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
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 Non-exercise estimated cardiorespiratory fitness(NEE-CRF)has been shown to be associated with mortality,although its association with cancer incidence is unknown.The study aimed to assess the prospective as...Background Non-exercise estimated cardiorespiratory fitness(NEE-CRF)has been shown to be associated with mortality,although its association with cancer incidence is unknown.The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women.Methods The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50–71 years who were free from cancer at baseline(1995–1996)(men(n=238,835)and women(n=163,713))and were followed until December 31,2015.The exposure variable was NEE-CRF expressed in metabolic equivalents.NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires.Primary outcomes were total cancer incidence and incidence of prostate,breast,lung,and colorectal cancers.Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors.Results During 13.7±3.2 years of follow-up(mean±SD),64,344 men and 31,315 women developed a new cancer.For every 1-metabolic equivalent higher NEE-CRF,the hazard ratios and 95%confidence intervals(95%CIs)were 0.96(95%CI:0.94–0.97)and 0.88(95%CI:0.84–0.92)of total and colorectal cancer incidence among men,and 0.95(95%CI:0.93–0.97)and 0.94(95%CI:0.91–0.97)of total and breast cancer incidence among women,respectively(all p<0.001).NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women.Conclusion These results suggest that higher CRF levels,as assessed by the applied non-exercise estimated method,may provide preventive benefits against the development of cancer,while low CRF could potentially serve as a modifiable cancer risk factor.Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.展开更多
Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for re...Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.展开更多
BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS...BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS Between September 2020 and December 2021,we performed a randomized controlled trial to evaluate the impact of CADe.Patients at Veterans Affairs Palo Alto Health Care System presenting for screening or low-risk surveillance were randomized to colonoscopy performed with or without CADe.Primary outcomes of interest included adenoma detection rate(ADR),adenomas per colonoscopy(APC),and adenomas per extraction.In addition,we measured serrated polyps per colonoscopy,non-adenomatous,non-serrated polyps per colonoscopy,serrated polyp detection rate,and procedural time.RESULTS A total of 244 patients were enrolled(124 with CADe),with similar patient characteristics(age,sex,body mass index,indication)between the two groups.Use of CADe was found to have decreased number of adenomas(1.79 vs 2.53,P=0.030)per colonoscopy compared to without CADe.There was no significant difference in number of serrated polyps or non-adenomatous non-serrated polyps per colonoscopy between the two groups.Overall,use of CADe was found to have lower ADR(68.5%vs 80.0%,P=0.041)compared to without use of CADe.Serrated polyp detection rate was lower with CADe(3.2%vs 7.5%)compared to without CADe,but this was not statistically significant(P=0.137).There was no significant difference in withdrawal and procedure times between the two groups or in detection of adenomas per extraction(71.4%vs 73.1%,P=0.613).No adverse events were identified.CONCLUSION While several randomized controlled trials have demonstrated improved ADR and APC with use of CADe,in this RCT performed at a center with high ADR,use of CADe was found to have decreased APC and ADR.Further studies are needed to understand the true impact of CADe on performance quality among endoscopists as well as determine criteria for endoscopists to consider when choosing to adopt CADe in their practices.展开更多
Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit interna...Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit international monitoring and surveillance.The objective of the study was to seek international consensus on a proposed,evidence-informed,Youth Fitness International Test(YFIT)battery and protocols for health monitoring and surveillance in children and adolescents aged 618 years.Methods:We conducted an international modified Delphi study to evaluate the level of agreement with a proposed,evidence-based,YFIT of core health-relatedfitness tests and protocols to be used worldwide in 6-to 18-year-olds.This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid,reliable,health-related,safe,and feasiblefitness tests to be used in children and adolescents aged 618 years.We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey,of whom one-third are from low-to-middle income countries and one-third are women.Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias.We pre-defined an agreement of 80%among the expert participants to achieve consensus.Results:We obtained a high response rate(78%)with a total of 169fitness experts from 50 countries and territories,including 63 women and 61 experts from low-or middle-income countries/territories.Consensus(>85%agreement)was achieved for all proposed tests and protocols,supporting the YFIT battery,which includes weight and height(to compute body mass index as a proxy of body size/composition),the 20-m shuttle run(cardiorespiratoryfitness),handgrip strength,and standing long jump(muscularfitness).Conclusion:This study contributes to standardizingfitness tests and protocols used for research,monitoring,and surveillance across the world,which will allow for future data pooling and the development of international and regional sex-and age-specific reference values,health-related cut-points,and a global picture offitness among children and adolescents.展开更多
Purpose:To assess the association between cardiorespiratory fitness(CRF)and the incidence and mortality from cancer in women,and to evaluate the potential public health implications for cancer prevention.Methods:Maxim...Purpose:To assess the association between cardiorespiratory fitness(CRF)and the incidence and mortality from cancer in women,and to evaluate the potential public health implications for cancer prevention.Methods:Maximal exercise testing was performed in a pilot cohort of 184 women(59.3 ± 15.2 years)who were followed for 12.0 ± 6.9 years.Cox hazard models adjusted for established cancer risk factors and accounting for competing events were analyzed for all-type cancer incidence and mortality from cancer.Population-attributable risks and exposure impact number were determined for low CRF(<5 metabolic equivalents(METs))as a risk factor.Results:During the follow-up,11.4% of the participants were diagnosed with cancer and 3.2% died from cancer.CRF was inversely and independently associated with cancer outcomes.For every 1-metabolic equivalent increase in CRF,there was a 20% decrease in the risk of cancer incidence(hazard ratio(HR)= 0.80,95% confidence interval(CI):0.69-0.92;p=0.001)and a 26% reduction in risk of cancer mortality(HR = 0.74,95%CI:0.61-0.90;p=0.002).The population-attributable risks of low CRF were 11.6% and 14% for incidence and mortality of cancer,respectively,and the respective exposure impact numbers were 8 and 20.Conclusion:Greater CRF was independently associated with a lower risk of incidence and mortality from cancer in women.Screening for low CRF as a cancer risk factor and referring unfit individuals to a supervised exercise program could be a public health strategy for cancer prevention in middle-age women.展开更多
Background and Study Aims: It has been postulated that chronic radiation proctopathy, clinically manifested by hematochezia and by the appearance of multiple telangiectasias, is caused by ischemia. This theory is base...Background and Study Aims: It has been postulated that chronic radiation proctopathy, clinically manifested by hematochezia and by the appearance of multiple telangiectasias, is caused by ischemia. This theory is based on reports that appeared in the 1980s which described obliterative endarteritis in patients with chronic radiation-induced ulcers. However, bleeding from radiation proctopathy is typically successfully treated endoscopically by widespread tissue coagulation, and the complications that would be expected to occur if the tissue was ischemic, such as poor wound healing, generally do not arise. We therefore hypothesized that the ischemia theory is incorrect and that rectal capillary oxygen saturation is normal in patients with telangiectasias of chronic radiation proctopathy. Patients and Methods: We developed a visible-light spectroscopy device that measures mucosal capillary hemoglobin oxygen saturation during endoscopy (having reported its operating characteristics previously). We prospectively studied 20 patients who had typical findings of multiple rectal telangiectasias, 1-20 years after undergoing external-beam irradiation for prostate or rectal carcinoma. We measured and compared the mucosal capillary oxygen saturations in the affected areas of the distal rectum and in endoscopically normal areas in the rectosigmoid colon. Results: Mucosal oxygenation was normal in all 20 patients in affected areas (64%-80%) and in unaffected areas (63%-75%). The mean mucosal hemoglobin oxygen saturation was actually slightly higher in the affected areas of the rectum than in the uninvolved rectosigmoid colon (73%vs. 69%, P < 0.01). Conclusions: The common form of chronic radiation proctopathy, characterized by multiple telangiectasias without ulcers or strictures, is not associated with ongoing mucosal ischemia. This finding may explain why endoscopic treatment of this disorder, in which large areas of the mucosa are coagulated with argon plasma or other treatment modalities that cause widespread ulceration, does not typically result in complications from poor wound healing.展开更多
Pulmonary arterial hypertension(PAH)is a devastating disease characterized by perivascular inflammation,immune dysregulation,and vascular remodeling.Recent studies have unveiled a potential link between the gut microb...Pulmonary arterial hypertension(PAH)is a devastating disease characterized by perivascular inflammation,immune dysregulation,and vascular remodeling.Recent studies have unveiled a potential link between the gut microbiome and PAH pathogenesis,suggesting that microbial dysbiosis and increased intestinal permeability may contribute to the inflammatory pathology in PAH and ultimately disease progression.This perspective highlights the emerging evidence of the role of leaky gut in PAH,the interplay between microbiota-induced immune responses,and the activation of endogenous retroviruses like human endogenous retrovirus K.Understanding these complex interactions opens new interdisciplinary avenues for research and therapeutic interventions,potentially transforming PAH management through microbiome-targeted strategies.展开更多
Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HC...Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).展开更多
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.
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 (in part) by the Intramural Research Program of the NIH,National Cancer Institute
文摘Background Non-exercise estimated cardiorespiratory fitness(NEE-CRF)has been shown to be associated with mortality,although its association with cancer incidence is unknown.The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women.Methods The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50–71 years who were free from cancer at baseline(1995–1996)(men(n=238,835)and women(n=163,713))and were followed until December 31,2015.The exposure variable was NEE-CRF expressed in metabolic equivalents.NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires.Primary outcomes were total cancer incidence and incidence of prostate,breast,lung,and colorectal cancers.Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors.Results During 13.7±3.2 years of follow-up(mean±SD),64,344 men and 31,315 women developed a new cancer.For every 1-metabolic equivalent higher NEE-CRF,the hazard ratios and 95%confidence intervals(95%CIs)were 0.96(95%CI:0.94–0.97)and 0.88(95%CI:0.84–0.92)of total and colorectal cancer incidence among men,and 0.95(95%CI:0.93–0.97)and 0.94(95%CI:0.91–0.97)of total and breast cancer incidence among women,respectively(all p<0.001).NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women.Conclusion These results suggest that higher CRF levels,as assessed by the applied non-exercise estimated method,may provide preventive benefits against the development of cancer,while low CRF could potentially serve as a modifiable cancer risk factor.Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.
文摘Sex differences in procedural skill learning have not been well characterized. Skill learning is an important area to explore in clinical settings that involve rehabilitation and deficit remediation, especially for returning Veterans that have a range of co-morbid conditions (traumatic brain injury, posttraumatic stress disorder, and depression) and possess impairments in multiple domains. Sixty-five (55 males, 10 females) Veterans completed two procedural learning tasks and answered self-report questionnaires. Participants’ performance and total learning slope were analyzed to determine sex differences in learning. Our results revealed sex differences in both tasks demonstrating females tend to perform better than males with a large effect size for these mean differences. While females performed better on the procedural learning tasks compared to males, their rate of learning was equivalent. Skill learning is an important requisite for rehabilitation, as skill learning is necessary to perform daily activities in new settings. Ultimately, these results provide insight into skill learning in Veterans with a range of co-morbid conditions and provide support for further investigation of sex differences in procedural learning.
文摘BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS Between September 2020 and December 2021,we performed a randomized controlled trial to evaluate the impact of CADe.Patients at Veterans Affairs Palo Alto Health Care System presenting for screening or low-risk surveillance were randomized to colonoscopy performed with or without CADe.Primary outcomes of interest included adenoma detection rate(ADR),adenomas per colonoscopy(APC),and adenomas per extraction.In addition,we measured serrated polyps per colonoscopy,non-adenomatous,non-serrated polyps per colonoscopy,serrated polyp detection rate,and procedural time.RESULTS A total of 244 patients were enrolled(124 with CADe),with similar patient characteristics(age,sex,body mass index,indication)between the two groups.Use of CADe was found to have decreased number of adenomas(1.79 vs 2.53,P=0.030)per colonoscopy compared to without CADe.There was no significant difference in number of serrated polyps or non-adenomatous non-serrated polyps per colonoscopy between the two groups.Overall,use of CADe was found to have lower ADR(68.5%vs 80.0%,P=0.041)compared to without use of CADe.Serrated polyp detection rate was lower with CADe(3.2%vs 7.5%)compared to without CADe,but this was not statistically significant(P=0.137).There was no significant difference in withdrawal and procedure times between the two groups or in detection of adenomas per extraction(71.4%vs 73.1%,P=0.613).No adverse events were identified.CONCLUSION While several randomized controlled trials have demonstrated improved ADR and APC with use of CADe,in this RCT performed at a center with high ADR,use of CADe was found to have decreased APC and ADR.Further studies are needed to understand the true impact of CADe on performance quality among endoscopists as well as determine criteria for endoscopists to consider when choosing to adopt CADe in their practices.
基金supported by the Grant PID2020-120249RB-I00PID2023-148404OB-100funded by MCIN/AEI/10.13039/501100011033+4 种基金by the Andalusian Government(Junta de Andalucía,Plan Andaluz de Investigación,ref.P20_00124)by the Erasmus+Sport Programme of the European Union within the project FitBack4Literacy(No.101089829)Additional support is provided by the University of Granada,Plan Propio de Inves-tigación,Units of ExcellenceUnit of Excellence on Exercise,Nutrition and Health(UCEENS)by theCIBERobn Physiopa-thology of Obesity and Nutrition,and by the Spanish Network in Exercise and Health,EXERNET Network(RED2022-134800-Tand EXP_99828).
文摘Background:Physicalfitness in childhood and adolescence is associated with a variety of health outcomes and is a powerful marker of current and future health.However,inconsistencies in tests and protocols limit international monitoring and surveillance.The objective of the study was to seek international consensus on a proposed,evidence-informed,Youth Fitness International Test(YFIT)battery and protocols for health monitoring and surveillance in children and adolescents aged 618 years.Methods:We conducted an international modified Delphi study to evaluate the level of agreement with a proposed,evidence-based,YFIT of core health-relatedfitness tests and protocols to be used worldwide in 6-to 18-year-olds.This proposal was based on previous European and North American projects that systematically reviewed the existing evidence to identify the most valid,reliable,health-related,safe,and feasiblefitness tests to be used in children and adolescents aged 618 years.We designed a single-panel modified Delphi study and invited 216 experts from all around the world to answer this Delphi survey,of whom one-third are from low-to-middle income countries and one-third are women.Four experts were involved in the piloting of the survey and did not participate in the main Delphi study to avoid bias.We pre-defined an agreement of 80%among the expert participants to achieve consensus.Results:We obtained a high response rate(78%)with a total of 169fitness experts from 50 countries and territories,including 63 women and 61 experts from low-or middle-income countries/territories.Consensus(>85%agreement)was achieved for all proposed tests and protocols,supporting the YFIT battery,which includes weight and height(to compute body mass index as a proxy of body size/composition),the 20-m shuttle run(cardiorespiratoryfitness),handgrip strength,and standing long jump(muscularfitness).Conclusion:This study contributes to standardizingfitness tests and protocols used for research,monitoring,and surveillance across the world,which will allow for future data pooling and the development of international and regional sex-and age-specific reference values,health-related cut-points,and a global picture offitness among children and adolescents.
文摘Purpose:To assess the association between cardiorespiratory fitness(CRF)and the incidence and mortality from cancer in women,and to evaluate the potential public health implications for cancer prevention.Methods:Maximal exercise testing was performed in a pilot cohort of 184 women(59.3 ± 15.2 years)who were followed for 12.0 ± 6.9 years.Cox hazard models adjusted for established cancer risk factors and accounting for competing events were analyzed for all-type cancer incidence and mortality from cancer.Population-attributable risks and exposure impact number were determined for low CRF(<5 metabolic equivalents(METs))as a risk factor.Results:During the follow-up,11.4% of the participants were diagnosed with cancer and 3.2% died from cancer.CRF was inversely and independently associated with cancer outcomes.For every 1-metabolic equivalent increase in CRF,there was a 20% decrease in the risk of cancer incidence(hazard ratio(HR)= 0.80,95% confidence interval(CI):0.69-0.92;p=0.001)and a 26% reduction in risk of cancer mortality(HR = 0.74,95%CI:0.61-0.90;p=0.002).The population-attributable risks of low CRF were 11.6% and 14% for incidence and mortality of cancer,respectively,and the respective exposure impact numbers were 8 and 20.Conclusion:Greater CRF was independently associated with a lower risk of incidence and mortality from cancer in women.Screening for low CRF as a cancer risk factor and referring unfit individuals to a supervised exercise program could be a public health strategy for cancer prevention in middle-age women.
文摘Background and Study Aims: It has been postulated that chronic radiation proctopathy, clinically manifested by hematochezia and by the appearance of multiple telangiectasias, is caused by ischemia. This theory is based on reports that appeared in the 1980s which described obliterative endarteritis in patients with chronic radiation-induced ulcers. However, bleeding from radiation proctopathy is typically successfully treated endoscopically by widespread tissue coagulation, and the complications that would be expected to occur if the tissue was ischemic, such as poor wound healing, generally do not arise. We therefore hypothesized that the ischemia theory is incorrect and that rectal capillary oxygen saturation is normal in patients with telangiectasias of chronic radiation proctopathy. Patients and Methods: We developed a visible-light spectroscopy device that measures mucosal capillary hemoglobin oxygen saturation during endoscopy (having reported its operating characteristics previously). We prospectively studied 20 patients who had typical findings of multiple rectal telangiectasias, 1-20 years after undergoing external-beam irradiation for prostate or rectal carcinoma. We measured and compared the mucosal capillary oxygen saturations in the affected areas of the distal rectum and in endoscopically normal areas in the rectosigmoid colon. Results: Mucosal oxygenation was normal in all 20 patients in affected areas (64%-80%) and in unaffected areas (63%-75%). The mean mucosal hemoglobin oxygen saturation was actually slightly higher in the affected areas of the rectum than in the uninvolved rectosigmoid colon (73%vs. 69%, P < 0.01). Conclusions: The common form of chronic radiation proctopathy, characterized by multiple telangiectasias without ulcers or strictures, is not associated with ongoing mucosal ischemia. This finding may explain why endoscopic treatment of this disorder, in which large areas of the mucosa are coagulated with argon plasma or other treatment modalities that cause widespread ulceration, does not typically result in complications from poor wound healing.
基金support from National Institutes of Health(NIH)grants 1U54AG089334-01,R01 HL158714,R01 HL087118,R01 HL138473,and R01 HL122887support from the National Institute on Aging(NIA)fellowship under Resource Centers for Minority Aging Research grant P30 AG059307+2 种基金support from the Leona M.and Harry B.Helmsley Charitable Trust(grant no.G-2004-03820)the Innovative Medicines Accelerator(grant no.IMA-1051)the RAMBAM-Stanford International Collaboration grant at Stanford University.
文摘Pulmonary arterial hypertension(PAH)is a devastating disease characterized by perivascular inflammation,immune dysregulation,and vascular remodeling.Recent studies have unveiled a potential link between the gut microbiome and PAH pathogenesis,suggesting that microbial dysbiosis and increased intestinal permeability may contribute to the inflammatory pathology in PAH and ultimately disease progression.This perspective highlights the emerging evidence of the role of leaky gut in PAH,the interplay between microbiota-induced immune responses,and the activation of endogenous retroviruses like human endogenous retrovirus K.Understanding these complex interactions opens new interdisciplinary avenues for research and therapeutic interventions,potentially transforming PAH management through microbiome-targeted strategies.
基金partially supported by an investigator-initiated research grant(IN-US-334-4309)from Gilead Sciences to Stanford University.
文摘Background and Aims:As practice patterns and hepatitis C virus(HCV)genotypes(GT)vary geographically,a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal.This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs,focusing on GT3 and GT6.Methods:We analyzed the sustained virological response(SVR12)of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific,North America,and Europe between 07/01/2014–07/01/2021.Results:The mean age was 62±13 years,with 49.6%male.The demographic breakdown was 91.1%Asian(52.9%Japanese,25.7%Chinese/Taiwan residents,5.4%Korean,3.3%Malaysian,and 2.9%Vietnamese),6.4%White,1.3%Hispanic/Latino,and 1%Black/African-American.Additionally,34.8%had cirrhosis,8.6%had hepatocellular carcinoma(HCC),and 24.9%were treatment-experienced(20.7%with interferon,4.3%with direct-acting antivirals).The largest group was GT1(10,246[64.6%]),followed by GT2(3,686[23.2%]),GT3(1,151[7.2%]),GT6(457[2.8%]),GT4(47[0.3%]),GT5(1[0.006%]),and untyped GTs(261[1.6%]).The overall SVR12 was 96.9%,with rates over 95%for GT1/2/3/6 but 91.5%for GT4.SVR12 for GT3 was 95.1%overall,98.2%for GT3a,and 94.0%for GT3b.SVR12 was 98.3%overall for GT6,lower for patients with cirrhosis and treatment-experienced(TE)(93.8%)but≥97.5%for tretment-naive patients regardless of cirrhosis status.On multivariable analysis,advanced age,prior treatment failure,cirrhosis,active HCC,and GT3/4 were independent predictors of lower SVR12,while being Asian was a significant predictor of achieving SVR12.Conclusions:In this diverse multinational realworld cohort of patients with various GTs,the overall cure rate was 96.9%,despite large numbers of patients with cirrhosis,HCC,TE,and GT3/6.SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent(>91%).
