A confirmatory factor analysis (CFA) was conducted to investigate the construct validity. For the reliability testing, Cronbach alpha values were calculated. Spearman’s rank correlation tested the criterion validity. Discriminant validity was applied using Mann–Whitney U-test and Kruskal–Wallis test. The Edinburgh Framework and COSMIN checklist were applicable for the analysis using SPSS 27.0; significance was set at p < 0.05. The confirmatory factor analysis indicated a good fit; all dimensions were reliable (α ≥ 0.70). Cronbach’s alpha was excellent (0.825–0.904). Strong correlations were found between the total scale (FertiQoL) and anxiety , depression , and helplessness cognitions  and moderate or no correlation with acceptance cognitions  and social support . The Hungarian version of SCREENIVF proved a valid and reliable tool to measure psychological maladjustment before ART. A longitudinal, randomized, controlled trial involving the partners could further strengthen the results, which is among our long-term plans.Examining possible psychosocial maladjustments should be an integral part of fertility care. For the early detection of vulnerability, the present study aimed to adapt and test the reliability and validity of the Hungarian version of SCREENIVF against the Fertility Quality of Life Questionnaire (FertiQoL) in a cross-sectional on subfertile women ( One of every ten or even one of every six couples is affected by one-year infertility ,2 in EurCouples often deal with the experience of infertility for several years before medical help-seeking and during the treatments ,17. No cThe European Society of Human Reproduction and Embryology (ESHRE) recommends that fertility clinics provide routine psychosocial care to patients dealing with infertility and ART . The guiThe Polish Psychiatric Association also draws the attention of fertility professionals to psychological susceptibility. Their recommendation for treating affective disorders in women of childbearing age also recommends screening patients with pregnancy loss and unsuccessful IVF with SCREENIVF and applying the tool in clinical practice to identify patients at risk of developing psychopathological symptoms .In Hungary, some studies were conducted about the psychosocial burden ,27,28,29However, at the start of ART, the risk of emotional maladjustment during or after the treatment could be detected by SCREENIVF ,33,34,35Therefore, the purpose of this study was the cultural adaptation and validity and reliability testing of SCREENIVF to the Hungarian population. We aimed to develop a Hungarian version equivalent to the original English version, translate and culturally adapt it to the target population, and assess its psychological properties in a cross-sectional study in Hungary.The translation and adaptation processes of the Hungarian version were carried out through six stages following the Guidelines for the Process of Cross-Cultural Adaption of Self-Report Measures by Beaton , with thA cross-sectional study with the purpose of validation was nested in a cohort study to analyze the effect of psychosocial and lifestyle factors—with special regard to self-reported and objective measures of pre-treatment habitual physical activity—on the course and primary and secondary outcome measures of ART. The specific purpose of the main study reasoned to strict inclusion criteria. To examine the effect of lifestyle and psychosocial factors, we intended to allocate a study population as homogeneous as possible and exclude factors that fundamentally affect the outcome of ART or physical activity, such as age, metabolic, vascular, or receptivity-related factors. Therefore, the involvement of the participants took place as follows.2 and ≤38 kg/m2, 18 to 40 years of age, and no metabolic and vascular diseases including diabetes mellitus, fatty liver diseases and atherosclerosis, severe endometriosis and/or adenomyosis, or any mental disorders. Even though only women were included in our study, the instrument itself is suitable for assessing both members of couples and even for assessing patients diagnosed with any co-morbidity for whom ART treatment has been prescribed. According to the date of the fertility consultation, 75 female patients with infertility diagnoses and indicated for fertility treatment (Pre-ART/ART) were consecutively invited to a cross-sectional, observational cohort study at the Assisted Reproduction Unit, Department of Obstetrics and Gynecology, University of Pécs, Hungary. Inclusion criteria were BMI ≥ 18 kg/mThe aim of the study was explained to each participant, and written informed consent was obtained before the research began by trained researchers. Data collection was carried out during the routine examination on the 3rd day of the unstimulated cycles. Then, 62 women filled out self-administered questionnaires in paper-pencil form between December 2018 and June 2019 at home. They returned the questionnaires on the 21st day by the second consultation, but two of the returned questionnaires should be excluded due to the high number of missing answers.n = 60) could be considered favorable compared to the average Hungarian population  with BDI-13, SSQ scored on average 13.14 (SD = 1.89) .The confirmatory factor analysis was calculated using IBM SPSS AMOS 24.0. The model fit statistics showed a good fit based on CFI and RMSEA. , while a moderate relationship (0.30 < R < 0.50) was found between Social Support, Anxiety, and Depression. Acceptance cognitions were also negatively correlated with Depression and Helplessness cognitions .The Cronbach’s alpha value for each dimension was determined, and the correlation of all dimension-subscales exceeded the value of 0.700. All dimensions adequately represent the concept that the tool measures . CronbacCriterion validity correlation coefficients of the SCREENIVF and FertiQoL, BDI-13, and Caldwell SSQ are shown in p = 0.004) and positively correlated with the Emotional, Mind-Body, Social, and Tolerability Scale of FertiQoL.Helplessness cognitions significantly correlated with all subscales of FertiQoL, SSQ, and BDI-13, as anxiety and depression as well, except for the environment scale. As expected, acceptance cognitions were negatively correlated with BDI-13 , BDI-13 , and relational subscale of FertiQoL  and against the assumptions no correlation could be described with the Social Scale of FertiQoL . Strong correlations were found between the total scale of FertiQoL and anxiety , depression , and helplessness cognitions  and moderate correlation with acceptance cognitions   .p = 0.018). SCREENIVF was invariant across other risk factors , concurrent reproductive trauma , and the type of treatment . A significant difference was found concerning previous miscarriage in the helplessness cognitions dimension between patients , depression (BDI-13), and fertility-related quality of life (FertiQoL) between women classified as at risk and not at risk were evaluated using Mann–Whitney U-test. The original scoring suggests using an at-risk score when one or more of the five dimensions show a clinically relevant problem . The curThe negative effects of infertility on emotional-, social- and somatic well-being is well known and based i. a. on unfulfilled child-wish, the presence of reproductive disorder, and its treatment . Before Psychosocial screening of patients at the start of ART treatment to provide tailored care is of considerable importance but not yet feasible in daily routine care in Hungary. Therefore, the purpose of this study was the validation and cultural adaptation of the SCREENIVF tool. We aimed to develop a Hungarian version equivalent to the original English version, culturally adapt it to the target population, and assess its psychological properties in a cross-sectional study in Hungary.p < 0.001), depression- and moderate correlation with acceptance cognitions . Based on our study, it could be claimed that the SCREENIVF tool is valid and reliable for measuring psychological maladjustment before starting ART treatments. The Hungarian version of SCREENIVF showed moderate validity with correlation coefficients.The Hungarian version confirmatory factor analysis indicated a good fit. All dimensions were reliable (α ≥ 0.70). Cronbach’s alpha of all dimensions was excellent and varied from 0.825 to 0.904. Strong correlations were found between the total scale of FertiQoL and anxiety  and depression (p = 0.03) are in close correlation with outcome measures of IVF and ICSI. Infertility and the perceived lack of control by patients during ART treatment make the situation a long-term stressor. The treatment, particularly a failed one, could be emotionally and physically demanding  and refers to a normal mood state. It is suggested that concerning patients with fertility problems, fertility-specific scales are suitable for setting up more sophisticated analyses than standardized generic instruments ,65,66,67This more specific approach also necessitated the development of SCREENIVF. In the Netherlands, SCREENIVF is used in the daily clinical routine and underpins the feasibility of tailored psychosocial care for clients. The development and validation of the tool were based on three high-quality studies. In the first study, Verhaak et al. investigated the psychometric characteristics of a screening tool, SCREENIVF, to identify women at risk of emotional problems at an early stage of treatment. Two hundred seventy-nine women in their first IVF cycle completed SCREENIVF both before the treatment and after the pregnancy test. 34% of the patients were identified as at risk, and 75% of the patients as at risk or not at risk were identified successfully with high (89%) negative predictive  (PVN) buIn our study, it was a consensus between authors to use FertiQoL for the comparative analysis. Huppelschotten and co-authors measured the difference between the quality of life and emotional status of infertile women and their partners using the same measurement tools in the second Dutch cross-sectional study . Women sOckhuijsen et al. examined the construct and criterion validity of the original Dutch version of SCREENIVF in the third perspective, longitudinal RCT among both genders (468 women and 383 men) undergoing fertility treatment and compared the tool to the Hospital Anxiety and Depression Scale (HADS). They found a good fit for the factor model. For women, 68.7% of the variance was explained by the sum score scale of SCREENIVF by time 1 (before treatment). They found good construct validity, but the predictive validity was poorer than the concurrent validity, and the authors caution against using it as a predictive tool .Reviewing the above study, Boivin also draws our attention  to the fp = 0.018). However, no conclusion could be drawn regarding the type of indication or fulfilling the recommended amount of physical activity (150 min/week) before the treatment. Verhaak et al. also found a significant increase in Helplessness  and a decrease in Acceptance  of infertility-related cognitions after failed treatment. In our studied sample, women and their partners dealt with fertility problems on average for six years (59.0 ± 38.4 months). Infertility and the perceived lack of control by clients during ART make the situation a long-term stressor, but a failed treatment could—depending on personality factors—lead to pathologic emotional response, increasing anxiety, and depression, as proved by the vulnerability model of Verhaak et al. . We examTo the best of the authors’ knowledge, after the original Dutch version, English 2.0 , Persianp < 0.001; comparative fit index = 0.97; root-mean-square error of approximation = 0.06 (90% CI 0.05–0.07)] and all dimensions were reliable . 52% of women and 30% of men were affected by the risk for maladjustment.Psychometric properties of the Portuguese version of SCREENIVF were investigated by Lopes et al.  The confp > 0.05). For patients with lower helplessness cognitions, higher anxiety was associated with lower compliance intentions . For patients with higher helplessness cognitions, higher depression was associated with lower intention to comply , but not for patients with lower helplessness cognitions . Although the Portuguese study also investigated men’s responses, the Portuguese version was evaluated as a valid and reliable tool for women undergoing any type of fertility treatment [One of the most important reasons for withdrawal from ART treatment is the psychological burden on couples . The risreatment .In our study, individuals at risk were classified at first following the screening concept of Verhaak et al. , using tThe ratio of respondents at risk for the original cut-off values was the highest (56.9%) in the dimension of Anxiety. Probably cut-off value overestimates the risk of Anxiety in the Hungarian population. This could have resulted when using the original concept “one or more of the five dimensions of SCREENIVF shows a clinically relevant problem,” which means being at risk. Almost all patients were categorized at risk. Based on such a consideration, we have decided that using two or more dimensions indicates clinically relevant risk; in this case, 50.00% of the women were at risk. Although a relevant cut of the value of Anxiety should be investigated in a further study, this short version (5 + 5 items) of STAI is not validated in Hungarian to have a normal value.p = 0.019), BDI-13  and relational subscale of FertiQoL  and against the assumptions no correlation could be described with the Social Scale of FertiQoL . The lack of correlation could be justified by the difference between the focus of the questions. Questions of the Social Scale in FertiQoL cover social support aspects, social inclusion, and expectations [We had also an unexpected result, fewer associations by the Social Support dimension of SCREENIVF were found as it was expected: significant correlations have been found only with SSQ , but qualitative methods  20 infertile couples and 14 experts examined the items for suitability, difficulty level, relevance, and ambiguity. They found that despite minor cultural differences, SCREENIVF, with the original item structure, has acceptable credibility and reliability and is easy to use for screening for emotional risk factors and designing appropriate interventions for couples under treatment in infertility clinics in Iran . p < 0.001, multiple explanatory coefficients 77.2%). The authors removed six items with an insufficient contribution. The final scale consisted of five subscales and 28 items. The item-total score correlation coefficients and subscale-total score correlation coefficients obtained for each subscale ranged between 0.31–0.98. The Cronbach’s alpha coefficient was accepted to be reliable (0.77). The ratio of women exposed to risk was considered relatively low; 16% of the participants were above the cut-off scores concerning anxiety and depression, 13.9% in acceptance, 8.2% in hopelessness, and 2% in social support subscales [The validation study of the Turkish version was conducted among infertile women (mean age 30.6 ± 3.4 years) against the COMPI-FPSS (F = 161.281, ubscales . In line with ESHRE guideline on ‘‘Routine psychosocial care in infertility and medically assisted reproduction” , the aimAlthough the Hungarian results confirmed that SCREENIVF is a valid and reliable tool for assessing psychological maladjustment in infertile Hungarian women, it should be borne in mind that the study’s limitations include the sample’s non-representative and non-randomized nature. Respondents were carefully selected to avoid potential confounders, but it made the study population modest. Although they tend to be less affected, ART also has a psychological impact on men. In our study, only women and not couples were investigated. Assessing test-retest reliability would further strengthen the results, although re-administration of the query was not possible. Thus, a subsequent study should also complement testing the invariance across genders and assessing the test-retest reliability. The Hungarian version of SCREENIVF showed moderate validity with correlation coefficients like other European studies. Based on our study’s results, the SCREENIVF tool is a valid and reliable questionnaire to measure psychological maladjustment before the start of ART treatments.


Mediation analyses revealed that functional capacity partially mediated the effects of age on global cognition and executive function . Increased levels of functional capacity were also associated with higher quality of life , lower fatigue levels , and better sleep quality . Conclusions: Functional capacity can mediate the effects of age on global cognition and executive function in older adults and greater levels of functional capacity are associated with improved quality of life, better sleep quality, and lower fatigue levels.Background: The present study aimed to explore the associations between functional capacity and global cognition, executive function and well-being in older adults. Methods: Ninety-seven older adults (age 80.6 ± 8.2 years) were examined for global cognitive function , executive function (symbol cancellation test), functional capacity  and well-being . Adjusted partial correlations were computed to examine the associations between variables. Mediation analyses were conducted to evaluate whether functional capacity would mediate the relationships between age and cognitive or executive function. Results: Greater levels of functional capacity were associated with better performance in cognitive and executive function tests ( Population aging is a global phenomenon; in the European Union, the number of people aged 65 and over will become a much larger share, rising from 19.5% in 2016 to 29.2% of the population in 2070 [Neurodegenerative diseases are emerging as a common medical condition in the geriatric population. Among them, dementia is the most prevalent disorder, which affects approximately 7 million people in the European Union and is estimated to double by 2050 . Age-relBesides cognitive impairment, another major cause of disability and dependency among older people is the deterioration of functional capacity that occurs with aging ,9. ImporAlthough there are a growing number of studies examining the association between cognitive and physical function, many of them evaluate global cognition. Executive function is a cognitive domain that allows people to engage in independent and purposive behavior . ExecutiTherefore, as both functional capacity and cognitive function are important determinants of independent living, it is highly relevant from a clinical perspective to identify the relationship between these parameters and their impact on well-being. A better understanding of these associations could provide insight for developing interventions to support healthy aging. Engaging in physical activity and exercise has been shown to provide protection against age-related cognitive function decline through various mechanisms such as increased neurotrophins and cerebrovascular reserve and reduced inflammation ,26. AccoThis was a cross-sectional study designed to assess various aspects of functional capacity, cognitive function and well-being among older adults. Power analysis for partial correlation was conducted in G*POWER software to determine a sufficient sample size using an alpha of 0.05, a power of 0.80, a medium effect size of 0.3 and two tails. Based on the above assumptions, the desired sample size was 82. Participants were recruited from long-term care facilities, and community and medical centers from the two largest cities of the country (distance between the cities: 85 km). The exclusion criteria of the population were: (a) age < 65 years, (b) inability to walk and stand alone or with technical assistance, (c) inability to understand and answer the questionnaires, (d) presence of dementia (MMSE < 10) and (e) having severe visual or hearing impairment. The descriptive characteristics of the participants are presented in The participants’ demographic information and medical history were retrieved from medical records. The Charlson Comorbidity Index was used to evaluate medical comorbidity , with hiThe participants were evaluated in two testing days by the same examiners to assess body composition, cognitive function, functional capacity, and well-being following the same testing order. During their first day of tests, the participants underwent a body composition evaluation. Afterwards, a cognitive function assessment was executed consisting of two tests: the Mini-Mental State Examination (MMSE) and the symbol cancellation test. During the second test day, well-being was assessed using questionnaires evaluating quality of life, fatigue, sleep quality and sleepiness. The interview method was used for the completion of all questionnaires. Then, the functional capacity measures were performed, including the timed up-and-go test (TUG), the handgrip strength test (HGS), the three sit-to-stand tests  and the 6 min walk test (6MWT). The tests were performed in the same order for all participants, allowing adequate time for recovery between each test. A lower number of participants was included in the analysis of some tests due to various reasons .MMSE is the most widely used measure of global cognition . It contCancellation tests have been considered as a potential measure of executive function ,31. The The TUG test examines balance, gait speed, and functional ability of an individual and it measures the time taken by the participant to stand up from a chair, walk a distance of 3 m, turn, walk back to the chair, and sit down again .HGS is a widely used indicator of overall muscle strength for aging adults . HandgriThe sit-to-stand tests evaluate lower body power, balance and muscle endurance and require participants to rise from a chair to a full stand with their arms across their chest and then return back to the initial seated position ,35. The The 6MWT evaluates the exercise capacity and endurance of the participants. The test requires the participant to cover as much ground as possible in six minutes and the total distance walked is measured .2). Total body fat percentage and trunk fat percentage were evaluated using bioelectrical impedance analysis .Body mass and height were measured to the nearest 0.05 kg  and 0.1 cm , respectively. Body mass index (BMI) was calculated as body mass (kg) divided by height  was used to evaluate quality of life . The SF-Subjective sleep quality was evaluated with the Pittsburg Sleep Quality Index . This quThe Epworth Sleepiness Scale was used for assessing the participants’ general level of daytime sleepiness . This quFatigue levels were evaluated by using the fatigue severity scale (FSS) . This 9-Cronbach’s alpha coefficients were computed to estimate the internal consistency reliability for each quality of life scale and for the sleep quality, daytime sleepiness and fatigue questionnaires. Internal consistency for the quality of life questionnaire exceeded the 0.70 standard in all scales  to 0.940 ), except the social functioning and general health scales, which scored 0.686 and 0.684, respectively. Reliability scores for sleep quality, daytime sleepiness and fatigue questionnaires were 0.766, 0.809 and 0.933, respectively. The validity of the Greek versions of these questionnaires has been previously demonstrated ,42,43,44t-test was used for comparisons between sexes. Adjusted partial correlations for age, sex and education were also computed to examine the relationships between functional capacity, cognitive function and well-being. The magnitude of the correlations for r = 0.12, 0.20, and 0.32 was interpreted as small, medium, and large effects according to the guidelines for effect size in gerontology [p < 0.05 was considered statistically significant.Statistical analysis was performed using SPSS version 22. Welch’s ontology . A compoontology . The anan = 73) of the participants were residents of long-term care facilities . According to their MMSE score, 41% (n = 40) of the participants were non-cognitively impaired (MMSE ≥ 24), while no significant difference was observed between the sexes in any of the cognitive function tests. Overall, 71% (n = 63/89) were obese (BMI ≥ 30 kg/m2), with females presenting higher values of total and trunk fat than males (p < 0.001). In functional capacity tests, the females had significantly lower performance than the males in all parameters (p < 0.05), except the 6MWT (p = 0.162).p < 0.05). Sixty-eight percent of the participants (n = 66) showed low sleep quality and twenty-three percent (n = 22) presented high daily sleepiness. No significant differences were found in sleep quality, sleepiness and fatigue between the sexes (p > 0.05).The results of the well-being questionnaires’ data for all participants are presented in p < 0.05, r from 0.23 to 0.49), indicating that better functional capacity results were reflected by a better cognitive performance. An exception was the association between TUG and symbol cancellation performance . Almost all functional capacity parameters were significantly associated with higher quality of life and lower fatigue levels . Sleep quality was also significantly correlated with some functional capacity parameters .Since functional capacity variables were significantly correlated with global cognition and executive function, it was examined whether functional capacity mediated the age-related effects of cognition. Therefore, a composite functional capacity score was derived by combining the six raw scores of functional capacity variables  and mediation analyses controlled for sex and education were performed. The mediation analysis revealed that functional capacity significantly partially mediated the effect of age on global cognition  A. A signThe results of the present study demonstrated that functional capacity could mediate the effect of aging on aspects related to global cognition and executive function. Greater levels of functional capacity were reflected in superior cognitive performance, higher quality of life, better sleep quality and lower fatigue levels in older adults, independent of confounding factors such as age, sex and education. These results highlight the importance of maintaining or even increasing the levels of functional capacity not only in the older population but throughout the human life span.The positive association found in the present study between functional capacity and global cognitive function is consistent with previous studies ,48,49,50In addition, apart from global cognition, the present study aimed to investigate whether a specific cognitive domain such as the executive function could be related with various aspects of functional capacity. The symbol cancellation test, the measure of executive function examined in the current study, requires abilities such as neglect, visuospatial function, organizational process and selective attention ,32,33, wTo further extend previous findings and to explore these aforementioned relationships, a mediation analysis was performed. In our model, functional capacity was evaluated as a potential mediator of the well-known age effect on cognitive functions. The results of the mediation analysis suggest that functional capacity can mediate the effects of age on both global cognition and executive function. Our results confirm the findings of one of the very few studies that performed a similar mediation analysis showing the mediator role of physical fitness on age-related global cognition decline . HoweverAs a cure for dementia has yet to be developed, early identification and intervention can be the most cost-effective ways to prevent or slow the onset of cognitive impairment and dementia. Therefore, this study provides beneficial information into the potential utility of functional capacity as a modifiable risk factor and a potential target for preventing cognitive decline in older adults, especially in those where polypharmacy seems to be an important barrier to effective multimorbidity management, thus reducing the rate of institutionalization and adverse outcomes in this age group. Therefore, future exercise interventions for cognitive aging should aim to improve functional capacity in order to minimize the deterioration of cognitive and executive functions associated with aging. Various training modalities such as aerobic, resistance and balance training have been shown to increase functional capacity ,72,73, wThe positive association between functional capacity and quality of life that was found in the present study is also important to take into consideration. Low scores on both physical and mental health components were observed, with females presenting lower scores than male older adults, confirming previous research . InteresThe present study has some limitations. Firstly, only one executive function test was utilized; including tests of different executive subdomains may also be useful to parse aspects of executive function that are affected by the functional capacity at an individual level. In addition, while exploring a broader range of executive abilities, larger studies are needed to confirm our results. Furthermore, we cannot exclude reverse causation, i.e., that older participants with better cognitive function are more prone to engage in physical activity, thus having greater levels of functional capacity. These issues may be addressed further by longitudinal studies of this population. Finally, the results of the current study should be interpreted with caution as the majority of the participants were overweight/obese women, living in long-term care facilities. On the other hand, this study included a wide range of functional capacity parameters and explored these relationships across the continuum from normal aging to mild and moderate cognitive impairment.This study showed that functional capacity mediates the deterioration of the cognitive and executive functions associated with aging. Furthermore, our results showed the positive associations of various functional capacity parameters with greater cognitive and executive functions and well-being in older adults. These results highlight the importance of maintaining or even increasing the levels of functional capacity in old age.


Surface waters of the oceans carry large amounts of material, including sediment grains, plankton organisms, and ice crystals, as well as pollutants, e.g., oil and plastic. Transport and spatio-temporal distribution of this material depend on its properties and on the dynamical processes in the ocean mixed layer—currents, waves, turbulence, and convective mixing—acting at a wide range of scales. Due to its importance for marine physics, biogeochemistry and ecology, substantial research efforts have been invested in recent years in observations and modelling of ocean material transport, especially in the context of marine plastic pollution. Nevertheless, many important questions remain unanswered. In this work, numerically simulated trajectories of surface-floating particles in the period 1993–2020 are used to analyse typical and anomalous transport pathways in the northern North Atlantic and the Arctic Ocean. Model validation is performed based on additional simulations of 387 buoy tracks from the International Arctic Buoy Programme in the years 2014–2020. The trajectories are computed based on surface currents from a hydrodynamic model and Stokes drift from a spectral wave model. It is shown that due to high amplitudes of Stokes drift (comparable with wind-induced currents in ice-free parts of the domain of study), combined with high directional variability, the drifting paths are substantially modified in ice-free regions, underlying the important role of wave-induced currents in surface material transport. A statistical analysis of  At a more general level, plastic parts—from micrometre-scale particles up to meter-sized objects—are just one of many types of material transported by ocean currents. Therefore, studies on marine plastic can benefit from the substantial progress in observational, theoretical and numerical research on material transport in the ocean, including high-resolution modelling7, and vice versa, floating plastic particles, owing to the interest they attract, provide invaluable data9 for testing theories and validating models.Rapidly increasing levels of plastic pollution in the world oceans, extending to even the most remote locations, have motivated growing research efforts towards a better understanding of their associated processes, leading to a boom of studies on their physical, biological, ecological, as well as economic and industrial aspects7, with 10 determine particles’ drift speed and direction, their diffusion rates, vertical distribution in the water column and, as a result, their trajectories from source locations to their  removal from the system by beaching, sinking, decomposition, etc. In general, processes related to material transport in the OML can be divided into three groups: material production/release, the actual transport, and deposition/removal. In the case of plastic, our knowledge of spatiotemporal variability of its sources and sinks, and of the detailed mechanisms involved, is still far from satisfactory6. Moreover, in situ and remote-sensing observations of OML material transport are limited, and the very large range of spatial and temporal scales involved—from small-scale turbulence to basin-scale ocean circulation—makes generalizations based on existing data difficult or impossible. Consequently, numerical modelling remains the only tool allowing systematic analyses across scales.From a physical point of view, objects submerged in sea water—which throughout this paper will be broadly referred to as particles, or drifters—are characterised by their size, shape and density, which in turn determine the oceanic and, possibly, atmospheric drag forces that act on them, and eventually their response to forcing from the surrounding environment. Due to the very high variability of drifters’ properties, this response is extremely complex and sensitive to the details of the ocean mixed layer (OML) dynamics. To the first order, the fate of drifters in the OML depends on the sign and value of their characteristic vertical velocity relative to the surrounding water, i.e., their terminal velocity 15, Lagrangian  modelling is used. We concentrate on only one type of particles—passive floaters (as defined above)—and on their transport pathways, without addressing release and deposition processes. The area of study are polar and subpolar regions of the Northern Hemisphere, of particular interest for at least two reasons. First, several studies suggest the role of the Arctic as a sink of plastic and other marine pollution originating at lower latitudes, especially in densely populated and highly industrialized regions of North America and Europe18. Second, recent climate change and the associated changes of atmospheric and oceanic circulation, amplified in polar regions19, together with the associated negative trends of sea ice extent and thickness, very likely lead to modified transport routes of plastics and other material20. Taken together, modified pathways of plastic and other floaters to/within the warming Arctic mean new opportunities for numerous marine species, relying on those floaters as rafts, to migrate to new territories21.In this study, as in several earlier oneshttps://iabp.apl.uw.edu/), as described in detail in Supplementary Note In our simulations, 28 years 1993–2020) of ocean surface current and wind-wave data from the Arctic Ocean and the northern North Atlantic are used as input for Lagrangian modelling. The method is validated against observational data from the International Arctic Buoy Programme , the role of wave-induced flow in the ice-covered regions of the Arctic Ocean is limited, so that the total currents are close to those associated with sea ice drift within the Beaufort Gyre and the Transpolar Drift, with average amplitudes of 0.05–0.15 m sThe large-scale, aggregate view of the surface material transport in the domain of study can be depicted in the form of a connection matrix, with rows/columns listing the source/destination regions, and cell values corresponding to the probability of particles travelling from source A to destination B Fig. a. As forConsidering the mean surface currents described earlier, the dominating transport directions are not surprising. For example, the south-east coast of Greenland (GLS) is the main destination for trajectories originating at GLN, JAM, ICE and SVA, i.e., source regions to the north, north-east and east of GLS, in the (average) upstream direction. Similarly, the Norwegian coast (NOR) is the main destination of floaters from GBR, SHE and FAR. Notably, due to the already mentioned relatively high speeds and directional stability of the major currents, these dominating pathways tend to be relatively fast  are a main source of anthropogenic drifters among the 16 regions analyzed  landed on ICE. This is a substantial number, especially if one considers that almost all of those particles were transported within just two events Fig. d, one in3% landedThe hitherto analysis concentrated on locations in the North Atlantic sector of the domain of study. The trajectories originating at ALA provide a good example of transport patterns in the second sub-domain, the Arctic Ocean. There are six destinations that receive floating material from ALA in significant quantities Figs.  and 4c,d23 and amplification in ice-drift curl24, combined with anomalies in the speed and orientation of the Transpolar Drift (TPD)25. In particular, the year 2007 was characterized by the strongest cross-TPD sea ice transport in the whole period 1979–201525. Remarkably, the period 2007–2009 seems also to mark a period of reversal in material transport between the two neighbouring regions of GLN and CAA , i.e., short, relatively steep waves from the high-frequency part of the wave energy spectrum contribute more strongly to the net drift than long waves around the peak of the spectrum34. This fact explains the high amplitudes of the Stokes drift discussed earlier : the “Arctic Ocean Physics Reanalysis” (https://resources.marine.copernicus.eu/product-detail/ARCTIC_MULTIYEAR_PHY_002_003/), and the “Arctic Ocean Wave Hindcast” (https://resources.marine.copernicus.eu/product-detail/ARCTIC_MULTIYEAR_WAV_002_013/). Both datasets contain results of numerical models run operationally at the Norwegian Meteorological Institute: the Hybrid Coordinate Ocean Model (HYCOM), using the coupled ensemble data assimilation system TOPAZ4b and coupled with a sea ice model, and the WAve Model (WAM) version 4.7.0. Both models are forced with ERA5 atmospheric data. Among variables assimilated in HYCOM are satellite-derived sea ice drift velocities from CERSAT, Ifremer. The products used in this work are: daily-mean velocity components of the surface currents, https://www.ecmwf.int/file/285503/). At the data preparation stage, the Stokes velocity components are daily-averaged and linearly interpolated onto the HYCOM grid. The vector sum The analysis in this work is based on two data sources, available through the Copernicus Marine Service, part of the European Union’s Earth Observation Programme . The differences between results with 43, the main conclusions from this study remain unaffected. . The results of validation, described in Supplementary Note equation . In thisIn all simulations, the maximum allowed duration of drift During their drift, the particles might leave the domain through its southern boundary in the North Atlantic, reach one of the coastal regions (including the one from which they had been released), or stay adrift throughout their whole life period of 3 years. No de-beaching is used, i.e., trajectories that reach land are terminated there. This makes the interpretation of the results easier and removes from the analysis poorly constrained parameters . Crucially, as follows from the description above, no information on the absolute or relative amounts of particles that in reality are released from the different regions is taken into account. The questions this study aims to answer are: if a floating object leaves a nearshore location A (at a particular time instance or within a specified time period), what is the probability that it reaches location B? What is the expected path length and the minimal/expected time needed to cover that distance?44: The computation of the mean and standard deviation of directions, https://www.cpc.ncep.noaa.gov/data/teledoc/telecontents.shtml, hte following ones are used in this analysis: North Atlantic Oscillation (NAO), East Atlantic (EA), East Atlantic/Western Russia (EAWR), Scandinavian (SCAND), and Arctic Oscillation (AO), see Supplementary Note From the monthly-mean atmospheric circulation indices, available in the period 1950–present from the NOAA Climate Prediction Center Supplementary Information.


To evaluate the safety and efficacy of fecal microbiota transplantation for autoimmune diseases and autoinflammatory diseases.Relevant literature was retrieved from the PubMed database, Embase database, Cochrane Library database, etc. The search period is from the establishment of the database to January 2022. The outcomes include clinical symptoms, improvement in biochemistry, improvement in intestinal microbiota, improvement in the immune system, and adverse events. Literature screening and data extraction were independently carried out by two researchers according to the inclusion and exclusion criteria, and RevMan 5.3 software was used for statistics and analysis.Overall, a total of 14 randomized controlled trials (RCTs) involving six types of autoimmune diseases were included. The results showed the following. 1) Type 1 diabetes mellitus (T1DM): compared with the autologous fecal microbiota transplantation (FMT) group (control group), the fasting plasma C peptide in the allogenic FMT group at 12 months was lower. 2) Systemic sclerosis: at week 4, compared with one of two placebo controls, three patients in the experimental group reported a major improvement in fecal incontinence. 3) Ulcerative colitis, pediatric ulcerative colitis, and Crohn’s disease: FMT may increase clinical remission, clinical response, and endoscopic remission for patients with ulcerative colitis and increase clinical remission for patients with Crohn’s disease. 4) Psoriatic arthritis: there was no difference in the ratio of ACR20 between the two groups.Based on current evidence, the application of FMT in the treatment of autoimmune diseases is effective and relatively safe, and it is expected to be used as a method to induce remission of active autoimmune diseases.https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021235055, identifier CRD42021235055. Autoimmune disease refers to a class of diseases caused by the breakdown of the immune system’s immune tolerance to its own components, thereby attacking its own organs, tissues, or cells, causing damage , 2. AccoAt present, the treatment of autoimmune disease is mainly symptomatic therapy (inhibition of inflammation and inhibition of autoimmunity) , 10. ForClostridium difficile infection. It has become an important treatment method recommended by US medical guidelines  refers to transplanting the functional microbiota in the feces of healthy people into the patient’s intestine to rebuild the healthy intestinal microbiota and achieve the treatment of intestinal and extraintestinal diseases , especiaidelines . FMT is idelines . A meta-idelines . A numbeidelines –30. CombThis study was performed in strict accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol registered in PROSPERO (CRD42021235055)  Interventions in the control group included FMT. 2) Duplicate literature: research was conducted in the same center, and duplicate cases were excluded after the full text was read; if the article was duplicated in Chinese and English, the latest published literature was selected. The following was also excluded: 3) non-RCTs, 4) non-adult patients, and 5) non-clinical research such as animal experiments, cytology research, or molecular biology research.The researchers searched PubMed, CNKI, Wanfang Database, Web of Science, VIP Database Medline Complete, Sinomed, and Embase for RCTs on FMT in the treatment of autoimmune diseases. The retrieval time was from inception to 16 January 2022. The Cochrane Library , China Clinical Trial Registry, and ClinicalTrials.gov were also searched. The search strategy is shown in Literature screening and retrieval were independently completed by two researchers according to the inclusion and exclusion criteria. If there was a disagreement, it would be resolved through discussion with all researchers. The following data were extracted for the included studies: author, publication year, study type, total number of study cases, number of patients included, average age, source of stool, transplantation method, relevant outcomes, adverse reactions and cases, and follow-up time. The included RCT literature was scored according to the Cochrane Risk Bias Assessment Tool , and the2 to quantitatively analyze the magnitude of the heterogeneity. If p > 0.1 and I2 < 50%, then the heterogeneity between the results of each study is considered to be small, and the fixed-effects model was used for meta-analysis; otherwise, the subgroup analysis is performed first, and if there is still heterogeneity, the random-effects model was used for meta-analysis. The risk ratio (RR) and its 95% confidence interval (CI) were used as the efficacy and safety statistics , systemic sclerosis (one RCT), ulcerative colitis (eight RCTs), pediatric ulcerative colitis (one RCT), Crohn’s disease (two RCTs), and psoriatic arthritis (one RCT). Most of the RCTs described the clinical research registration numbers. In addition, no more than 100 participants were involved in the endpoint assessment. Most studies performed FMT through gastroscopy or colonoscopy, four of which were performed through the upper gastrointestinal tract, and eight were performed through the lower gastrointestinal tract, while Haifer et al. (2022)  and CrotThe summary and graph of the risk of bias are shown in Twelve RCTs described the method of random sequence generation: de Groot et al. (2021) , ParamsoSun et al. (2018)  and DengSun et al. (2018)  only menFretheim et al. (2020) , Sun et Other sources of bias were not observed in 14 RCTs; therefore, the risks of other biases in the RCTs were low.Only one RCT of intestinal microbiota transplantation for the treatment of T1DM has been published [Fretheim et al. (2020) ]. The RCvs. 202 ± 85 pmol/L, Student’s t-test p = 0.0049). There was no significant difference between the two groups of blood sugar control (glycated hemoglobin (HbA1c) 46 vs. 53.5 mmol/mol, p = 0.19). The RCT also found that the difference between two groups of individual T-cell responses against IA-2, GAD65, and preproinsulin or blood frequencies of islet autoreactive CD8+ T cells (Qdot) was of no statistical significance. There was also no significant difference in the frequency of islet autoreactive CD8+ T cells between the two groups. However, the RCT found that the difference in CD4+ CXCR3+ cells between the treatment group and the control group was statistically significant (p = 0.01) and was negatively correlated with the change in the primary endpoint C-peptide area under the curve (AUC) at 12 months . The RCT observed the changes in the intestinal microbiota in the small intestine after FMT and found that the relative abundance of the microbiota in the control group decreased, while the relative abundance of the treatment group increased. In addition, the study also found that compared with the autologous FMT group (control group), the plasma metabolite of the allogenic FMT group has changed, including 1-myristoyl-2-arachidonoyl-GPC (MA-GPC)  and 1-arachidonoyl-GPC (A-GPC) (p = 0.02).This RCT showed that compared with the autologous FMT group (control group), the fasting plasma C peptide in the allogenic FMT group at 12 months was lower . The RCT finally included nine participants  for data analysis. For safety, there were five adverse events in the experimental group, all of which were mild adverse events, including bloating, constipation, abdominal discomfort (five times), nausea (four times), diarrhea (three times), and vomiting (one time). In the placebo group, a total of four adverse events occurred: one was a serious adverse event, and three were mild adverse events, including diarrhea, nausea (two times), bloating, constipation, vomiting, and fever (one time). This showed that the side effects of anaerobic cultivated human intestinal microbiota (ACHIM) were mild and transient.This RCT showed that at week 4, compared with one of two placebo controls, three patients in the experimental group reported a major improvement in fecal incontinence. Overall, in four-fifths of the patients in the experimental group (week 4 or 16) and two-quarters of patients in the placebo group (week 4 or 16), improvement in abdominal distension, diarrhea, and/or fecal incontinence was observed. In addition, the RCT also showed that the relative abundance of intestinal microbiota after FMT changed compared with the placebo group [beta diversity (p < 0.02) and number of distinct operational taxonomic units (OTUs) (p < 0.006)]. The genus whose relative abundance increased after the intervention was mainly in Firmicutes, including genera in Ruminococcaceae and Lachnospiraceae. The RCT also recorded modified Rodnan Skin Score (mRSS), new-onset digital ulcers, forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide (DLCO), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), but the results of the comparison between the groups were not seen.A total of eight RCTs reported FMT for the treatment of ulcerative colitis, and the outcomes could be pooled, so a meta-analysis was performed.2 = 61% and p = 0.02, which indicated that the included RCTs had high heterogeneity, and the random-effects model was used for analysis. The results of the meta-analysis showed that the clinical remission rate of the experimental group was higher than that of the control group  , p = 0.0004, fixed-effects model] , p = 0.02, fixed-effects model] , p = 0.40, random-effects model] , p = 0.78, fixed-effects model] , p = 0.84, fixed-effects model] , p = 0.04, random-effects model]  reported more adverse events but claimed that none of the adverse events were considered to be related to the FMT. Sood et al. (2019) did not report related adverse events Figure 9Alistipes spp. and Escherichia spp. may be associated with improvements in several clinical outcomes. During the 6-week intervention period, 10 people in the FMT group experienced adverse events compared with five people in the placebo group. Four patients (three in the FMT group and one in the placebo group) had worsening colitis requiring intravenous methylprednisolone. Two FMT patients with a history of Clostridioides difficile colitis were diagnosed with Clostridioides difficile colitis within 2 weeks of trial withdrawal.Only one RCT reported FMT for pediatric ulcerative colitis. The RCT finally included 31 participants (19 in the FMT group and 12 in the placebo enema group) for data analysis. For safety, the RCT reported that no serious adverse clinical events or adverse changes in plasma biochemistry were observed in the two groups. At week 6, 11 children in the FMT group had improvements in UC activity index, C-reactive protein, or fecal calprotectin, as compared with six in the control group . At 12 months, nine people in the FMT group maintained a clinical response. Beta diversity increased from baseline to week 6 in the FMT group compared to the placebo group. They found that Only one RCT reported FMT for psoriatic arthritis. The RCT finally included 31 participants (15 in the FMT group and 16 in the placebo enema group) for data analysis. They randomly assigned patients with psoriatic arthritis who were receiving methotrexate to an FMT group and a control group, using a gastroscopically guided approach to transplant gut microbiota or a placebo into the duodenum. No serious adverse events were observed at the 26-week assessment. However, they found a higher rate of treatment failure in the FMT group than in the control group . The HAQ-DI of the control group was lower than that of the FMT group (p = 0.031). There was no difference in the ratio of ACR20 between the two groups (p > 0.05). However, due to the small number of RCTs, the results need to be interpreted with caution.In addition, after searching in ClinicalTrials.gov and the Chinese Clinical Trials Registry, a total of registered RCTs for FMT treatment of seven types of autoimmune diseases were found: atopic dermatitis, ankylosing spondylitis, lateral sclerosis, rheumatoid arthritis, chronic urticaria, moderate-to-severe chronic plaque psoriasis, and multiple sclerosis  may lead to aberrant activation of innate immune cells leading to inflammation  and increased intestinal colonization of C. albicans and Enterobacteriaceae (except Escherichia coli) in children with T1DM  titers  titers . In additibodies .In this systematic review, only one RCT reported FMT for the treatment of T1DM [Fretheim et al. (2020) ]. This RClostridium were decreased in the gut microbiota of patients with systemic sclerosis, while potentially pathogenic genera, including Fusarium and Ruminococcus, were increased  ] and shoUlcerative colitis, a subtype of inflammatory bowel disease (IBD), is a disease of unknown etiology characterized by chronic, non-specific inflammation of the rectum and colon. The lesions are mainly limited to the intestinal mucosa and submucosa , 104. ThThis systematic review and meta-analysis also found that FMT may increase clinical remission, clinical response, and endoscopic remission for patients with ulcerative colitis, and increase clinical remission for patients with Crohn’s disease. These RCTs all reported that FMT did not significantly increase the incidence of adverse reactions, so it can be considered that fecal microbiota transplantation is relatively safe. However, due to the small number of RCTs and participants, interpretation of this result remains cautious; and more RCTs are needed to further explore the therapeutic effect and safety of fecal microbiota transplantation in IBD.Clostridium is the main producer of SCFAs, which can induce the production of IL-10 in the colon, while increasing the number of regulatory T cells (Treg) in the mucosa, and play a key role in intestinal homeostasis  for data analysis. They randomly assigned patients with psoriatic arthritis who were receiving methotrexate to an FMT group and a control group, using a gastroscopically guided approach to transplant gut microbiota or a placebo into the duodenum. No serious adverse events were observed at the 26-week assessment. However, due to the small number of RCTs, the results need to be interpreted with caution.There are no related RCTs reported for other diseases, but some of them have been registered in clinical research centers  antibody positive and rheumatoid factor (RF) abnormalities. Modern medicine believes that the pathogenesis of RA may be related to immune disorders, genetics, and environmental factors, but the specifics are not yet clear. In clinical observations, many scholars have found that there are significant differences in the types and quantities of intestinal microbiota between RA patients and healthy subjects, suggesting a correlation. The researchers analyzed the gut microbiota between 42 untreated RA patients and 10 healthy individuals. They found a fivefold increase in bacilli, a 17-fold increase in lactobacilli, and a significant decrease in ividuals . Metagenividuals . Severalividuals  analyzedividuals . In addiividuals .E. coli was significantly increased  according to the source of feces, it can be divided into allogeneic and autologous donors. 2) According to the acquaintance with the patient, the range of donors can be selected from relatives, friends, spouses, and unacquainted volunteers, but there is no clear evidence that these choices are related to the treatment effect. 3) According to the number of donors, it can be divided into single donors and multi-donor. Multi-donor batches have greater microbial diversity than individual donors. Previous studies have shown that donor species richness is a predictor of fecal microbiota transplantation treatment efficacy in patients with intestinal disease. However, multi-donor therapy may limit its ability to compromise beneficial or detrimental donor-specific and microbial content specificity . For theantation . C. perfbacteria . There wbacteria .The route of administration can be divided into the upper gastrointestinal tract, lower gastrointestinal tract, and swallowing capsules according to the location of injection. The upper gastrointestinal tract transplantation includes a gastroscope, nasogastric tube, and duodenal tube injection, and the lower gastrointestinal tract includes an enema and colonic approach through endoscopic enterotomy (TET). Among these methods, the following digestive transplantation route is more common. Although swallowing the capsules has the advantage of being convenient, due to the large number of capsules that need to be taken at a time, there may not be sufficient doses to maintain long-term treatment. TET has been reported to be a safe and convenient method for the frequency of transplantation and colonic administration , 154. AlAntibiotic pretreatment can increase foreign bacterial colonization in the frequency of transplantation . KeshtelThe strength is that this is the first systematic review and meta-analysis of FMT in the treatment of autoimmune diseases involving six diseases and 14 RCTs.The limitations are as follows: 1) the quality of Fretheim et al. (2020) , Sun et Based on the above limitations, it is expected that there will be more large-scale, multi-center RCTs involving multiple participants with high-quality FMT in the treatment of autoimmune diseases to further revise or confirm the conclusions of this systematic review and meta-analysis.Based on this systematic review and meta-analysis, the application of FMT in the treatment of autoimmune diseases is effective and relatively safe, and it is expected to be used as a method to induce remission of active autoimmune diseases. The transplantation route, source of fecal bacteria, application of antibiotics, and fecal types had no significant effect on the curative effect. Multiple long-term treatments with FMT could improve the curative effect. However, due to the small number of included RCTs, more high-quality RCTs are needed in the future for further studies to evaluate the long-term safety and efficacy of FMT.The original contributions presented in the study are included in the article/YD and LZ contributed equally to this work. All authors contributed to the article and approved the submitted version.The authors thank Xing Li  for assisting with the English translation and writing.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Baseline medication did not predict changes in MDI during the inpatient treatment. BMI increased from 14.9 (week 1) to 17.2 (week 8). Conclusions: Inpatient treatment of AN is associated with a reduction in depressiveness. This improvement in depressiveness scores correlates with an improvement in ED psychopathology but not with weight gain.Objective: Anorexia nervosa (AN) is a severe mental disorder frequently associated with high scores of depressiveness. We examined the short-term effects of inpatient treatment on depressiveness and eating disorder (ED) psychopathology using the self-rating Major Depression Inventory (MDI) and Eating Disorder Examination questionnaire (EDEq) for patients with AN. Material: Forty-nine patients with AN, all part of the PROspective Longitudinal all-comer inclusion study on EDs (PROLED), were observed over eight weeks with baseline psychometric measures, EDE-q at baseline and endpoint, and weekly MDI self-scoring. Methods: Apart from the weekly Body Mass Index (BMI) measurements, patients were assessed at baseline using the Eating Disorder Inventory (EDI) and the Symptom Check List 92 (SCL-92). Results: Inpatient treatment reduced MDI consistently over 8 weeks (Wilks Lambda = 0.59, F = 4.1,  Anorexia nervosa (AN) is a severe mental disorder presenting with distorted body image, severe weight loss, and an intense fear of becoming overweight . AssociaDepressiveness is very common in AN and is presented as the most common comorbidity . In geneOther studies have suggested that there is a relation between normalization of body weight in AN and a preferential distribution of body fat in central regions, although this was not found to influence eating disorder (ED) psychopathology or psychological distress scores . This acSince weight gain is an essential and established part of the treatment of AN, and comorbid depression has been found to negatively affect weight gain during treatment of AN , it is e-adult individuals (age 18–65 years);-admitted to the ED unit at the Psychiatric Center Ballerup, in Denmark;-a diagnosis of an ED.Participants in this study were all enrolled in the PROspective Longitudinal all-comer inclusion study on EDs (PROLED), which has been described previously . In totaIf subjects were under forced care during the time of enrollment, they were not eligible to be included. During the first years, 96% in 2016, 74% in 2017, 62% in 2018, and 68% in 2019 who were offered to be enrolled, accepted to join the study. In the capital region of Denmark, this is the only specialized ED unit for adults with AN.All participants went through clinical examination prior to hospitalization, and medical records were reviewed for information on psychiatric comorbidities and medication.The participants were undergoing multidisciplinary inpatient therapy with support for meals and rest as previously described .The PROLED protocol includes validated surveys that assess both general and specific psychopathologic aspects of AN. For this study, the Major Depression Inventory (MDI) , Eating Patients were asked to do the MDI self-questionnaire to rate their level of depression every week on Thursday at 1 pm local time while spending time in a relaxing environment .ED psychopathology, as assessed by the EDEq, was also measured a second time, at around the same time as the 8 weeks assessment for MDI, and was done in 47 of the 49 individuals who were completing the MDI. This allowed for an evaluation of the change in ED psychopathology over the same time-period in nearly all patients.All analyses were conducted using the Statistical Package for Social Sciences (SPSS) Version 27, IBM, Armonk, NY, USA. Using the MDI total score as an outcome, the smallest difference possible in the MDI was used i.e., a minimum group difference of 1 with a standard deviation of 1.5, to provide a power greater than β = 80% (type 2-error) and a significance of α = 5% (type 1-error), for a minimum of 36 cases was included. Clinical characteristics and psychometric measures were described as means and standard deviations . Correlan = 49) and their mean age was 24.31 years (SD = 7.49), and the mean baseline BMI was 14.85 kg/m2 (SD = 1.87). Of the 49 patients enrolled, 46 were women (94%), and the mean duration of illness was 6.47 years (SD = 7.11). Of the 49 patients, fifteen (31%) were treated with anti-depressive medication, nine (18%) with antipsychotic medication, and eight (16%) with anxiolytic medication during the 8 weeks. Over the same time period, the mean BMI increased from 14.85 (SD 1.87) to 17.16 (SD 1.77).The descriptive data of the sample are presented in A presentation of the mean scores of the EDE-Q, EDI, MDI, and AQ is shown in p < 0.01), and no correlations were found for age, duration of illness, EDE-q score to MDI, or any other factors.At baseline, only the BMI was correlated with the MDI scores , week 1 and week 5 (p < 0.001), and week 1 and weeks 6, 7, 8 respectively (p < 0.01).Follow-up comparisons indicated that the following pairwise comparisons with Bonferroni correction for multiple comparisons were significant; between weeks 1 and 4 , and weight concern (p < 0.05) but not in shape concern (ns) indicating that the changes observed in AN during inpatient weight restoration in ED psychopathology was confined mainly to restraining and eating concerns and possibly also weight concerns but not shape concerns.A repeated measures ANOVA was also done on the EDEq total scores which also indicated a significant time effect with Wilks Lambda = 0.82, F = 10.1, p < 0.01) while no correlation was found to the change in BMI during the same time period. Regarding the longitudinal correlations, the change over eight weeks in the MDI depression scores was positively correlated with the change in EDEq scores (r = 0.44; The results of this study confirm what a few other studies have found, namely that inpatient treatment is associated with a reduction in depression scores. In addition, this reduction in depression scores was correlated to a reduction in ED psychopathology, which thus far only has been described by one research team before us . In our Previous studies have also confirmed the high frequency of depression and depressive symptoms in patients undergoing weight restoration treatment at inpatient units, as demonstrated by using different assessment instruments for depression such as Beck’s depression inventory and the MDI ,26. FurtWe also found that especially restraint and eating concerns in the spectrum of ED psychopathology were alleviated by inpatient weight restoration, and potentially also weight concerns although to a lesser extent. Applying a correction for the number of statistical analyses done, the alleviation in weight concern would however no longer remain statistically significant, and thus, this change in weight concern should be interpreted with caution. Interestingly, no change in shape concern was found which also replicates what previous studies have described when applying different types of treatments to AN including weight restoration .There are some differences between this and previous studies ,11, for The baseline scores in the present population confirmed that depression and anxiety are among the most common comorbidities in AN . Of notiThe current study must be seen in light of the following limitations. The aim of the study was to study psychometric changes during hospitalization. Therefore, the results can not be generalized to weight changes in an outpatient setting. Moreover, drop-out is a well-recognized limitation in clinical research on patients with AN . In the The current study followed 49 individuals with a diagnosis of AN. The sample size was clearly sufficient to find a difference in the main outcome, the MDI, as evidenced by the sample size calculation. This sample size is similar to what was used in the study by el Gooch , who alsDepression was assessed by the MDI, a self-assessment questionnaire, which has been validated and proved to be a reliable and sensitive method in several studies on AN ,18. The In this study, we related changes in depression scores to BMI because a person’s mood is known to influence adherence to treatment and prognosis. However, there are multiple factors that may affect mood during treatment. For example, patients may need to acclimatize to the environment at the beginning of the stay which may drive a beneficial effect independent of the increase in BMI.Overall, the results demonstrate the beneficial effect of inpatient treatment of up to eight weeks on depression scores and ED symptoms, whereas this effect does not appear to be directly related to the weight gain itself, giving support to short-term inpatient treatment in moderate to severe AN. However, the conclusion of this study is not to neglect weight gain as a treatment goal, and the ultimate remission of the disease includes a normal body weight. In the long run, severe malnutrition leads to irreversible disability. Moreover, to develop better treatments for AN there is a need to study short-term effects, especially relevant to inpatient treatment due to the potential health economic aspects and the potential negative effects of long-term inpatient care. Depression is one of the strongest determinants of poor quality of life in AN  and sinc


Ktrans), rate constant (Kep), extracellular volume (Ve), and mean plasma volume (Vp) were calculated, and the parameters of patients of each grade were analyzed. The efficacy of each parameter in diagnosing glioma was analyzed through a receiver operating characteristic curve. All images were segmented by the CNN algorithm. The CNN algorithm showed good performance in DCE-MRI image segmentation. The mean, standard deviation, kurtosis, and skewness of Ktrans and Ve, the standard deviation and skewness of Kep, and the mean and standard deviation of Vp were statistically considerable in differentiating HGG and LGG (P < 0.05). ROC analysis showed that the standard deviation of Ktrans (0.885) had the highest diagnostic accuracy in distinguishing HGG and LGG. The values of Ktrans, Ve, and Vp were positively correlated with Ki-67 . In summary, the CNN-based DCE-MRI technology had high application value in glioma diagnosis and tumor segmentation.The aim of this study was to explore the application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) based on a convolutional neural network (CNN) algorithm in glioma diagnosis and tumor segmentation. 66 patients with gliomas who were diagnosed and treated in the hospital were selected as the research objects. The patients were rolled into the high-grade glioma group  and the low-grade glioma group  according to the World Health Organization glioma grading standard. All patients received a conventional plain scan and a DCE-MRI. Parameters such as volume transfer constant ( Glioma is one of the most common primary tumors in clinical practice. Clinical statistics showed that it is responsible for 81% of central nervous system malignancies . In geneOnce a glioma is diagnosed, patients do not survive for more than two years. Therefore, the early diagnosis of glioma is very important for the treatment and prognosis of the disease. At present, glioma can be graded by detecting molecular markers of glioma . HoweverHow to segment tumor regions from brain MRI images of patients has always been a key and difficult point in the clinical diagnosis of glioma. At present, the most important method for regional segmentation of tumors is still manual segmentation by doctors. Such a segmentation method not only requires doctors to master strong professional knowledge but also wastes a lot of time and increases the workload of doctors. Therefore, the study of an automatic segmentation method of glioma has great positive significance for the diagnosis and treatment of glioma. However, the infiltration of tumor cells into surrounding tissues makes the tumor boundary blurred . In addiIn this research, patients with glioma were taken as the research object, and dynamic contrast-enhanced (DCE)-MRI under the CNN algorithm was used to diagnose and segment patients with tumors, and the differences between the DCE-MRI-related parameters of patients with glioma of different grades were discussed and analyzed, to provide a good reference and basis for the diagnosis and treatment of clinically related diseases.From March 2019 to March 2020, 66 patients with gliomas in hospital were selected as the research objects, including 36 male patients and 30 female patients. The mean age of the patients was 53.6 ± 11.3 years. According to the World Health Organization (WHO) glioma grading standard, the patients were rolled into the high-grade glioma group  and the low-grade glioma group . All studies obtained patient informed consent and this study had been approved by the ethics committee of the hospital.Inclusion criteria were as follows: patients diagnosed with glioma after case diagnostic screening; patients with complete imaging and follow-up data; and patients with complete follow-up records. Exclusion criteria were as follows: patients with other malignant tumors at the same time; patients with other serious underlying diseases or with dysfunction of important organs such as the heart, lung, liver, and kidney; those who died of diseases or accidents other than glioma; and those who suffered from claustrophobia.2, matrix: 320 × 256, and bandwidth: 360 Hz/Px) and T2WI , with a layer thickness of 5 mm. DCE-MRI used cross-sectional T1 gradient 3D sequence scanning, and three groups of Tl-Vibe plain scans were performed before the examination . A dynamic enhanced examination was then performed, including a total of 40 acquisitions. After the third collection, the contrast agent was injected through the cubital vein at a rate of 2.0–4.0 mL/s and a total amount of 0.1 mmol/kg. All localization levels of the DCE-MRI examination were consistent. The flip angle of the dynamic acquisition sequence was 15°, and the other parameters were the same as the previous plain scan sequence.All cases were scanned by 3.0TMR with an 8-channel phased-array head coil. All patients underwent a routine plain scan and a DCE-MRI before surgery. Specific scanning parameters of conventional sequences were T1WI  is the activation function. The convolution operation has three modes of full convolution, same convolution, and valid convolution. The specific definitions are as follows. (I)Full convolution(II)Same convolution(III)Valid convolutionAll MRI images were processed using the CNN algorithm. The specific image processing process includes the input image, CNN, heat map, CRF, output image, and other steps. The specific image processing process is shown in The pooling layer can reduce the possibility of overfitting and improve the fault tolerance of the model. The calculation of the pooling layer is as follows:do  wn(•) is the downsampling function, and β and b are the multiplicative bias and the additive bias, respectively. There are two common pooling operations in deep learning-based multifeature fusion classification algorithms, namely, average pooling and maximum pooling. The average pooling refers to taking the mean value within the filter range as the pooled output. The maximum value pooling refers to using the maximum value within the filter range as the pooling output.As for the full connection process, in the multifeature fusion classification algorithm under deep learning, the full connection layer is a network node arranged linearly and encodes the output result of the previous layer into a one-dimensional vector. The fully connected layer is defined as follows:wl is the network weight coefficient, xl−1 is the output feature map of the previous layer, and bl is the fully connected layer bias item.In the above equation, T={(x(1), y(1)),…, (xm)}, the input sample is xi ∈ Rn, and yi) is defined as follows:Softmax classification layer is a multiclassifier connected to the fully connected layer, which can complete more than two classification tasks and convert multiple outputs into probability values in the  interval. In logistic regression, the training set is J(θ) is minimized as follows:The cost function The calculation of Softmax is as follows:T minimizes the damage function of Softmax. The expression of the minimum loss function is as follows:yi), peak signal-to-noise ratio (PSNR), and structural similarity (SSIM) are used to evaluate the segmentation effect quantitatively. The specific calculation methods of the three indicators are as follows:μm. III. The samples were put into 10 mM citric acid buffer and microwaved for 10 minutes. IV. The slices were cooled at room temperature for 20 minutes. V. Steps III and IV were repeated. VI. Slices were cooled at room temperature for 20 minutes before being removed from citric acid, washed twice with Tris-HCl buffer, and then left in Tris-HCl for staining. VII. Finally, Ki-67 labeling was carried out according to the conventional method.All patients' tumors were surgically removed, then the tumor specimens were analyzed, and the gliomas were classified into grades I to IV. Ki-67 immunohistochemical staining was performed on the obtained specimen, the whole specimen was browsed, and then the area with the highest positive expression density was selected. 1,000 tumor cells were counted under a 200× microscope, and the positive percentage of tumor cells was taken as the highest Ki-67 labeling index. The specific staining methods of Ki-67 were as follows: I. After samples were taken, the tissues were fixed with neutral formaldehyde for 24–48 hours, followed by conventional paraffin embedding treatment. II. The sample was sliced to 5∼7 s), and t-test was used to test the significance of patient data before and after surgery. The count data were expressed as actual number and percentage, and the significance test was carried out by χ2 test. P < 0.05 was considered statistically considerable.Statistical analysis of all data relied on SPSS 11.0 to complete. Measurement data were expressed as the mean ± standard deviation . The mean value, kurtosis, and skewness of Kep were significantly different between the two groups, P < 0.05. The mean value, standard deviation, kurtosis, and skewness of Ve were significantly different between the two groups, P < 0.05. There were significant differences in the mean and standard deviation of Vp between the two groups, P < 0.05.The comparison results of the histogram parameters of Ktrans standard deviation, kurtosis, and skewness between grades II and III. Kep kurtosis and skewness were significantly different. The mean values of Ve were significantly different with P < 0.05. There were significant differences in Ktrans average, kurtosis, and skewness between grades III and IV gliomas. Kep standard deviation was significantly different. There were significant differences in mean value, standard deviation, kurtosis, and skewness of Ve, all P < 0.05.The comparison results of the histogram parameters of different grades of glioma are shown in Ktrans, Kep, Ve, and Vp histogram parameters for diagnosing glioma. The histogram parameters of Ktrans, Kep, Ve, and Vp all showed good performance in the diagnosis of glioma, especially the Ktrans value had the best performance, and its standard deviation had the best diagnostic performance among all parameters.Ktrans, Ve, and Vp were positively correlated with Ki-67, and Kep had no correlation with Ki-67.Figures Glioma is the most common intracranial primary tumor, which is characterized by high vascularization, high heterogeneity, and strong invasiveness. In recent years, despite the continuous advancement of surgical and chemotherapy techniques, the survival of glioma patients after comprehensive treatment is still very low . ClinicaKtrans, Kep, Ve, and Vp. In recent years, DCE-MRI has been widely used in the differential diagnosis of single brain metastases, primary central nervous system lymphoma (PCNSL), and glioma [Ktrans and Ve, standard deviation and skewness of Kep, and mean and standard deviation of Vp were statistically significant in differentiating HGG from LGG (P < 0.05). ROC analysis showed that the above values had good diagnostic performance for differentiating HGG from LGG, and Ktrans had the highest standard deviation diagnostic accuracy. The standard deviation, kurtosis, and skewness of Ktrans, kurtosis and skewness of Kep, and mean value of Ve were statistically significant in differentiating grade II and III gliomas (P < 0.05). The mean, standard deviation, kurtosis, skewness of Ktrans and Ve, and standard deviation of Kep were statistically significant in differentiating grade III and IV gliomas (P < 0.05). Ktrans, Ve, and Vp were positively correlated with Ki-67. This indicates that DCE-MRI histogram-related indicators are of great significance in the diagnosis and grading of glioma. This can provide important reference information for clinical treatment. This is consistent with the results of some previous studies.In recent years, with the continuous progress and development of imaging technology, many new technologies have been developed in the diagnosis of craniocerebral diseases. DCE-MRI is a novel functional MR imaging technique based on microvascular permeability and pharmacokinetic model assumptions. Based on the magnetic field changes caused by the leakage of contrast agent, it can quantitatively measure the microvascular permeability of gliomas and then noninvasively, dynamically, and quantitatively evaluate the functional properties of microvessels and improve the accuracy of glioma grading –22. Quand glioma . At presd glioma . TherefoIn addition to grading gliomas after diagnosis, how to segment tumors from MRI images is also a focus and a difficulty in clinical research. At present, clinical segmentation of glioma tumor regions mainly relies on manual selection and division by doctors. This segmentation method is not only time-consuming and labor-intensive, but also the segmentation results are greatly influenced by the doctor's subjective opinion and require the doctor to have a strong professional knowledge reserve , 26. ThiKtrans, Kep, Ve, and Vp, and other indicators, and the correlation between Ktrans , Kep, Ve, and Vp, and other indicators in Ki-67 also showed significant differences. In summary, CNN and DCE-MRI have high clinical application value in the diagnosis and differentiation of glioma. Nevertheless, there are still some defects in this work. For example, this research only analyzed the effect of DCE-MRI on the diagnosis of glioma and did not compare it with other diagnostic methods, which did not prove that DCE-MR is the best method for the diagnosis of glioma. In future studies and work, we will improve the above problems and further address them.Patients with glioma were taken as research objects, and MRI with the CNN algorithm was used to classify glioma and segment glioma. The results showed that the CNN algorithm had good performance in DCE-MRI image segmentation of glioma patients. The DCE-MRI histogram of glioma of different grades showed significant differences in


To study the risk factors for the onset of secondary primary malignancies (SPM) and the latency between SPM and cervical cancer after radiotherapy.We selected patients with cervical cancer who underwent radiotherapy between 2000 and 2019 from the Surveillance, Epidemiology, and End Results (SEER) database. And the data of patients with cervical cancer who underwent radiotherapy in Guangxi Medical University Cancer Hospital during January 1,1997 to December 31,2016 were collected and analyzed. The factors associated with SPM onset and latency were then estimated by nomograms based on logistic regression and a complete risk model. Dynamic risk plots were performed by Poisson regression.A total of 32,313 cases of cervical cancer who underwent radiotherapy were downloaded from the SEER database; of these, 19,439 cases had a complete dataset and were included in the final analysis. In total, 561 cases suffered from SPM; the remaining 18,878 did not. And a total of 1486 cases of cervical cancer who underwent radiotherapy from Guangxi Medical University Cancer Hospital were analyzed, 27 cases caught SPM and the rest of 1459 cases did not. Patients with SPM were older than those without SPM(p=0.000); significant associations were also identified between SPM and white race(p=0.000), localized stage (p=0.000), squamous carcinoma (SCC)(p=0.003), surgery(p=0.000), and combination radiotherapy (p=0.026). A logistic regression nomogram showed that older age , localized stage  and regional stage , white  and black race , and the receipt of surgery  were all independent risk factors for the onset of SPM. The largest proportion of cases involved SPM in the female reproductive system. A dynamic risk plot showed that age, race, stage, and surgery had impacts on the latency of SPM onset. A competing risk regression analysis nomogram showed that age , surgery , localized stage  and regional stage , and black race  all had significant impacts on the cumulative incidence and latency of SPM.Advanced age, the receipt of surgery, earlier stages, and white and black race were identified as risk factors for SPM onset and influenced latency in patients with cervical cancer after radiotherapy. Cervical cancer is the fourth most frequently diagnosed form of cancer and the fourth leading cause of death by cancer in women, with an estimated 604,000 new cases and 342,000 deaths worldwide in 2020 . SurgeriA previous study reported that cervical cancer patients who underwent radiotherapy are vulnerable to secondary primary cancer of organs in the pelvis . HoweverAlthough many cervical cancer patients receive radiotherapy, not all of them suffer from secondary cancer. There are likely to be other factors that influence the final outcomes. Therefore, in this study, we analyzed patients with cervical cancer receiving radiotherapy and suffering from secondary cancer in order to demonstrate risk factors for the onset of secondary cancer.Female patients diagnosed with cervical cancer as the first primary cancer were identified from 17 registries of the Surveillance, Epidemiology, and End Results (SEER) database between the January 1, 2000 and the December 31, 2019. All primary cancer sites were coded according to the International Classification of Diseases for Oncology, Third Edition. The included patients were pathologically diagnosed with endocervix cancer (C53.0), exocervix cancer (C53.1), overlapping lesions of cervix uteri cancer (C53.8), and cervix uteri cancer (C53.9). The exclusion criteria included patients in whom rectal cancer was not the first primary cancer, patients who were aged younger than 20 years, patients who survived less than 5 years after the diagnosis of rectal cancer, patients with non-epithelial tumors, patients who did not undergo radiotherapy, and patients with missing data relating to radiotherapy, surgery, age, tumor stage, race, survival status, or follow-up. This study was approved by the Ethics Committee of Guangxi Medical University Cancer Hospital. Access to and the use of SEER data did not require informed patient consent. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013).Demographic and clinical variables were collected from the SEER database. We included patients with cervical cancer who received radiotherapy. Then, 70% of the cases included from the SEER database were randomly selected as a training set; the remaining patients were used as an internal validation set. A range of data were collated for each patient, including age, race, pathological type, histological grade, stage, surgery, chemotherapy, radiotherapy, year of diagnosis, overall survival (OS), and survival status.The clinical data of 1486 cases diagnosed with cervical cancer as the first primary cancer who admitted in Guangxi Medical University Cancer Hospital during January 1,1997 to December 31,2016 were collected and analyzed, including age, race, pathological type, histological grade, stage, surgery, chemotherapy, radiotherapy, year of diagnosis, overall survival (OS), and survival status. This study was approved by the Ethics Committee of Guangxi Medical University Cancer Hospital.The primary outcome of this study was the development of SPM, which was defined as any type of SPM occurring more than 5 years after the treatment of cervical cancer because of at least a 5-year latency period from radiotherapy exposure to the occurrence of a solid tumor. The SEER database adheres to the International Classification of Diseases for Oncology (Third Edition) guidelines and distinguishes SPM from recurrent disease. To obtain comprehensive estimations for the risk of SPM, the risk for all types of SPM was estimated . The follow-up for SPM began 5 years after the diagnosis of cervical cancer and ended at the date of diagnosis of any SPM. The cut-off point for follow-up was defined as January 1, 2016 (April 2019 SEER data release). A flow chart showing the experimental design is shown in All statistical analyses were performed by R 4.1.0 and Rstudio software. Continuous parametric and normal distributed data were compared using t-tests or rank-sum tests while categorical data were compared using the chi-squared test. Fisher exact test was used for categorical data when frequencies were below 5. The Mann-Whitney test was used to analyze continuous variables with a non-normal distribution, respectively. Univariable and multivariable logistical regression models were performed for the training cohort using the “rms,” “Hmisc,” and “lattice” packages in R. Nomograms were generated by the “regplot” in R to predict the risk of secondary cancer onset. The performance of the nomogram was further validated using the test cohort. The discrimination accuracy of the nomogram was quantified using Harrell’s concordance index (the C-index). Furthermore, a calibration curve with 400 resamples from bootstrapping was used to assess the nomograms. The “pROC” package in R was used to plot calibration curves and receiver operating characteristic curves (ROCs) to assess the calibration of the nomogram. The clinical utility of the nomogram was evaluated using decision curve analysis (DCA) which was performed in the “rmda” package in R.The radiotherapy-associated risk (RR) was estimated by Poisson regression analysis with the relative risk and 95% confidence intervals (CIs) of SPM development for patients with cervical cancer who received radiotherapy. To further evaluate the dynamic risks and incidence of SPM associated with different risk factors, we analyzed the RRs when stratified by latency time since SPM diagnosis in patients with cervical cancer. The data used for Poisson regression analysis were evaluated by the overdispersion test in the “qcc” package in R.Fine-Gray competing risk regression analysis was used to assess the cumulative incidence of SPM development. Experiencing a non-SPM and dying of all causes were considered to be competing events when we calculated hazard ratios (HRs) and 95% CIs for SPM occurrence. A multivariable risk model was built by a backward selection procedure with variables and a two-sided P < 0.05 in univariable analyses; significant factors were then included in multivariable analyses. Multivariable analysis was conducted by weighting the formula by the “crprep” function in R. These analyses were completed by the “mstate” and “cmprsk” packages in R. Calibration curves and ROCs were used to assess the performance of the nomogram.A total of 32,313 cases of primary cervical cancer met the selection criteria  showed the highest incidence in SPM (33.33%) followed by cancers of the respiratory system (21.03%). The lowest proportion of SPM cases involved nervous system tumors (0.71%). Further details are shown in A total of 1486 cases diagnosed with cervical cancer and receiving radiotherapy were analyzed  of all SPM, respectively. And the remain SPM included 1 case (3.70%) of primary ovarian cancer, carcinoma of head of pancreas, urethra cancer, gastric cancer, hepatic cancer, parotid gland cancer, thyroid cancer and synovial sarcoma of nervi ischiadicus and iliopsoas, respectively.A total of 19,439 cases were randomly divided into a training set and a test set in a ratio of 7:3. Detailed results of the univariable and multivariable logistic regression analysis of predicative variables from the training cohort are summarized in The discriminatory ability of these nomograms was further validated in the testing set. The calibration curves and ROC curves showed fair consistency between actual probability and nomogram-predicted probability in the testing set 5B. MoreTo assess the risks of SPM in different latency periods, ages, stages, pathological types, and surgery, we used Poisson regression to evaluate dynamic risk according to the nomogram results. Analysis showed that race was a risk factor for SPM. Compared to black females, the risk of SPM in white females showed an upward trend over 5-15 years but fell in late latency. The risk of SPM in females of other races increased during early and late latency (The Fine-Gray test showed that the incidence of the patients older than 50 years was 2.91% while that of patients younger than 50 was 1.87% (P=0.000). The incidence of SPM was 2.08% in patients with no surgery and 2.81% in patients receiving surgery (P=0.000). In stage-specific analyses, the cumulative incidence of localized and regional stages was significantly higher in patients with metastases . Different pathological types of cervical cancer showed significantly different cumulative incidences of SPM; the cumulative incidences of SCC , ADC , ASC , and NE  and others were 2.50%, 2.54%, 1.61%, 0%, and 0.90% (P=0.000). Moreover, different types of radiotherapy exerted differential impacts on the cumulative incidence of SPM; the incidences of beam radiation, brachytherapy, a combination of beam radiation with implants or isotopes, radioisotopes, and a non-specified source of radiation were 2.07%, 3.70%, 2.47%, 4.47%, and 5.57%, respectively (P=0.002). Furthermore, there was a significantly decreasing trend of cumulative incidence with poorer histological grades; the cumulative incidences of well, medium, poor differentiated, and undifferentiated cervical cancer were 3.53%, 2.48%, 2.22%, and 1.53%, respectively (P=0.004) , this model formula could not be fitted. So, the variable “race” in formula was excluded. The calibration curve of the nomogram confirmed that the probability of predicting 5,10,15,19-year latency was consistent with the actual observation both in the external test cohort (This study established the nomograms of onset risk, cumulative incidences and latency of secondary cancer following cervical cancer patients who received radiotherapy. For the onset risk, older age, surgery, earlier stages, SCC, white and black races, were the independent risk factors of secondary cancer following cervical cancer. While the key factors that influencing latency between primary and secondary cancer onset were age, surgeries, stages and pathological types of primary cervical cancer.Radiotherapy increased the risk of secondary cancers among cervical cancer patients and was associated with a significantly higher risk of developing a secondary cancer in the colon, rectum, anus, lung, bronchus, corpus uteri, ovary, and urinary bladder . Not onlWhite and black races are known to be vulnerable to SPM regardless of the type of primary cancer . In a prIn this study, we found that advanced age was an independent risk factor for both the onset of secondary cancer and OS. A similar result was obtained in a previous multivariate analysis of thyroid cancer in that the age at first radiotherapy increased the risk of secondary cancer . AnotherIn addition, we found that receiving surgery for the treatment of cervical cancer was an independent risk factor for the onset of secondary cancer. Moreover, surgery reduced the risk of overall mortality. With regard to cervical cancer, patients who receive surgeries are always in the early stages of disease. This suggests that surgery is likely to be an indirect cause for secondary cancers. On the one hand, the patients who received surgery were in the early stages of disease . The eraInterestingly, localized and regional stages, rather than distant metastatic stages, increase the risk of onset for secondary cancer. Jiang et al. constructed a nomogram to predict the prognosis of patients with cervical cancer and found that the stage of cancer was a risk factor for cervical cancer, irrespective of OS or CSS  FurthermThe pathological types of primary cervical cancer play an important role in the onset of SPM. We found that SCC was an independent risk factor for SPM; when compared to other pathological types, patients with SCC are at a greater risk from SPM due to their longer survival period. In a previous study, Gallardo-Alvarado et al. found that the recurrence rate of SCC was lower and the five-year overall survival and disease-free survival were longer when compared to ADC . In anotThere are some limitations in this study that need to be considered. First, the SEER data does not include detailed patient information, such as HPV infectious status. Second, due to the absence of data relating to specific radiotherapy methods, it was not possible to evaluate the effects of different radiotherapy methods on the onset of secondary cancer. Besides, the external test cohort data from our hospital was short of white and black races. Finally, we did not consider different types of secondary cancer; it is possible that different types could also influence OS. These limitations need to be investigated in future research.Standard forms of treatment for cervical cancer can improve the prognosis of patients but can also increase the incidence of SPM. In particular, an older age, surgery, earlier stages, and white and black race were identified as independent risk factors for SPM in patients with cervical cancer after radiotherapy. Although radiotherapy has been proven to be a risk factor for SPM, other features of primary cervical cancer can still exert impact on the onset latency of SPM. Therefore, it is important to carefully manage older patients for the onset of SPM in those of white and black race, those with earlier stages of disease, and those receiving surgery and radiotherapy.The original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Ethics committee of Guangxi Medical University Cancer Hospital. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.DY acted as the guarantor of this study and conceived the idea. MC and XP analyzed the data and wrote this paper. And HW performed manuscript editing. All authors contributed to the article and approved the submitted version.