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Following the innovations and new discoveries of the last 10 years in the field of lung ultrasound (LUS), a multidisciplinary panel of international LUS experts from six countries and from different fields (clinical and technical) reviewed and updated the original international consensus for point-of-care LUS, dated 2012. As a result, a total of 20 statements have been produced. Each statement is complemented by guidelines and future developments proposals. The statements are furthermore classified based on their nature as technical (5), clinical (11), educational (3), and safety (1) statements.

Triathlon’s popularity is rapidly increasing, and epidemiological data relating to its related medical conditions is crucial to the development of proper medical plans and safety guidelines for it. This study examined the data from the medical reports collected during three consecutive editions of Ironman Italy, from 2017 to 2019. Out of 10,653 race-starters, 3.3% required medical attention sustaining 472 medical conditions. A significantly higher injury risk was found for females versus males (χ2 = 9.78, p = 0.02) and in long-distance (IR: 4.09/1,000hours) rather than in Olympic/middle distance races (IR: 1.75/1,000hours). Most (68.4%) conditions (including muscular exhaustion, hypothermia, and dehydration) were systemic, whilst only 10.2% were acute traumatic injuries. Of a total of 357 triathletes requiring medical assistance, 8.1% were a candidate for hospitalisation. The equipment and personnel that are required for the medical assistance in future triathlon events were estimated based on Maurer’s algorithm, and ten practical recommendations for triathlon medical support were formulated.

Background Hydrofoil technology has changed sailing, significantly increasing its speed and resulting in spectacularity and mass media interest. Although high speed can expose participants to a risk of high-energy trauma, there are no scientific studies related to trauma in dinghies that exploit this technology. Therefore, this study aims primarily to measure the injury rate, and identify the kind and anatomical distribution of most common injuries and secondarily identify the traumatic dynamics most often involved and the main risk factors. Methods This descriptive epidemiology study examined data relative to injuries and illnesses suffered by 77 sailors (91% males) from 13 nationalities during three international, gathered through a specifically designed questionnaire. Results The prevalence of illnesses and overuse injuries during the regatta week were 6.5% and 18.2%, respectively, while the incidence of acute injuries was 16/1000 sailor-hours. Upper limbs, lower limbs and lumbar spine were involved in 34.6%, 26.9% and 15.4% of cases of musculoskeletal injuries, respectively. None of the acute injuries reached the maximal score of severity, while the higher score value was 63/100. Most of the reported illnesses (80%; n = 4) were upper respiratory tract infections with a prevalence in the week of the regatta of 5.2% and an incidence of 0.51/1000 sailor-hours. Environmental factors played a role in 77% of the incidents resulting in acute injuries. Conclusions This study provides valuable information for regatta organizers, boat builders, athletes, coaches, and doctors. In addition, it fosters the importance of ergonomics of boats, adequate clothing and specific physical training for injuries and illnesses prevention.

International audience; For the general public, BASE jumping is considered the ultimate extreme activity. Among BASE jumpers, those using wingsuits are generally perceived as the most experienced but also as the most risk-taking. Starting from this observation, we wanted to know whether wingsuit users differed in their psychological characteristics from other BASE jumpers. More specifically, we hypothesized that wingsuit users would be characterized by higher levels of mental toughness and by lower levels of harm avoidance. We also expected them to use more mental training techniques than the other jumpers. To this end, we conducted a vast survey on a sample of 183 BASE jumpers. Contrary to our hypotheses, the results did not reveal any significant difference in psychological characteristics between wingsuit users and other BASE jumpers. This absence of significant differences is discussed and recommendations for the use of mixed or multi-methods in the study of extreme sports are proposed.

Purpose This study aimed to conduct a diagnostic and cost-effective analysis of the cytopathology assistance in the ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for characterising thyroid nodules. Materials and methods We reviewed the reports relative to 9061 US-guided FNABs for the histologic definition of the nature of thyroid nodules: 45.4% completed with the cytopathologist assistance and 54.6% by the radiologist alone. We also performed the cost-effectiveness analysis (CEA) of the procedure with and without the cytopathologist assistance. Results We found a significant positive correlation between the adoption/non-adoption of cytopathologist assistance and the number of indeterminate (TIR1) (Chi-square; z-score, Z = 10.22; critical value 5%, C = 1.96; p r = 0.059; critical value 5%, C = 0.008; p The total cost of the model's cytopathologist-assistance branch is 109.87€, while the total cost of the non-cytopathologist-assistance branch is 95.08€. Conclusion The cytopathologist assistance resulted in fewer nondiagnostic results, thus excluding the procedure's repetition but involved a higher expense, mainly due to the professional cost of the pathologist's participation. These data may provide decision-makers in healthcare with a practical evidence based on the opportunity to include the cytopathologist assistance in the thyroid nodule's FNAB depending on the available resources and the population's expectance.

Adventure and extreme sports (AESs) are associated with high risk of injury and even death. This has important ramifications for sport, education, medical and health professions and has led to disc...

Background: This was a systematic review and meta-analysis of the incidence of concussion risk in youth athletes involved in action sports (AS). Methods: A search of PubMed and Web of Science (from January 1980 to August 2020). Titles, abstracts, and full text were screened according to predefined inclusion criteria to find relevant studies. Moreover, the methodological quality of the studies selected was assessed. Results: Nineteen of 1.619 studies were included in the systematic review and 14 in the meta-analysis. Motocross, sailing and snowboarding presented the highest incidence rates per 1000 athlete exposure at 39.22, 3.73 and 2.77 respectively, whereas alpine skiing had the lowest incidence rates resulting in 0.30. Overall risk of concussion was estimated at 0.33 (CI: 0.22, 0.45). Regarding the methodological quality, we have to report that 26.3% of the studies reported the definition of concussion while 36.8% presented age and gender-specific incidence rates. The mechanism of injury and follow up were reported only in one study. Conclusions: There are significant differences in the rates of incident youth concussion across AS. Despite some limitations, the data from this research can serve as the current sport-specific baseline risk of concussion among youth athletes who practice action sports.

Pneumothorax (PTX) represents accumulation of the air in the pleural space. A large or tension pneumothorax can collapse the lung and cause hemodynamic compromise, a life-threatening disorder. Traditionally, neonatal pneumothorax diagnosis has been based on clinical images, auscultation, transillumination, and chest X-ray findings. This approach may potentially lead to a delay in both diagnosis and treatment. The use of lung US in diagnosis of PTX together with US-guided thoracentesis results in earlier and more precise management. The recommendations presented in this publication are aimed at improving the application of lung US in guiding neonatal PTX diagnosis and management.

Extreme sports, those activities that lie on the outermost edges of independent adventurous leisure activities, where a mismanaged mistake or accident could result in death, have developed into a significant worldwide phenomenon. Extreme sport activities are continually evolving, typical examples include BASE (an acronym for Buildings, Antennae, Span, Earth) jumping and related activities such as proximity flying, extreme skiing, big wave surfing, waterfall kayaking, rope free solo climbing and high-level mountaineering. While participant numbers in many traditional team and individual sports such as golf, basketball, and racket sports have declined over the last decade or so, participant numbers in so called extreme sports have surged. Although extreme sports are still assumed to be a Western pastime, there has been considerable uptake in other parts of the world. Equally, the idea that adventure sports are only for the young is also changing as participation rates across the generations are growing. Baby boomers are enthusiastic participants of adventure sports more generally. Arguably, extreme sports now support a multi-billion dollar industry and the momentum seems to be intensifying. Traditional explanations for why extreme sports have become so popular are varied. For some, the popularity is explained as the desire to rebel against a society that is becoming too risk averse, for others it is about the spectacle and the merchandise that is associated with organized activities and athletes. For others it is just that there are a lot of people attracted by risk and danger or just want to show off. For others still it is about the desire to belong to sub-cultures and the glamour that goes with extreme sports. Some seek mastery in their chosen activity and in situations of significant challenges. This confusing array of explanations is unfortunate as despite their popularity there is still a negative perception about extreme sports participation. There is a pressing need for clarity. The dominant research perspective has focused on positivist theory-driven perspectives that attempt to match extreme sports against predetermined characteristics. For the most part empirical research has conformed to predetermined societal perspectives. Other ways of knowing might reveal more nuanced perspectives of the human dimension of extreme sport participation.

Ultrasound artefacts are ubiquitous; some depend on ultrasound system settings, others are influenced by the position of the probe and the patient, while still others depend solely on the intrinsic characteristics of ultrasounds. Although many artefacts are unwanted, others provide crucial information for interpreting the ultrasound image, and some, such as A- and B-line artefacts, are even essential semiological signs in thoracic ultrasound.

This chapter focuses on thoracic ultrasound as a noninvasive technique for diaphragm morphological and functional assessment, that can be used as an alternative to traditional, more challenging and uncomfortable methods, such as the fluoroscopic sniff test, nerve conduction studies, and electromyography. This chapter firstly focuses attention on the techniques that can be used and on the measurements that can be obtained. Lastly the pathophysiological significance and the potential clinical applications for diagnostic and prognostic purposes are described.

The adoption of bipedalism is a key benchmark in human evolution that has impacted talar morphology. Here, we investigate talar morphological variability in extinct and extant hominins using a 3D geometric morphometric approach. The evolutionary timing and appearance of modern human-like features and their contributions to bipedal locomotion were evaluated on the talus as a whole, each articular facet separately, and multiple combinations of facets. Distinctive suites of features are consistently present in all fossil hominins, despite the presence of substantial interspecific variation, suggesting a potential connection of these suites to bipedal gait. A modern human-like condition evolved in navicular and lateral malleolar facets early in the hominin lineage compared with other facets, which demonstrate more complex morphological variation within Homininae. Interestingly, navicular facet morphology of Australopithecus afarensis is derived in the direction of Homo, whereas more recent hominin species such as Australopithecus africanus and Australopithecus sediba retain more primitive states in this facet. Combining the navicular facet with the trochlea and the posterior calcaneal facet as a functional suite, however, distinguishes Australopithecus from Homo in that the medial longitudinal arch had not fully developed in the former. Our results suggest that a more everted foot and stiffer medial midtarsal region are adaptations that coincide with the emergence of bipedalism, whereas a high medial longitudinal arch emerges later in time, within Homo. This study provides novel insights into the emergence of talar morphological traits linked to bipedalism and its transition from a facultative to an obligate condition.

While in order to read an ultrasonic image correctly it is necessary to understand how ultrasounds interact with biological tissues and how the ultrasound system constructs the image, this is even more true when studying the thorax due to pulmonary air and the bones of the ribcage that alter the propagation of ultrasounds.

The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases. • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.

Neanderthal foot bone proportions and morphology are mostly indistinguishable from those of Homo sapiens, with the exception of several distinct Neanderthal features in the talus. The biomechanical implications of these distinct talar features remain contentious, fueling debate around the adaptive meaning of this distinctiveness. With the aim of clarifying this controversy, we test phylogenetic and behavioral factors as possible contributors, comparing tali of 10 Neanderthals and 81 H. sapiens (Upper Paleolithic and Holocene hunter-gatherers, agriculturalists, and postindustrial group) along with the Clark Howell talus (Omo, Ethiopia). Variation in external talar structures was assessed through geometric morphometric methods, while bone volume fraction and degree of anisotropy were quantified in a subsample (n = 45). Finally, covariation between point clouds of site-specific trabecular variables and surface landmark coordinates was assessed. Our results show that although Neanderthal talar external and internal morphologies were distinct from those of H. sapiens groups, shape did not significantly covary with either bone volume fraction or degree of anisotropy, suggesting limited covariation between external and internal talar structures. Neanderthal external talar morphology reflects ancestral retentions, along with various adaptations to high levels of mobility correlated to their presumably unshod hunter-gatherer lifestyle. This pairs with their high site-specific trabecular bone volume fraction and anisotropy, suggesting intense and consistently oriented locomotor loading, respectively. Relative to H.sapiens, Neanderthals exhibit differences in the talocrural joint that are potentially attributable to cultural and locomotor behavior dissimilarity, a talonavicular joint that mixes ancestral and functional traits, and a derived subtalar joint that suggests a predisposition for a pronated foot during stance phase. Overall, Neanderthal talar variation is attributable to mobility strategy and phylogenesis, while H. sapiens talar variation results from the same factors plus footwear. Our results suggest that greater Neanderthal body mass and/or higher mechanical stress uniquely led to their habitually pronated foot posture.

Participation rates in extreme sports have grown exponentially in the last 40 yr, often surpassing traditional sporting activities. The purpose of this study was to examine injury rates in foot-launched flying sports, i.e., sports in which a pilot foot-launches into flight with a wing already deployed.This paper is based on a retrospective analysis of the reports of incidents that occurred between 2000 and 2014 among the British Hang Gliding and Paragliding Association members.The majority of the 1411 reported injuries were in the lower limb, followed by the upper limb. The most common lower limb injury was to the ankle and included fractures, sprains, and dislocations. The distribution of injures was different in each discipline. The calculated yearly fatality rate (fatalities/100,000 participants) was 40.4 in hang gliding, 47.1 in paragliding, 61.9 in powered hang gliding and 83.4 in powered paragliding; the overall value for foot-launched flight sports was 43.9.Significant differences in injury rates and injury patterns were found among different sport disciplines that can be useful to steer research on safety, and adopt specific safety rules about flying, protective clothing and safety systems in each of these sports.Feletti F, Aliverti A, Henjum M, Tarabini M, Brymer E. Incidents and injuries in foot-launched flying extreme sports. Aerosp Med Hum Perform. 2017; 88(11):1016-1023.

Objective To evaluate, via a multidisciplinary approach, a distinctive paleopathological condition believed to be fibrous dysplasia, found on a 19th/20th century skeleton from Certosa Monumental Cemetery, Bologna, Italy. Materials A skeletonized cranium and mandible recovered from an ossuary in 2014. Methods Pathological alterations were analysed by radiological examination, dental macrowear, histopathological and genetic analyses. Result The skeleton is believed to be an adult male. Differential diagnoses include Paget's disease, McCune-Albright syndrome, osteochondroma and osteosarcoma. The radiographic findings, along with the solitary nature of the lesions, are strong evidence for the diagnosis of fibrous dysplasia (FD). Genetic analysis further revealed a frequency of ˜1% of mutant alleles with the R201C substitution, one of the post-zygotic activating mutation frequently associated with FD. Conclusions The multi-analytical method employed suggests a diagnosis of monostotic form of FD. The diagnostic design incorporates multiple lines of evidence, including macroscopic, histopathological, and genetic analyses. Significance Through the use of a multi-analytic approach, robust diagnoses can be offered. This case serves as one of the oldest examples of FD from an historical context. The genetic mutation detected, associated with FD, has not been previously reported in historical/ancient samples.

Balance is a complex motor skill requiring fine central processing of vestibular, visual, and somatosensory information to control and produce postural actions (Pankanin, Dobosiewicz, & Mietkowska, 2018). Without balance, humans normal functioning could not take place. Thus in activity that requires coordination, fast actions, and complex motor skills, such as during sports, balance becomes extremely relevant. Postural control is essential key component in athletic performances. The participations to extreme sports have grown in the past years, thus with it also the development of extreme sport medicine. Professional athletes are required to constantly improve performances, and one aspect of focus is balance. Similarly, injured patients are often forced to rehabilitate their vestibular system through proprioceptive and somatosensory exercises. In this chapter, we will brief report some of the posturography that athletes could use in training and for rehabilitative purposes.

Extreme aerial sports are a large subgroup of extreme sports. Participation in these activities has grown exponentially in the last decades, often surpassing traditional sports. Although fatalities related to extreme aerial sports are often generically ascribed to polytrauma, an autopsy can reveal unexpected elements in many cases. Forensic studies may lead us to ascertain different causes of death, such as anaphylaxis or myocardial infarction and together with eyewitness reports, they may make it possible to clarify the chain of events that led to an accident. This review paper may be critical not only for medico-legal reasons but also to provide useful information for the development of preventive measures, specific recommendations and safety systems. The paper aims to review available data about fatality rates, causes and dynamics in extreme aerial sports and to draw some possible conclusions about the role of forensic examinations in these sports.

La dysplasie developpementale de la hanche (DDH) resulte d’un retard dans le developpement de la cavite acetabulaire conduisant a une alteration de l’inclinaison du toit acetabulaire. En consequence, la tete femorale et la cavite cotyloidienne n’interagissent pas normalement. L’identification de trois cas de DDH parmi les restes decouverts dans l’unite stratigraphique la plus recente de la crypte de Roccapelago (Modene, Italie) nous permet de discuter de la presence de DDH dans cette region au cours du 18e siecle. Dans les trois cas, identifies comme deux hommes et une femme, la pathologie est bilaterale et de classe Dunn I. Ces cas de DDH sont vraisemblablement principalement dus a des facteurs mecaniques tels que la position en siege du foetus, probablement associee au rang de naissance. Mais compte tenu de leur similitude globale, ils peuvent avoir ete causes par l’utilisation de langes chez les nouveau-nes. En outre, les donnees actuelles du ministere italien de la Sante suggerent que l’incidence de la DDH est demeuree stable dans cette region, du 18e siecle jusqu’a nos jours. L’etude en cours des restes des unites stratigraphiques anterieures favorisera une comprehension plus profonde de la particularite de la prevalence de DDH a Roccapelago.

Background. Traditional monitoring of athletes during sports has long been hampered by bulky, complicated and tethered systems. In the past decade, this has changed due to the miniaturization of sensors and improvement of systems to store and transmit data. These systems have been integrated into textiles to create ‘smart clothing’ which has been so ubiquitous that a review of the recent literature is crucial for understanding its full potential and potential use in extreme sports. Methods. An electronic data base search was performed from 2003 to April 2019 for full length articles including “Smart” AND “Clothing” OR “Clothing” AND “Sport(s)” written in English with human subjects. Articles were evaluated according to the Newcastle-Ottawa Scale. Results. Twenty-four studies resulted in 18 systems comprised of 22 types of clothing with various capabilities, including: monitoring heart rate, electromyography, respiratory rate, steps, GPS, energy expenditure, posture, body temperature and identifying the activity. Conclusions. Many types of smart clothing from socks and gloves, to pants, shirts and bras are increasingly utilized to monitor sports activity worldwide and gather previously unavailable, yet highly valuable data. This provides a unique opportunity to study athletes during training and competition, potentially providing more effective training and better safety protocols.

Skateboarding has become an international action sport attractive to young people. For this reason, skateboarding has been promoted by some researchers as important for encouraging young people to become more physically active. However, skateboarding is also considered to be inherently dangerous by the medical and broader community and as a result skateboarding is banned in many places. This paper reviews scientific literature on the features, outcomes and risk factors related to skateboarding injuries. Findings suggest that while skateboarding injuries can be severe, skateboarding is not as dangerous as it might appear if appropriate risk management steps are taken. Skateboarding should be encouraged as a worthy physical activity and local communities should consider providing specialised, supervised spaces for young people to practice this sport.

Chest ultrasonography (CU) is a noninvasive imaging technique able to provide an immediate diagnosis of the underlying aetiology of acute respiratory failure and traumatic chest injuries. Given the great technologies, it is now possible to perform accurate CU in remote and adverse environments including the combat field, extreme sport settings, and environmental disasters, as well as during space missions. Today, the usage of CU in the extreme emergency setting is more likely to occur, as this technique proved to be a fast diagnostic tool to assist resuscitation manoeuvres and interventional procedures in many cases. A scientific literature review is presented here. This was based on a systematic search of published literature, on the following online databases: PubMed and Scopus. The following words were used: “chest sonography,” “ thoracic ultrasound,” and “lung sonography,” in different combinations with “extreme sport,” “extreme environment,” “wilderness,” “catastrophe,” and “extreme conditions.” This manuscript reports the most relevant usages of CU in the extreme setting as well as technological improvements and current limitations. CU application in the extreme setting is further encouraged here.

Objectives To correlate the radiologic findings detected with computed tomography scan with anthropological data in 13 naturally mummified bodies discovered during works of recovery of an ancient church in a crypt in Roccapelago, in the Italian Apennines. Methods From a group of about sixty not-intentionally mummified bodies, thirteen were selected to be investigated with volumetric computed tomography (CT). Once CT scan was performed, axial images were processed to gather MPR and Volume Rendering reconstructions. Elaborations of these images provided anthropometric measurements and a non-invasive analysis of the residual anatomical structures. For each body the grade of preservation and the eventual pathological changes were recorded. Furthermore, in order to identify nutritional and occupational markers, radiologic signs of bone tropism and degenerative changes were analysed and graded. Results Mummies included seven females and six males, with an estimated age ranging from 20 to 60 years. The first relevant finding identified was a general low grade of preservation, due to the lack of anatomic tissues different from bones, tendons and dehydrated skin. The low grade of preservation was related to the natural process of mummification. Analysing bone degenerative changes on CT scan, the majority of the bodies had significant occupational markers consisting of arthritis in the spine, lower limbs and shoulders even in young age. Few were the pathological findings identified. Among these, the most relevant included a severe bilateral congenital hip dysplasia and a wide osteolytic lesion involving left orbit and petrous bone that was likely the cause of death. Conclusions Although the low grade of preservation of these mummies, the multidisciplinary approach of anthropologists and radiologists allowed several important advances in knowledge for the epidemiology of Roccapelago. First of all, a profile of living conditions was delineated. It included occupational and nutritional conditions. Moreover, identification of some causes of death and, most importantly the definition of general living conditions.

© 2017, The Author(s). Previous research has considered action and adventure sports using a variety of associated terms and definitions which has led to confusing discourse and contradictory research findings. Traditional narratives have typically considered participation exclusively as the pastime of young people with abnormal characteristics or personalities having unhealthy and pathological tendencies to take risks because of the need for thrill, excitement or an adrenaline ‘rush’. Conversely, recent research has linked even the most extreme forms of action and adventure sports to positive physical and psychological health and well-being outcomes. Here, we argue that traditional frameworks have led to definitions, which, as currently used by researchers, ignore key elements constituting the essential merit of these sports. In this paper, we suggest that this lack of conceptual clarity in understanding cognitions, perception and action in action and adventure sports requires a comprehensive explanatory framework, ecological dynamics which considers person-environment interactions from a multidisciplinary perspective. Action and adventure sports can be fundamentally conceptualized as activities which flourish through creative exploration of novel movement experiences, continuously expanding and evolving beyond predetermined environmental, physical, psychological or sociocultural boundaries. The outcome is the emergence of a rich variety of participation styles and philosophical differences within and across activities. The purpose of this paper is twofold: (a) to point out some limitations of existing research on action and adventure sports; (b) based on key ideas from emerging research and an ecological dynamics approach, to propose a holistic multidisciplinary model for defining and understanding action and adventure sports that may better guide future research and practical implications.