Porcine reproductive and respiratory syndrome (PRRS) is one of the most important swine diseases causing enormous losses to pig producers all over the world. The intervention measure of “load-close-exposure” [interrupting the introduction of replacement pigs combined with whole-herd exposure to live PRRS virus (PRRSV)] has been widely used in North America and has shown wonderful outcomes in controlling PRRS in the field. In the present study, we performed analyses of the production performance of four herds acutely infected with PRRSV by adopting this measure for the first time in China. Our results showed that the development rate of gilts decreased by a mean of 8.56%, the farrowing rate of breeding sows decreased from 86.18 to 77.61%, the number of piglets born alive per sow decreased by a mean of 0.73 pigs, and the pre-weaning and post-weaning mortality of piglets increased by a mean of 2.74–4.97% compared to the parameters of 6 months before an outbreak. The time to PRRSV stability (TTS), defined as the time in weeks it took to produce PRRSV-negative pigs at weaning, is an important indicator of successful control of PRRSV. The median TTS among herds A, C, and D was 21.8 weeks (21.6 22.1 weeks). In herd B, TTS was 42.3 weeks, which could be explained by the double introduction of gilts. Our study suggests that the “load-close-exposure” strategy may be a good alternative for Chinese producers and veterinaries to control PRRS in the field. Betaarterivirus of the family Arteriviridae in the order Nidovirales Porcine reproductive and respiratory syndrome virus (PRRSV) is a small enveloped, positive single-stranded RNA virus belonging to the genus Various strategies and lots of efforts have been developed and undertaken to combat and control PRRS in the field since the initial outbreak of PRRS in the last century. Vaccination has been the first choice for most pig producers as some positive effects have been observed after the use of modified live virus (MLV) . Eradica® MLV in the other three farms. The four farms were identified to be infected by PRRSV in November 2014, March 2015, December 2016, and February 2017, respectively, based on clinical signs discovered by veterinarians and laboratory diagnosis, with negative results for classical swine fever virus (CSFV), pseudorabies virus (PRV), and porcine circovirus 2 (PCV2). Four PRRSV strains  were isolated from aborted fetuses collected from the four farms  with two-point production mode and one farrow-to-finish farm (D) of a large-scale swine company selected in the study consist of 5,100, 2,450, 3,800, and 1,750 sows, respectively. All four farms were in full-load production (about 5% of the sows were mated weekly) before a PRRS outbreak and were previously vaccinated with a MLV three times a year. TJM-F92, a kind of MLV derived from the highly pathogenic PRRSV strain TJ in China, were used in farm A, and Ingelvac PRRS® MLV at a 4-week interval in farms A and B. Gilts from farms C and D were first exposed to field live virus (FLV) and then vaccinated with Ingelvac PRRS® MLV at a 4-week interval, and breeding sows were exposed to Ingelvac PRRS® MLV two times  needed for replacement for the next 5–6 months were introduced at one time, but farm B performed an introduction two times at a 10-week interval due to insufficient availability of gilts. Gilts and other breeding sows were vaccinated two times with Ingelvac PRRSwo times . In all The main production parameters relevant to PRRS were acquired from the management system used in the farms, including: (1) culling rate, development rate for gilts; (2) mating rate after weaning (7 days), conception rate after mating (35 days), abortion rate per month, farrowing rate, piglets born alive per litter, stillbirths per litter, and mummies per litter for breeding sows; (3) weight at weaning (21 days), pre-weaning mortality, vaccine and medication costs for suckling piglets; and (4) mortality and culling rate, fattening days to reach 115 kg, feed conversion rate, vaccine and medication costs for nursery, and finishing pigs. For gilts, sows, and sucking piglets, we compared the production data between the first 6 months before a PRRS outbreak and the last 6 months after PRRS. For fattening pigs, the data acquired from the 6th to 10th month after a PRRS outbreak were compared to that of the 6 months before a PRRS outbreak, considering a growing time of 170 days (5–6 months) from birth (PRRSV positive) to slaughter.The time-to-stable (TTS) status for a PRRSV-infected herd is one of the important parameters to evaluate the efficiency of an intervention strategy. Twelve weeks after adopting the “load-close-exposure” strategy, serum was collected from weak pigs of weaning age  to perform PRRSV detection using real-time quantitative PCR  every 2 weeks as described before . The herTwo important variables were analyzed for introduced gilts. Culling rates for herds A, B, C, and D between 6 months before a PRRS outbreak were 3.84, 4.66, 4.46, and 4.97%, and increased to 7.10, 6.29, 8.74, and 8.51% after an outbreak, respectively, with an increase from 4.48 to 7.66%. The development rate of all four farms was above 90%, but was negatively affected to varying degrees after a PRRS outbreak, with a mean decrease of 8.56% (7.16–10.33%). In addition, to provide sufficient replacements, the pigs at 30–180 days of age were introduced into the program, but low age pigs (30–70 days) showed obvious clinical manifestation, especially when exposed to FLV. The development rate for herds C and D was only 69.08 and 70.58% for these low age pigs, suggesting that the age of the gilts introduced was important when using the FLV exposure program. For breeding herds, we analyzed seven production parameters that are mainly affected by PRRSV infection. The mating rate after weaning (7 days) was 88.35% before a PRRS outbreak, but decreased to 83.37%, with a decline of 4.98% on average, and the influence was mainly concentrated in the first 3 months and returned to basic performance by the 6th month, except in herd B . The conThree variables, weight at weaning (21 days), pre-weaning mortality, and vaccination and medication costs, were analyzed for suckling piglets . The meaThe “time to PRRSV stability” in pre-weaned pig herds is an important indicator to control PRRSV. A strict “30-60-120-120” modified monitoring program was enrolled to detect PRRSV in weaning-age pigs to determine the TTS. As shown in An optimized method combining introduction, herd closure, and MLV (load-close-exposure) was gradually popularized and performed in Chinese large-scale farms in recent years. In the present study, we firstly monitored and analyzed the production performance of four herds infected with PRRSV after using this method. The first step of the program was the introduction of replacement pigs into the breeding herd for at least 5–6 months. Strictly speaking, herd B should be dropped out because it underwent two introductions due to insufficient gilts being available at that time. Compared to the other three herds, culling and development rates were better for herd B, but the mating rate after weaning (7 days), pre-weaning mortality, mortality and culling rate of finishers were terrible, and even it took more than 20 weeks for herd B to produce PRRSV-negative piglets, which restresses the importance of performing once through gilt introduction and complete closure  when controlling PRRS outbreaks. Linhares et al.  comparedIn our present study, a total of 16 production parameters relevant to PRRSV were analyzed in detail. Four different PRRSV strains, SDwh1403 (a recombinant between NADC30-like and MLV), SDqd1501 (a recombinant between HP-PRRSV-like and QYYZ), SDwh1601 (a recombinant between JXA1-P80 (an MLV derived from HP-PRRSV) and NADC30-like), and SDwh1701 (a strain evolved from JXA1-P80) were isolated from herds A, B, C, and D, which might be the most important factor contributing to the different performance among the four herds –21. All The breeding herd was classified as “positively stable” once PRRSV infection was controlled and ultimately eliminated based on previously proposed terminology, usually based on the confirmation of a sustained absence of detectable viremia in weaning-age pigs sampled for a minimum of 90 days . All fouIn China, there exist a large number of pig farms with a diversity of size, different level of management and biosecurity. Many strategies are effective against PRRS, but not all of them have been proven to be the same in all cases. Thus, this study was only a quasi-experiment in which the metrics of “load-close-exposure” projects for many Chinese pig farms were analyzed. The strength of this study is the nature of the investigation all the four farms were from one company, and the acquired data were available and relatively accurate. However, the existence of unknown confounding variables might have biased the findings. Therefore, more precisely designed investigations, involving more herds, even with economic evaluation after different interventions, need to be studied in the future.In conclusion, this quasi-experimental study explored performance data from four PRRSV-infected herds, suggesting that “load-close-exposure” is a choice to control PRRS in the field although productivity was also negatively affected. The key to return to baseline performance and achieving stability depends largely on introducing enough gilts at a time, closing the herd completely and performing a strict “McReble” in the farrowing room.The original contributions presented in the study are included in the article/Ethical review and approval was not required for the animal study because Blood sampling was done in the course of routine diagnostics on farm, therefore animal ethics committee approval was not required.ZZ and XQ interpreted the data and drafted this manuscript. XQ coordinated the study. ZL and SY acquired the data from the management system used in the farms. XW and LS analyzed the data. BZ advised on the case study analysis. All authors read and approved the final manuscript.This work was supported by the Natural Science Foundation of Jiangsu Province (BK20201005) and Nanjing Dr. Vet Health Management CO., LTD.XQ, ZL, and SY was employed by Nanjing Dr. Vet Health Management CO Limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Most of the microplastics were found in fiber form (81.5%), whereas the remaining comprised fragment (18.31%) and film (0.19%) forms. Further analysis with Py-GC/MS under a selective ion monitoring mode indicated that pyrolytic products and fragment ions for a variety of polymers, such as polyvinyl chloride, polypropylene, polyethylene, polyethylene terephthalate, polyamide, and polymethylmethacrylate, were detected. This study provides an insightful application of Py-GC/MS techniques for microplastics monitoring, especially when dealing with analytical amounts of samples.Microplastics (the term for plastics at sizes of <5 mm) might be introduced into the environment from domestic or agricultural activities or from the breakdown of plastic pieces, particles, and debris that are bigger in size. Their presence in the aquatic environment has caused accumulation problems, as microplastics do not easily break down and can be digested by some aquatic organisms. This study was conducted to screen and monitor the level of microplastic pollution in polychaete worms using pyrolysis–gas chromatography/mass spectrometry (Py-GC/MS). The study was conducted in Setiu Wetlands, Malaysia from November 2015 to January 2017 at five-month intervals and covered all monsoon changes. Results from physical and visual analyses indicated that a total number of 371.4 ± 20.2 items/g microplastics were retrieved from polychaete for all seasons, in which, the majority comprised transparent microplastics (49.87%), followed by brown with 138.3 ± 13.6 items/g (37.24%), 21.7 ± 1.9 items/g for blue (5.84%), and 12.9 ± 1.1 items/g for black (3.47%), while the remaining were green and grey-red colors. Statistical analysis using Kruskal–Wallis showed insignificant differences ( The ever-increasing human population has made a high demand for resources and living space, which has resulted in the expansion of terrestrial urban areas and subsequently intruded the coastal territory. The construction of buildings, the constant generation of municipal wastes, and the unearthing of natural resources has not only brought ecological changes, but has also negatively affected many organisms living therein through pollution, food scarcity, poor reproduction, and alternative predation ,2. As a The biological interaction between microplastics and biota is crucial to understanding the movement, impact, and fate of microplastics in the environment. Several controlled laboratory and/or field studies have been conducted to clarify the impact of this problem. Recent attention has been focused on lower trophic level organisms, as these marine invertebrates have significant effects on the introduction of microplastics into the food chain . Recent Despite microplastic pollution being an emerging field of study, the impacts of microplastics on human health and the environment are yet to be fully discovered. Hence, the monitoring and identification of microplastic pollution is urgently needed prior to the development of efficient treatment strategies. As such, standardized field methods for collecting microplastics in sediment, sand, and surface-water samples and a novel analysis technique for the identification of microplastics have been developed and continue to be optimized. In due course, a global comparison of the amount of microplastics released can be carried out with field and laboratory protocols to elucidate the final distribution, impacts, and fate of microplastics . Two innNypa fruiticans and Avicennia sp.), which act as a shelter and dominate sand islets. On the other hand, marine water is channeled into the estuary of the South China Sea [Setiu Wetland comprises 23,000 ha terrestrial and aquatic environments that experience hot and humid climate intervals, with air temperatures ranging between 28 °C and 33 °C, seasonal salinity shifts from 3–33%, and annual rainfall between 2000 and 4000 mm ,27. Thishina Sea . The inp2 (20 m × 20 m) was set and had a 200 m interval before the next station, as illustrated by the red lines in the map. Sampling was conducted during the intermediate tide (1.2–2.0 m) by searching for polychaete worms  at the marked Nypa fruticans  vegetated riverbanks. This species is among the most abundant organisms in the benthic community in the mangrove area of Setiu Wetlands. These worms have special ability to adapt to their environment, thus allowing them to structure the dynamics of their surroundings and feed on rotten nypa palm [The sampling was performed four times from November 2015 until January 2017 in Setiu Wetlands, Terengganu, Malaysia, following the protocol of Hamzah et al. . The fieypa palm ,31. Durin = 10, weight~10 g) from each site and added to 10 mL of 10 M NaOH in a digestion tube. Data from the physical analysis of microplastics (sorting and isolation) were expressed as microplastics item/g of the polychaete, since the polychaete was pooled based on different sampling stations and periods during the digestion process. The digestion was conducted at 60 °C for 48 h. After the digestion process, the brown-translucent solution was filtered using a vacuum pump with cellulose nitrate filter paper  before being placed in a petri dish and dried in a desiccator. Physical identification of microplastics was conducted using the standardized size and color-sorted system according to the characterization protocol provided by Hidalgo-Ruz et al. [Ten polychaetes with approximate similar size and weights were pooled  in the absence of oxygen. The organic compounds were separated via the gas chromatography technique . In brief, the GC is equipped with a pre-column  and column  and characterized using mass spectrometer . For the analysis using Py-GC/MS, 20% of the microplastics item (for each station and period) was considered by adding 4 mg of calcium carbonate powder , and was derivatized with 5 µL 25% tetramethylammonium hydroxide (TMAH) solution in methanol  after being filtered using an aluminum oxide filter prior to the pyrolysis. The temperature programs were developed and optimized according to the manual from the supplier of pyrolyzer, Frontier Laboratories Ltd. , whereasn = 2, equivalent to 4 scans/s. Subsequently, a set of the calibration curve was prepared based on twelve common polymers, including polyethylene (PE), polypropylene (PP), polystyrene (PS), polycarbonate (PC), polyvinyl chloride (PVC), polyurethane (PU), polyethylene terephthalate (PET), acrylonitrile butadiene styrene (ABS), styrene-butadiene (SBR), and polymethyl methacrylate (PMMA), and polyamides such as nylon-6 (N-6) and nylon-6,6 (N-66). Quantitation of these polymers was performed referring to the selected pyrolytic products . Three-point calibration curve was created by the microplastics calibration standards containing calcium carbonate. In brief, 0.4 mg, 2.0 mg, and 4 mg of calibration standard were weighted precisely in the pyrolysis cup before 5 µL of 25% TMAH in methanol solution was added into the pyrolysis cup and left at room temperature for 20 min before the analysis. Analysis of calibration curve is as per described in and 0.99 .p < 0.05. The results obtained are presented in the form of a dendrogram graph, with 3 clusters of color following the number of the collected color sample within the sampling time. Box plot analysis was used to compare the shape distribution of the samples.The statistical analyses were performed using OriginPro version 9.1 software  and R Software . The abundance of microplastics was evaluated using Kruskal–Wallis (post hoc: Bonferonni correction) subjected to a non-parametric dataset for various types and colors between the station and period of the study. The significance level was set at Precautions were taken to prevent microplastics contamination during sample collection in the field and analysis in the dedicated clean room of the Microplastic Research Interest Group (MRIG) laboratory. Cotton lab gowns and single-use latex gloves were worn during all procedures of the experiment. The work surfaces were carefully washed with 80% filtered ethanol prior to the start of all procedures and during the experiment period. Glassware and instrumentation were washed with filtered Milli-Q water (Milli-Q water underwent double filtration with 1.2 µm Whatman GF/C filter paper prior usage) and rinsed three times with 80% ethanol. In addition, procedural blanks and control filter papers were first inspected by dissecting microscope  and later thoroughly analyzed to detect any contamination of microplastics from the laboratory surroundings and during sample handling .H(3) = 1.51, p = 0.68. When comparing the sampling stations  can present in various shapes, sizes, and colors ,35. In tstations A, S1 andBetween stations, polychaete samples from S3 recorded the highest number of microplastics , while the total abundance for the remaining sampling stations  was 19.1–22.6%. Since S3 is located on the depositional bank of the terrestrial area (low island) and near the mouth of the Ular River, it is thus susceptible to the wash-over pollution from the river downstream and the terrestrial area, as well as the tidal influx activity of the sea that brings marine debris and microplastics to this area ,36,37. AH(3) = 0.86, p = 0.834.Meanwhile, Nypa fruticans fibers. The discoloration of microplastics could be suggested as being due to the oxidation of microplastic-associated compounds either caused by environmental  or biological  factors. Polychaetes usually dominate the bottom community in open water, thus making them important for bioturbation. This organism can break down, deposit, and incorporate organic matter to recycle nutrients in their substrata [Similar to the previous findings by other researchers, the fiber type of microplastics represents the most common shape found in the polychaete samples ,42 FiguB. This cubstrata ,44; ruliubstrata ,46,47. Aubstrata ,42,47.m/z ratio that were selected for quantitative purposes, while The next analysis for the microplastics was the chemical characterization via pyrolysis-GC/MS. Theoretically, this technique required the pyrolysis of microplastics at a high temperature, and the volatiles were separated using gas chromatography, finally detected, or analyzed via mass spectrometry. m/z and 294 m/z), respectively [m/z); whereas the presence of styrene trimer (91 m/z), naphthalene (128 m/z), and benzene (77 m/z) could be used for PS and PVC, respectively. Additionally, 2,2-bis(4′methoxy-phenyl) propane and 4-isopropenylphenol were identified as a decomposition fragment for PC [Py-GC/MS is a well-established separation technique for the investigation of volatile and non-volatile compounds. Py-GC/MS has been frequently applied in the microstructural characterization and identification of synthetic polymers and copolymers in many industrial applications ,49. Chemectively . For PP,t for PC ,51,52.m/z. For PET and PMMA identifications, the pyrolytic products benzophenone (182 m/z), primarily used in the manufacturing of PET fiber, film and container plastics, and methyl methacrylate (100 m/z), commonly used in the paint industry and as rheology modifiers, were used to identify the respective polymers. Examples of fragmentation mechanisms for PVC into naphthalene and subsequently into benzene or toluene monomer (a), PS into styrene monomer (b), and PET into dimethyl terephthalate (c) are illustrated in +, which leads to the bond fragmentation to a smaller unit of monomers, such as methyl acrylate, as observed in the pyrolysis-GC/MS analysis.ε-Caprolactam, a monomer in the production of nylon-6, was used in the polyamide identification, in which, this fragment yielded a molecular weight of 133 Py-GC/MS could undoubtedly be used to characterize and quantify the relative mass content of microplastics in environmental samples with >50 µg/L  via the determination of specific polymeric decomposition products, independent of the natural organic and inorganic matrix . It is nNevertheless, based on the findings obtained , PVC wasThe sampling of polychaete was carried out within one year, with a 5-month interval at four different sampling stations. The result indicated that the most abundant color of microplastics that was ingested by the polychaetes during the northeast monsoon season was a brown color, whereas those that are transparent in color were more preferable during the southwest monsoon. The main reason for this observation is that all samples were collected in the digestive system of polychaetes and the original color of microplastics could be decolorized due to the ageing process or photo-degradation, as well as the biological interaction in the polychaete guts. The microplastics were further analyzed by employing chemical characterization via pyrolysis-GC/MS techniques, and the data indicated that several polymers were detected in the sample, including PVC, PE, PP, PS, PA, PMMA, and PET. The application of Py-GC/MS enables information on the composition of the plastic material to be obtained, though without clear data on the formulation. Additionally, the possibility of obtaining false positive data cannot be eliminated since Py-GC/MS will eventually pyrolyze all possible materials, hence producing similar molecular structures to those monomers. Nevertheless, it is proven that this technique can be applied to the qualitative and semi-quantitative analysis of a large variety of additives in polymeric items. Furthermore, analytical pyrolysis provides an extensive benefit in analyzing a complex sample for most compounds. It can determine mixed media and analyze both the polymer and associated organic plastic additives content in both an analytical amount and small size of samples, such as samples of invertebrates and planktonic microorganisms.


Additionally, medicine students had significantly higher mean knowledge score than students of medical laboratory (p < 0.001) and nursing (p = 0.008). In general, our research revealed that participants had favorable opinions regarding the disease’s preventative measures and a good awareness of it. However, more educational initiatives and campaigns that take into account KAP modifying elements are needed.Numerous measures have been taken to slow the Coronavirus disease (COVID-19) rapid spread. Such population control techniques may have a substantial impact on people’s attitudes, knowledge, and perception of COVID-19. This web-based cross-sectional survey aimed to assess Knowledge, Attitude, and Practices (KAP) towards COVID-19 among Hadhramout University Medical Students in Yemen from 15 June to 26 June 2020. This survey was performed using social media via the Google Platform among 422 Hadhramout University Medical students. After consenting, participants completed an online survey assessing sociodemographic data, 21 knowledge items, 15 attitudes items, and 5 perception items towards COVID-19. Of the total 422 participants, 389 (92.18%) were surveyed online, and 256 (65.8%) were females, and 133 (34.2%) were males aged 19-24 years (88.7%), studying medicine (58.9%), and living in urban areas (80.7%). The survey revealed that 64.0% of participants had good knowledge about the disease and 52.7% had positive attitudes towards protective measures against the virus. The majority of participants (98.2%) thought that the virus was transmitted through nasal droplets, and 59.6% agreed that the disease is dangerous. The majority of participants agreed that fever (99.2%), dry cough (97.9%), and difficulty breathing (99.5%) are the most common symptoms of the disease. The survey also showed high knowledge levels about preventive measures against the virus spreading, such as regular proper hand hygiene (99.7%), maintaining an appropriate distance (99.2%), avoiding touching eyes and nose (98.7%), and wearing facemasks in public places (97.4%). Moreover, 69.7% of participants agreed to be isolated at home if they got an infected person, 64.3% implemented washing hands with soap and water, 41.9% agreed to be separated at the hospital until they proved free from the disease, 46.0% agreed to inform the health authorities if they had any symptoms associated with the disease. By using sample T-test and analysis of variance (ANOVA), mean knowledge score about COVID-19 was significantly higher in males than in females ( A rapidly contagious disease first appeared in Wuhan, China, in late December 2019 . With a The primary pathogens of the respiratory system are indeed coronaviruses. They are part of a wide family of single-stranded Ribonucleic acid (RNA) viruses that have been linked to illnesses ranging from the common cold to those with severe symptoms, like Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) . The mosCOVID-19 transmission from human to human has been observed in health care, community, and family settings . It spreIn Yemen, the first confirmed case was recorded on 10 April 2020, in Al-Shiher city, located in Hadhramout Governorate ,7. HadhrMedical students are the first people who have close contact with those infected with COVID-19. One Chinese study addressed the psychological impact of the COVID-19 epidemic on college students during the pandemic and stated that they experienced high levels of psychological stress, which may lead to undesirable effects on their education and overall psychological wellbeing .Public health prevention and promotion rely heavily on knowledge, attitudes, and perception (KAP). It involves a variety of viewpoints regarding the disease’s etiology and aggravating factors, the recognition of symptoms, the available therapeutic options, and the potential outcomes . InformaThis web-based cross-sectional survey was conducted using the Google Platform Online among Hadhramout University Medical Students in Mukalla, Yemen, from 15 June to 26 June 2020. Among 422 Hadhramout University Medical Students of medicine, pharmacy, medical laboratory, and nursing colleges. Only 389 (92.18%) responded to this survey. Participants were recruited by convenience sampling following informed consent.Sociodemographic characteristics of the participants, including age, gender, residence area, educational level, and specialty.Knowledge of COVID-19, including sources of COVID-19 information, COVID-19 mode of transmission, COVID-19 symptoms, and preventive measures adopted to avoid contracting COVID-19 (21 questions).Attitudes and behaviors that may be associated with the prevention of the spread of the virus (15 questions).Perception about the virus and the disease including the dangers of the disease, possibility that another family member is infected with the virus, the infection is associated with stigma, the media coverage of the disease, and the virus is initially designed as a biological weapon (5 questions).Data were collected using a previously designed questionnaire provided in two languages (Arabic and English) . The queThe knowledge section consisted of 21 questions, and each question had a possible response of “Yes”, “No” and “Not sure”. The correct answer (Yes) was coded as 1, while the wrong answer (No/Not sure) was coded as 0. The total score ranged from 0 to 5, with an overall greater score indicating more accurate knowledge. The attitude section consisted of 15 questions, and the response to each question was indicated on a 5-point Likert scale as follows 0 (“Don’t agree”), 1 (“Not sure”), 2 (“Agree”), 3 (“Strongly agree”), and 4 (“Do strongly agree”). The total score was calculated by summating the raw scores of the 15 questions, indicating more positive attitudes towards COVID-19. The perception section included 5 questions, and each question had a possible response of “Yes”, “No” and “Not sure”. The correct answer (Yes) was coded as 1, while the wrong answer (No/Not sure) was coded as 0. The total score ranged from 0 to 5, with an overall greater score indicating more frequent practices towards COVID-19.A preliminary stage was conducted to assess the validity and reliability of the previously designed questionnaire . InitialThe sample was selected by the conventional method. The estimated sample size of n = 422 participants in this study was calculated using the WHO formula . The proThe study protocol followed the Declaration of Helsinki and was approved by the Ethics Committee of the Medicine College, Hadhramout University, Yemen . Participants who agreed opened the sent Google form link and filled it in, with their right to continue or withdraw.p-value < 0.05 was considered statistically significant. Statistical Package for the Social Sciences (SPSS) software, version 24 was used for statistical analysis.Descriptive analysis was used to summarize sociodemographic data and responses to questions concerning knowledge, attitudes, and perception towards COVID-19. Data were summarized as frequencies (n) and percentages (%) for categorical variables. The mean knowledge score is expressed as mean ± standard deviation (mean ± SD). Open-ended questions were analyzed separately, scored responses were summed and used in calculating the total scores of knowledge, attitudes, and perception for each participant. The knowledge of COVID-19 was assessed by answering 21 questions, then calculating each participant’s total cumulative knowledge score. Questions were given one point for the correct response and zero for the incorrect response. The association between knowledge score and sociodemographic variables was analyzed using the independent sample T-test and analysis variance (ANOVA). Post Hoc Analysis (LAD) was performed for multiple comparisons between every two categories. The statistical analysis was conducted at a 95% confidence level, and For each knowledge question, participants’ responses are presented in For each question focused on the attitudes of participants, the distribution of responses from participants is presented in For each question focused on perception of participants, the distribution of responses from participants is presented in p = 0.08), respectively. In contrast, there was a significant statistical difference between mean knowledge score of their gender (p = 0.03), respectively. Moreover, there was a significant statistical difference between mean knowledge score of participants according to their specialty (p < 0.001) and nursing , respectively, while pharmacy students (16.00 ± 2.10) had a higher mean knowledge score than medical laboratory students . There was no significant difference between students of medicine and pharmacy (p = 0.077).The relationship between the participants’ knowledge and their sociodemographic characteristics is shown in r gender . Mean knpecialty . FurtherThe COVID-19 disease has caused enormous damage throughout the world. The World Health Organization (WHO) referred to this illness as the first coronavirus-caused pandemic on 11 March 2020. One of the largest nations in the Arab world is Yemen, with more than 35 million people. This large population may provide a significant spread and mortality risk, particularly for the elderly and those suffering from chronic conditions, including diabetes, hypertension, and heart disease. Global efforts have been exerted to prevent the spreading of the virus. These efforts include political efforts by the governments, together with the health workers, which depend on the awareness of the general public about the disease. Here we explore the results of our survey about KAP of the Hadhramout University Medical Students, the Corner Stone of the Health System. From the most recently available information, our work is the first survey that assessed the KAP of COVID-19 in Yemen.In general, 64.0% of participants had a good knowledge score about the disease, its spread method, prevention, and treatment. This result is nearly close to studies among Egyptian  , JordaniRegarding information sources of COVID-19, the most important sources were social media (86.6%), while 8.7% of information was from international organizations . Social media  plays an important role in virus protection by raising public awareness about protective measures and through countering rumors . AccordiOn the other hand, most participants had good knowledge scores about the transmission of the virus through respiratory droplets and from infected persons to others, where 98.2% of participants agreed that the nasal droplets as the main source of infection and similar to other studies conducted to Egyptian (95%)  and UganIndeed, our survey found that more knowledge score was significantly higher in males than in females. Moreover, medicine students had more knowledge scores than students of medical laboratory and nursing, however, there was no significant difference between students of medicine and pharmacy. Similarly, Zhong et al. found that male sex, age group of 16–29 years, marital status, education, employment, and being a student were significantly associated with knowledge . TherefoThe major limitation of our work is that the survey was only distributed online, which allowed only students who had internet access to participate. Moreover, the sample was selected by convenience method. Moreover, our findings may not represent all Yemeni medical students.Our survey found that Hadhramout University Medical Students had good knowledge about COVID-19, and a positive attitude toward using protective measures to limit the spread of infection. This knowledge is mainly acquired through social media platforms. However, there is an urgent need for scientific awareness campaigns regarding the disease. Meanwhile, healthcare authorities can use our survey as a baseline to evaluate more accurate knowledge among the Yemeni population towards COVID-19 or any pandemic in the future.


Background: High triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance, is associated with an increased risk of albuminuria in adults. However, the relationship between high TyG index associated with renal hyperfiltration (RHF) and albuminuria among young adults is unclear. Methods: A total of 5420 participants aged 19–39 years were enrolled from the Korean National Health and Nutrition Examination Survey (2011–2014 and 2019) and their TyG index levels were analyzed. RHF was defined as eGFR with residuals > 90th percentile after adjusting for age, sex, weight, and height. Albuminuria was defined as urinary albumin-to-creatinine ratio ≥ 30 mg/g Cr. Logistic regression analyses were used to evaluate the association between TyG index, RHF, and albuminuria. Results: The mean age was 30.7 ± 6.0 years and 46.4% were male. The prevalence of albuminuria and RHF was higher in the higher tertiles of TyG index. In our multivariable model, high TyG index showed higher risk of albuminuria (odds ratio (OR) per 1.0 increase in TyG index, 1.56; 95% confidence interval (CI), 1.24–1.95 and OR in the highest tertile, 1.65; 95% CI, 1.08–2.52). High TyG index was associated with higher risk of RHF . When participants were divided into with or without RHF, high-TyG index-associated high risk of albuminuria was only observed in those with RHF. Participants with concurrent high TyG index and RHF showed the highest risk of albuminuria. Mediation analysis showed that 54.2% of the relation between TyG index and albuminuria was mediated by RHF . Finally, incorporating TyG index into our basic model improved the predictive value for albuminuria only in participants with RHF. Conclusion: High TyG index associated with RHF was the strongest risk factor for albuminuria in this study. Early identification of high TyG index with RHF may prevent future development of CKD in relatively healthy and young adults. Chronic kidney disease (CKD) is associated with high rates of morbidity and mortality, resulting in a substantial socioeconomic burden . Young aInsulin resistance is one of the key mechanisms involved in kidney disease development, which is accompanied by renal hyperfiltration (RHF) ,11,12. TThe triglyceride-glucose (TyG) index is a surrogate marker of insulin resistance. Recent studies have reported that a high TyG index is associated with insulin resistance and is related to poor kidney outcomes in adults ,20,21. H2. Finally, 5420 participants aged 19–39 years with normal kidney function were analyzed  from 2011–2014 and 2019. The KNHANES is a nationally representative database of the South Korean population controlled by the Korea Centers for Disease Control and Prevention . The KNHANES database consists of health interviews, health examinations, nutritional surveys, and laboratory tests. All participants were randomly selected from 600 randomly selected districts of cities and provinces in South Korea. In this retrospective cross-sectional study, 43,338 participants from the KNHANES were initially screened. Among them, 37,918 participants were excluded, including those aged ≥40 years or ≤18 years, missing demographic and laboratory data, or with an eGFR below 60 mL/min/1.73 manalyzed . All parDemographic and socioeconomic data, including age, sex, smoking status, alcohol intake, education, economic status, and medical history, were collected upon study enrollment. Detailed methods for data collection are described in The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The study participants were grouped by tertiles based on the TyG index levels (Tertile 1 (lowest), Tertile 2, and Tertile 3 (highest)). RHF was defined using previously suggested methods with some modifications . In brieContinuous variables are expressed as the mean ± standard deviation (SD) and categorical variables are expressed as an absolute number (%). Analysis of variance was used to compare continuous variables in each group, and the Chi-squared test was used for categorical variables. The Kolmogorov–Smirnov test was performed to evaluate the normality of the distribution of parameters. If the normal distribution was not verified in the resulting data, the geometric mean ± SD was reported. For multiple comparisons, the Kruskal–Wallis test was used. To further elucidate the association of high TyG index with RHF and the risk of albuminuria, participants were divided according to the presence of RHF and relative risks for albuminuria with TyG index levels and were then compared. Additionally, six groups were made combining the presence or absence of RHF and tertiles of TyG index, and the risks for albuminuria were compared using multivariable logistic analysis. Covariates adjusted for multivariable models included age, sex, smoking and alcohol status, education and income levels, BMI, SBP, histories of hypertension, diabetes, and dyslipidemia, hemoglobin, and eGFR. To investigate the association between TyG index level and albuminuria or RHF, we used multivariable logistic regression analyses. Variance Inflation Factors (VIF) and tolerance for multi-collinearity evaluation with diabetes, BMI, and smoking were performed, and variables with VIF < 10 or tolerance > 0.10 ,24 were 2). Second, to further evaluate the association of TyG index with RHF and the risk of albuminuria according to glucose levels ((1) prediabetes: 100 ≤ fasting glucose ≤ 125 or 5.7 ≤ HbA1c ≤ 6.4; (2) diabetes: fasting glucose ≥ 126 or HbA1c ≥ 6.5), multivariable logistic regression was performed. Lastly, the definition of RHF using a higher threshold of eGFR with residuals > 95th percentile after adjusting for age, sex, weight, and height was used and analyzed as a study endpoint. For all analyses, a value of p < 0.05 was statistically significant. All statistical analyses were conducted using SPSS version 25.0 , Stata version 17 , and R software version 4.1.0 .Several sensitivity analyses were performed. First, we performed subgroup analyses to observe interactive effects for RHF and albuminuria between TyG index and diabetes (no vs. yes), smoking (no vs. yes), and BMI  participants were male. The baseline characteristics of study participants according to tertiles of the TyG index are shown in p for trend < 0.001). To investigate the association between TyG index and the risk of albuminuria, logistic regression analysis was performed. High TyG index level was significantly associated with greater odds for albuminuria in the unadjusted model (odds ratio (OR) per 1.0 increase in TyG index level, 2.41; 95% confidence interval (CI), 2.03–2.86; p < 0.001). This association remained consistent after full adjustment for confounding variables (adjusted OR (AOR) per 1.0 increase of TyG index level, 1.56; 95% CI, 1.24–1.95; p < 0.001). A positive linear relationship between the TyG index levels and the risk of albuminuria was observed by restricted cubic spine curve analysis (p = 0.02).Of the 5420 participants, albuminuria was prevalent in 233 (4.3%) . Tertileanalysis A. When tp for trend < 0.001). To evaluate whether high TyG index is associated with an increased risk of RHF, multivariable logistic regression analysis was conducted. The unadjusted model showed that the risk of RHF increased as the TyG index level increased . In the multivariable model after full adjustment for confounding variables, high TyG index level was consistently associated with an increased risk of RHF . Comparing the risk of RHF according to tertiles of TyG index, the highest tertile was significantly associated with an increased risk of RHF compared to the lowest tertile .To elucidate whether high TyG index, which indicates worsening insulin resistance, is associated with kidney injury induced by glomerular hyperfiltration, we tested the association between TyG index and the risk of RHF. Among the study participants, 543 (10%) participants had RHF . Based op for interaction < 0.001). The prevalence of albuminuria was significantly increased in higher tertile of TyG index in both groups with and without RHF (p for trend < 0.001). When the adjusted odds for the albuminuria risk were assessed in participants with RHF, high TyG index was significantly associated with an increased risk of albuminuria . However, in participants without RHF, no significant associations were observed between TyG index levels and the risk of albuminuria . The restricted cubic spline curve analyses showed a positive linear relationship between TyG index levels and the albuminuria risk only in participants with RHF (p = 0.002). However, in participants without RHF, no significant associations were observed between the TyG index and the risk of albuminuria. We further constructed six groups by combining tertiles of TyG index and the presence or absence of RHF and then evaluated the risk of albuminuria among the six groups . In the adjusted multivariable model, the relation between the TyG index and albuminuria was fully mediated by RHF (p = 0.12 for direct effect), suggesting that RHF mediated 54.2% of the total effect . Additionally, to further confirm the potential mediation effect of RHF on the association between high TyG index and the risk of albuminuria, we performed mediation analysis, as presence of RHF showed a significant interaction between TyG index and the risk of albuminuria (d by RHF . In partp = 0.03)  .2) showed significant interactions with TyG index for the risk of albuminuria  showed a significant association between TyG index and an increased risk of albuminuria after adjustment for confounding variables . However, in the aspect of the risk of RHF, diabetes, smoking, and BMI showed no significant interactions with TyG index , suggesting that TyG index was independently associated with the risk of RHF , smoking (no vs. yes), and BMI . In contrast, there were no significant associations between TyG index and the risk of albuminuria in those without RHF in the prediabetes or diabetes groups .Second, to further investigate whether the TyG index with presence of RHF effects the risk of albuminuria according to the glucose levels (prediabetes or diabetes), we performed logistic regression analysis between the combination of TyG index and RHF and the risk of albuminuria in each group of glucose levels. In multivariable logistic regression models, there was a significant association between high TyG index with RHF and the risk of albuminuria in both prediabetes and diabetes groups . The parp < 0.001 and AOR, 2.44; 95% CI, 1.66–3.60; p < 0.001 in the highest tertile of TyG index). When the association between high TyG index with or without RHF defined by eGFR with residuals >95th percentile after adjusting for covariates and the risk of albuminuria was evaluated, high TyG index with RHF showed an increased risk of albuminuria   .In this cohort of young adults, high TyG index was associated with the risk of albuminuria and RHF. However, an increased risk of albuminuria associated with a high TyG index was only observed in participants with RHF as opposed to those without RHF. Furthermore, participants with concurrently high TyG index and RHF had a stronger association with the risk of albuminuria. The mediation effect of RHF accounted for 54.2% of the relation between the TyG index and albuminuria. Incorporating the TyG index into the traditional risk factor model with RHF significantly improved the predictive value for the risk of albuminuria. In our sensitivity analysis, participants with diabetes, smoking, and high BMI revealed a significant association with high TyG index and the risk of albuminuria. However, TyG index independently increased the risk of RHF regardless of diabetes, smoking, or BMI. Furthermore, the participants with higher insulin resistance showed an increasing risk of albuminuria with high TyG index in those with RHF, whereas those without RHF did not.TyG index is a surrogate marker for insulin resistance in the younger population, similarly to adults ,26,27,28The increasing incidence of obesity, hypertension, and diabetes among young adults is a growing public health concern worldwide . This phNevertheless, growing evidence suggests that insulin resistance or its related metabolic disturbance is associated with RHF and its attribution to the development of CKD in non-diabetic adults and the adolescent population ,37. In aThis study has several limitations. First, due to the cross-sectional observational study design, a causal relationship and mediation effect between the TyG index, RHF, and their effect on albuminuria development cannot be fully determined. Although a cross-sectional mediation analysis was performed to clarify the relationship between the TyG index, RHF, and the risk of albuminuria, a further longitudinal study is warranted to confirm causality. Second, due to the limitation of data, other insulin resistance indicators such as HOMA-IR or serum insulin levels were not measured and compared to the TyG index. However, previous studies have indicated that the TyG index is a reliable marker for insulin resistance compared to other indicators, particularly in young adults ,28,41,42High TyG index was associated with an increased risk of RHF and albuminuria in young adults. High TyG index with the presence of RHF was the strongest risk factor for albuminuria in this study. TyG index, a surrogate marker of insulin resistance, may serve as an early indicator of kidney damage. These findings suggest that early identification of high TyG index with RHF may help prevent future development of CKD in relatively healthy and young individuals.


This review describes the role of CXCL1, a chemokine crucial in inflammation as a chemoattractant for neutrophils, in physiology and in selected major non-cancer diseases. Due to the vast amount of available information, we focus on the role CXCL1 plays in the physiology of bones, bone marrow, muscle and the nervous system. For this reason, we describe its effects on hematopoietic stem cells, myoblasts, oligodendrocyte progenitors and osteoclast precursors. We also present the involvement of CXCL1 in diseases of selected tissues and organs including Alzheimer’s disease, epilepsy, herpes simplex virus type 1 (HSV-1) encephalitis, ischemic stroke, major depression, multiple sclerosis, neuromyelitis optica, neuropathic pain, osteoporosis, prion diseases, rheumatoid arthritis, tick-borne encephalitis (TBE), traumatic spinal cord injury and West Nile fever. CX3C chemokines (1 representative in humans),CXC chemokines (17 in humans),CC chemokines (26 in humans),XC chemokines (2 in humans).Chemokines are chemotactic cytokines , whose mCXC motif chemokine ligand 1 (CXCL1), a CXC chemokine  and melahttps://pubmed.ncbi.nlm.nih.gov; accessed on 30 December 2021). The search phrases included: This review is based on articles available in PubMed ((CXCL1 or CINC-1 or MIP-2 or MIP2 or (KC chemokine) or MGSA or gro-a or gro-alpha) and (bone or muscle or brain or astrocyte or microglia or neuron) not review.The results included all articles with the title, abstract or keywords mentioning selected organs and CXCL1 or paralogs of this chemokine in rodents. Review papers were not searched. Over 1700 articles were searched and preselected based on the title of the paper. Based on the literature searched, subsections were written about the physiological role of CXCL1 in given tissues and organs. After selecting the most exhaustive 100 articles, 15 diseases were selected in which CXCL1, or its mouse or rat paralog, plays an important role. Then to write each of the subsections on the role of CXCL1 in diseases, articles were searched by the phrase: “the name of the disease” and (CXCL1 or MIP-2 or MIP2 or (KC chemokine) or MGSA or gro-a or gro-alpha) and not review.Next, a selection of search articles was made by title. The papers were then read and searched for new and interesing literature references.https://pubmed.ncbi.nlm.nih.gov; accessed on 30 December 2021) was used and the phrase: In addition, each subsection contains a brief introduction about the disease being discussed. To write these introductions, PubMed  in rats ,10, and Due to these discrepancies, we adopted the following principles when writing this review. First, to show whether CXCL1 has a role in a given process in humans, we showed elevated CXCL1 expression in patients with a given disease or at the site of given physiological processes. Then, we described the mechanism of CXCL1 action, including in vivo studies on experimental animals with elevated expression of chemokines that are ligands for CXCR2, namely, KC or macrophage inflammatory protein-2 (MIP-2) in the mouse and CINC-1 in the rat. It can be assumed that if KC, MIP-2, CINC-1 and CXCL1 appear in different species in the same disease, then they play the same role in disease mechanisms. Importantly, in the present study we focus only on human CXCL1, although it is possible that other human ligands for CXCR2 also have the same function in the diseases we discuss.In some studies on mice, KC has a significant function in a given disease, even though in humans CXCL1 does not. In such a case, we describe the mechanism of action of CXCR2 ligands in a given disease and then provide possible CXC chemokines that play some role in humans, most frequently CXCL8/IL-8. The large majority of literature does not examine all ligands for CXCR2 and for this reason it is possible that other CXC chemokines, not just CXCL8/IL-8, may also be involved in the mechanisms of a given disease.+ monocytes . γ. γ134]. Expression of ligands for CXCR2 during ischemic stroke may also depend on miRNAs. In rats, an ischemic stroke is associated with promoter hypermethylation of miR-532-5p , which rMajor depression is a mental illness that affects approximately 6% of the population and its pathogenesis may be related to inflammation . In miceThe mechanism of CXCL1 involvement in major depression in humans appears to differ significantly from the animal model. Depressed suicidal persons experience a reduction in CXCL1 expression in the prefrontal cortex, similar to the reduction in the expression of CXCL2 and CXCL3 . Plasma There are no studies showing correlations between depression on CXCL1 expression in the hippocampus in humans. It is possible that, as in experimental animals, depression is associated with an increase in CXCL1 expression in this brain structure in humans. If, in contrast, the human hippocampus showed a decrease in CXCL1 expression, it would indicate that CXCL1 plays an important role in brain function in humans and a decrease in the expression of this chemokine could cause depression. This would likely be related to hippocampal neurogenesis  or impaiMultiple sclerosis is a neurodegenerative and autoimmune disease of the brain and spinal cord, with an estimated incidence of 0.2 to 240 people per 100,000, depending on the population studied . Myelin-CXCL1 is a significant element in the course of multiple sclerosis. This chemokine has been shown to have both neuroprotective and inhibitory properties in the progression of multiple sclerosis , as wellCXCL1 expression is increased in the brains of patients with multiple sclerosis . In part+ T helper type 17 (Th17) cells which produce IL-17 [In multiple sclerosis, CXCL1 is produced by activated microglia  and astrce IL-17 ,164,165.ce IL-17 . IL-17 ace IL-17 . As the ce IL-17 . In micece IL-17 ,168, whiInflammation has a destructive effect on oligodendrocyte progenitor cells as shown by experiments on human embryonic stem cell-derived oligodendrocyte progenitor cells  and muriCXCL1 also participates in the progression of multiple sclerosis . CXCR2 aNeuromyelitis optica is a neurodegenerative and autoimmune disease. Auto-antibodies to aquaporin 4 (AQP4) are responsible in over 80% of cases of this disease . The incChemokines, such as CXCR2 ligands, are important in the development of neuropathic pain. However, due to bioethical constraints, all knowledge about the importance of CXC chemokines in the development of neuropathic pain is based on experiments on laboratory animals. Due to the fact that CXCR2 ligand systems differ significantly between humans and mice, the presented mechanism of neuropathic pain gives only a hint of the role that CXCL1 may play in this disease in humans.Following nerve injury in mice, KC expression increases in spinal astrocytes ,181,182.+ currents [+ currents in sensory neurons [CXCR2 activation on neurons and spinal microglia has been found to lead to neuropathic pain ,186,187.currents  and upre neurons . Another neurons . CGRP is neurons .It has been found that KC can also cause neuropathic pain by recruiting neutrophils ,192,193.Also, studies with laboratory animals show that CXCR2 ligands reduce spontaneous activity . This inSc) [C) into PrPSc. This is followed by aggregation of PrPSc in neural tissue which leads to spongiform degeneration. Examples of prion diseases include sporadic Creutzfeldt-Jakob disease (sCJD), fatal familial insomnia and kuru. An important element in the course of prion diseases is neuroinflammation [Prion diseases form a group of neurodegenerative diseases caused by scrapie-associated prion protein (PrPSc) . This prammation  involvinammation ,200,201.ammation . In contAs KC is a murine paralog for human CXCL1 ,11, it mSc reduces the activity of these cells [CXCL1 does not play an important role in prion diseases. In multiple sclerosis, an increase in CXCL1 expression in the brain has a destructive effect on neural tissue through infiltration of neural tissue by neutrophils ,173. Evese cells  and therFlavivirus. It infects animals in central and eastern Europe and northern Asia. In humans, TBEV infection usually gives mild symptoms; however, some 2% of cases of TBEV infection are fatal. TBEV is a neurotropic pathogen that attacks neural tissue, including the brain. The vector for this virus is the Ixodes sp. tick, which means the virus enters the body of the host during feeding by these parasites. Tick-borne encephalitis (TBE) is a disease caused by the tick-borne encephalitis virus (TBEV) . Its genAt the same time, the feeding of the tick involves a strong immune response . The ticOther evasins inactivate other groups of chemokines. For example, Evasin-1 inactivates the proinflammatory chemokines CCL3 and CCL4 . EvasinsTBEV is a neurotropic pathogen causing a severe neuropathological disorder . One comTraumatic spinal cord injury involves damage to the spinal cord as a result of a violent accident or fall. It is estimated that there are approximately 17,000 cases of traumatic spinal cord injury per year in the United States alone . ApproxiFlavivirus [West Nile fever is caused by West Nile Virus (WNV) from the genus avivirus . Its genavivirus .Culex sp. For this reason it is found in warm countries in Africa, Asia, Australia and Europe. When bitten by the mosquito, the virus is introduced into the skin [WNV acts as a neurotropic pathogen that affects the nervous system and also other tissues and organs such as the skin, kidney and gastrointestinal tract. WNV is a zoonotic pathogen that is transmitted to humans by mosquitoes, mainly by the skin . It infethe skin , causingthe skin . This reAnti-inflammatory substances in the mosquito saliva reduce inflammatory responses , which aWNV is a neurotropic pathogen that can get into the brain and spinal cord, although this form of infection is rare in humans . There aThe role of CXCL1 in physiology and in non-cancer diseases has been fairly well studied. Nevertheless, the biggest shortcoming in knowledge of this chemokine is the huge difference in CXCR2 ligand systems between humans and rodents. For this reason, human CXCL1 does not have functions identical to those of murine KC and rat CINC-1. The results obtained in studies on animals cannot be completely and unqualifiedly compared to a human patient’s condition during a given disease. For this reason, until new research models are invented and disseminated, certain areas of knowledge about CXCL1 are still in the realm of conjecture.One direction of CXCL1 research should be the application of existing knowledge in practice. CXCL1 plays an important role in the pathogenesis of many non-cancer diseases. Therefore, it is possible to use either CXCR2 inhibitors or anti-CXCL1 antibodies in the therapy of these diseases. As there are 7 chemokines that activate CXCR2, it seems that the use of CXCR2 inhibitors is a better option. However, the chemokines that are CXCR2 activators differ in their sites of expression, among other things. For this reason, antibodies to individual CXCR2 activators may also be a convenient therapeutic option, provided we learn the exact differences between individual CXCR2 activators in a given disease.


This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient’s QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment. Bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT) is an effective treatment for adults with hematological diseases . This thAfter oncological treatment, many patients develop long-term psychoemotional disorders that reduce their quality of life (QoL) , as faticancer-related fatigue is one of the most common and disabling symptoms experienced by cancer patients [Depression and anxiety emerge in the cancer patient as a result of reaction to diagnosis, therapy, or relapse or during survivorship. It is pathological if it compromises the person’s normal functioning and if it is disproportionate to the level of threat [Psychological distress is considered a serious problem for patients diagnosed with cancer. It is a “multifactorial unpleasant emotional experience of a psycho-social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms, and its treatment” [Sleep habit influences cognition, attention, memory, and learning. Moreover, according to cross-sectional studies in cancer patients, poor sleep quality is associated with poor cognitive functioning [QoL evaluates the person‘s well-being in relation to diverse emotional, social, and physical dimensions of life, which may be influenced by disease or disability. The measurement of QoL can contribute to modify therapies and to prevent secondary effects or diseases [Of the variables mentioned above, (a) patients . In the patients . Thus, fpatients . Cancer-patients , or frompatients . (b) Depf threat . Depressf threat . (c) Psyeatment” . Cancer eatment” ,26. (d) ctioning . (e) QoLdiseases .Until 1960, the recommendation of exercise was only reported for cardiac, pulmonary, and renal physical pathologies. In 1989, significant improvements in maximal oxygen uptake (VO2max) were found in 45 women with breast cancer after postchemotherapy with 10 weeks of aerobic exercise intervention . In 1996However, from 1989, a first quasi-experimental study reported a home exercise program that improved the performance of 12 leukemia patients with 30 min and 3 sessions per week at 85% of heart rate maximal. No significant results were obtained in functional capacity or in the reduction of depression by Beck’s scale . SubsequSpecifically, exercise programs in HSCT-BMT patients are now known to produce positive effects in QoL, which is a predictor of physical, functional, and emotional well-being ,35,36,37Our outcomes are in accordance with two systematic reviews and meta-analyses ,45, whicThen, the purpose of this manuscript is to systematically review the current literature and analyze the scientific evidence that have examined the effects of exercise programs on psychoemotional and QoL factors in adult patients with cancer and HSCT.The systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), as well as possible consequences for the risk of bias . An elecStudies meeting the following criteria were included in this review: (a) published studies, (b) published in English, (c) randomized controlled trials (RCTs), (d) adult patients (age ≥ 18 years old) of both sexes who suffered or had suffered from any type of cancer at the time of the study, (e) patients in the process of receiving or who received an HSCT, (f) patients who had undergone an exercise program intervention, (g) studies with an effect on psychoemotional and QoL factors in adult patients, and (h) only studies with a score ≥6 in the Physiotherapy Evidence Database (PEDro) scale ,49,50,51The study selection process was conducted via step 1 (title and abstract screening), followed by step 2 (full-text screening). In step 2, the studies were evaluated with the PEDro scale to select those that scored ≥ 6 points.The following variables from the included studies were extracted independently by two authors (E.M.R. and J.L.C.): sample (N), sex and age of participants, type of cancer, characteristics of the interventions , and effects of psychoemotional and QoL variables. At the same time, discussion and consensus on data extraction resolved discrepancies. The exercise programs before and after HSCT in cancer patients were separated.Two authors (E.M.R and J.L.C.) independently scored the studies using the PEDro scale, based, in turn, on the Delphi list , and disn = 646) and removing studies for other reasons  (n = 453), 222 studies were included. After screening by title and abstract (n = 150) and full text (n = 72), 202 studies were excluded, which were excluded by PEDro (n = 14), and 20 studies overcame all the inclusion criteria , they performed mobilization and/or stretching exercises ,57; in 3The quality of the 20 studies included was high . They were divided into an EXP group with 606 patients (230 women) and a CT group with 613 patients (302 women), but there were some studies ,64 that The characteristics of the exercise interventions  were verSupervision: Exercise programs were supervised by investigators in 15 studies (75%) [es (75%) ,62,63,65es (75%) ,56,66, aes (75%) ,67.Frequency: A total of 3 studies (15%) applied the exercise intervention 7 days per week ,56,67, 9Intensity training: A total of 7 studies (35%) did not provide information for the type of intensity training ,60,64,67Duration: A total 11 studies (55%) were up to 8 weeks [ studies % were up 8 weeks ,63,65,66 8 weeks ,60,61,67 8 weeks ; and in  8 weeks ,58. In 6 studies % were up 8 weeks ,63,66; i 8 weeks ,61,65,67 8 weeks ,60,62,64Type: The majority of the studies included multicomponent exercise interventions. A total of 9 studies (45%) were focused on strength and aerobic training [training ,61,62,64training ,65; 2 sttraining ,63; 1 sttraining ; 1 studytraining ; 1 studytraining ; 1 studytraining ; 1 studytraining ; 1 studytraining ; and 1 straining . When reDelivery setting: A total of 10 interventions (50%) were conducted in healthcare settings  [spitals) ,63,65,66spitals) ,60,62,67spitals) , and 1 ispitals) .A total of 10 of the 20 papers (50%) presented the compliance rates of their subjects with exercise, with the adherence data for the patients shown as follows: <40% ,67, 40–8Psychoemotional variables were examined in 14 of the 20 studies (70%). The next variables of the fatigue factor were directly monitored using a Fatigue Impact Scale (5%) , Brief FIn 7 of the 14 the studies (50%), the results suggested a significant increase in the following psychoemotional variables: (a) fatigue measures with the scales: Fatigue Impact Scale , MultidiParticipants in the studies in which these variables were increased had: (a) a mean age between 49 and 58 years, (b) 38.8%–41.7% were women in the experimental group, and (c) the primary cancer in these studies was multiple myeloma, although no patient’s cancer stage was detailed, which does not allow us to find out whether the improvement is the same for all patients or not.QoL variables were examined in 19 of the 20 studies (95%). The variable QoL was measured through the different scales: (a) QoL measures with the scales: Symptom Scales of the EORTC Myeloma Module (5%) , QLQ-C30In 10 of 19 studies 53%), the results suggest a significant increase in the following QoL variables before and after HSCT: (a) QoL measures with the scales: QLQ-C30 ,51,52,58%, the rePatients in the studies in which these variables were increased shared: (a) a mean age between 34.1–62.2, (b) 16–47% were women in the experimental group, and (c) the common cancers in these studies were leukemia and multiple myeloma, without specifying the stage of the cancer, not being able to establish whether the improvement is the same for all patients.This systematic review of the literature analyzed the effects of the exercise programs on psychoemotional and QoL factors in adult patients with cancer and HSCT-BMT. Only randomized controlled trials were included, providing a high selection of methodologically sound studies. The main finding of this study is that exercise program interventions produced significant improvements in psychoemotional and QoL variables of over 50% in those studies analyzed before and after HSCT, being less than 40% in studies analyzed exclusively after HSCT.Our results are in line with two systematic reviews and meta-analyses that examined the effects of exercise on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. The review dates were, respectively: from 1 January 2010 to 1 July 2020 and from inception to 5 December 2020. Our systematic review presents similarities with these reviews: these two reviews included 7 of the 20 studies that are also discussed in our review ,45, adheA total of 8 of 14 studies (57%) observed improvements in psychoemotional variables: fatigue, mood state, anxiety and depression, and health status. In the case of fatigue, the exercise interventions showed a mean improvement of 16.1% (6.5–34.1%) in the different dimensions used in the tools used to measure fatigue ,50,51,52Regarding the state of mind variable, two studies ,59 used The depression variable has also been measured using the Montgomery–Asberg Depression Rating Scale, which also takes anxiety into account , in whicFinally, the health status variable showed an improvement in the experimental group of 18.2% in the vitality domain of the 36-Item Short Form Survey.The Multidimensional Fatigue Inventory is the main tool to assess fatigue globally , and theOn the other side, 6 of the 14 studies 43%) found no significant improvement after the exercise interventions. This absence of positive effect may be due to the following reasons: the patient sample consisted exclusively of allogeneic transplant recipients ; the tre% found nAccording to the studies analyzed, the most appropriate exercise program to improve psychoemotional variables had the following characteristics: it was supervised, with a duration of 12 weeks and sessions of between 20 and 40 min. It combined strength and aerobic training and was performed in health facilities. Unfortunately, almost all the studies did not adequately report the intensity of training, so the most appropriate intensity cannot be proposed.In 10 of 19 studies 53%), improvements were observed in the measured of QoL variables. Regarding the QoL variable, the experimental group showed improvements in the following dimensions: the physical functioning dimension showed a mean improvement of 4.9% (3.3–6.5%) ,50; the %, improvThe most used QoL tool in oncology is QLQ-C30 , which aStudies indicate that physical exercise after cancer diagnosis has a positive effect on QoL in emotional well-being . This waHowever, 12 of the 19 studies (63%) found no significant improvements after the exercise interventions. This lack of improvement may be caused by the following reasons: no randomization of baseline fitness characteristics prior to exercise intervention, independently of the severity of pathology or symptomatology ; a smallExercise program interventions appear to be safe in adult oncology transplant patients and produce benefits in cardiorespiratory fitness, endurance, functional capacity , and quaAs a practical application of the present systematic review, the program that produced improvements in QoL was supervised, with a frequency of 5 days a week, a duration of 8 weeks, and sessions with duration between 15 and 40 min. It combined strength and aerobic training, and was carried out in health facilities. Again, intensity was not well described in most studies, but of the few studies that did describe it, it appears that the most usual intensity of strength and aerobic training was moderately low.This review reveals that the literature published so far on this theme has limitations in respect to: (a) the small sample size (13 of 19 studies) including <100 participants; however, it must consider that sometimes it may be hard to collect data from numerous patients with the same cancer type and treatment and to meet all the inclusion and exclusion criteria; (b) heterogeneous characteristics of the sample ; (c) heterogeneity of exercise interventions ; (d) lack of follow-up ,67; (e) Future lines of research need to center on RCTs in progressing towards new exercise programs with different load planning and homogeneity and long-term follow-up of the exercise program to blind the evaluators to group assignment and description of the cancer stage of the studied patients.In conclusion, it seems that an exercise program intervention provides benefits in psychoemotional state and QoL in adult patients with cancer and HSCT. Thus, exercise training programs may have a positive emotional effect, as well as a preventive effect on possible complications of transplantation. However, more RCTs are needed to confirm these conclusions, as some studies do not seem to show significant improvement in the variables studied due to: (a) measurement of fatigue with Multidimensional Fatigue Inventory and QLQ-C30, the latter being a less specific tool in its measurement ; (b) meaAccording to the studies analyzed, the most appropriate exercise program to improve psychoemotional variables had the following characteristics: it was supervised, with a duration of 12 weeks and sessions between 20 and 40 min. It combined strength and aerobic training and was performed in health facilities. Unfortunately, almost all the studies did not adequately report the intensity of training, so the most appropriate intensity cannot be proposed.Our results show that exercise program interventions are clinically relevant and need to be widely implemented in these patients. Most of the programs analyzed were supervised, multicomponent , with a frequency range between 2 and 7 days a week, lasting 5 to 18 weeks, with sessions of 15 to 60 min, and performed in healthcare facilities or at the patient’s home (depending on the patient’s condition).In addition, to maximize the emotional and QoL benefits of the program, exercise load and intensity should be individualized and monitored during the training process.


Gastric low-grade intraepithelial neoplasia (LGIN) is a precancerous lesion of gastric cancer. Endoscopic therapies represented by radiofrequency ablation (RFA) and argon plasma coagulation (APC) have been applied to treat gastric LGIN in recent years. However, no comparative study examining the effectiveness and safety profiles of RFA and APC has been reported.  A single-center, large-scale, retrospective study, including 73 and 50 patients treated with RFA and APC, respectively, was conducted in the First Medical Center of Chinese PLA General Hospital from October 2015 to October 2020, with a two-year follow-up. Effectiveness, complications, operative factors, and other data were assessed. p > 0.05). However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001); there was also a significant difference in the composition ratio of large lesions between the two groups (p < 0.001). No serious postoperative complications showed in either group, and the abdominal pain was the most common symptom in the short term after surgery.  At 2 years of follow-up, cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively, with no statistically significant differences between the two groups (all  RFA and APC are both safe and effective destructive therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. An intraoperative submucosal injection is expected to be an effective method for relieving postoperative abdominal pain. A few decades ago, the World Health Organization (WHO) introduced the notion of intraepithelial neoplasia in the recent classification of digestive system tumors, referring to the Vienna International Consensus –3. In thAs LGIN is at an earlier stage than HGIN in precancerous lesions, endoscopic resection therapies are also feasible, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), as confirmed by previous reports , 13. HowCorrespondingly, radiofrequency ablation (RFA) and argon plasma coagulation (APC), the two most commonly used methods in damage therapy, have been preliminarily reported in clinical studies for the treatment of gastric LGIN in recent years –19. TheyNo study has reported the differences in effectiveness and complication among damage therapies for gastric LGIN. For this purpose, we designed this retrospective study to compare RFA and APC in the treatment of gastric LGIN.The records of 123 consecutive patients administered RFA or APC for gastric LGIN in The First Medical Center of Chinese PLA General Hospital between October 2015 and October 2020 and followed up for more than 2 years were reviewed in this single-center retrospective study. Among them, 73 and 50 patients received RFA and APC, respectively. All the patients provided written informed consent for the procedure, and the study was reviewed and approved by the Ethics Committee of Chinese PLA General Hospital.The inclusion criteria were as follows: (a) treatment with RFA (macroscopic type 0-II lesions according to the Paris classification ) or APC 2 insufflator .The BARRX System  was used for RFA, and the argon plasma coagulation unit  was used for APC. A disposable injector  with normal saline solution was used for submucosal injections. An accessory of the BARRX System  was used for lesion ablation. Hemostatic forceps  were used to prevent hemorrhage and perforation. Other equipment and accessories included a high-frequency generator , gastroscopes , and carbon dioxide gas with a CO2. After ablation, the lesion surface showed white coagulation and necrosis. Before the next ablation, the coagulated necrotic tissue on the surface was removed with RFA electrodes. RFA was repeated three times for each lesion to ensure complete ablation. In addition, submucosal injection could be administered to lesions, which was beneficial for the procedure, especially in case of difficult lesions. Other details of the RFA procedure were described in our previous study [The procedure applied for RFA has been reported previously . After tus study .The procedure applied for APC was simpler than that of RFA. First, it was also necessary to re-evaluate the lesions with ME combined with NBI. Next, with the help of endoscopy, an argon plasma catheter was placed close to the lesion surface and cauterized in a subcontact state. Unlike RFA, we set the output power for APC to 35 W. After APC, the lesion surface showed white, light yellow, or brown-black coagulation areas and necrosis. Finally, the procedure was considered to be completed after confirming that the treatment had completely covered the lesion area. It is important to note that APC does not require retreatment of the same lesion area except for a local omission. Similar to RFA, submucosal injection was used in APC during the procedure. Other details of the APC procedure were described in our previous study . The proPostoperative management and follow-up were performed according to the previous study .Each patient fasted for 4–6 h after the procedure. Then, a liquid or semiliquid diet was provided, followed by gradual transition to a normal diet. At the same time, patients were administered a proton pump inhibitor (PPI) and a mucosal protectant for 1 month postsurgically. Moreover, we explained the Wong–Baker FACES Pain Rating Scale  to the pAll patients were required to return to our hospital for follow-up at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after surgery. Patients were examined by gastroscopy, and biopsies were performed in the original treatment area and other suspected areas. Pathological findings were used to determine whether the treatment was effective, as well as to assess relapse, recurrence, and progression. In this research, according to the study design, the data of patients followed up for 2 years after the operation were used as the evaluation criteria. The following definitions were used. (1) LGIN disappearance in the original treatment area indicated by pathological biopsy indicated a curative effect. (2) LGIN presence in the original treatment area indicated relapse. (3) LGIN presence in a nontreatment area was indicated recurrence. (4) HGIN or EGC presence in the original treatment area indicated disease progression.On the other hand, perioperative complications and adverse events, including bleeding, perforation, infection, and postoperative abdominal pain, were used to assess the safety of each operation.χ2 test or Fisher's exact test. The Chi-square test was performed to compare categorical variables. The measurement data were analyzed by the t-test and one-way analysis of variance or the rank-sum test according to normality. p < 0.05p < 0.05 was considered statistically significant.Data analysis was performed using SPSS Statistics for Windows, version 26.0 . The data were retrospectively collected, and the procedural parameters were compared. Measurement data were expressed as the mean ± standard deviation or the median with range, whereas numerical data were described as frequency and percentage and were compared by the Helicobacter pylori (H. pylori) infection and 27 atrophic gastritis cases in the RFA group compared with that of 8 and 14 cases in the APC group, respectively. There were no statistically significant differences between the two groups in gender, age, disease course, lesion location, operation time, proportion of submucosal injection, H. pylori infection, and atrophic gastritis . However, the mean lesion size was significantly larger in the RFA group (2.6 ± 1.0 cm) than in the APC group (1.5 ± 0.6 cm) (p < 0.001). Moreover, there were also significant differences in the composition ratio of large lesions between the two groups (p < 0.001). All clinical characteristics and procedure-related parameters of both groups are shown in A total of 123 patients with the mean age of 56.9 (range: 22–80) years were enrolled in the study . Seventy-three patients received RFA and 50 underwent APC. Of all patients, 59 had a course of disease longer than 1 year, including 33 and 26 in the RFA and APC groups, respectively. In the RFA group, there were 1, 4, 29, and 39 lesions located in the gastric fundus, body, angle, and antrum, respectively, versus 1, 3, 17, and 29 cases in the APC group, respectively. The average operation time of the two procedures was about 15.2 minutes and 14.7 minutes, respectively. During the operation, 32 patients in the RFA group and 20 in the APC group received submucosal injection. In addition, there were 15 p > 0.05). Some patients with relapse and recurrence were treated with RFA or APC again, while others were followed up for observation. The follow-up of these patients is still ongoing, and no case with further progression has been recorded yet. Additional ESD therapy was performed in all 4 patients with HGIN disease progression. The short-term follow-up results of all 4 patients indicated curative resection, and the long-term follow-up is still in progress. The specific data are also shown in All patients in both groups completed 2 years of postoperative follow-up, including endoscopic and symptomatic examinations. At 2 years of follow-up, the cure, relapse, recurrence, and progression rates were 90.4%, 9.6%, 9.6%, and 2.7% in the RFA group, respectively, versus 90%, 10%, 12%, and 4% in the APC group, respectively. However, these differences were not statistically significant between the two groups . Most of the pain occurred within 14 days postoperatively. All these patients experienced gradual relief of symptoms after taking PPIs and mucosal protectants. Meanwhile, in the RFA group, abdominal pain was developed in 10 of the 32 patients administered submucosal injection, compared to 32 of the 41 who did not receive submucosal injection (p < 0.001). Similarly, in the APC group, 7 in 20 patients administered submucosal injection developed abdominal pain, while 6 in 30 individuals not administered submucosal injection had no obvious abdominal pain, showing a significant difference between the two groups (p=0.001). Overall, only 17 of the 52 patients administered submucosal injection developed abdominal pain, while up to 56 of the 71 not administered submucosal injection developed abdominal pain, with a statistically significant difference (p < 0.001). These data are presented in detail in As shown in Recently, endoscopic RFA and APC have been applied for the clinical treatment of gastric LGIN, with their working principles described in several previous reports –19, 21. As previously mentioned, a few studies have preliminarily explored the clinical treatment effectiveness of RFA and APC in gastric LGIN. However, no reports have compared large clinical samples between RFA and APC, and this study filled this gap.H. pylori infection and atrophic gastritis). However, the overall lesions were larger in the RFA group than in the APC group, which may be related to divergent working principles of RFA and APC. For the former method, using an electrode patch for ablation can treat larger lesion areas, while the latter is more favorable for treating smaller lesions because of the point-like cauterization. Similarly, flat lesions were selected for RFA because the electrode patch used for ablation is flat, while the treatment method in APC is point-like cauterization so that APC is also suitable for swelling or sunken lesions. This caused a significant difference in the composition ratio of large lesions between the two groups. However, it should be noted that HGIN or EGC more likely occurs in nonflat lesions, especially in depressed ones. Therefore, special attention should be paid to preoperative evaluation and screening.First, we compared clinical characteristics and procedure-related parameters between the two groups. In this study, no statistically significant differences were found between the RFA and APC groups in terms of the gender, age, disease course, lesion location, operation time, proportion of submucosal injection, and mucosal background . According to the results, H. pylori infection and atrophic gastritis might change the overall state and microenvironment of the gastric mucosa to some extent, and a longer disease course might further exacerbate these changes, which are all possible causes of LGIN relapse or recurrence. This finding corroborated previous studies [H. pylori predisposes the mucosa to intestinal metaplasia and the odds of intraepithelial neoplasia are higher in atrophic and intestinal metaplasia than in the normal mucosa. Meanwhile, we noted that more than half of lesions were concentrated in the gastric antrum, which might be associated with the early occurrence of mucosal atrophy in the gastric antrum and its susceptibility to H. pylori. This also supported our conclusions from another aspect.Secondly, both RFA and APC showed good clinical effectiveness for gastric LGIN, with effectiveness rates in both groups surpassing 90% in the 2-year follow-up period, which preliminarily suggests the damage therapy of gastric LGIN is simple and efficient. However, there were still some patients with postoperative relapse and recurrence. The results showed  studies , 24 becaIn addition, during the follow-up period, 4 patients in both groups had disease progression, from LGIN to HGIN. A review of previous studies showed that lesion size >1 cm, erythema, erosion, ulceration, nodular changes on the lesion surface, and significant depression of the lesion are all risk factors for progression from LGIN to HGIN or EGC , 26. LesThirdly, in terms of postoperative adverse events, more than half of patients in both groups experienced short-term abdominal pain after surgery. Further analysis indicated patients administered submucosal injection during surgery had a lower incidence of postoperative abdominal pain compared with those not administered submucosal injection in the RFA, APC, or whole cohort, corroborating a previous study . The mecLast but not the least, operation times in both groups were very short, about 15 minutes. In general, RFA and APC can be performed by endoscopists as long as they are skilled in gastroscopy, which results in significantly reduced cost and the learning curve for surgical training in RFA and APC. Meanwhile, both procedures can be performed on an outpatient basis, which effectively saves medical resources. All these advantages constitute the basis for the clinical application and promotion of these techniques in the future.This study had some limitations. Firstly, this was a single-center retrospective study with a certain inherent bias. In addition, improving the accuracy of preoperative evaluation remains a clinical difficulty that needs further investigation. Furthermore, it is also urgent to carry out large-sample randomized controlled clinical studies on submucosal injection for the relief of postoperative abdominal pain.RFA and APC are both safe and effective damage therapies for gastric LGIN. RFA is more suitable for flat and large lesions, while APC is more suitable for small lesions, especially those with slight local uplift or depression. Intraoperative submucosal injection is expected to be an effective tool for relieving postoperative abdominal pain. As simple and efficient endoscopic treatment techniques for gastric LGIN, both tools are worthy of further clinical promotion.