No abstract

Current guidelines for obesity treatment recommend reducing daily caloric intake for weight loss. However, long-term weight loss continues to be an issue in obesity management. Alternative weight loss strategies have increased in popularity, such as intermittent energy restriction (IER), a type of eating pattern with periods of fasting alternating with unrestricted eating. The effects of IER on weight loss, cardiovascular risk factors, inflammation, and appetite are not clear. The purpose of this systematic review was to analyze short- (<24 weeks) and long-term (≥24 weeks) effects of IER on anthropometric, cardiometabolic, inflammatory, and appetite outcomes in adults with overweight/obesity. PubMed, CINAHL, Embase, and PsycInfo were searched from inception to July 2020. Human randomized controlled trials (RCTs) on IER with participants with a body mass index ≥25 kg/m2 were included in this review. A total of 42 articles (reporting on 27 different RCTs) were included. In short-term studies, IER showed pre-to-post treatment improvements in eight of nine studies that assessed weight. Weight outcomes were sustained in the long-term. However, no significant long-term between group differences were observed in fat mass, other anthropometric, cardiometabolic, inflammatory, or appetite outcomes. Compared to continuous energy restriction (CER), IER showed no significant long-term differences in anthropometric, cardiometabolic, inflammatory, or appetite outcomes in included studies. More long-term studies are needed to assess the benefits of IER on health outcomes.

Mohs micrographic surgery (MMS) is recognized as the goldstandard treatment for high-risk nonmelanoma skin cancers (NMSC) of the head and neck. Given the rising incidence of skin cancer, the past two decades have seen a rapid increase in the number of centres providing this service in the U.K. However, data on the safety, complication rates and patient acceptance of MMS in the U.K. are lacking. Over a 3-month period (September to November 2012) eight regional MMS centres collected data that included tumour site, number of stages to clearance, method of reconstruction and intra-and postoperative complications. In addition to collecting basic demographic and medical information, patients were also asked to rate, on a 10-point Likert scale, (i) their perceived anxiety levels preoperatively, (ii) how well they tolerated the surgery on the day, and (iii) when followed up, their overall acceptance of having undergone MMS under local anaesthesia (LA). Data on 565 patients were analysed. There were 278 women and 287 men, with a median age of 67 years (range 28-93 years). The majority of lesions treated were NMSC (98%). The average number of stages to tumour clearance was 1Á3 (range 1-5). Overall, 60% of patients were clear of tumour within one stage and 34% in two stages, with 6% requiring three or more stages. On average, patients were able to leave the department a little over 4 h after commencing treatment. In total, 88% of all reconstructions (including large flaps and interpolated flaps) were performed on the day by the Mohs surgeon. No major peri-or postoperative complications occurred. Although trouble-

A 95-year-old woman presented with a 4-week history of lethargy, and gradual onset of a florid eruption of asymptomatic red cutaneous nodules on her trunk and legs (top).

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