Restricted Group Research Articles

Long-term effects of flexible visitation in the intensive care unit on family members' mental health: 12-month results from a randomized clinical trial.

The aim of this study was to assess the effects of flexible intensive care unit (ICU) visitation on the 1-year prevalence of post-traumatic stress, anxiety and depression symptoms among family members of critically ill patients. This is a long-term outcome analysis of a cluster-crossover randomized clinical trial that evaluated a flexible visitation model in the ICU (12h/day) compared to a restrictive visitation model (median 1.5h/day) in 36 Brazilian ICUs. In this analysis, family members were assessed 12months after patient discharge from the ICU for the following outcomes: post-traumatic stress symptoms measured by the Impact Event Scale-6 and anxiety and depression symptoms measured by the Hospital Anxiety and Depression Scale. A total of 519 family members were analyzed (288 in the flexible visitation group and 231 in the restrictive visitation group). Three-hundred sixty-nine (71.1%) were women, and the mean age was 46.6years. Compared to family members in the restrictive visitation group, family members in the flexible visitation group had a significantly lower prevalence of post-traumatic stress symptoms (21% vs. 30.5%; adjusted prevalence ratio [aPR], 0.91; 95% confidence interval [CI] 0.85-0.98; p = 0.01). The prevalence of anxiety (28.9% vs. 33.2%; aPR 0.93; 95% CI 0.72-1.21; p = 0.59) and depression symptoms (19.2% vs. 25%; aPR, 0.78; 95% CI 0.60-1.02; p = 0.07) did not differ significantly between the groups. Flexible ICU visitation, compared to the restrictive visitation, was associated with a significant reduction in the 1-year prevalence of post-traumatic stress symptoms in family members.

Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones

The 1-year results of the SECURE trial, a randomized trial comparing a restrictive strategy vs usual care for select patients with symptomatic cholelithiasis for cholecystectomy, resulted in a significantly lower operation rate after restrictive strategy. However, a restrictive strategy did not result in more pain-free patients at 1 year. To gauge pain level and determine the proportion of pain-free patients, operation rate, and biliary and surgical complications at the 5-year follow-up. This randomized clinical trial was a multicenter, parallel-arm, noninferiority, prospective study. Between February 2014 and April 2017, patients from 24 hospitals with symptomatic, uncomplicated cholelithiasis were included. Uncomplicated cholelithiasis was defined as gallstone disease without signs of complicated cholelithiasis, ie, biliary pancreatitis, cholangitis, common bile duct stones, or cholecystitis. Follow-up data for this analysis were collected by telephone from July 11, 2019, to September 23, 2023. Patients were randomized (1:1) to receive usual care or a restrictive strategy with stepwise selection for cholecystectomy. The primary, noninferiority end point was proportion of patients who were pain free as evaluated by Izbicki pain score at the 5-year follow-up. A 5% noninferiority margin was chosen. The secondary end points included cholecystectomy rates, biliary and surgical complications, and patient satisfaction. Among 1067 patients, the median (IQR) age was 49.0 years (38.0-59.0 years); 786 (73.7%) were female, and 281 (26.3%) were male. At the 5-year follow-up, 228 of 363 patients (62.8%) were pain free in the usual care group, compared with 216 of 353 patients (61.2%) in restrictive strategy group (difference, 1.6%; 1-sided 95% lower confidence limit, -7.6%; noninferiority P = .18). After cholecystectomy, 187 of 294 patients (63.6%) in the usual care group and 160 of 254 patients (63.0%) in the restrictive strategy group were pain free, respectively (P = .88). The restrictive care strategy was associated with 387 of 529 cholecystectomies (73.2%) compared with 437 of 536 in the usual care group (81.5%; 8.3% difference; P = .001). No differences between groups were observed in biliary and surgical complications or in patient satisfaction. In the long-term, a restrictive strategy results in a significant but small reduction in operation rate compared with usual care and is not associated with increased biliary and surgical complications. However, regardless of the strategy, only two-third of patients were pain free. Further criteria for selecting patients with uncomplicated cholelithiasis for cholecystectomy and rethinking laparoscopic cholecystectomy as treatment is needed to improve patient-reported outcomes. CCMO Identifier: NTR4022.

Subnutrition in different pregnancy stages affects IGF-1 serum concentration, its receptor expression and testicular morphology in pubertal male rats

In order to study the effects of subnutrition during different pregnancy stages on testicle development and its impact on both, IGF-1 serum concentration and its receptor production in Sertoli, Leydig and myoid cells, twenty-four primiparous female Wistar rats (331.9 ± 12.4 g body weight) were mated by the same male rat. Four groups were established: (CC) fed ad libitum during the entire pregnancy, (RC) restricted for days 0–10 of pregnancy, restricted from day 11 of pregnancy till parturition and (CR) restricted during the entire pregnancy (RR). All males from all groups were fed without restrictions since birth until puberty at day 40. During restriction stages, animals were offered 50% of the ad libitum daily food intake. Both, body and testicular weight were affected depending on which pregnancy stage the treatment was applied. On the other hand, IGF-1 production and the total Sertoli cell number was lower at day 40 if the treatment had been applied during either the entire pregnancy or in the second half. IGF-1 receptor expression was affected in Leydig cells if restriction was applied, regardless of which restricted group was studied. However, in myoid cells IGF-1 receptor expression increased when treatment was applied during the entire pregnancy. In conclusion, subnutrition in the different pregnancy stages affects body development, testicular weight and testicular morphology in pubertal male rats.

Reinforced steering Evolutionary Markov Chain for high-dimensional feature selection

The increasing accessibility of extensive datasets has amplified the importance of extracting insights from high-dimensional data. However, the task of selecting relevant features in these high-dimensional spaces is made more difficult due to the curse of dimensionality. Although Evolutionary Algorithms (EAs) have shown promise in the literature for feature selection, creating EAs for high dimensions is still challenging. To address the problem of feature selection in high dimensions, a novel concept of Evolutionary Reinforced Markov Chain is proposed in this paper. The proposed work has the following contributions and merits: (i) The paradigms of evolutionary computation, reinforcement learning, and Markov chain are incorporated into an integrational framework for feature selection in high dimensional spaces in a recursive manner. (ii) To support the global convergence of the algorithm and manage its computational complexity, a restricted group of the most effective agents is maintained within the evolutionary population. (iii) The dynamic Markov chain process efficiently manages agent evolution and communication, ensuring effective navigation through the search space. (iv) Agents moving in the right way are rewarded with an increase in their associated transition probability, while the agents going in the wrong direction are discouraged with a decrease in their associated transition probabilities; this promotes the establishment of an equilibrium state and leads to convergence. (v) The effective size of successful agents is reduced recursively while progressing through different states to further facilitate the speed of convergence and decrease the number of features. (vi) The performance comparison with state-of-the-art feature selection methods shows a significant improvement and promise of the proposed method over the existing methods.

The Effects of Short-Term Electromyostimulation Exercises and Different Diet Types on Body Composition in Obese Women

Obesity is one of the world's most risky health problems with increasing prevalence. This study aimed to investigate the effect of calorie-restricted diet and intermittent fasting diet on body composition with electromyostimulation (EMS) applications in obese females. The study was conducted with 90 obese females. Participants were randomly divided into 5 groups, EMS, EMS+intermittent fasting (EMS+IF), EMS+calorie restricted (EMS+CR), intermittent fasting (IF), and calorie restricted (CR) diet groups. EMS groups received 27min/2g/week EMS exercise protocol for 4 weeks. Furthermore, dietary interventions were conducted with all groups (except EMS). Body composition measurements of the participants were obtained with a bioelectrical impedance device. Two-way repeated measures ANOVA was used to analyze the obtained data. BMI, body mass, and body fat weight decreased significantly in the EMS+IF, and EMS+CR groups compared to the EMS group while skeletal muscle weight decreased dramatically in all four groups compared to the EMS group. In body analysis regional (right-left arm, right-left leg, and trunk) parameters, fat weight decreased significantly in EMS+IF, and EMS+CR groups compared to the other groups. Moreover, muscle mass decreased more in the EMS+CR and EMS+IF groups compared to the other groups. Dietary interventions in the form of CR or IF with EMS significantly affected body composition measurements in obese participants. EMS and IF dietary interventions may be therapeutic tools to combat obesity.Keywords:Calorie-Restricted Diet, Electromyostimulation, Exercise, Intermittent Fasting, Obesity

Levator Ani Muscle Avulsion After Vaginal Delivery Comparing Routine Versus Restrictive Episiotomy: A Pilot Study.

The objective was to compare the rate of levator ani muscle avulsion following vaginal birth after routine and restrictive episiotomy. This study consists of two cohorts of pregnant women prospectively enrolled between September 2015 and December 2017 at a university hospital. The pregnant women were subject to a randomized controlled trial, in which participants received a restrictive episiotomy protocol versus a routine episiotomy protocol for vaginal delivery. Levator ani avulsion was evaluated by four-dimensional ultrasound screening. Sixty-one post-partum primipara women were enrolled in our study. Thirty-two women (52.5%) had undergone routine episiotomy whereas 29 women (47.5%) had gone through restrictive episiotomy. Right mediolateral episiotomies were performed in all cases. The rate of anal sphincter tear was 12.5% in the routine episiotomy group versus 13.8% in the restrictive episiotomy group (p = 1.00). Levator ani avulsion was detected in 9.4% of the routine episiotomy group (only on the right side) and in 10.3% of the restrictive episiotomy group (p = 1.00). No bilateral levator avulsion was detected in either of the groups. There were no statistical differences in the distances of the bladder neck descent, cystocele descent, uterine descent, rectocele descent, and the ballooning of the genital hiatus area between the groups. In our pilot study, there was no reduction of the rate of levator ani avulsion in women with restrictive episiotomy compared with routine episiotomy. There were no differences in pelvic floor ultrasound parameters between the two groups.

Vascular Care Delivery during the COVID-19 Pandemic: Impact of Office-Based Laboratory and Ambulatory Surgery Center

Objective: To evaluate how access to an office-based laboratory (OBL) and ambulatory surgery center (ASC) impacted vascular care during the Coronavirus Disease 2019 (COVID-19) pandemic. Methods: Vascular procedures performed by our group during the 6-week period before COVID-19 restrictions (group 1) and in the first 6-week period during the COVID-19 restrictions (group 2) were reviewed. The number of procedures performed was categorized as hospital inpatient (HIP), hospital outpatient (HOP), OBL, ASC, and vein center (VC). The procedures were also grouped by type: aneurysm (AAA), carotid (CAR), peripheral arterial disease (PAD), amputation/wound care (AMP), vascular access (VA), deep vein thrombosis (DVT), and venous reflux (CVI). The number of healthcare provider contact points for each patient undergoing care at the HOP, OBL, and ASC were also collected and compared between groups 1 and 2. Differences between groups were determined using the two-way ANOVA. Results: There were no statistically significant differences between groups 1 and 2 for procedure location or type of procedure (p > 0.05). Patient contact with healthcare providers decreased between groups 1 and 2 for ambulatory care. However, projecting the number of contacts for patients in group 2 if they had to have ambulatory care in the HOP setting (913) compared to contacts in the OBL and ASC setting (588) was statistically significant (p < 0.05). No patient or staff member at the OBL or ASC developed COVID-19 infection because of the care received at these venues. Conclusions: The ability to provide essential care for patients in an ambulatory environment was enhanced using our OBL and ASC without compromising safety, efficacy, or transmission of the virus to patients or staff during the height of the COVID-19 pandemic and limited their contact with healthcare workers and therefore reduced the consumption of personal protective equipment by healthcare personnel.

Restrictive versus Decision Support Guided Fluid Therapy during Major Hepatic Resection Surgery: A Randomized Controlled Trial.

Fluid therapy during major hepatic resection aims at minimizing fluids during the dissection phase to reduce central venous pressure, retrograde liver blood flow, and venous bleeding. This strategy, however, may lead to hyperlactatemia. The Acumen assisted fluid management system uses novel decision support software, the algorithm of which helps clinicians optimize fluid therapy. The study tested the hypothesis that using this decision support system could decrease arterial lactate at the end of major hepatic resection when compared to a more restrictive fluid strategy. This two-arm, prospective, randomized controlled, assessor- and patient-blinded superiority study included consecutive patients undergoing major liver surgery equipped with an arterial catheter linked to an uncalibrated stroke volume monitor. In the decision support group, fluid therapy was guided throughout the entire procedure using the assisted fluid management software. In the restrictive fluid group, clinicians were recommended to restrict fluid infusion to 1 to 2 ml · kg-1 · h-1 until the completion of hepatectomy. They then administered fluids based on advanced hemodynamic variables. Noradrenaline was titrated in all patients to maintain a mean arterial pressure greater than 65 mmHg. The primary outcome was arterial lactate level upon completion of surgery (i.e., skin closure). A total of 90 patients were enrolled over a 7-month period. The primary outcome was lower in the decision support group than in the restrictive group (median [quartile 1 to quartile 3], 2.5 [1.9 to 3.7] mmol · l-1vs. 4.6 [3.1 to 5.4] mmol · l-1; median difference, -2.1; 95% CI, -2.7 to -1.2; P < 0.001). Among secondary exploratory outcomes, there was no difference in blood loss (median [quartile 1 to quartile 3], 450 [300 to 600] ml vs. 500 [300 to 800] ml; P = 0.727), although central venous pressure was higher in the decision support group (mean ± SD of 7.7 ± 2.0 mmHg vs. 6.6 ± 1.1 mmHg; P < 0.002). Patients managed using a clinical decision support system to guide fluid administration during major hepatic resection had a lower arterial lactate concentration at the end of surgery when compared to a more restrictive fluid strategy. Future trials are necessary to make conclusive recommendations that will change clinical practice.

Substructures of the Weyl group and their physical applications

We study substructures of the Weyl group of conformal transformations of the metric of (pseudo)Riemannian manifolds. These substructures are identified by differential constraints on the conformal factors of the transformations which are chosen such that their composition is associative. Mathematically, apart from rare exceptions, they are partial associative groupoids, not groups, so they do not have an algebra of infinitesimal transformations, but this limitation can be partially circumvented using some of their properties cleverly. We classify and discuss the substructures with two-derivatives differential constraints, the most famous of which being known as the harmonic or restricted Weyl group in the physics literature, but we also show the existence of a lightcone constraint which realizes a proper subgroup of the Weyl group. We then show the physical implications that come from invariance under the two most important substructures, concentrating on classical properties of the energy-momentum tensor and a generalization of the quantum trace anomaly. We also elaborate further on the harmonic substructure, which can be interpreted as partial gauge fixing of full Weyl invariance using BRST methods. Finally, we discuss how to construct differential constraints of arbitrary higher-derivative order and present, as examples, generalizations involving scalar constraints with four and six derivatives.

A De Lellis–Müller type estimate on the Minkowski lightcone

We prove an analogue statement to an estimate by De Lellis–Müller in R3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\mathbb {R}^3$$\\end{document} on the standard Minkowski lightcone. More precisely, we show that under some additional assumptions, any spacelike cross section of the standard lightcone is W2,2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$W^{2,2}$$\\end{document}-close to a round surface provided the trace-free part of a scalar second fundamental form A is sufficiently small in L2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$L^2$$\\end{document}. To determine the correct intrinsically round cross section of reference, we define an associated 4-vector, which transforms equivariantly under Lorentz transformations in the restricted Lorentz group. A key step in the proof consists of a geometric, scaling invariant estimate, and we give two different proofs. One utilizes a recent characterization of singularity models of null mean curvature flow along the standard lightcone by the author, while the other is heavily inspired by an almost-Schur lemma by De Lellis–Topping.

Differential training benefits and motor unit remodeling in wrist force precision tasks following high and low load blood flow restriction exercises under volume-matched conditions

BackgroundBlood flow restriction (BFR) resistance training has demonstrated efficacy in promoting strength gains beneficial for rehabilitation. Yet, the distinct functional advantages of BFR strength training using high-load and low-load protocols remain unclear. This study explored the behavioral and neurophysiological mechanisms that explain the differing effects after volume-matched high-load and low-load BFR training.MethodsTwenty-eight healthy participants were randomly assigned to the high-load blood flow restriction (BFR-HL, n = 14) and low-load blood flow restriction (BFR-LL, n = 14) groups. They underwent 3 weeks of BFR training for isometric wrist extension at intensities of 25% or 75% of maximal voluntary contraction (MVC) with matched training volume. Pre- and post-tests included MVC and trapezoidal force-tracking tests (0–75%–0% MVC) with multi-channel surface electromyography (EMG) from the extensor digitorum.ResultsThe BFR-HL group exhibited a greater strength gain than that of the BFR-LL group after training (BFR_HL: 26.96 ± 16.33% vs. BFR_LL: 11.16 ± 15.34%)(p = 0.020). However, only the BFR-LL group showed improvement in force steadiness for tracking performance in the post-test (p = 0.004), indicated by a smaller normalized change in force fluctuations compared to the BFR-HL group (p = 0.048). After training, the BFR-HL group activated motor units (MUs) with higher recruitment thresholds (p < 0.001) and longer inter-spike intervals (p = 0.002), contrary to the BFR-LL group, who activated MUs with lower recruitment thresholds (p < 0.001) and shorter inter-spike intervals (p < 0.001) during force-tracking. The discharge variability (p < 0.003) and common drive index (p < 0.002) of MUs were consistently reduced with training for the two groups.ConclusionsBFR-HL training led to greater strength gains, while BFR-LL training better improved force precision control due to activation of MUs with lower recruitment thresholds and higher discharge rates.

The spectrum of infections identified in pregnant women with different types of fetal growth restriction

BACKGROUND: Bacterial, viral and protozoal infections can cause miscarriage, antenatal death, congenital organ abnormalities or other limited consequences depending on the pathogen. The role of infection processes identified during pregnancy on placental pathology and fetal growth restriction. AIM: The aim of this study was to conduct a comparative analysis of infections identified in pregnant women with different types of fetal growth restriction, as well as to assess a potential impact of identified infections on the outcomes of fetal growth restriction in newborns in the same groups. MATERIALS AND METHODS: We performed a retrospective analysis of outcomes for 394 pregnant women with an established diagnosis of fetal growth restriction, who had given birth from 2018 to 2022 in the Perinatal Center of the Arkhangelsk Regional Clinical Hospital. Maternal and neonatal case histories were obtained using a continuous sampling method. Considering the transition to new criteria for establishing the diagnosis of fetal growth restriction in Russia, we formed four study groups, of which only 139 cases met the Delphi criteria of clinical guidelines by Russian Society of Obstetricians and Gynecologists, 2021. In the selected groups, we analyzed the results of microscopic and microbiological tests of various localizations in mothers during antepartum examination, as well as postpartum examination of the placenta and culture tests in newborns in their relation to adverse outcomes. RESULTS: A high prevalence (25–70.4%) of positive bacteriological findings was revealed in all of the study groups. The frequency was highest in the group of pregnant women with fetal growth restriction before 32 weeks (90–92%). Combined infections (two or more localizations) were noted in 59.2% of pregnant women in groups with early fetal growth restriction compared to 23.3% in late fetal growth restriction groups. In all cases, we observed a direct relationship between the severity of fetal growth restriction and the prevalence of infections. The range of infections identified during routine examination of pregnant women is quite limited; Candida spp. (from 40.8% in the control group to 75% in the comparison group), Escherichia coli (from 22.9 to 33.3%, respectively), and Chlamydia trachomatis (from 4.5 to 23.5%, respectively) being identified most commonly. In a morphological study of the placenta, infectious and inflammatory lesions were the most significant and ranged from 100 to 81.4% of cases in groups with early and late fetal growth restriction, respectively, with signs of hematogenous transmission prevailed. When analyzing infectious lesions in fetuses, we have found the presence of three and more localizations of the infectious process in 90 to 45% of cases with a fatal outcome for early and late fetal growth restriction, respectively. In the control groups, similar rates were 40 and 15.8%. When assessing the distribution of various types of infectious process in newborns, Candida spp., Escherichia coli, and Enterococcus faecalis also took the lead in all cases. However, the percentage of the same etiology of maternal and neonatal infections turned out to be very low (from 0 to 31% for individual pathogens), which makes it difficult to apply preventive treatment during pregnancy. CONCLUSIONS: Authors identified indirect but numerous signs of significant involvement of infectious processes in the development of fetal growth restriction, especially its early type, as well as the influence of infections on the outcomes for such newborns. In most cases, infectious processes during pregnancy are subclinical. Current screening of pregnant women is insufficient to identify high-risk groups. Examination of pregnant women for infections carried out by culture tests provide low-component and, most likely, incomplete information.

Fluid management for sepsis-induced hypotension in patients with advanced chronic kidney disease: a secondary analysis of the CLOVERS trial

BackgroundEarly fluid management in patients with advanced chronic kidney disease (CKD) and sepsis-induced hypotension is challenging with limited evidence to support treatment recommendations. We aimed to compare an early restrictive versus liberal fluid management for sepsis-induced hypotension in patients with advanced CKD.MethodsThis post-hoc analysis included patients with advanced CKD (eGFR of less than 30 mL/min/1.73 m2 or history of end-stage renal disease on chronic dialysis) from the crystalloid liberal or vasopressor early resuscitation in sepsis (CLOVERS) trial. The primary endpoint was death from any cause before discharge home by day 90.ResultsOf 1563 participants enrolled in the CLOVERS trial, 196 participants had advanced CKD (45% on chronic dialysis), with 92 participants randomly assigned to the restrictive treatment group and 104 assigned to the liberal fluid group. Death from any cause before discharge home by day 90 occurred significantly less often in the restrictive fluid group compared with the liberal fluid group (20 [21.7%] vs. 41 [39.4%], HR 0.5, 95% CI 0.29–0.85). Participants in the restrictive fluid group had more vasopressor-free days (19.7 ± 10.4 days vs. 15.4 ± 12.6 days; mean difference 4.3 days, 95% CI, 1.0–7.5) and ventilator-free days by day 28 (21.0 ± 11.8 vs. 16.5 ± 13.6 days; mean difference 4.5 days, 95% CI, 0.9–8.1).ConclusionsIn patients with advanced CKD and sepsis-induced hypotension, an early restrictive fluid strategy, prioritizing vasopressor use, was associated with a lower risk of death from any cause before discharge home by day 90 as compared with an early liberal fluid strategy.Trial RegistrationNCT03434028 (2018-02-09), BioLINCC 14149.

Effects of Short-Term Nighttime Carbohydrate Restriction Method on Exercise Performance and Fat Metabolism.

The sleep-low method has been proposed as a way to sleep in a low-glycogen state, increase the duration of low glycogen availability and sleep and temporarily restrict carbohydrates to improve exercise performance. However, long-term dietary restriction may induce mental stress in athletes. Therefore, if it can be shown that the effects of the sleep-low method can be achieved by restricting the carbohydrate intake at night (the nighttime carbohydrate restriction method), innovative methods could be developed to reduce weight in individuals with obesity and enhance athletes' performance with reduced stress and in a shorter duration when compared with those of previous studies. With this background, we conducted a study with the purpose of examining the intervention effects of a short-term intensive nighttime carbohydrate restriction method. A total of 22 participants were recruited among university students participating in sports club activities. The participants were assigned at random to groups, including a nighttime carbohydrate restriction group of 11 participants (6 males, 5 females; age 22.3 ± 1.23) who started a carbohydrate-restricted diet and a group of 11 participants (5 males, 6 females; age 21.9 ± 7.9) who continued with their usual diet. The present study had a two-group parallel design. In the first week, no dietary restrictions were imposed on either group, and the participants consumed their own habitual diets. In the second week, the total amount of calories and carbohydrate intake measured in the first week were divided by seven days, and the average values were calculated. These were used as the daily calorie and carbohydrate intakes in the second week. Only the nighttime carbohydrate restriction group was prohibited from consuming carbohydrates after 4:00 p.m. During the two-week study period, all participants ran for one hour each day before breakfast at a heart rate of 65% of their maximum heart rate. The results obtained from young adults participating in sports showed significant differences in peak oxygen consumption (V·O2peak), work rate max, respiratory quotient (RQ), body weight and lean body mass after the intervention when compared with before the intervention in the nighttime carbohydrate restriction group (p < 0.05). Our findings suggest that the nighttime carbohydrate restriction method markedly improves fat metabolism even when performed for a short period. This method can be used to reduce body weight in individuals with obesity and enhance athletes' performance. However, it is important to consider the intake of nutrition other than carbohydrates.

Protective Role of Caloric Restriction versus L-Carnitine on Aluminium Chloride Induced Cognitive Deficit in Rats

Abstract Introduction Alzheimer’s disease (AD) is a worldwide chronic progressive neurodegenerative disease. However, its pathophysiology is still unclear and there is no determined cure for it up till now. Both Acetyl-L-carnitine (ALCAR) and caloric restriction (CR) slow down the aging process. Hypothesis To compare the neuroprotective impacts of ALCAR and CR on aluminum chloride (AlCl3) induced AD in adult male rats to explore the pathogenesis and therapeutic strategies of AD. Materials and Methods Our study was carried out on 67 adult male albino rats that were allocated into 4 groups: Control, AlCl3, AlCl3-Acetyl-L-Carnitine and AlCl3-Caloric Restriction groups. AlCl3 and ALCAR were taken by gavage in a dose of 100 mg/1ml/kg. B.W. and CR was done by 70% of the daily average caloric intake of the control group for 30 days. All rats were subjected to behavioral assessment; open field test (OFT), Y maze, novel object recognition test (NORT) and passive avoidance test (PAT), biochemical assay of serum phosphorylated tau (pTau), hippocampal homogenate phosphorylated adenosine monophosphate kinase (pAMPK), Beclin-1, Bax (Bcl-2-associated X protein), Bcl2 (B-cell lymphoma-2) and Bax/Bcl2 ratio as well as hippocampal histological studies using H&amp;E, Silver stain and Immunohistochemistry (nuclear protein Ki 67 &amp; glial fibrillary acidic protein GFAP). Results The results showed cognitive and behavioral deficits induced by AlCl3 and this were coincident with increased level of serum pTau, aggregated neurofibrillary tangles (NFTs) and senile plaques with increased pAMPK. impaired autophagy and enhanced apoptosis associated with defective neurogenesis and defective astrocyte activation. Conclusion ALCAR and CR partially improved the AlCl3 induced behavioral, cognitive, biochemical and histological changes, with more ameliorative effect of ALCAR on hippocampal apoptotic markers, with more obvious behavioral and histological improvement with CR.

Transfusion strategy trials excluding patients transfused outside the trial study period are more likely to report a trend favoring restrictive strategies: a meta-analysis

ObjectivesSome large, randomized trials investigating red cell transfusion strategies have significant numbers of transfusions administered outside the trial study period. We sought to investigate the potential impact of this methodological issue. Study Design and SettingMeta-analysis of randomized controlled trials (RCTs) comparing liberal vs restrictive transfusion strategies in cardiac surgery and acute myocardial infarction patients. The outcome of interest was 30-day or in-hospital mortality. ResultsIn cardiac surgery, the pooled risk ratio for mortality was 0.83 (95% confidence interval [CI] 0.62-1.12, P = .22) times lower in the restrictive group when compared to the liberal group in trials applying a transfusion strategy throughout the patient's entire perioperative period, and 1.33 (95% CI 0.84-2.11, P = .22) times higher in the restrictive group in trials not applying transfusion strategies throughout the entire perioperative period. When combined, the risk ratio for mortality was 0.98 (95% CI 0.73-1.32, P = .89). In patients with acute myocardial infarction, the risk ratio for mortality was 0.72 (95% CI 0.40-1.28, P = .26) times lower in the restrictive group when compared to the liberal group in 1 trial excluding patients administered the intervention prerandomization and 1.19 (95% CI 0.96-1.47, P = .11) times higher in the restrictive group in 1 trial including patients receiving the intervention prerandomization. When combined the risk ratio for mortality was 1.00 (0.62-1.59, P = .99). ConclusionThough not statistically significant, there was a consistent difference in trends between RCTs administering significant numbers of transfusion outside the trial study period compared to those that did not. The implications of our results may extend to RCTs in other settings that ignore if and how frequently an investigated therapy is administered outside the trial window.

Long-term intermittent caloric restriction remodels the gut microbiota in mice genetically prone to breast cancer

ObjectivesGut microbiota dysbiosis is among the risk factors for breast cancer development, together with genetic background and dietary habits. However, caloric restriction has been shown to remodel the gut microbiota and slow tumor growth. Here, we investigated whether the gut microbiota mediates the preventive effects of long-term chronic or intermittent caloric restriction on breast cancer predisposition. Methods10-week-old transgenic breast cancer-prone mice were randomly assigned to dietary groups (ad libitum, chronic caloric restriction, and intermittent caloric restriction groups) and fed up to week 81. Stool samples were collected at weeks 10 (baseline), 17 (young), 49 (adult), and 81 (old). 16S rRNA gene sequencing was performed to identify the gut microbiota profile of the different groups. In order to investigate the breast cancer gut microbiota profile within genetically predisposed individuals regardless of diet, mammary tumor-bearing mice and mammary tumor-free but genetically prone mice were selected from the ad libitum group (n = 6). ResultsIntermittent caloric restriction increased the microbial diversity of adult mice and modified age-related compositional changes. A total of 13 genera were differentially abundant over time. Pathogenic Mycoplasma was enriched in the re-feeding period of the old intermittent caloric restriction group compared with baseline. Furthermore, mammary tumor-free mice showed shared gut microbiota characteristics with mammary tumor-bearing mice, suggesting an early link between genetic predisposition, gut microbiota, and breast cancer development. ConclusionsOur study revealed the role of gut microbes in the preventive effects of caloric restriction against breast cancer development, implying the significance of diet and microbiome interplay.

The effect of liver surgery and fluid strategy on renin activity and aldosterone and anti-diuretic hormone levels: a secondary analysis of the GALILEO trial

BackgroundIt is unknown whether liver surgery leads to increased RAAS activity and anti-diuretic hormone (ADH) levels and subsequent fluid accumulation. Furthermore, it is unknown whether the peri-operative fluid strategy changes this effect. MethodsThis is a pre-planned post hoc analysis of a randomised controlled trial which compared restrictive (n = 20) versus liberal fluid strategy (n = 20) in patients undergoing liver surgery. Primary outcomes for the current study were the difference in hormone levels after anaesthesia induction and after liver resection. Fluid overload was defined as a ≥10% increase in weight. ResultsRenin activity (6 [2.1–15.5] vs. 12 [4.6–33.5]) and ADH levels (6.0 [1.7–16.3] vs. 3.8 [1.6–14.7]) did not differ significantly before and after resection. However, aldosterone levels were significantly higher after resection (0.30 [0.17–0.49] vs. 0.69 [0.31–1.21] ). Renin activity and aldosterone levels did not differ between the groups. ADH was significantly higher in the restrictive strategy group (1.6 [1.1–2.1] vs 5.9 [3.8–16.0]). No differences in hormone levels were found in patients with and without fluid overload. DiscussionAldosterone levels increased after liver surgery but renin activity and ADH levels did not. ADH levels were higher in the restrictive group. Development of post-operative fluid overload was not associated with RAAS activity or ADH levels.

Response to Hyperthermia and Hypoxia Stress during Compensatory Growth in Penaeus vannamei

This study evaluated oxidative stress and resistance to abiotic stress factors of juvenile Penaeus vannamei during compensatory growth. Shrimp underwent two dietary treatments in a 50-day experiment: a reference group (REF) fed ad libitum and a restricted group (T50) fed 50% of the REF diet for 10 days, followed by 40 days of ad libitum refeeding. During refeeding, shrimp from both groups were exposed to two abiotic challenges: 1) hyperthermia (34°C) for 12 hours and 2) hypoxia (1.5 mgO2 L-1) for 9 hours, followed by reoxygenation for 3 hours (5 mgO2 L-1). Compensatory growth in the T50 group was evidenced by increased specific growth rate, hyperphagia, and improved feed efficiency. Moreover, the malondialdehyde content (MDA) and catalase activity in the shrimp hepatopancreas increased during compensatory growth, indicating oxidative stress. This result converges with the increased metabolism assessed by metabolic chambers. While hyperthermia caused oxidative stress, as indicated by the increase in MDA content in both groups, shrimp under compensatory growth demonstrated similar resistance to the REF group. Exposition to hypoxia and reoxygenation did not generate significant oxidative stress. Compensatory growth induced oxidative stress in P. vannamei without compromising resistance to hyperthermia or hypoxia events.

Ductus arteriosus diameters in fetuses with early- and late-onset fetal growth restriction.

Fetal growth restriction (FGR) is a common pregnancy complication that can be associated with several adverse perinatal outcomes. One of these negative outcomes is ductus arteriosus, especially in preterm babies. In this study, intrauterine heart function and ductus diameter were evaluated in babies with FGR. Thirty-seven fetuses with FGR were compared with 37 normal-weight fetuses at the same gestational week. In our study, ventricular diameters, aorta, pulmonary artery, ductus arteriosus (DA), aortic arch diameter, and flow traces were examined. In addition, the aorta and aortic isthmus diameters were proportioned to the ductus diameter, and the left ventricular myocardial performance index (MPI) [(ICT + IRT)/ET] was evaluated. There was no difference in DA diameters between the patient and control groups. The intragroup comparison of the cases with early- and late-onset FGR revealed no statistically significant difference between DA diameters. However, the ratios of the aortic annulus diameter/ductus diameter (AOD/DAD) and aortic isthmus diameter/ductus diameter (AID/DAD) were significantly lower in early-onset FGR because the diameter of the DA was greater. In addition, the mod-MPI values were higher in the patient group. In our study, although the ductal diameters did not change significantly in the patient group, the ductal diameter was greater in the early-onset intrauterine growth restriction (FGR) group compared with other cardiac measurements. The mod-MPI value, a cardiac function indicator, was higher in fetuses with FGR. These findings may be useful for evaluating postnatal cardiac functions in FGR.