BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread ...BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.展开更多
The nutritional status of an individual can significantly influence its life history traits,including development,growth,reproduction,and survival.In the predatory mite Phytoseiulus persimilis Athias-Henriot(Acari:Phy...The nutritional status of an individual can significantly influence its life history traits,including development,growth,reproduction,and survival.In the predatory mite Phytoseiulus persimilis Athias-Henriot(Acari:Phytoseidae),the plasticity of life history traits,such as developmental time and size at maturity,is influenced by the quality and quantity of food.This study aimed to investigate the effects of dietary restriction at different life stages(i.e.,juvenile,early adulthood,and later adulthood)on the lifespan and fecundity of P persimilis.We found that reduced dietary intake during early adulthood resulted in a shorter lifespan for both male and female P persimilis.Furthermore,this study demonstrated a sex-specific response to dietary restriction:it extended the lifespan of males but reduced that of females during later adulthood.Diet restriction during the postovipositional period of females showed the most variable life history trait response.Our results showed that the impact of diet restriction at different life stages can have combined influences on the postovipositional duration of P persimilis,where the individuals receiving diet restriction during immature development and early adulthood had a greater reduction in ovipositional duration as those experiencing diet restriction during late adulthood.In addition,we observed a positive correlation between the lifespan and fecundity of females,with higher prey availability increasing both.The insights obtained from our research contribute to a better understanding of the aging process and dietary requirements of P persimilis,which can facilitate the development of more effective biological control strategies using this predator for spider mites in agriculture.展开更多
Objectives:To investigate the impact of a supervised bloodflow restriction(BFR)training program performed at different times of the morning on body composition and muscle performance in older,inactive adults.Methods:A...Objectives:To investigate the impact of a supervised bloodflow restriction(BFR)training program performed at different times of the morning on body composition and muscle performance in older,inactive adults.Methods:A single-arm intervention of supervised BFR resistance training was performed three times per week for six weeks.Participants(n=24;aged 65+years)were categorized into early morning(n=13;05:00–08:59)or late morning(n=11;09:00–12:00)groups.Primary outcomes were changes in body composition,total work,average peak power,average peak torque,muscle strength,and physical function.Results:Mixed model analysis of variance revealed a significant within-subject effect of time for all strength measures(p ranging from 0.017 to<0.001)and some physical function measures including the 30 s chair stand test,30 s bicep curl test,and grip strength(p ranging from 0.015 to<0.001).No between-group or time by group interaction effect was observed for all outcomes.Conclusions:This study showed that only six weeks of BFR training,performed at different time of the morning,did not enhance muscle mass and performance,but provided similar changes in muscle strength and some physical function tests in older adults.展开更多
BACKGROUND Poor musculoskeletal recovery following foot and ankle injury can result in chronic instability and persistent muscle weakness.Preliminary evidence has shown that blood flow restriction(BFR)rehabilitation c...BACKGROUND Poor musculoskeletal recovery following foot and ankle injury can result in chronic instability and persistent muscle weakness.Preliminary evidence has shown that blood flow restriction(BFR)rehabilitation can increase muscle strength and stability,helping to restore physical function and prevent repeated injury.AIM To determine whether BFR is more effective than traditional rehabilitation in improving muscle strength,size,and stability after foot and ankle injury.METHODS A systematic review and meta-analysis were performed.Articles were retrieved from MEDLINE,EMBASE,and CENTRAL databases.Included studies compared the effectiveness of BFR rehabilitation to traditional foot and ankle rehabilitation exercises.Eligible patients were those with a history of foot or ankle injury.Muscle strength,size,and dynamic balance were assessed by comparing impro vements in peak torque,cross-sectional area,and percent muscle activation.Methodological quality assessments were performed using the PEDro scale and Methodological Index for Non-Randomized Studies(MINORS).RESULTS Ten studies met the inclusion criteria.Five studies were of good to excellent quality according to the PEDro scale,and 5 studies were of moderate quality as per the MINORS criteria.Two studies compared the effect of BFR and non-BFR rehabilitation on muscle strength;the overall mean difference between the BRF and non-BFR groups was 0.09[95%CI:(0.05,0.12),P<0.0001].Two studies analyzed muscle activation following BFR and non-BFR rehabilitation;the overall mean difference between the BRF and non-BFR groups was 0.09[95%CI:(0.05,0.12),P<0.0001].Data on dynamic balance was synthesized from two studies;the mean difference between the BFR and control groups was 1.23[95%CI:(-1.55,4.01);P=0.39].CONCLUSION BFR rehabilitation is more effective than non-BFR rehabilitation at improving muscle strength and activation following foot and ankle injury.Additional studies are needed to develop a standardized BFR training protocol.展开更多
To enhance the gas-damping effect and improve the bearing performance,a restricted layer is applied on the surface of aerostatic porous bearings.Based on the gas lubrication theory,a mathematical model of an aerostati...To enhance the gas-damping effect and improve the bearing performance,a restricted layer is applied on the surface of aerostatic porous bearings.Based on the gas lubrication theory,a mathematical model of an aerostatic porous bearing with a restricted layer is established,and two proportional coefficients,a permeability ratio δ and a thickness ratioγ,are proposed.Critical values of δ and γ are determined through sensitivity analyses of complex restriction-layer parameters.The static characteristics of aerostatic porous bearings with a restricted layer or an unrestricted layer are comparatively analyzed by using Fluent simulation.The results show that when δ≈0.005 and γ≈0.010,the load capacity and static stiffness of the restricted-layer aerostatic porous bearing are high;compared with the unrestricted-layer aerostatic porous bearing,the restricted-layer aerostatic porous bearing has a lower sensitivity to changes in the air supply area.The existence of the restricted layer not only enhances the throttling effect and reduces the mass flow rate,but also effectively improves the static stiffness of the bearing.展开更多
Purpose We aimed to determine:(a)the chronic effects of interval training(IT)combined with blood flow restriction(BFR)on physiological adaptations(aerobic/anaerobic capacity and muscle responses)and performance enhanc...Purpose We aimed to determine:(a)the chronic effects of interval training(IT)combined with blood flow restriction(BFR)on physiological adaptations(aerobic/anaerobic capacity and muscle responses)and performance enhancement(endurance and sprints),and(b)the influence of participant characteristics and intervention protocols on these effects.Methods Searches were conducted in PubMed,Web of Science(Core Collection),Cochrane Library(Embase,ClinicalTrials.gov,and International Clinical Trials Registry Platform),and Chinese National Knowledge Infrastructure on April 2,with updates on October 17,2024.Pooled effects for each outcome were summarized using Hedge's g(g)through meta-analysis-based random effects models,and subgroup and regression analyses were used to explore moderators.Results A total of 24 studies with 621 participants were included.IT combined with BFR(IT+BFR)significantly improved maximal oxygen uptake(VO2_(max))(g=0.63,I^(2)=63%),mean power during the Wingate 30-s test(g=0.70,I^(2)=47%),muscle strength(g=0.88,I^(2)=64%),muscle endurance(g=0.43,I^(2)=0%),time to fatigue(g=1.26,I^(2)=86%),and maximal aerobic speed(g=0.74,I^(2)=0%)compared to IT alone.Subgroup analysis indicated that participant characteristics including training status,IT intensity,and IT modes significantly moderated VO2_(max)(subgroup differences:p<0.05).Specifically,IT+BFR showed significantly superior improvements in VO2_(max)compared to IT alone in trained individuals(g=0.76)at supra-maximal intensity(g=1.29)and moderate intensity(g=1.08)as well as in walking(g=1.64)and running(g=0.63)modes.Meta-regression analysis showed cuff width(β=0.14)was significantly associated with VO2_(max)change,identifying 8.23 cm as the minimum threshold required for significant improvement.Subgroup analyses regarding muscle strength did not reveal any significant moderators.Conclusion IT+BFR enhances physiological adaptations and optimizes aspects of endurance performance,with moderators including training status,IT protocol(intensity,mode,and type),and cuff width.This intervention addresses various IT-related challenges and provides tailored protocols and benefits for diverse populations.展开更多
BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders ...BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders have been described following bariatric surgery.However,the differentiation of pathologic eating patterns from expected dietary changes following bariatric surgery can sometimes be difficult to discern.CASE SUMMARY A female in her early 40s presented for medical stabilization of severe protein calorie malnutrition after losing 52.3 kg over the last six months after Roux-en-Y gastric bypass,with subsequent development of cyclic nausea and vomiting.Fear of these aversive physical symptoms led to further restriction of nutritional intake and weight loss.The patient was diagnosed with avoidant/restrictive food intake disorder,which has not been previously reported after bariatric surgery.CONCLUSION Improvement in the diagnostic nomenclature for feeding and eating disorders is warranted for patients who have undergone bariatric surgery.展开更多
This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices...This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices(RPs).Specifically,this RCT investigated the impact of VR on the handling of aggressive patients by psychiatric staff compared to traditional training methods.Despite significant reductions in perceived discrimination in the VR group,there were no major improvements in self-efficacy or anxiety levels.The system usability scale rated the VR platform highly,but it did not consistently outperform traditional training methods.Indeed,the study shows the potential for VR to reduce RPs,although fluctuations in RP rates suggest that external factors,such as staff turnover,influenced the outcomes.This manuscript evaluates the study’s methodology,results,and broader implications for mental health training.Additionally,it highlights the need for more comprehensive research to establish VR as a standard tool for psychiatric staff education,focusing on patient care outcomes and real-world applicability.Finally,this study explores future research di-rections,technological improvements,and the potential impact of policies that could enhance the integration of VR in clinical training.展开更多
The inheritance of chloroplast DNA (cpDNA) in sweet potato (Ipomoea batatas Lain.) was analyzed using DNA restriction fingerprinting. The cpDNA fingerprints of hybrids from reciprocal crosses between Xushu18 and AB78-...The inheritance of chloroplast DNA (cpDNA) in sweet potato (Ipomoea batatas Lain.) was analyzed using DNA restriction fingerprinting. The cpDNA fingerprints of hybrids from reciprocal crosses between Xushu18 and AB78-1 were found to be identical to those of their female parents, which reveals that cpDNA of sweet potato is maternally inherited in this intervarietal crossing. This maternal cpDNA transmission pattern does not accord with the putative one based on former cytological studies. The plastid inheritance in Convolvulaceae has been briefly reviewed in this study, and the utility of DNA restriction fingerprinting analysis in the study of plastid inheritance is also discussed.展开更多
In this study, non radioactive Digoxigenin labeled ribosomal DNA(rDNA) probes were used for Southern blotting analysis to study the molecular phylogeny of the giant panda and related species. Restriction maps in the ...In this study, non radioactive Digoxigenin labeled ribosomal DNA(rDNA) probes were used for Southern blotting analysis to study the molecular phylogeny of the giant panda and related species. Restriction maps in the regions of rDNA spacers were compared between giant panda( Ailuropoda melanoleuca ), lesser panda( Ailurus fulgens ), Asiatic black bear( Selenarctos thibetanus ), sun bear( Helarctos malayanus ), raccoon( Procyon lotor ) and lynx( Felis lynx ). Phylogenetic trees for these species were constructed using maximum likelihood and parsimony method. The results show that in respect to rDNA RFLPs, the giant panda is more closely related to bear than to lesser panda; while the lesser panda is slightly related to the raccoon.展开更多
The literature is full of claims regarding the consumption of polyphenol or polyamine-rich foods that offer some protection from developing cardiovascular disease(CVD). This is achieved by preventing cardiac hypertrop...The literature is full of claims regarding the consumption of polyphenol or polyamine-rich foods that offer some protection from developing cardiovascular disease(CVD). This is achieved by preventing cardiac hypertrophy and protecting blood vessels through improving the function of endothelium. However, do these interventions work in the aged human hearts? Cardiac aging is accompanied by an increase in left ventricular hypertrophy, along with diastolic and systolic dysfunction. It also confers significant cardiovascular risks for both sexes. The incidence and prevalence of CVD increase sharply at an earlier age in men than women. Furthermore, the patterns of heart failure differ between sexes, as do the lifetime risk factors. Do caloric restriction(CR)-mimetics, rich in polyphenol or polyamine, delay or reverse cardiac aging equally in both men and women? This review will discuss three areas:(1) mechanisms underlying age-related cardiac remodeling;(2) gender-related differences and potential mechanisms underlying diminished cardiac response in older men and women;(3) we select a few polyphenol or polyamine rich compounds as the CRmimetics, such as resveratrol, quercetin, curcumin, epigallocatechin gallate and spermidine, due to their capability to extend health-span and induce autophagy. We outline their abilities and issues on retarding aging in animal hearts and preventing CVD in humans. We discuss the confounding factors that should be considered for developing therapeutic strategies against cardiac aging in humans.展开更多
Let h be a nonnegative integer. The h-restricted edge connectivity λ h(G) of a simple connected graph G is defined as the minimum cardinality over the sets of edges of G, if any, whose removal disconnects G and every...Let h be a nonnegative integer. The h-restricted edge connectivity λ h(G) of a simple connected graph G is defined as the minimum cardinality over the sets of edges of G, if any, whose removal disconnects G and every component of the resulting graph has more than h vertices. This paper gave a necessary and sufficient condition and also three useful sufficient conditions to guarantee the existence of λ h(G). Moreover, it explicitly characterized the graphs whose 2-restricted edge connectivities do not exist.展开更多
[ Objective] To profile the differentially expressed genes in small intestine between piglets with intrauterine growth restriction （IUGR）, describe the relationships between growth performance and gene expression in...[ Objective] To profile the differentially expressed genes in small intestine between piglets with intrauterine growth restriction （IUGR）, describe the relationships between growth performance and gene expression in IUGR piglets, and thus provide a theoretical basis for further research. [Metbed] Eight suckling piglets at the age of 21 d Efour with normal body weight （NBW） of （1 503 ± 310） g and four with low BW of （806 ±35） g] were killed, and the intestinal samples were collected. Gene expression was detected by Affymetrix Porcine GeneChip and further confirmed by quantitative real-time PCR. [ ReseltJ Microarray analysis showed that there were 156 differentially expressed genes in the small intestine between the IUGR piglets and the age-matched NBW piglets, including 61 down-regulated genes and 95 up-regulated genes, The up-regulated genes included protein tyrosine phosphatase, myosin, troponin, heat shock protein, metallothionein, arginine vasopressin-induced 1, ribosomal protein L6, apoptosls antagonizing transcription factor, muscle creatine kinase, mannosidase, lysozyme, folliculin, urate transporterchannel protein, pyrroline-5-carboxylate reductese-like, and adenine phosphor-dbosyltransferase. The down-regulated genes included protein kinase, arachidohate 12-1ipoxygenase, transcription factor A, GTP-GDP dissociation stimulator 1, serine （or cysteine） proteinase inhibitor, fetuin, dolichol-phosphate-mannose synthase, apolipoprotein H, argininosuccinate synthetase 1, iron-regulated transporter, alpha-2-macroglobulin, immunoglobulin superfamily, thioltransferase, and guanylate binding protein 2. The gene expression profile changed in the small intestine of piglets with intrauterine growth restriction, providing a theoretical basis for eady intervention in growth restriction.展开更多
BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to i...BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.展开更多
To solve the extended fuzzy description logic with qualifying number restriction （EFALCQ） reasoning problems, EFALCQ is discretely simulated by description logic with qualifying number restriction （ALCQ）, and ALCQ...To solve the extended fuzzy description logic with qualifying number restriction （EFALCQ） reasoning problems, EFALCQ is discretely simulated by description logic with qualifying number restriction （ALCQ）, and ALCQ reasoning results are reused to prove the complexity of EFALCQ reasoning problems. The ALCQ simulation method for the consistency of EFALCQ is proposed. This method reduces EFALCQ satisfiability into EFALCQ consistency, and uses EFALCQ satisfiability to discretely simulate EFALCQ satdomain. It is proved that the reasoning complexity for EFALCQ satisfiability, consistency and sat-domain is PSPACE-complete.展开更多
Energy restriction is defined as reducing nutrient intake without dragging the organism into malnutrition. Energy restriction is preferred because it is a non-genetic intervention that increases life expectancy. Nicot...Energy restriction is defined as reducing nutrient intake without dragging the organism into malnutrition. Energy restriction is preferred because it is a non-genetic intervention that increases life expectancy. Nicotinamide adenine dinucleotide(NAD~+)and adenosine monophosphate(AMP)levels, which are the indicators of intracellular energy deficiency, increase with energy restriction. The increase in NAD~+ level stimulates sirtuin(SIRT)enzymes, and the increase in AMP level stimulates AMP-activated protein kinase(AMPK). Various mechanisms are regulated by stimulating these enzymes. By Forkhead box O(FoxO)transcription factors, the ability of resistance to oxidative stress increases, and antioxidant genes, DNA repair, and autophagy genes are stimulated. Apoptosis is induced by stimulation of the p53 protein, and tumor growth is suppressed by the disruption of aging cells. The suppression of phosphoinositide 3-kinase(PI3K)-/-Akt, and therefore mTOR signal stimulates autophagy and mitophagia, and cleanses damaged cells and organelles. Mitochondrial biogenesis is stimulated, antioxidant capacity increases, and inflammatory response decreases. Adipose tissue and lipid metabolism are regulated by the regulation of fatty acid synthesis and oxidation. As a consequence, the effects of caloric restriction on cellular metabolism are regulated through the genetic pathways.展开更多
The benefits of dietary restriction （DR） on health and aging prevention have been well recognized. Recent studies suggest that DR may enhance brain functions including learning and memory, synaptic plasticity, and n...The benefits of dietary restriction （DR） on health and aging prevention have been well recognized. Recent studies suggest that DR may enhance brain functions including learning and memory, synaptic plasticity, and neurogenesis, all of which are associated with brain health. Under the stress stimulated by DR, a favorable environment is established for facilitating neuronal plasticity, enhancing cognitive function, stimulating neurogenesis and regulating inflammatory response. DR-induced expressions of factors such as heat shock proteins （HSPs）, neurotrophic factors, and Sirtuin1 （SIRT1） are responsible for the effect of DR on the brain. Due to the difficulty in practising long-term DR in human, the potential mimics of DR are also discussed.展开更多
In order to understand the educational quality in rural schools,I went deep into Huangjia Middle School(situatedin Northern China)to make the research.In this article,I focus on the restrictions on educational quality...In order to understand the educational quality in rural schools,I went deep into Huangjia Middle School(situatedin Northern China)to make the research.In this article,I focus on the restrictions on educational qualitys,which is one of themain themes about rural education.The factors influencing quality in rural schools are analyzed in this article.It is concludedthat educational quality depends on the relationship of teaching and learning and its supporting context.展开更多
WOMBAT is a software package for quantitative genetic analyses of continuous traits, fitting a linear, mixed model; estimates of covariance components and the resulting genetic parameters are obtained by restricted ma...WOMBAT is a software package for quantitative genetic analyses of continuous traits, fitting a linear, mixed model; estimates of covariance components and the resulting genetic parameters are obtained by restricted maximum likelihood. A wide range of models, comprising numerous traits, multiple fixed and random effects, selected genetic covariance structures, random regression models and reduced rank estimation are accommodated. WOMBAT employs up-to-date numerical and computational methods. Together with the use of efficient compilers, this generates fast executable programs, suitable for large scale analyses. Use of WOMBAT is illustrated for a bivariate analysis. The package consists of the executable program, available for LINUX and WINDOWS environments, manual and a set of worked example, and can be downloaded free of charge from http：//agbu. une.edu.au/-kmeyer/wombat.html展开更多
AIM To discuss type 2 diabetes mellitus(T2DM) medication changes required during the popular 5:2 intermittent energy restriction(IER) diet. METHODS A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane ...AIM To discuss type 2 diabetes mellitus(T2DM) medication changes required during the popular 5:2 intermittent energy restriction(IER) diet. METHODS A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets(VLCD) in people with T2 DM. The search terms used included "VLCD" or "very low energy diet" or "very low energy restriction" or "IER" or "intermittent fasting" or "calorie restriction" or "diabetes mellitus type 2" and "type 2 diabetes". Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized.RESULTS A total of 8 studies were found that investigated the use of VLCD in T2 DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2 DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. CONCLUSION Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.展开更多
基金Huxiang TCM Physique Intervention Clinical Research Center,No.2023SK4061Traditional Chinese Medicine Research Project of Hunan Province,No.B2023065+4 种基金Hunan Province"14th Five-Year Plan"key specialty of TCM,No.[2023]4Hunan University of Chinese Medicine and Hospital Joint Foundation,No.2023XYLH019 and 2024XYLH365R&D Plan for Key Areas of Hunan Provincial Department of Science and Technology,No.2019SK2321Excellent Youth Program of Hunan Education Department,No.24B0346Hunan Provincial Natural Science Foundation for Young Scientists,No.2025JJ60626.
文摘BACKGROUND Anxiety and depression are prevalent among patients with chronic heart failure(CHF)and can adversely contribute to treatment adherence and clinical outcomes.Poor fluid restriction adherence is a widespread challenge in the management of CHF.To effectively manage disease progression and alleviate symptoms,it is crucial to identify key influencing factors to facilitate the implementation of targeted interventions.AIM To investigate the status of anxiety and depression among patients with CHF and determine the factors contributing to poor fluid restriction adherence.METHODS Three hundred CHF patients seeking medical treatment at The First Hospital of Hunan University of Traditional Chinese Medicine between June 2021 and June 2023 were included in the study.Questionnaires,including the Psychosomatic Symptom Scale,Self-Rating Anxiety Scale,Self-Rating Depression Scale,and Fluid Restriction Adherence Questionnaire were administered to patients.Based on their anxiety and depression scores,patients were categorized into anxiety/depression and non-anxiety/depression groups,as well as fluid restriction adherence and fluid restriction non-adherence groups.General patient data were collected,and univariate and logistic regression analyses were conducted to determine the occurrence of depression and anxiety.Logistic regression analysis was used to identify independent factors influencing fluid restriction adherence.RESULTS Statistically significant differences in age,New York Heart Association(NYHA)grading,marital status,educational attainment,and family support were observed between depressed and non-depressed CHF patients(P<0.05).Age,NYHA grading,marital status,educational attainment,and family support were identified as factors influencing the development of depression.The anxiety and non-anxiety groups differed statistically in terms of gender,age,NYHA grading,smoking history,alcohol consumption history,monthly income,educational attainment,and family support(P<0.05).Gender,smoking,alcohol consumption,monthly income,and educational attainment affected anxiety in these patients.The fluid restriction adherence rate was 28.0%,and thirst sensation,anxiety,and depression were identified as independent influencing factors.CONCLUSION CHF patients are susceptible to anxiety and depression,with multiple associated influencing factors.Moreover,anxiety and depression are independent factors that can influence fluid restriction adherence in these patients.
基金supported in part by New Zealand Government core funding for Crown Research Institutes from the Ministry of Business,Innovation,and Employment's Science and Innovation Group.
文摘The nutritional status of an individual can significantly influence its life history traits,including development,growth,reproduction,and survival.In the predatory mite Phytoseiulus persimilis Athias-Henriot(Acari:Phytoseidae),the plasticity of life history traits,such as developmental time and size at maturity,is influenced by the quality and quantity of food.This study aimed to investigate the effects of dietary restriction at different life stages(i.e.,juvenile,early adulthood,and later adulthood)on the lifespan and fecundity of P persimilis.We found that reduced dietary intake during early adulthood resulted in a shorter lifespan for both male and female P persimilis.Furthermore,this study demonstrated a sex-specific response to dietary restriction:it extended the lifespan of males but reduced that of females during later adulthood.Diet restriction during the postovipositional period of females showed the most variable life history trait response.Our results showed that the impact of diet restriction at different life stages can have combined influences on the postovipositional duration of P persimilis,where the individuals receiving diet restriction during immature development and early adulthood had a greater reduction in ovipositional duration as those experiencing diet restriction during late adulthood.In addition,we observed a positive correlation between the lifespan and fecundity of females,with higher prey availability increasing both.The insights obtained from our research contribute to a better understanding of the aging process and dietary requirements of P persimilis,which can facilitate the development of more effective biological control strategies using this predator for spider mites in agriculture.
基金Public Health Agency of Canada:Healthy Seniors Pilot Project(project number:C0089).
文摘Objectives:To investigate the impact of a supervised bloodflow restriction(BFR)training program performed at different times of the morning on body composition and muscle performance in older,inactive adults.Methods:A single-arm intervention of supervised BFR resistance training was performed three times per week for six weeks.Participants(n=24;aged 65+years)were categorized into early morning(n=13;05:00–08:59)or late morning(n=11;09:00–12:00)groups.Primary outcomes were changes in body composition,total work,average peak power,average peak torque,muscle strength,and physical function.Results:Mixed model analysis of variance revealed a significant within-subject effect of time for all strength measures(p ranging from 0.017 to<0.001)and some physical function measures including the 30 s chair stand test,30 s bicep curl test,and grip strength(p ranging from 0.015 to<0.001).No between-group or time by group interaction effect was observed for all outcomes.Conclusions:This study showed that only six weeks of BFR training,performed at different time of the morning,did not enhance muscle mass and performance,but provided similar changes in muscle strength and some physical function tests in older adults.
文摘BACKGROUND Poor musculoskeletal recovery following foot and ankle injury can result in chronic instability and persistent muscle weakness.Preliminary evidence has shown that blood flow restriction(BFR)rehabilitation can increase muscle strength and stability,helping to restore physical function and prevent repeated injury.AIM To determine whether BFR is more effective than traditional rehabilitation in improving muscle strength,size,and stability after foot and ankle injury.METHODS A systematic review and meta-analysis were performed.Articles were retrieved from MEDLINE,EMBASE,and CENTRAL databases.Included studies compared the effectiveness of BFR rehabilitation to traditional foot and ankle rehabilitation exercises.Eligible patients were those with a history of foot or ankle injury.Muscle strength,size,and dynamic balance were assessed by comparing impro vements in peak torque,cross-sectional area,and percent muscle activation.Methodological quality assessments were performed using the PEDro scale and Methodological Index for Non-Randomized Studies(MINORS).RESULTS Ten studies met the inclusion criteria.Five studies were of good to excellent quality according to the PEDro scale,and 5 studies were of moderate quality as per the MINORS criteria.Two studies compared the effect of BFR and non-BFR rehabilitation on muscle strength;the overall mean difference between the BRF and non-BFR groups was 0.09[95%CI:(0.05,0.12),P<0.0001].Two studies analyzed muscle activation following BFR and non-BFR rehabilitation;the overall mean difference between the BRF and non-BFR groups was 0.09[95%CI:(0.05,0.12),P<0.0001].Data on dynamic balance was synthesized from two studies;the mean difference between the BFR and control groups was 1.23[95%CI:(-1.55,4.01);P=0.39].CONCLUSION BFR rehabilitation is more effective than non-BFR rehabilitation at improving muscle strength and activation following foot and ankle injury.Additional studies are needed to develop a standardized BFR training protocol.
文摘To enhance the gas-damping effect and improve the bearing performance,a restricted layer is applied on the surface of aerostatic porous bearings.Based on the gas lubrication theory,a mathematical model of an aerostatic porous bearing with a restricted layer is established,and two proportional coefficients,a permeability ratio δ and a thickness ratioγ,are proposed.Critical values of δ and γ are determined through sensitivity analyses of complex restriction-layer parameters.The static characteristics of aerostatic porous bearings with a restricted layer or an unrestricted layer are comparatively analyzed by using Fluent simulation.The results show that when δ≈0.005 and γ≈0.010,the load capacity and static stiffness of the restricted-layer aerostatic porous bearing are high;compared with the unrestricted-layer aerostatic porous bearing,the restricted-layer aerostatic porous bearing has a lower sensitivity to changes in the air supply area.The existence of the restricted layer not only enhances the throttling effect and reduces the mass flow rate,but also effectively improves the static stiffness of the bearing.
文摘Purpose We aimed to determine:(a)the chronic effects of interval training(IT)combined with blood flow restriction(BFR)on physiological adaptations(aerobic/anaerobic capacity and muscle responses)and performance enhancement(endurance and sprints),and(b)the influence of participant characteristics and intervention protocols on these effects.Methods Searches were conducted in PubMed,Web of Science(Core Collection),Cochrane Library(Embase,ClinicalTrials.gov,and International Clinical Trials Registry Platform),and Chinese National Knowledge Infrastructure on April 2,with updates on October 17,2024.Pooled effects for each outcome were summarized using Hedge's g(g)through meta-analysis-based random effects models,and subgroup and regression analyses were used to explore moderators.Results A total of 24 studies with 621 participants were included.IT combined with BFR(IT+BFR)significantly improved maximal oxygen uptake(VO2_(max))(g=0.63,I^(2)=63%),mean power during the Wingate 30-s test(g=0.70,I^(2)=47%),muscle strength(g=0.88,I^(2)=64%),muscle endurance(g=0.43,I^(2)=0%),time to fatigue(g=1.26,I^(2)=86%),and maximal aerobic speed(g=0.74,I^(2)=0%)compared to IT alone.Subgroup analysis indicated that participant characteristics including training status,IT intensity,and IT modes significantly moderated VO2_(max)(subgroup differences:p<0.05).Specifically,IT+BFR showed significantly superior improvements in VO2_(max)compared to IT alone in trained individuals(g=0.76)at supra-maximal intensity(g=1.29)and moderate intensity(g=1.08)as well as in walking(g=1.64)and running(g=0.63)modes.Meta-regression analysis showed cuff width(β=0.14)was significantly associated with VO2_(max)change,identifying 8.23 cm as the minimum threshold required for significant improvement.Subgroup analyses regarding muscle strength did not reveal any significant moderators.Conclusion IT+BFR enhances physiological adaptations and optimizes aspects of endurance performance,with moderators including training status,IT protocol(intensity,mode,and type),and cuff width.This intervention addresses various IT-related challenges and provides tailored protocols and benefits for diverse populations.
文摘BACKGROUND Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders.Indeed,numerous maladaptive eating behaviors and eating disorders have been described following bariatric surgery.However,the differentiation of pathologic eating patterns from expected dietary changes following bariatric surgery can sometimes be difficult to discern.CASE SUMMARY A female in her early 40s presented for medical stabilization of severe protein calorie malnutrition after losing 52.3 kg over the last six months after Roux-en-Y gastric bypass,with subsequent development of cyclic nausea and vomiting.Fear of these aversive physical symptoms led to further restriction of nutritional intake and weight loss.The patient was diagnosed with avoidant/restrictive food intake disorder,which has not been previously reported after bariatric surgery.CONCLUSION Improvement in the diagnostic nomenclature for feeding and eating disorders is warranted for patients who have undergone bariatric surgery.
基金Supported by Basic Science Research Program Through the National Research Foundation of Korea(NRF)Funded by the Ministry of Education,No.NRF-RS-2023-00237287 and No.NRF-2021S1A5A8062526Local Government-University Cooperation-Based Regional Innovation Projects,No.2021RIS-003.
文摘This manuscript critically evaluates the randomized controlled trial(RCT)conducted by Phiri et al,which assessed the effectiveness of virtual reality(VR)training for psychiatric staff in reducing restrictive practices(RPs).Specifically,this RCT investigated the impact of VR on the handling of aggressive patients by psychiatric staff compared to traditional training methods.Despite significant reductions in perceived discrimination in the VR group,there were no major improvements in self-efficacy or anxiety levels.The system usability scale rated the VR platform highly,but it did not consistently outperform traditional training methods.Indeed,the study shows the potential for VR to reduce RPs,although fluctuations in RP rates suggest that external factors,such as staff turnover,influenced the outcomes.This manuscript evaluates the study’s methodology,results,and broader implications for mental health training.Additionally,it highlights the need for more comprehensive research to establish VR as a standard tool for psychiatric staff education,focusing on patient care outcomes and real-world applicability.Finally,this study explores future research di-rections,technological improvements,and the potential impact of policies that could enhance the integration of VR in clinical training.
文摘The inheritance of chloroplast DNA (cpDNA) in sweet potato (Ipomoea batatas Lain.) was analyzed using DNA restriction fingerprinting. The cpDNA fingerprints of hybrids from reciprocal crosses between Xushu18 and AB78-1 were found to be identical to those of their female parents, which reveals that cpDNA of sweet potato is maternally inherited in this intervarietal crossing. This maternal cpDNA transmission pattern does not accord with the putative one based on former cytological studies. The plastid inheritance in Convolvulaceae has been briefly reviewed in this study, and the utility of DNA restriction fingerprinting analysis in the study of plastid inheritance is also discussed.
文摘In this study, non radioactive Digoxigenin labeled ribosomal DNA(rDNA) probes were used for Southern blotting analysis to study the molecular phylogeny of the giant panda and related species. Restriction maps in the regions of rDNA spacers were compared between giant panda( Ailuropoda melanoleuca ), lesser panda( Ailurus fulgens ), Asiatic black bear( Selenarctos thibetanus ), sun bear( Helarctos malayanus ), raccoon( Procyon lotor ) and lynx( Felis lynx ). Phylogenetic trees for these species were constructed using maximum likelihood and parsimony method. The results show that in respect to rDNA RFLPs, the giant panda is more closely related to bear than to lesser panda; while the lesser panda is slightly related to the raccoon.
基金supported by grants from the National Natural Science Foundation of China(81800245,81970228,82102306,81900779)the China Postdoctoral Science Foundation(2020M670030ZX)+1 种基金the Shaoguan Science and Technology Program(2019sn078)the Start-up Fund for RAPs under the Strategic Hiring Scheme(P0035913)。
文摘The literature is full of claims regarding the consumption of polyphenol or polyamine-rich foods that offer some protection from developing cardiovascular disease(CVD). This is achieved by preventing cardiac hypertrophy and protecting blood vessels through improving the function of endothelium. However, do these interventions work in the aged human hearts? Cardiac aging is accompanied by an increase in left ventricular hypertrophy, along with diastolic and systolic dysfunction. It also confers significant cardiovascular risks for both sexes. The incidence and prevalence of CVD increase sharply at an earlier age in men than women. Furthermore, the patterns of heart failure differ between sexes, as do the lifetime risk factors. Do caloric restriction(CR)-mimetics, rich in polyphenol or polyamine, delay or reverse cardiac aging equally in both men and women? This review will discuss three areas:(1) mechanisms underlying age-related cardiac remodeling;(2) gender-related differences and potential mechanisms underlying diminished cardiac response in older men and women;(3) we select a few polyphenol or polyamine rich compounds as the CRmimetics, such as resveratrol, quercetin, curcumin, epigallocatechin gallate and spermidine, due to their capability to extend health-span and induce autophagy. We outline their abilities and issues on retarding aging in animal hearts and preventing CVD in humans. We discuss the confounding factors that should be considered for developing therapeutic strategies against cardiac aging in humans.
基金National Natural Science Foundation of China( No.199710 5 6)
文摘Let h be a nonnegative integer. The h-restricted edge connectivity λ h(G) of a simple connected graph G is defined as the minimum cardinality over the sets of edges of G, if any, whose removal disconnects G and every component of the resulting graph has more than h vertices. This paper gave a necessary and sufficient condition and also three useful sufficient conditions to guarantee the existence of λ h(G). Moreover, it explicitly characterized the graphs whose 2-restricted edge connectivities do not exist.
基金Supported by grants from Knowledge Innovation Project of Chinese Academy of Sciences ( KSCX2-YW-N-051 and SW-323)NSFC ( 30901040,30901041,30928018,30828025,30700581,and 30771558)+2 种基金National Basic Research Program of China ( 2009CB118800)National 863 project(2008AA10Z316)National Scientific and Technological Supporting Project ( 2007BAQ01047,and 2006BAD12B07)~~
文摘[ Objective] To profile the differentially expressed genes in small intestine between piglets with intrauterine growth restriction （IUGR）, describe the relationships between growth performance and gene expression in IUGR piglets, and thus provide a theoretical basis for further research. [Metbed] Eight suckling piglets at the age of 21 d Efour with normal body weight （NBW） of （1 503 ± 310） g and four with low BW of （806 ±35） g] were killed, and the intestinal samples were collected. Gene expression was detected by Affymetrix Porcine GeneChip and further confirmed by quantitative real-time PCR. [ ReseltJ Microarray analysis showed that there were 156 differentially expressed genes in the small intestine between the IUGR piglets and the age-matched NBW piglets, including 61 down-regulated genes and 95 up-regulated genes, The up-regulated genes included protein tyrosine phosphatase, myosin, troponin, heat shock protein, metallothionein, arginine vasopressin-induced 1, ribosomal protein L6, apoptosls antagonizing transcription factor, muscle creatine kinase, mannosidase, lysozyme, folliculin, urate transporterchannel protein, pyrroline-5-carboxylate reductese-like, and adenine phosphor-dbosyltransferase. The down-regulated genes included protein kinase, arachidohate 12-1ipoxygenase, transcription factor A, GTP-GDP dissociation stimulator 1, serine （or cysteine） proteinase inhibitor, fetuin, dolichol-phosphate-mannose synthase, apolipoprotein H, argininosuccinate synthetase 1, iron-regulated transporter, alpha-2-macroglobulin, immunoglobulin superfamily, thioltransferase, and guanylate binding protein 2. The gene expression profile changed in the small intestine of piglets with intrauterine growth restriction, providing a theoretical basis for eady intervention in growth restriction.
文摘BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.
基金The National Natural Science Foundation of China(No60403016)the Weaponry Equipment Foundation of PLA Equip-ment Ministry (No51406020105JB8103)
文摘To solve the extended fuzzy description logic with qualifying number restriction （EFALCQ） reasoning problems, EFALCQ is discretely simulated by description logic with qualifying number restriction （ALCQ）, and ALCQ reasoning results are reused to prove the complexity of EFALCQ reasoning problems. The ALCQ simulation method for the consistency of EFALCQ is proposed. This method reduces EFALCQ satisfiability into EFALCQ consistency, and uses EFALCQ satisfiability to discretely simulate EFALCQ satdomain. It is proved that the reasoning complexity for EFALCQ satisfiability, consistency and sat-domain is PSPACE-complete.
文摘Energy restriction is defined as reducing nutrient intake without dragging the organism into malnutrition. Energy restriction is preferred because it is a non-genetic intervention that increases life expectancy. Nicotinamide adenine dinucleotide(NAD~+)and adenosine monophosphate(AMP)levels, which are the indicators of intracellular energy deficiency, increase with energy restriction. The increase in NAD~+ level stimulates sirtuin(SIRT)enzymes, and the increase in AMP level stimulates AMP-activated protein kinase(AMPK). Various mechanisms are regulated by stimulating these enzymes. By Forkhead box O(FoxO)transcription factors, the ability of resistance to oxidative stress increases, and antioxidant genes, DNA repair, and autophagy genes are stimulated. Apoptosis is induced by stimulation of the p53 protein, and tumor growth is suppressed by the disruption of aging cells. The suppression of phosphoinositide 3-kinase(PI3K)-/-Akt, and therefore mTOR signal stimulates autophagy and mitophagia, and cleanses damaged cells and organelles. Mitochondrial biogenesis is stimulated, antioxidant capacity increases, and inflammatory response decreases. Adipose tissue and lipid metabolism are regulated by the regulation of fatty acid synthesis and oxidation. As a consequence, the effects of caloric restriction on cellular metabolism are regulated through the genetic pathways.
基金supported by thefund of the Jessie Ho Professorship in Neuroscience (The University of Hong Kong Foundation for Educational De-velopment and Research Limited)the National Natural Sci-ence Foundation of China (No.30828012)the Areas of Excellence Scheme established under the University Grants Committee of the Hong Kong Special Administrative Region,China (Project No. AoE/ B-15/01-II)
文摘The benefits of dietary restriction （DR） on health and aging prevention have been well recognized. Recent studies suggest that DR may enhance brain functions including learning and memory, synaptic plasticity, and neurogenesis, all of which are associated with brain health. Under the stress stimulated by DR, a favorable environment is established for facilitating neuronal plasticity, enhancing cognitive function, stimulating neurogenesis and regulating inflammatory response. DR-induced expressions of factors such as heat shock proteins （HSPs）, neurotrophic factors, and Sirtuin1 （SIRT1） are responsible for the effect of DR on the brain. Due to the difficulty in practising long-term DR in human, the potential mimics of DR are also discussed.
文摘In order to understand the educational quality in rural schools,I went deep into Huangjia Middle School(situatedin Northern China)to make the research.In this article,I focus on the restrictions on educational qualitys,which is one of themain themes about rural education.The factors influencing quality in rural schools are analyzed in this article.It is concludedthat educational quality depends on the relationship of teaching and learning and its supporting context.
基金Project (No. BFGEN.100B) supported by the Meat and LivestockLtd., Australia (MLA)
文摘WOMBAT is a software package for quantitative genetic analyses of continuous traits, fitting a linear, mixed model; estimates of covariance components and the resulting genetic parameters are obtained by restricted maximum likelihood. A wide range of models, comprising numerous traits, multiple fixed and random effects, selected genetic covariance structures, random regression models and reduced rank estimation are accommodated. WOMBAT employs up-to-date numerical and computational methods. Together with the use of efficient compilers, this generates fast executable programs, suitable for large scale analyses. Use of WOMBAT is illustrated for a bivariate analysis. The package consists of the executable program, available for LINUX and WINDOWS environments, manual and a set of worked example, and can be downloaded free of charge from http：//agbu. une.edu.au/-kmeyer/wombat.html
文摘AIM To discuss type 2 diabetes mellitus(T2DM) medication changes required during the popular 5:2 intermittent energy restriction(IER) diet. METHODS A search was conducted in MEDLINE, EMBASE, AMED, CINAHL and Cochrane library for original research articles investigating the use of very low calorie diets(VLCD) in people with T2 DM. The search terms used included "VLCD" or "very low energy diet" or "very low energy restriction" or "IER" or "intermittent fasting" or "calorie restriction" or "diabetes mellitus type 2" and "type 2 diabetes". Reference lists of selected articles were also screened for relevant publications. Only research articles written in English, which also included an explanation of medication changes were included. A recent pilot trial using the 5:2 IER method, conducted by our research group, will also be summarized.RESULTS A total of 8 studies were found that investigated the use of VLCD in T2 DM and discussed medication management. Overall these studies indicate that the use of a VLCD for people with T2 DM usually require the cessation of medication to prevent hypoglycemia. Therefore, the 5:2 IER method will also require medication changes, but as seen in our pilot trial, may not require total cessation of medication, rather a cessation on the 2 IER days only. CONCLUSION Guidelines outlined here can be used in the initial stages of a 2-d IER diet, but extensive blood glucose monitoring is still required to make the necessary individual reductions to medications in response to weight loss.
