Neonatal intensive care units (NICUs) greatly expand the use of technology. There is a need to accurately diagnose discomfort, pain, and complications, such as sepsis, mainly before they occur. While specific treatments are possible, they are often timeconsuming, invasive, or painful, with detrimental effects for the development of the infant. In the last 40 years, heart rate variability (HRV) has emerged as a noninvasive measurement to monitor newborns and infants, but it still is underused. Hence, the present paper aims to review the utility of HRV in neonatology and the instruments available to assess it, showing how HRV could be an innovative tool in the years to come. When continuously monitored, HRV could help assess the baby's overall wellbeing and neurological development to detect stress-/painrelated behaviors or pathological conditions, such as respiratory distress syndrome and hyperbilirubinemia, to address when to perform procedures to reduce the baby's stress/pain and interventions, such as therapeutic hypothermia, and to avoid severe complications, such as sepsis and necrotizing enterocolitis, thus reducing mortality. Based on literature and previous experiences, the first step to efficiently introduce HRV in the NICUs could consist in a monitoring system that uses photoplethysmography, which is low-cost and non-invasive, and displays one or a few metrics with good clinical utility. However, to fully harness HRV clinical potential and to greatly improve neonatal care, the monitoring systems will have to rely on modern bioinformatics (machine learning and artificial intelligence algorithms), which could easily integrate infant's HRV metrics, vital signs, and especially past history, thus elaborating models capable to efficiently monitor and predict the infant's clinical conditions. For this reason, hospitals and institutions will have to establish tight collaborations between the obstetric, neonatal, and pediatric departments: this way, healthcare would truly improve in every stage of the perinatal period (from conception to the first years of life), since information about patients' health would flow freely among different professionals, and high-quality research could be performed integrating the data recorded in those departments.

Objectives The construct of the osteopathic structure-function models is reported as a cornerstone of clinical reasoning and treatment processes. Nevertheless, there are no shared procedures described for their use in clinical practice. The present narrative review aims to analyze a more comprehensive perspective on the phenomenon. Methods A structured narrative review was conducted. A database search was conducted using Pubmed, ScienceDirect, and Google Scholar. Peer-reviewed papers without specifying limits on dates and design were included. Results Twenty-five findings were reported and grouped into two main themes: 1) Debate on models and theoretical frameworks for osteopathic care; 2) Clinical reasoning and decision-making process in the osteopathic field. Conclusions An integrated osteopathic care approach based on the structure/function models represents a starting point to establish a shared osteopathic diagnostic and clinical reasoning and an evidence-informed practice promoting health in an interdisciplinary person-centered care process. The present review highlights the limited amount of literature on using osteopathic conceptual models in decision-making and treatment strategies. A research plan is required to develop a common framework for an evidence-based osteopathic practice that promotes well-being in an interdisciplinary person-centered care process.

No abstract

The present narrative review aims to highlight the possible effects manual therapies could have on cells and mitochondria, as these effects could improve athletic performance management. To this aim, this review summarizes the relationship between mechanical stimulation, with a special focus on physical activity, and cell response based on the most recent mechanobiology findings. Mechanobiology analyzes how cells respond to mechanical stressors coming from the environment. Indeed, endogenous (e.g., blood pressure, heartbeat and gastrointestinal motility) and exogenous (e.g., physical activity and manual therapies) stimuli can induce biochemical and epigenetic modifications that alter protein synthesis with heavy consequences on cell behavior. Mechanical stress can also influence mitochondrial behavior (i.e., biogenesis, autophagy, fusion, fission and energy production), sarcoplasmic response and calcium ion (Ca2+) flux. Since manual therapies have been shown to affect the extracellular matrix, which represents a primary source of mechanical stress that may alter both the cytoskeleton and mitochondrial metabolism, it is conceivable manual therapies could also affect cellular and mitochondrial behavior. Lastly, by suggesting possible directions for future laboratory and clinical studies, the authors expect this review to inspire further research on how manual therapies could affect bioenergetic metabolism and, thus, athletic performance.

Aims To highlight the relationship among compression therapy (CT), the autonomic nervous system (ANS) (parasympathetic and sympathetic system), and the heart rate variability (HRV) analysis. Background Beyond the typical analgesic and anti-inflammatory effects of CT in patients affected by venous and/or lymphatic diseases, some literature about CT influence on wellbeing has been published as well. More specifically, CT influence on the ANS has been elucidated mostly through HRV application, providing useful quali-quantitative data for scientific and clinical purposes. Material and Methods A literature search was performed through several web-based search engines to investigate the available evidence concerning the possible influence of CT on the ANS and on psychoneuroendocrineimmunology. Moreover, we examined literature data regarding HRV use in the assessment of CT. Lastly, a preliminary cross-over study was performed on 10 patients affected by phlebolymphedema of the lower limbs, undergoing CT with 18–21 mmHg stockings for 10 h and investigated by means of HRV. Results A CT-based increase of the anti-inflammatory activity of the parasympathetic (vagal) system has been elucidated in most scientific literature. Similarly, CT application has generally resulted in an improvement of HRV, which indicates a beneficial influence on the ANS. In our preliminary experience with compression stockings and HRV, two parasympathetic-based parameters improved by 22.8% and 68.0% after 10 h, whereas they decreased in the same subjects without stockings by 2.7% and 8.2%, during normal breathing. The remaining HRV parameters did not show relevant variations, especially during diaphragmatic breathing. Conclusions From literature data and based on our very preliminary experience, it is possible to deduce that CT exerts different effects on the psychobiological parameters of the individual, overall improving HRV and parasympathetic activity. Incorporating both HRV/ANS assessment in phlebolymphology and the beneficial neural action of CT in health care may represent viable options in the future biomedical science.

La risposta di stress, tramite il rilascio dei glucocorticoidi e delle catecolamine e modificando le risposte endocrine, neurali e immunitarie, può influenzare la struttura corporea, sia a livello tissutale sia a livello cellulare. In particolare, tramite il coinvolgimento del sistema immunitario, la risposta di stress può alterare la struttura della fascia, un tipo di tessuto connettivo presente nell'interno organismo che svolge importanti ruoli architetturali e di comunicazione per tutti gli organi. Nel presente articolo, attraverso una disamina della risposta di stress, del sistema immunitario e del tessuto connettivo, gli autori eseguono una revisione di queste interazioni alla luce della Pnei per evidenziare come struttura e funzioni corporee siano strettamente collegate. Particolare attenzione verrà posta a come fascia, muscoli e ossa risentano della risposta di stress e a come lo stile di vita possa giocare un ruolo determinante in questo equilibrio.

Introduction 3. The stress response: an updated explanation 3.1. The stress control room: the hypothalamus 3.2. The three branches of the stress response 3.3. The systemic effects of stress hormones 3.4. The immune system and its relationship with the stress response 4. The connective tissue 4.1. ECM structure and function 4.2. The fibroblasts 4.3. The myofibroblasts 5. Acute and chronic effects of stress and immunity on fascia, muscles, and bones 5.1. Acute and chronic effects of cortisol on fascia, muscles, and bones 5.2. Acute and chronic effects of adrenaline and noradrenaline on the fascia 5.3. Interactions between HPA axis, sexual hormones, and fascia 5.4. Interactions between immune cells and connective tissue 5.5. Summary of the effects of stress and immunity on the body structure 6. Conclusions and implications for bodywork therapies 7. Acknowledgments 8. References

La ricerca scientifica, negli ultimi anni, sta sempre più mettendo in risalto la complessità delle relazioni Pnei esistenti tra l'essere umano ed il suo ambiente, sia interno che esterno. Conoscerne i meccanismi è fondamentale per comprendere la salute e la malattia, ma anche per pianificare strategie terapeutiche sempre più efficaci. La seguente revisione narrativa ha lo scopo di mettere in evidenza, in senso bidirezionale, la relazione strutturale e funzionale tra la biomeccanica umana, l'attivazione dell'asse dello stress e la conseguente stimolazione in senso infiammatorio dei leucociti. Nello specifico, considerando che molte cellule immunitarie hanno come terreno di azione la fascia, viene posta attenzione alla reciproca influenza tra i vari costituenti di quest'ultima e le cellule immunitarie. Scopo ultimo dell'articolo, infatti, è contribuire alla promozione di una clinica integrata nell'assistenza sanitaria dei pazienti affetti da patologie muscolo-scheletriche e/o infiammatorie croniche.