It scores and HR mean than IN and INVR ( p < 0.001) and greater SMS-PA scores and HR max than IN ( p < 0.01 and p < 0.05, respectively). No significant differences were found between OUT and INVR regarding HR max and SMS-PA scores ( p > 0.05). Findings suggest that physical activity in an immersive technology may lead to physiological loads comparable to the outdoor environment. OUT is more enjoyable than IN and INVR but exhibits a mindfulness response comparable to INVR. Therefore, INVR could be an alternative to OUT for those who cannot engage in outdoor activities for various reasons.

The present study aimed to assess the effectiveness of an expressive writing (EW) intervention on psychological and physiological variables after kidney transplant. The final sample of 26 were randomly assigned to an expressive writing group (EWG) and control group (CG). Outcomes were focused on depression, anxiety, alexithymia, empathy, resilience, locus of control, creatinine, CDK-EPI, and azotemia. Depressive symptoms and alexithymia levels decreased in the EWG, with better adherence. Resilience declined over time in both groups. The EWG showed a significantly higher CDK-EPI, indicating better renal functioning. EW seems an effective intervention to improve the psychological health of transplanted patients, with a possible effect on renal functioning. These findings open the possibility of planning brief psychological interventions aimed at processing emotional involvement, in order to increase adherence, the acceptance of the organ, and savings in healthcare costs.

Background: BK virus (BKV) infection represents a potentially dreadful complication after kidney transplantation (KT). When BK viremia is detected, the best therapeutic approach remains not entirely clarified. Critical elements of BK viremia treatment are immunosuppression minimization and introduction of drugs like leflunomide, everolimus, and fluoroquinolones. The study aimed to analyze the results of the BK viremia management in 2 collaborative Italian centers., Methods: Ten patients undergoing KT in the 2 collaborative Italian centers of Sapienza University of Rome and University of L'Aquila from January 2013 to December 2017 and showing a post-KT diagnosis of BK viremia were retrospectively investigated., Results: Mean time from KT to BKV positivity was 7 months (range: 1-19 months). At diagnosis, the mean viral load was 683,842 copies/mL (range: 5800-4,052,415 copies/mL), with an average zenith of 2,428,410 copies/mL (range: 6762-18,022,500 copies/mL). In the 5 patients with BKV nephropathy, we observed a switch from antimetabolite to leflunomide (n = 5), a switch from tacrolimus to everolimus (n = 3), or an introduction of fluoroquinolones (n = 3). BKV clearance was achieved in 3 patients., Conclusions: Early BKV diagnosis and stepwise minimization of immunosuppression remain the first-line approach in patients with BK viremia. In the presence of BKV nephropathy, a combination of antiviral drugs like leflunomide and fluoroquinolones/everolimus should favor viremia clearance., (Copyright © 2019. Published by Elsevier Inc.)

The fundamental role of antibodies in the development of acute graft rejection has been established recently. Antibody-mediated acute rejection may develop at any time during the post-transplant period. Several therapeutic approaches have been proposed in the last decades. However, there is no standardized therapy. The aim of this study is to report the Sapienza University experience of combined plasma treatment and high-dose intravenous immunoglobulin ± extracorporeal photopheresis. From January 2006 to September 2009, 6 patients were treated at Sapienza University. In 5 cases (83%) complete regression of the acute rejection was observed, followed by stable renal function (median creatinine value at 1-year follow-up: 1.5 mg/dL). No adverse events were reported. Our approach seems to give good results in terms of graft survival and procedure safety. Further studies on a larger number of patients will be needed to confirm the validity of these findings. Moreover, comparison between our protocol and other treatments is necessary.

Hepatitis C virus (HCV) infection occurs much more frequently in the hemodialysis population than in the general population. Patients with chronic kidney disease with persistent HCV infection may develop serious and progressive chronic liver disease, with associated long-term morbidity and mortality related to cirrhosis and hepatocellular carcinoma. Monocytes and macrophages are known to produce extrahepatic breeding sites and spread the disease. Our aim was to lower the levels of macrophages, granulocytes, monocytes, proinflammatory cells and viremia using an extracorporeal device: the Adacolumn ® leukocyte apheresis system (Otsuka). The Adacolumn is a direct hemoperfusion-type leukapheresis device. The column is a single-use (disposable) polycarbonate column with a capacity of about 335 mL, filled with 220-g cellulose acetate beads of 2 mm in diameter bathed in physiological saline. The carriers adsorb ''activated'' granulocytes and monocytes/macrophages that bear Fc and complement receptors. The patients underwent five 1-hour sessions for five consecutive days. The column was placed in an extracorporeal setting with a perfusion rate of 30 mL/min and a duration of 60 minutes. A reduction of viremia was observed in all patients in association with a decrease in cytokine levels and a proportional decrease in immune cells. Although this study investigated responses in a small number of patients, it was shown that the Adacolumn changed the cellular immunity and promoted early viral response.

In our 3-year experience, we treated 63 patients with Molecular Adsorbent Recirculating System (MARS). The patients were divided as follows: 10 primary non-function (PNF) 16%, 10 delayed non-function (DNF) 16%, 16 Fulminant hepatitis (FH) 24%, 23 acute decompensation of chronic liver disease (ACLF) 38%, and 4 hepatic resection 6%. All patients who underwent MARS treatment had bilirubin >15 mg/dL, Glasgow Coma Score between 9 and 11, ammonium >160 microg/dL and non-coagulability. The determining factors taken into consideration for the continuation of MARS treatment were: an improvement in Glasgow Coma Score, and a decrease in ammonium and bilirubin. We also monitored hemodynamic parameters, acid-base equilibrium, and blood gas analysis before and after each treatment. In order to determine patients' neurological conditions, we not only took into account the Glasgow Coma Score, which does not give mathematically precise results but also took into account the fact that patients with hepatic coma had lower cerebral mean velocity in the cerebral arteries than patients without encephalopathy. For this reason, in the last 22 patients we monitored cerebral perfusion, determined by mean flow velocity (Vmean) in the middle cerebral artery. Our results were expressed as mean +/- SD and we analyzed the differences between mean values for each variable, before and after treatment by means of Student's t-test. At the end of treatment, we obtained significant P-values for bilirubin, ammonium, Glasgow Coma Score and creatinine. In 16/20 patients, we could demonstrate a clear correlation between the improvement in clinical conditions (especially neurological status) and improvement in cerebral perfusion, measured by color Doppler US.