Pancreatic ß-cell failure, clinical implications, and therapeutic strategies in type 2 diabetes.

ABSTRACT: Pancreatic ß-cell failure due to a reduction in function and mass has been defined as a primary contributor to the progression of type 2 diabetes (T2D). Reserving insulin-producing ß-cells and hence restoring insulin production are gaining attention in translational diabetes research, and ß-cell replenishment has been the main focus for diabetes treatment. Significant findings in ß-cell proliferation, transdifferentiation, pluripotent stem cell differentiation, and associated small molecules have served as promising strategies to regenerate ß-cells. In this review, we summarize current knowledge on the mechanisms implicated in ß-cell dynamic processes under physiological and diabetic conditions, in which genetic factors, age-related alterations, metabolic stresses, and compromised identity are critical factors contributing to ß-cell failure in T2D. The article also focuses on recent advances in therapeutic strategies for diabetes treatment by promoting ß-cell proliferation, inducing non-ß-cell transdifferentiation, and reprograming stem cell differentiation. Although a significant challenge remains for each of these strategies, the recognition of the mechanisms responsible for ß-cell development and mature endocrine cell plasticity and remarkable advances in the generation of exogenous ß-cells from stem cells and single-cell studies pave the way for developing potential approaches to cure diabetes.

Exercise precision medicine for type 2 diabetes: Targeted benefit or risk?

Concurrent exercise and metformin administration may reduce the acute and chronic effects of exercise on glucose metabolism in the patients with type 2 diabetes (T2D). However, several studies suggest that combing metformin and exercise treatment may have neither additive effect nor even cause adverse effects in T2D patients. This case report aimed to highlight the challenges associated with prescribing exercise to type 2 diabetes patients undergoing metformin treatment. A 67-years old woman was followed-up for five months, including assessment of the acute and chronic glucose and lactate metabolism induced by concomitant exercise and metformin. The findings were four-fold: 1) During a high-intensity interval training bout, blood glucose systematically decreased, while blood lactate concentrations fluctuated randomly; 2) Basal blood lactate levels were well above 2 mmol/L on days with medication only; 3) Combined exercise and metformin administration induced additive effects on the normalization of glucose and 4) high levels of physical activity had a positive impact on the continuous glucose fluctuations, while decreased levels of physical activity induced a large fluctuation of glucose due to home confinement of an infectious disease caused by the SARS-CoV-2 virus. Our findings showed that when combined with exercise and metformin treatment for T2D patients, exercise may contribute to improving glycemic control while metformin may elevate lactate levels in the long term. The observed results underline the need to prescribe exercise and monitor lactate levels for reducing possible risks associated with metformin treatment and reinforce the importance of tailoring exercise therapy.

Impact of Functional Training on Functional Movement and Athletic Performance in College Dragon Boat Athletes.

Functional training has become a popular training method in different sports, yet limited studies have focused on paddle sports. The purpose of this study was to evaluate the effects of functional training on functional movement and athletic performance in college dragon boat athletes. A total of 42 male athletes were divided into 2 groups: a functional training (FT) group (n = 21, 21 ± 1.47 years) and a regular training (RT) group (n = 21, 22 ± 1.50 years). The FT group participated in an 8-week (16-session) functional-training program, while the RT group trained with strength-training sessions. Functional movement screen (FMS), Y-balance test (YBT) and athletic performance evaluations were conducted before and after the intervention. Repeated measure ANOVA and t-test evaluations were employed to examine differences for both groups. The FT group was significantly improved in FMS scores (F = 0.191, p < 0.001) and YBT scores (F = 2.59, p = 0.027), and it also showed significantly improved muscular fitness (pull-ups: F = 0.127, p < 0.001; push-ups: F = 1.43, p < 0.001) and rowing speed (F = 4.37, p = 0.004). It is recommended to include functional training as a part of training and routine exercise, as it appears to be an effective way of improving FMS and athletic performance in paddle sports.

The Effect of Mindfulness Intervention on the Psychological Skills and Shooting Performances in Male Collegiate Basketball Athletes in Macau: A Quasi-Experimental Study.

BACKGROUND: This study adopted a quasi-experimental design to examine the effect of a 7-week mindfulness intervention on the psychological coping ability and shooting performance of college-level male basketball athletes in Macau. METHODS: A total of 43 male college basketball athletes in Macau were selected as the participants. Besides the regular basketball training, the intervention group (n = 23) received a 7-week mindfulness training; the weekly mindfulness intervention session lasted around one hour according to the mindfulness training manual for athletes, while the control group (n = 20) did not receive any mindfulness training. Before and immediately after the 7-week intervention, all players performed the following tests: the "Five-Facet Mindfulness Questionnaire", the "Acceptance and Action Questionnaire", the "Sport Competition Anxiety Test", the "Mindfulness Attention Awareness Scale", and three shooting tests. An independent-sample t-test and a paired-sample t-test were used to analyze the between- and within-group differences. Moreover, a repeated measures ANOVA was used to assess the group, time, and group-by-time effects on psychological skills and shooting performances. RESULTS: The intervention resulted in both significant between-group and within-group differences in mindfulness level, acceptance level, attention level, three-point, and free-throw shooting performances (all p < 0.05, Cohen's d ranging from 0.565 to 1.117). CONCLUSION: While further study is necessary, the present study suggests that the 7-week mindfulness training program can significantly improve psychological outcomes and shooting performance in Macau college basketball athletes. Future studies involving competition settings and objective metrics will aid in verifying mindfulness as the prevalent practice among basketball practitioners and athletes.

Effects of Mindfulness-Based Interventions on Promoting Athletic Performance and Related Factors among Athletes: A Systematic Review and Meta-Analysis of Randomized Controlled Trial.

In recent years, mindfulness-based interventions (MBIs) have been widely applied in competition sports with respect to athletic performance and mental health promotion, whereas evidence of randomized controlled trials (RCTs) has not been well summarized. Therefore, this study aimed to systematically review and meta-analyze the existing evidence on the effects of MBIs on improving athletic performance, mindfulness level, mindfulness-related psychological components (e.g., acceptance, self-compassion, flow), and mental health (e.g., burnout, stress, psychological well-being) among athletes. Following the PRISMA guidelines, a literature search was implemented on five electronic databases (Web of Science, PubMed, Scopus, ProQuest, and ScienceDirect) and relevant review papers. The article selection, risk of bias assessment, and data extraction were performed by two investigators independently. The standardized mean difference (SMD) was calculated to evaluate the effects of interventions using the random effect model. Among the 1897 original hits, thirty-two eligible RCT studies were included in the systematic review, of which seven were involved in the meta-analysis. The results showed that MBIs were effective in promoting athletes' athletic performances (by narrative synthesis), mindfulness-level (n = 3; SMD = 0.50, 95% CI = [0.17, 0.83]; I2 = 45%, p = 0.16), and mindfulness-related psychological components (n = 5; SMD = 0.81, 95% CI = [0.53, 1.10], I2 = 77%, p =0.001), while no significant intervention effects were found on the mental health of athletes (n = 4; SMD = -0.03, 95% CI = [-0.35, 0.29], I2 = 89%, p < 0.001). Our findings preliminarily support the potential effectiveness of MBIs, whereas more high-quality RCTs were needed in the future.

Inter-relationships of depressive and anxiety symptoms with suicidality among adolescents: A network perspective.

BACKGROUND: Persons with suicidality including suicidal ideation (SI), suicide plans (SP) and/or suicide attempts (SA) are at higher risk for future suicide than those without suicidality. To reduce the risk of future suicide, it is important to understand symptoms of emotional distress that have the strongest links with SI, SP and SA. This network analysis examined item-level relations of depressive and anxiety symptoms with suicidality among adolescents during the COVID-19 pandemic. METHODS: Adolescents between 12 and 20 years of age were assessed with the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), and individual binary reponse (no/yes) items assessing SI, SP, and SA during the pandemic. The structure of depressive symptoms, anxiety symptoms and suicidality was characterized using "Expected Influence" and "Bridge Expected Influence" as centrality indices in the symptom network. Network stability was tested using a case-dropping bootstrap procedure. Node-specific predictive betweenness was computed to examine short paths of anhedonia, other depressive symptoms and anxiety symptoms with suicidality. A Network Comparison Test (NCT) was conducted to examine whether network characteristics differed based on gender. RESULTS: Prevalence rates of depressive symptoms, anxiety symptoms, and suicidality were 44.60 % (95% confidence interval (CI) = 41.53-47.67 %), 31.12 % (95%CI = 28.26-33.98 %), and 16.95 % (95%CI = 14.63-19.26 %), respectively, in the study sample. The network analysis identified GAD3 ("Worry too much") as the most central symptom, followed by GAD6 ("Irritability") and PHQ6 ("Guilt") in the sample. Additionally, PHQ6 ("Guilt"), GAD6 ("Irritability"), and PHQ2 ("Sad mood") were bridge nodes linking depressive and anxiety symptoms with suicidality. A flow network indicated that the connection between S ("Suicidality") and PHQ6 ("Guilt") reflected the strongest connection, followed by connections of S ("Suicidality") with GAD2 ("Uncontrollable worrying"), and S ("Suicidality") with PHQ2 ("Sad mood"). Finally, PHQ2 ("Sad mood") was the main bridge node linking anhedonia with other depressive and anxiety symptoms and suicidality in the sample. CONCLUSIONS: Findings highlight the potential importance of reducing specific depressive and anxiety symptoms as possible means of reducing suicidality among adolescents during the pandemic. Central symptoms and key bridge symptoms identified in this study should be targeted in suicide prevention for at-risk adolescents.

Effectiveness of Yoga on the Interrectus Distance in Early Postpartum Women: A High-Frequency Ultrasound Study.

To investigate the effects of ultrasonic evaluation of a progressive yoga exercise program on reducing the inter-recti distance (IRD) among women in the early postpartum period. Postpartum women (n = 116), free of obstetric complications and in recovery following vaginal delivery between weeks 1 and 12, were recruited. Participants were randomly assigned to the control and yoga exercise group in the pre- and post-intervention design. The control group received no treatment, while the yoga exercise group participated in a guided 12-week progressive yoga exercise program started at postpartum week 1. The IRD was examined using high-frequency ultrasound at postpartum weeks 6 and 12. The results showed that the supraumbilical, umbilical, and subumbilical IRD were significantly decreased in the yoga exercise group after the 12-week progressive yoga exercise intervention compared with the first (week 6) and second (week 12) measurements. The differences in IRD at supraumbilical, umbilical, and subumbilical intervals between weeks 6 and 12 significantly increased in the yoga exercise group. Progressive yoga exercises are effective program that reduce IRD among women in the early postpartum period through ultrasound evaluation. In conclusion, women should advocate combined yoga exercise in the early postpartum days following a supervised program.

Network analysis of depression, anxiety, insomnia and quality of life among Macau residents during the COVID-19 pandemic.

BACKGROUND: Although the Coronavirus Disease 2019 (COVID-19) has greatly impacted individuals' mental health and quality of life, network analysis studies of associations between symptoms of common syndromes during the pandemic are lacking, particularly among Macau residents. This study investigated the network structure of insomnia, anxiety, and depression and explored their associations with quality of life in this population. METHOD: This online survey was conducted in Macau between August 18 and November 9, 2020. Insomnia, anxiety, depressive symptoms, and quality of life were assessed with the Insomnia Severity Index, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and World Health Organization Quality of Life-brief version, respectively. Analyses were performed to identify central symptoms and bridge symptoms of this network and their links to quality of life. RESULTS: 975 participants enrolled in this survey. The prevalence of depressive, anxiety and insomnia symptoms were 38.5% (95% confidence interval (CI): 35.5%-41.5%), 28.8% (95%CI: 26.0%-31.7%), and 27.6% (95% CI: 24.8%-30.4%), respectively. "Sleep maintenance" had the highest expected influence centrality, followed by "Trouble relaxing", "Interference with daytime functioning", "Irritability", and "Fatigue". Five bridge symptoms were identified: "Sleep problems", "Restlessness", "Irritability", "Severity of sleep onset", and "Motor activity". The insomnia symptom, "Sleep dissatisfaction", had the strongest direct relation to quality of life. CONCLUSION: Insomnia symptoms played a critical role in the distress symptom network regarding node and bridge centrality as well as associations with quality of life among Macau residents. Close attention to these symptoms may be critical to reducing risk and preventing exacerbations in common forms of distress in this population.

Changes in Fat Oxidation and Body Composition after Combined Exercise Intervention in Sedentary Obese Chinese Adults.

(1) Background: Evidence suggests that aerobic exercise and high-intensity interval training (HIIT) might increase fat oxidation and reduce fat. However, limited research has examined the effects of combining progressive aerobic exercise and HIIT interventions in sedentary adults with overweight and obesity, and differences in its effects between men and women remain unclear. The purpose of this study was to investigate the effects of combined progressive aerobic exercise and HIIT (CAEH) on fat oxidation and fat reduction in sedentary Chinese adults and compare sex differences in sedentary adults after seven weeks. (2) Methods: Eighty-four sedentary obese adults were enrolled and allocated to two groups in baseline (experimental (EXP) group:42; control (CON) group:42), and fifty-six subjects (EXP:31; CON:25) completed the experiments and were included in the final analysis. Subjects in the EXP group performed CAEH three times per week for seven weeks. Subjects in the CON group were advised to continue with their normal daily activities. Anthropometric, lipid profile, cardiorespiratory fitness, and fat oxidation outcomes were assessed before and after the intervention. (3) Results: After seven weeks of the CAEH intervention, compared with the CON group, the EXP group showed significant increases in fat oxidation at rest (FO_rest) (+0.03 g/min, p < 0.01), maximal fat oxidation (MFO) (+0.05 g/min, p < 0.01), and maximal oxygen intake (VO2max) (+3.2 mL/kg/min, p < 0.01). The changes in the percentages of the FO_rest (+57%) and the VO2max (+16%) were significantly greater (+20%, +6%) in males than in females (p < 0.05, p < 0.05). The body mass index (BMI) (-1.2 kg/m2, p < 0.01), body fat percentage (-3.2%, p < 0.001), visceral fat area (-12.8 cm2, p < 0.001), and total cholesterol (TC) levels (-0.4 mmol/L, p < 0.05) were significantly decreased in the EXP group. (4) Conclusions: Seven weeks of the CAEH intervention effectively improved FO_rest, MFO, and VO2max in sedentary obese adults, and the improvements in FO_rest and VO2max were more pronounced in males than in females. CAEH also improved body composition and TC levels in sedentary obese adults.

Identification of central symptoms in Internet addictions and depression among adolescents in Macau: A network analysis.

BACKGROUND: Internet addiction (IA) and depression are common among adolescents and often are co-occurring. This study examined the network structures of IA and depressive symptoms (depression hereafter) in adolescents. METHODS: A total of 1,009 adolescents were recruited. IA and depression were measured using the Internet Addiction Test (IAT) and the 9 items-Patient Health Questionnaire (PHQ-9), respectively. A network analysis was conducted to identify central symptoms and bridge symptoms using centrality indices. Network stability was evaluated using the case-dropping procedure. The Network Comparison Test (NCT) was conducted to examine whether network characteristics differed by gender. RESULTS: Network analysis revealed that nodes IAT-15 ("Preoccupation with the Internet"), IAT-2 ("Neglect chores to spend more time online"), PHQ-6 ("Guilty"), and IAT-16 ("Request an extension for longer time spent online") were the most central symptoms within the model of coexisting IA and depression. The most important bridge symptom was node IAT-11 ("Anticipation for future online activities"), followed by IAT-12 ("Fear that life is boring and empty without the Internet") and IAT-19 ("Spend more time online over going out with others"). Gender did not significantly influence the network structure. The IA and depression network model showed a high degree of stability. CONCLUSION: The central symptoms along with key bridge symptoms identified could be potentially targeted when treating and preventing IA and depression among adolescents.

The Effect of a Ketogenic Low-Carbohydrate, High-Fat Diet on Aerobic Capacity and Exercise Performance in Endurance Athletes: A Systematic Review and Meta-Analysis.

A low-carbohydrate, high-fat (LCHF) diet has been proposed to enhance the fat utilization of muscle and the aerobic capacity of endurance athletes, thereby improving their exercise performance. However, it remains uncertain how the macronutrient intake shift from carbohydrate to fat affects endurance exercise training and performance. This study performed a systematic review and meta-analysis to explore the effects of a ketogenic low-carbohydrate, high-fat (K-LCHF) diet on aerobic capacity and exercise performance among endurance athletes. Searches were carried out in five electronic databases, and we followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The search included studies using an LCHF diet as an intervention protocol and compared data on factors such as maximum oxygen uptake (VO2max) and rating of perceived exertion (RPE) from the graded exercise test. In this case, 10 studies met the criteria and were included in the meta-analysis. We did not find a significant effect of K-LCHF diet interventions on VO2max, time to exhaustion, HRmax or RPE. However, a significant overall effect in the substrate oxidation response to respiratory exchange rate was observed. The meta-analysis showed that K-LCHF diets did not affect aerobic capacity and exercise performance. Therefore, high-quality interventions of a K-LCHF diet are needed to illustrate its effect on various endurance training programs.

Internet addiction among adolescents in Macau and mainland China: prevalence, demographics and quality of life.

Internet addiction (IA) is common among adolescents and significantly determined by sociocultural and economic factors. The aim of this study was to compare the prevalence of IA among adolescents between Macau and mainland China and also examine its association with quality of life. A total of 2892 secondary school students were included. Standardized instruments were used to measure IA, depressive symptoms and quality of life. The overall prevalence of IA was 23.7%, with 32.5% in Macau and 19.8% in mainland China. Students in Macau were more likely to suffer from IA than those in mainland China (OR = 2.15, p < 0.001). Correlates of IA included being in higher school grades, poor academic performance, and more severe depressive symptoms. Students with IA reported lower quality of life in physical, psychological, social, and environmental domains. IA is common among Chinese adolescents, particularly in Macau. Considering the negative impact of IA on health and quality of life, regular screening and effective interventions should be undertaken for young Internet users.