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IntroductionThe use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research.MethodThis systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0–18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally.ResultsA heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting.DiscussionThis systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions.Systematic review registrationPROSPERO (CRD42020210663).

Abstract Background A growing consumption of natural (plant-derived) dietary supplements with ergogenic aims, with particular regard for ecdysteroids, phytoestrogens and vegetal sterols, has been registered over the last years among “recreational” athletes. The present study was carried out in order to evaluate the real knowledge of plant-derived nutritional supplements among physically active people as well as their real consumption. Additional aim was to evaluate the effects of these supplements on the health profile of the users. Methods Twenty-three trained subjects who habitually used natural dietary supplements, and 30 matched controls were analyzed for plasma biochemical markers and hormonal profile. Results The laboratory tests revealed the absence of any sign of organ toxicity/damage in both athletes and controls. On the contrary, hormone profiles revealed marked alterations in 15 (65%) out of the 23 of investigated athletes. Specifically, 10 males presented increased plasma levels of progesterone, 15 subjects presented abnormal estrogen levels, including 5 (2 F and 3 M) presenting a “dramatic” increased estrogen values and 2 two males with increased estrogen levels, increased testosterone levels and associated suppression of luteinizing hormone and follicle-stimulating hormone. Conclusions The results of the present study highlighted that the habitual consumption of plant-derived nutritional supplements is frequently associated with significant hormonal alterations both in male and female subjects. Although these biochemical alterations were not associated with signs or symptoms of organ toxicity/damage at the moment of the study, it cannot be excluded that, in the mid/long-term, these subjects would suffer of health problems secondary to chronic exposure to heavily altered hormonal levels. Further large scale studies are needed to confirm the results of this pilot study as well as to investigate the biological mechanisms at the base of the observed hormonal alterations.

Over the last 20 years, there has been much interest in the quest for the 'ideal' pre-participation screening (PPS) for competitive athletes that could effectively prevent sudden cardiac death. The main features requested for this screening would be (1) feasibility in very large populations (millions of people in each country), (2) cost-effectiveness, and (3) high diagnostic accuracy (identifying only athletes with cardiac diseases without producing false-positive or false-negative results). Areas of agreement: Two models of PPS are currently applied: the American and the Italian models. The Italian PPS guidelines include a 12-lead ECG, both at rest and after exercise (3 minute step-test), in addition to medical history and physical examination, in contrast to the American PPS guidelines. This model appears to be the best method for detecting cardiovascular conditions that may predispose athletes to sudden death. Areas of controversy: Controversy exists concerning the possibility of further increase the efficacy of the screening by using echocardiography. Growing points: Based on the available evidence, echocardiographic evaluation at the beginning of the competitive activity would allow for the early identification of many congenital cardiac defects otherwise undetectable, and should be included in the European screening protocol. Timely areas for developing research: Well-constructed long-term longitudinal studies will allow ascertainment of the effectiveness of the pre-participation screening programmes. On the basis of the available evidence, the screening should probably be applied to the population at large to be effective. [ABSTRACT FROM AUTHOR]

Background: The number of competitive master athletes (MA, over 40 years) has been rising. Since the incidence of coronary artery disease (CAD) is increasing in this population, cardiovascular pre-participation screening, including a maximum exercise test, is recommended. In this context the addition of contrast to echo could be useful because wall thickening and motion are better markers of myocardial function when the whole endocardial border (EB) is visible.Objective: To evaluate the feasibility and usefulness of rest and exercise contrast echo for the assessment of LV wall motion in competitive master athletes with suboptimal acoustic windows.Methods: Forty consecutive MA underwent echo and contrast echo both at rest and during exercise. Contrast-enhanced images were achieved at rest and at peak exercise after administration of SonoVue (BR1), using apical 4 and 2-chamber views divided into 6 myocardial segments (MS). The EB resolution for each segment was graded as: 0=not visible, 1=barely visible, 2=well-delineated.Results: In the baseline at-rest echo 17/40 (45%) patients were graded as score 0, 22/40 (55%) were graded as score 1 and only 1 athlete has reached score 2. In at-rest echo contrast 28/40 (70%) athletes have reached score 1 and 12/40 (30%) score 2. Nobody was graded as score 0. At the same time in the baseline peak-exercise echo 12/40 (30%) athletes were graded as score 0, 24/40 (60%) athletes reached score 1 and 4/40 (10%) score 2, while using contrast at peak-exercise echo 28/40 (70%) were grated as score 1 and 12/40 (30%) reached score 2.The differences about the grading of the score between the two groups with and without contrasts, at rest and at peak exercise, are statistically significant (p<0.001). Considering the whole of the MS analyzed in the majority of the athletic population studied, we can see that at-rest echo, 64/480 MS (13.3%) were graded as 0, 156/480 MS (32.5%) as 1 and 260/480 MS (54.2%) were graded 2, while in the peak-exercise 96/480 MS (20%) were graded as 0, 235/480 MS (48.9%) as 1 and 209/480 MS (43.5%) were graded 2. On the other hand, using contrast, in at-rest echo, 480/480 MS (100%) were graded as 2 while in the peak-exercise echo 460/480 MS (95.9%) were graded as 2 and 20/480 MS (4.1%) as 1. The percentage of the MS graded as 2 reach almost the whole number of the analyzed MS with a percentage increment in the at-rest and peak-exercise echo of 85% and 120%, respectively.Conclusions: Our results show that the use of contrast echo improves the visibility of the EB in a way that the two groups of competitive athletes show at rest and after exercise a significant increment of the score 2 compatible with a better visibility of the EB. These results suggest that contrast echo, both at rest and during exercise, is a better method for EB analysis to understand the behaviour of the wall motion in subjects with suboptimal acoustic windows, and could be suitable for cardiovascular screening in master athletes. [ABSTRACT FROM AUTHOR]

Since 2002 19 laparoscopic adrenalectomies with a lateral transperitoneal access have been performed at our Division of Surgery. Three patients had Conn's syndrome, 8 incidentaloma, 4 pheochromocytoma, 2 Cushing's syndrome, 1 metastases from a contralateral renal cancer and 1 metastases from lung cancer. The parameters considered for data analysis were: intra- and postoperative hypertensive crises, haemorrhage, subcutaneous emphysema, conversions, dura- tion of surgery, hospital stay, postoperative comfort, and canalisation and mobilisation times. The results obtained in our experience were comparable to those reported in the literature, confirming the reproducibility and feasibility of this type of surgical procedure. Comparison of the data obtained with laparoscopic, surgery and those obtained with traditional surgical treatment suggest that it is reasonable to claim that the laparoscopic approach is today the gold standard for adrenal surgery.