Search Results (76)

Time Division Multiplexing Passive Optical Networks (TDM-PONs) serve as a key enabler for the evolution of broadband access network infrastructure. As TDM-PONs adapt to support 6G networks, reducing energy consumption becomes increasingly critical. Sleep modes have been widely adopted as an effective energy-saving solution. However, their use can introduce delays that compromise performance. This issue becomes especially problematic in 6G PONs, where ultra-low latency and stringent service requirements leave minimal tolerance for delay-related inefficiencies. In this paper, we propose a novel sleep synchronization mechanism for both single and multiple TDM-PONs, allowing Optical Network Units (ONUs) to join one or more sleep/wake-up groups based on the service type and delay tolerance. Our practical design framework incorporates delay-based grouping and existing sleep modes to address the operational complexities of multi-PON systems while remaining fully compatible with current PON standards. The simulation results show that our approach satisfies the requirements of delay-sensitive traffic and achieves up to 37% energy savings. Compared to baseline methods such as adaptive scheduling and fixed-interval cyclic sleep, it offers a 15–20% improvement in the energy–delay trade-off. These results demonstrate the potential for near-term deployment of 6G PONs and lay the foundation for more advanced, delay-aware energy management strategies in next-generation optical access networks. Full article

Background/Objectives: Rapid eye movements (REMs) during sleep were initially associated with dreaming, suggesting a relationship between REMs and dream content; however, this hypothesis was questioned by their differences with the REMs during wakefulness and the evidence that REMs are also present in blind individuals with no visual dreaming. Successive studies have focused on the phenomenology and physiological significance of REMs during sleep. REMs are categorized as expressions of the phasic REM component, which is characterized by bursts of eye movements, whereas the tonic REM component is characterized by quiescent periods without eye movements. Methods: The study is a retrospective analysis of 105 sleep records from 15 subjects. We analyzed the two components, tonic and phasic REM, across the sleep period, the REM activity in the first 5 min and in the last 5 min of each REM period were also assessed. Results: Phasic epochs were more represented than tonic epochs across the whole night period. REM activity in the first and last five minutes of an REM period presented different, although non-significant, patterns across the night. REM activity in the first 5 min showed a curvilinear profile, whereas REM activity in the last 5 min showed a linear increasing trend. A significant correlation was found between the REM activity in the first 5 min of the REM period and the total duration of the REM period. Conclusions: According to our results, the analysis of REM activity and the focus on segments of an REM period could provide more information both on the temporal evolution of REM activity within an REM period and on the possible role of REMs in REM sleep regulation and its significance in psychiatric and neurological disorders. Full article

Background: The brain is never truly at rest. Even in the absence of external tasks, it remains active, continuously organizing itself into large-scale resting-state networks involved in shaping our internal thoughts and experiences. Understanding the networks’ structure and dynamics is key to uncovering how the brain functions as a whole. While previous studies have mapped resting-state networks and explored the roles of individual brain regions (network vertices), the relevance of the time-dependent functional interactions (network edges) between them remains largely unexplored. Methods: Here, we assess this relevance by elucidating the time-evolving importance of both brain regions and their interactions, associated with the networks’ constituents, using the fundamental concept of centrality. We investigate long-term electrophysiological recordings of brain dynamics from more than 100 participants and reveal new insights into how resting-state networks are organized over longer times. Results: Our findings reveal that the functional architecture of brain networks in a resting state is critically shaped by the dynamic interplay between brain regions. We identified functional importance backbones–core sets of dynamically central vertices and edges–whose configuration varies significantly between subgroups and further varies with different brain states, including wakefulness and sleep. Notably, regions associated with the default mode network exhibited adaptable patterns of centrality, challenging the notion of static network cores. Conclusions: By considering the temporal evolution of both vertices and edges, we provide a more comprehensive understanding of intrinsic brain activity and its functional relevance. This dynamic perspective reveals how the brain’s intrinsic activity is coordinated across space and time, highlighting the existence of functional importance backbones that adapt to different brain states. Full article

COVID-19 causes instant and often prolonged effects with multisystemic and heterogeneous symptoms, significantly affecting the bio-psychosocial life of patients. In view of this, the present prospective cohort study aims to document the evolution of symptoms in hospitalized COVID-19 patients, monitoring variations in their mental and physical health for eighteen months after clinical recovery. A sample of 117 patients was examined at four distinct time points: at 2, 6, 12 and 18 months after discharge from the Pulmonology Clinic of the General University Hospital of Larissa (single-center approach). The data collection focused on psycho-physical symptoms, sleep disturbances and quality of life indicators. The study results revealed that over the 18-month period the participants gradually recovered both physically and psychologically, as well as regained pre-disease sleep patterns. However, substantial recovery was noted by month 6, followed by stabilization of their health status. However, a complete return to the pre-disease state of all assessed variables was not achieved, confirming and reinforcing the need for long-term follow-up and overall patient care. Full article

Electroencephalography (EEG) remains an essential method for monitoring brain activity, but the limitations of conventional systems due to the complexity of installation and lack of portability have led to the introduction and development of in-ear EEG technology. In-ear EEG is an emerging method of recording electrical activity in the brain and is an innovative concept that offers multiple advantages both from the point of view of the device itself, which is easily portable, and from the user’s point of view, who is more comfortable with it, even in long-term use. One of the fundamental components of this type of device is the electrodes used to capture the EEG signal. This innovative method allows bioelectrical signals to be captured through electrodes integrated into an earpiece, offering significant advantages in terms of comfort, portability, and accessibility. Recent studies have demonstrated that in-ear EEG can record signals qualitatively comparable to scalp EEG, with an optimized signal-to-noise ratio and improved electrode stability. Furthermore, this review provides a comparative synthesis of performance parameters such as signal-to-noise ratio (SNR), common-mode rejection ratio (CMRR), signal amplitude, and comfort, highlighting the strengths and limitations of in-ear EEG systems relative to conventional scalp EEG. This study also introduces a visual model outlining the stages of technological development for in-ear EEG, from initial research to clinical and commercial deployment. Particular attention is given to current innovations in electrode materials and design strategies aimed at balancing biocompatibility, signal fidelity, and anatomical adaptability. This article analyzes the evolution of EEG in the ear, briefly presents the comparative aspects of EEG—EEG in the ear from the perspective of the electrodes used, highlighting the advantages and challenges of using this new technology. It also discusses aspects related to the electrodes used in EEG in the ear: types of electrodes used in EEG in the ear, improvement of contact impedance, and adaptability to the anatomical variability of the ear canal. A comparative analysis of electrode performance in terms of signal quality, long-term stability, and compatibility with use in daily life was also performed. The integration of intra-auricular EEG in wearable devices opens new perspectives for clinical applications, including sleep monitoring, epilepsy diagnosis, and brain–computer interfaces. This study highlights the challenges and prospects in the development of in-ear EEG electrodes, with a focus on integration into wearable devices and the use of biocompatible materials to improve durability and enhance user comfort. Despite its considerable potential, the widespread deployment of in-ear EEG faces challenges such as anatomical variability of the ear canal, optimization of ergonomics, and reduction in motion artifacts. Future research aims to improve device design for long-term monitoring, integrate advanced signal processing algorithms, and explore applications in neurorehabilitation and early diagnosis of neurodegenerative diseases. Full article

Background/Objectives: Narcolepsy was first described in the late 19th century, and in the current decade, narcolepsy patients are reaching their senior years. Little is known about the evolution of clinical features, the management of narcolepsy medications, and the development of comorbid conditions. We aimed to present the clinical characteristics, comorbidities, and therapeutic choices of seniors with narcolepsy. Methods: We extracted 21 charts of patients older than 65 with a diagnosis of narcolepsy according to the International Classification of Sleep Disorders Third Edition. We reviewed and analyzed all clinical and available polysomnographic data. Results: A total of 21 patients (median age 69 years. 67.0–71.0 interquartile range IQR; 71% female) were included. Three (14.3%) had type I and 18 (85.7%) had type II narcolepsy. The average age at symptom onset was 23 years (IQR 19.5–27.5). Diagnosis was made at an average age of 41 years (IQR 33–45), between 1990 and 2002. Median time from onset to diagnosis was 13.7 years (IQR 9.5–19). The most prevalent cardiovascular/metabolic comorbidity was hypertension (57.1%). All patients were historically using narcolepsy medications. Fewer patients were currently on wake-promoting agents (85.7%), with over half on modafinil (55.6%). None currently reported the need to nap during the daytime. Conclusions: Narcolepsy is a lifelong, but not progressive disorder, that has yet to be well-characterized in the senior population. A few seniors appear to outgrow the disorder and to no longer need wake-promoting agents. It is important to consider cardiometabolic comorbidities in the management of narcolepsy in this population. Geriatricians should be educated on narcolepsy with specific programs for these seniors. Full article

Melatonin is an indolamine derived from tryptophan, which is highly conserved throughout evolution, including in zebrafish, where it controls important cellular processes, such as circadian rhythms, oxidative stress, inflammation, and mitochondrial homeostasis. These functions of melatonin and its synthesis route are quite similar to those in humans. One of the most important enzymes in melatonin synthesis is acetylserotonin O-methyltransferase (ASMT), the rate-limiting enzyme, which catalyzes its final step. Due to genome duplication, zebrafish has two genes for this enzyme, asmt1 and asmt2. These genes show differential expression; asmt1 is primarily expressed in the retina and the pineal gland, and asmt2 is expressed in peripheral tissues, indicating different functions. Therefore, the aim of this work was to develop a mutant model for each asmt gene and to analyze their phenotypic effects in zebrafish. The results showed that the loss of 80% of the asmt2 gene affected melatonin concentration and consequently disrupted the sleep/wake rhythm in larvae, decreasing by 50% the distance traveled. In contrast, the loss of asmt1 had a greater influence on the physical condition of adults, as locomotor activity decreased by 50%, and 75% showed malformations. These data reveal distinct functional roles of melatonin depending on their site of production that may affect the development of zebrafish. Full article

Objectives: The aim of this study was to evaluate the effects of spinal cord stimulation (SCS) on pain, neuropathic symptoms, and other health-related metrics in patients with chronic painful peripheral neuropathy (PN) from multiple etiologies. Methods: A prospective single center observational longitudinal cohort study assessed SCS efficacy from April 2023 to May 2024, with follow-ups at 2, 4, 6, and 12 months in 19 patients suffering from the painful polyneuropathy of diverse etiologies: diabetic (DPN), idiopathic (CIAP), chemotherapy-induced (CIPN), and others. Patients were implanted with a neurostimulator (WaveWriter Alpha^TM, Boston Scientific Corporation, Valencia, CA, USA) and percutaneous leads targeting the lower limbs (T10–T11) and, if necessary, the upper limbs (C4–C7). Stimulation programming was individualized based on patient preference and best response. Assessments were performed before and after implantation and included pain intensity (VAS and DN4), neuropathic pain symptoms (NPSI and SF-MPQ-2), autonomic symptoms (SFN-SIQ and SAS), sensory and small fiber nerve injury (UENS), functionality (GAF), sleep (CPSI), global impression of change (CGI and PGI), and quality of life (EQ-VAS and EQ-5D). Intra-epidermal nerve fiber density (IENFD) via skin biopsy was also performed at baseline (diagnostic) and after 12 months to assess potential small fiber re-growth. Statistical analyses were conducted to determine the evolution of treatment success. Results: To date, 19 patients have undergone implantation and completed follow-up. SCS produced a significant consistent and sustained improvement in pain intensity by 49% in DN4 and 76% in VAS, in neuropathic pain symptoms by 73%, in autonomic symptoms by 26–30%, in the sensorimotor physical exam by 8%, in functionality by 44%, in sleep by 74%, and in quality of life (69% for EQ-VAS and 134% EQ-5D). Both clinicians and patients had a meaningful global impression of change, at 1.1 and 1.3, respectively. Distal intra-epidermal nerve fiber density improved by 22% at 12 months while proximal intra-epidermal nerve fiber density decreased by 18%. Conclusions: SCS is an effective therapy for managing various types of PN. Full article

Background and Objectives: Up until now, behavioral interventions and pharmacological therapies were the main approach available for the management of obesity. Diet and exercise, when used as a singular therapeutic method, are inadequate for a successful outcome. Research shows promising results for the surgical treatment of obesity, especially in the area of bariatric surgery (BaS). The relevance of this study is the valuable analysis of the evolution of obese patients with increased cardiovascular risk. Materials and Methods: The patients eligible for BaS commonly suffer from multiple chronic conditions, including type 2 diabetes, obstructive sleep apnea, cardiovascular diseases, and non-alcoholic fatty liver disease. Additionally, obesity contributes to an increased probability of developing certain types of cancer, osteoarthritis, urinary incontinence, and chronic kidney disease. In this review, we focused especially on the cardiovascular status of obese patients who underwent bariatric procedures. Results: BaS has been found to be strongly associated with a reduced incidence of severe complications in individuals with a history of myocardial infarction (MI) and severe obesity. Specifically, this procedure is linked to a lower occurrence of major adverse cardiovascular events and a decrease in overall mortality. Also, BaS is correlated with a reduced risk of recurrent MI and the development of new-onset heart failure. Conclusions: The results of BaS involve a significant amelioration of the BMI, contributing to a considerable decrease in cardiovascular risk factors and to a notable refinement in the cardiovascular structure and function. Full article

Despite the massive efforts of modern medicine to stop the evolution of Alzheimer’s disease (AD), it affects an increasing number of people, changing individual lives and imposing itself as a burden on families and the health systems. Considering that the vast majority of conventional drug therapies did not lead to the expected results, this review will discuss the newly developing therapies as an alternative in the effort to stop or slow AD. Focused Ultrasound (FUS) and its derived Transcranial Pulse Stimulation (TPS) are non-invasive therapeutic approaches. Singly or as an applied technique to change the permeability of the blood–brain–barrier (BBB), FUS and TPS have demonstrated the benefits of use in treating AD in animal and human studies. Adipose-derived stem Cells (ADSCs), gene therapy, and many other alternative methods (diet, sleep pattern, physical exercise, nanoparticle delivery) are also new potential treatments since multimodal approaches represent the modern trend in this disorder research therapies. Full article

Objective: To investigate the long-term effects of intravenous neridronate treatment in patients with complex regional pain syndrome type 1 (CRPS) in a real-life setting. Methods: We conducted a retrospective study on consecutive CRPS patients treated at our hospital from February 2018 to July 2023. All were treated within three months of the onset of CRPS symptoms. The Patient-Reported Outcomes Measurement Information System 29-Item Health Profile (PROMIS-29) version 2.1 was administered. The main outcome of interest was the evolution of the PROMIS-29 scores from baseline to the last follow-up visit. Patients were categorized as “complete responders” or “non-complete responders”. The association of clinical and demographic variables with a complete response was analyzed using chi-square tests and univariate logistic regression. Results: Thirty-six patients were included, with a median follow-up time of 4.8 years. A significant improvement was noted in the mean numerical pain rating scale (from 6.4 ± 1.9 to 3.1 ± 2.4, p < 0.001), as well as across all PROMIS-29 domains. Physical function improved from 34.2 ± 4.9 to 49.2 ± 9.9, p < 0.001; anxiety from 58.0 ± 6.7 to 49.6 ± 6.9, p < 0.001; depression from 55.3 ± 6.3 to 47.7 ± 6.6, p < 0.001; fatigue from 55.7 ± 7.7 to 50.9 ± 8.7, p < 0.001; sleep disturbance from 53.8 ± 6.8 to 51.3 ± 6.6, p = 0.034; social roles and activities from 41.8 ± 5.2 to 51.8 ± 8.9, p < 0.001; and pain interference from 64.1 ± 5.9 to 52.4 ± 9.9, p < 0.001. The likelihood of achieving a complete response was associated with the male sex, foot or ankle injuries (compared to hand and wrist injuries), and a younger age. No association was found with the type of inciting event or with the body mass index. Conclusions: Our real-life data indicate that early treatment with neridronate leads to substantial benefits in patients affected by CRPS type 1. The strongest responses are seen in young patients, males, and those with lower limb involvement. Full article

Excessive daytime sleepiness (EDS) and insomnia (IN) complaints represent the most common sleep/wake disorders. Currently, the specific needs of these patients and their relatives, as well as the overall socio-economic burden of IN and EDS remains widely unexplored. This pilot study to be carried out in Switzerland is a retro- and prospective, national, one-center cohort observational study for the systematic evaluation of the burden of EDS and IN and its evolution 12 months after the first assessment. Patient recruitment will be organized through 7–8 primary care providers (primary/general care practitioners and pharmacies). Primary outcomes are the prevalence of EDS/IN in the primary care setting and the association between EDS/IN with health-related quality of life (QOL) as assessed with the established instruments. Secondary outcomes are the association between EDS/IN with the presence of comorbidities, number of injuries/accidents, and number of sick/leave days for the subgroup of working subjects. Calculation of direct per-patient costs will be undertaken to analyze the economic implications of sleep/wake disorders, providing valuable insights into the financial burden experienced by affected individuals within the healthcare system. This research will provide information on the feasibility of such a study and inform on aspects of the QOL most associated with EDS/IN. Based on this pilot project, a European multicenter study on the burden of sleep/wake disorders will be conducted by the European Academy of Neurology. Full article

Wearable technologies have become increasingly popular in recent years, as athletes and coaches look for ways to gain a competitive edge. These devices can track a variety of metrics, including heart rate, sleep quality, and movement patterns. This information can be used to identify areas for improvement and make small, incremental changes that can lead to significant gains in performance. The purpose of this narrative review is to provide an integrative overview of the literature on the impact of wearable technologies on marginal gains in sports performance. The literature review was conducted using the Scopus, PubMed, and Web of Science databases, and a total of 55 papers were considered eligible. The results of the literature overview suggest that wearable devices can be classified into three main categories. (1) Location-based wearables (LBW) track an athlete’s location and movement, which can be used to analyze training patterns and identify potential injury risks. (2) Biometric wearables (BMW) track physiological data such as heart rate, sleep quality, and body temperature; these data can be used to monitor an athlete’s fitness levels and identify signs of overtraining. (3) Performance wearables (PMW) track performance metrics such as power output, speed, and distance; this information can be used to optimize training programs and track progress over time. For each category, this paper provides the five most important data points measured by each suggested device. Additionally, sport-specific examples are provided for each category based on the literature data. The limitations of wearable devices, such as accuracy, validity, reliability, interpretability, and cost, are also discussed. However, despite these limitations, the results of the literature review suggest that wearable technologies can be a valuable tool for athletes and coaches who are looking to improve performance. Ultimately, this technological evolution in sports science is likely to dramatically change the state of the art in athletic monitoring and sports analytics. Full article

Night Eating Syndrome (NES) is a distinct eating disorder characterized by recurrent episodes of night eating, either through excessive food consumption after the evening meal or eating after awakening from sleep. Despite its recognition, there remains a dearth of research on NES, limiting our understanding of its etiology, prevalence, diagnosis, and treatment. This paper conducts a narrative review spanning a wide spectrum of studies focusing on the etiology, assessment, and clinical treatment strategies of NES. This review traces the historical evolution of NES definitions, distinguishes NES from obesity-related eating behaviors and other eating disorders, explores the psychological determinants of NES, and discusses existing therapeutic options. This review highlights the complex etiology of NES, influenced by circadian rhythms, hormonal changes, psychological distress, and personality traits. It emphasizes the need for reliable assessment tools and a holistic approach to treatment, considering the high comorbidity of NES with other psychiatric and medical conditions. Current treatment options, such as cognitive behavioral therapy and pharmacotherapy, show promise but require further research for refinement. NES remains underdiagnosed and undertreated, with challenges including unclear diagnostic criteria, comorbidities, and lack of evidence-based treatments. Future research should focus on developing reliable assessment tools, exploring etiology, comparing treatment approaches, and considering prevention strategies, utilizing diverse and representative samples to advance our understanding and improve clinical care. Full article

(1) Background: The lockdown, imposed to limit the pandemic evolution, impacted the social habits and lifestyle of inhabitants also from many countries other than Italy. Caffeine consumption could be a useful option to improve mood, as the lockdown strongly affected mental health, particularly increasing anxiety and sleep disorders. (2) Methods: It was a cross-sectional study aimed to evaluate the change in caffeine consumption after the pandemic period in a sample of Italian University students. It investigated coffee and products containing caffeine consumption, the anxiety level by State Trait Anxiety Inventory (STAI) and sleep quality with the Insomnia Severity Index (ISS). (3) Results: A total of 404 participants were enrolled in the study. During the lockdown period, 23% of subjects consumed more coffee compared to the pre-pandemic period. Daily coffee consumption also changed after the lockdown period compared to the pre-pandemic period, with 36.1% of subjects that increased their consumption. Comparing other caffeine-based products, energizing supplement consumption showed a greater increase after the lockdown period than energy drinks. Regarding anxiety, subjects who reported increased coffee consumption reported higher STAI scores and ISS. (4) Conclusions: About a quarter of university students increased their consumption of caffeine-based products after the pandemic, reporting higher levels of anxiety and poor sleep quality. Full article