Triticum aestivum L.) cv. Sakha 93 plants. Experiments were conducted in the Experimental Farm of the Faculty of Agriculture, Menoufia University, Egypt, during two consecutive winter seasons. Pot experiments involved ten treatments with non-magnetized and magnetized water with various degrees of salinity. Plant samples were taken 95 days after sowing. Irrigation with magnetically treated seawater was found to have beneficial effects on plant growth, water relations, biochemical characteristics, and yield components compared with untreated plants. The germination of wheat seeds increased 13% when treated with magnetic seawater. On the yield scale, the spike length was increased by 40% in season one, and 82% in season two when compared to the control, while the weight of 100 grains increased by 148% and 171%, in each season, respectively, when treated with magnetic water. The anatomical leaf and stem parameters of the plants were markedly improved by watering with magnetically treated seawater at 10 dS m−1 compared to the control. However, the leaf water deficit, transpiration rate, and abscisic acid content in the plant shoots decreased significantly (p < 0.05). The use of magnetically treated seawater of up to 7.5 dS m−1, instead of tap water, is recommended due to benefits to germination and seedling parameters, growth, yield, and physiological, chemical, and anatomical characteristics. In conclusion, magnetic treatment of seawater improved germination performance, growth, and yield of wheat under saline conditions.Salinity is an abiotic stress that reduces the seed germination and productivity of wheat. The objective of this study was to assess the impact of irrigation with magnetically treated seawater on the germination, growth, certain physiological and anatomical parameters, and production attributes of wheat ( Triticum aestivum L.) is the most important strategic crop in Egypt, and its cultivation area reached 3.8 million acres during the winter growing season of 2018–19, with an entire national output of approximately 9 million tons , and refractive index, while lowering surface tensions and salt levels in the soil . These cSeawater has the potential to be used as an alternative source for irrigation of crop plants in order to address water scarcity and overpopulation. Furthermore, effective technologies, such as the use of magnetic fields, should be utilized to overcome the adverse effects of salinity on plant growth. However, to date, studies on using magnetic fields to reduce the negative effects of seawater are scarce. Therefore, the aim of the current study was to evaluate the impact of irrigation with magnetically treated seawater on germination, growth, and certain physiological, anatomical, and yield components of wheat plants.In vitro and pots experiments were conducted to investigate physiological and anatomical changes as well as the germination parameters of wheat cultivar, Sakha 93 irrigated with seawater of varying salinity levels and exposures to magnetic fields. The wheat grains were obtained from different resources, Ministry of Egyptian Agriculture and Land Reclamation, Giza, Egypt, and Field Crops Research Institute, Agricultural Research Center, Giza, Egypt. Sakha 93 is a stripe rust-resistant Egyptian cultivar that was introduced in 1990 .Water was pumped The laboratory and pot trails were conducted as the following:These experiments were carried out to study the germination parameters. Ten grains with five replicates were put in Petri plates containing moisturized Whatman No.1 filter paper.Pot experiment was carried out in a greenhouse at the Faculty of Agriculture’s experimental farm in Shebin El-Kom, Egypt. This trial was carried out during two successive winter seasons (2018–19 and 2019–20), from ten November to 3 May; The experimental treatments were described as the following:−1 (control) and various levels of diluted seawater  without magnetic treatment.Irrigation using tap water with an EC of 0.40 dS mIrrigation with the same above-mentioned treatments but treated with exposure to a magnetic field by passing the water through a magnetron.−1) prepared from 100% synthetic seawater following the method of 2.6H2O, CaSO4 and K2SO4 with the volume of 473:102:20:12 mEq.l−1, respectively. Irrigation was carried out manually, based on the field capability, by supplying the needed amount of prepared water.Irrigation was carried out with seawater with different levels of salinity : the number of normal seedlings was counted 15 days after sowing (DAS), according to the following formula:Mean germination time (MGT) was calculated according to the equation of where Germination index (GI) or germination sprouting was determined according to the equation of where Coefficient of velocity (CV) was estimated according to where −1), and dry weight , radicle length , and plumule length , were also determined.Seedling growth characteristics, such fresh weight  was calculated using the formula according to −1, shoot DW (g), root DW (g), and the entire plant DW (g), shoot/root ratio, leaf area (cm2 plant−1) were determined following the according to the procedure of disk and leaf area indices measured by Root length , plant height , number of leaves plant2) were also measured according to the formula provided by Flag leaf width, length and flag leaf area  in leaves was estimated as previously described .The RWC and leaf water deficit (LWD) were calculated using the formula of The osmotic pressure (atm) was obtained by using special tables following the method of −2 h−1) was estimated by the following formula  to determine the membrane integrity MI; .a and b and carotenoids (Car), were determined using a spectrophotometer  otometer .−1.UV-absorbing substances (UVAS) were determined in the leaves according to −1) and total free amino acids (FAA) in the fine dry leaf powder were separated with chloroform: methanol  on ice for 30 min according to the method of Total soluble sugars , 3% sulphosalicylic acid was recovered from fresh wheat leaves  and peroxidase (EC 1.11.1.7) activities were determined according to the previous methods  as the f2SO4 and H2O2 (5:1) for chemical analyses of nitrogen (N), phosphorus (P), potassium (K), iron (Fe), and chloride , grains number.spike−1 (GNSp), grains weight (g plant−1), 100 grains weight , and straw yield (g plant−1) were also estimated.The yield components, spike length , spike weight . In FAA, specimens were fixed in fixation solution  for 2 days. The fixed specimens were cleaned in 50% ethanol, dehydrated in a series of butanol concentrations, embedded in melted paraffin wax at 56°C, segmented to a 20 μm thickness, then stained in safranin-light green, and destained in xylene and mounted in Canada balsam based method . Pieces −1). The significant differences between means were adopted via Duncan’s New Multiple Range Test at 5% significance degree.The data means were analyzed by analysis of variance (ANOVA) using SAS software, v 9.2 . The ANOp < 0.05). Examining seawater at 12.5 dS m−1, the largest drop in germination % and DW of seedlings was observed at 15% and 20%, respectively, when compared to their controls.Germination and seedling parameters of Sakha 93 wheat seeds irrigated with different seawater levels and exposed to magnetic treatment are shown in p < 0.05) as seawater level increased. With a seawater level of 12.5 dS m−1, the DM deficit in whole plants was 33% and 49% in the first and second seasons, respectively, compared to the control. With a seawater level of 7.5 dS m−1, significant increases of 36% and 69% in leaf area index and flag leaf area of wheat plants were obtained utilizing magnetically treated seawater compared to the non-magnetic treatment in the first growing season. In this respect, the results of both seasons are similar.Growth characteristics of wheat plants as affected by different levels of magnetically treated seawater are shown in −1.During both seasons, increased seawater levels resulted in a significant decrease in water relations values . The RWC−1, the decrease in total chlorophyll (a + b) was 31% and 27% lower in the first and second seasons, respectively, compared to the control. These changes boost photosynthetic efficiency. Additionally, magnetic treatments increased the synthesis of ultraviolet absorbing compounds in the leaves, making them more resistant to harmful UV-B radiation.When seawater stress increased, the photosynthetic pigment content in the wheat plants reduced dramatically compared to the control . With a −1 compared to the control during the second season. In the second season, FAA and Pro were enhanced in wheat plant leaves by approximately 11% and 250%, respectively, under a stress level of 12.5 dS m−1, compared to the control. The same trend in grains was observed  decreased by approximately 28%, 19%, and 14%, respectively, with increasing seawater levels; while the concentration of abscisic acid (ABA) increased by about 90% at a 10 dS m−1 seawater level compared to the control (The concentrations of indole-3-acetic acid (IAA), cytokinins (CKs) and gibberellic acid (GA control . The inf−1), GNSp, grain weight (g plant−1), weight of 100 grains (g), and straw yield (g plant−1)] dropped significantly with increasing seawater levels during both seasons. In the first and second seasons, the reduction in grain weight was 91% and 68%, respectively, at the elevated seawater of 12.5 dS m−1 in contrast to the control. The irrigation with magnetic water; however, increased the previous yield attributes by roughly 16%, 30%, 58%, 688%, 37%, and 11%, respectively, at a seawater stress level of 10 dS m−1 in the first season, compared to controls. The second season followed the same pattern.−1 exhibited histological features of flag leaf formation and stems (−1 the deficits in lamina thickness (μm), midvein bundle dimensions (μm), stem diameter (mm), and vascular bundle thickness (μm) were approximately 29%, 11%, 40%, and 12%, respectively, as contrasted to the control.The magnetic technology utilized in this study had a strong positive effect and reduced the negative impacts of seawater irrigation on all the previously described characteristics of Sakha 93 wheat plants. In addition, the internal composition of the flag leaf and stem of wheat plants developed underneath seawater stress subjected to a magnetic field should be studied. In comparison with the control, wheat plants treated with magnetic technology and seawater at 10 dS mnd stems , 2. In t−1 level when compared to the control. Magnetic seawater of 10 dS m−1 increased the midvein bundle and metaxylem vessel diameter (μm) by 8% and 100%, respectively, as compared to the control. In comparison to untreated plants, the application of magnetically treated water increased stem diameter (mm) and stem cavity diameter (mm) by approximately 17% and 32%, respectively, at seawater levels of 10 dS m−1. The magnetic seawater at level 10 dS m−1 increased the number of vascular bundle cross sections, thickness, and metaxylem vessel diameter (μm) of the stem by 29%, 39%, and 73%, respectively compared to the non-magnetic treatment.Magnetic water treatment raised the lamina and midrib thickness (μm) of the flag leaf by approximately 17% and 40%, respectively, at the 10 dS mPath analysis  was accoa and b on GI where R2 value was 0.708. The second, is the direct effect of GI and GNSp where R2 value was 0.933.Concerning the direct effects, the first is the direct effect of plant leaf area (PLA), Chl a and Chl b on grain weight plant−1 (GWP) where R2 value was 0.950. On the other hand, the indirect effects were two effects, the first is the indirect effect of plant leaf area (PLA), Chl a and Chl b on SpW, via GI. The second is the indirect effect of GI and GNSp on GWP via SpW. All the direct effects were significant (p < 0.05) except for GI on SpW. All the indirect effects were insignificant except for the indirect effect of GNSp on GWP via SpW. The total direct effects (0.533) were almost equal to the total indirect effects (0.514). In conclusion, GWP was affected directly and indirectly through interrelationships among yield components.The third, is the direct effect of SpW, Chl Heatmap in −1 while the low values (blue color) were found in the treatment of no magnetic tap water. The highest values of TSS in shoot and grains were found in the treatment with magnetic tap water, while the lowest values were found in the treatment of no magnetic seawater 12.5 dS m−1. The lowest values of FAA were in no magnetic tap water, while the highest were in the treatment of magnetic seawater 10 dS m−1 for shoot and the treatment of magnetic tap water for grains. It seems that magnetizing seawater increased the Pro in both shoot and grains; however, wheat grain yield was more associated with TSS than FAA and Pro.From the heatmap in Heatmap in −1 than 10 and 12.5 dS m−1 where Na and Cl in shoot and root were decreased and consequently N, P, and K in both shoot and root were increased. These results may be due to the decreasing in water surface tension and viscosity which resulted in an improvement in water uptake  where the irrigation with magnetically treated salt water boosted relative growth rate and leaf area of seedlings compared to non-magnetically treated salt water irrigation  in TWC, osmotic pressure and MI; while LWD and TR were both reduced by approximately 12% and 16%, respectively, when irrigated with 10 dS m−1 seawater. According to our data, the obtained results in both seasons were almost similar in this study. These findings were in-line with Our results in 2 levels . The mag+ in seawater can damage the membrane system, decrease cell osmotic potential, stomatal conductance, gas exchange, and the absorption of iron ions. This is involved in Chl-protein production; and therefore, this resulted in a decrease in the photosynthetic rate . In their study, it was found that cotton plants synthesized Pro, aspartic acids, stress-related proteins, and enzyme levels using N ions when were under salinity stress. The patterns of grain measurements were similar to those examined in this study. These findings were consistent with those of Our findings illustrated in −1 was found to boost phenoloxidase and peroxidase enzyme activity in wheat plant leaves by approximately 24% and 26%, respectively, compared to the controls. Similarly, magnetic treatments increased the activity of the enzymes phenoloxidase and peroxidase in potato plants  were all negatively affected by irrigation with normal (non-magnetic) seawater. Magnetic technology, on the other hand, alleviated the negative effects of seawater stress on all the characteristics evaluated. Consequently, the GWP of wheat plants increased by approximately three-fold compared to the controls after applying a magnetic field. Therefore, the use of magnetically treated seawater of up to a level of 7.5 dS mThe original contributions presented in the study are included in the article/DS, MZ, KE-T, SA, and SE conceived and designed the research. ME-S, KE-T, SA, and SE supervised the study. DS, MA, HE, AE-T, and OI performed field experiments. DS, MZ, MA, ME-S, AE-T, and OI developed the biochemical and physiological analyses. DS, MB, KE-T, SA, and SE analyzed the data. MB and ME-S assisted with experiments and/or data evaluation. DS, KE-T, and SA wrote the manuscript. All authors contributed to the article and approved the submitted version.This project was funded by the Abu Dhabi Research Award (AARE2019) for Research Excellence-Department of Education and Knowledge  to KE-T and Khalifa Center for Biotechnology and Genetic Engineering-UAEU (grant number 31R286) to SA.The 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.


The mechanical properties, thermal properties, aging properties,moderate strength properties, and microstructure of the compositeswere evaluated. Studies have shown that mixing the two can producea certain interface interaction and effectively improve the compatibility.The physical properties of the material tended to decrease duringthe increase in the added amount of silicone rubber (MVQ). The maximumtensile strength of the hybrid material can reach 15 MPa. The optimalmixing ratio is fluororubber/silicone rubber (FKM/MVQ) = 9/1. At thistime, the mechanical properties of the composite material are in thebest state, and SiO2 and black caron (N990) have a reinforcingeffect, which can effectively improve the mechanical properties. Afterthe composite was kept at 200 °C for 48 h, the tensile strengthand elongation of the best sample A1 were 99.5 and 97.0%, respectively,showing excellent anti-aging properties. This work provides a methodto fabricate high-strength fluorine/silicone composites using synergisticfillers that may be used in heat-medium-sealed environments.Fluorine/siliconecomposite rubber is widely used as a sealingmaterial in aerospace, missile, automotive, petroleum, and other industries,but the traditional process does not use synergistic fillers to strengthenthe composite system. In this research, fumed SiO The selection of synergistic materials involvesthe design and preparation of materials, which can be another rubberor filler.15Rubber products are widely used in automobiles, construction, electricalappliances, medical equipment, and other fields.17 Therefore, it can bewidely used as a sealing material in modern missiles, rockets, automobiles,petroleum industry, aviation, aerospace, and other fields. However,fluororubber is difficult in processing, has a high cost, and hasa low-temperature performance, which limits its application in theabove-mentioned fields. Therefore, research on improving these problemsis imminent.20 Silicone rubber is a material composed of siliconchains containing methyl groups and a small amount of vinyl groups.21 Its main features are excellent low-temperatureperformance, long-term use at −60 °C, and poor resistanceto solvents and oily media.22 Today, researchersare using it as a potential material to improve the properties offluoroelastomers.23 On one hand, it canimprove the low-temperature and processing performance of fluororubber,and on the other hand, it can improve the medium durability of siliconerubber. This replaces the expensive fluorosilicone rubber, which notonly effectively reduces the cost but also realizes the improvementof economic value.24 Previous studies haveshown that fluoroelastomers and silicone rubbers are thermodynamicallyincompatible systems, but they are technically compatible. Even ifthere is great difficulty in working together, they can reduce phaseseparation through high-strength physical interactions.25 In recent years, research on fluororubber andsilicone rubber has been actively carried out,29 and their composite materialshave also appeared.31 Sipra Khanra32 added fluorosilicone rubber and modified silica fillerto a combination of fluorosilicone rubber and silicone rubber in differentfillers. It could be found that the two are compatible and the mixturecan be used in a wide range of applications as a sealing system scope,including oil- and fuel-resistant O-rings and seals. Wu33 investigated various manufacturing conditions,vulcanization systems, and compounding ratios to optimize the co-vulcanizationand compatibility of fluororubber and silicone rubber, as well asthe tensile strength and thermal properties of vulcanizates. The researchshows that the application temperature of the blend is higher thanthat of fluororubber, the blend also has a good compatibility, andmeanwhile, the mechanical properties and thermal properties of theblend are further improved. Ghosh34 studiedthe processing rheology and phase behavior of fluororubber and siliconerubber during mixing, finding that low-viscosity silicone rubber canimprove the vulcanization behavior during mixing. There are many studieson fluorosilicone composites in the existing literature, but the strengthof the composites produced is low, and there are few studies on synergisticfillers. The hybrid filler can effectively improve the dispersionand crosslink density, and the wear resistance of the mixed compositematerial has been significantly improved.35 On one hand, hybrid fillers can enhance the comprehensive propertiesof rubber, especially the mechanical properties and tensile properties.On the other hand, hybrid fillers can effectively improve the compatibilitybetween rubbers. Therefore, hybrid fillers have superiority and advancement.36 In this research, fillers and masterbatcheswere mixed separately. It is convenient for the base material to beeffectively combined with the rubber, thereby providing more vulcanizationsites for the blended rubber to promote vulcanization. Besides, itcan increase the crosslinked network during mixing. This can effectivelyincrease the two-phase interaction, endow the fluorine/silicon compositewith high strength, and improve compatibility.Due to the high C–Fbond energy and the small atomic radius,there exists the strongest electronegativity of the fluorine atomand the strong electron-withdrawing effect. Fluorine rubber effectivelyshields and protects the C–C bond in the main chain, givingthe fluorine rubber excellent high-temperature resistance, aging andstability, and so forth.2 as the fillers for the fluorosilicon composite.A series of fluorine/silicone composite rubbers were prepared by mechanicalmixing process. By characterizing the mechanical properties, thermalproperties, surface properties, and aging properties of the composites,the optimal fluorosilicone rubber material was determined, and theeffects of rubber types and mixed fillers on the properties of thecomposites were analyzed. In addition, its feasibility has been proved.Fluorine/silicone composite rubber material prepared in this studyhas excellent mechanical properties, good compatibility, and superiorresistance to media. It is expected to be further applied in high-temperaturemedium oil seals, high-strength seals, and other systems.This paper selectedthree fluororubbers as the matrix material,one silicone rubber as the composite material, and carbon black N990and fumed SiO22.1tert-butylhexane peroxide (DBPMH), triallyl isocyanurate (TAIC), carbon black(N990), and zinc oxide were purchased from Shanghai Qiaodi ChemicalCo., Ltd. The following figure is the molecular formula structureof fluorine rubber.Fluorine rubber (FKM) , FKM ,and FKM  were purchased from Zhonghao ChenguangChemical Research Institute Co., Ltd. Silicone rubber (MVQ) is methylvinyl silicone rubber  purchased from Dongjue Silicone GroupCo., Ltd. Nanosilica (CQ-300) was provided by Emeishan Changqing NewMaterials Co., Ltd. 2,5-Dimethyl-2,5-di-2.2FMCcomposites are produced by blending process. This particular experimentconsists mainly of three simple steps. In the first step, fluororubber(FKM)  and silica carbon black mixed filler  are mixed with a mixer(ZG-0.2KH) for 5 min. The fluororubber compound is transferred intoan open mixer (ZG-160L), adjusting the nip to 1 mm. Then, TAIC  and vulcanizing agent DBPMH are added, and the materials are turned around to be mixed evenly,which thinly pass five times. The triangle bag is beaten more thanfive times and parked for 4 h after discharge. In the second step,silicone rubber (MVQ) , zinc oxide , and hydroxy silicone oil  weremixed; then vulcanizing agent DBPMH  wasadded after mixing in the open mill for 5 min, adjusting the rolldistance to 2 mm, and the sheet was left for 4 h for standby. Thethird step is to add the fluororubber mixture obtained in the firststep to the open mill to adjust the roll distance to less than 1 mmand wrap the rolls, then add the silicone rubber mixture obtainedin the second step five times, and turn the materials left and rightto be mixed. After refining evenly, the materials are thinly passedfive times, the triangle bag is beaten more than five times, and thetablets are left for 4 h for later use. Next, the formed blend wassubjected to one-stage molding vulcanization for 10 min on a flatvulcanizer (QLB-50T) at 175 °C; finally, a second-stage vulcanizationwas performed in a blast drying oven at 200 °C for 4 h, and theFMC composite material was obtained after cooling. The specific formulationsare shown in 2.32.3.1In order to studythe microscopic morphology of FMC of this seriesof composite materials, the test was carried out by scanning electronmicroscopy (thermo scientific Apreo 2C) to observe the tensile sectionof the composite material and elemental analysis.2.3.2T90), and vulcanization rate indexCRI.In order to investigatethe vulcanization performance of this seriesof FMC composite materials, a rotorless vulcanizer (2000E) was usedto conduct the vulcanization test, the test temperature was 175 °C,and the test time was 10 min. The curing properties of the FMC compositesare the incremental torque of the material (MH-ML), positive curingtime (2.3.3–1. The contact angle test uses a contact anglemeter (C602) to characterize the wettability of the surface of thecomposite material, thereby evaluating the surface tension of thematerial. The surface energy of fluororubber and silicone rubber wasdetermined by Owens two-liquid method, thereby indicating the compatibilityof the composite material. First, we measure the samples FKM, MVQ,and FMC and cut them into contact angles of 2.5 × 2.5 cm. Thenwe measure with a contact angle meter at room temperature. The crosslinkdensity was characterized by measuring the swelling index (SI) ofthe composites. The specific process is as follows: the weight isthat the vulcanized rubber sample W1 isplaced in a 250 mL conical flask, and the flask is filled with about50 mL of xylene, sealed, and then soaked in xylene at 30 °C for48 h until the equilibrium weight is reached. The swollen sample isquickly clamped onto dry, clean filter paper with tweezers. The solventis gently wiped off from the swollen sample surface with filter paper.The mass W2 is noted exactly and correctedto 0.1 mg.37 The equation for calculatingthe SI is 3W1 is the mass of FMC before swelling, and W2 is the mass of FMC after swellingGS is the saturatedvapor of the liquid that reaches the surface tension of the equilibriumsolid. γLS is the interfacial tension between theliquid and solid. γL is the surface tension of theliquid. θ is the contact angle of the liquid on the solid surfaceLd is the surface tension of water, γLp is the surfacetension of diiodomethane, and γSd is the surface tension of the polymer in water.γSp isthe surface tension of the polymer in diiodomethane. Therefore, thesurface energy of the polymer can be calculated.The compatibilityof the composites was characterized by Fourier-transform infrared(FT-IR) spectroscopy, contact angle test, and swelling test. The FT-IRspectra of FKM, MVQ, and FMC were measured with a Fourier transforminfrared spectrometer (INVENIO R), respectively, and the samples weretested in attenuated total reflection mode in the range of 4400–400cm2.3.4m0 is theinitial mass of FMC and m1 is the massof FMC after soakingm0 is themass of FMC in air before immersion, m0w is the mass of FMC in distilled water before immersion, m1 is the mass of FMC in air after immersion,and m1w is the mass of FMC in distilledwater after immersionl0 is thesize of FMC before immersion and l1 isthe size of FMC after immersion.The oil resistanceof the material is the key to high-temperature sealing. To test theoil resistance of the composites, a 25 × 50 mm standard samplewas immersed in ASTM no. 1 standard oil at 150 °C for 70 h, andthe change behavior of the material was observed. The equation forcalculating the rate of change is as follows 4–64where2.3.5X0 is theperformance value before aging and X1 isthe performance value after aging.In order toanalyze the stability, decomposition behavior, and performance maintenanceof FMC composites at high temperature, thermogravimetric analysiswas performed under a nitrogen atmosphere using a thermogravimetricanalyzer (METTLER TOLEDO TGA/DSC 3+) with a heating rate of 10 °C/min;the test temperature is from room temperature to 800 °C, andit is evaluated by the change of mass decomposition at different temperatures.The composites were aged in a hot air oven at 200 °C for 48 h,and then the heat-aged samples were subjected to tensile testing tomeasure tensile strength and elongation at break. The retention ratewas calculated by eq 2.3.6In orderto test the physical and mechanical properties, the sample uses auniversal testing machine (E43.504) for tensile test. The test speedis 500 mm/min. The hardness was measured using a type A shore hardnesstester (GL02-HT-6510A). For the density of the sample using (FA2104J)measurements, first, we measure the composite material sample in theair, then we measure the sample in water, and finally, the densitymeter will read the density value of the sample. We test each samplethree times to reduce the influence of error. At 200 °C, we selecta compression rate of 25%, compress the sample under the fixture for24 h, and calculate the permanent compression deformation rate ofthe sample. Physical and mechanical properties of the FMC compositeare evaluated by the tensile strength, elongation at break, hardness,density, and permanent compressive deformation rate of the material.2.3.7E′ of the material.Inorder to study the viscoelastic properties of FMC of this series ofcomposite materials, a dynamic mechanical analyzer (Q800) was usedin the test at −60 to 100 °C, the heating rate was 5 °C/min,the frequency was 1 Hz, and the amplitude was 20 μm, the testsample mode selection adopts a single cantilever fixture, and theviscoelastic properties of the material are represented by the glass-transitiontemperature tan δ and the storage modulus 33.1To researchmicrostructures of the composites, a scanning electron microscopewas used to observe the tensile sections of the composites. The resultis shown in 3.238T90 of the A-series and B-series composites decreased,and the curing time T90 of the C-seriescomposites increased. The vulcanizationperformance of composite materials is an important factor to evaluatethe comprehensive properties of composite materials. When under hightemperature and pressure, silicone rubber will produce vinyl radicalsand methylene radicals, and the two will crosslink. Fluororubber willproduce bromine-containing radicals, and fluororubber will form anetwork structure in the presence of TAIC. Therefore, as long as itcan be co-vulcanized, the composite will remain stable. 3.3–1 are shown in 3, −CF2, and −CF at 1394, 1131, and891 cm–1, respectively. The characteristic absorptionpeaks of MVQ at 1295, 1081, and 795 cm–1 are assignedto the symmetrical −Si–C symmetric peaks, −Si–Opeaks, and −Si–C stretch peak, respectively. The abovecharacteristic peaks appear in FMC materials, but their characteristicpartial shift of the peak occurred, which may be due to the smallpolarity of MVQ and the bonding effect with fumed silica. The contentof FKM itself is low after a small amount is introduced into FKM,which leads to the shift of the characteristic peak. On the whole,FKM and MVQ in FMC materials have a certain combination and have acertain compatibility. Rubber materials expand under the action ofsolvents, and there is a certain compatibility. Rubber materials willswell under the action of solvents, so the crosslinking density ofrubber can be indirectly reflected by testing the swelling behaviorof composite FMC under medium conditions. The smaller the SI underthe same constant temperature solvent condition, the higher the crosslinkingdensity of FMC composites and the better the compatibility of highcrosslinking density composites.3739 studied theeffect of mixed fillers and pointed out that the mixed introductionof chemical fillers can effectively increase the loading of fillers,resulting in higher mixed filler polymers and filler networks. Theresults show that the composites formed by MVQ and FKM with the helpof N990 filler and silica have the effects on reducing the surfaceenergy, the contact angle, and the surface tension and improving thecompatibility of FMC composites.Compatibility is animportant basis for determining the properties of composite materials.In this study, the changes in FT-IR, swelling property, and contactangle were used to reflect the compatibility changes of compositeFMC. The infrared absorption peaks of FKM, MVQ, and FMC compositeswithin 4000–400 cm3.4The oil resistanceof the material limits the application of composites, which is currentlythe key to high-temperature sealing. To study the oil resistance ofFMC composites, the samples were immersed in ASTM no. 1 standard oilat a temperature of 150 °C for 70 h. The results in 3.52, ZnO, and part of the FKM, and the analysis curvecan get the corresponding proportion of the composite material, whichis consistent with the actual condition. The addition of MVQ willcause the composite rubber to begin to degrade with temperature hysteresis,indicating that the heat resistance of silicone rubber is better thanthat of fluororubber to a certain extent, and silicone rubber caneffectively improve the thermal stability of composite rubber. Ascan be seen from the B1 thermogravimetry–derivative thermogravimetry(TG-DTG) map in 2, accounting for 27.26% of the whole.40 The first stage between 410 and 439 °Cis the decomposition of a small fraction of the fluororubber in thecomposite, and the second stage occurs between 439 and 500 °C.During this period, most of the fluororubber degraded and the siliconerubber also degraded. At the same time, we found that the type offluororubber has little effect on the thermal stability of the composite.The aging curves for A, B, and C show the same trend, and the curvesare very close at high temperature. In In order to studythe high-temperature stability of FMC composites, two methods, thermogravimetricanalysis and high-temperature aging, were used. The results are shownin 3.6Mechanicalproperties are important criteria for rubber application. The effectsof fluororubber varieties and blending ratios on the mechanical propertiesof FMC composites were explored. The tensile properties, compressibility,density, and hardness of the materials were measured, as shown in 3.7Tg of MVQ is −34.7 °C and that of FKM is 6.9 °C.The relationship of the composite material Tg is B1 > B2 > B3 > G503. The composite shows a weakpeak around−30 °C, which is the low content of MVQ and high contentof FKM, just corresponding to the peaks of MVQ and FKM in the compositematerial. Tg of the composites shifts to the left after the introductionof MVQ, indicating that the effect of the composites is improved afterthe introduction of MVQ. Due to the difference in polarity betweenthe two composite materials, it can be concluded from E at the sametemperature is G503 > B1 > B2 > B3 > MVQ, indicating thatFKM is betterthan FKM. MVQ has more rigidity. After the energy consumption processreaches the Tg temperature, the storagemodulus E′ shows a constant trend, indicatingthat the energy has been reduced to the minimum. Generally, compositematerial B has good damping performance.The dynamicmechanical analysis (DMA) of the composites is shown in 3.82 is first added to thesilicone rubber, and N990 is then added to the fluororubber. In thisway, the substrate and the filler can be fully combined, and the compositephase separation of the two can be reduced to a certain extent. Second,SiO2 and N990 in the fluorine/silicone premix preparedby compounding are evenly distributed, and this method for mixingcan make the blending of the composite material sufficient. Due tothe existence of intermolecular forces, there is also a certain interactionbetween the two phases in the premix, which potentially increasesthe crosslinked network during the vulcanization process. Finally,when vulcanized at high temperature and high pressure and inducedwith peroxide vulcanizing agent, the crosslinking points graduallyincreased; that is, the number of yellow points in Inthe formation mechanism of the composite material, due to thesynergy between its fillers, SiO4In this study, FMC compositeswere efficiently prepared by mechanicalblending method. The composites have good sulfuration behavior. FT-IR,mechanical properties, and contact angle test thermodynamics showthe improved compatibility of FMC composites, reducing the phase separationbetween FKM/MVQ, and then the interface contact is better. Silicaand N990 used as fillers are synergistic, which facilitates the combinationof FKM and MVQ and improves the properties of the composites. Thestudy found that the optimal blending ratio of FMC is 90/10, and thestrength of the composite material can reach 15.4 MPa at this time,which has an obvious high strength. Comparing three different fluororubbers,it is found that the G503 series composites have the best comprehensiveperformance under the same conditions. At the same time, experimentalanalysis data show that FMC composite material has excellent agingresistance, oil resistance, medium resistance, and high/low-temperatureperformance, which can effectively broaden the scope of use. Comparedwith expensive fluorosilicone rubber, FMC material has a lower costand an excellent economic value, also confirming the feasibility ofthis study.


This study aimed to develop a score including novel putative predictors for predicting the risk of sICH and outcomes after thrombolytic therapy with intravenous (IV) recombinant tissue-type plasminogen activator (r-tPA) in acute ischemic stroke patients.All patients with acute ischemic stroke treated with IV r-tPA at three university-based hospitals in Chongqing, China, from 2014 to 2019 were retrospectively studied. Potential risk factors associated with sICH (NINDS criteria) were determined with multivariate logistic regression, and we developed our score according to the magnitude of logistic regression coefficients. The score was validated in another independent cohort. Area under the receiver operating characteristic curve (AUC-ROC) was used to assess the performance of the score. Calibration was evaluated using the Hosmer–Lemeshow goodness-of-fit method.2A2 score (0 to 8 points) consisted of history of smoking , onset-to-needle time , NIH Stroke Scale on admission , neutrophil percentage , ASPECT score , and age . The SON2A2 score was strongly associated with sICH  and poor outcomes . AUC-ROC in the derivation cohort was 0.82 (95%CI 0.77–0.86). Similar results were obtained in the validation cohort. The Hosmer–Lemeshow test revealed that predicted and observed event rates in derivation and validation cohorts were very close.The SON2A2 score is a simple, efficient, quick, and easy-to-perform scale for predicting the risk of sICH and outcome after intravenous r-tPA thrombolysis within 4.5 h in patients with ischemic stroke, and risk assessment using this test has the potential for early and personalized management of this disease in high-risk patients.The SON From 2013 to 2019, the prevalence of stroke in China increased significantly from 2.28–2.58% . Post-thIncreasing evidence showed that baseline factors and individual variables played a predominant role in affecting the risk of post-thrombolytic sICH –11. ThesAlberta Stroke Program Early CT score is a generally accepted predictor for both functional outcomes and symptomatic hemorrhage in AIS patients, which has never been incorporated into score systems. It was found that in patients with an extended time window, the incidence of sICH was similar among NCCT ASPECT score, CTP, and MRI-guided endovascular treatment population . It may 2A2 score, derived from our multi-center cohorts for acute AIS patients treated with IV r-tPA.In this study, we aimed to develop and validate a simple and reliable scoring tool for predicting the risk of sICH and outcomes in AIS patients with IVT in Chinese population, which may help certain patients receiving IVT avoid fatal thrombolytic complications. We present the SONAll patients with acute ischemic stroke treated with IV r-tPA from June 2014 to June 2019 at the First Affiliated Hospital of Chongqing Medical University, Chongqing, China, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, China, and the Yongchuan Hospital of Chongqing Medical University, Chongqing, China, were included in this study. The inclusion criteria were as follows: (1) All patients had to meet the diagnostic criteria of acute ischemic stroke according to Guidelines in China 2018; (2) R-tPA was administrated at the standard dose (0.9 mg/kg of body weight) within 4.5 h after the onset of symptoms; (3) cerebral CT scans were performed at admission and within 24 h after thrombolysis or whenever ICH was suspected; and (4) all patients had to be hospitalized more than 3 days [almost all sICHs occurred within 36 h after thrombolysis ] or diagBaseline demographics, vascular risk factors, medical history, stroke type, baseline NIHSS score, OTT, laboratory parameters, and radiologic data of the eligible patients were obtained by reviewing electronic medical records. The ASPECT score based on noncontrast CT before treatment was reviewed by two independent neuroradiologists without any knowledge of patients, and inter-rater reliability was tested by Spearman's rank correlation coefficient; any dispute was resolved by negotiation. Functional outcome at discharge was evaluated using mRS. Good short-term outcome was defined as mRS score 0 to 2, and poor short-term outcome was defined as mRS score 3 to 6. Eligible patients were dichotomized into two groups, namely, the non-sICH and sICH group, according to the NINDS criteria. Independent risk factors were considered to be predictors of sICH, and point values assigned to predictors were based on their magnitude of regression coefficients by rounding off to the nearest integer value. For each patient, the total risk score was calculated as the sum of points assigned to the predictors.2A2 score system was established, internal cross-validation of the regression model between parameters of the SON2A2 score and short-term outcome was performed based on 1,000 bootstrap replicates. External validation was performed in an independent cohort of 160 patients receiving thrombolysis from the Ninth People's Hospital of Chongqing, Chongqing, China (2014–2019). All the patients in the validation cohort met the same inclusion and exclusion criteria of the derivation cohort.After the SONt-test or Mann–Whitney U test for continuous variables and Pearson's χ2 tests or the Fisher's exact test for categorical variables, as appropriate. Continuous data were divided into two categories using receiver operating characteristic curve (ROC) combined with clinical practicality. Univariate logistic regression was used to identify risk factors for sICH, and variables associated with sICH at the P ≤ 0.10 level in the univariate analysis were incorporated as potential predictive factors into the multivariate logistic regression model. In this analysis, independent risk factors for sICH were determined by a backward regression procedure. Confounding factors were excluded in the backward regression procedure. This process is presented in We performed descriptive statistics for all available baseline variables including patients with or without sICH. Normally distributed continuous variables were presented as the mean ± SD, and continuous variables with abnormal distribution were presented as the median (IQR). Categorical variables were presented as percentages. Differences between sICH and non-sICH groups were compared using Student's 2A2 score in predicting short-term outcomes. The discrimination capacity of the risk score was assessed by area under the receiver operating characteristic curve (AUC-ROC), and calibration was evaluated using the Hosmer–Lemeshow goodness-of-fit method. Statistically significant differences were set at P < 0.05. All analyses were performed using SPSS statistical software version 24.0 for Windows.We stratified the total risk scores into the following four tiers according to the predicted probability: low, moderate, high, and extremely high risk. Then, binary logistic regression was conducted to test the efficiency of the SONA total of 883 acute ischemic stroke patients treated with IV r-tPA met the inclusion criteria, and 167 patients were eventually excluded for not meeting the predetermined study criteria. Finally, 716 patients  were eligible for analysis. Prevalence of sICH was 10.3% (95%CI 8.3–12.3%) according to the NINDS criteria (91 of 883). The overall median age was 72 years , the median baseline NIHSS score was 11 , and the median time from symptom onset to therapy was 2.5 h . The median mRS at discharge was 2 . The inter-rater reliability was 0.82, indicating high inter-rater consistency and reliability. The detailed baseline characteristics of the patients in the derivation and validation cohorts are presented in P < 0.01), were more likely to have a longer time delay from stroke attacks  and a higher NIHSS score , as well as were inclined to have a poorer ASPECT score . Additionally, patients with an elevated neutrophil percentage, prolonged PT, and reduced blood platelet count were more frequent to progressing to sICH . The risk of sICH according to gender, medical comorbidities, and medication use is illustrated in Compared with the counterparts, patients with sICH in the derivation cohort tended to be older . Prediction probability for sICH per increasing point in the above three cohorts is shown in 2A2 score was 3, and the best threshold for the SON2A2 score to diagnose sICH was 3.5 with a positive likelihood ratio of 2.46. Moreover, our risk scores strongly correlated with poor short-term outcomes in the entire population . The proportion of patients with good and poor outcomes for each SON2A2 point is illustrated in 2A2 score was divided into four levels, which are 0–1, 2–4, 5–6, and 7–8 for low (1.7%), moderate (7.4%), high (26.9%), and extremely high risk (62.7%), respectively.The SONP < 0.01, vs. 0.82, 95%CI 0.77–0.87, P < 0.01, and 0.88, 95%CI 0.80-0.96, P < 0.01). ROC curve of the derivation cohort is presented in 2 = 4.6, df = 5, P = 0.47 vs. χ2 = 0.61, df = 5, P = 0.99), indicating that the model was well calibrated.Discrimination power of the score evaluated by AUC-ROC was similar in the derivation cohort, the internal cross-validation cohort, and the external validation cohort . We subsequently dichotomized neutrophil percentage into more than and equal to 80% and <80%, and then, we found a high neutrophil percentage independently predicted sICH after adjusting confounders . Smoking is a recognized risk factor for ischemic stroke. To be intriguing, in our study history of smoking was found to be a protective factor for sICH. Coincidentally, smoking was independently associated with recanalization and reperfusion, indicating that thrombolytic therapy acts more effectively in smokers , compared with those with low risk (1.7%) and moderate risk (7.4%). Therefore, we think it might not be rational to perform thrombolysis therapy among patients with extremely high risk of sICH. As for whether to withhold thrombolysis in patients with high risk (26.9%) of sICH, an assessment of potential net benefit to the patients is required.Stroke outcomes have improved in the past decade, caused by the improvements in in-hospital stroke care. According to a big data study from Singapore , there h2A2 score comprises five aspects. This may be one of the possible reasons why our risk score has a higher AUC-ROC over other four scores . Without practice application and head-to-head comparison, we cannot say our scores have a better performance than other established scores. We have to declare that we do not propose withholding r-tPA treatment for patients at high risk of sICH according to the SON2A2 score before prospective evidence is available. However, clinicians could quantify risks based on our score and tell patients and their relatives what potential risks may involve in thrombolytic treatment. For patients at high risk of hemorrhagic transformation, more positive and effective medical care measures, such as longer stay in stroke unit, more frequent assessments of neurological deficit, and shorter CT scan intervals, should be taken.According to the established score systems, for developing a clinical risk score for predicting the risk of post-thrombolytic sICH, any combinations of the following aspects of predictors could be used: (1) demographic characteristics; (2) medical history; (3) baseline neurological examination; (4) laboratory findings; (5) neuroradiologic features; and 6) specific therapy. To our knowledge, the more aspects a score covers, the higher accuracy and precision it may have. Compared with three aspects in GRASPS  specific scores aThis study has limitations attributed to its retrospective nature. All of our data came from teaching hospitals, and the number of patients experiencing ICH, especially sICH, was relatively small. We only included patients for whom all required elements were available, and 18.9% patients were excluded for not meeting the predetermined study criteria. These can only be addressed in a prospective study. Stratification of continuous variables and conversion of correlation coefficients to score point values, although convenient to clinical applications, are likely to cause a loss of information and decrease model accuracy.2A2 score is easy to perform and time-saving, is well calibrated and validated, and has good predictive ability for the risk of sICH and outcomes in patients with ischemic stroke treated with IVT, providing clinicians, patients, and relatives an understanding of the risks involved in the current treatment.In conclusion, the SONThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.QY, XS, LZha, ZH, XD, and YR participated in the conception and design of the study. JL, LZho, XB, YC, and BW performed the data collection and analysis. YR wrote the first draft of the manuscript. All authors contributed to the study conception and design, commented on previous versions of the manuscript, and read and approved the final manuscript.This work was supported by grants from the National Natural Science Foundation of China (Grant nos. 82171456 and 81971229) and the Project of Science and Technology Strategic Cooperation between City and University (22SXQT0046).The 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.


Whether left ventricular non-compaction (LVNC) bears a different prognosis than dilated cardiomyopathy (DCM) is still a matter of debate.p = 0.001). For this reason, a subgroup analysis was performed comparing only patients with LVEF ≤ 45%, including 56 with LVNC and 49 with DCM.From a multicenter French prospective registry, we compared the outcomes of 98 patients with LVNC and 65 with DCM. The primary endpoint combined cardiovascular death, heart transplantation, and hospitalization for cardiovascular events. The two groups presented similar outcomes but different left ventricular ejection fractions (LVEF)  among 56 patients with LVNC and 18 (36.7%) among 49 patients with DCM (p = 0.02). Hospitalization for heart failure  and heart transplantation were more frequent in the LVNC than in the DCM group. The incidences of rhythmic complications , embolic events, and cardiovascular death were similar between LVNC and DCM cases. Among the 42 patients with LVNC and LVEF > 45%, the primary endpoints occurred in only 4 (9.52%) patients, including 2 hospitalizations for heart failure and 3 rhythmic complications, but no embolic events.Among patients with LVEFIn this prospective cohort, patients with LVNC who have left ventricular dysfunction present a poorer prognosis than DCM patients. Heart failure events were especially more frequent, but embolic events were not. Patients with LVNC and preserved ejection fraction present very few events in 5 years. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterized by the association of prominent trabeculations and deep recesses in the left ventricle –7. This The prognosis of LVNC also differed between previous studies, ranging from young populations of patients with the malignant course , 8 to thTo answer this question, we initiated a prospective multicenter French registry for patients newly diagnosed with LVNC between 2012 and 2014. The genetic defects carried by those patients were recently published . This stWe report here the results of this prospective study, focusing on the respective outcomes of the populations of LVNC and DCM.From 2012 to 2014, patients newly diagnosed with LVNC or DCM in 9 French centers for inherited cardiac diseases were prospectively included. Inclusion criteria: all patients above the age of 18 who were newly diagnosed (<6 months) with isolated LVNC or idiopathic DCM by TTE ± MRI more than 1 month after an episode of acute heart failure. We applied the Jenni criteria for LVNC selection . A specific, unique code was used to identify each of the centers and patients. Demographics, comorbidities, and laboratory data were collected at baseline and at 1 and 2 years of follow-up. All patients were subjected to a physical examination and electrocardiography at the time of enrollment, which was repeated after 1 and 2 years. The scheduled end of the study visit was the 2-year follow-up visit for surviving patients. For deceased or transplanted ones, the last visit before the event was considered the end of the study visit. Data about the type of event and date of occurrence were obtained from patients' or clinicians' reports. A 5-year follow-up was also obtained through phone calls or contact with the patient or his practitioner.The primary endpoint was the occurrence of cardiac death, heart transplantation, or hospitalization for cardiovascular complications  during follow-up. An initial follow-up was scheduled at 2 years, and then completed by a final evaluation at 5 years. Hemodynamic events were defined as the occurrence of pulmonary edema or hospitalization for acute heart failure. Embolic events include the occurrence of a stroke or of clinically detectable embolism in any territory requiring hospitalization. Rhythmic events included sustained ventricular tachycardia, syncope, or ICD-appropriate shock, as well as permanent or paroxysmal atrial fibrillation. Implantation of a pacemaker or defibrillator was also collected.Secondary endpoints were the occurrence of any of the events that were comprised in the primary outcome.To reduce the influence of LVEF on prognosis, a specific substudy was performed, including only patients with LVEF <45%, following the recent definition of DCM given by a position statement of the ESC working group on myocardial and pericardial diseases  and the t-test, depending on the application conditions. Categorical variables were described by their number and percentage and were compared using the chi-squared test or the Fisher test, depending on the application conditions. Event-free survival distributions were estimated using the Kaplan–Meier method. The log-rank test was used to compare survival distributions for categorical variables, such as the cardiomyopathy variable. The effect of continuous variables on the risk of an event occurring was estimated and tested using a Cox model. Multivariate analyses were performed using the Cox model. Inclusion of variables in the fitted model was carried out according to the following criteria: p < 0.20 in univariate analysis as the threshold for entering variables, number of missing values <10% for these variables, effective presence in both categories of a bivariate variable >10%, and according to their clinical relevance. The final models selected were those with the lowest Akaike information criteria (AIC). Tests were performed in bilateral situations and were considered statistically significant for p < 0.05. Statistical analysis was performed using R software (version 3.6.2) and RStudio (version 1.2.5).Continuous variables were expressed as mean and standard deviation and were compared using the Mann–Whitney nonparametric U test or Student's p = 0.05). DCM patients presented with more severe LV dysfunction, including higher end-diastolic and end-systolic volumes and lower LVEF . Concerning the LVNC group, mutations were identified in 47 (48%) patients, including sarcomeric mutations in 23 (48.9%)  and ion-channel mutations in 15 (32% of mutated patients) (8 patients with mutations in HCN4 and 7 in RYR2).Between January 2012 and February 2014, a total of 98 LVNC and 65 DCM cases were prospectively included. The clinical and echocardiographic characteristics of the study population are summarized in p = 0. 57. The mean 5-year follow-up was 73.69 months. The Kaplan–Meier curve in The mean follow-up was 18.2 months for patients with LVNC and 17.8 months for patients with DCM, with 8 and 10 patients lost to follow-up, respectively. At 2-year follow-up, the primary endpoint was reached in 22 (22.4%) LVNC and 12 (17.9%) DCM cases, To compare patients with similar LVEF, we compared the prognosis of patients with LVEF <45% in both groups, including 56 patients with LVNC and 49 patients with DCM. No significant difference was observed in demographics or TTE parameters between the two groups .p = 0.02)  patients with LVNC and 18 (36.7%) patients with DCM ( = 0.02) . The KapWhen looking at the occurrence of the primary outcome components taken separately , hospitan = 56) were compared with patients with LVNC and LVEF > 45% (n = 42). Global longitudinal strain (GLS) values were available in 30 of 42 patients with LVNC and LVEF > 45%. GLS was relatively low in these patients . Events were very rare in the latter group during the 5-year follow-up, with primary endpoints occurring in only four (9.5%) patients, including two hospitalizations for heart failure, three rhythmic complications, and no embolic events (Patients with LVNC and LVEF ≤ 45% (c events .Patients with LVNC and left ventricular dysfunction (LVEF <45%) present with a significantly worse prognosis at a 5-year follow-up as compared with matched patients with DCM and similar LV dysfunction.Notably, heart failure events are more frequent in patients with LVNC than in those with DCM, while embolic events are not observed.Conversely, patients with LVNC and LVEF >45% have very few events at 5 years.p = 0.002, HR = 2.481). Unfortunately, in these series, patients were matched only on age and not on LVEF.The prognosis of LVNC has always been debated. Initially considered as a rare cause of heart disease (<1%) affecting young patients, LVNC natural course accounted for early and frequent cardiovascular events , 8. InitOur study is the largest prospective cohort comparing LVNC to DCM. All centers followed the European Society of Cardiology's current recommendations, and patient care was conducted accordingly. Although the occurrence of cardiovascular death was similar in LVNC and DCM cases, the primary endpoint, including the occurrence of cardiac death, heart transplantation, or hospitalization for cardiovascular complications , was more frequent at 5-year follow-up in the LVNC group.Overall survival depends on the occurrence of cardiovascular events with different impacts of hemodynamic, rhythmic, and embolic factors.LVNC embolic risk is supposed to be related to the formation of thrombus in the trabeculations. Some authors have recommended curative anticoagulation as primary prevention even when LV dysfunction is only moderate (<45%) –25. SedaThe incidence of hemodynamic events also varies but is generally very high from 25% to more than 50% at 3 years of follow-up , 26. In Rhythmic events occurred in >40% of our population of LVNC, slightly  more frequently than in DCM. Since the first prognostic studies that showed 18% of sudden cardiac deaths , rhythmiOur study suffers from some limitations. First, the diagnosis of LNVC is frequently difficult, and the differentiation between LVNC and DCM may be difficult in some patients , 6. HoweWe report the largest LVNC prognostic prospective cohort with a clear trend toward poorer prognosis compared to DCM when considering patients with left ventricular dysfunction. Although cardiovascular mortality is similar between LVNC and DCM, heart failure events and, to a lesser degree, rhythmic events are more frequent in patients with LVNC than in those with DCM, while embolic events are not. Our results support the careful evaluation and prevention of hemodynamic complications as well as regular screening for rhythmic complications. Conversely, our results do not support prophylactic anticoagulation in LVNC unless a specific indication exists.Further long-term survival studies are needed to evaluate the effects of different therapeutic strategies on the treatment of patients with LVNC.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by institutional review board La Timone Hospital. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.HG, NI, HM, KN, RG, PC, and GH were involved in the conception and design or analysis and interpretation of data. PR, ED, J-CE, OH, CS-S, PR-R, GJ, NM, CS, FA, J-FP, A-CC, NM, VD, LF, RG, PC, and GH were involved drafting of the manuscript or revising it critically for important intellectual content. HG, KN, PC, and GH were involved in the approval of the manuscript submitted. All authors contributed to the article and approved the submitted version.This study was supported by grants from the PHRC  PHRC 2011-A-00987-34 (France).The 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.


Tuberculosis (TB) treatment outcomes are a key indicator in the assessment of TB control programs. We aimed to identify spatial factors associated with TB treatment outcomes, and to provide additional insights into TB control from a geographical perspective.We collected data from the electronic TB surveillance system in Shanghai, China and included pulmonary TB patients registered from January 1, 2009 to December 31, 2016. We examined the associations of physical accessibility to hospitals, an autoregression term, and random hospital effects with treatment outcomes in logistic regression models after adjusting for demographic, clinical, and treatment factors.Of the 53,475 pulmonary TB patients, 49,002 (91.6%) had successful treatment outcomes. The success rate increased from 89.3% in 2009 to 94.4% in 2016. The successful treatment outcome rate varied among hospitals from 78.6% to 97.8%, and there were 12 spatial clusters of poor treatment outcomes during the 8-year study period. The best-fit model incorporated spatial factors. Both the random hospital effects and autoregression terms had significant impacts on TB treatment outcomes, ranking 6th and 10th, respectively, in terms of statistical importance among 14 factors. The number of bus stations around the home was the least important variable in the model.Spatial autocorrelation and hospital effects were associated with TB treatment outcomes in Shanghai. In highly-integrated cities like Shanghai, physical accessibility was not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals. Tuberculosis (TB) remains a major global health problem. It affects approximately 10 million people worldwide and kills more than 1 million every year . In the The treatment success rate is one of the most important indicators for monitoring the implementation of the End TB Strategy . The gloTherefore, the objective of this study was to use an 8-year TB surveillance dataset in Shanghai, China to identify the relationships between TB treatment outcomes and spatial factors, focusing on physical accessibility, spatial autocorrelation, and hospital effects. We hope to provide additional insights into the TB surveillance system, particularly from a geographical perspective, based on the 8-year TB surveillance dataset in Shanghai.Shanghai, a coastal city located in east China, is the largest industrial and commercial city in China , and oneIn Shanghai, all patients with suspected pulmonary TB symptoms are referred to designated TB hospitals for diagnosis, and the results are then reported to the Shanghai Municipal Center for Disease Control and Prevention (SCDC) . An elecThe longitude and latitude of each patient’s residence at the time of diagnosis and of each designated hospital were geocoded using Baidu Maps , which is a Chinese-language-based web geocoding tool. The geographic coordinate system was WGS 1984 and the projection coordinate system was Gauss Kruger-Xian 1980 _3_degree_GK_cm_120E.According to the guideline for implementing TB control programs in China , patienthukou system. TB patients were managed by the SCDC of each district in the form of full-course supervision , intensive-phase supervision , full-course management , or self-administration [3R3Z3E3/4H3R3, 2HRZE/4HR, 2H3R3Z3E3S3/6H3R3E3, 2HRZES/6HRE, and other regimens [Patients were grouped into local and migrant categories. Migrant patients were people whose household registration status was not in Shanghai through the Chinese stration ,22. Bactregimens . PersonaFirstly, basic characteristics of TB patients were compared between the successful and poor outcome groups. Proportions were used to describe the distribution of categorical variables, and the chi-square test was used to compare the distributions between the two groups.Secondly, the proportion of treatment outcomes was calculated for each study year, and the proportion of poor treatment outcomes was compared among designated hospitals.Thirdly, we used Kulldorff spatial scan statistics to detect spatial clusters for the proportion of poor treatment outcomes in each year. This method identifies a significant excess of cases within a moving circle that increases in size until it reaches an upper size limit. We set this maximum spatial cluster size to 30% of all patients. The likelihood ratio test was based on Bernoulli models, and p-values were obtained by Monte Carlo simulation with 999 replications.Lastly, the final models were built to identify the effects of physical accessibility, spatial autocorrelation, and hospitals on TB treatment outcomes. The dataset was randomly divided into a training data set and a test data set with a ratio of 3:1, and models were first developed using the training data and then tested using test data. Univariate logistic regression was used to identify risk factors with a p-value of ≤ 0.10 for poor TB treatment outcomes, and those risk factors were then included in a multivariable logistic regression model with a backward elimination procedure. In separate models, we also used an autoregression term and random intercepts to account for spatial autocorrelation and hospital effects, respectively -26. A toStatistical significance was defined at the 5% alpha level. The Kulldorff spatial scan statistical analysis was performed using SaTScan version 9.5 . Other data analyses were conducted in R version 3.4.0 .The collection of data from TB cases was part of a continuing public health investigation of an emerging outbreak determined by the National Health and Family Planning Commission. Hence, this study was exempt from institutional review board assessment.In 2009-2016, there were a total of 54,301 pulmonary TB cases in Shanghai. After excluding 19 imprisoned patients and 807 cases with missing treatment outcomes, we included 53,475 (98.5%) patients in our analysis. Of these 53,475 patients, 36,656 (68.5%) were male . The medAmong the smear-positive patients , 17,596 (86.2%) patients were cured and 187 (0.9%) patients completed treatment, resulting in an overall successful treatment rate of 87.1% . In smear-negative or unknown patients , 31,219 (94.4%) completed treatment, corresponding to a successful treatment rate of 94.4% . Altogether, the successful treatment rate was 91.6% . During the 8-year period, the success rate increased significantly from 86.0% to 90.0% in smearpositive patients and from 91.8% to 96.6% in smear-negative or unknown patients (p<0.001) . The ratSpatial scan analysis indicated 12 significant spatial clusters for poor treatment outcomes (0-3 clusters for each study year) . The numThe ethnic group, symptom to first diagnosis time, distance from home to hospital, and distance from home to the nearest subway line were not included in the multivariate models because of the variable selection procedure. Among the 4 multivariate models, when the autoregression term and random intercepts were considered, the AIC decreased from 19,638 in model 1 to 19,387 in model 4, and the AUC improved from 0.740 (model 1) to 0.761 (model 4) in the training dataset . CompareCompared with model 1, model 4 resulted in similar risk factors that were associated with poor treatment outcomes: male sex ; ≥ 45 years of age ; an occupational status of laborer, retired, or house worker , being a migrant , retreatment , management under intensive-phase supervision or self-administration , personalized regimen , bacteriological positivity , an interval of < 7 days from the first diagnosis to confirmed diagnosis , an interval of ≥7 days of confirmed diagnosis to treatment , and an earlier treatment year  .From model 1 to model 4, the estimate for number of bus stops within 1 km from the patient’s home changed notably from a significant positive correlation to no correlation or even a negative correlation. In model 4, the autoregression term was highly significant . Management type, bacteriological status, age, treatment type, and treatment year were the top 5 important predictors , followeBased on Shanghai TB surveillance data from 2009 to 2016, 91.6% of more than 50,000 pulmonary TB patients were successfully treated, which is comparable with China’s 93% success rate reported in 2016 ,28.In our spatial scan analysis, spatial clusters of poor treatment outcomes were detected, and most clusters were in districts with relatively weak economic status and sparse TB designated hospitals, such as Fengxian District . TranspoAmong the 4 logistic models, we found that model 4  fit the data the best. This suggests that additional spatial information can reduce information loss and improve the model’s predictive power. After adjusting for patient characteristics, the random hospital effects and autoregression term remained important predictors, indicating that the effect of spatial factors was non-negligible. In addition, the significance of the autoregression term suggested that there were other unmeasured variables that caused the spatial autocorrelation. For example, to compensate for the lack of information on the socio-economic status of the patients and the residential areas, we used patients’ occupations as a surrogate for income, but this might not have been adequate. The significance of random hospital effects suggests that different hospitals have different effects on treatment outcomes after adjusting for patients’ characteristics. Prospective studies might need to find the reason for this difference.Our study showed that an increase in the number of bus stops within 1 km from home was no longer a protective factor after accounting for the random hospital effect, and even had a significantly negative effect on treatment outcomes. The reason for this is that if patients are treated at the same hospital, number of bus stops, which is an indicator of physical accessibility, is not related to the treatment outcomes, and the significant negative effect could be due to the extremely well-developed traffic and heavy population density in the neighborhood. When we constructed model 4 with just one hospital, such as Shanghai Pulmonary Hospital, which treats half of the patients in Shanghai and has a sufficient sample size, we found that the number of bus stops was not significantly associated with treatment outcomes (results not shown). This indicates that when patients are treated at the same hospital, physical accessibility to this hospital may not be associated with treatment outcomes in our study.The distance from home to the treatment center, which is another indicator of physical accessibility, was associated with treatment outcomes in previous studies ,35 conduTo increase the physical accessibility of TB hospitals and improve the quality of patient management, the government of Shanghai has set at least 1 TB designated hospital in each district according to the national TB control plan since 2002 . DistricThere are several limitations of our study. First, other potential variables related to treatment outcomes  ,38-40 weIn conclusion, we identified spatial clusters of poor treatment outcomes in suburban regions and spatial factors in association with TB treatment outcomes in Shanghai. Spatial autocorrelation and hospital effects need to be taken into consideration when risk factors for poor treatment outcomes are investigated. In highly-integrated cities like Shanghai, physical accessibility is not related to treatment outcomes. Governments need to pay more attention to the mobility of patients and different success rates of treatment among hospitals.


For locomotor skills, appropriate results reliability , infit , outfit , and point-biserial correlations  were found; the trend was similar for ball skills: reliability , infit , outfit ; point-biserial correlations  were obtained. Two motor criteria: gallop, item-1, and one-hand forehand strike, item-4, were the most difficult items; in contrast, run, item-2, and two-hand catch, item-2, were the easiest items. Differential item functioning for age was observed in nine locomotor and ten ball skills items. These items were easier for older children compared to younger ones. The TGMD-3 has items with different difficulty levels capable of differential functioning across age groups.The assessment of motor proficiency is essential across childhood to identify children’s strengths and difficulties and to provide adequate instruction and opportunities; assessment is a powerful tool to promote children’s development. This study aimed to investigate the hierarchal order of the Test of Gross Motor Development-Third Edition (TGMD-3) items regarding difficulty levels and the differential item functioning across gender and age group . Participants are 989 children (3 to 10.9 years; girls  Across childhood, motor proficiency in fundamental motor skills (FMS) is considered the essential building block for children to learn more complex movements and participating in sports and physical activity. FMS requires large muscle groups to move the body from one place to another  and receive or keep the objects under control  ,2. AdditThe evaluation of children’s levels of motor proficiency requires that teachers and clinicians use valid and reliable tools for specific populations; the information obtained from the assessments ensures adequate care for children with delays, complementing the overall clinical evaluation, supporting the design and implementation of interventions, and the adaptation, when necessary, of the school curriculum. However, the assessment of motor delays across childhood is sometimes arduous, if the signs are subtle and complex to discriminate between typical and atypical development, since children present a broad repertoire of skills and could be less proficient in one specific area than in other  ,4,5.Children develop at different rates and paths depending on their experience. Understanding these trajectories and outcomes is essential to designing the appropriate programs. Consequently, it is essential to use the appropriate instruments to identify children with typical and atypical development, detect changes over time, and predict health outcomes. Besides, the continuous investigation of different aspects of norm-referenced assessment validity can provide relevant information regarding the motor development status across different cultures .One norm-referenced, globally recognized instrument is the Test of Gross Motor Development (TGMD-3) , a proceFundamental motor skill levels have been investigated for children worldwide using the various versions of the Test of Gross Motor Development . The psyTo the best of the authors’ knowledge, no study investigated the TGMD-3 motor criteria regarding variance and hierarchal order. For example, two recent studies investigated the TGMD-3 skills discriminant power across gender and age ,21. HoweThe TGMD-3 has 50 motor criteria, 3 to 5 for each skill; further understanding the items’ variance, hierarchal difficulty, and its differential function by gender and age will provide relevant information for practice. During instruction of a skill, a therapist or professor must know what the most difficult or easy criterion is and how difficult a specific criterion is regarding each skill for a child to master. Besides, some criteria could discriminate regarding different groups of children, such as girls and boys, or across ages, and determining what age to expect the child to acquire the more demanding proficient criterion of one skill is essential for intervention planning. Therefore, there is a need to examine the variation, hierarchal organization, and separation of the items that comprise the TGMD-3. This study aimed to investigate the hierarchal order of the TGMD-3 items regarding difficulty levels and the differential item functioning across gender and age groups .This study included 989 children from 3 to 10.9 years old (mean (M) = 6.8, standard deviation (SD) = 2.1; girls: M = 6.9, SD = 2.0; boys: M = 6.9, SD = 2.1) from 22 schools (public and private), 10 cities in eight states  from the five main regions of Brazil . Children with physical disabilities  reported by parents, teachers, or caregivers, were excluded from the study. Participants’ descriptive statistics are presented in We used the Test of Gross Motor Development-3rd Edition (TGMD-3) , validatWe used the Brazilian Economic Classification questionnaire  to verifThe sample size was estimated considering a minimum of 10 subjects per threshold ,33; in tFor data collection, parents or legal guardians of the child were informed, by letter, of the study’s aims and procedures. The informed consent was sent home to the parents interested in participating; children who returned the signed informed consent were assessed after being asked and verbally agreeing to participate in the study. Parents/legal guardians completed a demographic information questionnaire. The TGMD-3 was administered at school by three members of the research team. The assessment was conducted with two children simultaneously, following the protocol procedures regarding instruction, demonstration, practice trial, and formal trials. The assessment of all children was video recorded for later motor performance scoring. Two trained raters, with extensive coding experience using the TGMD-3, coded all video records (N = 989). Considering a minimum acceptable reliability (ICC) (ρ0 = 0.6), expected reliability (ICC) (ρ1 = 0.75), significance level (α) = 0.05, power (1 − β) = 80%, and number of repetitions per subject (k) = 2, the intra-rater sample size calculated was 102 . Then, 1The sample size was calculated using Epilnfo statistical software (version 70), considering an expected 50% frequency, a design effect of 1.5, a 95% confidence level, a 4% acceptable margin of error, and 10 to 15% possible losses. The number of subjects comprising the final sample was between 990 and 1.035 children.Data entry errors and inconsistent records were identified and corrected. Data cleaning was performed using Excel—360 and SPSS, version 22.0 . The LOCThe fit of the items to the model was examined using the standardized indices of infit mean-square, measuring the discrepancy between the model’s prediction and the observation of the participants’ responses by weighting with item information. Outfit mean-square is not weighted by item information, thus proving more sensitive to extreme residuals (outlier cases), where the item misfit or discrepancy occurs far from the level of the subject’s latent trait ,38. ItemDifferential item functioning (DIF) was used to identify items that function differently concerning specific subgroups within the population of interest. An item exhibits DIF when participants who possess the same ability level, but come from different subgroups, are not equally likely to answer it correctly or endorse a particular response category . The DIFHierarchic order of the TGMD-3 items: item adjustment and motor performance difficulty.Participants’ scores on the LOCS, using the Rasch measure, ranged from −4.06 to 2.96 , with a mean standard error of 0.33 (SD = 0.07). The participants’ mean infit was 0.98 (SD = 0.44), and the mean outfit was 1.18 (SD = 1.27). The person separation coefficient was 2.09; values above 2 are considered adequate , and theThe item-person map represents children’s LOCS performance on the TGMD-3, with the difficulty level of the items listed from least to most difficult, are presented in Regarding the analyses of each LOCS item, Due to adjustment problems in run items 2, 3, and 4, the model was reanalyzed, and the indexes did not change substantially regarding participants’ scores  and items .Participants’ scores on the BS, using the Rasch measure, ranged from −4.15 to 3.93, with a mean of −0.01 (SD= 0.69) and a mean of the standard error of 0.28 (SD =0.05). The infit mean was 0.99 (SD = 0.13), and the outfit mean was 1.08 (SD = 0.70). The person separation coefficient was 2.12. The reliability of the estimates of abilities was 0.82. The reliability of the scale was 1.00, with the separation index of 16.74, the mean infit of the items was 0.99 (SD = 0.13), and the outfit was 1.08 (SD = 0.52), with a standard error mean of 0.05 (SD = 0.07).The item-person map of the children’s BS performance is presented in Concerning the analyses of each BS item, Considering the outfit problems presented in two-hand catch, item 1, the model was reanalyzed, and the indexes did not change markedly. Regarding LOCS by age group, eight items had differential functioning, run , hop (item 4), skip (item 2), jump (item 4), and slide (item 3 and 4). All these items were more difficult for younger children (3 to 5 years old).Regarding BS by age group, ten items had differential functioning, two-hand strike (item 2), two-hand catch (item 2), two-hand catch (item 3), one-hand dribble (item 2), one-hand dribble (item 3), kick (items 1 and 4), overhand throw (item 4), underhand-throw (item 2), and underhand-throw (item 4). All these items were more difficult for younger children (3 to 5 years old).This study aimed to investigate the hierarchic order of the TGMD-3 items regarding difficulty levels and the differential item functioning across gender and age group . Although recent studies investigated the TGMD-3 skills item difficulty , all of In this study, Rasch rating scale model analyses showed adequate indexes for participants’ scores. The person separation coefficient for LOCS and BS dimensions were acceptable ; values above 2 are considered adequate . RegardiRegarding the items, Rasch analyses also showed adequate indexes for the person separation coefficient and the scale’s reliability in both LOCS and BS . FurtherThe analyses showed items with inadequate outfit. Items 3 and 4 for run, and item 1 from two-hand catch, showed higher unexpected performance than other items . This means that the items are less robust to extreme cases and, for example, children with high level of the latent traits for locomotor and ball skills performed unsatisfactorily for these items, and vice versa. According to Linacre , outfit pbde = 0.14), and two-hand catch, item 1 (ρpbde = 0.10). The point biserial correlation results, specifically, regarding run, item 3, and two-hand catch, item 1, indicated a very weak relationship with their respective locomotor and ball skills latent trait. This means that the item can fail to discriminate those individuals with distinct latent traits [We also observed low point biserial correlation values in run, item 3  ,48,49. IRegarding hop, item 4, only the capability of the children for performing hops with preferred the leg, for four times consecutively, is assessed, focusing on the product of the movement. Neither qualitative aspect of the movement is required; therefore, completing this item is less difficult. Furthermore, in Brazil, children frequently are enrolled in free play activities that require hops for consecutive times, for example, amarelinha (hopscotch), pula corda (jumping rope), or elástico/trancelim (jumping an elastic rope) ,59,60. TConcerning the ball skills, the one-hand forehand strike, item 4, was the most difficult item. This item requires a follow-through movement across the body , which may constrain the amplitude of movement if less force is applied at the beginning of movement. Although other TGDM-3 ball skill items include a contralateral follow-through movement , these do not require holding or retaining an implement. Holding a paddle while performing the movement adds an additional demand that can make this TGMD-3 item more difficult for children. In addition, the lack of practice may explain this result. In general, activities that involve striking a ball with a paddle occur less frequently, or are not included in the physical education curriculum in most Brazilian public schools ,62. ThusThe second most difficulty ball skill item was the underhand throw, item 2. The obtained result is plausible, considering the numerous demands required to complete the task. This item requires a coordination of the upper and contralateral low limb, with a body projection forward. Besides, the movement of the throwing hand is focused on hitting the ball into a prior specified target , which can increase the difficulty of the task. In TGMD-3, the overhand throw, item 3, also requires coordination between the upper and contralateral lower limb and body projection forward, but different from the underhand throw, item 2, it does not require throwing a ball into a wall.Another high-difficulty item was the dribble, item 1; this item requires that children contact the ball with one hand at waist level, demanding visuo-motor coordination with the ball in motion. In this situation, the children must combine sensory information with motor response, coordinating the eye and the hand movements, trying to achieve temporal and spatial accuracy for manually intercepting the ball in motion . If the The results showed that the less difficult items were two-handed catch, items 1 and 2, and kick, item 4. These two items cited from the catch skill seem to require a low motor demand; the first, with the arms extending to reach the ball, and the other, a ready or waiting position, in this case, to remain standing in front to the ball. This can explain the low difficulty of both items. Regarding the kick, item 4, kicking a ball with the instep or inside of the preferred foot is a not so difficult task for Brazilian children, considering their further experiences throughout childhood with soccer and futsal practices at school and during outdoor free play . The chiNo one item showed differential item functioning between gender; the response pattern for both locomotor and ball skills items was similar in girls and boys. It is important to emphasize that although the literature addresses the differences in performance between girls and boys ,5,28, atConcerning locomotor item functioning across age groups, the analyses showed that, for example, some run, hop, slide, skip, and jump items were easier for older children compared to the youngest ones (3 to 5 years old). Consequently, with an increase in age, the percentage of children demonstrating mastery in these items also increased; similar evidence was reported by Ulrich . For exaBall skills items also showed differential functioning. Two-hand catch, item 2, and kick, item 4, were even easier for the older children groups compared to the younger children. Furthermore, two-hand strike, item 2, two-hand catch, item 3, dribble, items 2 and 3, kick, item 1, and overhand throw, item 4, were easier for older children. The results from Ulrich  also conThe TGMD-3 has items with hierarchical levels of difficulties according to age, allowing the identification of specific challenges within each skill. Teachers and therapists will benefit from this information by understanding the motor criteria within each skill that require more instruction and practice, or specific strategies for children, especially the younger ones, to achieve skill mastery. Understanding motor criteria hierarchy within each skill across different ages may also help teachers and therapists to design more effective intervention programs to enhance the motor development of children with delays. Another possible implication of the present study is regarding TGMD-3 research recommendations. The nondifferentiation in function for gender and the observed differentiation across different ages emphasized the importance of addressing the motor criteria in further studies across gender and sex to build additional knowledge into the paths of children’s developmental trajectories in different cultures.In advancing the previous study, the analysis of the results from the Rasch method provided important evidence for TGMD-3′s hierarchy, difficulty, and item differential functioning. Furthermore, the separation into distinct performance groups showed the ability of TGMD-3 to detect different levels of motor performance in all age groups. The combination of information acquired in this study shows the sensitivity of TGMD-3 in detecting changes, collecting crucial information for identifying children who need further support, and referring children to a specific clinical intervention.The evidence highlighted in this study must also be observed from the perspective of its limitations. The first limitation is related to the sample enrolled. It was composed of typically developing children. Another limitation is the lack of previous studies examining item psychometrics, which restrains our capacity for comparison with other samples.Item difficult varies according to the children’s latent trait levels. For example, a given item can be easy for typical children, but, more difficult for atypical children . It is plausive, therefore, to test the hierarchy, difficulty, and item differential functioning among typical and atypical children. Including children with disabilities could provide different trends in the item’s difficulty, broadening the knowledge about where these children are localized in the locomotor and ball skills latent trait continuum. In addition, the models showed a high precision for estimating the participant’s theta located within a reasonably wide limit of the theta continuum. However, it is important to investigate how the inclusion of items with more difficulty can increase the precision for theta estimating those children with high or very high motor performance.The results observed in the present study showed that the TGMD-3 contains locomotion and ball skills items with different levels of difficulty; therefore, it has the ability to identify motor changes in Brazilian children, with different levels of performance in research and educational contexts. Furthermore, we verified that the TGMD-3 showed differential item functioning in the performance of distinct age groups for children, indicating that the instrument is suitable for monitoring motor development over time during childhood. These findings offer reliable support to health and education professionals dedicated to carrying out scientific research aimed at assessing and monitoring children’s motor behavior, as well as planning interventions appropriate to the level of child development according to age.