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Introduction: Despite the importance of sports bras for comfort during exercise in people with breasts, concerns persist regarding their potential effects on athletic performance. Discrepancies in previous studies necessitate a closer examination of the interaction between sports bras, breast volume, exertional symptoms, and exercise performance. Methods: Twenty-three recreationally-active, normal bodyweight females completed three 10-km time-trials on a cycle ergometer on three separate occasions in a randomized order, while wearing a professionally fitted highsupport sports bra, a professionally fitted low-support sports bralette, or a personal, self-selected sports bra. Performance was quantified as the time to complete the 10-km distance. Cardiorespiratory and symptom responses were measured throughout. Results: Participants were grouped by their estimated breast volumes (small: mean ± SD 284 ± 38 ml, median bra size: 32C; large: 560 ± 97 ml, 34DD; p = 0.002, g = 3.84). The average time-trial duration was 23.1 ± 3.1 min and comparable across breast volume groups and sports bra conditions (betweengroup: p = 0.794, ηp 2 < 0.01; between-bras: p = 0.273, ηp 2 < 0.01). Notably, larger-breasted participants experienced stronger symptoms of chest tightness (p = 0.042, ηp 2 = 0.18), which were associated with their ratings of perceived exertion and breathlessness (intensity and unpleasantness). Irrespective of breast volume, the high-support sports bra also evoked stronger symptoms of chest tightness (p = 0.039, ηp 2 = 0.15). Discussion: Stronger symptoms of chest tightness associated with larger breast volumes or high-support sports bras do not impede performance during selfpaced non-weight-bearing exercise in recreationally-active females. [ABSTRACT FROM AUTHOR]

Reference equations for fat-free mass (FFM) and lean soft tissue mass (LM) measures obtained from dual-energy X-ray absorptiometry (DEXA) are important for the interpretation of body composition. This study developed and validated reference equations for FFM and LM using DEXA from the Canadian Longitudinal Study on Aging. Reference equations were developed using data from a random population-based sample of ostensibly healthy and functionally independent adults aged 45–85 years. Reference equations for absolute (accounting for age, sex, height, and body mass) and height-adjusted aka index (accounting for age, sex, and body mass index) measures of FFM and LM were developed using quantile regression. Reference equations were respectively developed and validated in derivation (80%) and validation cohorts (20%). Reference equations were applied to symptomatic adults with self-reported chronic obstructive pulmonary disease (COPD) or heart disease to assess discriminant validity; and compared with other published equations to assess performance. Bland-Altman analyses and Lin's concordance correlation coefficients were utilised to assess agreement. Reference equations for 5th, 10th, 50th, 90th, and 95th percentiles were developed for DEXA-derived estimates of FFM and LM based on 1881 healthy participants (57% male) aged 55 [IQR: 50–61] years. Reference equations performed comparably in the validation cohort and discriminated reference values between ostensibly healthy adults and people with symptomatic COPD or heart disease. Previously published reference equations tended to over- or under-predict estimates of LM compared with the current reference equations. This study provides a comprehensive and validated set of reference equations for estimating and interpreting FFM and LM from DEXA in Canadian adults aged 45–85 years, although additional validation may be required for those >75 years. [ABSTRACT FROM AUTHOR]

Pulmonary arterial hypertension affects females more frequently than males, and there are known sex‐related differences in the lungs. However, normal sex‐related differences in pulmonary vascular structure remain incompletely described. We aimed to contrast computed tomography‐derived pulmonary vascular volume and its distribution within the lungs of healthy adult females and males. From the CanCOLD Study, we retrospectively identified healthy never‐smokers. We analyzed full‐inspiration computed tomography images, using vessel and airway segmentation to generate pulmonary vessel volume, vessel counts, and airway counts. Vessels were classified by cross‐sectional area >10, 5–10, and <5 mm2 into bins, with volume summed within each area bin and in total. We included 46 females and 36 males (62 ± 9 years old). Females had lower total lung volume, total airway counts, total vessel counts, and total vessel volume (117 ± 31 vs. 164 ± 28 mL) versus males (all p < 0.001). Females also had lower vessel volume >10 mm2 (14 ± 8 vs. 27 ± 9 mL), vessel volume 5–10 mm2 (35 ± 11 vs. 55 ± 10 mL), and vessel volume <5 mm2 (68 ± 18 vs. 82 ± 19 mL) (all p < 0.001). Normalized to total vessel volume, vessel volume >10 mm2 (11 ± 4 vs. 16 ± 4%, p < 0.001) and 5–10 mm2 (30 ± 6 vs. 34 ± 5%, p = 0.001) remained lower in females but vessel volume <5 mm2 relative to total volume was 18% higher (59 ± 8 vs. 50 ± 7%, p < 0.001). Among healthy older adults, pulmonary vessel volume is distributed into smaller vessels in females versus males. [ABSTRACT FROM AUTHOR]

Exertional breathlessness is a cardinal symptom of cardiorespiratory disease. How does breathlessness abnormality, graded using normative reference equations during cardiopulmonary exercise testing (CPET), relate to self-reported and physiologic responses in people with chronic airflow limitation (CAL)? An analysis was done of people aged ≥ 40 years with CAL undergoing CPET in the Canadian Cohort Obstructive Lung Disease study. Breathlessness intensity ratings (Borg CR10 scale [0-10 category-ratio scale for breathlessness intensity rating]) were evaluated in relation to power output, rate of oxygen uptake, and minute ventilation at peak exercise, using normative reference equations as follows: (1) probability of breathlessness normality (probability of having an equal or greater Borg CR10 rating among healthy people; lower probability reflecting more severe breathlessness) and (2) presence of abnormal breathlessness (rating above the upper limit of normal). Associations with relevant participant-reported and physiologic outcomes were evaluated. We included 330 participants (44% women): mean ± SD age, 64 ± 10 years (range, 40–89 years); FEV 1 /FVC, 57.3% ± 8.2%; FEV 1 , 75.6% ± 17.9% predicted. Abnormally low exercise capacity (peak rate of oxygen uptake < lower limit of normal) was present in 26%. Relative to peak power output, rate of oxygen uptake, and minute ventilation, abnormally high breathlessness was present in 26%, 25%, and 18% of participants. For all equations, abnormally high exertional breathlessness was associated with worse lung function, exercise capacity, self-reported symptom burden, physical activity, and health-related quality of life; and greater physiologic abnormalities during CPET. Abnormal breathlessness graded using CPET normative reference equations was associated with worse clinical, physiological, and functional outcomes in people with CAL, supporting construct validity of abnormal exertional breathlessness. [ABSTRACT FROM AUTHOR]

Purpose: This study assessed the individual and combined effects of sports bras and breast volume on pulmonary system and respiratory symptom responses to exercise in recreationally-active females., Methods: Twenty-three healthy females (18-27 y; bra sizes 32B-36DDD) were divided into small and large breast volume groups (SBV and LBV, respectively) around median volume (324 ml; mean ± SD SBV: 284 ± 38 ml vs. LBV: 560 ± 97 ml; p < 0.001, g = 3.84). Participants completed three 5-minute bouts of constant-load cycle exercise at 30, 60, and 90% of their peak power output while wearing a high-support sports bra, low-support sports bralette, or their own (self-selected) sports bra in randomized order. Measurements included ventilation, breathing pattern, respiratory pressures, diaphragm electromyogram (EMGdi), and ratings of perceived exertion (RPE), breathlessness (intensity and unpleasantness) and chest tightness due to bra., Results: Compared to low-support and personal sports bras, the high-support sports bra evoked stronger sensations of restricted breathing and chest tightness ('slight' to 'moderate' restriction in n = 7 [30%] vs. n = 1 [4%] in low-support and personal bras; p = 0.014). There was, however, no evidence of greater concomitant inspiratory constraints, EMGdi, or inspiratory muscle pressure generation in either bra (all p > 0.05). Notably, LBV compared to SBV participants reported greater RPE (p = 0.037, ηp2 = 0.20), breathlessness intensity (p = 0.039, ηp2 = 0.20) and unpleasantness (p = 0.041; ηp2 = 0.19), which, in the setting of comparable pulmonary system responses to exercise, was likely driven by stronger perceived chest tightness and/or bra awareness in LBV participants., Conclusions: Despite evoking mild-to-moderately severe chest tightness due to bra during exercise - correctly fitted sports bras, whether low- or high-support, do not impose a physiological burden to the respiratory system and its response to mild-to-heavy intensity exercise in otherwise healthy females., Competing Interests: Conflict of Interest and Funding Source: C. I. is supported by an Accelerate postdoctoral fellowship from the Mathematics of Information Technology and Complex System (MITACS, award #IT28775) with partner organization Lululemon athletica inc., Vancouver, British Columbia, CA. D. J. holds a Canada Research Chair, Tier II, in Clinical Exercise & Respiratory Physiology from the Canadian Institutes of Health Research., (Copyright © 2024 by the American College of Sports Medicine.)

Introduction: The natural history of patients with well-documented presumptive diverticular hemorrhage (TICH) is unknown. Our aims are to report (i) rebleeding rates and clinical outcomes of presumptive TICH patients with and without rebleeding, (ii) conversion to definitive TICH during long-term follow-up (F/U), and (iii) risk factors of presumptive diverticular (TIC) rebleeding., Methods: This was a retrospective cohort study of prospectively collected results of presumptive TICH patients from 1994 to 2023. Presumptive TICH was diagnosed for patients with TICs without stigmata of recent hemorrhage and no other cause of bleeding found on anoscopy, enteroscopy, capsule endoscopy, computed tomography angiography, or tagged red blood cell scan. Patients with ≤6 months of F/U were excluded., Results: Of 139 patients with presumptive TICH, 104 were male and 35 female. The median age was 76 years. There were no significant differences in baseline demographics of rebleeders and non-rebleeders. During long-term median F/U of 73 months, 24.5% (34/139) rebled. A total of 56% (19/34) of rebleeders were diagnosed as definitive TICH, and they had significantly higher rates of readmission ( P < 0.001), reintervention ( P < 0.001), and surgery ( P < 0.001). During F/U, there were significantly higher rates of newly diagnosed hypertension and/or atherosclerotic cardiovascular disease in rebleeders ( P = 0.033 from a logistic model). All-cause mortality was 42.8%, but none was from TICH., Discussion: For presumptive TICH during long-term F/U, (i) 75.5% did not rebleed and 24.5% rebled. (ii) 56% of rebleeders were diagnosed as definitive TICH. (iii) New development of hypertension and atherosclerotic cardiovascular disease were risk factors of TIC rebleeding., (Copyright © 2024 by The American College of Gastroenterology.)

Background & Aims: Non-selective β-blockers (NSBBs) and endoscopic variceal-ligation (EVL) have similar efficacy preventing first variceal bleeding. Compensated and decompensated cirrhosis are markedly different stages, which may impact treatment outcomes. We aimed to assess the efficacy of NSBBs vs EVL on survival in patients with high-risk varices without previous bleeding, stratifying risk according to compensated/decompensated stage of cirrhosis., Methods: By systematic review, we identified RCTs comparing NSBBs vs EVL, in monotherapy or combined, for primary bleeding prevention. We performed a competing-risk, time-to-event meta-analysis, using individual patient data (IPD) obtained from principal investigators of RCTs. Analyses were stratified according to previous decompensation of cirrhosis., Results: Of 25 RCTs eligible, 14 failed to provide IPD and 11 were included, comprising 1400 patients (656 compensated, 744 decompensated), treated with NSBBs (N = 625), EVL (N = 546) or NSBB+EVL (N = 229). Baseline characteristics were similar between groups. Overall, mortality risk was similar with EVL vs. NSBBs (subdistribution hazard-ratio (sHR) = 1.05, 95% CI = 0.75-1.49) and with EVL + NSBBs vs either monotherapy, with low heterogeneity (I 2  = 28.7%). In compensated patients, mortality risk was higher with EVL vs NSBBs (sHR = 1.76, 95% CI = 1.11-2.77) and not significantly lower with NSBBs+EVL vs NSBBs, without heterogeneity (I 2  = 0%). In decompensated patients, mortality risk was similar with EVL vs. NSBBs and with NSBBs+EVL vs. either monotherapy., Conclusions: In patients with compensated cirrhosis and high-risk varices on primary prophylaxis, NSBBs significantly improved survival vs EVL, with no additional benefit noted adding EVL to NSBBs. In decompensated patients, survival was similar with both therapies. The study suggests that NSBBs are preferable when advising preventive therapy in compensated patients., (© 2023 John Wiley & Sons Ltd.)