BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis a...BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis and treatment.There is a limited number of case reports in the literature and there has been no recent analysis of the literature to consolidate their common features.The purpose of the featured study is to review the available cases of adolescent/adult PB and analyze the common genetic features,histologic features,treatment regimens,tumor sizes,tumor locations,and areas of metastasis to advance ongoing research and better understand and treat this rare condition.AIM To present a patient case and systematically review all available cases in the literature to consolidate the common physical,genetic,and histologic features of PB.METHODS This is a systematic review of the literature with a case study.A total of 89 patient cases were discovered in the literature database for adolescent/adult PB,all of which were reviewed and are included in our research.Patients aged 16-18 were considered adolescent and patients aged greater than 18 were considered adult.Adolescents and adults were grouped together for the purpose of this study.The patient from the case report was seen in a community hospital setting.RESULTS The 89 cases analyzed from the literature were found in 51 references(our case report included),which were consolidated into the six categories mentioned above.A plurality of references reports PB in the head of the pancreas,4.0-10.0 cm in size,and with the most common site of metastasis to the liver.Histology studies most commonly included acinar groups,squamous corpuscles/nests,cytokeratin,chromogranin,trypsin,chymotrypsin,and synaptophysin.Genetic studies most commonly included adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin mutations.The mainstay of treatment was surgery with chemotherapy typically including cisplatin,carboplatin,doxorubicin,5 fluorouracil,mitomycin,bleomycin,gemcitabine,and vindesine.Radiation was also often used.CONCLUSION Common pancreatoblastoma features include acinar groups,chromogranin,chymotrypsin,squamous corpuscles,synaptophysin and trypsin on histology and adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin genetic mutations.展开更多
This study aims to systematically explore the differences in health status between empty-nest and non-empty-nest older adults and further analyze the potential impact of empty-nest and non-empty-nest status on their p...This study aims to systematically explore the differences in health status between empty-nest and non-empty-nest older adults and further analyze the potential impact of empty-nest and non-empty-nest status on their physical and mental health.The study surveyed older adult populations in Anhui Province(N=379,average age=69.51 years)to assess their mental and physical health.Correlation analysis,multiple linear regression analysis,and propensity score matching were used to quantify the health differences between empty-nest and non-empty-nest older adults.Multiple linear regression analysis showed that empty-nest status has a significant positive impact on mental health but a negative impact on physical health.Propensity score matching analysis further validated the main findings of the multiple regression analysis.These findings should be interpreted within specific contexts and conditions,considering individual characteristics and historical perspectives,and fully considering the actual circumstances of the respondents.展开更多
Background Conditional relative survival(CRS),the probability of survival given that an individual has already survived a certain period post-diagnosis,is a more clinically relevant measure for long-term survival than...Background Conditional relative survival(CRS),the probability of survival given that an individual has already survived a certain period post-diagnosis,is a more clinically relevant measure for long-term survival than standard relative survival(RS).This study aims to evaluate the 5-year CRS among adolescent and young adult(AYA)breast cancer patients by age,tumor stage,and receptor subtype to guide disclosure periods for insurance.Methods Data of all females aged 18–39 years and diagnosed with invasive breast cancer between 2003 and 2021(n=13,075)were obtained from The Netherlands Cancer Registry(NCR).The five-year CRS was calculated annually up to 10 years post-diagnosis using a hybrid analysis approach.Results For the total AYA breast cancer study population the 5-year CRS exceeded 90%from diagnosis and increased beyond 95%7 years post-diagnosis.Patients aged 18–24 reached 95%9 years post-diagnosis,those aged 25–29 after 5 years,and those aged 30–34 and 35–39 after 8 years.For stage I,the 5-year CRS reached 95%from diagnosis,for stage II after 6 years,while the 5-year CRS for stages III and IV did not reach the 95%threshold during the 10-year follow-up.Triple-negative tumors exceeded 95%after 4 years,human epidermal growth factor receptor 2(HER2)positive tumors after 6 years,while hormone receptor(HR)positive tumors did not reach 95%.Conclusion Excess mortality among AYA breast cancer patients tends to be little(CRS 90%–95%)from diagnosis and becomes minimal(CRS>95%)over time compared to the general population.These results can enhance expectation management and inform policymakers,suggesting a shorter disclosure period.展开更多
The presence of endogenous neural stem/progenitor cells in the adult mammalian brain suggests that the central nervous system can be repaired and regenerated after injury.However,whether it is possible to stimulate ne...The presence of endogenous neural stem/progenitor cells in the adult mammalian brain suggests that the central nervous system can be repaired and regenerated after injury.However,whether it is possible to stimulate neurogenesis and reconstruct cortical layers II to VI in non-neurogenic regions,such as the cortex,remains unknown.In this study,we implanted a hyaluronic acid collagen gel loaded with basic fibroblast growth factor into the motor cortex immediately following traumatic injury.Our findings reveal that this gel effectively stimulated the proliferation and migration of endogenous neural stem/progenitor cells,as well as their differentiation into mature and functionally integrated neurons.Importantly,these new neurons reconstructed the architecture of cortical layers II to VI,integrated into the existing neural circuitry,and ultimately led to improved brain function.These findings offer novel insight into potential clinical treatments for traumatic cerebral cortex injuries.展开更多
Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults p...Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults presenting diagnostic and treatment challenges due to its overlap with other gastrointestinal disorders such as celiac disease.Initial diagnostic criteria for AIE include small bowel villous atrophy,lack of response to dietary restrictions,presence of anti-enterocyte antibodies,and predisposition to autoimmunity without severe immu-nodeficiency.Refined criteria emphasize characteristic histological findings and exclusion of other causes of villous atrophy.AIE is associated with various autoimmune disorders and can present with overlapping features with Celiac disease,including villous atrophy but without significant intraepithelial lympho-cytosis.Treatment primarily involves immunosuppression using corticosteroids,calcineurin inhibitors,and anti-tumor necrosis factor therapy,alongside nutri-tional support.Despite the challenges,understanding AIE’s diverse manifest-ations and improving diagnostic criteria are essential for effective management and improved patient outcome.Further research is needed to elucidate the pathogenesis,disease progression and long-term outcomes of AIE.展开更多
Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic ...Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.展开更多
In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and so...In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and social determinants that disproportionately affect marginalized communities.In this study,I would like to synthesize current evidence on the prevalence,presentation,and trajectories of mental health concerns among older adults,highlighting common challenges such as late-life depression,anxiety,cognitive concerns,and underutilization of care.I am going to examine barriers to outreach and treatment,including stigma,cultural and linguistic mismatches,access limitations,and gaps in geriatric mental health services.The analysis in the paper identifies promising pathways to improve outcomes:Community-engaged interventions,culturally tailored care models,integration of mental health with primary and geriatric care,and policy reforms to expand coverage and reduce disparities.As a conclusion,with actionable recommendations for clinicians,researchers,policymakers,and community organizations to break the silence,enhance early detection,and foster resilient aging through equitable,person-centered approaches.展开更多
BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all inte...BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all intestinal obstructions and 5%of all intussusceptions,with malignancy being the most common cause.In the past,it was typically diagnosed intraoperatively.However,with the availability of computed tomography for abdominal imaging,recognizing the condition's signs has become crucial.Surgical intervention is essential for managing neoplastic cases and their complications.CASE SUMMARY A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen,abdominal distension,vomiting,and persistent constipation.Over the past two months,she has also experienced considerable weight loss.After an initial history review,examination,and imaging investigations,the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon.This condition was surgically managed through an extended right hemi colectomy.CONCLUSION Intussusception is uncommon in adults,but it should be considered in patients with intestinal obstruction.Surgical intervention is essential.展开更多
BACKGROUND Human beings,by nature,have many expectations that create a feeling of anxiety about the future,but they are endured and long-ranged.They expect to have relationships with others and need to perceive an emo...BACKGROUND Human beings,by nature,have many expectations that create a feeling of anxiety about the future,but they are endured and long-ranged.They expect to have relationships with others and need to perceive an emotional interest,an interpersonal bond,and sustainment to continue living.Perceiving this link is required for feelings of belongingness,which decreases future anxiety.AIM To investigate the future anxiety and belongingness of young and older adults and determine their relationships.METHODS The study was conducted with 404 volunteer participants.Data were collected using the demographic characteristics from the“Dark Future Scale”and“General Belongingness Scale”.RESULTS The mean age of older adults was 66.76±3.74,while that of younger adults was 36.72±10.12.The average score for“future anxiety”was 18.81±7.59,and for“general belongingness",it was 63.31±1.40.Findings indicated a reverse correlation between future anxiety and belongingness.A significant difference in belonging scores was observed between young and older adults(P=0.016,which is<0.05),whereas no significant difference was found regarding future anxiety scores(P>0.05).CONCLUSION Participants had a moderate level of“future anxiety”and higher“belongingness”.Lower belongingness scores correlated with increased future anxiety.Older adults reported a lower sense of belonging than younger individuals.展开更多
BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy...BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.展开更多
Objectives:Walking sports,whereby traditional disciplines of sport modify gameplay by limiting physical activity to walking only,may offer benefits for physical activity engagement and subjective wellbeing outcomes in...Objectives:Walking sports,whereby traditional disciplines of sport modify gameplay by limiting physical activity to walking only,may offer benefits for physical activity engagement and subjective wellbeing outcomes in older adults.Questionnaires were used to collect physical activity and health related data from a cross section of older South Australian walking sports participants(n=56),which was compared to a population-based sample of their peers(n=1817)to explore these potential benefits.Methods:Ordinal logistic regression and linear regression were used for between-group comparisons across three subgroups of participants,who reported engaging in:(1)walking sports,(2)traditional sports,and(3)no sport.All analyses were adjusted for age,marital status,education and employment status.Results:Compared to walking sports participants,those who did not participate in sports were more than twice as likely to report poorer self-rated health.Walking sports and traditional sports participants reported meeting the minimum weekly physical activity requirements.No significant differences in subjective wellbeing were found between the three participant subgroups.Conclusions:Older adults who participated in walking sports had significantly higher self-rated health and physical activity levels,than those not involved in sports.Therefore,sport organisations should consider offering walking sports programs to engage older adults who face barriers to engaging in traditional sports,supporting their continued involvement in physical activity.展开更多
BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-ter...BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.展开更多
Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality...Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality,Cross River State.Materials and Methods:Participants(aged 18-45)were randomly assigned to either an intervention group receiving structured health education or a control group receiving general health information.Stratified randomization was used between the groups.A sample size of 340 participants was recruited to detect a 20%difference in outcomes with 80%power.Data were collected using prevalidated questionnaires at baseline,immediately after the intervention,and at a 3-month follow-up.The intervention consisted of three weekly 90-min educational sessions covering genetics,the benefits of screening,and practical guidance on accessing genetic services.The primary outcomes were changes in awareness and practices related to genetic screening,with secondary outcomes focusing on attitudes and intentions toward genetic counseling.Results:Findings revealed that awareness of genetic screening was higher in the intervention group,with 65.9%of participants aware of early detection,compared to 59.4%in the control group,although the difference was not statistically significant(P=0.23).In terms of practice,42.9%of the intervention group and 40.0%of the control group engaged in genetic screening programs,with no significant difference(P=0.57).Logistic regression analysis highlighted that age,educational level,and knowledge of teratogens were significant predictors of genetic screening awareness.Participants aged 36 years and above were 1.52 times more likely to be aware(odds ratio[OR]=1.52,P=0.003),and those with tertiary education had nearly double the likelihood of awareness(OR=1.96,P<0.001).Conclusion:The study underscores the importance of targeted education in improving genetic screening awareness.展开更多
BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patel...BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.展开更多
Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted educ...Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted education can promote safe practices and reduce preventable harms.By fostering open conversations and integrating addiction literacy into healthcare,providers can support informed decision-making.展开更多
Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the resea...Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.展开更多
This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regio...This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regions,HAV is now increasingly affecting adults,also seen globally due to improved sanitation.The study highlights public health challenges from adult HAV infections,which can lead to complications like coagulopathy and acute liver failure.It also has limitations,including being a single-center study and lacking seroprevalence and socioeconomic data,indicating the need for further research.This letter calls for urgent public health measures to extend adult vaccination programs and improve sanitation to address the increasing HAV infection in adult populations.展开更多
Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and wide...Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.展开更多
Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold s...Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.展开更多
In the December 2025 issue of the Journal of Sport and Health Science,Tomkinson et al.^(1)present international norms for adult handgrip strength(HGS)developed from a systematic review of 100 studies with 2.4 million ...In the December 2025 issue of the Journal of Sport and Health Science,Tomkinson et al.^(1)present international norms for adult handgrip strength(HGS)developed from a systematic review of 100 studies with 2.4 million adults aged 20 to 100+years from 69 countries and regions.Twenty-eight interna-tional handGRIP Strength(iGRIPS)researchers contributed to the study.展开更多
基金Supported by the Honor Health Foundation,Michael and Mary Ellen Francisthe Seena Magowitz Foundation.
文摘BACKGROUND Adolescent/adult pancreatoblastoma(PB)is an uncommon malignant pancreatic tumor.The paucity of data stemming from the rarity of this disease leads to minimal generalized guidelines regarding its diagnosis and treatment.There is a limited number of case reports in the literature and there has been no recent analysis of the literature to consolidate their common features.The purpose of the featured study is to review the available cases of adolescent/adult PB and analyze the common genetic features,histologic features,treatment regimens,tumor sizes,tumor locations,and areas of metastasis to advance ongoing research and better understand and treat this rare condition.AIM To present a patient case and systematically review all available cases in the literature to consolidate the common physical,genetic,and histologic features of PB.METHODS This is a systematic review of the literature with a case study.A total of 89 patient cases were discovered in the literature database for adolescent/adult PB,all of which were reviewed and are included in our research.Patients aged 16-18 were considered adolescent and patients aged greater than 18 were considered adult.Adolescents and adults were grouped together for the purpose of this study.The patient from the case report was seen in a community hospital setting.RESULTS The 89 cases analyzed from the literature were found in 51 references(our case report included),which were consolidated into the six categories mentioned above.A plurality of references reports PB in the head of the pancreas,4.0-10.0 cm in size,and with the most common site of metastasis to the liver.Histology studies most commonly included acinar groups,squamous corpuscles/nests,cytokeratin,chromogranin,trypsin,chymotrypsin,and synaptophysin.Genetic studies most commonly included adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin mutations.The mainstay of treatment was surgery with chemotherapy typically including cisplatin,carboplatin,doxorubicin,5 fluorouracil,mitomycin,bleomycin,gemcitabine,and vindesine.Radiation was also often used.CONCLUSION Common pancreatoblastoma features include acinar groups,chromogranin,chymotrypsin,squamous corpuscles,synaptophysin and trypsin on histology and adenomatous polyposis coli,B-cell lymphoma/leukemia 10,catenin beta 1,and Wnt/beta-catenin genetic mutations.
基金Shanghai Philosophy and Social Science Planning General Project“Research on the Mechanism of Population Aging in the Yangtze River Delta Urban Agglomeration on Economic Growth”(2023ZSH002).
文摘This study aims to systematically explore the differences in health status between empty-nest and non-empty-nest older adults and further analyze the potential impact of empty-nest and non-empty-nest status on their physical and mental health.The study surveyed older adult populations in Anhui Province(N=379,average age=69.51 years)to assess their mental and physical health.Correlation analysis,multiple linear regression analysis,and propensity score matching were used to quantify the health differences between empty-nest and non-empty-nest older adults.Multiple linear regression analysis showed that empty-nest status has a significant positive impact on mental health but a negative impact on physical health.Propensity score matching analysis further validated the main findings of the multiple regression analysis.These findings should be interpreted within specific contexts and conditions,considering individual characteristics and historical perspectives,and fully considering the actual circumstances of the respondents.
基金supported by The Netherlands Organization for Scientific Research VIDI(grant number:198.007).
文摘Background Conditional relative survival(CRS),the probability of survival given that an individual has already survived a certain period post-diagnosis,is a more clinically relevant measure for long-term survival than standard relative survival(RS).This study aims to evaluate the 5-year CRS among adolescent and young adult(AYA)breast cancer patients by age,tumor stage,and receptor subtype to guide disclosure periods for insurance.Methods Data of all females aged 18–39 years and diagnosed with invasive breast cancer between 2003 and 2021(n=13,075)were obtained from The Netherlands Cancer Registry(NCR).The five-year CRS was calculated annually up to 10 years post-diagnosis using a hybrid analysis approach.Results For the total AYA breast cancer study population the 5-year CRS exceeded 90%from diagnosis and increased beyond 95%7 years post-diagnosis.Patients aged 18–24 reached 95%9 years post-diagnosis,those aged 25–29 after 5 years,and those aged 30–34 and 35–39 after 8 years.For stage I,the 5-year CRS reached 95%from diagnosis,for stage II after 6 years,while the 5-year CRS for stages III and IV did not reach the 95%threshold during the 10-year follow-up.Triple-negative tumors exceeded 95%after 4 years,human epidermal growth factor receptor 2(HER2)positive tumors after 6 years,while hormone receptor(HR)positive tumors did not reach 95%.Conclusion Excess mortality among AYA breast cancer patients tends to be little(CRS 90%–95%)from diagnosis and becomes minimal(CRS>95%)over time compared to the general population.These results can enhance expectation management and inform policymakers,suggesting a shorter disclosure period.
基金supported by the National Natural Science Foundation of China,Nos.82272171(to ZY),82271403(to XL),81941011(to XL),31971279(to ZY),31730030(to XL)the Natural Science Foundation of Beijing,No.7222004(to HD).
文摘The presence of endogenous neural stem/progenitor cells in the adult mammalian brain suggests that the central nervous system can be repaired and regenerated after injury.However,whether it is possible to stimulate neurogenesis and reconstruct cortical layers II to VI in non-neurogenic regions,such as the cortex,remains unknown.In this study,we implanted a hyaluronic acid collagen gel loaded with basic fibroblast growth factor into the motor cortex immediately following traumatic injury.Our findings reveal that this gel effectively stimulated the proliferation and migration of endogenous neural stem/progenitor cells,as well as their differentiation into mature and functionally integrated neurons.Importantly,these new neurons reconstructed the architecture of cortical layers II to VI,integrated into the existing neural circuitry,and ultimately led to improved brain function.These findings offer novel insight into potential clinical treatments for traumatic cerebral cortex injuries.
文摘Autoimmune enteropathy(AIE)is a rare immune mediated disorder primarily affecting children,characterized by chronic diarrhea,malabsorption,vomiting,weight loss and villous atrophy.It has also been observed in adults presenting diagnostic and treatment challenges due to its overlap with other gastrointestinal disorders such as celiac disease.Initial diagnostic criteria for AIE include small bowel villous atrophy,lack of response to dietary restrictions,presence of anti-enterocyte antibodies,and predisposition to autoimmunity without severe immu-nodeficiency.Refined criteria emphasize characteristic histological findings and exclusion of other causes of villous atrophy.AIE is associated with various autoimmune disorders and can present with overlapping features with Celiac disease,including villous atrophy but without significant intraepithelial lympho-cytosis.Treatment primarily involves immunosuppression using corticosteroids,calcineurin inhibitors,and anti-tumor necrosis factor therapy,alongside nutri-tional support.Despite the challenges,understanding AIE’s diverse manifest-ations and improving diagnostic criteria are essential for effective management and improved patient outcome.Further research is needed to elucidate the pathogenesis,disease progression and long-term outcomes of AIE.
文摘Adolescence and the journey to adulthood involves exciting opportunities as well as psychosocial stress for young people growing up.These normal experiences are potentially magnified for teenagers living with chronic illness or disability and their families.Advances in care have improved survival for children with a variety of serious chronic medical conditions such that many who may once have died in childhood now survive well into adulthood with ongoing morbidity.For those with highly complex needs,care is often provided at major paediatric hospitals with expertise,specially trained personnel,and resources to support young people and their families for the first decades of life.At the end of adolescence,however,it is generally appropriate and necessary for young adults and their caregivers to transition to the care of clinicians trained in the care of adults at general hospitals.While there are some well-managed models to support this journey of transition,these are often specific to certain conditions and usually do not involve intensive care.Many patients may encounter considerable challenges during this period.Difficulties may include the loss of established therapeutic relationships,a perception of austerity and reduced amenity in facilities oriented to caring for adult patients,and care by clinicians with less experience with more common paediatric conditions.In addition,there is a risk of potential conflict between clinicians and families regarding goals of care in the event of a critical illness when it occurs in a young adult with major disability and long-term health issues.These challenges present genuine opportunities to better understand the transition from paediatric to adult-based care and to improve processes that assist clinicians who support patients and families as they shift between healthcare settings.
文摘In this editorial,I comment on the article conducted by Yang and Woo.Mental health in older adults remains underserved and underexamined,with final decades shaped by cumulative life stressors,chronic conditions,and social determinants that disproportionately affect marginalized communities.In this study,I would like to synthesize current evidence on the prevalence,presentation,and trajectories of mental health concerns among older adults,highlighting common challenges such as late-life depression,anxiety,cognitive concerns,and underutilization of care.I am going to examine barriers to outreach and treatment,including stigma,cultural and linguistic mismatches,access limitations,and gaps in geriatric mental health services.The analysis in the paper identifies promising pathways to improve outcomes:Community-engaged interventions,culturally tailored care models,integration of mental health with primary and geriatric care,and policy reforms to expand coverage and reduce disparities.As a conclusion,with actionable recommendations for clinicians,researchers,policymakers,and community organizations to break the silence,enhance early detection,and foster resilient aging through equitable,person-centered approaches.
文摘BACKGROUND Intussusception is the invagination of a segment of the bowel into an adjacent segment.It is the most common cause of intestinal obstruction in children,but in adults,it is rare,accounting for 1%of all intestinal obstructions and 5%of all intussusceptions,with malignancy being the most common cause.In the past,it was typically diagnosed intraoperatively.However,with the availability of computed tomography for abdominal imaging,recognizing the condition's signs has become crucial.Surgical intervention is essential for managing neoplastic cases and their complications.CASE SUMMARY A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen,abdominal distension,vomiting,and persistent constipation.Over the past two months,she has also experienced considerable weight loss.After an initial history review,examination,and imaging investigations,the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon.This condition was surgically managed through an extended right hemi colectomy.CONCLUSION Intussusception is uncommon in adults,but it should be considered in patients with intestinal obstruction.Surgical intervention is essential.
文摘BACKGROUND Human beings,by nature,have many expectations that create a feeling of anxiety about the future,but they are endured and long-ranged.They expect to have relationships with others and need to perceive an emotional interest,an interpersonal bond,and sustainment to continue living.Perceiving this link is required for feelings of belongingness,which decreases future anxiety.AIM To investigate the future anxiety and belongingness of young and older adults and determine their relationships.METHODS The study was conducted with 404 volunteer participants.Data were collected using the demographic characteristics from the“Dark Future Scale”and“General Belongingness Scale”.RESULTS The mean age of older adults was 66.76±3.74,while that of younger adults was 36.72±10.12.The average score for“future anxiety”was 18.81±7.59,and for“general belongingness",it was 63.31±1.40.Findings indicated a reverse correlation between future anxiety and belongingness.A significant difference in belonging scores was observed between young and older adults(P=0.016,which is<0.05),whereas no significant difference was found regarding future anxiety scores(P>0.05).CONCLUSION Participants had a moderate level of“future anxiety”and higher“belongingness”.Lower belongingness scores correlated with increased future anxiety.Older adults reported a lower sense of belonging than younger individuals.
基金Key Project of Traditional Chinese Medicine Science and Technology Plan of Zhejiang Province (GZY-ZJ-KJ-24077)National Natural Science Foundation of China (No. U23A202181, 8207101520, 82272860)+2 种基金Central Guidance on Local Science and Technology Development Fund of Zhejiang Province (2023ZY1017)Fundamental Research Funds for the Central Universities (No. 226-2023-00038)Special Financial Support for Zhejiang Traditional Chinese Medicine Innovation Teams。
文摘BACKGROUND: The increasing morbidity of liver cancer has led to a growing demand for transplantation. Split liver transplantation(SLT) is a promising way to ameliorate organ shortages. However, the safety and efficacy of SLT are still controversial. The aim of this study was to assess the clinical outcome of SLT in liver cancer patients at our center. METHODS: A total of 74 patients who received liver transplantation at a tertiary hospital from March 2019 to July 2023 were retrospectively studied, of whom 37 recipients underwent SLT and 37 recipients underwent whole-graft liver transplantation(WGLT). Clinical data were analyzed and compared between patients who underwent SLT and WGLT.RESULTS: SLT and WGLT were successfully performed, with no intraoperative transplantrelated mortality. Postoperatively, no significant differences in total bilirubin(TB, P=0.266), alanine transaminase(ALT, P=0.403) and aspartate transaminase(AST, P=0.160) levels within 30 d were detected between the two groups. The transplant-related mortality rates were 8.1% in the SLT group and 5.4% in the WGLT group within 30 d of surgery(P=1.000), and 10.8% and 8.1%, respectively, at 90 d after surgery(P=1.000). There were no significant differences in overall survival(OS) and progress-free survival(PFS) between the SLT and WGLT groups(P=0.910, P=0.190). CONCLUSION: Our results show that SLT does not imply additional risks in treating liver cancer compared with WGLT.
文摘Objectives:Walking sports,whereby traditional disciplines of sport modify gameplay by limiting physical activity to walking only,may offer benefits for physical activity engagement and subjective wellbeing outcomes in older adults.Questionnaires were used to collect physical activity and health related data from a cross section of older South Australian walking sports participants(n=56),which was compared to a population-based sample of their peers(n=1817)to explore these potential benefits.Methods:Ordinal logistic regression and linear regression were used for between-group comparisons across three subgroups of participants,who reported engaging in:(1)walking sports,(2)traditional sports,and(3)no sport.All analyses were adjusted for age,marital status,education and employment status.Results:Compared to walking sports participants,those who did not participate in sports were more than twice as likely to report poorer self-rated health.Walking sports and traditional sports participants reported meeting the minimum weekly physical activity requirements.No significant differences in subjective wellbeing were found between the three participant subgroups.Conclusions:Older adults who participated in walking sports had significantly higher self-rated health and physical activity levels,than those not involved in sports.Therefore,sport organisations should consider offering walking sports programs to engage older adults who face barriers to engaging in traditional sports,supporting their continued involvement in physical activity.
文摘BACKGROUND Endoscopic retrograde cholangiopancreatography(ERCP)is an essential diagnostic and therapeutic procedure for pancreatobiliary disorders.However,few large-scale studies from South Asia have examined long-term ERCP outcomes,particularly using established quality benchmarks.AIM To evaluate ERCP indications,success rates,complications,and quality performance at a high-volume tertiary care center in Pakistan over a 17-year period.METHODS This retrospective study analyzed 13215 ERCP procedures performed between 2006 and 2023.Data included demographics,indications,cannulation rates,complications,and pediatric cases.Findings were assessed against American Society of Gastroenterology/European Society of Gastrointestinal Endoscopy quality indicators.RESULTS Biliary ERCP accounted for 93.1%of procedures;choledocholithiasis was the most common indication(40%).Cannulation success was 93.9%for biliary and 94.2%for pancreatic ERCP.Pediatric ERCP comprised 4%of cases,mostly for stones and chronic pancreatitis.Bleeding(1.7%)and post-ERCP pancreatitis(2.3%)were the most frequent complications.Performance met or exceeded most American Society of Benchmarks.CONCLUSION This study offers insight into nearly two decades of ERCP practice within a public sector hospital.Our experience echoes the quality and efficiency of ERCP not previously available in Pakistan.As healthcare systems in resourcelimited sectors expand,our findings serve as a reference point.Continued training and quality improvement studies can further enhance ERCP effectiveness in the region and beyond.
文摘Objective:This randomized controlled trial aimed to assess the impact of a targeted educational intervention on the awareness and practice of genetic screening and counseling among young adults in Calabar Municipality,Cross River State.Materials and Methods:Participants(aged 18-45)were randomly assigned to either an intervention group receiving structured health education or a control group receiving general health information.Stratified randomization was used between the groups.A sample size of 340 participants was recruited to detect a 20%difference in outcomes with 80%power.Data were collected using prevalidated questionnaires at baseline,immediately after the intervention,and at a 3-month follow-up.The intervention consisted of three weekly 90-min educational sessions covering genetics,the benefits of screening,and practical guidance on accessing genetic services.The primary outcomes were changes in awareness and practices related to genetic screening,with secondary outcomes focusing on attitudes and intentions toward genetic counseling.Results:Findings revealed that awareness of genetic screening was higher in the intervention group,with 65.9%of participants aware of early detection,compared to 59.4%in the control group,although the difference was not statistically significant(P=0.23).In terms of practice,42.9%of the intervention group and 40.0%of the control group engaged in genetic screening programs,with no significant difference(P=0.57).Logistic regression analysis highlighted that age,educational level,and knowledge of teratogens were significant predictors of genetic screening awareness.Participants aged 36 years and above were 1.52 times more likely to be aware(odds ratio[OR]=1.52,P=0.003),and those with tertiary education had nearly double the likelihood of awareness(OR=1.96,P<0.001).Conclusion:The study underscores the importance of targeted education in improving genetic screening awareness.
文摘BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.
基金Supported by FAPESP and Conselho Nacional de Desenvolvimento Cientifico e Tecnologico,No.2024/13209-0.
文摘Addiction literacy equips older adults with the knowledge to navigate substance use risks amid unique challenges like polypharmacy and social isolation.With rising trends in cannabis use among this group,targeted education can promote safe practices and reduce preventable harms.By fostering open conversations and integrating addiction literacy into healthcare,providers can support informed decision-making.
文摘Objectives:This study aimed to develop a mobile frailty management platform for Chinese communitydwelling older adults and evaluate its effectiveness,usability and safety.Methods:Based on literature research,the research team combined the frailty cycle and integration models,self-determination theory,and technology acceptance models and determined the frailty interventions through expert discussion,then transformed it into multimedia resources,finally,engineers developed the mobile management platform.A cluster sampling,parallel,single-blind,controlled quasiexperimental trial was conducted.Sixty older adults from two community health service centers were recruited from March to August 2023.The control group received routine community care,while the intervention group used the mobile frailty management platform.The incidence of frailty,scores of quality of life,depression,sleep quality,and grip strength within 12 weeks were compared between the two groups,and the availability and safety of the platform were assessed.Results:A total of 52 participants completed the study,27 in the intervention group and 25 in the control group.At 12 weeks after the intervention,the frailty state of the intervention group was reversed to prefrailty.There were no significant differences in the scores of quality of life,depression,sleep quality,and grip strength between the two groups before and 4 weeks after intervention.At 8 weeks and 12 weeks after the intervention,the quality of life,depression,and grip strength of the intervention group were improved with statistical significance(P<0.05).Sleep quality was statistically significant only 12 weeks after the intervention(P<0.05).System Usability Scale score for the platform was(87.96±5.88),indicating a highly satisfactory user experience.Throughout the intervention,no adverse events were reported among the older adults.Conclusions:The mobile frailty management platform effectively improved frailty status,depressive mood,sleep quality,grip strength,and quality of life for Chinese community-dwelling older adults.It holds clinical application value and is an effective tool for strengthening frailty management among Chinese community-dwelling older adults.
文摘This letter evaluates Shahid et al’s study in 2025 on the rising hepatitis A virus(HAV)among adults in Pakistan,highlighting a shift in the virus’s epidemiology.Once primarily a childhood disease in low-income regions,HAV is now increasingly affecting adults,also seen globally due to improved sanitation.The study highlights public health challenges from adult HAV infections,which can lead to complications like coagulopathy and acute liver failure.It also has limitations,including being a single-center study and lacking seroprevalence and socioeconomic data,indicating the need for further research.This letter calls for urgent public health measures to extend adult vaccination programs and improve sanitation to address the increasing HAV infection in adult populations.
基金supported by European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie grant agreement(No.101028929)BJFis supported by National Heart Foundation of Australia Postdoc-toral Fellowship(No.106588)+1 种基金BG is supported by Australian Government Research Training Program ScholarshipDPLis supported by Clive Kearon Award,McMaster University.Additional funding information can be found in Supplemen-tary Funding.
文摘Background:Muscular strength is a powerful marker of current health status and robust predictor of age-related disease and disability.Handgrip strength(HGS)using isometric dynamometry is a convenient,feasible,and widely used method of assessing muscular strength among people of all ages.While adult HGS norms have been published for many countries,no study has yet synthesized available data to produce international norms.The objective of this study was to generate international sex-and age-specific norms for absolute and body size-normalized HGS across the adult lifespan.Methods:Systematic searches were conducted in 6 databases/web search engines(MEDLINE,SPORTDiscus,Embase,Web of Science,CINAHL,and Google Scholar)up to December 1,2023.We included full-text peer-reviewed observational studies that reported normative HGS data for adults aged ≥20 years by sex and age.Pseudo data were generated using Monte Carlo simulation following harmonization for methodo-logical variation.Population-weighted Generalized Additive Models for Location,Scale,and Shape were used to develop sex-and age-specific norms for absolute HGS(kg)and HGS normalized by height(Ht,m)squared(i.e.,HGS/Ht^(2)in kg/m^(2)).Norms were tabulated as percentile values(5th to 95th)and visualized as smoothed percentile curves.Results:We included data from 100 unique observational studies representing 2,405,863 adults(51.9%female)aged 20 to 100+years from 69 countries and regions tested from the year 2000 onward.On average,absolute and normalized HGS values negligibly improved throughout early adulthood,peaked from age 3039 years(at 49.7 kg(males)and 29.7 kg(females)for absolute HGS or 16.3 kg/m^(2)(males)and 11.3 kg/m^(2)(females)for HGS/Ht^(2)),and declined afterwards.The age-related decline in HGS accelerated from middle to late adulthood and was slightly larger for males than for females during middle adulthood.Conclusion:This study provides the world’s largest and most geographically comprehensive international norms for adult HGS by sex and age.These norms have utility for global peer-comparisons,health screening,and surveillance.
基金supported by a grant from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska Curie(Grant agreement No.101028929)supported by an Investigator Grant from the Medical Research Future Fund(MRF1193862)supported by an Australian Government Research Training Program Scholarship.
文摘Background:Cardiorespiratory fitness(CRF)is a powerful health marker recommended by the American Heart Association as a clinical vital sign.Comparing the predictive validity of objectively measured CRF(the"gold standara")and estimated CRF is clinically relevant because estimated CRF is more feasible.Our objective was to meta-analyze cohort studies to compare the associations of objectively measured,exerciseestimated,and non-exercise-estimated CRF with all-cause and cardiovascular disease(CVD)mortality in adults.Methods:Systematic searches were conducted in 9 databases(MEDLINE,SPORTDiscus,Embase,Scopus,PsycINFO,Web of Science,PubMed,CINAHL,and the Cochrane Library)up to April 11,2024.We included full-text refereed cohort studies published in English that quantified the association(using risk estimates with 95%confidence intervals(95%CIs))of objectively measured,exercise-estimated,and non-exercise-estimated CRF with all-cause and CVD mortality in adults.CRF was expressed as metabolic equivalents(METs)of task.Pooled relative risks(RR)for all-cause and CVD mortality per 1-MET(3.5 mL/kg/min)higher level of CRF were quantified using random-effects models.Results:Forty-two studies representing 35 cohorts and 3,813,484 observations(81%male)(362,771 all-cause and 56,471 CVD deaths)were included.The pooled RRs for all-cause and CVD mortality per higher MET were 0.86(95%CI:0.83-0.88)and 0.84(95%CI:0.80-0.87),respectively.For both all-cause and CVD mortality,there were no statistically significant differences in RR per higher MET between objectively measured(RR range:0.86-0.90)and maximal exercise-estimated(RR range:0.85-0.86),submaximal exercise-estimated(RR range:0.91-0.94),and non-exercise-estimated CRF(RR range:0.81-0.85).Conclusion:Objectively measured and estimated CRF showed similar dose-response associations for all-cause and CVD mortality in adults.Estimated CRF could provide a practical and robust alternative to objectively measured CRF for assessing mortality risk across diverse populations.Our findings underscore the health-related benefits of higher CRF and advocate for its integration into clinical practice to enhance risk stratification.
文摘In the December 2025 issue of the Journal of Sport and Health Science,Tomkinson et al.^(1)present international norms for adult handgrip strength(HGS)developed from a systematic review of 100 studies with 2.4 million adults aged 20 to 100+years from 69 countries and regions.Twenty-eight interna-tional handGRIP Strength(iGRIPS)researchers contributed to the study.
