BACKGROUND:Recurrent hospitalizations and mortality are frequent among frail older adults, reflecting reduced physiological reserve and vulnerability to stressors. Identifying inexpensive and readily available biomarkers for risk stratification remains a priority in geriatric medicine. The Fibrosis-4 (FIB-4) index, originally developed to estimate liver fibrosis, has recently emerged as a systemic risk marker beyond hepatic disease. METHODS:We conducted a prospective observational study including 248 hospitalized patients aged ≥ 70 years admitted to an internal medicine department. Frailty was assessed using the Frailty Index (FI), which was calculated at hospital admission. The primary composite endpoint was all-cause mortality or unplanned hospital readmission during follow-up (mean 159 ± 128 days). RESULTS:Participants were categorized as low FIB-4 (< 1.3, n = 53) or intermediate-high FIB-4 (≥ 1.3, n = 195). Individuals with FIB-4 ≥ 1.3 showed higher inflammatory burden (increased C-reactive protein), lower nutritional reserve (reduced pre-albumin), higher D-dimer levels, and longer hospital stay. During follow-up, 128 events occurred (39 deaths and 89 readmissions). FIB-4 ≥ 1.3 was associated with increased risk of the composite endpoint (HR 2.268, 95% CI 1.210-4.252, p = 0.011). After adjustment for sex, smoking status, BMI, and frailty index, FIB-4 remained independently associated with adverse outcomes (HR 2.045, 95% CI 1.206-4.199, p = 0.016). CONCLUSIONS:FIB-4 appears to reflect reduced biological reserve and systemic vulnerability rather than isolated liver dysfunction. As a cost-free parameter derived from routine blood tests, FIB-4 may represent a practical tool for risk stratification in hospitalized frail older adults.

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndromecharacterized by diastolic dysfunction, preserved left ventricular ejection fraction, and arange of myocardial structural and metabolic abnormalities1. Rather than representingan isolated cardiac disorder, HFpEF is increasingly recognized as a multisystemdisorder, driven by multiple comorbidities, and manifesting as diverse clinicalphenotypes defined by differences in comorbidity burden, disease severity, cardiacstructure, biomarkers, and prognosis. Metabolic comorbidities such as obesity,dyslipidemia, type 2 diabetes (T2D), and hypertension are highly prevalent in HFpEFand may define a distinct cardiometabolic HFpEF (cmHFpEF) phenotype, marked bymore severe symptoms and poorer quality of life2. The coexistence of metaboliccomorbidities drives multisystem pathophysiological changes, worsening prognosis,and limiting the effectiveness of current therapies3.This study aimed to investigate the pathophysiological mechanisms of HFpEF, with afocus on cardiometabolic risk burden as a major contributor to HFpEF phenotypicheterogeneity, to inform future phenotyping strategies and therapeutic approaches.

Syncope and polypharmacy are prevalent in older adults and negatively affect quality of life. This study compares the impact of medication regimen complexity, the total number of medications per day as a measure of polypharmacy, and orthostatic hypotension (OH)-inducing drug burden in older adults with syncope. It also sought to determine a polypharmacy threshold warranting medication review and to identify a distinct polypharmacy phenotype among older adults with syncope and metabolic syndrome (MetS).This study included 104 patients presenting with syncope, stratified by age. Therapeutic complexity was measured using the Medication Regimen Complexity Index (MRCI), total number of medications per day, and an OH risk score (OHscore-SGLT2i). Older adults had significantly higher MRCI, total number of medications per day, and OHscore-SGLT2i than younger adults (p < 0.001), with the youngest-old and middle-old subgroups showing the highest therapeutic complexity (p < 0.05). Regression models adjusted for the comorbidity burden confirmed these findings. ROC analysis identified the total number of medications per day as the best discriminator (AUC = 0.841), with an optimal threshold of 3.5 medications. Notably, 85.7% of older adults with syncope and MetS exceeded this threshold (p < 0.001) and were significantly more likely to experience clinically significant polypharmacy with adverse outcomes (OR 18.9).Polypharmacy is the primary driver of therapeutic complexity in older adults with syncope. A threshold of four or more medications per day may prompt polypharmacy review, particularly in older adults with MetS, who may benefit most from targeted deprescribing.

Background/Objectives: The COVID-19 pandemic has caused sickness and death among many health care workers. However, the apparent resistance of health care workers to SARS-CoV-2 infection despite their high-risk work environment remains unclear. To investigate if inflammation and circadian disruption contribute to resistance or diminished susceptibility to the SARS-CoV-2 virus, we retrospectively evaluated a cohort of volunteer hospital nurses (VHNs). Methods: A total of 246 apparently healthy VHNs (mean age 37.4 ± 5.9 years) who had received the BNT162b2 mRNA vaccine were asked to report their sleep quality, according to the Pittsburgh Sleep Quality Index, and number of SARS-CoV-2 infections during the observational study period (from the end of December 2020 to April 2025). The expression of inflammation-associated mediators and circadian transcription factors in peripheral blood mononuclear cells, as well as sleep quality, were examined. Results: Our findings revealed no anthropometric, biochemical, or inflammation-associated parameters but demonstrated significantly greater levels of NFE2L2, also known as nuclear factor erythroid-derived 2-like 2 (NFR2), gene expression in peripheral blood mononuclear cells among VHNs who had never been infected with SARS-CoV-2 (n = 97) than in VHNs with only one (n = 119) or with two or more (n = 35) prior SARS-CoV-2 infections (p < 0.01). This result was confirmed through one-to-one propensity score matching (p < 0.01). Moreover, NRF2 gene expression was not associated with the number of COVID-19 vaccinations (p = 0.598). Finally, NRF2 gene expression was higher among participants who reported better sleep quality (p < 0.01). Conclusions: Our findings suggest possible interactions among NRF2 gene expression, protection against SARS-CoV-2 infection, and the modulation of COVID-19 vaccination efficacy.

Backgrounds and purpose. . In-hospital older patients have a high mortality and a higher risk of severe COVID-19 outcomes. However, it is unclear whether COVID-19 infection further increases the already-high mortality risk. This study aimed to assess whether COVID-19 could impact in-hospital and post-discharge mortality in older individuals. Methods. . We compared in-hospital and up to 240 days after hospital discharge all-cause mortality in hospitalized 75 years and older patients with and without COVID-19. One-to-one propensity score allocated study participants into two balanced groups (n = 69 for both). Notably, this study was carried out in 2020, when COVID-19 vaccination was not available yet. Results. . COVID-19 patients died more frequently within 30 days of hospital admission than non-COVID patients (36.2 vs 18.8%, respectively; p = 0.018). In contrast, the 240-day post-discharge mortality rate did not differ between groups (42.0 vs 47.8%, respectively; p = 0.304). After controlling for clinical covariates, we found that 30-day all cause-mortality was significantly and independently associated with COVID-19 infection (HR = 2.284, 95% CI = 1.068-4.883, p = 0.033) whereas 240-day all-cause mortality was not significantly associated with the infection (HR = 1.525, 95% CI = 0.869-2.678, p = 0.141). Conclusions. . Our results confirm that COVID-19 significantly increases the mortality risk of patients aged 75 or older during hospitalization. However, we found no substantial difference in post-discharge mortality risk between COVID-19 and non-COVID-19 patients. We suggest that continued monitoring of COVID-19 patients after discharge remains crucial to understand the breadth and severity of the long-term effects of SARS-CoV-2 infection, particularly as currently the number of COVID-19 unvaccinated individuals is still high.

Background: The pathogenesis of many syncopal episodes remains unexplained. Intestinal dysbiosis could be involved in the pathophysiological mechanisms of syncope due to its connection with the central nervous system via the microbiota–gut–brain axis. This pilot study aimed to explore the specific cardiometabolic risk factors and gut microbiota in unexplained syncope (US), compared to other types of syncope, to assess their similarity or verify their different origins. Methods: We studied 86 participants with syncope, who were divided into four groups: an orthostatic syncope group (OH, n = 24), a neuromediated syncope group (NMS, n = 26), a cardiological syncope group (CS, n = 9), and an unexplained syncope group (US, n = 27). We evaluated the anthropometric, clinical, and metabolic characteristics of the four groups; the α- and β-diversity; and the differences in the abundance of the microbial taxa. Results: The US group had a lower incidence of systolic hypertension at the first visit and a lower frequency of patients with nocturnal hypertension than the CS group. Compared to the OH and NMS groups, the US group had a higher incidence of carotid plaques and greater carotid intima–media thickness, respectively. The microbiota differed significantly between the US and CS groups, but not between the US group and the OH or NMS group. Conclusions: We observed significant differences in the gut microbiota between CS and US. Future studies are necessary to evaluate the involvement of the gut microbiota in the complex pathogenesis of syncope and whether its analysis could support the interpretation of the pathophysiological mechasnisms underlying some episodes classifiable as US.

Background: This study aims to identify a metabolomic signature that facilitates the classification of syncope and the categorization of the unexplained syncope (US) to aid in its management. Methods: We compared a control group (CTRL, n = 10) with a transient loss of consciousness (TLC) group divided into the OH group (n = 23) for orthostatic syncope, the NMS group (n = 26) for neuromediated syncope, the CS group (n = 9) for cardiological syncope, and the US group (n = 27) for US defined as syncope without a precise categorization after first- and second-level diagnostic approaches. Results: The CTRL and the TLC groups significantly differed in metabolic profile. A new logistic regression model has been developed to predict how the US will be clustered. Using differences in lysophosphatidylcholine with 22 carbon atom (C22:0-LPC) levels, 96% of the US belongs to the NMS and 4% to the CS subgroup. Differences in glutamine and lysine (GLN/LYS) levels clustered 95% of the US in the NMS and 5% in the CS subgroup. Conclusions: We hypothesize a possible role of C22:0 LPC and GLN/LYS in re-classifying US and differentiating it from cardiological syncope.

Objective. . The global elderly population is anticipated to surpass 1.5 billion by the year 2050. Within the population covered by the Iran Health Insurance Organization (IHIO), approximately 8% consists of individuals aged 65 and above, amounting to over 3.5 million people. A critical concern in the elderly is the prevalent use of potentially inappropriate medications (PIM), leading to adverse drug reactions and hospitalizations. This study aimed to assess the prevalence of PIM prescriptions and polypharmacy among outpatient geriatrics in Tehran. Methods. . In this cross-sectional study, electronic medical records of geriatric patients (>= 65 years), covered by IHIO were collected from outpatient clinics over one year in Tehran. The evaluation of PIM was conducted with the Beers Criteria 2023, and analysis was performed utilizing the CRISP data mining methodology. Results. . This study analyzed 1,273,622 prescription medications from 327,295 patients. Approximately 57.14% of prescriptions were for female patients, and 60.27% of prescriptions were for the age group of 65 to 74 years. Polypharmacy was found in 36.95% of prescriptions. 21.04% (267,954 prescriptions) had at least one PIM. Ketorolac was the most often prescribed PIM. Psychiatrists exhibited a high PIM-prescribed prevalence. Linear regression analysis showed there was no association between patient age ((3 =-0.021) or gender ((3 =-0.038) and the prevalence of PIM prescriptions. Conclusions. . The notable prevalence of PIM and polypharmacy in Tehran's geriatric population raises the imperative for healthcare professionals, policymakers, and the IHIO to collaborate closely to enhance the prescription safety of the elderly population.

Background/Aim: Sentinel lymph node (SLN) procedures have gained popularity in early breast cancer thanks to the reduction of surgical side-effects. The standard SLN mapping procedure uses 99mTc-nanocolloid human serum albumin with/without blue dye; limitations include logistical challenges and adverse reactions. Recently, contrast-enhanced ultrasound (CEUS) using sulfur hexafluoride has emerged as a promising technique for SLN mapping. Our study aimed to compare the CEUS technique with the standard isotope method. Materials and Methods: AX-CES, a prospective, monocentric, single-arm phase-3 study was designed (EudraCT: 2020-000393-20). Inclusion criteria were histologically diagnosed early breast cancer eligible for upfront surgery and SLN resection, bodyweight 40-85 kg, and no prior history of ipsilateral surgery or radiotherapy. All patients underwent CEUS prior to surgery and blue dye injection was performed in areas with contrast accumulation. After the experimental procedure, all patients underwent the standard mapping procedure and SLN frozen section assessment was performed. Data on the success rate, systemic reactions, mean procedure time, CEUS appearance, SLN number, and concordance with standard mapping procedure were collected. Results: Among 16 cases, a median of two SLNs were identified during CEUS. In all cases, at least one SLN was identified by CEUS (100%). In six cases, SLNs were classified during CEUS as abnormal, which was confirmed by definitive staining in four cases. After the standard mapping technique, in 15 out of the 16 cases (87.50%), at least one SLN from the standard mapping procedure was marked with blue dye in the CEUS procedure. In our series, sensitivity and specificity of SLN detection by CEUS were 75% and 100%, respectively. Conclusion: CEUS is a safe and manageable intraoperative procedure. When compared with standard techniques, US appearance during CEUS may provide additional information when associated with histological assessment.

Backgrounds and Aims: Since the start of the SARS-CoV-2 pandemic, healthcare workers have been at elevated risk of contracting COVID-19. Although COVID-19 vaccines have contributed to the eradication of, or substantial decreases in, the incidence of lethal diseases, the major determinant of COVID-19 vaccine hesitancy is a fear of associated adverse effects. Here, we performed a survey assessing the reactogenicity and safety of BNT162b2 in a real-world setting. Methods: Data were collected from March 1 and June 14, 2021. A total of 206 hospital employees undergoing BNT162b2 mRNA vaccination completed the survey. These hospital workers received a questionnaire to collect the common and uncommon adverse effects developing 2–6 days after the second dose of the Pfizer-BioNTech vaccine. Results: After the second dose, female sex was found to be associated with a higher risk of vaccine-related severe systemic adverse effects than male sex (odds ratio [OR] 3.116, 95% CI 2.365–7.113). We also observed that the anti-SARS-CoV-2 receptor-binding domain titer, determined on the day when the second dose of the Pfizer-BioNTech vaccine was administered, was significantly higher in participants with severe systemic effects than those without such effects (OR 1.017, 95% CI 1.001–1.034). Conclusion: Our study suggested that healthy female healthcare workers had a three-fold higher risk than healthy male healthcare workers of developing severe adverse effects after the second dose of the Pfizer-BioNTech vaccine. Further research is warranted to determine whether a high anti-SARS-CoV-2 RBD titer determined at the time of the second vaccination might indicate a disproportionate inflammatory systemic reaction leading to severe adverse effects. Our findings might contribute to a decrease in the disappearance of COVID-19 vaccine hesitancy.

Aims The purpose of this review is to explore the interconnected pathways of the microbiota-gut-brain axis (MGBA), focusing on the roles of the vagus nerve and glucagon like peptide-1 in appetite control, and in the development of obesity and diabetes. Methods Type 2 diabetes mellitus (T2DM) and obesity are metabolic disorders whose prevalence has significantly increased in recent decades and is expected to increase every year, to pandemic proportions. These two pathologies often coexist and have substantial public health implications. The term “diabesity” defines the pathophysiological connection between overweight and T2DM. The gut microbiota affects many aspects of the host. Beyond the regulation of intestinal functions and the activation of immune responses, the gut microbiota plays a role in central nervous system functions (i.e., mood, and psychiatric conditions associated with stress and memory) and is a central regulator of metabolism and appetite. Results The MGBA involves pathways such as the autonomic and enteric nervous systems, the hypothalamic– pituitary–adrenal axis, the immune system, enteroendocrine cells, and microbial metabolites. Notably, the vagus nerve plays an essential role in eating behavior by modulating appetite and learning nutritional preferences. Conclusions Because of its enteroendocrine cell-mediated interaction with the gut microbiota, the vagus nerve may provide a potential pathway through which gut microorganisms influence host feeding behavior and metabolic control of physiological and pathological conditions.

Syncope is a short-term transient loss of consciousness, characterized by rapid onset and complete spontaneous recovery. According to the 2018 European Society of Cardiology guidelines, three different types of syncope have been identified. However, all forms of syncope share a common final pathophysiological event, global cerebral hypoperfusion, which results from the inability of the circulatory system to maintain blood pressure at the level required to efficiently supply blood to the brain. The vasovagal syncope (VVS) is the most common form of syncope. Although, VVS is generally harmless, its frequent occurrence can negatively affect quality of life and increase the risk of adverse events. The pathophysiological mechanisms underlying VVS remain obscure. The multifaceted nature of VVS presents a veritable challenge to understanding this condition and developing preventative strategies. Thus, the aim of this review was to discuss the factors contributing to the pathogenesis of VVS and provide guidance for future research.

Objectives Patients with SLE have higher cardiovascular (CV) risk compared with healthy controls (HC) and are characterised by accelerated atherosclerosis; intima media thickness (IMT), marker of subclinical atherosclerosis, is higher in patients with SLE than in HCs. Retinal microvascular impairment detected through optical coherence tomography angiography (OCTA) was investigated as a marker of systemic vascular involvement in SLE.The aim of the study was to evaluate the relationship between retinal vascular impairment and IMT in SLE.Methods Cross-sectional study recruiting patients with SLE and HCs. Data of the study population were collected. CV risk was evaluated through the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, Framingham and QRESEARCH risk estimator V.3 (QRISK3) scores. Both groups underwent OCTA and carotid ultrasound with IMT assessment.Statistical analysis was accomplished using Pearson/Spearman, t-test/Mann-Whitney or χ2 test. Variables statistically significant at univariate regression analysis were tested in an age-corrected and sex-corrected multivariate regression model.Results 43 patients with SLE and 34 HCs were recruited. Patients with SLE showed higher triglycerides (p=0.019), Triglycerides-Glucose (TyG) Index (p=0.035), ACC/AHA guidelines (p=0.001), Framingham Risk Scores (p=0.008) and a reduced superficial (p<0.001) and deep (p=0.005) whole retinal vessel density (VD) compared with HCs.In SLE univariate analysis, deep whole VD showed a negative correlation with IMT (p=0.027), age (p=0.001), systolic blood pressure (p=0.011), QRISK3 Score (p<0.001), Systemic Lupus International Collaborating Clinics Damage Index (p=0.006) and apolipoprotein B (p=0.021), while a positive correlation was found with female sex (p=0.029). Age-adjusted and sex-adjusted multivariate analysis confirmed QRISK3 Score (p=0.049) and IMT (p=0.039) to be independent risk factors for reduced retinal VD.Conclusions Patients with SLE showed lower retinal VD and higher CV risk indicators compared with HCs. Among patients with SLE, QRISK3 Score and IMT were found to be independent risk factors for retinal vascular impairment, suggesting a role of OCTA in evaluating preclinical CV involvement in SLE. Moreover, TyG Index could represent a biomarker of CV risk in patients with SLE compared with HCs.

The immune system in humans is regulated by the circadian rhythm. Published studies have reported that the time of vaccination is associated with the immune response to vaccine for some pathogens. Our study aimed to evaluate the association between time of dose administration of challenge HBV vaccine and seroconversion for anti-HBs in medical students vaccinated at birth who were found to be unprotected at pre-training screening. Humoral protection for HBV was assessed in 885 medical students vaccinated during childhood. In total, 359 (41.0%) of them showed anti-HBs titer < 10 UI/mL and received a challenge dose of HBV vaccine followed by post-vaccination screening 30–60 days later. The challenge dose elicited a protective immune response (anti-HBs IgG titer > 10 UI/mL) in 295 (83.8%) individuals. Seroconversion was significantly associated with female gender and time of vaccination after controlling for age group and nationality at logistic regression analysis. Students who received the booster dose in the morning had a higher response rate than those who received the vaccine in the afternoon (OR 1.93; 95% C.I. 1.047–3.56: p < 0.05). This finding suggests that morning administration of the HBV booster may result in a better immune response in susceptible individuals.

Hyperglycemia strongly affects endothelial function and activation, which in turn increases the risk of atherosclerotic cardiovascular disease. Among pharmacotherapies aimed at lowering blood glucose levels, glucagon-like peptide 1 receptor agonists (GLP-1RA) represent a class of drugs involved in the improvement of the endothelium damage and the progression of cardiovascular diseases. They show antihypertensive and antiatherosclerotic actions due at least in part to direct favorable actions on the coronary vascular endothelium, such as oxidative stress reduction and nitric oxide increase. However, cumulative peripheral indirect actions could also contribute to the antiatherosclerotic functions of GLP-1/GLP-1R agonists, including metabolism and gut microbiome regulation. Therefore, further research is necessary to clarify the specific role of this drug class in the management of cardiovascular disease and to identify specific cellular targets involved in the protective signal transduction. In the present review, we provide an overview of the effects of GLP-1RAs treatment on cardiovascular disease with particular attention on potential molecular mechanisms involving endothelium function on formation and progression of atherosclerotic plaque.

In elderly Type 2 Diabetes (T2D) patients the relationship between the destabilization of gut microbiome and reversal of dysbiosis via glucose lowering drugs has not been explored. We investigated the effect of 6 months therapy with a fixed combination of Liraglutide and Degludec on the composition of the gut microbiome and its relationship with Quality of Life, glucose metabolism, depression, cognitive function, and markers of inflammation in a group of very old T2D subjects (n=24, 5 women, 19 men, mean age=82 years). While we observed no significant differences in microbiome biodiversity or community among study participants (N = 24, 19 men, mean age 82 years) who responded with decreased HbA1c (n=13) versus those who did not (n=11), our results revealed a significant increase in Gram-negative Alistipes among the former group (p=0.013). Among the responders, changes in the Alistipes content were associated directly with cognitive improvement (r=0.545, p=0.062) and inversely with TNFα levels (r=-0.608, p=0.036). Our results suggest that this combination drug may have a significant impact on both gastrointestinal microbes and cognitive function in elderly T2D individuals.

The COVID-19 pandemic has severely affected health systems worldwide and raised the issue of vaccine hesitancy. In 2022, the World Health Organization reported an outbreak of measles infection among people over 20 years of age in the European Region. Previous studies found low rates of measles immunization among Italian healthcare workers (HCWs) and medical students. Vaccine hesitancy is a relevant cause of low immunization rate among HCWs and the general population. We aim to evaluate the measles vaccine uptake among medical students of a large teaching hospital, compared to the pre-pandemic period. This is a retrospective observational study, that evaluated the immune status and the vaccine acceptance rate for measles in medical students at the University of Tor Vergata, Rome, who underwent occupational health surveillance from 1 January to 1 December 2022. We also compared the data with the results of a pre-pandemic survey conducted in 2018. Vaccine uptake among unprotected medical students was 59.5%. The data showed no significant difference in vaccine uptake compared with the pre-COVID-19 period. Conversely, the rate of serologically immune subjects to measles increased from 89.66% in 2018 to 97.45% in 2022 as a result of the recent mandatory vaccination policy. Despite efforts to tackle vaccine hesitancy during the COVID-19 pandemic, measles vaccine uptake is still low among young adults starting their medical training, and their compliance with free workplace vaccination offers is suboptimal. Occupational health services should raise awareness among workers and work together to implement strategies to achieve comprehensive measles vaccination coverage among occupational health workers.

Today, 463 million people worldwide suffer from diabetes, while 374 million have prediabetes. Unfortunately, this number is expected to double by 2030. However, data about the prevalence of diabetes are influenced by the age group to which it refers. For example, in 2000, 12% of people between 65 and 70 years old as well as 15% of the over 80s were affected by diabetes. Nowadays, the percentage of over 65s with diabetes is about 20-25%, with some geographical differences. Dementia is another critical health problem which is greatly increasing especially among the elderly. While it is well known that diabetes is a significant risk factor for worsening vision, renal function, and increased risk of cardiovascular disease, a number of recent epidemiological evidence reported that diabetes can also be considered a risk factor for cognitive dysfunction. Therefore, while basic research and trials on human models are focused on understanding the pathophysiological mechanisms underlying the development of cognitive decline in individuals with diabetes, in clinical practice the prevention of cognitive decline in the individual with diabetes is critically important. In this paper, we will discuss the pathogenetic mechanisms, clinical approach, and diagnostic strategies that can be used in a clinical-ambulatory setting for early diagnosis of cognitive decline in patients with diabetes.

Aims Disturbances in circadian rhythms may promote cardiometabolic disorders in rotating night shift workers (r-NSWs). We hypothesized that timed light therapy might reverse disrupted circadian rhythms and glucose intolerance observed among r-NSWs). Methods R-NSWs were randomly assigned to a protocol that included 12 weeks on followed by 12 weeks off light therapy ( n = 13; 6 men; mean age, 39.5 ± 7.3 years) or a no-treatment control group ( n = 9; 3 men; mean age 41.7 ± 6.3 years). Experimental and control participants underwent identical metabolic evaluations that included anthropometric, metabolic (including oral glucose tolerance tests), lipid, and inflammation-associated parameters together with an assessment of sleep quality and expression of circadian transcription factors REV-ERBα and BMAL1 in peripheral blood mononuclear cells (PBMCs) at baseline, 12 weeks, and 24 weeks of the protocol. Results Twelve weeks of warm white-light exposure (10,000 lx at 35 cm for 30 min per day) had no impact on sleep, metabolic, or inflammation-associated parameters among r-NSWs in the experimental group. However, our findings revealed significant decreases in REV-ERBα gene expression ( p = 0.048) and increases in the REV-ERBα/BMAL1 ratio ( p = 0.040) compared to baseline in PBMCs isolated from this cohort. Diminished expression of REV-ERBα persisted, although the REV-ERBα/BMAL1 ratio returned to baseline levels after the subsequent 12-day wash-out period. Conclusions Our results revealed that intermittent light therapy had no impact on inflammatory parameters or glucose tolerance in a defined cohort of r-NSWs. However, significant changes in the expression of circadian clock genes were detected in PBMCs of these subjects undergoing light therapy.

Night shift work has been associated with cardiovascular and metabolic disease, endocrine and immunological disorders. Published studies have reported that a reduced total sleep time with sleep-wake cycle alterations were associated with a reduced rate of humoral response following vaccination. Our study aimed to evaluate the association between night shift work and serological status for HBV among workers employed in a university hospital in Rome. We evaluated medical records of 986 HCWs working at Tor Vergata Policlinic of Rome. We screened all study subjects for anti-HBs IgG, anti-HBc IgG and HBsAg. Serological protection for HBV was evaluated in relation to sex, age group, job task, risk setting and night shift work status. Protective titer was found in 856 (86.8%) study participants and the mean titer was significantly high in females, in subjects aged less than 40 years, in night shift workers and in high-risk setting workers. After adjustment for study covariates, night shift work was no longer associated with an HBV-protective titer. This finding suggests that a vaccination strategy for dampening HBV transmission should be carefully addressed in health care workers (HCWs) doing night shift.