Orexins, or hypocretins, are excitatory neuropeptides involved in the regulation of feeding behavior and the sleep and wakefulness states. Since their discovery, several lines of evidence have highlighted that orexin neurons regulate a great range of physiological functions, giving it the definition of a multitasking system. In the present review, we firstly describe the mechanisms underlining the orexin system and their interactions with the central nervous system (CNS). Then, the system’s involvement in goal-directed behaviors, sleep/wakefulness state regulation, feeding behavior and energy homeostasis, reward system, and aging and neurodegenerative diseases are described. Advanced evidence suggests that the orexin system is crucial for regulating many physiological functions and could represent a promising target for therapeutical approaches to obesity, drug addiction, and emotional stress.

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Physiological Role of Orexinergic System for Health

The Coronavirus Pandemic has forced millions of people around the world to look at home. This resulted, as a consequence, in a remodelling of the lifestyle; in this scenario the correct nutrition combined with regular physical activity becomes fundamental for health. Although the sedentary lifestyle of a few weeks involves risks such as lowering the immune system, it favours overweight and obesity, high blood pressure, metabolic disorders, depression and anxiety, and in some subjects they react to the risk of onset of cardiovascular disease, diabetes and other diseases. The importance of healthy lifestyle is crucial to prevent also viral infection. Indeed, as reported by many data literature, during lung infections, IL-6 and TNF-a create the pathway between adipose tissue and lung system demonstrating the important involvement of adipose tissue in lung diseases. In obese condition, adipose tissue endocrine function is altered. There is an imbalance in the production of pro-inflammatory cytokines such as IL-6 and TNF-a and anti-inflammatory mediators such as IL-10. In the light of these evidences, the immune response is influenced by nutritional status and by physical activity which are able to reduce pro-inflammatory mediators and increase anti-inflammatory mediators such as IL-10 . In addition, the power of viral infection is influenced by host predisposition. For these reasons, a correct lifestyle, and physical activity are a valid strategy in the prevention and treatment of not metabolic diseases also of inflammatory diseases.

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Physical activity as protective factor against COVID-19 disease

Obesity is a multifactorial disease and the most primary risk of this is the development of type 2 diabetes. Numerous studies show that the effects of obesity on glucose metabolism result in the deterioration of glucose tolerance, the development of insulin resistance and the consequent damage of the secretory function of beta-cells. The type 2 diabetes is a worldwide health problem associated with obesity and sedentary lifestyle. As reported the American Diabetes Association, the physical activity is fundamental for type 2 diabetes patients, reducing blood pressure, cardiovascular events, and improve glucose metabolism and insulin sensitivity. In the light of these evidences, the aim of this study is to analyse the effects of healthy lifestyle, characterized by a correct diet and by adequate physical activity program in type 2 diabetes patients. We analysed 25 sedentary type 2 diabetes patients subjected to a correct diet and therapeutic treatment and 20 active type 2 diabetes patients subjected to a correct nutrition and a program of physical activity. We found an amelioration in biochemical and anthropometric parameters such as blood pressure, glycemia, glycated haemoglobin, body mass index (BMI). Given these results we can conclude that the physical activity has always been considered one of the cornerstones of type 2 diabetes therapy together with diet and pharmacotherapy. However, the results obtained show that physical activity deserves the same level of consideration as diet and insulin therapy even in the subject with type 2 diabetes.

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Functional evaluation of the diabetic athlete: Role of the sports doctor

Regular physical activity and sport are able to modify the diffused neuro-immuno-endocrine-endothelial system. This emerges from careful scientific research that finds deep interconnections between the psyche, the nervous system, endocrine organs and the immune response. There is an interconnection between the psychoendocrine-immunological system and respiratory infections in athletes. The appearance of leucocytosis during intense physical activity can explain to us how strenuous exercise is responsible for a temporary depression of the immune system; indeed, the physical activity reduces the proliferative activity and function of T-lymphocytes and Natural Killer cells. This is associated with the influence of multiple factors such as age and gender. The respiratory mechanics during strenuous physical activity favours the dehydration of the mucous membranes, the modification of the mucociliary clearance and therefore the predisposition to infections, until the appearance of more complicated diseases such as neoplasms, as reported by data literature. In conclusion, regular and moderate exercise improves the immune system, reduces environmental and psychological stress, decreases the demand and administration of chemotherapy and immunosuppressants.

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Immune system and physical activity

Indocyanine green (ICG) when injected intravenously into the bloodstream allows us to show stomach vascularity in real time. The aim of our study was to observe the preliminary results of the application of indocyanine green fluorescence (IGF) during laparoscopic sleeve gastrectomy (LSG) in our center and how the perfusion of the staple line of the stomach affects the onset of fistula.82 patients underwent LSG with ICG fluorescence angiography at our center from January 2020 to December 2021. 5 ml of ICG was injected intravenously to identify the blood supply of the stomach, carefully assessing the angle of His.In the ICG-tested LSG, we recorded adequate perfusion in all patients but one: the leakage rate was 1.2%. This data is inferior to the non-tested patients' group.Intraoperative ICG testing may be helpful in determining which patients are at an increased risk for leakage but there are multiple factors contribute to the pathophysiology and the incidence of gastric fistula not only the perfusion. Trial registration Retrospectively registrated. 

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Ambrosio Antonio

Papers

Physical activity and modification of lifestyle induce benefits on the health status