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This meta-analysis and systematic review examines the use of computer-aided detection (CADe) systems during colonoscopy in the context of colorectal cancer (CRC) screening programs based on the fecal immunochemical test (FIT). The study found that the implementation of CADe systems resulted in increased detection rates of adenomas, advanced adenomas, and serrated lesions in FIT+ patients. However, there was also a higher rate of unnecessary removal of non-neoplastic polyps. The level of heterogeneity in the results was associated with variability in colonoscopy quality performances. [Extracted from the article]

Background: The resect-and-discard strategy allows endoscopists to replace post-polypectomy pathology with real-time prediction of polyp histology during colonoscopy (optical diagnosis). We aimed to investigate the benefits and harms of implementing computer-aided diagnosis (CADx) for polyp pathology into the resect-and-discard strategy., Methods: In this systematic review and meta-analysis, we searched MEDLINE, Embase, and Scopus from database inception to June 5, 2024, without language restrictions, for diagnostic accuracy studies that assessed the performance of real-time CADx systems, compared with histology, for the optical diagnosis of diminutive polyps (≤5 mm) in the entire colon. We synthesised data for three strategies: CADx-alone, CADx-unassisted, and CADx-assisted; when the endoscopist was involved in the optical diagnosis, we synthesised data exclusively from diagnoses for which confidence in the prediction was reported as high. The primary outcomes were the proportion of polyps that would have avoided pathological assessment (ie, the proportion optically diagnosed with high confidence; main benefit) and the proportion of polyps incorrectly predicted due to false positives and false negatives (main harm), directly compared between CADx-assisted and CADx-unassisted strategies. We used DerSimonian and Laird's random-effects model to calculate all outcomes. We used Higgins I 2 to assess heterogeneity, the Grading of Recommendations, Assessment, Development, and Evaluation approach to rate certainty, and funnel plots and Egger's test to examine publication bias. This study is registered with PROSPERO, CRD42024508440., Findings: We found 1019 studies, of which 11 (7400 diminutive polyps, 3769 patients, and 185 endoscopists) were included in the final meta-analysis. Three studies (1817 patients and 4086 polyps [2148 neoplastic and 1938 non-neoplastic]) provided data to directly compare the primary outcome measures between the CADx-unassisted and CADx-assisted strategies. We found no significant difference between the CADx-assisted and CADx-unassisted strategies for the proportion of polyps that would have avoided pathological assessment (90% [88-93], 3653 [89·4%] of 4086 polyps diagnosed with high confidence vs 90% [95% CI 85-94], 3588 [87·8%] of 4086 polyps diagnosed with high confidence; risk ratio 1·01 [95% CI 0·99-1·04; I 2 =53·49%; low-certainty evidence; Egger's test p=0·18). The proportion of incorrectly predicted polyps was lower with the CADx-assisted strategy than with the CADx-unassisted strategy (12% [95% CI 7-17], 523 [14·3%] of 3653 polyps incorrectly predicted with a CADx-assisted strategy vs 13% [6-20], 582 [16·2%] of 3588 polyps incorrectly diagnosed with a CADx-unassisted strategy; risk ratio 0·88 [95% CI 0·79-0·98]; I 2 =0·00%; low-certainty evidence; Egger's test p=0·18)., Interpretation: CADx did not produce benefit nor harm for the resect-and-discard strategy, questioning its value in clinical practice. Improving the accuracy and explainability of CADx is desired., Funding: European Commission (Horizon Europe), the Japan Society of Promotion of Science, and Associazione Italiana per la Ricerca sul Cancro., Competing Interests: Declaration of interests CHas reports consultancy fees from Fujifilm and Medtronic. YM reports consultancy fees, speaking honoraria, and equipment loan from Olympus, and license fee for the co-developed artificial intelligence medical devices from Cybernet System (in the field of colonoscopy, one of which has been included in the analysis in this Article). AR reports consultancy fees from Fujifilm, Olympus, and Medtronic. DvR reports research grants from Fujifilm, Eberhard & Robert Bosch Elektronik (ERBE), and Boston Scientific; speaker fees from Fujifilm, ERBE, Boston Scientific, and Medtronic; support for attending meetings from Fujifilm and ERBE, and endoscopy device loan from Fujifilm and ERBE. ER reports speaking honoraria from Fujifilm; consultancy fees from Medtronic; and speaker fees from Fujifilm. OP reports speaker fees from Medtronic, Boston Scientific, AbbVie, Falk, Luvos, and Olympus. ED reports consulting fees from Olympus, Fujifilm, Ambu, InterVenn, Norgine, and Exact Science; speaker fees from Olympus, GI Supply, Norgine, IPSEN-Mayoly, and Fujifilm; and endoscopy device loan from Fujifilm. POV reports research grant from European Comission (Horizon Europe 101057099). PS reports research grants from ERBE, Fujifilm, Nippon Electric Company, and Sebela; and consulting fees from Olympus, Boston Scientific, Salix Pharmaceuticals, Cipla, Medtronic, Takeda, Samsung Bioepis, and CDx. DKR reports research grants from Olympus, Sebela Pharmaceuticals, and ERBE; consulting fees from Olympus, Sebela Pharmaceuticals, Boston Scientific, and Laborie Medical; speaker fees from Boston Scientific, Laborie Medical, and Medtronic; and ownership of stock in Satisfai Health. PB reports research grants from NEC-Europe, Boston Scientific, and 3-D matrix and consulting fees from Fujifilm. GA reports research grants from the European Society of Gastrointestinal Endoscopy, consulting fees from Medtronic and Cosmo IMD, and speaker fees from Medtronic. JWL reports speaker fees from Olympus and Fujifilm. MMe reports license fee for the co-developed artificial intelligence medical devices from Cybernet System (in the field of colonoscopy, one of which has been included in the analysis in this Article) and consulting fees and speaker fees from Olympus. S-eK reports license fees for the co-developed artificial intelligence medical devices from Cybernet System (in the field of colonoscopy, one of which has been included in the analysis in this Article) and speaker fees from Olympus. RM reports research grants from ERBE, Fujifilm, Olympus, Pentax, and Boston Scientific. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Active play allows children to develop social and cognitive skills, which could lead to higher school engagement. Little is known about the role of child socioemotional difficulty in these associations. This study aims to examine the interaction between active play and socioemotional difficulty in childhood and their prospective association with academic engagement in adolescence. The participants were 4537 children (51.1% boys) who were longitudinally followed, between ages 6 and 14 years, from the National Longitudinal Study on Children and Youth (NLSCY), Canada. Active play (weekly organized sport and unstructured physical activity outside of school hours) and child behavior (hyperactivity, anxiety, and relational difficulties) were reported by mothers for their children at age 6 years. Academic engagement was self-reported at age 14 years. Unstructured physical activity predicted lower subsequent school engagement for boys (β = -0.057, p < 0.05). Boys with high anxiety symptoms and high relational aggression who participated in more unstructured physical activity in childhood were subsequently less engaged in school (respectively, β = -0.066, p < 0.05 and β = -0.062, p < 0.05). Girls who partook in more organized sports showed lower school engagement in adolescence when they had high anxiety symptoms (β = -0.067, p < 0.05). Although past studies have highlighted the contribution of active play to school engagement, certain socioemotional difficulties could impede the child's ability to reap its benefits.

Background/Objectives: conducting fitness tests in educational settings can lead to advantages for both individuals and groups, beyond just enhancing fitness. With the aim of appropriately interpreting performance, this study was conducted to establish sex- and age-specific percentile normative data for a physical fitness (PF) protocol and to define a compound measure of physical performance. Methods: In this cross-sectional study, a short, feasible, and easy-to-administer test battery was performed for 5106 school children, aged 6-10 years. Gender- and age-specific percentiles for the PF tests were constructed, and a Physical Fitness-Motor Competence Performance Index (PF-MC PI) was calculated according to the percentiles. Results: Boys scored higher in all the PF tests when compared to girls ( p < 0.001). There was also a trend towards increased PF levels as the age increased in both genders ( p < 0.0001). Correlations between scores on individual test items were moderate to high (r from 0.549 to 0.700), and all individual test item scores significantly correlated with the PF-MC PI ( p < 0.0001). Conclusions: the provided percentile values will enable the correct interpretation and monitoring of the fitness status of children and the PF-MC PI can be used for easily rating children's health-related fitness qualities.

Introduction: We studied the postural behaviour of a 52-year-old professional mountain climber who underwent bilateral amputation of all five toes after severe frostbite., Methods: Two tasks were examined: static posturography (SP) and gait initiation (GI), both performed barefoot and with prosthetic shoes. During SP, the participant kept the upright stance for 30 s while an optoelectronic system with reflective markers recorded feet position and body sway, and two force plates measured the Center of Pressure (CoP) displacement and Ground Reaction Force (GRF) of each foot. During GI, the participant stood on the force plates for at least 10 s and then spontaneously started walking, while optoelectronic system was used to monitor heel-off events; wireless EMG probes recorded the anticipatory postural adjustments (APAs) in trunk and lower limb muscles., Results: Compared to shod condition, during barefoot SP the participant showed a reduced anteroposterior (AP) and mediolateral (ML) extension of the Base of Support (BoS), and the whole-body CoP shifted about 7 mm more anteriorly, approaching the "safer" geometric center of the BoS. Despite this difference, the AP and ML ranges of CoP oscillations were similar in both conditions. In GI, the trunk dorsal muscles showed different APA patterns: when barefoot they were excitatory in the trailing and inhibitory in the leading side while they were bilaterally inhibitory when shod., Discussion: In parallel to CoP shift toward a "safer" position in SP, in barefoot GI the body rotation toward the trailing side may reveal a more "cautious" approach; this also shows that different postural strategies may be adopted in GI by one and the same individual., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Storniolo, Farinelli, Onesti, Correale, Peyré-Tartaruga, Esposti and Cavallari.)

Background/Objectives : Physical activity is an important protective factor throughout life. However, little research has observed the associations between the practice of physical activity and academic success longitudinally, and none have done so with a pan-Canadian sample. This article aims to examine the prospective associations between active leisure in middle childhood and academic achievement in emerging adulthood, for both boys and girls, beyond several family factors. Methods : Participants are 2775 children from the National Longitudinal Study on Children and Youth (NLSCY) aged between 12 and 20 years. Active leisure was self-reported by children at age 12 years regarding their weekly organized sport, artistic sport, and unstructured physical activity participation outside of school hours. Academic success was measured by self-reported school average at age 18 years and the obtention of high school diploma at age 20 years. Results : Girls who engaged in more organized or artistic sports at age 12 years had better academic results at age 18 years (respectively β = -0.082, p < 0.01; β = -0.228, p < 0.001). Both boys and girls who partook in more organized sports at age 12 years were more likely to graduate from high school by age 20 years (respectively β = -0.146, p < 0.001; β = -0.071, p < 0.05). However, girls who engaged in more unstructured physical activity at age 12 years had lower academic achievement at age 18 years (β = 0.077, p < 0.001). Conclusions : Policy makers should aim to reduce the many barriers to an active lifestyle in childhood. Parents should be encouraged to lead their children to go play outside with friends to allow them to fully reap the benefits of an active lifestyle from a young age.

Background : Stroke-induced immunosuppression (SII) represents a negative rehabilitative prognostic factor associated with poor motor performance at discharge from a neurorehabilitation unit (NRB). This study aims to evaluate the association between SII and gait impairment at NRB admission. Methods : Forty-six stroke patients (65.4 ± 15.8 years, 28 males) and 42 healthy subjects (HS), matched for age, sex, and gait speed, underwent gait analysis using an inertial measurement unit at the lumbar level. Stroke patients were divided into two groups: (i) the SII group was defined using a neutrophil-to-lymphocyte ratio ≥ 5, and (ii) the immunocompetent (IC) group. Harmonic ratio (HR) and short-term largest Lyapunov's exponent (sLLE) were calculated as measures of gait symmetry and stability, respectively. Results : Out of 46 patients, 14 (30.4%) had SII. HR was higher in HS when compared to SII and IC groups ( p < 0.01). HR values were lower in SII when compared to IC subjects ( p < 0.01). sLLE was lower in HS when compared to SII and IC groups in the vertical and medio-lateral planes ( p ≤ 0.01 for all comparisons). sLLE in the medio-lateral plane was higher in SII when compared to IC subjects ( p = 0.04). Conclusions : SII individuals are characterized by a pronounced asymmetric gait and a more impaired dynamic gait stability. Our findings underline the importance of devising tailored rehabilitation programs in patients with SII. Further studies are needed to assess the long-term outcomes and the role of other clinical features on gait pattern.

Understanding the changes in running mechanics caused by fatigue is essential to assess its impact on athletic performance. Changes in running biomechanics after constant speed conditions are well documented, but the adaptive responses after a maximal incremental test are unknown. We compared the spatiotemporal, joint kinematics, elastic mechanism, and external work parameters before and after a maximal incremental treadmill test. Eighteen recreational runners performed 2-minute runs at 8 km·h-1 before and after a maximal incremental test on a treadmill. Kinematics, elastic parameters, and external work were determined using the OpenCap and OpenSim software. We did not find differences in spatiotemporal parameters and elastic parameters (mechanical work, ankle, and knee motion range) between premaximal and postmaximal test conditions. After the maximal test, the runners flexed their hips more at contact time (19.4°-20.6°, P = .013) and presented a larger range of pelvis rotation at the frontal plane (10.3°-11.4°, P = .002). The fatigue applied in the test directly affects pelvic movements; however, it does not change the lower limb motion or the spatiotemporal and mechanical work parameters in recreational runners. A larger frontal plane motion of the pelvis deserves attention due to biomechanical risk factors associated with injuries.

Background: Computer-aided diagnosis (CADx) allows prediction of polyp histology during colonoscopy, which may reduce unnecessary removal of nonneoplastic polyps. However, the potential benefits and harms of CADx are still unclear., Purpose: To quantify the benefit and harm of using CADx in colonoscopy for the optical diagnosis of small (≤5-mm) rectosigmoid polyps., Data Sources: Medline, Embase, and Scopus were searched for articles published before 22 December 2023., Study Selection: Histologically verified diagnostic accuracy studies that evaluated the real-time performance of physicians in predicting neoplastic change of small rectosigmoid polyps without or with CADx assistance during colonoscopy., Data Extraction: The clinical benefit and harm were estimated on the basis of accuracy values of the endoscopist before and after CADx assistance. The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. The outcome measure for benefit was the proportion of polyps predicted to be nonneoplastic that would avoid removal with the use of CADx. The outcome measure for harm was the proportion of neoplastic polyps that would be not resected and left in situ due to an incorrect diagnosis with the use of CADx. Histology served as the reference standard for both outcomes., Data Synthesis: Ten studies, including 3620 patients with 4103 small rectosigmoid polyps, were analyzed. The studies that assessed the performance of CADx alone (9 studies; 3237 polyps) showed a sensitivity of 87.3% (95% CI, 79.2% to 92.5%) and specificity of 88.9% (CI, 81.7% to 93.5%) in predicting neoplastic change. In the studies that compared histology prediction performance before versus after CADx assistance (4 studies; 2503 polyps), there was no difference in the proportion of polyps predicted to be nonneoplastic that would avoid removal (55.4% vs. 58.4%; risk ratio [RR], 1.06 [CI, 0.96 to 1.17]; moderate-certainty evidence) or in the proportion of neoplastic polyps that would be erroneously left in situ (8.2% vs. 7.5%; RR, 0.95 [CI, 0.69 to 1.33]; moderate-certainty evidence)., Limitation: The application of optical diagnosis was only simulated, potentially altering the decision-making process of the operator., Conclusion: Computer-aided diagnosis provided no incremental benefit or harm in the management of small rectosigmoid polyps during colonoscopy., Primary Funding Source: European Commission. (PROSPERO: CRD42023402197)., Competing Interests: Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2865.

Background and study aims Artificial Intelligence (AI) systems could make the optical diagnosis (OD) of diminutive colorectal polyps (DCPs) more reliable and objective. This study was aimed at prospectively evaluating feasibility and diagnostic performance of AI-standalone and AI-assisted OD of DCPs in a real-life setting by using a white light-based system (GI Genius, Medtronic Co, Minneapolis, Minnesota, United States). Patients and methods Consecutive colonoscopy outpatients with at least one DCP were evaluated by 11 endoscopists (5 experts and 6 non-experts in OD). DCPs were classified in real time by AI (AI-standalone OD) and by the endoscopist with the assistance of AI (AI-assisted OD), with histopathology as the reference standard. Results Of the 480 DCPs, AI provided the outcome "adenoma" or "non-adenoma" in 81.4% (95% confidence interval [CI]: 77.5-84.6). Sensitivity, specificity, positive and negative predictive value, and accuracy of AI-standalone OD were 97.0% (95% CI 94.0-98.6), 38.1% (95% CI 28.9-48.1), 80.1% (95% CI 75.2-84.2), 83.3% (95% CI 69.2-92.0), and 80.5% (95% CI 68.7-82.8%), respectively. Compared with AI-standalone, the specificity of AI-assisted OD was significantly higher (58.9%, 95% CI 49.7-67.5) and a trend toward an increase was observed for other diagnostic performance measures. Overall accuracy and negative predictive value of AI-assisted OD for experts and non-experts were 85.8% (95% CI 80.0-90.4) vs. 80.1% (95% CI 73.6-85.6) and 89.1% (95% CI 75.6-95.9) vs. 80.0% (95% CI 63.9-90.4), respectively. Conclusions Standalone AI is able to provide an OD of adenoma/non-adenoma in more than 80% of DCPs, with a high sensitivity but low specificity. The human-machine interaction improved diagnostic performance, especially when experts were involved., Competing Interests: Conflict of Interest Paggi S and Amato A: speaker honoraria from Fujifilm Co. Rondonotti E: speaker honoraria from Fujifilm Co., Medtronic Co. consultancy. Radaelli F: Speaker honoraria from Fujifilm Co; research grant from Fujifilm Co; endoscopy equipment loan from Medtronic Co. Hassan C: Medtronic Co, Fujifilm Co and Odin Co. consultancy. All the other authors declare no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Rating of perceived exertion (RPE) is considered a valid method for prescribing prolonged aerobic steady-state exercise (SSE) intensity due to its association with physiological indicators of exercise intensity, such as oxygen uptake (V̇O 2 ) or heart rate (HR). However, these associations between psychological and physiological indicators of exercise intensity were found during graded exercise tests (GXT) but are currently used to prescribe SSE intensity even though the transferability and validity of the relationships found during GXT to SSE were not investigated. The present study aims to verify whether (a) RPE-HR or RPE-V̇O 2 relations found during GXTs are valid during SSEs, and (b) the duration and intensity of SSE affect these relations., Methods: Eight healthy and physically active males (age 22.6 ± 1.2 years) were enrolled. On the first visit, pre-exercise (during 20 min standing) and maximal (during a GXT) HR and V̇O 2 values were measured. Then, on separate days, participants performed 4 SSEs on the treadmill by running at 60% and 80% of the HR reserve (HRR) for 15 and 45 min (random order). Individual linear regressions between GXTs' RPE (dependent variable) and HRR and V̇O 2 reserve (V̇O 2 R) values (computed as the difference between maximal and pre-exercise values) were used to predict the RPE associated with %HRR (RPE HRR ) and %V̇O 2 R (RPE V̇O2R ) during the SSEs. For each relation (RPE-%HRR and RPE-%V̇O 2 R), a three-way factorial repeated measures ANOVA ( α  = 0.05) was used to assess if RPE (dependent variable) was affected by exercise modality ( i.e. , RPE recorded during SSE [RPE SSE ] or GXT-predicted), duration ( i.e. , 15 or 45 min), and intensity ( i.e. , 60% or 80% of HRR)., Results: The differences between RPE SSE and GXT-predicted RPE, which were assessed by evaluating the effect of modality and its interactions with SSE intensity and duration , showed no significant differences between RPE SSE and RPE HRR . However, when RPE SSE was compared with RPE V̇O2R , although modality or its interactions with intensity were not significant, there was a significant ( p  = 0.020) interaction effect of modality and duration yielding a dissociation between changes of RPE SSE and RPE V̇O2R over time. Indeed, RPE SSE did not change significantly ( p  = 0.054) from SSE of 15 min (12.1 ± 2.0) to SSE of 45 min (13.5 ± 2.1), with a mean change of 1.4 ± 1.8, whereas RPE V̇O2R decreased significantly ( p  = 0.022) from SSE of 15 min (13.7 ± 3.2) to SSE of 45 min (12.4 ± 2.8), with a mean change of -1.3 ± 1.5., Conclusion: The transferability of the individual relationships between RPE and physiological parameters found during GXT to SSE should not be assumed as shown by the results of this study. Therefore, future studies modelling how the exercise prescription method used (e.g., RPE, HR, or V̇O 2 ) and SSE characteristics ( e.g. , exercise intensity, duration, or modality) affect the relationships between RPE and physiological parameters are warranted., Competing Interests: Carlo Ferri Marini, Matteo Vandoni, and Luca Correale are Academic Editors for PeerJ. Luca Zoffoli is employed by Technogym S.p.A., Cesena, FC, Italy., (©2024 Ferri Marini et al.)

Stroke affects the interconnection between the nervous and immune systems, leading to a down-regulation of immunity called stroke-induced immunosuppression (SII). The primary aim of this study is to investigate SII role as a predictor of functional, neurological, and motor outcomes in the neurorehabilitation setting (NRB). We conducted a prospective observational study enrolling post-acute stroke patients hospitalized for neurorehabilitation. At NRB admission (T 0 ) and discharge (T 1 ), we assessed presence of SII (defined by a neutrophil-to-lymphocyte ratio ≥ 5) and we evaluated functional independence (Functional Independence Measure-FIM, Barthel Index-BI), motor performances (Tinetti Score, Hauser Ambulation Index) and neurological impairment (NIHSS). We enrolled 96 patients (45.8% females, 70.6 ± 13.9 years, 88.5% ischemic stroke). At T 0 , 15.6% of patients (15/96) had SII. When compared to immunocompetent patients (IC), the SII group was characterized by worse baseline functional independence, motor performances and neurological disability. The same was confirmed at T 1 (FIM p = 0.012, BI p = 0.007, Tinetti p = 0.034, NIHSS p = 0.001). Neurological disability demonstrated a less pronounced improvement in SII (ΔNIHSS: SII: - 2.1 ± 2.3 vs. IC: - 3.1 ± 2.5, p = 0.035). SII group presented a higher percentage of infectious complications during the neurorehabilitation period (SII 80% vs. IC 25.9%; p = 0.001). SII may represent a negative prognostic factor in the neurorehabilitation setting. SII patients were characterized by poorer functional, motor, neurological performances and higher risk of infectious complications. ClinicaTrial registration: NCT05889169., (© 2024. The Author(s).)

Aim: The analyses here reported aim to compare the screening performance of digital tomosynthesis (DBT) versus mammography (DM)., Methods: MAITA is a consortium of four Italian trials, REtomo, Proteus, Impeto, and MAITA trial. The trials adopted a two-arm randomised design comparing DBT plus DM (REtomo and Proteus) or synthetic-2D (Impeto and MAITA trial) versus DM; multiple vendors were included. Women aged 45 to 69 years were individually randomised to one round of DBT or DM., Findings: From March 2014 to February 2022, 50,856 and 63,295 women were randomised to the DBT and DM arm, respectively. In the DBT arm, 6656 women were screened with DBT plus synthetic-2D. Recall was higher in the DBT arm (5·84% versus 4·96%), with differences between centres. With DBT, 0·8/1000 (95% CI 0·3 to 1·3) more women received surgical treatment for a benign lesion. The detection rate was 51% higher with DBT, ie. 2·6/1000 (95% CI 1·7 to 3·6) more cancers detected, with a similar relative increase for invasive cancers and ductal carcinoma in situ. The results were similar below and over the age of 50, at first and subsequent rounds, and with DBT plus DM and DBT plus synthetic-2D. No learning curve was appreciable. Detection of cancers >= 20 mm, with 2 or more positive lymph nodes, grade III, HER2-positive, or triple-negative was similar in the two arms., Interpretation: Results from MAITA confirm that DBT is superior to DM for the detection of cancers, with a possible increase in recall rate. DBT performance in screening should be assessed locally while waiting for long-term follow-up results on the impact of advanced cancer incidence., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Paolo Giorgi Rossi reports financial support was provided by Italian Ministry of Health. Pierpaolo Pattacini reports was provided by Emilia-Romagna Regional Health Authority. Antonio Ponti reports financial support was provided by Piedmont Region (Department of Health). Antonio Ponti reports financial support was provided by foundation Edo Tempia (a non-profit organisation). Antonio Ponti reports equipment, drugs, or supplies was provided by Regional Consortium for Informative Systems (CSI). Antonio Ponti reports financial support was provided by University of Turin. Paola Mantellini reports financial support was provided by Tuscany Region. Pierpaolo Pattacini reports equipment, drugs, or supplies and travel were provided by GE Healthcare. Antonio Ponti reports equipment, drugs, or supplies was provided by im3D S.p.A Torino. Stephen Duffy has received indirect funding in the past from Hologic Inc. Valentina Iotti, Andrea Nitrosi reports travel was provided by GE Healthcare. Pierpaolo Pattacini, Valentina Iotti, Andrea Nitrosi, Francesco Sardanelli reports a relationship with GE Healthcare that includes: speaking and lecture fees. Valentina Iotti reports a relationship with Bayer that includes: speaking and lecture fees. Paolo Giorgi Rossi, Livia Giordano, Stephen Duffy, and Francesco Sardanelli are members of the European Commission Initiative on Breast Cancer working groups. They contributed to the development of new breast cancer screening recommendations and quality assurance scheme. Livia Giordano is past president of the Gruppo Italiano Screening Mammografico, the Italian scientific society on breast cancer screening. All remaining authors have declared no conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The maximal running speed (V MAX ) determined on a graded treadmill test is well-recognized as a running performance predictor. However, few studies have assessed the variables that predict V MAX in recreationally active runners., Methods: We used a mathematical procedure combining Fick's law and metabolic cost analysis to verify the relation between (1) V MAX versus anthropometric and physiological determinants of running performance and, (2) theoretical metabolic cost versus running biomechanical parameters. Linear multiple regression and bivariate correlation were applied. We aimed to verify the biomechanical, physiological, and anthropometrical determinants of V MAX in recreationally active runners. Fifteen recreationally active runners participated in this observational study. A Conconi and a stead-steady running test were applied using a heart rate monitor and a simple video camera to register the physiological and mechanical variables, respectively., Results: Statistical analysis revealed that the speed at the second ventilatory threshold, theoretical metabolic cost, and fat-mass percentage confidently estimated the individual running performance as follows: V MAX = 58.632 + (-0.183 * fat percentage) + (-0.507 * heart rate percentage at second ventilatory threshold) + (7.959 * theoretical metabolic cost) (R 2 = 0.62, p = 0.011, RMSE = 1.50 km.h -1 ). Likewise, the theoretical metabolic cost was significantly explained (R 2 = 0.91, p = 0.004, RMSE = 0.013 a.u.) by the running spatiotemporal and elastic-related parameters (contact and aerial times, stride length and frequency, and vertical oscillation) as follows: theoretical metabolic cost = 10.421 + (4.282 * contact time) + (-3.795 * aerial time) + (-2.422 * stride length) + (-1.711 * stride frequency) + (0.107 * vertical oscillation)., Conclusion: Critical determinants of elastic mechanism, such as maximal vertical force and vertical and leg stiffness were unrelated to the metabolic economy. V MAX , a valuable marker of running performance, and its physiological and biomechanical determinants can be effectively evaluated using a heart rate monitor, treadmill, and a digital camera, which can be used in the design of training programs to recreationally active runners., Competing Interests: Leonardo A. Peyré-Tartaruga and Cosme F. Buzzachera are Academic Editors for PeerJ. The remaining authors declare that they have no competing interests., (© 2024 Peyré-Tartaruga et al.)