Premature ventricular contractions (PVCs) are common arrhythmia encountered in patients with and without structural heart disease. Although often benign and asymptomatic, they may also cause palpitations, exercise intolerance, presyncope, and reduced quality of life, and in some patients can contribute to PVC-induced cardiomyopathy or trigger malignant ventricular arrhythmias. Their clinical significance depends on symptom burden, PVC frequency, ventricular function, and the presence of underlying myocardial disease. Diagnostic evaluation includes electrocardiography, ambulatory rhythm monitoring, echocardiography, exercise testing, and cardiac magnetic resonance imaging for tissue characterization and risk stratification. Management ranges from reassurance and lifestyle modification to pharmacologic therapy and catheter ablation. Beta-blockers and nondihydropyridine calcium channel blockers remain common first-line options, whereas antiarrhythmic drugs may be considered in carefully selected patients. Catheter ablation is an effective treatment for symptomatic PVCs, high PVC burden, and PVC-induced cardiomyopathy, with high procedural success rates and favorable effects on arrhythmic burden and ventricular function. Novel approaches, including electrocardiographic imaging-guided planning, pulsed field ablation, stereotactic radioablation, neuromodulation, and renal denervation, may further expand future therapeutic options. This review summarizes the pathophysiology, clinical implications, diagnostic evaluation, and contemporary management of PVCs, with emphasis on medical therapy, catheter ablation, and emerging treatments.

Cancer survivorship is increasingly characterized by long-term treatment sequelae, including cardiometabolic disease, fatigue, sleep disturbance, psychological distress, and risk of second malignancies. As survivorship populations expand, there is growing recognition that traditional symptom-focused follow-up does not adequately address modifiable drivers of long-term morbidity. This review evaluates lifestyle medicine as a structured framework integrating physical activity, nutrition, sleep health, psychological well being, and substance cessation to improve survivorship outcomes across solid tumors and hematologic malignancies. Evidence from randomized trials, cohort studies, and consensus guidelines demonstrates that lifestyle interventions influence systemic inflammation, immune function, metabolic regulation, and functional capacity. Physical activity improves fatigue, cardiorespiratory fitness, and quality of life, while plant-forward dietary patterns are associated with improved survival outcomes. Sleep optimization and stress reduction interventions improve inflammatory signaling and psychological outcomes. Tobacco cessation and alcohol reduction reduce recurrence risk and mortality. Emerging literature highlights the relevance of cardiometabolic pathways and behavioral interventions as modifiable determinants of survivorship trajectories. Lifestyle medicine provides a biologically plausible and clinically actionable framework to address shared mechanisms underlying cancer recurrence, treatment toxicity, and chronic disease risk. Integration of multidisciplinary interventions and digital health tools may enable scalable survivorship models focused on prevention, functional recovery, and long-term health optimization. Future research should prioritize mechanistic studies and pragmatic trials evaluating multimodal interventions across diverse cancer populations.

Mediating effect of sex hormones and modification of lifestyle: Association between pyrethroid exposure and hypertension.

AGA Clinical Practice Update on Diagnosis and Treatment of Hemorrhoids: Expert Review.

Alzheimer's disease and related dementias (ADRD) pose a growing public health challenge, with 45% of cases attributable to 14 modifiable risk factors. Midlife represents a critical window for prevention. Hispanic/Latino adults face disproportionate ADRD risk, compounded by health inequities such as limited healthcare access and higher prevalence of cardiovascular and metabolic conditions. In Rhode Island, where 17.6% of residents identify as Hispanic/Latino, culturally tailored interventions are urgently needed. This study aims to inform the cultural adaptation of the TEACH intervention (Tailored Education for Aging and Cognitive Health), an evidence-based, multidomain behavioral intervention designed to reduce ADRD risk through lifestyle modification, to ensure its cultural relevance for Hispanic/ Latino adults. The research team will follow the Cultural Adaptation Process (CAP) model to guide the adaptation of the TEACH intervention, emphasizing linguistic and cultural relevance for Hispanic/Latino adults in southern New England by incorporating the views and perspectives of key stakeholders. We will conduct semi-structured qualitative interviews with bilingual stakeholders (N=6-8) and Hispanic/Latino adults aged 40-69 (N=10-12) recruited from clinical and community settings. Interviews will explore brain health beliefs, perceived intervention needs, barriers, and cultural values. Qualitative data will be analyzed using framework matrix and applied thematic analysis approaches to identify adaptation priorities across language, content, and delivery. This project was funded in September 2023. Data collection began in 2024, and analysis is projected to be completed in 2026. Findings will guide cultural adaptation of the TEACH intervention using the CAP model. This work addresses a critical gap in ADRD prevention for U.S. Hispanic/Latino populations and lays the foundation for a future randomized controlled trial to evaluate efficacy of the adapted intervention.

Over the past decade, metabolic dysfunction-associated steatotic liver disease (MASLD) has become a leading cause of chronic liver disease in Japan, with estimated prevalence rising from 33.7% (2020) to 44.8% (2040), owing to an aging population and lean individuals. In this narrative review, we summarize the epidemiology, pathogenesis, diagnostic strategies, and emerging treatments for MASLD and metabolic dysfunction-associated steatohepatitis (MASH) in Japan, culminating in a proposed ideal patient care pathway tailored to local needs. MASLD pathogenesis involves complex interactions between metabolic dysfunction, inflammation, insulin resistance, and genetic susceptibility. In Japan, a stepwise diagnostic algorithm is endorsed, starting with non-invasive liver disease assessments (NILDA) such as fibrosis-4, followed by imaging-based fibrosis evaluation and selective biopsy. We propose a two-tiered diagnosis combining first-line NILDA (fibrosis-4) with second-line NILDA (e.g., enhanced liver fibrosis, Mac-2 binding protein glycosylation isomer, cytokeratin-18 fragment, andserum type IV collagen 7S) to refine risk stratification, reduce unnecessary referrals, and optimize healthcare resources, with qualifying patients referred to a hepatologist and treatment plans based on imaging-based NILDA or liver biopsy. The management of MASLD/MASH relies on lifestyle modification and pharmacological agents targeting metabolic comorbidities. However, novel anti-fibrotic, anti-inflammatory, and metabolism-targeted therapies are advancing, with future treatment decisions expected to integrate genomic and metabolomic profiling alongside NILDA. The proposed care model is multidisciplinary, engaging physicians, hepatologists, dietitians, psychologists, pharmacists, and hepatitis medical care coordinators to address both hepatic and systemic metabolic care. This evolving paradigm emphasizes proactive, personalized care informed by real-world data and long-term monitoring to improve outcomes and quality of life for patients with MASLD/MASH in Japan.

Evaluation of oxidant stress markers in a population involved in a health care program.

Obesity has reached epidemic proportions globally, with its prevalence nearly tripling since 1975. It is now recognized as a chronic, relapsing disease associated with increased morbidity and mortality due to its strong relationship with several cardio-renal-metabolic conditions. This narrative review aims to explore the major obesity-related complications - namely obstructive sleep apnea syndrome (OSAS), metabolic dysfunction-associated steatotic liver disease (MASLD), dyslipidemia, and chronic kidney disease (CKD) - highlighting their pathophysiological mechanisms, clinical consequences, and current therapeutic strategies. Obesity contributes to OSAS by increasing upper airway collapsibility and to MASLD through ectopic fat accumulation, insulin resistance, and inflammatory responses. Dyslipidemia in obesity is characterized by elevated triglycerides, small dense LDL particles, and low HDL-C, driven by chronic inflammation and insulin resistance. CKD progression, particularly obesity-related glomerulopathy (ORG), is also mediated by metabolic and hemodynamic derangements, including renin-angiotensin-aldosterone system activation and glomerular hyperfiltration. Therapeutic interventions such as lifestyle modification, pharmacological therapy - including glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) - and bariatric surgery have shown efficacy not only in promoting weight loss but also in improving the clinical course of these obesity-related conditions. In particular, Very Low Energy Ketogenic Therapy (VLEKT) is emerging as a promising approach in improving metabolic parameters, hepatic steatosis, and cardiovascular risk factors. A comprehensive and multidisciplinary approach to obesity is essential, focusing not only on weight loss but also on mitigating associated complications. Effective management can significantly improve patients' quality of life and reduce the long-term burden of obesity on healthcare systems.

Obesity Management in End-Stage Kidney Disease: Pathways to Improve Kidney Transplant Access.

An endoscopically placed duodenal-jejunal bypass liner (DJBL) may provide a safe adjunctive therapy for those with poorly controlled type 2 diabetes mellitus (T2DM) and obesity. Although some endoscopic therapies have been shown to improve glycemic indices secondary to weight loss, small bowel interventions may have direct metabolic effects. A meta-analysis of observational studies demonstrated reduction in HbA1c by 1.3% at 1 year after DJBL in patients with T2DM and obesity. This was a multicenter, double-blind, randomized, sham-controlled trial comparing DJBL to sham procedure with medical management and lifestyle modification. Primary endpoints included mean difference in changes in HbA1c at 12 months between arms, and device-related serious adverse events (SAEs). Secondary endpoints included percent total weight loss (%TWL) and subjects achieving HbA1c≤7% and TWL≥5% at 12 months. Three hundred twenty subjects were randomized to DJBL (n=212) and sham (n=108). Baseline HbA1c and BMI were 8.79±0.92% and 38.45±5.75kg/m 2 . On modified intent-to-treat analysis, change in HbA1c at 12 months was -1.10±1.45% and -0.28±1.54% for DJBL and sham groups, respectively ( P =0.0004). Rate of device-related SAEs was 9.4% including intolerance (3.7%), hemorrhage (2.8%), and hepatic abscess (2.3% stopping study early). At 12 months, DJBL group experienced greater weight loss compared with sham (7.7±9.6% TWL and 2.1±5.4% TWL, respectively; P <0.0001), with significantly more patients achieving HbA1c ≤ 7% (28.3% vs. 9.4%; P <0.0003) and TWL ≥ 5% (60.4% vs. 21.3%; P <0.0001). DJBL met primary glycemic control efficacy and primary safety endpoints, while providing clinically significant weight loss, and comorbidity improvement.

Mechanism and interventions of the bile acid-gut-liver axis imbalance in the progression of non-alcoholic fatty liver disease.

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, as demonstrated by a 50% increase in the prevalence over the past three decades. More than one quarter of the global population and nearly 40% of adults in the United States are affected by this burdensome disease. Once thought to be an "innocent bystander," MASLD is now understood as a multisystem disease associated with obesity, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease. Its rising prevalence emphasizes the critical role of primary care providers, including nurse practitioners (NP), in early identification and management. Existing on a spectrum, MASLD ranges from simple hepatic steatosis to nonalcoholic steatohepatitis with inflammation, fibrosis, and cirrhosis. Early stages are often asymptomatic, but progression can lead to portal hypertension, end-stage liver disease, hepatocellular carcinoma, and death. Disease management focuses on lifestyle modification and optimal control of metabolic comorbidities, including glycemic management, statin therapy for dyslipidemia, blood pressure control, and treatment for obstructive sleep apnea. Pharmacologic options remain limited, although vitamin E and pioglitazone may benefit select patients. Furthermore, emerging therapies are under investigation. This article presents a case of MASLD in a patient with metabolic comorbidities and persistently elevated aminotransferases, illustrating the significance of focused assessments and highlighting the role of nurse practitioners in screening, lifestyle counseling, early intervention, and longitudinal follow-up to prevent disease progression and improve outcomes.

Knee osteoarthritis (KOA) is a major cause of pain, disability, and reduced quality of life worldwide. Exercise therapy is widely recommended as a first-line non-pharmacological treatment; however, evidence on a strengthening-based home exercise program (SHEP) remains limited. This study aimed to investigate the effects of 8 weeks SHEP intervention on pain and function in KOA. This randomized controlled trial involved 247 KOA participants aged 45-70, who were randomly assigned to the experimental group receiving SHEP with lifestyle advice, or the control group receiving pain medication with lifestyle advice for 8 weeks. Primary outcomes included pain intensity measured using the Numeric Pain Rating Scale (NPRS), pressure pain threshold (PPT) assessed with an algometer, and functional ability measured using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes included muscle strength, range of motion (ROM), Six-Minute Walk Test (6MWT), and quality-of-life measures. Outcomes were assessed at baseline and after 8 weeks. After 8 weeks, the experimental group demonstrated significantly greater improvements than the control group (p < 0.001). Pain intensity was reduced (mean difference [MD] = -1.95; 95% CI: -2.28 to -1.62), PPT increased (MD = 0.46; 95% CI: 0.32-0.60), and WOMAC total score improved (MD = -12.62; 95% CI: -14.37 to -10.86). Significant between-group improvements were also observed in muscle strength, ROM, 6MWT, and quality-of-life scores (p < 0.001). No serious adverse events were reported throughout the trial. Eight weeks SHEP intervention was associated with significant improvements in pain, physical function, and quality of life in individuals with KOA. This intervention appeared to be feasible and was generally well tolerated by participants, supporting its potential as a sustainable rehabilitation strategy, particularly in resource-limited healthcare settings. Trial Registration: ID: CTRI/2025/03/081575.

The development of rheumatoid arthritis (RA) is amultistage process that often begins decades before the first joint symptoms appear. The first critical turning point is the loss of immunological tolerance [1]. Under the influence of chronic stimuli on the mucous membranes increased citrullination of proteins can occur [1]. Particularly in carriers of the shared epitope, the immune system recognizes these altered proteins as "foreign" and thereby produces anticitrullinated protein antibodies (ACPA), marking the onset of systemic autoimmunity [1, 2]. This primordial phase thus represents apotential therapeutic window of opportunity for preventive interventions [3]. In particular, smoking in conjunction with the presence of the shared epitope is associated with an up to 21-fold increased risk for ACPA-positive individuals [4, 5]. Other modifiable environmental factors such as smoking, obesity, diet and periodontitis also contribute to an increased risk of RA development, and thus represent the first key initial focus of primary prevention. In secondary prevention, recent interventional studies in high-risk individuals (ACPA/RF-positive with arthralgia) have shown mixed results: While hydroxychloroquine (STOP-RA) [8] remained ineffective, methotrexate (TREAT EARLIER) [9] was able to delay disease progression, particularly in ACPA-positive patients [9, 10]. Abatacept has so far proven to be the most promising approach (APIPPRA and ARIAA), with asignificant reduction in the progression rate and lasting effects well beyond the treatment period. [11, 12].. The ARIAA long-term data also demonstrate that just 6months of abatacept treatment delays the development of RA for up to 5years, with IgA-ACPA-positive patients benefiting particularly [14]. Modern imaging using magnetic resonance imaging (MRI) and ultrasound enables the detection of subclinical inflammation, with tenosynovitis considered ahighly sensitive early marker [15, 17]. The new EULAR/ACR risk stratification criteria enable the precise identification of high-risk individuals for prevention studies [18, 21]. The combination of lifestyle modifications and targeted drug intervention in high-risk patients could already be revolutionizing RA prevention today.

Umbilicus repositioning alleviates constipation in diabetic patients: A double-blind randomized clinical trial.

Early-stage type 1 diabetes: is there a role for lifestyle modifications?

A mechanistic digital twin of ovarian aging integrating follicular dynamics, mitochondrial decline, and lifestyle perturbations.

Introduction Cystinuria is a rare inherited disorder characterized by recurrent cystine stone formation. When lifestyle modification and urine alkalinization fail, cystine-binding medication such as tiopronin and D-penicillamine are indicated. Despite proven benefit, their accessibility across Europe appears limited. We hypothesized that access to this medication is restricted and varies substantially between European countries. Methods We surveyed physicians affiliated with the European Reference Network for Rare Kidney Diseases (ERKNet) regarding access barriers and prescribing practices. The online questionnaire was completed by 40 clinicians from 15 countries. Results Eighty-five percent of respondents had prescribed cystine-binding medication in the past two years, with tiopronin being the preferred agent. However, 30% reported having no access to tiopronin at all, and 83% of recent prescribers experienced accessibility problems, including high costs and unfilled prescriptions. Substantial differences were observed both between and within countries. Prescription rates correlated with physicians' cystinuria caseload. Discussion Cystine-binding medication is poorly and inconsistently accessible across Europe. Coordinated efforts are urgently needed to stabilize supply and ensure equitable, affordable access.

Introduction. Cardiovascular diseases remain the leading cause of mortality, disability, and premature loss of working capacity worldwide. Nutrition is one of the major modifiable cardiovascular risk factors, as dietary habits directly influence lipid and carbohydrate metabolism, endothelial function, blood pressure regulation, systemic inflammation, and oxidative stress. Excessive intake of salt, saturated fats, trans fats, refined carbohydrates, and ultra-processed foods contributes to dyslipidemia, arterial hypertension, obesity, insulin resistance, and atherosclerosis. The aim of the study. To summarise current scientific evidence regarding the role of nutrients in the prevention and complex treatment of cardiovascular diseases, as well as to evaluate the potential of nutrient correction in reducing cardiovascular risk and improving patient prognosis. Materials and methods. An analytical review of current scientific publications, clinical guidelines, systematic reviews, meta-analyses, and randomised clinical trials was conducted. The effects of dietary patterns, macro- and micronutrients on cardiometabolic risk were analysed. Results. Adequate intake of omega-3 polyunsaturated fatty acids, potassium, magnesium, dietary fibre, antioxidants, and polyphenols was associated with improved lipid profile, endothelial function, blood pressure stabilisation, and reduced inflammatory activity. The Mediterranean and DASH diets demonstrated the strongest cardioprotective effects. Conclusions. Nutrient correction is an important component of cardiovascular prevention and complex treatment. Rational nutrition should be combined with lifestyle modification, individualised dietary recommendations, and evidence-based pharmacotherapy.

Food addiction (FA) likely contributes to obesity within a complex system of psychological, behavioral, and physiological factors. However, interactions among these factors remain incompletely understood. This study used a network approach to identify interrelationships among FA,eating motives, lifestyle habits, and weight indicators in a developmental youth cohort. Alongitudinal panel study was conducted in Eastern China. Youth aged >8 years (mean ages 13-14 years) completed survey and anthropometric measurements. The Chinese version of the dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0), Kids Palatable Food Eating Motive Scale (K-PEMS) and Mindful Eating Scale for Children (MEQ-C) were used to measure addictive eating motives and behaviors. Semi-quantitative food intake, physical activity and sleep duration were assessed, and height and weight were measured by trained researchers to calculate a Body Mass Index Z score (BMIZ). Body composition measurement utilized bioelectrical impedance for detecting subcutaneous fat content (FC) and a visceral fat level (VFL). Network analysis, including cross-sectional network estimation at each time point, longitudinal network comparison, and cross-lagged panel network (CLPN) modeling, was used to examine the centrality, connectivity, and temporal relationships among FA and key variables. Among the 2680 participants enrolled, 2054 completed both waves of surveys (retention rate: 76.7%; 49.5% girls). In the baseline (T1) cross-sectional network, FA showed the highest closeness and betweenness and was linked to the weight-related subnetwork (BMIZ, FC, and VFL) primarily through VFL. The follow-up (T2) cross-sectional network showed a broadly similar overall pattern. Longitudinal comparison suggested generally stable centrality patterns across time, with lifestyle-related factors showing relatively greater prominence at T2. In the CLPN, the strongest directional paths primarily extended from FA to later eating motives, whereas direct longitudinal paths from FA to weight indicators were not observed. FA and mindful eating exhibited bidirectional relationships, and mindful eating was also negatively associated with subsequent reward-based eating motives. FA may represent an important intervention target within the broader obesity-related psychobehavioral system in youth, particularly in relation to eating motives and reward-driven eating processes. Interventions that address FA together with mindful eating and modifiable lifestyle factors may offer a more comprehensive approach to youth weight-related health.