Mild Restriction Research Articles

The Effect of high-intensity interval training with caloric restriction on gene expression of apoptosis indices HSP70 and HSP60 in the myocardium of male rats

Background and aims: The purpose of this study was to investigate the effect of high-intensity interval training combined with calorie restriction on the expression of HSP70 and HSP60 in the myocardium of male rats. Methods: A total of 27 male rats were randomly divided into three groups (9 rats in each group): control, caloric restriction, and caloric restriction with high-intensity interval training. During the study, the control group had free access to water and food, but the amount of food in the food restriction group was limited to 50% and the calorie restriction-exercise group was limited to 25% of the control group. The restriction-exercise group was subjected to intense interval training for eight weeks. The gene expression of apoptotic indicators HSP70 and HSP60 was assessed using the real-time PCR method. The data were analyzed using Shapiro-Wilk test and ANOVA test. Results: Body weight in both calorie restriction groups significantly decreased (P=0.001). The results of the post hoc test showed a significant increase in the expression of HSP70 and HSP60 genes in the myocardium of male rats in the calorie-restricted-exercise group compared to the calorie-restricted and control groups (P=0.001). Additionally, no significant difference was observed between the two restriction and control groups in terms of HSP70 and HSP60 (P=0.102). Conclusion: The combination of high-intensity interval training and mild food restriction significantly increased HSP60 and HSP70 expression.

Phenotypic subtypes of fibrotic hypersensitivity pneumonitis identified by machine learning consensus clustering analysis

BackgroundPatients with fibrotic hypersensitivity pneumonitis (f-HP) have varied clinical and radiologic presentations whose associated phenotypic outcomes have not been previously described. We conducted a study to evaluate mortality and lung transplant (LT) outcomes among clinical clusters of f-HP as characterized by an unsupervised machine learning approach.MethodsConsensus cluster analysis was performed on a retrospective cohort of f-HP patients diagnosed according to recent international guideline. Demographics, antigen exposure, radiologic, histopathologic, and pulmonary function findings along with comorbidities were included in the cluster analysis. Cox proportional-hazards regression was used to assess mortality or LT risk as a combined outcome for each cluster.ResultsThree distinct clusters were identified among 336 f-HP patients. Cluster 1 (n = 158, 47%) was characterized by mild restriction on pulmonary function testing (PFT). Cluster 2 (n = 46, 14%) was characterized by younger age, lower BMI, and a higher proportion of identifiable causative antigens with baseline obstructive physiology. Cluster 3 (n = 132, 39%) was characterized by moderate to severe restriction. When compared to cluster 1, mortality or LT risk was lower in cluster 2 (hazard ratio (HR) of 0.42; 95% CI, 0.21–0.82; P = 0.01) and higher in cluster 3 (HR of 1.76; 95% CI, 1.24–2.48; P = 0.001).ConclusionsThree distinct phenotypes of f-HP with unique mortality or transplant outcomes were found using unsupervised cluster analysis, highlighting improved mortality in fibrotic patients with obstructive physiology and identifiable antigens.

Lateral-type posterior fossa ependymomas in pediatric population

BackgroundLateral-type posterior fossa ependymomas are a well-defined subtype of tumours both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series. MethodsAmong 30 cases of ependymoma operated in our paediatric department in the last ten years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study. ResultsMean age of our patients was 3.75 years. 6 cases presented with hydrocephalus. Mean tumour volume at diagnosis was 61 cc. A complete resection was achieved in six cases and a near-total resection in one patient. 5 patients transiently required a gastrostomy and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. 4 cases of hydrocephalus required a ventriculoperitoneal CSF shunt and two were managed with a third ventriculostomy. At last follow-up 4 patients carried a normal life and two displayed a mild restriction according to Lansky´s scale. ConclusionsThe aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumours may identify risk factors that guide stratification of adjuvant therapies.

Healthy Aging in Times of Extreme Temperatures: Biomedical Approaches.

Climate extremes and rising energy prices present interconnected global health risks. Technical solutions can be supplemented with biomedical approaches to promote healthy longevity in hot and cold conditions. In summer, reducing basal metabolic rate through mild caloric restriction or CR mimetics, such as resveratrol, can potentially be used to lower body temperature. In winter, activating brown adipose tissue (BAT) for non-shivering thermogenesis and improved metabolic health can help adaptation to colder environments. Catechins found in green tea and in other food could be alternatives to drugs for these purposes. This review examines and discusses the biomedical evidence supporting the use of CR mimetics and BAT activators for health benefits amid increasingly extreme temperatures.

Single Bone Intramedullary Fixation of the Radius in Pediatric Both Bone Forearm Fractures Using Straight Stainless Steel Kirschner Wire: A Cross-sectional Study on Radiological and Clinical Feature.

We aimed to report radiological and clinical features of single bone intramedullary fixation of the radius in pediatric both bone forearm fractures using straight stainless steel Kirschner (K) wire. Fifty-eight children (42 boys and 16 girls) referred to our hospital with both bone diaphyseal forearm fractures were operated on by using the single bone rigid K-wire intramedullary fixation and mini-open technique. The mean follow-up time was 8.9 months (6-12). The mean age of the patients was 7.4 years (4-12). More than 2/3 of the fractures were in the right hand. Around 63% of the fractures were in the middle third, 28% in the distal third, and 9% in the proximal third. Moreover, 12% were open type I Gustilo-Anderson fractures. The mean time from injury to surgery was two days (1-4), and the mean length of hospital stay was 2.8 days (2-5). The mean duration of surgery was 24.7 minutes (18-38), and the mean follow-up time was 8.9 months (6-12). All fractures united within 4-16 weeks (mean: 7.62). The cast and implant were removed simultaneously as the radiographic fracture union. There was no serious complication. Superficial infection of the pin track and loosening of the pin occurred in three cases (5%), all controlled by antibiotics and timely removal of the pins. Mild restriction of elbow extension (less than 20 degrees) was observed in three cases, which returned to normal at the last follow-up. Limitation of dorsiflexion of the wrist by more than 20° occurred in two patients (35° and 45°), which reverted to 25° and 25°, respectively, at the last follow-up. In both bone forearm fractures in children, open reduction and internal fixation of only the radius with a stainless steel straight Kirschner wire could be a promising method with good results. This retrograde technique of intramedullary fixation is a simple and cost-effective method with minimal complications and acceptable outcomes in children aged 4-12 years.

Chronic Mild Sleep Restriction Does Not Lead to Marked Neuronal Alterations Compared With Maintained Adequate Sleep in Adults

BackgroundSleep restriction (SR) has been shown to upregulate neuronal reward networks in response to food stimuli, but prior studies were short-term and employed severe SR paradigms. ObjectiveOur goal was to determine whether mild SR, achieved by delaying bedtimes by 1.5 h, influences neuronal networks responsive to food stimuli compared with maintained adequate sleep (AS) >7 h/night. MethodsA randomized controlled crossover study with 2 6-wk phases, AS (≥7 h sleep/night) and SR (−1.5 h/night relative to screening), was conducted. Adults with AS duration, measured using wrist actigraphy over a 2-wk screening period, and self-reported good sleep quality were enrolled. Resting-state and food-stimulated functional neuroimaging (fMRI) was performed at the endpoint of each phase. Resting-state fMRI data analyses included a priori region-of-interest seed-based functional connectivity, whole-brain voxel-wise analyses, and network analyses. Food task-fMRI analyses compared brain activity patterns in response to food cues between conditions. Paired-sample t tests tested differences between conditions. ResultsTwenty-six participants (16 males; age 29.6 ± 5.3 y, body mass index 26.9 ± 4.0 kg/m2) contributed complete data. Total sleep time was 7 h 30 ± 28 min/night during AS compared with 6 h 12 ± 26 min/night during SR. We employed different statistical approaches to replicate prior studies in the field and to apply more robust approaches that are currently advocated in the field. Using uncorrected P value of <0.01, cluster ≥10-voxel thresholds, we replicated prior findings of increased activation in response to foods in reward networks after SR compared with AS (right insula, right inferior frontal gyrus, and right supramarginal gyrus). These findings did not survive more rigorous analytical approaches (Gaussian Random Field theory correction at 2-tailed voxel P < 0.001, cluster P < 0.05). ConclusionsThe results suggest that mild SR leads to increased reward responsivity to foods but with low confidence given the failure to meet significance from rigorous statistical analyses. Further research is necessary to inform the mechanisms underlying the role of sleep on food intake regulation.This trial was registered at clinicaltrials.gov as NCT02960776.

Large time-stepping, delay-free, and invariant-set-preserving integrators for the viscous Cahn–Hilliard–Oono equation

Stabilization techniques are frequently used to construct efficient and stable schemes for stiff and nonlinear systems. However, the introduced errors may lead to severe delay effects when facing large time-steps or stabilization parameters. Considering a fourth-order-in-space viscous Cahn–Hilliard–Oono equation that consists of both short- and long-range interactions, and equipped with either a polynomial or logarithmic potential, we analyze its invariant sets by proposing a novel reformulation. Additionally, we devise a family of temporal integrators up to eighth-order, along with a suitable stabilization parameter, to ensure the preservation of these invariant sets for any time-step. To eliminate the lagging phenomenon, we propose rewriting the method into a parametric two-step Runge–Kutta (TSRK) formulation, quantifying the rescaled time-step, and finally performing a relaxation technique. We demonstrate that the s-stage, pth-order parametric relaxation TSRK integrators retain the order of the underlying TSRK Butcher tableau, and promote the strong-stability-preserving coefficient to at most s when p>2. To further reduce the stabilization parameter, we propose a parametric relaxation integrating factor TSRK framework that treats the stiff linear operator as an integrating factor. The proposed framework has mild restrictions on the underlying TSRK tableau, i.e., the coefficients are non-negative and the parametric abscissas are non-decreasing. Numerical experiments demonstrate the accuracy and structure-preserving property of the proposed schemes, and are used to investigate the effect of parameters on microphase separations in diblock copolymer melts.

Primary Central Nervous System ALK-negative Anaplastic Large Cell Lymphoma, with TP53 Deletion

Abstract Introduction/Objective ALK-negative anaplastic large cell lymphoma (ALCL) primary to the central nervous system (CNS), is a sporadic and rare lymphoma, characterized by neoplastic T-cells which are CD30 positive and ALK negative. It has a male predominance, mostly affects old adults and usually displays supratentorial, single or multiple lesions. Methods/Case Report We report the case of a 57-year-old woman with medical history of breast cancer, S/P lumpectomy and radiation therapy, who came to our institution with confusion, partial aphasia and headache. MRI showed a thick-walled, irregular, ring enhancing mass in the periventricular white matter of the occipital and temporal horns of the lateral ventricle with surrounding vasogenic edema and mass effect. It was isointense to cortex on T1- and heterogeneously hyperintense on T2-weighted images with mild diffusion restriction in the enhancing portion. A left parieto-occipital decompressive craniotomy was performed and tissue was procured for diagnosis. The biopsy showed an infiltrating, angiocentric neoplasm, composed of large anaplastic cells, including hallmark cells with "horseshoe" nuclei, abundant eosinophilic cytoplasm and occasional perinuclear clearing. Large areas of necrosis and pericellular reticulin deposits of the vascular walls were also noted. On immunohistochemistry, the neoplastic cells diffusely expressed CD45, CD2, CD3, CD25, CD43, MUM1, and CD30, and were negative for ALK, CD20, CD79a, PAX-5, CD15, CD5, BCL-6, BCL-2, Granzyme B, GFAP, Pancytokeratin. In situ hybridization for EBER was negative. The proliferative index (Ki-67), while variable, was as high as 80%. TP53 deletion was detected by FISH in 100% of the cells analyzed. No rearrangements in the ALK or MYC genes was noted by FISH. Additional studies revealed a complex karyotype including loss of chromosomes 9 and 10, gain of chromosome 17 and a marker chromosome, and structural rearrangements involving chromosomes 4, 10, and 13. Previously reported rearrangements involving DUSP22 (6p25) and TP63 (3q28) were not identified. TCR gene rearrangement was also identified by PCR. High dose Cytarabine/Methotrexate, and radiation were not successful in controlling disease progression and home hospice was recommended. Results (if a Case Study enter NA) N/A Conclusion This is an infrequent type of primary CNS lymphoma with a poor prognosis and, while TP53 has been reported in sporadic, and cutaneous ALCL, to our knowledge, this is the first report of primary CNS ALK-negative anaplastic large cell lymphoma with TP53 deletion.

Microbiota configuration determines nutritional immune optimization.

Mild or transient dietary restriction (DR) improves many aspects of health and aging. Emerging evidence from us and others has demonstrated that DR also optimizes the development and quality of immune responses. However, the factors and mechanisms involved remain to be elucidated. Here, we propose that DR-induced optimization of immunological memory requires a complex cascade of events involving memory T cells, the intestinal microbiota, and myeloid cells. Our findings suggest that DR enhances the ability of memory T cells to recruit and activate myeloid cells in the context of a secondary infection. Concomitantly, DR promotes the expansion of commensal Bifidobacteria within the large intestine, which produce the short-chain fatty acid acetate. Acetate conditioning of the myeloid compartment during DR enhances the capacity of these cells to kill pathogens. Enhanced host protection during DR is compromised when Bifidobacteria expansion is prevented, indicating that microbiota configuration and function play an important role in determining immune responsiveness to this dietary intervention. Altogether, our study supports the idea that DR induces both memory T cells and the gut microbiota to produce distinct factors that converge on myeloid cells to promote optimal pathogen control. These findings suggest that nutritional cues can promote adaptation and co-operation between multiple immune cells and the gut microbiota, which synergize to optimize immunity and protect the collective metaorganism.

Long time [formula omitted]-stability of fast L2-1[formula omitted] method on general nonuniform meshes for subdiffusion equations

In this work, the global-in-time H1-stability of a fast L2-1σ method on general nonuniform meshes is studied for subdiffusion equations, where the convolution kernel in the Caputo fractional derivative is approximated by sum of exponentials. Under some mild restrictions on time stepsize, a bilinear form associated with the fast L2-1σ formula is proved to be positive semidefinite for all time. As a consequence, the uniform global-in-time H1-stability of the fast L2-1σ schemes can be derived for both linear and semilinear subdiffusion equations, in the sense that the H1-norm is uniformly bounded as the time tends to infinity. To the best of our knowledge, this appears to be the first work for the global-in-time H1-stability of fast L2-1σ scheme on general nonuniform meshes for subdiffusion equations. Moreover, the sharp finite time H1-error estimate for the fast L2-1σ schemes is reproved based on more delicate analysis of coefficients where the restriction on time step ratios is relaxed comparing to existing works.

Measuring Upward Mobility

We conceptualize and measure upward mobility over income or wealth. At the core of our exercise is the Growth Progressivity Axiom: transfers of instantaneous growth rates from relatively rich to poor individuals increases upward mobility. This axiom, along with mild auxiliary restrictions, identifies an “upward mobility kernel” with a single free parameter, in which mobility is linear in individual growth rates, with geometrically declining weights on baseline incomes. We extend this kernel to trajectories over intervals. The analysis delivers an upward mobility index that does not rely on panel data. That significantly expands our analytical scope to data-poor settings. (JEL D31, D63, I32, O15, O40)

Ependimomas de fosa posterior de tipo lateral en la edad pediátrica

Background and aimsLateral-type posterior fossa ependymomas are a well-defined subtype of tumors both clinically and pathologically, with a poor prognosis. Their incidence is low and surgical management is challenging. The objective of the present work is to review our series of lateral-tye posterior fossa ependymomas and compare our results with those of previous series. Materials and methodsAmong 30 cases of ependymoma operated in our pediatric department in the last 10 years, we identified seven cases of lateral-type posterior fossa ependymomas. We then performed a retrospective, descriptive study. ResultsMean age of our patients was 3.75 years. Six cases presented with hydrocephalus. Mean tumor volume at diagnosis was 61cc. A complete resection was achieved in six cases and a near-total resection in one patient. Five patients transiently required a gastrostomy and a tracheostomy. Mean follow-up was 58 months. One case progressed along this period and eventually died. Four cases of hydrocephalus required a ventriculoperitoneal CSF shunt and two were managed with a third ventriculostomy. At last follow-up four patients carried a normal life and two displayed a mild restriction according to Lansky's scale. ConclusionsThe aim of surgical treatment in lateral-type posterior fossa ependymomas is complete resection. Neurological deficits associated to lower cranial nerve dysfunction are common but transient. Deeper genetic characterization of these tumors may identify risk factors that guide stratification of adjuvant therapies.

Effects of Weight Change and Weight Cycling on Lung Function in Overweight and Obese Adults.

Rationale: Epidemiological studies have reported on the detrimental effects on lung function after natural, and thus limited, weight gain in unselected populations. Studies on bariatric surgery, on the contrary, have indicated large improvements in lung function after substantial weight loss. Objectives: To study the associations between profound weight loss or gain and pulmonary function within the same population. A second objective was to investigate the effect of weight cycling on pulmonary function. Methods: From our lung function database, we selected the records of subjects in follow-up for continuous positive airway pressure therapy for sleep apnea with a weight change of ⩾20 kg within 5 years. Lung function (N = 255) at baseline was normal except for a tendency toward mild restriction in morbid obesity. Within this sample, 73 subjects were identified with significant "weight cycling", defined as a ⩾10-kg opposite change in body weight before or after the ⩾20-kg weight change. Results: Weight change affected pulmonary function more in men than in women (P < 0.001). In men, forced vital capacity (FVC) increased an average of 1.4% predicted per unit of body mass index after weight loss and the reverse after weight gain, whereas women exhibited a smaller change of 0.9% predicted per unit of body mass index. Weight loss slightly increased the ratio of forced expiratory volume in 1 second to FVC and decreased the specific airway resistance, whereas the opposite occurred with weight gain. Greater effects of weight change on lung function were observed in leaner subjects (P = 0.02) and in older subjects (P < 0.002). Changes in total lung capacity followed the changes in FVC, with no change in residual volume, and the greatest change was observed in functional residual capacity. In subjects with weight cycling, the improvement in lung function due to weight loss was reversed by subsequent weight gain and vice versa. Conclusions: This study provides evidence that the detrimental effect of obesity on lung function is a passive and reversible process.

Paradoxical Effects of Prolonged Insufficient Sleep on Lipid Profile: A Pooled Analysis of 2 Randomized Trials.

Background Insufficient sleep is associated with increased cardiovascular disease risk, but causality is unclear. We investigated the impact of prolonged mild sleep restriction (SR) on lipid and inflammatory profiles. Methods and Results Seventy-eight participants (56 women [12 postmenopausal]; age, 34.3±12.5 years; body mass index, 25.8±3.5 kg/m2) with habitual sleep duration 7 to 9 h/night (adequate sleep [AS]) underwent two 6-week conditions in a randomized crossover design: AS versus SR (AS-1.5 h/night). Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglycerides, and inflammatory markers (CRP [C-reactive protein], interleukin 6, and tumor necrosis factor-α) were assessed. Linear models tested effects of SR on outcomes in the full sample and by sex+menopausal status (premenopausal versus postmenopausal women+men). In the full sample, SR increased high-density lipoprotein cholesterol compared with AS (β=1.2±0.5 mg/dL; P=0.03). Sex+menopausal status influenced the effects of SR on change in total cholesterol (P-interaction=0.04), LDL-C (P-interaction=0.03), and interleukin 6 (P-interaction=0.07). Total cholesterol and LDL-C decreased in SR versus AS in premenopausal women (total cholesterol: β=-4.2±1.9 mg/dL; P=0.03; LDL-C: β=-6.3±2.0 mg/dL; P=0.002). Given paradoxical effects of SR on cholesterol concentrations, we explored associations between changes in inflammation and end point lipids under each condition. Increases in interleukin 6 and tumor necrosis factor-α during SR tended to relate to lower LDL-C in premenopausal women (interleukin 6: β=-5.3±2.6 mg/dL; P=0.051; tumor necrosis factor-α: β=-32.8±14.2 mg/dL; P=0.027). Conclusions Among healthy adults, prolonged insufficient sleep does not increase atherogenic lipids. However, increased inflammation in SR tends to predict lower LDL-C in premenopausal women, resembling the "lipid paradox" in which low cholesterol associates with increased cardiovascular disease risk in proinflammatory conditions. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT02835261, NCT02960776.

Optimality conditions and duality for nonsmooth multiobjective semi-infinite programming problems with vanishing constraints on Hadamard manifolds

This article is concerned with nonsmooth multiobjective semi-infinite programming problems with vanishing constraints in the setting of Hadamard manifolds (abbreviated as, (NMSIPVC)). We present the Abadie constraint qualification (abbreviated as, (ACQ)) and a modified version of (ACQ), namely, (NMSIPVC)-tailored Abadie constraint qualification (abbreviated as, (NMSIPVC-ACQ)), for (NMSIPVC). The Karush-Kuhn-Tucker (abbreviated as, KKT) type necessary criteria of optimality for (NMSIPVC) are derived by employing (ACQ) and (NMSIPVC-ACQ). Moreover, sufficient criteria of optimality for (NMSIPVC) are derived under generalized geodesic convexity hypotheses and certain mild restrictions on the index sets. Further, we formulate Wolfe type and Mond-Weir type dual models related to (NMSIPVC) and derive several duality results that relate (NMSIPVC) and the corresponding dual models. Non-trivial numerical examples are incorporated to demonstrate the validity of the results established in this paper. To the best of our knowledge, this is for the first time that constraint qualifications, optimality conditions, and duality results have been investigated for (NMSIPVC) in the setting of Hadamard manifolds.

Mild sleep restriction increases endothelial oxidative stress in female persons

Sleep restriction is associated with increased cardiovascular risk, which is more pronounced in female than male persons. We reported recently first causal evidence that mild, prolonged sleep restriction mimicking “real-life” conditions impairs endothelial function, a key step in the development and progression of cardiovascular disease, in healthy female persons. However, the underlying mechanisms are unclear. In model organisms, sleep restriction increases oxidative stress and upregulates antioxidant response via induction of the antioxidant regulator nuclear factor (erythroid-derived 2)-like 2 (Nrf2). Here, we assessed directly endothelial cell oxidative stress and antioxidant responses in healthy female persons (n = 35) after 6 weeks of mild sleep restriction (1.5 h less than habitual sleep) using randomized crossover design. Sleep restriction markedly increased endothelial oxidative stress without upregulating antioxidant response. Using RNA-seq and a predicted protein–protein interaction database, we identified reduced expression of endothelial Defective in Cullin Neddylation-1 Domain Containing 3 (DCUN1D3), a protein that licenses Nrf2 antioxidant responses, as a mediator of impaired endothelial antioxidant response in sleep restriction. Thus, sleep restriction impairs clearance of endothelial oxidative stress that over time increases cardiovascular risk.Trial Registration: NCT02835261

Effects of the COVID-19 pandemic on the physical activity and screen time habits of children aged 11-13 years in Sweden.

Physical activity (PA), exercise, sedentary behavior and screen time are lifestyle factors that have been shown to significantly impact child health in different ways. These lifestyle factors were affected to different degrees by global restrictions during the COVID-19 pandemic. We investigated PA and screen time in a cohort of Swedish children in both 2019 and 2021, before and during the pandemic. Adolescents born in 2008 in Halland, Sweden, and included in a previous longitudinal birth cohort study were invited to take part in follow-up questionnaires about PA, screen time and COVID-19. A total of 1041 children aged 11 (in 2019) and 13 years (in 2021) replied and 777 of them answered on both occasions. Most children (42.1%) reported that their leisure time PA was unchanged from 2019 to 2021. Compared to unchanged PA 33.9% exercised more often (p = 0.011) and 23.9% exercised less (p < 0.001), both differences statistically significant. Roughly, 43.2% of boys and 34.9% of girls in 2021 exercised so that they became breathless or broke a sweat at least 4 times a week not counting physical education in school, corresponding figures for 2019 were 38.2% for boys and 35.2% for girls. The majority of children were able to continue attending leisure time sports clubs during the pandemic, but participation decreased from 88.3% to 76.3% from 11 to 13 years of age. Most reported that sports club routines changed during the pandemic, but only 40.9% reported fewer practice opportunities. Attending a sports club gave greater protection against loss of PA during the pandemic than not belonging to one (41.0% vs. 23.2%, p < 0.001). The majority (71.1%) of children spent more time on screens in 2021 than 2019, with a mean increase of 9.4 h (95% CI 8.6 to 10.2 h) from 20.7 to 30.1 hours per week (p < 0.001) during the study. Swedish children largely maintained their levels of PA during the pandemic at 13 years of age and these were possibly safeguarded by the comparably mild pandemic restrictions in Sweden in 2021. However, they did increase their screen time between 11 and 13 years of age.

SPIROMETRY EVALUATION OF PULMONARY FUNCTIONS IN TYPE 2 DIABETES MELLITUS PATIENTS: A CROSS-SECTIONAL STUDY

Background and Aims: Type 2 diabetes mellitus (T2DM) during the chronic stage elicits significant micro and macrovascular complication and imposes mortality and morbidity among the individuals. However, the effect of T2DM on the lung as a target end organ damage was not widely studied. Hence, the present study was done for the spirometry analysis of pulmonary functions in T2DM patients. Methods: This was a cross-sectional study conducted on 50 T2DM patients and they were subjected to spirometry evaluation. The restrictive pattern of lung functions was analyzed by evaluating the following parameters forced vital capacity (FVC) in liters, forced expiratory volume in 1 second (FEV1), and FEV1/FVC were evaluated. The association between lung function parameters and duration of diabetes, glycated hemoglobin (HbA1c) were also analyzed. Results: In this study among the diabetic patients, the mean FVC was 2.45±0.36 L, the mean FEVI was 1.82±0.12 (L/s) and the mean FEV1/FVC was 87.42±7.54, respectively. Regarding lung complication, out of 50 diabetic patients, 25 (50%) had normal lung functions, 16 (32%) had mild restriction and 9 (18%) had moderate restriction. The FVC, FEVI, and FEV1/FVC were significantly reduced in diabetic patients with moderate lung restriction as compared to normal and mild restriction patterns. Diabetes duration displayed no significant association with a decline in pulmonary function and FEV1/FVC showed weak significant negative correlation (r=−0.412; p=0.02) with HbA1c levels. Conclusion: The study shows that in diabetics patients there was a marked decline in pulmonary function and it might be due to uncontrolled diabetes-related complications.

Trial of the MIND Diet for Prevention of Cognitive Decline in Older Persons

BackgroundFindings from observational studies suggest that dietary patterns may offer protective benefits against cognitive decline, but data from clinical trials are limited. The Mediterranean–DASH Intervention for Neurodegenerative Delay, known as the MIND diet, is a hybrid of the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet, with modifications to include foods that have been putatively associated with a decreased risk of dementia.MethodsWe performed a two-site, randomized, controlled trial involving older adults without cognitive impairment but with a family history of dementia, a body-mass index (the weight in kilograms divided by the square of the height in meters) greater than 25, and a suboptimal diet, as determined by means of a 14-item questionnaire, to test the cognitive effects of the MIND diet with mild caloric restriction as compared with a control diet with mild caloric restriction. We assigned the participants in a 1:1 ratio to follow the intervention or the control diet for 3 years. All the participants received counseling regarding adherence to their assigned diet plus support to promote weight loss. The primary end point was the change from baseline in a global cognition score and four cognitive domain scores, all of which were derived from a 12-test battery. The raw scores from each test were converted to z scores, which were averaged across all tests to create the global cognition score and across component tests to create the four domain scores; higher scores indicate better cognitive performance. The secondary outcome was the change from baseline in magnetic resonance imaging (MRI)–derived measures of brain characteristics in a nonrandom sample of participants.ResultsA total of 1929 persons underwent screening, and 604 were enrolled; 301 were assigned to the MIND-diet group and 303 to the control-diet group. The trial was completed by 93.4% of the participants. From baseline to year 3, improvements in global cognition scores were observed in both groups, with increases of 0.205 standardized units in the MIND-diet group and 0.170 standardized units in the control-diet group (mean difference, 0.035 standardized units; 95% confidence interval, −0.022 to 0.092; P=0.23). Changes in white-matter hyperintensities, hippocampal volumes, and total gray- and white-matter volumes on MRI were similar in the two groups.ConclusionsAmong cognitively unimpaired participants with a family history of dementia, changes in cognition and brain MRI outcomes from baseline to year 3 did not differ significantly between those who followed the MIND diet and those who followed the control diet with mild caloric restriction. (Funded by the National Institute on Aging; ClinicalTrials.gov number, NCT02817074.)

Coping Mechanisms for Lymphedema: An Analysis of Patient Experiences.

Background and objective Lymphedema is a condition caused by impaired lymphatic function. Acquired lymphedema is often due to neoplasia, infection, trauma, or radiation damage. Most patients rely on advice from fellow patients and personal research to manage their symptoms. We believe coping mechanisms for lymphedema can be more streamlined and made easily accessible if the most common effective strategies are determined and collected in a single repository for reference. To that end, we aimed to assess the experiences of lymphedema patients and the coping mechanisms they employed. Methods Feedback from lymphedema patients was obtained using a 19-item questionnaire-based survey distributed to multiple online lymphedema support groups. It focused on the type of lymphedema and its effect on the respondents and sought data to characterize coping mechanisms that individuals with lymphedema use and their effectiveness. Results The respondents (n=400) had a median age of 55 years (range: 18-83 years). The overall mean BMI was 35.8 kg/m2, with respondents with lower extremity (LE) lymphedema having a greater mean BMI (38.4 vs. 31.0, p<0.05). Most of the respondents were female (n=382, 95.5%). LElymphedema was more common (n=280, 70%) than the upper extremity (UE) variant (n=120, 30%). Within the LE group, 99 were unilateral (35.4%) and 181 were bilateral (64.6%). Moderate restriction was the most reported level with 44% in the unilateral group and 64% in the bilateral group. Stretching, low-impact exercise, manual lymphatic drainage (MLD), and compression bandages were the most commonly used coping methods and most of the respondentsrated them as somewhat effective. Of note, 30% of respondents in either group rated increased water intake as either slightly, moderately, or very helpful; 25% of respondents also rated decreased alcohol intake as very helpful. The use of a therapist and familyand doctor support was rated as extremely helpful. Within the UE group, 105 were unilateral (87.5%) and 15 were bilateral (12.5%). The most common cause of UE lymphedema was breast cancer-related (98/120, 81.7%) followed by melanoma treatment. Mild restriction was the most reported level (n=48, 45.7%). The UE group had similar results as the LE group in terms of coping mechanisms, dietary changes, and psychosocial support. Conclusion Based on the experiences of the lymphedema patients surveyed, the management of the condition is multifactorial and hence not compatible with a one-size-fits-all strategy. LE lymphedema was more common than the UE variant; but both groups reported engaging in stretching, low-impact exercise, manual lymphatic drainage, and compression bandages with similar rates of satisfaction reported in both groups. Dietary changes were not commonly employed. Therapy, doctor, and family support were the most commonly used support mechanisms, with high satisfaction among both groups. The overall coping mechanisms and their ratings in terms of efficacy between UE and LE groups were similar although the impact of quality of life was greater for bilateral conditions. We believe our findings represent the first steps to providing information potentially useful to aid future and current lymphedema patients in finding the coping methods that work best for them.