Maria Ruberto

Orexin System: The Key for a Healthy Life

The orexin-A/hypocretin-1 and orexin-B/hypocretin-2 are neuropeptides synthesized by a cluster of neurons in the lateral hypothalamus and perifornical area. Orexin neurons receive a variety of signals related to environmental, physiological and emotional stimuli, and project broadly to the entire CNS. Orexin neurons are “multi-tasking” neurons regulating a set of vital body functions, including sleep/wake states, feeding behavior, energy homeostasis, reward systems, cognition and mood. Furthermore, a dysfunction of orexinergic system may underlie different pathological conditions. A selective loss orexin neurons was found in narcolepsia, supporting the crucial role of orexins in maintaining wakefulness. In animal models, orexin deficiency lead to obesity even if the consume of calories is lower than wildtype counterpart. Reduced physical activity appears the main cause of weight gain in these models resulting in energy imbalance. Orexin signaling promotes obesity resistance via enhanced spontaneous physical activity and energy expenditure regulation and the deficiency/dysfunction in orexins system lead to obesity in animal models despite of lower calories intake than wildtype associated with reduced physical activity. Interestingly, orexinergic neurons show connections to regions involved in cognition and mood regulation, including hippocampus. Orexins enhance hippocampal neurogenesis and improve spatial learning and memory abilities, and mood. Conversely, orexin deficiency results in learning and memory deficits, and depression.

Effectiveness and safety of Nintendo Wii Fit Plus™ training in children with migraine without aura: a preliminary study

Background Migraine without aura (MoA) is a painful syndrome, particularly in childhood; it is often accompanied by severe impairments, including emotional dysfunction, absenteeism from school, and poor academic performance, as well as issues relating to poor cognitive function, sleep habits, and motor coordination. Materials and methods The study population consisted of 71 patients affected by MoA (32 females, 39 males) (mean age: 9.13±1.94 years); the control group consisted of 93 normally developing children (44 females, 49 males) (mean age: 8.97±2.03 years) recruited in the Campania school region. The entire population underwent a clinical evaluation to assess total intelligence quotient level, visual-motor integration (VMI) skills, and motor coordination performance, the later using the Movement Assessment Battery for Children (M-ABC). Children underwent training using the Wii-balance board and Nintendo Wii Fit Plus™ software (Nintendo Co, Ltd, Kyoto, Japan); training lasted for 12 weeks and consisted of three 30-minute sessions per week at their home. Results The two starting populations (MoA and controls) were not significantly different for age (P=0.899) and sex (P=0.611). M-ABC and VMI performances at baseline (T0) were significantly different in dexterity, balance, and total score for M-ABC (P<0.001) and visual (P=0.003) and motor (P<0.001) tasks for VMI. After 3 months of Wii training (T1), MoA children showed a significant improvement in M-ABC global performance (P<0.001), M-ABC dexterity (P<0.001), M-ABC balance (P<0.001), and VMI motor task (P<0.001). Conclusion Our study reported the positive effects of the Nintendo Wii Fit Plus™ system as a rehabilitative device for the visuomotor and balance skills impairments among children affected by MoA, even if further research and longer follow-up are needed.

Heart Rate Variability as predictive factor for Sudden Cardiac Death

Sudden cardiac death (SCD) represents about 25% of deaths in clinical cardiology. The identification of risk factors for SCD is the philosophers stone of cardiology and the identification of non-invasive markers of risk of SCD remains one of the most important goals for the scientific community. The aim of this review is to analyze the state of the art around the heart rate variability (HRV) as a predictor factor for SCD. HRV is probably the most analyzed index in cardiovascular risk stratification technical literature, therefore an important number of models and methods have been developed. Nowadays, low HRV has been shown to be independently predictive of increased mortality in post- myocardial infarction patients, heart failure patients, in contrast with the data of the general population. Contrariwise, the relationship between HRV and SCD has received scarce attention in low-risk cohorts. Furthermore, in general population the attributable risk is modest and the cost/benefit ratio is not always convenient. The HRV evaluation could become an important tool for health status in risks population, even though the use of HRV alone for risk stratification of SCD is limited and further studies are needed.

Positional abnormalities during sleep in children affected by obstructive sleep apnea syndrome: the putative role of kinetic muscular chains.

Sleep-related breathing disorders (SRBD) are disorders of breathing during sleep characterized by prolonged partial upper airway obstruction, intermittent complete or partial obstruction (obstructive apnea or hypopnea), or both prolonged and intermittent obstruction that disrupts normal ventilation during sleep, normal sleep patterns, or both. Children with OSAS may sleep in unusual positions, such as seated or with neck hyperextended, even if the neck position is not the only unusual posture or the special sleeping positions that is possible to detect in children with SRBD. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We can postulate that the prevertebral and antero-lumbar muscular chains could be oversolicited during the apnoic events, and the assumption of abnormal posture could be interpreted as a way to relax or diminish the strain or muscular stress caused by the apneas. The consequence of this hypothesis could be summarized in the concept that a specific rehabilitation or muscular program to improve the tone of this kinetic chain, could be useful to limit the effect nocturnal or diurnal of this so impacting syndrome.

Psychomotor approach in children affected by nonretentive fecal soiling (FNRFS): a new rehabilitative purpose.

Background According to the Rome III criteria, encopresis without constipation was defined as nonretentive fecal soiling (FNRFS) with not yet well understood etiology. Treatment approaches reported in the literature with varying results include biofeedback, hypnosis, reflexology, and Internet-based educational programs. In developmental age, another behavioral treatment could be identified in the psychomotor approach, which is called psychomotricity in the European countries, or is also known as play therapy. The aim of the present study was to verify the safety and efficacy of play therapy plus toilet training in a small sample of prepubertal children affected by FNRFS. Materials and methods Twenty-six patients (group 1; 16 males, mean age of 5.92 ± 0.84 years) underwent a psychomotor approach therapy program in association with toilet training for 6 months, and the other 26 subjects (group 2; 17 males, mean age of 5.76 ± 0.69) underwent the sole toilet training program for 6 months. During the observational time period (T0) and after 6 months (T1) of both treatments, the patients were evaluated for FNRFS frequency and for the behavioral assessment. Results At T0, the FNRFS mean frequency per month for group 1 was 20.115 episodes/month (standard deviation [SD] ± 3.024) and for group 2 was 20.423 (SD ± 1.879) (P = 0.661). At T1 the mean frequency per month was 6.461 (SD ± 1.333) episodes/month and 12.038 (SD ± 1.341), respectively (P < 0.001). Moreover, the delta percent average of the frequency between T0 and T1 was 67.121 ± 8.527 for group 1 and 40.518 ± 9.259 for group 2 (P < 0.001). At T1, a significant improvement in scores on the behavioral scale was identified. Conclusion Our preliminary results show the importance of a multidisciplinary approach, and suggest the positive effect of an additional psychomotor approach, as this holds a new and interesting rehabilitative purpose for children in a toilet training program, even if further research is necessary.

VISUOMOTOR INTEGRATION SKILLS IN CHILDREN AFFECTED BY OBSTRUCTIVE SLEEP APNEA SYNDROME: A CASE-CONTROL STUDY

MARIA RUBERTO*1, FRANCESCO PRECENZANO*2, LUCIA PARISI3, MARGHERITA SALERNO4, AGATA MALTESE3, GIOVANNI MESSINA5,6, MICHELE ROCCELLA3 1Clinic of Child and Adolescent Neuropsychiatry; Headache Center for children and adolescents; Department of Mental Health and Physical Medicine and prevented; Second University of Naples 2Department of Medical-Surgical and Dental Specialties; Second University of Naples 3Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy 4Sciences for Mother and Child Health Promotion, University of Palermo, Italy 5Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy 6Department of Experimental Medicine, Second University of Naples, Naples , Italy

Internalizing symptoms in children affected by childhood absence epilepsy: A preliminary study

FRANCESCO PRECENZANO*, PAOLA LOMBARDI*, MARIA RUBERTO**, LUCIA PARISI***, MARGHERITA SALERNO****, AGATA MALTESE***, ILARIA D’ALESSANDRO*, IMMACOLATA DELLA VALLE*, ROSARIA MARTINA MAGLIULO*, GIOVANNI MESSINA*****, MICHELE ROCCELLA*** *Clinic of Child and Adolescent Neuropsychiatry; Headache Center for children and adolescents; Department of Mental Health and Physical and Preventive Medicine; Second University of Naples **Department of Medical-Surgical and Dental Specialties; Second University of Naples ***Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy ***Sciences for Mother and Child Health Promotion, University of Palermo, Italy ****Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy Francesco Precenzano, Paola Lombardi and Maria Ruberto equally contributed to the manuscript

Influence of football on physiological cardiac indexes in professional and young athletes

Background: After long-term intensive training, considerable morphological and functional heart changes occur in professional athletes. Such changes arise progressively and regress upon interruption of the physical activity. Morphological and functional alterations on heart are known as “Athletes heart” condition. Objective: This study aims to compare echocardiographic parameters in two different groups of professional athletes. Furthermore, a prospective study is performed analyzing the echocardiographic changes occurring in 12 professional players in 3 years of follow-up. Materials and Methods: 78 football players were examined from July 2011 to May 2016 (40 enrolled in Group A and 38 in Group B). Twelve players of GROUP A were followed for 3 consecutive seasons. The general clinical examination, the cardiopulmonary evaluation, the ECG, the ergometer stress test, the spirometric examination and the standard cardiac eco color doppler test were recorded. Results: Left ventricle dimensions, left atrium dimensions, and interventricular septum dimensions were higher in A players than in B players. Moreover, following up 12 players for 3 years, a statistically significant increase of such values was observed. Discussion: In A players, higher dimensions of the left chambers and the interventricular septum were observed, compared to B players. No statistically significant difference was found regarding the ejection fraction. The 3 years follow-up showed a statistically significant increase of both left chambers and interventricular septum dimensions, particularly in the second and third year. Conclusions: These findings demonstrated that A players have higher echocardiographic parameters respect to B players. The results of this study support the scientific theory that long-term intensive training influences heart function, inducing “athletes heart” with morphological adaptations. No significant echocardiographic variation within the examined sample was observed for different roles (goalkeeper, defender, midfielder, or attacker) or skills of individual players.

Borderline intellectual functioning and parental stress: An italian case-control study

FRANCESCO PRECENZANO*, MARIA RUBERTO**, LUCIA PARISI***, MARGHERITA SALERNO****, AGATA MALTESE***, ILARIA D’ALESSANDRO*,MARIA FRANCESCA GRAPPA*, ROSARIA MARTINA MAGLIULO*, GIOVANNI MESSINA*****, MICHELE ROCCELLA*** *Clinic of Child and Adolescent Neuropsychiatry; Headache Center for children and adolescents; Department of Mental Health and Physical and Preventive Medicine; Second University of Naples **Department of Medical-Surgical and Dental Specialties; Second University of Naples ***Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy ****Sciences for Mother and Child Health Promotion, University of Palermo, Italy *****Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy #Francesco Precenzano and Maria Ruberto equally contributed to the manuscript

Adhd-like symptoms in children affected by obstructive sleep apnea syndrome: A case-control study

FRANCESCO PRECENZANO*, MARIA RUBERTO**, LUCIA PARISI***, MARGHERITA SALERNO****, AGATA MALTESE***, ILARIA D’ALESSANDRO*, IMMACOLATA DELLA VALLE*, GENNARO VISCO*, ROSARIA MARTINA MAGLIULO*, GIOVANNI MESSINA*****, MICHELE ROCCELLA*** *Clinic of Child and Adolescent Neuropsychiatry; Headache Center for children and adolescents; Department of Mental Health and Physical and Preventive Medicine; Second University of Naples **Department of Medical-Surgical and Dental Specialties; Second University of Naples ***Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Italy ****Sciences for Mother and Child Health Promotion, University of Palermo, Italy *****Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine; Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy #Francesco Precenzano and Maria Ruberto equally contributed to the manuscript