Background and Objectives: Hormonal replacement therapy (HRT) is effective in treating many debilitating symptoms of menopause. However, its use in women with uterine fibroids is widely debated, based on the susceptibility of these tumors to sexual steroids. This review aims to ascertain the effects of HRT on leiomyomas development and growth in postmenopausal women. Materials and Methods: Electronic databases  were searched from January 1990 until May 2019. All English-written studies evaluating the impact of various HRT regimens on uterine leiomyomas were selected. Results: Seventeen papers, considering a total of 1122 participants, were included. Fifteen of these were prospective trials, of which nine were randomized controlled trials. The remaining two works were a retrospective observational trial and a retrospective case series respectively. Five studies evaluated the effects of tibolone, also comparing it with various estrogen/progestin combinations, while two were about raloxifene. Thirteen studies compared different combinations of estrogens/progestins, the most common being transdermal estrogens (used in nine studies) and medroxyprogesterone acetate at different doses (used in 10 studies). Conclusions: For women with uterine fibroids, the choice of the most appropriate HRT regimen is crucial to avoid leiomyomas growth and the symptoms possibly related to it. Available data are conflicting, but suggest that uterine fibroids might be influenced by HRT, without representing an absolute contraindication to hormonal replacement therapy. Women with uterine fibroids subjected to HRT should be periodically examined and hormonal treatment should be discontinued if leiomyomas appear to increase in size. Moreover, the minimal effective dose of progestin should be employed. Leiomyomas are the most common benign uterine neoplasms, affecting up to 80% of reproductive age women and causing morbidity in up to 30% of them ,2,3,4. TIt is well established that uterine leiomyomas are hormone-dependent masses. In fact, they show a tendency to enlargement during reproductive age, have never been observed before menarche and tend to shrink after menopause ,14. MoreFibroids growth appears to be influenced both by ovarian steroidogenesis and by estrogen produced in situ, by conversion of local androgens to estrogens by aromatase . InteresProgestins may also play a crucial role in the development and growth of uterine leiomyomas , as provBased on this, the use of hormonal replacement therapy (HRT) in women affected by fibroids has been widely debated, and the previous diagnosis of leiomyomas has even been considered as a relative contraindication to the prescription of HRT. In fact, uterine fibroids tend to shrink during menopause and often become asymptomatic, thus requiring no treatment in the majority of patients ,14. SpecWith the increase in life expectancy, it is estimated that 1.2 billion women worldwide will reach menopause by 2030 . MenopauIn light of this, HRT use in menopausal women with fibroids is controversial, because of the possible role of estrogens and progestins on myomas growth. Therefore, the aim of this state-of-the-art review is to revise current literature on the possible implications of HRT on leiomyomas development, growth and symptoms in postmenopausal women.ClinicalTrials.gov, EMBASE, Sciencedirect, the Cochrane Library at the CENTRAL Register of Controlled Trials, Scielo) was performed from January 1990 until May 2019. Search terms used were the following text words: “menopause,” “uterine leiomyomas”, “hormonal replacement therapy”, “menopause hormonal therapy”, “uterine fibroids.” Only English-written papers were considered for this review. No restrictions for geographic location were applied. In addition, the reference lists of all identified articles were examined to identify studies not captured by electronic searches. The electronic search and the eligibility of the studies were independently assessed by three authors . Final inclusion was decided after detailed examination of the studies. Differences were discussed, and consensus reached. We included all randomized clinical trials, retrospective studies, literature reviews and case reports and series dealing with the use of hormonal replacement therapy in menopause in patients with evidence of uterine leiomyomas.To identify relevant papers for inclusion in our literature review, a thorough search of Electronic databases . No differences were noted between the mean PI values of growing and stable fibromas in groups B and C.Gregoriou et al. analyzed the influence of a 2.5 mg/day tibolone regimen in post-menopausal women with leiomyomas in two studies ,27. In aIn a randomized controlled trial, De Aloysio et al.  comparedFedele and colleagues  conducte3, whereas in the transdermal estradiol arm it increased from 23.1 to 27.3 cm3, without any statistical significance, neither within nor between groups. Also, there was no statistical difference in terms of frequency of myomas growth, although it was slightly higher in the transdermal treatment arm (21.4% vs. 12.5%). Moreover, three women in the tibolone group and two in the transdermal one reported abnormal uterine bleeding; endometrial biopsies did not show any relevant alterations in four women, whereas an endometrial polyp was diagnosed in a patient receiving tibolone.Another study conducted by Simsek et al.  comparedSeveral studies compared different regimens of HRT in postmenopausal women with uterine fibroids. Colacurci et al.  studied p < 0.001).In a prospective observational trial, Frigo et al.  studied In a prospective non-randomized trial, Palomba et al.  evaluateYang et al.  conducteA large population composed of 159 women at least 2 months from their last spontaneous menstruation was studied by Ylostalo and colleagues . They weSchwartz and colleagues  publisheLastly, Chang et al.  recentlyIn a prospective trial by Sener and colleagues , 40 meno3. Furthermore, while a non-significant increase in myoma volume at 12 months was noted in group C (18.6 ± 1.4 vs. 19.2 ± 1.1 cm3), myomas in women subjected to transdermal estradiol and MPA grew significantly after the first year of treatment (19.3 ± 1.3 vs. 23.8 ± 0.9 cm3). Uterine fibroids showed a mean volume increase of 4.8% in group C and of 25.5% in group D.Polatti and colleagues  studied In the wake of this study and suspecting a central role of the progestin dose in the growth of fibroids in postmenopausal women, Palomba and colleagues  conducteSERMs are a group of compounds that are able to elicit tissue- and target-specific responses, acting as estrogen receptors agonists or antagonists . Having Raloxifene is a second-generation SERM which exerts an estrogen antagonistic activity on the breast and the endometrium, but acts as an estrogen agonist in the bone. Its influence on fibromatous tissue was investigated in two studies by Palomba and colleagues ,32.In their first experience, the authors enrolled 62 postmenopausal women with 1-2 leiomyomas measuring > 20 mm; 31 of them were subjected to raloxifene 60 mg/day, whereas 31 received placebo. After one year, leiomyomas volume in patients treated with raloxifene were significantly reduced in volume compared to the control group. Particularly, after 12 treatment courses a significant reduction in myomas size was noted in 83.9% of women. On the other hand, amenorrhea incidence and number and severity of AUB was comparable between the two groups.3) both compared to baseline values and fibroids size in the control group, who were practically unchanged (150.3 ± 58.7 vs. 150.4 ± 58.0 cm3).In another prospective randomized double-blind trial , the autUterine leiomyomas are the most common benign neoplasm of the female reproductive organs. Although their exact etiology remains uncertain, the expression of estrogen and progesterone receptors in their tissue has been demonstrated by several studies ,21,22,23This state-of-the-art review aimed to clarify the influence of different kinds of HRT on fibroids growth and fibroids-related symptoms after menopause, verifying whether a specific treatment method could be more appropriate in this instance.Of the seventeen eligible studies found by our research, the majority had a prospective design, with nine being randomized controlled trials, whereas only two were retrospective studies. On the other hands, these studies were mostly conducted in the late 90s, had a small population and lacked a rigorous statistical analysis, having no power analysis, no clear randomization criteria and sometimes investigating different types of HRT at the same time. Moreover, many of these papers had a short-term follow-up, usually just 12 months. Thus, evidence from these studies should be taken with caution, making it difficult to draw general conclusion applicable to a large population.Five studies investigated the effects of tibolone, a synthetic steroid which shows androgenic, estrogenic and progestogenic actions. In particular, three studies compared its influence on uterine fibroids with different regimens of HRT ,29,30. FAs for HRT, results are often conflicting. Some combinations of estrogen and progestin have exhibited a significant influence on fibroids enlargement, as well as in frequency of newly detected myomas in menopause ,35,39,40Interestingly, some of the studies that found a significant increase in fibroids dimensions used different progestin compounds ,35,40, oSome efforts have been made to try to discover a possible marker for fibroids growth during HRT. According to Colacurci et al. , uterineAs for SERMs, raloxifene has demonstrated an inhibitory effect on fibromatous tissue ,32, bothTo date, a wide variety of therapeutic options are available to treat menopause-related symptoms. The choice of the most appropriate therapy is crucial for women with uterine fibroids, especially those who were symptomatic and who already have large fibroids. Given the unevenness of available data, it could be argued that uterine myomas might be influenced by HRT, without representing an absolute contraindication to treatment. Indeed, several authors encourage the use of HRT in postmenopausal women with fibroids. However, these patients should be regularly subjected to a thorough follow-up, including transvaginal ultrasound for the monitoring of myomas size, and HRT should be discontinued if an increase in size of uterine fibroids is documented. Moreover, according to some authors it would be better to administer the minimal effective dose of progestin during HRT, to minimize the risk of fibroids growth.


Prior functional Magnetic Resonance Imaging (fMRI) studies have indicated increased neural activation when zinc nanoparticles are added to odorants in canines. Here we demonstrate that zinc nanoparticles up-regulate directional brain connectivity in parts of the canine olfactory network. This provides an explanation for previously reported enhancement in the odor detection capability of the dogs in the presence of zinc nanoparticles. In this study, we obtained fMRI data from awake and unrestrained dogs while they were being exposed to odorants with and without zinc nanoparticles, zinc nanoparticles suspended in water vapor, as well as just water vapor alone. We obtained directional connectivity between the brain regions of the olfactory network that were significantly stronger for the condition of odorant + zinc nanoparticles compared to just odorants, water vapor + zinc nanoparticles and water vapor alone. We observed significant strengthening of the paths of the canine olfactory network in the presence of zinc nanoparticles. This result indicates that zinc nanoparticles could potentially be used to increase canine detection capabilities in the environments of very low concentrations of the odorants, which would have otherwise been undetected. Additionally, we have previously demonstrated that zinc nanoparticles are cleared from olfactory epithelium within 10 s  for the duration of the scanning, carried out while the dogs were awake and unrestrained. Positive reinforcement behavior shaping procedures were used to keep them as still as possible and to desensitize them to the loud scanner noise.−12 M)  and (−) carvone in water at a concentration of 0.016 mM. This is well above the dog's LOD (level of detection) in air for odorants we used, which has been shown to be at the level of 5 pM (10−12 M) . This od−12 M) . The odo−12 M) , for whi−12 M) . These d−12 M) . This fa−4), the concentration of the odorants in the head space is in parts per billion range. For example, the concentration of Eugenol in head space can be estimated using Amoore-Buttery equation for the water/air partition coefficient, Kaw, from value of vapor pressure, solubility in water and molecular weight  equals to Ch = 1.3 × 10−9 M = 1.3 nMCh = (Mass in m3)/molecular mass) × (volume of 1 mole) = (9.5 μg/m3/164.2 g/mol) × 24.45 = 1.4 ppb.CThe procedure of obtaining and mixing of the zinc nanoparticles was similar to that described in Jia et al. . The zin2, flip angle (FA) = 90 degree, in-plane resolution 3 × 3 mm2, in-plane matrix 64 × 64, and whole brain coverage. Anatomical data was obtained for registration purposes using an MPRAGE sequence with the following parameters: TR = 1,550 ms, TE = 2.64 ms, voxel size: 0.792 × 0.792 × 1 mm3, FA = 9°, in-plane matrix = 192 × 192, FOV = 152 × 152 mm2, number of slices: 104.The data acquisition procedure was described in detail in our previous publications , 40. BriData was obtained for each dog while being exposed to the following set of odorants: Odorants+ zinc nanoparticles (OZ), odorants alone (O), water vapor + zinc nanoparticles (WZ), water vapor alone (W). Each scanning session included 1 run of structural scan, 2 runs of functional scans involving odor stimulation with zinc nanoparticles, 2 runs with odorant alone, 2 runs of functional scans involving exposure to zinc nanoparticles alone in water vapor, and 2 runs of functional scans involving exposure to water vapor alone. These functional scans were run in random order for each dog.As described in Jia et al. , each fuA schematic of the experimental paradigm is shown in Figure http://www.fil.ion.ucl.ac.uk/spm/software/spm8/, Functional Imaging Lab, The Welcome Trust Centre for NeuroImaging, in the Institute of Neurology at University College London). The basic steps of slice timing correction, realignment to the first functional image, spatial normalization to a template defined by us as in Jia et al.  as compared to other control conditions of odorant (O), water vapor + zinc nanoparticles (WZ), and only water vapor (W) were indicated.Considering the activations obtained from the contrast mentioned above (only the activated voxels) the following Regions of Interest (ROIs) were selected: Amygdala, Hippocampus, Olfactory bulb, Thalamus, Caudate, Pyriform lobe, Frontal cortex. While the voxels themselves were dictated by the contrast defined above, the nomenclature of the ROIs they belong to were identified using a dog atlas . For eacp < 0.05 for the condition of Odorant + Zinc nanoparticles greater than the conditions of Odorant, water vapor + zinc nanoparticles, water vapor  were obtained and are listed in the Table All the paths with corrected n = 16), which was consistent with the ~3-fold increase of electro-olfactogram (EOG) amplitude evoked by a 10-fold increase in odorant concentration in rodents (Our previous fMRI analysis of the olfactory system in conscious dogs showed that an increase of odorant concentration of 10 times caused a considerable escalation of brain activity manifested by the growth of the total number of activated voxels from 379 to 759, at the ratio of 2.0 . When zi rodents , 36, and rodents , 40. Anain vitro cellular (In vivo imaging studies till now have mostly concentrated on activations in various regions of the brain (Canine olfaction has been very useful to mankind over decades for various tasks such as detecting explosives, people etc. However, they still do not seem to be accurate on occasions due to reasons such as the low concentrations of the odorant in the surrounding environment. Therefore, understanding the olfactory system in canines and methods of enhancing their olfactory capabilities are of high interest. Efforts have been made in this direction using cellular , 64 or bhe brain , 40. GivPerceived odor intensities by humans are observed to be highly correlated with the EOG amplitude . EOG stuin vitro enhancement of the olfactory response in olfactory sensory neurons in the presence of zinc nanoparticles (in vivo enhancement observed in terms of increased fMRI-based activation of olfaction-relevant regions of the dog brain (Our hypothesis, that the connectivity of the various signal paths involved in the process of olfaction will increase in the presence of the zinc nanoparticles, is motivated by previous works which have shown articles , 36, 72 og brain . The senog brain . Below, Electrical potentials measured in the ORNs , 74 at tIt is interesting to note that in our previous report , we had The results of study suggest that zinc nanoparticles enhance the canine olfactory sensitivity by potentially upregulating both activity  and connGD, VV, TD, EM, and PW conceived the idea and designed the experiment. GD, NS, and RB optimized sequences and acquired the data. PW handled the dogs. OP prepared the odorants and operated the odor applicator device. CW trained GD and RB for using the external motion tracking device in addition to providing the device. GD, BR, and VV analyzed the data. GD, BR, VV, and JK interpreted the results. All authors contributed toward writing the manuscript.Two of the authors are employed by commercial companies. CW is the founder and CEO of MRRA Inc., who supplied the optical motion tracking system and contributed to this work by training the first author on using this product. MRRA Inc., is the license holder for the patent covering the motion tracking product. NS is an employee of Siemens Healthcare, Malvern, PA who is stationed at the MRI Research Center in Auburn University. She contributed by optimizing the sequences used to acquire fMRI data in this study. However, note that these authors had no role in data analysis and its interpretation. These competing interests do not alter the authors' adherence to common policies on sharing data and materials. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Simultaneously, soil core samples were obtained and soil properties were measured in the laboratory. Soil properties were estimated using VNIR spectra alone and in combination with depth, ECa, and CI (DECS). Estimated soil properties included soil organic carbon (SOC), total nitrogen (TN), moisture, soil texture , cation exchange capacity (CEC), calcium (Ca), magnesium (Mg), potassium (K), and pH. Multiple preprocessing techniques and calibration methods were applied to the spectral data and evaluated. Calibration methods included partial least squares regression (PLSR), neural networks, regression trees, and random forests. For most soil properties, the best model performance was obtained with the combination of preprocessing with a Gaussian smoothing filter and analysis by PLSR. In addition, DECS improved estimation of silt, sand, CEC, Ca, and Mg over VNIR spectra alone; however, the improvement was more than 5% only for Ca. Finally, differences in estimation accuracy were observed between the two fields despite them having similar soils, with one field demonstrating better results for all soil properties except silt. Overall, this study demonstrates the potential for in-situ estimation of profile soil properties using a multi-sensor approach, and provides suggestions regarding the best combination of sensors, preprocessing, and modeling techniques for in-situ estimation of profile soil properties.Optical diffuse reflectance spectroscopy (DRS) has been used for estimating soil physical and chemical properties in the laboratory. In-situ DRS measurements offer the potential for rapid, reliable, non-destructive, and low cost measurement of soil properties in the field. In this study, conducted on two central Missouri fields in 2016, a commercial soil profile instrument, the Veris P4000, acquired visible and near-infrared (VNIR) spectra (343–2222 nm), apparent electrical conductivity (EC Traditional agriculture applies uniform management to fields without considering the spatial heterogeneity of soil properties and plant growth. This contributes to potential over-application of chemical inputs such as fertilizer, pesticides, and herbicides, leading to increased environmental risk. In contrast, precision agriculture aims to manage at the field scale and apply inputs according to the needs of each area within a field. Thus, precision agriculture has the potential to improve crop production, prevent excess application of chemical inputs, reduce expenses, and reduce environmental impacts. To reach this goal, site-specific soil properties that affect plant growth and crop production need to be measured to provide a basis for precision agriculture management. Measuring multiple soil properties at a high temporal and/or spatial frequency is time consuming and costly, using conventional methods. Therefore, alternative approaches are needed to achieve high resolution, field scale information for producers.2 ranging from 0.73 to 0.95 )boratory , and to 2 ≥ 0.80 . Another2 ≥ 0.80 ,22. 2 = 0.90 ) spectra (343–2222 nm), dipole contacts for ECa (mS·m−1) data collection, and a load cell which quantified CI (kPa) by measuring the insertion force on the conical tip of the probe  were measured simultaneously to a depth of ~1 m. To increase the signal-to-noise ratio through averaging sensor data, probe measurements were repeated five times ~15 cm apart at each location. All sensor data were obtained at a nominal 20 Hz rate as the probe was hydraulically inserted into the soil at ~30 mm·s−1. Instrument output data were the mean of every 25 raw measurements, and each output measurement represented an approximately 4-cm depth increment. Spectral data were visually examined before analysis to identify any near-surface scans that may have been affected by exposure of the detector to sunlight. Any such spectra were deleted prior to analysis, as were data at wavelengths <400 nm due to their low signal-to-noise ratio.The Veris P4000 probe included a halogen light source, sapphire window, and spectrometer to collect profile VNIR absorbance , exchangeable cations , and pH following established methods [To characterize the soil at each location, one 5 cm diameter soil core was extracted, no further than 0.5 m from any probe insertion. The soil cores were described and segmented by pedogenic horizon, homogenized with a 5 mm sieve, then stored in a cooler at 4 °C until laboratory analysis. The number of horizons per core varied from 2 to 6, with a median of 4, for a total of 148 horizon samples. In total, profile data and soil cores were obtained from 20 locations in F1 and 13 locations in F3. Soil samples were analyzed for SOC and TN using a Leco TruMac C/N combustion analyzer , following standard procedures . Samplesa, and CI) were collected at different depth increments, it was necessary to combine them to a common level of spatial  support. This was done using weighted averaging of the sensor data to match the soil samples segmented by variable thickness horizons from the soil cores. The weighting procedure was based on the fact that the sensor depth recorded was the final depth of the instrument at the end of the 25-scan observation period. This depth then defined the starting depth for the next observation in the probing sequence. These sensor-data depth segments varied in thickness, with an average thickness of 4.1 cm and a standard deviation of 1.4 cm. The initial starting depth for the first observation in any probe was unknown. Therefore, we chose to start at a depth of zero for the first scan, or at a depth such that the first observation represented no more than 4.0 cm of depth. Observations that fell entirely into a single soil layer were weighted by the depth increment of the observation divided by the total thickness of the layer. Where observations spanned two soil layers, the observation was partitioned into both layers based on the amount of depth represented in each layer and again divided by layer thickness. At the end of this procedure, the weighted average sensor data were merged with the corresponding soil properties. Observations with missing laboratory or sensor data were dropped, resulting in a final dataset of 148 observations for analysis. Because soil and sensor data  and RMSE calculated in the validation dataset.Different combinations of spectral preprocessing techniques, sensor data sources, and modeling methods were evaluated and compared to select the best combination for in-situ estimation of profile soil properties. The procedure included: (1) comparison of ten spectral preprocessing techniques for PLSR analysis of the DECS dataset; (2) using the best preprocessing technique and PLSR, comparing DECS and VNIR spectra results; (3) using DECS and the best preprocessing technique, comparison of results from four modeling methods (detailed below); and (4) comparison of calibration models developed for a single field with those developed for multiple fields. Model evaluation was based on coefficient of determination  should receive additional weighting to compensate for the effect of many variables (n = 374) in the spectral data vector. The use of this preprocessing step, known as block scaling in PLSR analysis [One consideration in preparing the DECS dataset was whether the scalar variables Reflectance spectra (transformed from absorbance to reflectance);(2)Absorbance spectra (the default output format of the P4000 instrument);(3)Mean normalized spectra, smoothed with a 9-point moving average;(4)Spectra smoothed with a 9-point moving average and then mean normalized;(5)30-point moving average;(6)30-point Lowess smoothing;(7)30-point Gaussian window smoothing;(8)30-point Exponential smoothing;(9)Standard normal variate (SNV) transformation;(10)SNV plus 30-point Gaussian smoothing.After screening a larger number of preprocessing techniques on a preliminary dataset, ten different techniques were applied to the spectra in Matlab 2016  and the results were compared:Absorbance spectra, the default output of the P4000 instrument, and the standard transformation from absorbance to reflectance , were evaluated without further preprocessing. The remaining preprocessing techniques 3–10) were applied to the absorbance spectra, including various normalization and moving average smoothing techniques commonly used in soil DRS sensing ,10,26. T were appBased on a review of past work and preliminary analysis of a larger set of methods on a previous dataset, four calibration methods were chosen for evaluation on the DECS dataset. These were PLSR, neural networks (NN), regression trees (RT), and random forests (RF). Partial least squares regression is a statistical method that finds a linear regression model by projecting the dependent and independent variables to a new space. A new set of uncorrelated variables, called factors, was created to explain the variation of predictor and response variables . For higThe NN approach was implemented with the Neural Network Fitting Tool of Matlab 2016. Neural networks are inspired by biological nervous systems and consist of simple elements, which work in parallel. As in nature, the connections between elements largely determine NN function, and can be trained to implement a particular function by adjusting the values of the connections (weights) between elements. Ideally, a NN is able to predict a particular target after proper training. In this study, the Neural Network Fitting Tool was used to build NN by modifying example code to import spectra and soil properties. Data were divided into three subsets: 70% to train the network, 15% to validate network generalization and to stop training before overfitting, and 15% to test the performance of the trained network when predicting to a new dataset. Regression trees and RF were implemented in IBM SPSS Modeler 18.0 . Standard regression methods assume a parametric relationship between the response and predictor variables . In contrast, RT construct a set of decision rules based on the predictor variables ,55,56. TA RF is a collection of decision trees, regression trees in this case, where a subset of the data is selected randomly for each decision tree that is part of the RF. This concept uses a combination of tree predictors, each depending on a randomly selected subset of data . SpecifiFor all calibration methods, division into training and prediction sets was done randomly by sample. It has been previously suggested  that sucTo understand the differences in our dataset, we conducted a limited analysis, comparing by-sample and by-location selection when using PLSR and NN models, and finding little consistency in results. For NN analysis, by-sample results were better for 7 of 11 soil properties, while PLSR by-sample results were better in only 3 of 11 cases. Thus, our data did not strongly support the need for by-location validation set selection. This may be due in part to our depth-sampling procedure based on soil horizons rather than the fixed depth increments used in , which mMultiple spectral preprocessing techniques, sensor data sources, and modeling methods were evaluated and compared to select the best combination for in-situ estimation of profile soil properties. Detailed results are provided in the sections below. 2 for each spectral preprocessing technique across all soil properties. Results are presented for three datasets: F1, F3, and the combination of F1 and F3. When averaged across the three datasets, the grand  mean prediction R2 was very similar for all preprocessing techniques, ranging from 0.58 to 0.61, with the 30-point Gaussian window smoothing and SNV plus Gaussian performing the best (R2 = 0.61), followed by the 30-point moving average and SNV (R2 = 0.60). Thus, when averaged across all variables and datasets, no single pretreatment was clearly better than the other. The complex field environment, including variable temperature and soil moisture conditions, is known to impact the accuracy of in-situ sensor measurements. Various preprocessing techniques have the potential to improve the accuracy of in-situ measurements. Here, ten different preprocessing techniques were applied to spectral data, and multiple soil properties were subsequently estimated using DECS and PLSR. 2 = 0.33 and 0.43, respectively) and clay content . Across the individual soil properties, the 30-point Gaussian window smoothing technique performed the best for four of the eleven soil properties , and was not one of the two worst preprocessing techniques for any soil property. The next best technique, SNV, also performed the best for the four soil properties , but was one of the two worst techniques for Ca. Generally, there was very little difference in estimation accuracy between these top two preprocessing techniques, with ΔR2 < 0.01 for all but two soil properties. As the  best preprocessing technique of those evaluated, the 30-point Gaussian window smoothing was selected for use in subsequent analyses.The prediction statistics of individual soil properties for each spectral preprocessing technique are shown in a has been correlated with soil moisture, clay content, CEC, and other soil properties [2 of spectra and DECS was 0.58 and 0.59, respectively. Overall, DECS performed slightly better than spectra for silt, sand, CEC, Ca, and Mg. However, RMSE with DECS decreased by more than 5% only for Ca compared to spectra alone. Spectra alone performed slightly better for TN, moisture, clay content, and K, while results for SOC and pH were the same with both datasets. These results are in accordance with other studies [The combined F1 and F3 DECS dataset was compared to the dataset containing only spectra to investigate if the additional information from DECS improved estimation of soil properties. It was expected that each of the auxiliary sensors might improve results for at least some of the soil properties. For example, soil properties are known to vary with depth, so the depth measurement might be important. Soil ECoperties ,39,40. Aoperties ,42 has boperties ,44,45. T studies ,27, wher studies ,27. This2 values across all soil properties for PLSR, NN, RT, and RF were 0.59, 0.46, 0.39, and 0.45, respectively. When looking at individual soil properties, PLSR results were best for six of 11 . Neural network results were best for SOC, TN, and silt, while RF performed the best for clay and sand. The lowest R2 values were consistently produced by the RT method, with some RT analyses not converging to a solution. In addition to the six soil properties where it gave the best results, PLSR was the second-best performing for four other properties  where R2 with PLSR was within 10% of the best method. Therefore, PLSR was selected as the most robust calibration method with DECS, and was used for subsequent analysis.Multiple calibration modeling methods  were compared for the estimation of soil properties. The PLSR method was either the most accurate or the second most accurate method for each of the soil properties . The aveTo examine the performance of DECS and PLSR at the field scale, the data from F1 and F3 were analyzed independently and compared. Soils and conditions of the two fields were similar at the time of sampling and data collection, except F3 was tilled approximately one week prior to measurement and the surface soil was loose and somewhat drier. Mean soil moisture in the surface horizon was 20.6% for F1 and 18.7% for F3. The profile soil moisture of F1 varied from 18.5% to 22.7% with a median of 20.6%, while the profile soil moisture of F3 varied from 16.1% to 21.5% with a median of 18.7%. For all soil properties except silt, the estimation accuracy for F3 was better than for F1 . For mos2 and RMSE across all soil properties for F1, F3, and the combination of F1 and F3 is shown in 2 (magnitude >0.05) were for TN, soil moisture, and Ca in F1, moisture, silt, sand, and Ca in F3, and Ca in the combination dataset. Averaged across all soil properties, there was an increase in R2 of 0.03 and 0.01 with DECS for F3 and the combination, respectively, while there was a decrease of 0.01 with DECS for F1. There was little consistency across the datasets as to whether DECS or spectra were better. A notable exception was for Ca, where DECS was considerably better than spectra alone in all three datasets, likely due to ECa responding to the clay mineralogy. Smectitic clay minerals such as montmorillonite dominate in this region [a response.A comparison of prediction Rs region . These es region ,62 and lIn general, we note that vertical and lateral spatial correlation, which was not accounted for in our analyses, may have caused overestimation of model performance. However, in a study like this, where the main objective is a comparison of methods , it seems likely that the results and conclusions regarding the outcome of the comparisons would be similar given that the same validation set selection approach was used consistently. On the other hand, if the goal was to develop robust calibrations suitable for application to unsampled locations, different sample selection approaches  might bea, and CI simultaneously down to a 1 m depth. Soil core samples were obtained at the same locations for laboratory measurement of soil properties, including SOC, TN, moisture, clay, silt, sand, Ca, Mg, K, CEC, and pH. Soil property estimates obtained using a variety of datasets, spectral preprocessing techniques, and modeling methods were compared. Conclusions from this research were:2 = 0.03) among the 10 preprocessing techniques.Of the preprocessing techniques investigated, absorbance spectra smoothed with a 30-point Gaussian window produced the most consistently accurate estimates, but only slightly better than absorbance spectra with a SNV transformation. When averaged across all soil properties, there was little difference in accuracy  dataset performed better for others. However, DECS estimates improved by more than 5% in RMSE only for Ca, a marginal improvement with the additional complexity of multiple sensors.Overall, PLSR was the best modeling method, providing most accurate results for six soil properties and second best for another four, out of the 11 properties investigated. Estimation accuracy was more strongly affected by choice of modeling method than by choice of sensor dataset or preprocessing method.Accuracy varied considerably between two fields with similar soils, suggesting that in this case field-specific characteristics or management activities may have influenced the relationship of sensor data to soil properties.In this study, the Veris P4000 instrument was used to acquire in-situ profile DRS spectra, ECThe findings of this research regarding the best combination of sensors, preprocessing, and modeling techniques for in-situ estimation of profile soil properties should be confirmed through additional data collection and analysis for a wide range of soils and locations. Overall, this study showed that multiple soil physical and chemical properties could be estimated with good accuracy using profile spectral or DECS data with PLSR, demonstrating the ability of in-situ data collection to provide rapid assessment of soil properties at high spatial and/or temporal resolution for precision agriculture applications.


Background. Lactococcus garvieae (LG) is a gram-positive coccus known to be a major pathogen in aqua farming, which is responsible for severe outbreaks. Its incidence in humans is extremely rare. Prior to 1985, all bacteria in the genus Lactococcus were included in the Streptococcus genus. The first human infection was documented in 1991, and since then, the relevance and clinical significance in humans has increased. Case Description. We present the clinical course of an LG endocarditis in a 78-year-old man who had a history of exertional dyspnea. The patient’s blood tests showed increased inflammation values, and a transesophageal ultrasound (TEE) showed a stenosis of the prosthetic aortic valve. Blood cultures were positive for LG, leading to a diagnosis of infective endocarditis. After 6 weeks of intravenous antibiotics and a prosthetic aortic valve replacement, the patient made a good recovery. Review of the Literature. After the first documented case in 1991 to 2018, 25 cases of LG endocarditis have been described in PubMed and MEDLINE. We reviewed all reported cases of LG endocarditis, commenting on predisposing risk factors, the course and outcome of the disease. Conclusion. LG endocarditis is a rare disease. Consumption of raw fish, abnormalities of the digestive tract, immune deficiency, and underlying cardiac conditions appear to be risk factors for an infective endocarditis due to LG. Improved determination techniques are likely to lead to a better and faster identification of the bacterium. This identification allows a faster and individualized therapy, which in turn affects the outcome. Lactococcus garvieae is a catalase-negative, facultative anaerobic, nonhemolytic, gram-positive chain cocci1 present throughout the world. It is also known as Enterococcus seriolicida.2Lactococcus garvieae was first described in 1983.3 Since then, it has been described frequently in the literature as a highly opportunistic pathogen in aqua farming, and outbreaks of L garvieae infections in fish colonies significantly affect production.4Lactococcus garvieae proliferation peaks during summer, when the water temperature rises, and this also coincides with a rise in the number of L garvieae infections in fish.4L garvieae was reported in 1991.5 Since then, various types of infections have been described, including lumbar osteomyelitis, meningitis, hepatic abscess, and infective endocarditis (IE).6The first case of human infection with L garvieae has increased in recent decades, as has its clinical significance in humans.7 However, meager information is currently available about the process of transmission to humans. We assume the infection follows the consumption of raw fish, especially in patients with digestive disorders, which was previously described in other cases of L garvieae IE.8 More recently, studies carried out on dairy products obtained from raw milk suggest another possible ecological niche as an origin of L garvieae.2The relevance of L garvieae from enterococci,9 and misidentifications of L garvieae as Enterococcus species are common in small clinical microbiology laboratories.7 Laboratories in tertiary hospitals are more easily able to identify L garvieae species.It is difficult to distinguish 1014L garvieae can also be obtained by specific polymerase chain reaction (PCR) amplification.15 True identification is now possible due to the use of mass spectrometry, especially matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF). MALDI-TOF mass spectrometry has emerged in recent years as an alternative to conventional identification techniques for the accurate, rapid, and inexpensive identification of a broad spectrum of pathogenic bacteria in clinical microbiology laboratories.16Different molecular methods, such as API strips, BD Phoenix, the VITEK system, and MicroScan, have been examined to identify L garvieae from clinical specimens.17 Due to the similarity between L garvieae and streptococcal infections, treatment plans are often the same or comparable. These treatments usually require high doses of β-lactams, including ampicillin, amoxicillin, or ceftriaxone, administered alone or in combination with aminoglycosides such as netilmicin, tobramycin, or gentamicin. In cases where no β-lactams are possible, aminoglycosides could be paired with glycopeptides such as vancomycin or teicoplanin.19 Other combinations, with the risk of more side effects, contain the application of ceftriaxone/levofloxacin or vancomycin/gentamicin.20The treatment is not yet standardized because no test has been established to determine the exact criteria of susceptibility screening.L garvieae infections in humans, despite physicians increasing awareness of the clinical relevance of L garvieae as a human pathogen, can be explained by incorrect interpretation of other streptococcal species and, in the past, by a lack of sufficient laboratory equipment. Only 25 cases of IE due to L garvieae have been described since 1991,5 when it first was identified as the cause of an IE. We will describe L garvieae IE in a patient who has an aortic prosthetic valve replacement.The low prevalence of We present a case of a 78-year-old male with extensive cardiac history, including paroxysmal atrial fibrillation, essential hypertension, chronical renal dysfunction , stenosis of the right external carotid artery, and stenting of the right coronary artery. The patient underwent cardiac surgery including aortic valve replacement  and coronary artery bypass grafting  1½ years prior this presentation.He was admitted to the hospital with a 5-day history of exertional dyspnea NYHA III (New York Heart Association Class III) and expectoration. On admission, he had a tympanic temperature of 38.5°C, a heart rate of 71 beats/min, blood pressure of 148/68 mm Hg, and oxygen saturation of 97% of room air. During his physical examination, there was an aortic systolic murmur (4/6) on auscultation. His medications included mucolytic, aspirin, β-blocker, statin, diuretic, pantoprazole, and rivaroxaban. He was admitted for progressive heart failure with a fever of 38.5°C and chills.9/L, a C-reactive protein level of 209 mg/L, and an interleukin-6 level of 24.93 pg/mL (<6.4 pg/mL). Four blood cultures were drawn, and it was then started to treat the patient with empirical antibiotics  due to concern for prosthetic valve IE.Admission laboratory results were significant for a white blood cell count of 20.1 × 10L garvieae had grown in all 3 positive blood cultures. L garvieae was also found in the repeated blood cultures . It was resistant to clindamycin, which has previously been described in other cases. Empiric antibiotic treatment was completed for 6 weeks with 4 million units of penicillin given every 4 hours. During the first 2 weeks, gentamicin was also given, initially 320 mg given every 24 hours, then later reduced to 240 mg every 24 hours.max 5.42 m/s, Pmax 117 mm Hg, and Pmean 71 mm Hg) and visually impaired pocket valve separation  and pedunculated echogenic material of 10-mm diameter on the prosthetic aortic valve, no paravalvular leak. No vegetation was seen on pacemaker leads. Mitral valve with degenerative change emphasizes posterior mitral leaflet/anulus with central mitral valve insufficiency I°/II°. Tricuspid valve was inconspicuous as far as visible. No tricuspid valve insufficiency. Aorta with evidence of arteriosclerotic changes. An abdominal ultrasound showed shrunken kidneys and an enlarged spleen.A transesophageal ultrasound (TEE) was performed and we obtained the results described below. Left atrial appendage without detection of thrombotic material with good flow velocity (>0.5 m/s). Atrial septum without detection of atrial septal defect or patent foramen ovale. Aortic valve replacement  morphologically with degenerative stenosis  was needed and performed. A Medtronic Hancock II Porcine, 21 mm, was inserted into the aortic valve position. The intraoperative TEE showed no evidence of paravalvular leaks or prosthetic heart valve insufficiency. The following intensive care stay was uneventful, as well as the rest of the patient’s hospitalization.L garvieae bacterial as well as inflammatory cells, in the form of granulocytes. Microbiological testing of the blood culture detected L garvieae by using MALDI-TOF mass spectrometry. The final diagnosis was IE caused by L garvieae.Microscopic examination of the prosthetic aortic valve showed sclerotic tissue, and microbiological testing detected The patient was discharged on postoperative day 8, after 11 days of intravenous antibiotics, which were continued during the patient’s post-hospitalization rehabilitation. The patient underwent a total course of 6 weeks of penicillin and 2 weeks of gentamicin.L garvieae IE  occurred in the Middle East (Israel). Fourteen patients were men (53.8%), and 12 were women (46.2%). The mean age was 68 years (67.8 years), and 18 patients were 60 years of age or older (69.2%).Including our case, a total of 26 cases of IE caused by Eleven patients underwent cardiac surgery, and 4 of the 11 were repeated procedures. Seventeen cases (65.4%) involved a native valve. Prior the case we describe above, the previous 25 cases included 5 patients (20%) with multivalve IE, for a total of 31 affected valves. Among these were 4 native aortic valves (12.9%), 13 native mitral valves (41.9%), 8 prosthetic aortic valves (25.8%), prosthetic mitral valves, and 1 prosthetic tricuspid valve (3.2%).39Of these 25 cases, 5 patients (19.2%) died due to multi-organ failure, heart failure, or cerebral hemorrhage.L garvieae infection occurred due to a barrier gap in the digestive tract  while consuming contaminated food, especially raw fish or fermented milk products. This fits with the observation that most of the L garvieae infections are described during summer and in patients who have a history of consuming raw fish.4 The number of L garvieae infections in fish also peak in the summer months  when the water temperature is warmest.The exact mechanism leading to transmission to humans is not yet established. Previous case reports assume that This study shows that out of the 26 cases, 6 cases (23%) had a history of prior raw fish consumption. Gastrointestinal disorders  were present in 13 cases .Our patient was immunocompromised and had a postoperative ileus 1½ years ago and colorectal cancer, which could have facilitated the infection, together with the predisposing factor of a biological prosthetic valve. However, he denied eating raw fish in the last couple of weeks prior to admission to the hospital.L garvieae requires specific care and therapy. IE may be higher than reported in the literature and might be explained due to the fact that it is often misdiagnosed. Lactococcus is difficult to distinguish from Enterococcus,9 and some microbiological laboratories do not have the optimal equipment and capabilities to differentiate this bacterium. Although L garvieae is considered opportunistic, there is more need for research in this area.Even with only 26 cases described in the world, an infection due to L garvieae is through 2 or 3 sets of blood cultures and, in case of surgery, by analyzing a sample of the removed valve. With this material, it is possible to distinguish L garvieae by MALDI-TOF mass spectrometry and the 16s rRNA gene PCR, in addition to finding a susceptibility profile. In order to determine the final diagnosis of IE, the clinical symptoms, the microbiological findings, and the imaging procedures  must be evaluated using the Duke criteria.In conclusion, the best way to identify 40 with 1 major criterion  and 3 minor criteria .The presented case fulfills the modified Dukes criteria of IEL garvieae  and showed a susceptibility to ampicillin, vancomycin, cefotaxime, ceftriaxone, penicillin, and gentamicin (high level). It was resistant to clindamycin, similar to other described cases of garvieae .L garvieae IE is not yet standardized because the exact criteria of the susceptibility test have not been established. In the case described above, the patient received a 6-week course of intravenous penicillin, 4 million units every 4 hours, and a 2-week course of gentamicin, 320 mg every 24 hours, later reduced to 240 mg every 24 hours.The treatment for Lactococcus garvieae endocarditis is a rare disease in humans. Including our case, a total of 26 cases have been reported in the world.1Lactococcus bacteria were included in the Streptococcus genus. The first human infection with L garvieae was documented in 1991, and since then, the relevance and clinical significance in humans has increased. Improved determination techniques, such as MALDI-TOF mass spectrometry and the 16s rRNA gene PCR, are likely to lead to a better and faster identification of the bacterium.Prior to 1985, L garvieae endocarditis, consumption of raw fish, abnormalities in the digestive tract, and underlining cardiac conditions  seem to be risk factors for an IE due to L garvieae. This bacterium seems to mainly affect elderly and immunocompromised individuals with underlying cardiac conditions or those with anatomical or physiological alterations of their gastrointestinal tract. However, there have also been infections described in young and healthy people.As observed in other cases of L garvieae endocarditis cases, it is assumed that L garvieae exposure can lead to infections in immunosuppressed humans via raw fish consumption and/or with underlying gastrointestinal disorders.On the basis of existing literature of L garvieae endocarditis for changes in their gastrointestinal tract as a potential port of entry for infection.In the future, consideration should be given to examining patients with


Pelvic inflammatory disease (PID) is an infectious disease that causes tubal occlusion and other pelvic and abdominal adhesions. The incidence of pelvic inflammatory disease (PID) has increased due to the sexually active status of the young population. This leads to a more serious problem and a larger effect than previously observed. However, there have been few studies on this topic in Asian populations.We aimed to evaluate the risk of preterm labor and/or ectopic pregnancy in Taiwanese women following PID.Using the Taiwan National Health Insurance Database, we designed a retrospective cohort study that included 12- to 55-year-old pregnant women between 2000 and 2010. We selected a 1:3 age-matched control group of non-PID women. The endpoint was any episode of preterm labor or ectopic pregnancy; otherwise, the patients were tracked until 31 December 2010.The risk factors for preterm labor or ectopic pregnancy were explored. For cases included from the index date until the end of 2010, we analyzed the risk of incident preterm labor or ectopic pregnancy. With the use of a multivariate Cox proportional hazard regression analysis, we calculated the hazard ratio (HR) with a 95% CI and compared it with that of the control group.This study examined 30,450 patients with PID and 91,350 controls. During the follow-up period, patients in the PID group were more likely to develop preterm labor or ectopic pregnancy than patients in the control group. The cumulative incidence rates for developing preterm labor were 1.84%  in patients with PID and 1.63%  in patients without PID. On the other hand, the cumulative incidence rate for developing ectopic pregnancy in patients with PID was 0.05%  but was only 0.04%  in patients without PID. Compared with those without PID, the patients with PID had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy.Our study provided evidence of an increased risk of preterm labor or ectopic pregnancy in PID patients. Pelvic inflammatory disease (PID) is an infectious and inflammatory disease of the upper female genital tract, including the uterus, fallopian tubes, and related pelvic organs. PID is a polymicrobial infection typically observed in sexually active females. When microorganisms ascend from the lower genital tract into the upper genital tract, PID gradually develops. The clinical presentation of PID varies in severity, with most patients presenting with mild disease. The diaIn a famous multicenter, randomized clinical trial designed for PID in North America, the PEACH trial, upper genital tract detection of gonorrhea, chlamydia, or endometritis was sufficient to confirm a diagnosis of PID. The PEABoth obstetricians and gynecologists focus on women's health, and the prevention of pregnancy complications is the main concern. Ectopic pregnancy is a complication of early pregnancy, and preterm labor is a complication that occurs in the second and third trimesters. Getting pregnant and delivering a healthy baby is an important issue for women, families and society. Preterm labor and ectopic pregnancy can have negative consequences on obstetric results and on a woman’s psychological health. Preterm labor and ectopic pregnancy are two independent events, and they have different pathophysiologies. However, both of these conditions share the same risk factor: infection or a previous infectious episode.Tubal occlusion was found to be diagnosed in 12.8% of patients after one infection, in 35.5% of patients after two infections, and in 75% of patients after three or more infections . Some stTherefore, we conducted a population-based study utilizing data from a nationwide health insurance database, the Taiwan National Health Insurance Research Database (NHIRD), to examine the risk of developing ectopic pregnancy and preterm labor among patients with PID.In this study, we used data from the Taiwan National Health Insurance Research Database (NHIRD) to investigate the risk of ectopic pregnancy or preterm labor in patients with PID over a 10-year period. We reviewed records from 2000 to 2010 in the Health Insurance Database, which constitutes a valid representative sample of the total population in Taiwan. The NHIRD has been documenting the medical information of all insured patients since 1995. The national database includes a population of 23.74 million individuals, and it reached 99.6% coverage in 2009. Each smThis study utilized a retrospective matched-cohort design. Among the 986,713 individuals recorded from the outpatient and inpatient data from January 1, 2000, to December 31, 2010, 32,239 individuals were diagnosed with PID (ICD-9-CM codes 614.9) prior to the index date. Patients were excluded if they met one of the following criteria: were diagnosed with PID before the index date, had preterm labor or ectopic pregnancy before tracking, were aged <12 years or > 55 years, and were male.Ultimately, the PID group consisted of 30,450 individuals. The control group had the same exclusion criteria as the case group, but individuals in the control group did not have PID during the study period. The controls were matched 3:1 by index date and age, and the control group included 91,350 individuals. The tracking of the case and control groups continued until December 31, 2010. Tracking ended with the occurrence of preterm labor or ectopic pregnancy. Individuals having had at least two diagnoses of PID (ICD-9-CM code 614.9) according to a gynecologist at a minimum of two visits per year were defined as diagnosed with PID .Our study participants were followed from the index date until the onset of preterm labor (ICD-9-CM 644.0–644.9) or ectopic pregnancy (ICD-9-CM 633.0–633.9), until the withdrawal from the National Health Insurance (NHI) program, or until the end of 2010.The covariates included the age group, geographical area of residence, urbanization level of residence (level 1 to 4), number of pregnancies and monthly income. The age groups were categorized as 12–19, 20–29, 30–39, 40–49, or 50–55 years old. The geographical areas of residence were categorized as northern, central, southern, or eastern Taiwan or outlet islands. The urbanization level of residence was defined according to the population and various indicators of the level of development. Level 1 was defined as a population >1,250,000 people and with a specific designation as political, economic, cultural or metropolitan development. Level 2 was defined as a population between 500,000 and 1249,999 people that played an important role in the political system, economy, and culture. Urbanization levels 3 and 4 were defined as a population between 149,999 and 499,999 and <149,999, respectively. The monthly income was categorized into three groups in New Taiwan Dollars [NTD]: <18,000, 18,000 to 34,999, and >35,000. Baseline comorbidities included diabetes mellitus (ICD-9-CM code 250), hypertension (ICD-9-CM codes 401–405), hyperlipidemia (ICD-9-CM code 272), obesity (ICD-9-CM codes 278), heart disease (ICD-9-CM codes 410–429), and chronic kidney disease (CKD) .All analyses were performed using SPSS 21 software . Chi-square and t tests were used to evaluate the distributions of categorical and continuous variables, respectively.Differences in the distribution of age, insurance premiums, comorbidities, season, location, urbanization level, level of care between the two groups and between subjects with and without ectopic pregnancy or preterm labor were compared using the chi-square test. Multivariate Cox proportional hazard regression analysis was used to determine the risk of preterm labor and ectopic pregnancy, and the results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs). The preterm labor and/or ectopic pregnancy risk difference between the two groups was estimated using the Kaplan-Meier method along with the log-rank test. The results were considered statistically significant if two-tailed p values were less than 0.05.This study examined 30,450 patients with PID and 91,350 controls. Compared to the controls, patients with PID tended to have lower insurance premiums  and had lower rates of DM , HTN , hyperlipidemia  and CKD . Regarding the season of hospital visits, patients with PID had more frequent visits in summer  and autumn  than controls. Patients with PID lived more often in less urbanized areas and in northern areas (45.19% V.S. 42.13%) and in eastern Taiwan (5.27% V.S. 4.56%) (P<0.001) than controls. Compared to the controls, more patients with PID were treated in the hospital center (34.60% V.S. 30.47%) and in regional hospitals (44.25% V.S. 32.65%) (P<0.001). Regarding the ages between the two groups, there was a significantly higher percentage of patients between the ages of 12 and 39 in the PID group than in the control group  .A Cox regression analysis of the factors associated with the risk of preterm labor and ectopic pregnancy was performed. After adjusting for season, urbanization level of residence, location, number of births and monthly income, the patients with PID had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy than patients without PID .Comparing the different age groups, those aged between 12 and 19 years had a significantly higher risk of developing preterm labor than those aged between 20 and 29 , 30 and 39 , and 40 and 49 . Those aged between 12 and 19 years had a significantly higher risk of developing ectopic pregnancy than those aged between 30 and 39 years  and between 40 and 49  years old. Those with hypertension (HTN) (P = 0.004), heart disease (P<0.001), and chronic kidney disease (CKD) (P = 0.017) were associated with a higher risk of developing preterm labor than those without these comorbidities. Additionally, those with heart disease (P<0.001) were associated with a higher risk of developing ectopic pregnancy than those without these comorbidities. A higher incidence of preterm labor or ectopic pregnancy development was observed among PID patients who visited the hospital center and regional hospitals than among those who visited local hospitals .The incidence and HR of preterm labor or ectopic pregnancy in populations with or without PID relative to those of the controls are listed in Despite the other factors, patients with a history of PID had HRs for preterm labor ranging from 1.410 (P<0.001) to 2.772 (P<0.001), which were significantly different compared with the values of those without a history of PID. The same status was also noted in the population with ectopic pregnancies; despite the other factors, patients with a history of PID had HRs ranging from 1.753 (P<0.001) to 4.654 (P<0.001), which were significantly different compared with the values of those without a history of PID.Pelvic inflammatory disease (PID) is an inflammatory condition of the female upper genital tract and includes a combination of endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis,35. ApprBy understanding the association of PID with preterm labor and ectopic pregnancy, assistance and intervention strategies for the clinical prevention of poor outcomes could be provided ,30,48,49The role of salpingitis in the recurrence of ectopic pregnancy was studied in a historical cohort of 2,501 women who had undergone laparoscopic examination for acute salpingitis. The study concluded that salpingitis was a risk factor for first ectopic pregnancy. HoweverThis nationwide, population-based study is a large-scale study that investigates the association of PID with ectopic pregnancy and preterm labor. We confirmed that PID is a significant risk factor for ectopic pregnancy and preterm labor. The PID population is at higher risk of ectopic pregnancy and preterm labor compared to the general population. Among PID patients, patients aged 12–19 years have a higher risk of developing ectopic pregnancy and preterm labor than other age groups. Some infectious diseases are pandemic diseases with obvious seasonal characteristics, and outbreaks occur periodically. The results showed that there was no significant difference between seasons. PID is not a pandemic disease.In addition, patients with hypertension, heart disease, and CKD have an approximately 1.057 to 1.404 times higher risk of preterm labor. Therefore, hypertension, heart disease, and CKD are contributing factors to the development of preterm labor in patients with PID. People with poor health or hygiene problems may have more serious problems or consequences. Patients with hypertension, heart disease, and CKD have the potential for high-risk pregnancies with other complications. With the development of preeclampsia, eclampsia, general edema, or severe dyspnea complicated by heart disease and CKD, delivery is considered an important treatment, and preterm delivery may occur. From the analysis of related factors, we know that women of a young age are at the highest risk of PID. Sexual risk behavior is a critical problem in adolescents. Adolescents engaging in early and unsafe sexual activities represent a high-risk population for infection with human immunodeficiency virus, other sexually transmitted diseases, and unplanned pregnancy. AdolescThe strengths of our study include its population-based design, the use of well-established cohort data with a large sample size and the extended follow-up period used to identify PID as a risk factor for developing preterm labor and ectopic pregnancy. Nevertheless, there are still some limitations of this study. First, although the coding of the NHIRD has been validated for some diseases, no reports are available regarding the coding severity of PID. The infectious pathogens and microbiology involved in PID were also unable to be retrieved via the databank. At the same time, the effect on the severity of preterm labor or the site of ectopic pregnancy could not be analyzed. Second, the NHIRD registry was not able to provide detailed information regarding the laboratory results, health-related lifestyle or past history of the patients, such as smoking status, body mass index, gynecological history and family history, some of which can increase the risk of preterm or ectopic pregnancy. Third, the incidence of PID may be underestimated because patients without a hospital visit or a diagnosis of subclinical pelvic inflammatory disease could noThis study demonstrated that PID is a significant and independent risk factor for preterm labor and ectopic pregnancy. Compared with those without PID disease, patients with PID history had a 1.864 times (P<0.001) higher risk of developing preterm labor and a 2.121 times (P = 0.003) higher risk of developing ectopic pregnancy. The effect of disease progression on the development of preterm labor and/or ectopic pregnancy needs to be further elucidated in future studies. The results from this study indicate that clinical doctors need to perform a cautious assessment of PID patients with pregnancy problems.S1 Table(DOCX)Click here for additional data file.S2 Table(DOCX)Click here for additional data file.


Objective: To study the prevalence of depression and related factors among men who have sex with men (MSM) in Shenzhen China. Methods: Using a cross-sectional design, convenient sampling was applied to recruit participants at the AIDS(Acquired Immune Deficiency Syndrome)voluntary counseling and testing (VCT) clinic and gay clubs in 2015, thereby collecting data on sociodemographics, serological information, sexual behaviotablers, and depression. Descriptive analyses were conducted to determine the distribution of the measured variables. A chi-square test was applied to test the association between different levels of factors and depression status, alongside a binary logistic regression for multivariate analysis of depression. Results: A total of 334 MSM completed the survey. Their mean age was 29.88 ± 7.56, and 35.6% had at least college education; 44.9% considered themselves to be homosexual, and 43.4% considered themselves bisexual. The median score of depression was 12, with 116 people (34.7%) depressed. A total of 267 took the serological test. Of these 267, 60 (22.5%) were reported HIV(Human Immunodeficiency Virus) positive, 33 (12.4%) were syphilis positive, and none were hepatitis C positive. The multiple logistic regression analysis showed that a lack of awareness of AIDS knowledge (OR(Odds Ratio): 2.636, 95% CI: 1.384–5.020), peer education , and lack of heterosexuality  increased the odds of depression. Conclusion: Raising awareness of AIDS and strengthening peer education can improve depression among men who have sex with men. A large number of studies worldwide have shown that men who have sex with men (MSM) have a poor mental health status compared to those with only heterosexual partners. MSM also face general mental health conditions, such as drug abuse, depression, anxiety, and suicidal intentions and behaviors ,4,5,6,7.Individual-level risks for HIV acquisition among MSM have been well documented ,13,14, iIn this survey, we sought to understand the prevalence of depression and its associated factors, as well as the infection status and sexual behaviors pertinent to MSM in Shenzhen, China in order to provide a scientific basis for proposing a reasonable reference for psychological–behavioral intervention services among the MSM population and support the local national demonstration area for the comprehensive prevention and treatment of AIDS.Using a cross-sectional epidemiology design, data were collected anonymously through self-filling questionnaires between March and December 2015 in Shenzhen: a city with large quantities of HIV-positive MSM in Guangdong, China. Convenient sampling was applied to recruit participants at the AIDS voluntary counseling and testing (VCT) clinic and from gay clubs (both conducted under the assistance of the Baoan District Center for Disease Control and Prevention (CDC)). A pre-survey was conducted in February 2015, with twelve active MSM recruited by insiders submitting their opinions on the contents of the survey to improve the rationality of the questionnaire and the acceptability of the target population. There were two ways to reach potential respondents at the two sites used for recruitment. The doctors at the VCT clinic informed the MSM who were actively seeking counseling and testing services about recommended, qualified people who could come over and test them. In addition, based on cooperation with and assistance from gay social organizations, questionnaires and blood samples were taken at gay social activities, and the blood was brought back for testing by staff. Each participant received CNY 50 as compensation for their time spent on the survey. All research activities were managed by experienced research assistants in the MSM and HIV prevention fields. Participants were briefed about the study’s purpose and then provided written informed consent before completing the survey questionnaire. The participant self-administered the questionnaire using a pen and paper form, with an explanation given by the research assistant if the participant had any difficulty with any question or item, as well as to check for completeness and consistency of the data while the participant was still present.Individuals were eligible for the study if they were male, 18 years or older, could provide informed consent for the study, and indicated that they had sex with another male prior to data collection. Those who had severe cognitive impairment or communication disorders were excluded. A total of 466 eligible participants were approached, of whom 363 (a response rate of 78%) participated in the survey. Of the 363 questionnaires collected, 29 were unqualified due to a lack of key information , resulting in a total of 334 participants. Ethics approval was obtained from the ethics committee of Sun Yat-sen University.General demographic characteristics include age, nationality, census register, education level, occupation, marital status, monthly income, etc., were collected through self-filling questionnaires.Treponema pallidum particle assay (TPPA) for confirmation, in cooperation with the Baoan District Chronic Disease Prevention and Treatment Institute. The hepatitis C antibody was detected by ELISA.Serological information included the routine items of VCT clinic and outreach services for high-risk populations, including antibody testing for HIV, syphilis, and hepatitis C. In strict accordance with the “National AIDS Testing Technical Specifications” (revision of 2009), the Baoan district CDC used an enzyme-linked immunosorbent assay (ELISA) to screen HIV antibodies, and western blotting (WB) for confirmation. Syphilis antibody screening was performed by a rapid plasma reagin (RPR) test and a AIDS prevention and treatment included eight questions on AIDS knowledge adopted by the national sentinel surveillance    was usedp < 0.05 was considered to be statistically significant.The database was built using EpiData version 3.1  with the questionnaire given double entries for consistency. Descriptive analyses were conducted to determine the distribution of the demographic factors and other measured variables. A chi-square test was applied to test the association between the different levels of factors and depression status, as well as a binary logistic regression for multivariate analysis of depression. According to an empirical estimate of 10 times the covariates, the existing sample size meets these conditions. All statistical analyses were performed with SPSS version 21.0 , and a two-tailed A total of 334 MSM completed the survey, including 142 (42.5%) samples from VCT and 192 (57.5%) from clubs. The mean age was 29.88 (SD = 7.56) years, among whom 68.3% were single and 25.4% were married; also, 82.3% were not registered in the Guangdong census. A total of 267 participants among them took the serological test; 60 (22.5%) were reported to be HIV positive, 33 (12.4%) were syphilis positive, and none were hepatitis C positive. Other sociodemographic characteristics, such as the degree of education, personal income, etc., are detailed in Of the eight questions about AIDS knowledge adopted by the national sentinel surveillance, 267 MSM gave the correct answers to six or more questions, and the total awareness rate was 79.9%. The details of the participants’ HIV/AIDS knowledge are shown in Among the respondents, 150 (44.9%) considered themselves to be homosexual, 145 (43.4%) bisexual, and 39 (11.7%) uncertain. A total of 231 respondents (69.2%) had revealed their sexual orientation to their families. The age of the participants at their first sexual encounter ranged from 12 to 35 years old (average 21.2 ± 3.7), and 182 of the participants (54.5%) had their first sexual encounter with a homosexual. The number of sexual partners in the last six months ranged from 0 to 50, mainly concentrated around 1–6 (average 2.9 ± 3.9), and 224 participants (67.1%) had sexual intercourse with two or more partners (multiple partners) in the past six months. Details are shown in The scores for depression ranged from 0 to 48, the median was 12.00, and the interquartile range was 15.75; the score was non-normally distributed, so these statistics were used. Further, 116 (34.7%) of the participants were depressed, and 218 were not.p = 0.369. syphilis testing, p = 0.175, hepatitis C testing, p = 0.348), and details are shown in p= 0.295. syphilis testing, p = 0.109). The total awareness of HIV/AIDS knowledge (p = 0.012) was statistically significant for the depression of MSM. For single questions, the awareness of “Can proper use of condoms reduce the spread of AIDS?”(p < 0.001) and “Does having sex with only sexual partner reduce the spread of AIDS?”(p = 0.009) were statistically significant while the other six questions were not; the gender of their first sexual partner, sexual behavior during anal/oral sex, having anal sex in the last six months, and heterosexual behavior were statistically significant (p < 0.05) determinants for the depression of MSM; details are shown in For MSM with different sociodemographic characteristics, HIV/AIDS knowledge, different sexual behaviors, and rate of depression was determined by a chi-square test. Social demographics were not found to be related to depressive symptoms. There was no statistically significant difference in depression rates between the serological results . Using the forward LR (likelihood-ratio test) method, including the standard of 0.10 and excluding the standard of 0.05, a dummy variable was set for the categorical variables. To perform a multivariate logistic regression analysis, the results showed that awareness of AIDS knowledge, peer education, and sexual behavior with women were influencing factors of depression for MSM. AIDS knowledge, experiences with peer education, and heterosexual behaviors were relatively protective factors, as shown in Variables in univariate analysis with a According to our knowledge, this is a rare type of study collecting information on the prevalence of depressive symptoms and related factors among MSM in Shenzhen, China. In this study, 34.7% of MSM among the 334 respondents had depression symptoms. Compared to previous findings, the results of the depression rate were consistent with studies in northeast China and Jiangsu province  and The results of the multivariate analysis showed that a lack of awareness of AIDS knowledge , peer education  increased the odds of depression, while more peer educators with a high informational support profile was related to higher self-efficacy, social support, and behavior management . In addip-value is very close to the boundary in our study, so we cannot determine a certain conclusion.Serological results were not associated with depression in the univariate analysis in our study. For the individuals who took the serological test and had a positive result in the investigation, these serological results were not clear while filling out the questionnaires. Previous studies ,27,28,29For the results of the serological test, 22.5% (60/267) were HIV positive (higher than the Shenzhen sentinel monitoring data from 2012 ), and 12There are potential limitations to this study. Firstly, although the research process followed strict quality control, it is inevitable that an investigation of sensitive information, such as sexual orientation, sexual partners, sexual behaviors, and other relatively personal information, may be concealed in the self-report to some extent, thereby affecting the results of analyzing the influencing factors. Second, we were not able to use a random sampling scheme, so there may be a lack of representation for all sub-populations among Shenzhen-based MSM. Consequently, our findings may not be generalizable to other regions of China. However, most studies on MSM populations rely on improbability/approximate probability methods for relatively invisible groups, making it difficult to obtain good results through traditional sampling methods . We usedWe provide evidence of depression and its influencing factors, as well as the serological results of MSM in Shenzhen, China. We believe that awareness of AIDs and peer education help with depression so that relevant measures can be strengthened in practical work. People with MSM may have a relatively closed social state or self-identity; more efforts are needed to improve depression and possibly to improve traditional social identity to eliminate discrimination and homophobia in mainland China.


The authors wish to add the following corrections to their paper published in the International Journal of Environmental Research and Public Health . When coIn the abstract, the sentence regarding the Total Cost should be as follows: The total economic loss of youth suicide in Australia is estimated at $511 million a year , ranging from $460 to $586 million. Abstract should read as follows. Abstract: Suicide is the leading cause of death among Australians between 15 and 24 years of age. This study seeks to estimate the economic cost of youth suicide (15–24 years old) for Australia using 2014 as a reference year. The main outcome measure is monetized burden of youth suicide. Costs, in 2014 AU$, are measured and valued as direct costs, such as coronial inquiry, police, ambulance, and funeral expenses; indirect costs, such as lost economic productivity; and intangible costs, such as bereavement. In 2014, 307 young Australians lost their lives to suicide . The average age at time of death was 20.4 years, representing an average loss of 62 years of life and close to 46 years of productive capacity. The average cost per youth suicide is valued at $2,884,426, including $9721 in direct costs, $2,788,245 as the value of lost productivity, and $86,460 as the cost of bereavement. The total economic loss of youth suicide in Australia is estimated at $511 million a year , ranging from $460 to $586 million. These findings can assist decision-makers understand the magnitude of adverse outcomes associated with youth suicide and the potential benefits to be achieved by investing in effective suicide prevention strategies. Results should read as follows:The total economic cost of youth suicide in Australia was estimated at $511.1 million (in 2014 AU$) per year, of which the indirect cost was the largest cost accounting for 94% . The amoThe economic cost of youth suicide in Australia is estimated at $511 million a year ($460–586 million) in 2014 AU$. Direct costs account for $3 million ; indirect costs at $482 million (94%); and intangible costs at $27 million (5%).The cost of suicide increases by age cohort, from $192 million (for 15–19-year-olds) to $317 million (for 20–24-year-olds). This increase is attributable to the higher prevalence of suicide among 20–24-year-olds  compared to 15–19-year-olds . It is also worth noting that the cost of male youth suicide is significantly higher than the cost of female suicide , again due to higher prevalence of suicide deaths in the former group . Threats to breathing are the most common cause of death regardless of the age or gender and account for over $385 million (75%) of the estimated total cost.Although the effectiveness of this approach is yet to be established, our findings suggest that the impact of meeting a 10% reduction in youth suicide could potentially save many lives and over $51 million a year, including $298,421 ($0.3 million) in direct costs, $3 million as intangible and $48 million as indirect costs.An average of 319 young Australians take their lives each year at an economic cost of $511 million. In Table 1, the average weekly earnings for females were $940 and for males—$1430.19Int. J. Ment. Health Psychiatry2016, 2, doi:10.4172/2471-4372.1000130.Doran, C.M.; Ling, R.; Milner, A.; Kinchin, I. The Economic Cost of Suicide and Non-Fatal Suicidal Behaviour in the Australian Construction Industry. Reference 19 should read:


Purpose: This study aims to evaluate the physical activity of healthcare personnel and the affecting factors of physical activity (PA) in a hospital using an accelerometer device (Actigraph wGT3X-BT). Method: A total of 63 subjects  participated and wore an accelerometer for seven days. Among the outputs, the mean counts for a minute, time spent for light, moderate, and vigorous intensity PA, and step count were extracted. As a secondary study, 16 subjects continued for one more week after feedback on their PA of the previous week and counseling to encourage PA. Result: Most of (62/63) the participants fulfilled the recommended amount of PA, which is more than 300 min of moderate to vigorous physical activity (MVPA). Physicians showed significantly less PA than nurses or supporting staffs: Mean counts per minute (210.4 vs. 476.0 and 441.8 respectively), time in MVPA per week (904.7 min vs. 1471.3 min and 1451.0 min), and step counts per week  (p < 0.001). Nurses and supporting staff were not statistically different. There was no significant difference in the PA of workers in the hospital regarding gender and marital status. However, the average calorie expenditure of the child raising group was significantly higher. There was no statistically significant difference in PA before and after counseling. No participants reported a vigorous degree of exercise intensity over the study period. Conclusion: Most of the healthcare personnel met the recommended PA, however, only 57% (36/63) recalled having engaged in MVPA during the study period. The group of physicians showed less PA compared to nurses or supporting staff. Single check-up and counseling were not found to increase PA. Physical activity (PA) is defined as any bodily movement produced by skeletal muscles that requires energy expenditure . PA, espThe World Health Organization (WHO) provided recommendations for PA to benefit health in 2010. These recommendations stated that for additional health benefits, adults should increase their moderate intensity aerobic PA to 300 min per week, or engage in 150 min of vigorous intensity aerobic PA per week, or an equivalent combination of moderate and vigorous intensity activity [Nevertheless, the levels of physical inactivity are rising in many countries and have major implications for the general health of the population worldwide ,10. AbouHealthcare personnel endure heavy workloads in emotionally stressful conditions, and they are prone to musculoskeletal problems, psychiatric disorders, such as depression or burnout, and a lower health-related quality of life ,14,15. WThis study was performed at one university hospital from 1 May to 31 August 2017. An institutional review board reviewed the study protocol (VC170ESI0101), and informed consent was obtained from each subject. The inclusion criteria of our study were those (1) who work in the hospital as a physician, nurse, or supporting staff, such as radiographers or patient-transfer workers, etc., (2) aged from 19 to 60 years, (3) who agreed to participate with informed consent. Persons with fractures or other serious medical conditions or social circumstances that limit PA, or those who have two or more days off-duty during one week of study were excluded.We used Actigraph wCT3x-BT  to monitor PA. Actigraph wGT3X-BT is a small accelerometer; it weighs about 19 g and measures the amount of PA objectively by recording the acceleration of the body movement. The wGT3X-BT has been widely used to capture and record continuous PA. It measures raw acceleration, the number of activity counts carried out, calorie expended, time spent according to intensity of activity; light, moderate, vigorous, and very vigorous intensity PA, average metabolic equivalent of tasks (METs) per hour, the number of steps taken, total device wear time, sleep latency, total hours of sleep, and sleep efficiency.The participants were told to wear the accelerometer on the wrist of the non-dominant hand for the entire study period all day long including sleep time, except during water-based activities, such as bathing or swimming. It was given on the first day, and the subjects made an appointment to return the device and see the physician to discuss the analyzed results and to receive counseling about the PA on the seventh day. Demographic information was collected with participants’ questionnaires on their age, gender, height, weight, occupation, marital status, having kids or not, medical history, and smoking status. On the seventh day, each participant was asked about estimated total wear time per day, how many days, what exercise, and which intensity they did work out, to improve the accuracy of wear time and PA measurement. This was for additional validation of wear time and for comparing the accelerometer measurement with the subjectively perceived amount and intensity of physical activity. A simplified form of Korean-version of the International Physical Activity Questionnaire (IPAQ-K) for adults (15–69 years) was used for the questionnaire regarding exercise ,19. AfteAfter the study period, each collected data was extracted and analyzed through the ActiLife software version 6.13.3 . We adopted the calculation of estimated energy expenditure using the method developed by Freedson et al., 1998 . The act2), having children or not, and types of work  to analyze the information on PA. Using the WHO Asia-Pacific region classification of BMI in adult Asians, BMI was classified as underweight (BMI < 18.5), normal (18.5 ≤ BMI < 23), and overweight (BMI ≥ 23) [The participants were categorized into subgroups according to gender, marital status, body mass index  .t-test and one-way ANOVA were used for the normal distribution and the Kruskal–Wallis test was used for the non-normal distribution (subgroups based on occupation or BMI). Regarding marital status, gender, and having kids, an independent t-test was used. Maximal average MET per hour score and total sleep time according to the occupation were analyzed with one-way ANOVA. Comparison of data after counseling with initial study, paired t-test was used if parameters are normally distributed and Wilcoxon signed rank test if parameters are not normally distributed. Paired t-test was used for mean counts per minute, maximum average MET per hour, light and moderate intensity activity per minute, and average steps count per minute. Wilcoxon signed rank test was used for total wear time and average calorie expended per hour. To identify the correlation between total sleep time and MVPA, Pearson correlation coefficient was used. SPSS version 21.0  was used and p < 0.05 was considered statistically significant.The independent A total of 65 participants were recruited and enrolled for the study. We set the minimal device wear time at more than 10 hours per day except sleep time according to the frequently accepted minimal wear time ,23,24. Tp < 0.001). Nurses and supporting staff did not show a statistical difference with the above parameters. The maximal average MET per hour, time spent on the light intensity of physical activity (LPA), and calorie expended per hour was not significantly different among the occupation , 21 of 22 (96%) physicians, and 100% of nurses and supporting staff, spent over 300 min in MVPA per week meeting WHO guidelines. Among the different occupation groups, the physicians group showed significantly fewer mean counts per minute (210.4 of physicians vs. 476.0 of nurses and 441.8 of supporting staffs), MVPA per week (904.7 min of physicians vs. 1471.3 min of nurses and 1451.0 min of supporting staffs), and step counts per week  than the other two groups (cupation .p < 0.001). Calorie expended per hour was 55.01, 41.44, and 27.19 and maximum average MET per hour was 3.0, 2.3, and 1.7 in over-, normal, and under-weighted groups, respectively. However, the mean counts per minute, time spent on MVPA and LPA, and step count per week were not statistically different among the groups . The participants raising children burned significantly more calories per hour than those without children   .Nineteen participants reported that they performed vigorous intensity physical exercise over 20 min per day at least once a week (0.75 ± 1.44 days). Thirty-six participants reported the completion of moderate intensity PA over 30 min per day, at least once a week (1.43 ± 1.71 days). All the participants reported having done LPA over 30 min per day, at least once a week (5.95 ± 1.57 days) on a questionnaire. All the participants showed sleep latency within the normal range (less than 30 min). Total sleep time was 5.88 ± 1.34 hours. Sixty-two of 63 participants showed normal sleep efficiency which is over 85% (91.99 ± 3.30). The total sleep time revealed no statistical difference among the occupation groups . Furtherp < 0.05)  . No partThis study provides the PA status of healthcare personnel using the accelerometer and how various factors, such as sex, occupation, marital status, having kids or not, and BMI effect the parameters of PA. Unexpectedly, the time spent in MVPA of the most of healthcare personnel met WHO guidelines ,25. AlthThis study shows each person’s task in the workspace would be the key factor that determines one’s amount of PA. The physician group showed significantly less time spent for MVPA, mean counts per minute, and step count per week, compared to the nurse or supporting staff groups. This might be due to desk-based tasks, aa most of them were in the non-surgery department. The surgical doctors were reluctant to participate because it was cumbersome to wear the device during surgery. Therefore, we cannot exclude the possibility of a selection bias in the physician group. Clemes et al. measured PA among office workers using an accelerometer. It showed time in MVPA was 32 ± 26 min per day . The meaThe high intensity of labor with a long work time is an inevitable character of tasks in hospitals. Patient handling or transferring, moving medical equipment, walking around to care for various inpatients or outpatients, and coping with the emergency are included in the tasks. The United States Department of Labor 2005 revealed a higher musculoskeletal disorder rates among healthcare practitioners . LorussoConcerning gender, men showed higher calorie expended per hour than women, whereas women had higher step counts, mean counts per minute and time in MVPA, but neither was statistically significant. The married group showed a tendency toward higher PA and calorie expended per hour, number of steps, and mean counts per minute and time in MVPA than the single group, irrespective of gender, though it was not statistically significant. Interestingly, the group who raised children showed significantly higher calorie expended per hour than the others, which may be due to additional housework.Additionally, we aimed to figure out if the extent of PA would change after feedback and counseling. However, there was a significantly decreased wear time during the second time given that hot and humid weather might hinder one from wear the device all day long. Again, nobody did vigorous exercise. In the secondary study, all the parameters showing PA were not improved. The participants became aware of a lack of vigorous activity and recognized the need for PA; however, lifestyle modification or effort to exercise was not to be seen in a week. This result suggests that single counseling or encouraging is insufficient to lead to a prompt change in PA. There have been many studies that reveal the effective ways to increase PA. In a study, internet-based PA intervention, with self-monitoring, personalized goal setting, and interaction with other participants and study staff, was conducted on women with a family history of breast cancer. It revealed significantly increased MVPA at 3 months and 5 months . AnotherMany people state ‘lack of time’ as a major barrier for exercise. Over 50% of employees reported that they have little time to exercise because of a busy work schedule . Also, aThis study has several limitations. First, only a small number of the workers participated. The number of participants was smaller than expected which may be due to less interest in PA and the cumbersome of wearing the device in a hospital working environment. Especially, the number of the under-weight group was four, and this is too small a sample size to interpret as conclusive. The study was exploratory research to observe the PA status of workers in a hospital, hence, power calculation was not done initially. However, there have been a few studies on the PA of healthcare personnel, therefore this study is meaningful that our results show PA status of healthcare personnel with an objective manner. Further research with a more significant number of participants is needed for more in-depth analysis. Second, the working hours of the subjects were not consistent, which is a characteristic of healthcare personnel. Their working time was divided into day and night time, including the three eight-hour shift schedules of nurses. Additionally, because of the small number of participants, data during work time and off-duty time were not considered. Despite these limitations, we were able to study PA based on each’s characteristics within one common workplace.Most of the participants fulfilled the recommended level and amount of PA despite the lack of vigorous intensity of PA. This implicates that the physical intensity of tasks of the hospital is high and health care workers are not much involved in leisure activity for individual exercise. Among subgroups, the physicians revealed to have significantly less PA compared to nurses or supporting staff. Gender and marital status did not influence the PA of workers in the hospital. However, raising a child may increase the average calorie expenditure. Also, individual counseling, including education on the positive impact and necessity of PA was not effective towards increasing PA. This shows that a single intervention without an individualized goal and checkup might be insufficient to lead to a successful outcome. To improve health, we need to constantly pay attention to increase PA in daily life, including in the workplace. Future research should focus on practical ways to enhance PA, including strategies which can be applied in the workplace.