Non-optical polyp-based resect and discard strategy: A prospective clinical study.

BACKGROUND: Post-polypectomy surveillance intervals are currently determined based on pathology results. AIM: To evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and size. METHODS: Patients undergoing elective colonoscopies at the Montreal University Medical Center were enrolled prospectively. The polyp-based strategy was used to assign the next surveillance interval using polyp size and number. Surveillance intervals were also assigned using optical diagnosis for small polyps (< 10 mm). The primary outcome was surveillance interval agreement between the polyp-based model, optical diagnosis, and the pathology-based reference standard using the 2020 United States Multi-Society Task Force guidelines. Secondary outcomes included the proportion of reduction in required histopathology evaluations and proportion of immediate post-colonoscopy recommendations provided to patients. RESULTS: Of 944 patients (mean age 62.6 years, 49.3% male, 933 polyps) were enrolled. The surveillance interval agreement for the polyp-based strategy was 98.0% [95% confidence interval (CI): 0.97-0.99] compared with pathology-based assignment. Optical diagnosis-based intervals achieved 95.8% (95%CI: 0.94-0.97) agreement with pathology. When using the polyp-based strategy and optical diagnosis, the need for pathology assessment was reduced by 87.8% and 70.6%, respectively. The polyp-based strategy provided 93.7% of patients with immediate surveillance interval recommendations vs 76.1% for optical diagnosis. CONCLUSION: The polyp-based strategy achieved almost perfect surveillance interval agreement compared with pathology-based assignments, significantly reduced the number of required pathology evaluations, and provided most patients with immediate surveillance interval recommendations.

Changes in corticospinal excitability during consolidation predict acute exercise-induced off-line gains in procedural memory.

A single bout of cardiovascular exercise performed immediately after practicing a motor task improves the long-term retention of the skill through an optimization of memory consolidation. However, the specific brain mechanisms underlying the effects of acute cardiovascular exercise on procedural memory are poorly understood. We sought to determine if a single bout of exercise modifies corticospinal excitability (CSE) during the early stages of memory consolidation. In addition, we investigated if changes in CSE are associated with exercise-induced off-line gains in procedural memory. Participants practiced a serial reaction time task followed by either a short bout of acute exercise or a similar rest period. To monitor changes in CSE we used transcranial magnetic stimulation applied to the primary motor cortex (M1) at baseline, 15, 35, 65 and 125min after exercise or rest. Participants in the exercise condition showed larger (∼24%) improvements in procedural memory through consolidation although differences between groups did not reach statistical significance. Exercise promoted an increase in CSE, which remained elevated 2h after exercise. More importantly, global increases in CSE following exercise correlated with the magnitude of off-line gains in skill level assessed in a retention test performed 8h after motor practice. A single bout of exercise modulates short-term neuroplasticity mechanisms subserving consolidation processes that predict off-line gains in procedural memory.