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Purpose: This study aimed to determine if an association exists between basal levels of stress and immune mediators and military physical performance among Canadian Armed Forces members (CAF). Methods: Blood samples from 219 CAF members (86 women and 133 men), were analysed for levels of cortisol, C-reactive protein (CRP), Adiponectin, INF-γ, TNF-α, IL-1β, IL-2, IL-6, IL-8 and IL-18. Grip strength, aerobic capacity and performance on six military physical performance tests (sandbag fortification, escape to cover, picking and digging, picket and wire carry, stretcher carry and vehicle extrication) were also assessed. A composite score for total performance was computed, based on rank scores from the six tasks. Results: The results from the linear regression analysis showed that higher CRP values were associated with lower total performance scores (slope -23.0,p≤0.05), a slower picking and digging time (slope 45.75,p≤0.05), lower aerobic capacity (slope -71.81,p≤0.05) and shorter plank time (slope -21.82,p≤0.05). A positive association between IL-2 values and grip strength was also observed (slope 20.83,p≤0.05). Adiponectin values were positively associated with plank time (slope 21.42,p≤0.05), but negatively associated with grip strength (slope -8.27,p≤0.05). Conclusion: The results from this study suggest that high levels of immune mediators (like CRP) could be a marker of decreased military physical performance. [ABSTRACT FROM AUTHOR]

In the spring of 2024, the federal government is expected to report on its legislative review of the Cannabis Act (2018). One of the most contentious issues is whether to relax restrictions on cannabis promotion. This commentary describes the tension between the public health aims of legalization and the secondary aim of displacing the illicit market. We maintain that among jurisdictions that have legalized cannabis, Canada stands out as having the stated primary objective of safeguarding public health, and its restrictions on promotion are evidence-based and innovative. These measures must be preserved, even in the face of growing industry pressure to loosen them., (Copyright © 2024 Longwoods Publishing.)

Background: Transanal endoscopic surgery is the treatment of choice in patients with rectal adenomas that cannot be removed by endoscopy. However, the risk of adenoma recurrence and optimal surveillance is not well defined. The objective of this study was to characterize the timing and frequency of rectal adenoma recurrence after removal by transanal endoscopic surgery and identify recurrence risk factors., Methods: This was a retrospective cohort study of a large, single-center academic institution in Vancouver, BC, Canada. Consecutive patients between May 1, 2007 and September 30, 2016 with pathology-confirmed rectal adenoma treated by primary excision with transanal endoscopic surgery and at least 1 year of confirmed endoscopic follow-up were included. Main outcome measures were recurrence rates following TEM as well as risk factors for recurrence., Results: 297 patients met inclusion criteria. The mean age of patients was 66.5 ± 11.5 years and 57.9% were male. Median follow-up was 623 (range 56-3841) days. A total of 62 recurrences occurred in 41 patients (13.8% of study population). Recurrences were managed with repeat transanal endoscopic surgery or endoscopic resection 67.7% and 25.8% of the time, respectively. Radical resection was required for adenocarcinoma in 4 patients. Recurrence-free survival rates were 93.4% at 1 year, 86.2% at 2 years, and 73.1% at 5 years. After adjusting for individual surgeons, adenoma height, size > 3 cm, high-grade dysplasia, positive margins, and management of the rectal defect, patients who underwent surgery in the latter 5 years of the study had lower odds of recurrence (OR 0.42, 95% CI 0.19, 0.93, p = 0.03)., Conclusions: Rectal adenomas managed by transanal endoscopic surgery are lesions at high risk for recurrence; surveillance should be performed within the first 2 years and continued for a total of at least 5 years. Most recurrences can be successfully treated with repeat TEM or endoscopic resection.