Restricted Group Research Articles

The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma.

The efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase. This cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%. The 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days. Although non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.

Evaluation of Inferior and Superior Vena Cava and the Vena Cava Ratio in Growth Restricted Fetuses.

To evaluate the changes in the diameters of superior vena cava (SVC) and inferior vena cava (IVC) and to measure the ratio between SVC and IVC in growth-restricted fetuses and compare these results with normally grown fetuses. Twenty-three consecutive patients with fetal growth restriction (FGR) (Group I) and 23 pregnant gestational age-matched controls (Group II) between 24 and 37 weeks of gestation were enrolled in the study between January 2018 and October 2018. The diameter of the SVC and IVC from inner wall to inner wall was measured in all patients by sonographic examination. The ratio between the diameter of the SVC and IVC was also measured in each patient to eliminate the gestational age factor. We have named this ratio the "vena cava ratio" (VCR). All parameters were compared between the two groups. The diameter of the SVC was significantly greater in the fetuses with FGR (2.6-7.7 [5.4]) than in controls (3.2-5.6 [4.1]; P = .002; P < .01). The diameter of the IVC was significantly less in the fetuses with FGR (1.6-4.5 [3.2]) than in controls (2.7-5 [3.7]; P = .035; P < .05). The VCR was between 1.1 and 2.3 and the median value was 1.8 in Group I. The VCR was between 0.8 and 1.7 and the median value was 1.2. VCR was significantly higher in fetuses with FGR (P = .001 P < .01). This study shows that VCR is higher in fetuses with growth restriction. Further studies are needed to clarify the association between VCR and antenatal prognosis and postnatal results.

Comparative Analysis of the Growth Rate, Body Weight Gain, and Feed Conversion Ratio of Broilers Raised Under Ad Libitum and Restricted Feeding Programs

Background: Among the various feeding strategies employed, two predominant methods have emerged as the primary focus of research and industry implementation: ad libitum and restricted feeding programs.&#x0D; Objectives: This comparative study aimed to assess the growth rate, body weight gain, and feed conversion ratio (FCR) of broilers raised under ad libitum and restricted feeding programs.&#x0D; Methods: A total of 350-day-old broiler chicks were assigned to two groups. The broilers under ad libitum feeding exhibited higher growth rates throughout the six-week study period, with average weight gains of 165.2 grams, 427.5 grams, 864.7 grams, 1405.5 grams, 2008.8 grams, and 2330.7 grams in successive weeks. In contrast, the broilers under restricted feeding showed lower growth rates, ranging from 140.7 grams to 2020.1 grams in the corresponding weeks.&#x0D; Results: The ad libitum group also consumed consistently higher amounts of feed compared to the restricted group. However, there were no statistically significant differences in FCR between the two feeding programs.&#x0D; Conclusion: These findings highlighted the importance of providing broilers with continuous access to feed to optimize their growth, while further research is needed to validate the results and explore FCR variations.

Effect of yoga on anthropometry, quality of life, and lipid profile in patients with obesity and central obesity: A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis aimed to determine the effectiveness of yoga on anthropometry, quality of life, and lipid profiles in patients with obesity and central obesity. MethodologyThe Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed (1985-January 2022) and trial registries for relevant randomised clinical trials were used. Relevant and published randomised clinical trials were reviewed and evaluated. The primary outcomes were anthropometry measurements, which were weight, waist circumference, body mass index (BMI), and body fat percentages. The secondary outcomes were changes in quality of life, psychological impact, lipid profile measurement, presence of adverse events, and changes in blood pressure and blood glucose. We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. Results15 studies are included, involving 1161 participants. The analysis performed is based on three comparisons. For the first comparison between yoga and control, yoga reduces the waist circumference (MD −0.84, 95% CI [−5.12 to 3.44]), while there is no difference in body weight, BMI, or body fat percentages. In the second comparison between yoga and calorie restriction, yoga reduces body weight (MD −3.47, 95% CI [−6.20 to −0.74]), while there is no difference in waist circumference, BMI, or body fat percentage. In the third comparison between yoga and exercise, yoga reduces the body weight (MD −7.58, 95% CI [−11.51 to −3.65]), while there is no difference in waist circumference or BMI. For the secondary outcomes, yoga intervention reduces total cholesterol (MD −17.12, 95% CI [−32.24 to −2.00]) and triglycerides (MD −21.75, 95% CI [−38.77 to −4.73]) compared to the control group, but there is no difference compared to the calorie restriction and exercise group. There is no difference in the rest of the outcomes, which are LDL, HDL, quality of life, psychological impact, adverse events, blood pressure, and blood glucose. However, findings are not robust due to a high risk of bias and low-quality evidence. ConclusionFrom our review, there were methodological drawbacks and very low to moderate quality of evidence across all comparisons, and hence, it is inconclusive to say that yoga can significantly improve anthropometric parameters. More well-designed trials are needed to confirm and support the beneficial effects of yoga.

Controlling Inputter Variability in Vignette Studies Assessing Web-Based Symptom Checkers: Evaluation of Current Practice and Recommendations for Isolated Accuracy Metrics.

The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs' performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability. This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance. Healthily's SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). κ statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs. Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%. We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics.

Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates.

Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.

The effect of restrictive vs. liberal fluid protocols on ocular parameters in patients undergoing prone spine surgery: a randomized controlled trial

BackgroundElevated intraocular pressure (IOP) and optic nerve edema occurring during prone surgeries may cause ocular and optic nerve ischaemia injury. We hypothesized that a liberal fluid protocol might further increase IOP and optic nerve sheath diameter (ONSD) than a restrictive fluid protocol for patients in the prone position.MethodsA single-centre, prospective and randomized trial was conducted. Patients were randomly allocated into 2 groups: the liberal fluid infusion group, in which repeated bolus doses of Ringer’s lactate solution were given to maintain pulse pressure variation (PPV) within 6~9%, and the restrictive fluid infusion group, where PPV was maintained within 13–16%. IOP and ONSD were measured in both eyes at 10min after the anaesthesia induction in the supine position, 10min after the prone position placement, and 1h and 2h since the prone position was placed, at the conclusion of surgery, and returned to the supine position.ResultsA total of 97 patients were recruited and completed the study. IOP increased significantly from 12±3mmHg in the supine position to 31±5 mmHg (p<0.001) at the end of surgery in the liberal fluid infusion group and from 12±2 to 28±4 mmHg (p<0.001) in the restrictive fluid infusion group. There was a statistically significant difference in the change of IOP over time between the two groups (p=0.019). ONSD increased significantly from 5.3±0.3mm in the supine position to 5.5±0.3mm (p<0.001) at the end of surgery in both groups (both p<0.001). There was no statistically significant difference in the change of ONSD over time between the two groups (p>0.05).ConclusionsCompared to the restrictive fluid protocol, the liberal fluid protocol increased IOP but not ONSD in patients undergoing prone spine surgery.Trial registrationThe study was registered in ClinicalTrials.gov (https://clinicaltrials.gov) prior to patient enrollment, ID: NCT03890510, on March 26, 2019. The principal investigator was Xiao-Yu Yang.

Complexity and pitfalls in maximal exercise testing for persons with multiple sclerosis.

Valid measurements of cardiorespiratory fitness in persons with multiple sclerosis (pwMS) are essential during inpatient rehabilitation for a precise evaluation of the current health status, for defining appropriate exercise intensities, and for evaluation of exercise intervention studies. We aim (i) to examine the proportion of pwMS that attain the American College of Sports Medicine (ACSM) criteria for maximal effort during graded cardiopulmonary exercise testing (CPET), and (ii) to provide insight into participant characteristics that limit maximal exercise performance. This cross-sectional study comprises a retrospective examination of ACSM criteria for maximal effort during graded CPET of n=380 inpatient pwMS (mean age: 48±11 years; 66% female). Chi-square or Fisher's exact tests were conducted to compare differences in the distribution of criteria achieved. Participants' characteristics were examined as potential predictors using binary logistic regression. Only 60% of the overall sample attained a respiratory exchange ratio ≥1.10. With regard to the definition applied, only 24% or 40% of the participants achieved an oxygen consumption plateau, and 17% or 50% attained the heart rate criterion. Forty-six per cent met at least two out of three criteria. The disability status, gender, disease course and body mass index were associated with the attainment of maximal effort. Our findings suggest that a relevant proportion of inpatient pwMS do not attain common criteria utilized to verify maximal oxygen consumption. Identified predictors for criteria attainment can be used to create models to predict cardiorespiratory fitness and to optimise CPET protocols in restrictive groups of pwMS.

The Optimal Fluid Strategy Matters in Liver Surgery: A Retrospective Single Centre Analysis of 666 Consecutive Liver Resections.

As optimal intraoperative fluid management in liver surgery has not been established, we retrospectively analyzed our fluid strategy in a high-volume liver surgery center in 666 liver resections. Intraoperative fluid management was divided into very restrictive (<10 m kg-1 h-1) and normal (≥10 mL kg-1 h-1) groups for study group characterization. The primary endpoint was morbidity as assessed by the Clavien-Dindo (CD) score and the comprehensive complication index (CCI). Logistic regression models identified factors most predictive of postoperative morbidity. No association was found between postoperative morbidity and fluid management in the overall study population (p = 0.89). However, the normal fluid management group had shorter postoperative hospital stays (p = <0.001), shorter ICU stays (p = 0.035), and lower in-hospital mortality (p = 0.02). Elevated lactate levels (p < 0.001), duration (p < 0.001), and extent of surgery (p < 0.001) were the most predictive factors for postoperative morbidity. In the subgroup of major/extreme liver resection, very low total (p = 0.028) and normalized fluid balance (p = 0.025) (NFB) were associated with morbidity. Moreover, fluid management was not associated with morbidity in patients with normal lactate levels (<2.5 mmol/L). In conclusion, fluid management in liver surgery is multifaceted and must be applied judiciously as a therapeutic measure. While a restrictive strategy appears attractive, hypovolemia should be avoided.

A new type restricted quantum group

In this paper, we define a new type restricted quantum group Ūq(sl2*) and determine its Hopf Poincaré-Birkhoff-Witt-deformations Ūq(sl2*,κ) in which Ūq(sl2*,0)=Ūq(sl2*) and the classical restricted Drinfeld–Jimbo quantum group Ūq(sl2) is included. We show that Ūq(sl2*) is a basic Hopf algebra, then uniformly realize Ūq(sl2*) and Ūq(sl2) via some quotients of (deformed) preprojective algebras corresponding to the Gabriel quiver of Ūq(sl2*). Moreover, we obtain a uniform tensor-categorical realization of Ūq(sl2*) and Ūq(sl2), which is consistent with the above-mentioned Hopf-algebraic realization.

Effect of ad libitum feeding of Holstein Friesian calves on immunological parameters and molecular stress on a transcriptional level

Our aim was to compare the health and performance of ad libitum (ADLIB) and restrictedly fed Holstein Friesian heifer calves. Calves were selected to ADLIB (n = 13) and control (n = 13) groups randomly. The period of ADLIB feeding lasted for 3 weeks after colostrum supplementation. The calves in the control group received the same milk replacer, which was supplied according to the restrained feeding schedule of the farm. There was no difference between the two groups in weight, weight gain or movement activity, furthermore in the values of glucose, albumin, total protein, BHB, AST, oxidant and antioxidant status incl. dROM, PAT and OSI. The IL8 gene had higher levels (non significant, p > 0.05) of expression in the ADLIB group during the first 20 days of life, which indicates that ADLIB feeding might potentiate a stronger immune response to environmental stress. The IGF1 gene showed increased expression in the ADLIB fed group at almost all time points, however the difference was already detected on the first day of the study, indicating the importance of individual differences even within the same breed. During the first 10 days INS expression was higher in the restricted group, followed by a shift by day 20 and after, when the ADLIB group showed a higher relative expression level. The observed values describe a trend that, although not significant (p > 0.05), would seem to indicate that ADLIB feeding might potentiate a stronger immune response to environmental stress.

Tax Confidentiality as a Limitation in the Procedure for Public Control of the State of Public Finances

AbstractAny control, regardless of the field to which it relates, requires information. This claim is also valid in the field of citizen’s control. For an individual to be able to effectively assess what is going on around him or her and make sound decisions on that basis, he or she must be able to obtain a variety of information, including, above all, information that is comprehensive public knowledge. According to what follows from the regulations of the Act of 6 September 2001 on access to public information, their catalogue is broad and, more importantly, open. Although on the surface it might seem that the individual does not need anything more, it should not be forgotten that the same legislator determines a number of restrictions that block or completely close the way to certain pieces of public information. This group of statutory restrictions includes tax confidentiality as defined by the Tax Ordinance Act of 29 August 1997. The main objective of the considerations undertaken in this article is to determine to what extent tax confidentiality by its very nature restricts the process of public scrutiny of the state of public finances, taking into account its subjective and objective scope and its positioning among all the premises limiting accessibility to public knowledge.

Relationship of the Hennings and Witten–Reshetikhan–Turaev invariants for higher rank quantum groups

The Hennings invariant for the small quantum group associated to an arbitrary simple Lie algebra at a root of unity is shown to agree with the Witten–Reshetikhin–Turaev (WRT) three-manifold invariant arising from Chern–Simons field theory for the same Lie algebra and the same root of unity on all integer homology three-spheres, at roots of unity where both are defined. This partially generalizes the work of Chen et al. [On the relation between the WRT invariant and the Hennings invariant, Math. Proc. Cambridge Philos. Soc. 146(1) (2009) 151–163; Three-manifold invariants associated with restricted quantum groups, Math. Z. 272(3–4) (2012) 987–999] which relates the Hennings and WRT invariants for [Formula: see text] and [Formula: see text] for arbitrary rational homology three-spheres.

DASH VS. MEDITERRANEAN DIET ON A SALT RESTRICTION BACKGROUND IN ADULTS WITH HIGH NORMAL BLOOD PRESSURE OR GRADE 1 HYPERTENSION: A RANDOMIZED CONTROLLED TRIAL

Objective: Non-pharmacological measures are recommended as the first-line treatment for individuals with high-normal blood pressure (BP) or mild hypertension. Studies directly comparing the BP effects of the Dietary Approaches to Stop Hypertension (DASH) vs. the Mediterranean diet (MedDiet) on a salt restriction background are currently lacking. Thus, our purpose was to assess the BP effects of a 3-month intensive dietary intervention implementing salt restriction either alone or in the context of the DASH, and the MedDiet compared to no/ minimal intervention in adults with high normal BP or grade 1 hypertension. Design and method: We randomly assigned never drug-treated individuals to a control group (CG, n = 60), a salt restriction group (SRG, n = 60), a DASH diet with salt restriction group (DDG, n = 60), or a MedDiet with salt restriction group (MDG, n = 60). The primary outcome was the attained office systolic BP difference among the randomized arms at the end of the study. Results: A total of 240 patients were enrolled, while 204 (85%) completed the study. According to the intention-to-treat analysis, compared to the CG, office and 24h ambulatory systolic and diastolic BP were reduced in all intervention groups. A greater reduction in the mean office systolic BP was observed in the MDG compared to all other study groups (MDG vs. CG: mean difference = -15.1 mm Hg; MDG vs. SRG: mean difference = -7.5 mm Hg, and MDG vs. DDG: mean difference = -3.2 mm Hg, all P-values &lt; 0.001). The DDG and the MDG did not differ concerning the office diastolic BP and the 24h ambulatory systolic and diastolic BP; however, both diets were more efficient in BP-lowering compared to the SRG. Conclusions: On a background of salt restriction, the MedDiet was superior in office systolic BP-lowering, but the DASH and MedDiet reduced BP to an extent higher than salt restriction alone. Registration number: NCT05669404

0211 Experimental Sleep Restriction, Moral Absolutism, and Religiosity

Abstract Introduction Moral absolutism is the notion that “rights” and “wrongs” are independent of situational circumstances, and it is a core philosophy of many religious traditions. We tested whether active church members and Christian pastors showed resiliency to mild sleep restriction when reporting religious beliefs/cognitions, when logging spiritual behaviors, and when judging the deserved-punishments for moral mistakes. Methods We recruited 92 adults who identified as active in Christian churches (members and pastors). On a Monday, participants completed baseline religiosity, mood, and cognitive functioning measures and were then randomly assigned to adhere to early (10:30pm) or late (1:30am) bedtimes for four nights, with 7:30am waketimes, while wearing actigraphy and keeping a daily diary of spiritual behaviors. On Friday, participants repeated the baseline assessments, responded whether a series of biblical stories were literal versus figurative, and rated a series of vignettes about moral mistakes that were committed by in-group leaders (pastors) and out-group leaders (imams; vignettes counterbalanced). Results The late bedtime condition reduced actigraphy-defined sleep by 85 min/night (p&amp;lt;.001). Despite spending more time awake, this sleep restricted group reported engaging in fewer spiritual behaviors during the week (e.g., prayer time; p&amp;lt;.01). On Friday, the sleep restricted group had worse mood disturbances (p&amp;lt;.001), worse subjective sleepiness (p&amp;lt;.001), and altered perceptions of the meaning of the Garden of Eden and Noah’s ark biblical stories (p&amp;lt;.05). Fluid intelligence was unaffected (p=.78). When evaluating religious leaders who made moral mistakes, the sleep restricted participants were significantly less forgiving (p&amp;lt;.01); for example, well-rested participants thought such leaders were still “somewhat likely” to get into Heaven, but sleep-restricted participants rated the leaders as “not very likely” to get into Heaven (p&amp;lt;.01). The effects of sleep restriction were most prominent in participants who most frequently attended religious services and when rating out-group religious leaders (r = -.49; opposite patterns were noted when participants were well-rested). Conclusion In contrast to moral absolutism philosophies, very mild sleep restriction produced significant changes to religious cognitions (story interpretation), spiritual behaviors, and expressions of beliefs (likeliness of getting into Heaven), and expressions of virtues (decreased forgiveness). Support (if any) URSA Grant and National Science Foundation (1920730, 1943323).

Importance of Tissue Doppler Evaluation in Dilated Cardiomyopathy: The Value of Diastolic Filling Pattern as a Prognostic Predictor.

(1) Background: The presence of restrictive left ventricular diastolic filling pattern (LVDFP) is associated with an unfavorable prognosis in many cardiac diseases, but few data are available on the prognostic implications of this pattern in patients with dilated cardiomyopathy (DCM). We aimed to establish the main prognostic predictors at the 1- and 5-year follow-ups in DCM patients and the value of restrictive LVDFP in increasing morbidity and mortality. (2) Methods: A prospective study of 143 patients with DCM divided in non-restrictive LVDFP group (95 patients) and restrictive group (47 patients). The patients were evaluated at a 5-year follow-up through an in-patient visit during the pre-pandemic period and hybrid methods (face-to-face, teleconsultation and home monitoring with a telemedicine application) during the pandemic period. Statistical analysis compared the two groups in terms of NYHA class, quality of life, hospitalizations/emergency department (ED) visits due to HF exacerbation and total mortality. (3) Results: The mortality rate in the restrictive group was markedly higher than that in the non-restrictive group at 1 year (17.02% vs. 10.59%, respectively, p < 0.05) and at 5 years (68.08% vs. 50.53%, p < 0.05). In the restrictive group, hospitalizations/ED visits due to HF decompensations at 1 year were significantly higher (85.11% vs. 57.89%, p < 0.05), with hospitalizations for ventricular arrhythmia being almost three times higher (21.28% vs. 7.37%, respectively, p < 0.05). The percentage of patients with a favorable evolution (in terms of NYHA class and quality of life) at the 1- and 5-year follow-ups were higher in the non-restrictive LVDFP group. The main prognostic predictors in patients with DCM at the 1-year follow-up were: restrictive LVDFP, age > 75 years, markedly dilated LV, comorbidities (DM, COPD), 2nd-degree mitral regurgitation and severe pulmonary hypertension (p < 0.05). (4) Conclusions: At the 1- and 5-year follow-ups, the presence of the restrictive LVDFP in DCM patients was independently associated with a poor prognosis, being the best clinical predictor for unfavorable evolution, after adjustment for other well-established predictive parameters in DCM patients.

Effect of Roselle Flower Extract (Hibiscus sabdariffa Linn.) on Reducing Steatosis and Steatohepatitis in Vitamin B12 Deficiency Rat Model.

Background and Objectives: Non-alcoholic Fatty Liver Disease (NAFLD) can occur as a result of micronutrient deficiencies. Hibiscus sabdarifa, a plant used in traditional medicine, contains ingredients that can help prevent this process. This study looked at the potency of Hibiscus sabdariffa Ethanol Extract (HSE) to prevent homocysteine-induced liver damage in animals that were deficient in vitamin B12. Materials and Methods: A comparative study of the effects of roselle extract is presented in an experimental design. Thirty Sprague-Dawley rats were divided into six groups using randomization. To demonstrate the absence of liver damage in the experimental animals under normal conditions, a control group was fed a normal diet without HSE. For the induction of liver damage in the experimental animals, the vitamin B12-restricted group was administered a vitamin B12-restricted diet. To test the effect of HSE on liver damage, the treatment group was given HSE along with a vitamin B12-restricted diet. Each group was given two treatment periods of eight and sixteen weeks. These results were compared with the results of the parameter examination between the vitamin B12 restriction group, with and without HSE, using an ANOVA statistic. The data were analyzed with licensed SPSS 20.0 software. Results: HSE significantly increased the blood levels of vitamin B12 while lowering homocysteine levels. The administration of HSE reduced liver damage based on the activity of liver function enzymes in the plasma due to a limitation of vitamin B12. HSE decreased Sterol Regulatory Element-Binding Protein-1c (SREBP1c) and Nuclear Factor Kappa B (NFkB) protein expressions in the liver tissue, but did not decrease Glucose-Regulated Protein 78 (GRP78) protein expression. Significantly, the levels of Tumor Necrosis Factor alpha (TNF-a) and IL-6 in the liver tissue were lower, while the levels of IL-10 and Nuclear factor-erythroid-2 Related Factor 2 (NRF2) were higher with HSE administration. HSE produced a better histopathological profile of the Hematoxylin and Eosin (H&E)-Masson tricrome for inflammation, fat and fibrosis in the liver. Conclusions: In this study, HSE was found to slow the development of liver damage in experimental animals that were given a vitamin B12-deficient diet.

Alternate-day modified fasting diet improves weight loss, subjective sleep quality and daytime dysfunction in women with obesity or overweight: a randomized, controlled trial.

Both sleep time and quality can be associated with overweight or obesity. In obese people, visceral fat tissue develops, which results in an increment in the production of cytokines. The increased production of inflammatory cytokines can disturb the sleep/wake cycle. Therefore, weight loss by reducing fat tissue can improve sleep disorders. Intermittent fasting diets are popular and effective diets that can decrease body weight and improve anthropometric data and body composition. The present study aimed to evaluate the effect of Alternate-day Modified Fasting (ADMF) on sleep quality, body weight, and daytime sleepiness. Classification of 56 obese or overweight women, based on age and body mass index (BMI), was done using stratified randomization. Then individuals were assigned to the ADMF group (intervention) or Daily Calorie Restriction (CR) group (control) using the random numbers table for 8 weeks. We measured the Pittsburgh sleep quality Index (PSQI), weight, BMI, and the Epworth sleepiness scale (ESS) as primary outcomes and assessed subjective sleep quality (SSQ), sleep latency, sleep disturbances, habitual sleep efficiency, daytime dysfunction, and sleep duration as secondary outcomes at baseline and after the study. Following an ADMF diet resulted in a greater decrease in weight (kg) [-5.23 (1.73) vs. -3.15 (0.88); P < 0.001] and BMI (kg/m2) [-2.05 (0.66) vs. -1.17 (0.34); P < 0.001] compared to CR. No significant differences were found in the changes of PSQI [-0.39 (1.43) vs. -0.45 (1.88); P = 0.73] and ESS [-0.22 (1.24) vs. -0.54 (1.67); P = 0.43] between two groups. Also, following the ADMF diet led to significant changes in SSQ [-0.69 (0.47) vs. -0.08 (0.40); P = <0.001], and daytime dysfunction [-0.65 (0.57) vs. 0.04 (0.75); P: 0.001] in compare with CR diet. These results suggested that an ADMF could be a beneficial diet for controlling body weight and BMI. The ADMF diet didn't affect PSQI and ESS in women with overweight or obesity but significantly improved SSQ and daytime dysfunction. The Iranian Registry of Clinical Trials (IRCT20220522054958N3), https://www.irct.ir/trial/64510.

Effect of a Reduced-Calorie Diet on Plasma Levels of Inflammatory and Metabolic Factors in Overweight/Obese Patients with Cardiovascular Risk Factors.

Calorie restriction without malnutrition is likely to improve cardiovascular risk factors. The aim of this study was to investigate calorie restriction on markers of cardiometabolic risk in overweight/obese adults with cardiovascular risk factors. In a parallel controlled trial, patients with overweight or obesity and one or more cardiovascular risk factor were randomized to a modest reduced-calorie diet (75% of the total calculated energy requirements) or control (no calorie restriction) groups and followed up for two months. Body weight, dietary intake, fasting plasma levels of C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), brain-derived neurotrophic factor (BDNF), neuropeptide Y (NPY), lipids, and glycemic factors were measured at baseline, and after two months. The differences were analyzed with analysis of covariance (ANCOVA). Sixty-six participants (33 in each group) completed the study. Body weight changed in the reduced-calorie diet group (- 3.05 ± 2.65 kg), and blood pressure was improved (systolic -6.96 ± 12.04 and diastolic - 3.90 ± 8.97 mmHg). The reduced-calorie diet improved plasma ICAM-1 (change from baseline - 0.45 ± 1.99 ng/mL, P = 0.033, ANCOVA), MCP-1 (change from baseline - 0.50 pg/mL, P = 0.011, ANCOVA), low-density lipoprotein cholesterol (change from baseline - 9.35 ± 19.61 mg/dL, P < 0.001, ANCOVA), and triglyceride (change from baseline -33.66 ± 49.08, P = 0.001, ANCOVA), but BDNF, NPY, and other cardiometabolic factors were not different. In overweight/obese subjects with cardiovascular risk factors which have been under medical treatment with risk-reducing medications, a modest weight loss induced by a reduced-calorie diet improved lipid profile, blood pressure, and reduced ICAM-1 and MCP-1 levels but had no effect on plasma BDNF or glycemic factors.

Associations between biopsychosocial factors and transportation patterns of older adults residing in Klang Valley, Malaysia.

Aging is associated with physiological changes in multiple systems in the body and may impact the transportation choices of older adults. In this study, we examine the associations between biopsychosocial factors and the transportation choices of Malaysian older adults. One hundred and nineteen (119) older adults, aged 60 and above, living in Klang Valley, Malaysia were recruited for this cross-sectional study. Participants were interviewed face-to-face to obtain sociodemographic data, health status (whether there were and, if yes, the number of comorbidities), outdoor mobility and transportation patterns, Instrumental Activity Daily Living (IADL) status and cognitive function. Participants' physical performance (dominant handgrip strength, 10-m walk, and timed up and go tests), hearing threshold (pure tone audiometry), and vision function (visual acuity, contrast sensitivity) were measured. Transportation patterns of older adults were categorized into three groups, that is, flexible (using public transport and/or private vehicles), using only private vehicles and restricted (relying on others or walking). Further information is needed to enable such older adults as older women, those with comorbidities and poorer functional status to access transportation, especially to meet their health care needs. The majority (51%) of participants were in the 'using only private vehicles' group, followed by the 'flexibles' (25%) and the 'restricted' (24%). Factors significantly associated with the restricted transportation group were: (a) being female (AdjOR 15.39, 95% CI 0.86-23.39, p < 0.001); (b) being Malay (AdjOR 21.72, 95% CI 0.36-16.12, p < 0.001); (c) having higher number of comorbidities (AdjOR 14.01, 95% CI 0.20-13.21, p = 0.007); and (d) being dependent in IADL (AdjOR 13.48, 95% CI 0.51-1.78, p = 0.002).