Background. Biological synchronized rhythmicity is a critical physiological process. The lack of synchronized rhythms, mainly those showing a circadian basis, like sleep, the heart rate (HR) and arterial blood pressure (BP), often leads to several organic challenges, usually associated with adverse outcomes. Objectives. The aim of the study was to investigate whether the intensive care unit (ICU) environment favors clock genes and cardiorespiratory changes. Material and methods. A total of 22 critically ill patients (16 males; 72.73%) with a mean age of 60.82 +/- 20.07 years and well-established cardiovascular conditions were selected from ICU. Blood samples were obtained, and total RNA was isolated and reverse-transcribed into complementary DNA (cDNA). A quantitative polymerase chain reaction (qPCR) was performed to assess the target gene expression levels. The urinary concentration levels of melatonin (MEL) were assessed. The heart rate, BP (systolic - SBP, diastolic - DBP and mean - MBP) and the oxygen saturation (SpO2) levels were assessed as continuous variables. Results. The urinary MEL and Brain and muscle Arnt-like protein-1 (BMAL1) levels were shown to have a non-linear relationship with HR (coefficient (coef): 2.318, p = 0.032; coef: 2.722, p = 0.006, respectively) and SBP (coef: 1.000, p = 0.008; coef: 2.000, p = 0.037, respectively), with an explanatory power of up to 50.3% and 39.7% of the HR and SBP variability, respectively. Melatonin, but not BMAL1, was also shown to have a non-linear relationship with MBP (coef: 1.000, p = 0.007), with an explanatory power of up to 31.3% regarding the MBP variability. The HR and SBP oscillatory dynamics was shown to be related to changes in the genetic expression of BMAL1 and the urinary MEL concentrations.To a lower degree, MEL also impacted the variation of MBP. Conclusions. Our results suggest that not only are circadian functional matrices crucial for the dynamics of vital parameters in critically ill patients, but also that routinely assessed cardiovascular parameters like HR and BP may constitute important markers for the circadian timing system function. These parameters are easy to assess and have a relevant prognostic value regarding recovery outcomes, as well as the morbidityand mortality rates in ICU.

Background/Objectives: Fragility fractures cause disability, independence loss, and death in older adults with osteoporosis. While exercise rehabilitation is recommended, its effectiveness and consistency in improving function, quality of life, and outcomes after a fracture remain uncertain. This study aimed to systematically assess the impact of structured exercise programs on physical function, quality of life, falls, morbidity, and mortality among adults recovering from fragility fractures. Methods: This review and meta-analysis followed PRISMA guidelines, with protocol registration in PROSPERO (CRD42024503933). MEDLINE, PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched. Randomized controlled trials and quasi-experimental studies including adults (mean age ≥ 50 years) with fragility fractures were eligible if they evaluated structured exercise programs lasting ≥8 weeks compared with usual care or minimal intervention, and reported physical function, quality of life, falls, mortality, or morbidity outcomes. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions guidelines. Primary outcomes comprised physical function, strength, balance, and health-related quality of life. Random-effects meta-analysis was applied where data were comparable. Results: Twenty-six studies with 4142 participants were included (n = 4142; ~80.4% women; mean age ~74.83 years). Interventions were mainly multicomponent (strength, balance, mobility, and functional training). Exercise improved physical function outcomes. At 12 months, pain measured by QUALEFFO-41 decreased (MD −11.61; 95% CI −22.99 to −0.23). Effects on strength, balance, and cognitive outcomes were inconsistent. Conclusions: Exercise-based rehabilitation after fragility fractures may improve physical function and reduce pain, but pooled effects are inconsistent and often highly heterogeneous. Evidence for effects on falls and mortality is sparse and does not support firm conclusions. Physical function measures may be the most practical primary endpoint for evaluating these interventions, interpreted cautiously. Funding: PIGE-0040-2020.

Background: The paediatric intensive care unit exposes critically ill children to non‐physiological environmental stimuli, such as noise, artificial light and thermal instability, which may interfere with physiological regulation and circadian organization. Aim: To examine how environmental conditions in the paediatric intensive care unit (PICU), including noise, lighting and ambient temperature, affect cardiovascular, respiratory and thermoregulatory physiology in paediatric patients admitted after extracorporeal cardiac surgery. Study Design: This prospective cohort study used continuous environmental monitoring and repeated physiological measurements in a tertiary‐level paediatric intensive care unit. Environmental variables were recorded at 30‐s intervals and aggregated to 15‐min resolution to align with routinely collected physiological data. Associations between environmental exposures and heart rate, blood pressure, respiratory rate, oxygen saturation and rectal temperature were evaluated using generalized additive mixed models (GAMMs) incorporating cyclic terms to account for circadian variation and patient‐level random effects. Results: Twenty‐seven paediatric patients aged 0–14 years were analysed. Environmental factors showed consistent non‐linear associations with cardiovascular and respiratory parameters. Heart rate and respiratory rate were the most sensitive variables, particularly in relation to visible light exposure, whereas blood pressure, oxygen saturation and rectal temperature showed comparatively attenuated responses. Despite critical illness, several physiological outcomes continued to exhibit significant 24‐h temporal variation throughout the observation period. Age influenced baseline physiology but did not substantially modify the direction of environmental associations. Noise levels consistently exceeded recommended thresholds and lighting patterns lacked a structured day‐night cycle. Conclusions: PICU environmental conditions were associated with changes in key physiological systems in paediatrics following extracorporeal cardiac surgery and may contribute to altered temporal physiological organization. Relevance to Clinical Practice: Environmental optimization strategies—particularly structured light–dark cycles and noise reduction warrant further investigation as potential nursing‐led interventions to support physiological regulation and circadian organization in paediatric critical care.