All participants performed the Movement Assessment Battery for Children (M-ABC) to assess fine and gross motor skills, while the Developmental Profile 3 (DP-3) checklist was administered to the parents in order to screen strengths and weaknesses of five developmental areas of their relatives with DS. Results: Our results showed positive correlations between the following variables: global motor coordination and global development, global motor coordination and adaptive behavior development area, aiming and catching skills and global development, aiming and catching skills and adaptive behavior development area. As for the practice of PA, PA-G showed higher scores than PI-G in all the tasks of both the M-ABC and the DP-3, though significant differences were found only for the global motor coordination, for the aiming and catching skills, as well as for the physical development area. Conclusions: The findings of this study reinforce the need to implement and encourage the practice of PA in order to promote well-being and social inclusion in subjects with DS.Background: Many research studies have investigated motor impairments and delayed development in children with Down Syndrome (DS). However, very few studies detected these features in adults with DS. Hence, this study aimed to investigate the relationship between motor coordination and global development in subjects with DS, including adults. Furthermore, the second aim was to detect any differences in motor coordination and global development as a function of the practice of physical activity (PA) in this population. Methods: Twenty-five participants with DS , with a chronological mean age of 27.24 years and development mean age of cognitive area of 4.93 years, were enrolled and divided into a physically active group (PA-G;  Research has amply demonstrated a close relationship between Intellectual Quotient (IQ) and motor proficiency, showing that people with mild or moderate Intellectual Disability (ID) exhibit delays in motor development with significant impairment of daily functioning ,2,3,4. IFollowing the International Classification of Functioning, Disability, and Health (ICF), which postulates a close relationship between body, person, and society as components of personal functioning, both in health and disability conditions, a growing emphasis has been addressed on Physical Activity (PA) for increasing the well-being and social inclusion of the population with ID .The link between ID and impaired motor skills has been largely investigated in children and adolescents with Down Syndrome (DS) ,8,9. HowLarge-scale research conducted by Smits-Engelsman and Hill (2012) involving 460 children with ID  showed that children with lower IQ were more likely to show associated lower motor performances . MoreoveOverall, following the “delay hypothesis”, infants and children with DS achieve motor development milestones and motor patterns later than Typically Developing (TD) peers, and this gap increases with age and level of difficulty of motor tasks ,14,15,16Similarly, as concerns the fine motor development in DS, it demonstrated the same trajectory as TD peers, but at delayed ages. Fine motor skills were more impaired than gross motor skills and were characterized by lower developmental increases . For exaNevertheless, motor impairments in the DS population refer to restrictions in domains such as motor planning and control, locomotion and object control skill, manual dexterity, fine motor skills, and writing skills ,20,21,22Notwithstanding ample research on motor development in children and adolescents with DS has been produced, studies on motor proficiency in adults with DS are lacking. Nevertheless, it is plausible that adults with DS show impaired motor skills coherently with the decline in their IQ, increasing the difficulty in autonomous skills ,34. ConsThe impaired motor proficiency is associated with an inactive lifestyle which, in turn, contributes to increased health-related complications in DS people . PA is rRecently, increasing research has demonstrated the relationship between regular PA and brain development, particularly in the prefrontal cortical area, because sport and PA influence the production of neurotrophins, synaptogenesis, and angiogenesis which, consequently, can increase cognitive performances in terms of information processing speed, working memory, and behavioral control strategies . MoreoveHowever, most people with DS do not meet the World Health Organization (WHO) recommendations for the practice of PA, which consist of at least 60 min/day of moderate-to-vigorous intensity PA for children and adolescents aged 5–17 years (mostly aerobic), and at least 150 min/week of moderate-intensity aerobic PA, or at least 75 min/week of vigorous-intensity aerobic PA for adults aged 18–64 years . ConsequIn light of these theoretical premises, this study aims to analyze the relationship between motor coordination and global development in subjects with DS, as well as to investigate motor coordination and global development as a function of PA. As concern this second aim, the following specific hypotheses were tested: (H1) motor coordination such as manual dexterity, aiming and catching, and static and dynamic balance were better performed in physically active subjects with DS than in physically inactive subjects with DS; (H2) global development such as physical, adaptive behavior, social-emotional, cognitive, and communication area were better mastered in physically active subjects with DS than physically inactive subjects with DS; (H3) we expect a correlation between motor coordination and global development in subjects with DS and, moreover, greater motor competence in physically active subjects than in physically inactive ones.The study’s novelty relates to the inclusion of the adult population with DS for the evaluation of these characteristics.Participants with DS were recruited through a national public hospital in Palermo city  and two not-for-profit associations that provide support and community resources to people with DS and their families. Medical doctors and educational practitioners from the abovementioned institutions contacted and met with the parents of the subjects with DS to announce the research project and explain the goals and procedures of the study. Subsequently, study researchers asked parents to allow their relatives with DS to take part in the study on a scheduled day. A number of 25 subjects showed up on the day scheduled for the screening and all of them were eligible for the study.Twenty-five subjects with DS  and development mean age of cognitive area of 4.93 participated in the study. Of these, 15 subjects were attributed to the physically active group (PA-G), given by ≥3 consecutive years of PA practice and according to the WHO recommendations for the practice of PA, while 10 subjects were attributed to the physically inactive group (PI-G), given by ≥3 consecutive years of an inactive lifestyle .The inclusion criteria were as follows: the presence of trisomy 21; the moderate level of ID previously certified by the national public health; the absence of any perceptive disease; the absence of organic impairment; the absence of impairments in independence in stance and ambulation. Participants with DS were excluded from the study if they had mosaicism or trisomy with translocation and a severe level of ID. All participants belonged to medium socioeconomic backgrounds.Following this recruitment phase, all participants were administered a questionnaire on personal data, health status, and PA practice. In particular, in the questionnaire, administered by the same researcher, the participants had to indicate the number of days per week and the number of minutes per day of any type of PA practiced. Subsequently, the same researcher expert in PA and sport, based on the answers obtained, was able to identify whether each participant had reached the minimum levels of PA recommended by the WHO  in order to allocate the participant in the PA-G . The infSubsequently, the same researcher with expertise in this research field administered a standardized evaluation to measure participants’ motor coordination, while the parents were given a questionnaire to assess the developmental delays of their relatives with DS.Regarding the measurement of motor skills, although there is a wide availability of assessments in children, there is a lack of tests in adults. Furthermore, to the best of our knowledge, there are no standardized tests to measure motor coordination in ID. A suggestion is to compare the performances of adults with DS and people with “equivalent age” or “test age” because this would be a cleaner index of the real competencies mastered by each person, increasing or decreasing proportionally in relation to mental age and contextual adaptation . Based on these premises, typical population norm-referenced tests are used for the atypical population, without making any attempt to adapt to the condition of ID. For these reasons, we selected a standardized motor coordination evaluation for children because the participants recruited for the study had a development age of cognitive area of 4.93 and on physical area of 4.24. In fact, as reported in the literature, people with moderate ID function at a mental age of about 6–8 years as adults, and they are characterized by difficulties and limitations in basic daily living and in several skills . MoreoveThe study respects the statements of the Declaration of Helsinki for the participation of persons in research, and the Institutional Review Committee of the University of Palermo approved the study (Ref Num 56/2021). Parents provided written informed consent for participation in the study.Motor coordination was measured through the Movement Assessment Battery for Children (M-ABC) 2nd edition . This stThe score was binary 0 or 1. The raw scores, such as completion time in secs, number of errors/correct, catches/correct, throws/steps/jumps/hops , were computed by adding the scores items pertaining to each category with high scores indicating poor performance. A global motor coordination raw score was obtained by adding scores for each category. We used the raw scores without normalizing them by age because, according to the literature, we considered the mental age and not the chronological age for comparisons. It is appropriate to compare the performances of people with DS and people of “equivalent age” .After giving the assignment, which was based on the Examiner’s Manual guidelines, the experimenter showed the exercise to ensure correct understanding by the participants. Verbal reinforcement was given after each task was performed.All participants attended tasks without any resistance and showed full cooperation.The assessment was individual, took place in a quiet room, and lasted about 25–30 min.As concern the psychometric properties, the internal consistency was Cronbach’s α = 0.83 for the total scale, α = 0.59 for the manual dexterity subscale, α = 0.79 for the aiming for and catching subscale, and α = 0.91 for the balance domain subscale.Global development was measured through the Italian version  of the DEach scale has start points corresponding to the chronological age. Parents were asked to indicate if their relatives with DS mastered (score = 1) or not (score = 0) skills related to the abovementioned areas. The raw scores were computed by adding the scores items pertaining to each area. A global development raw score was obtained by adding scores for each area.The assessment took place in a quiet room.The Italian translation used proves to have a reliability (α = 0.68) equal to that of the original version in English (α = 0.68).A priori sample size power analysis was calculated using G*Power software 3.1.9.2 .The distribution of normality was checked through the Shapiro-Wilk test.Since data were not normally distributed, a non-parametric analysis was performed. Firstly, a descriptive statistic of all the variables was carried out. A Spearman’s Rank-Order correlation coefficient was calculated to measure any relationship between motor coordination skills and global development areas in the entire sample.U test was computed in order to assess any differences in motor coordination and global development between the two groups .A Mann–Whitney Scatterplots and boxplots were used to represent the significant correlations and differences found, respectively.®, TIBCO® Software Inc, Palo Alto, CA, USA) was used to perform all the statistical analyses with the significance set at p < 0.05.The software Statistica 12 .The a priori sample size power analysis  revealed that the total sample size required to obtain a power of 0.80 should be 102 participants .Descriptive statistics of the entire sample for both the M-ABC and the DP-3 variables are reported in p = 0.002) (p = 0.021) (p = 0.006) (p = 0.023)  , the glo= 0.021) , the aim= 0.006) , the aim= 0.023) . In TablU test, significant differences were found only for the global raw score of the M-ABC  (p = 0.025) (p = 0.048) (As presented in = 0.012) , and for= 0.025) , as well= 0.048) .The post-hoc sample size power analysis  revealed a power of 0.33.The first aim of this study was to investigate the relationship between coordinative proficiency and global development in subjects with DS including adults.On the whole, significant positive correlations were found between global motor coordination and global development, and moreover between global motor coordination and the adaptive behavior development area. Similarly, we found significant positive correlations between the aiming and catching skills and global development, and moreover between the aiming and catching skills and the adaptive behavior development area. These results are well documented in the literature showing how motor skills and postural patterns are related to adaptive functioning, independence, and participation in social activities ,36. IndeThe second aim of the current study was to investigate motor coordination skills and global development as a function of PA by the hypothesis that physically active subjects with DS would show higher levels of performance than physically inactive subjects with DS.Regarding motor coordination, subjects with DS who regularly practice PA performed higher scores than physically inactive subjects with DS in all the tasks. However, significant differences were found only in the global motor coordination and in the aiming and catching skills. These results are coherent with physically active DS participants’ higher motor competencies that were reported by their parents compared to physically inactive participants. Thus, better motor competencies were demonstrated by adults with DS practicing PA with both the measures. These measures involve two approaches, such as long-term information on fine and gross motor proficiency in an ecological context, derived from a performance test as the M-ABC, and a more exhaustive assessment, derived from a parent’s checklist as the DP-3. Similarly, participants with DS belonging to the PA-G reported higher levels of global development and higher scores for each area. Indeed, higher motor performances in physically active subjects are documented in the literature showing that PA practice is a key factor to improve health, cognitive function, and performances of daily living activities in adults with DS ,59. MoreResearch has shown that the regular practice of PA affects the production of neurotrophins, synaptogenesis, and angiogenesis which, as a consequence, is likely to increase cognitive abilities such as information processing speed, working memory, and behavioral control strategies . In partFor these reasons, it is realistic to assume that health complications may present barriers to the practice of PA in subjects with DS and that, when clinical features are efficiently overcome, PA can be facilitated.Moreover, a further explanation could be linked to the inclusion in the PA-G of those children with DS who had achieved the minimum levels of PA recommended by the WHO. This allowed us to include subjects participating in a wide range of PA, exercise, or sport . The subjects of the PA-G had, therefore, not carried out specific training protocols for the improvement of manual dexterity, body balance, adaptive behavior area, social-emotional area, cognitive area, and communication area. Nevertheless, we detected that the practice of the minimum levels of PA recommended by the WHO overall induced higher scores in motor coordination and global development in physically active subjects with DS than in physically inactive ones.To the best of our knowledge, only sparse studies have previously investigated the motor competence in adults with DS in association with global development in cognitive and adaptive areas and this represents the major strength of the study. However, the most important limitation of the current study lies in methodological concerns as the relatively small sample size and the measures carried out. In effect, although the sample represents one of the main limitations of the study, it is known that the recruitment of large numbers of participants in clinical populations (and in particular those who practice PA) is one of the greatest difficulties that is experienced. Furthermore, the pandemic situation did not allow us to extend the sample size. Regarding methodological concerns, although there is a lack of motor coordination tests for adults with DS it should be noted that: (1) we used a standardized motor coordination assessment for children because the participants had a moderate level of ID ; (2) we used the raw scores obtained by the participants and not the standardized ones for the typical population. Finally, another limitation of the study that should be mentioned is the moderate magnitude of the correlations we found. This finding could be primarily explained by the small sample size we recruited.To sum up, the findings of this study reinforce the need to implement and encourage the practice of PA in order to promote well-being and social inclusion not only, as it is already known, in children and adolescents but also in adults with DS. Moreover, researchers and practitioners are encouraged to implement PA to enhance motor and cognitive skills in DS adults, as well as their sense of social inclusion and ADL, and belonging, self-determination, and self-esteem ,68,69,70


Trauma is one of the important issues in public health because it is responsible for 90% of mortality in Low and Middle-Income Countries (LIMCs). The present study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center in the Midwest of Iran from 2014 to 2020.This study was a retrospective study that was performed on 29,804 trauma patients admitted to Be′sat Hospital in Hamadan from January 2014 to December 2020. Data was collected using Health Information Management (HIM) Center of the Be′sat Hospital. For investigating the relationship of the characteristics of trauma patients and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. All statistical analyses were performed using the IBM SPSS Statistics version 24.RTAs compared to other mechanism were: season and hospital length of stay (LOS); in falls and violence: age, sex, season, and LOS; and in burn: age, sex, season, evening time, and LOS (p < 0.05).The mean age of all patients was 35.4 (SD = 21.9) years. Most of them were men (71.7%). The most common mechanism of trauma was road traffic accidents (RTAs) (39.6%) followed by falls (30.2%), other (19.7%), violence (6.2%), and burn (4.4%). 1.5% of the trauma patients expired. The results of multiple multinomial logistic regression indicated that significant affected factor on odds referring because of Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs. Trauma is the leading cause of death, hospitalization, and disability in the world , 2. TrauIran as a middle-income developing country faces a high mortality and morbidity rate due to trauma . In IranTrauma can be classified according to the mechanism , the area , and the features of the causative factor  . The mec(69.5%) and followed by falls (12.3%) . The stuConsidering the high prevalence of trauma, high-rate mortality, and severe complications due to trauma in Iran, it seems that the use of preventive methods in the field of trauma is effective when accurate information and statistics about the incidence of various mechanisms of trauma and its consequences are available in the community. Determining the common mechanisms of trauma in this study can be helped to develop the treatment protocols for identifying at-risk groups and their special care. This may improve the quality of services provided to trauma patients. Although nature trauma is well known, the mechanisms of trauma are less known especially in developing countries where few studies have been conducted on the epidemiology of trauma and its mechanisms . To our This study was a retrospective study (from January 2014 to December 2020.).Different wards of Be′sat Hospital in Hamadan, Iran. Be′sat Hospital is a regional trauma center in Hamadan, Midwest of Iran.Trauma patients admitted to different wards of Be′sat Hospital.Characteristics of trauma patients including age, sex, season, time of week, referral time, mechanisms of trauma, history of hospitalization, hospital length of stay (LOS), surgery, and final status of patients was investigated.In this study, data source was Health Information Management (HIM) Center of the Be′sat Hospital.Twenty-nine thousand eight hundred four trauma patients who had been admitted to different wards of Be′sat Hospital.Quantitative variables were presented as mean and SD. Qualitative variables were expressed as frequency and percentages.P value < 0.05 considered to be as significant. All statistical analyses were performed using the IBM SPSS Statistics version 24.The mechanisms of trauma were considered as the dependent outcome variable . It is noteworthy that in this study, “other” in the mechanism of trauma included drowning, electrocution, suicide, homicide, poisoning, animal attacks, bites, and playing (sports) trauma. For investigating the relationship of the demographic and the mechanisms of trauma, Multiple Multinomial Logistic Regression (MMNLR) model was used. In MMLR model, “other” in the mechanisms of trauma was considered as reference group and the effect of each risk factor was measured on each mechanism of trauma compared to other. The results of model fitting were presented as Odds Ratios (OR) and their 95% confidence intervals. Twenty-nine thousand eight hundred four trauma patients who had been admitted to different wards of Be’sat Hospital from January 2014 to December 2020.The mean age of all patients was 35.4 SD = 21.9) years. The mean age of males and females was 32.2 (SD = 19.9) and 40.9 (SD = 21.9), respectively. Most of the trauma patients were men (71.7%). The most referral season was summer (32.1%). About half of the referrals were recorded in the evening (46.4%). 70% of patients were hospitalized with 3 or less days. 95.8% of patients were discharged from the hospital and 1.5% of the trauma patients expired (Table .9 years.The most common the mechanism of trauma was RTAs (39.6%) followed by fall (30.2%) Fig. .Fig. 1MeRTAs compared to other were: spring and > 3 days hospital length of stay (LOS); odds referring because of falls compared to other in following variables were significant: age of > 18 years, being males, spring, summer, autumn, > 3 days LOS; odds referring because of in violence compared to other: age of > 18 years, being males, spring, autumn, and > 3 days LOS; and odds referring because of in burn compared to other: age of > 18 years, being males, spring, summer, autumn, evening time, and > 3 days LOS were statistically significant  model indicated that significant affected factor on the odds of referring because of nt Table .Table 2TThe current study aimed to determine the epidemiological pattern of trauma patients in a regional trauma center, Be′sat Hospital, in Hamadan from January 2014 to December 2020. The strengths of this study consisted of a large sample size and the ability to examine the epidemiological pattern of common trauma mechanisms separately.Our results indicated that most trauma patients were > 18 years and males. Other studies have pointed to this , 18. TheThe most common mechanism of trauma was RTAs. This finding is consistent with previous studies , 17, 25.In this study, RTAs had a significant association with the season and hospital length of stay. So, the odds of referral due to RTAs compared to other, in patients in spring compared to winter decreased and this decrease was significant. Haji Aghajan et al. reported that the number of RTAs was higher in the summer followed by spring . One of In line with the results of our study, in other studies falls were the second cause of trauma , 23, 32.Patients with ≤18 years were more likely than patients over 18 years to transfer to the hospital for trauma caused by falls. This finding is documented; For example, a Swedish study of trauma patients under 19 years of age showed that falls were the most common injury among all age groups, except adolescents . Also, PFemales of our study were more likely than males to transfer to the hospital for trauma caused by falls. There are contradictory findings in the literature in this regard. For example; in some studies, females had a higher rate of fall –41 and iSelf-directed violence . b) Interpersonal violence  Collective violence  [c) iolence) . In thisiolence) . Also, tMales were more likely than females to transfer to the hospital for trauma caused by violence. This finding was reported in prior studies , 23. HajThe odds of referral to the hospital due to violence significantly decreased compared to other of trauma in spring and autumn compared to winter and this decrease was significant. This result is in contrast to the results of a study in Norway. The study pointed out that the highest frequency of violence had occurred in June. Reasons for these contradictory results could be included such as differences in geographical locations, climatic, genetic, and social factors .Based on the latest report of WHO, although burns are preventable, about 180,000 deaths every year are caused by burns that the majority of them occur in low- and middle-income countries . Our stuWomen and children are vulnerable to burns . PatientThere are conflicting results about being at risk of burns based on gender in prior researches. For example; in line with our study, Cutillas et al. found that women were more frequently victims of burns than men . AccordiAlthough, the odds of referral to the hospital due to burn significantly decreased in the evening, Chein reported that the most common hours for occurring burn were 10:00 to 12:00 h and 16:00 to 18:00 h when family members are preparing lunch and dinner . In our Hospital length of stay (LOS) is considered as an important criterion to evaluate trauma care . ReductiOur study had two limitations. First, the mortality rate of trauma patients was based on hospitalization only. Second, we were not able to investigate the Injury Severity Score (ISS). Because this score was not recorded in the Health Information Management (HIM) Center of the studied hospital.Large sample size was the strength of this study. Larger sample sizes give more reliable results with greater precision and power.Based on the investigation of 29,804 trauma patients, in Iran as a developing country, RTAs and falls were two common mechanisms of trauma. It seems that as a short-term plan, it is possible to focus on road safety, to improve the quality of vehicles, to hold training courses for drivers. Also, as a long-term goal, considering that the elderly population in Iran is increasing, it is necessary to pay attention to fall reduction programs.


Periodontitis (PD), a common chronic inflammatory disease, may be associated with the subsequent development of atrial fibrillation (AF) through a mechanism of systemic inflammation. However, little is known about the impact of PD on the recurrence of atrial fibrillation after catheter ablation (CA).A total of 132 patients  who underwent periodontal examinations and the first CA for paroxysmal atrial fibrillation (PAF) were investigated. Clinical periodontal examination was performed by independent trained periodontists, and patients were diagnosed with PD when the maximum periodontal probing depth was equal to or greater than 4 mm and bleeding on probing was evident. Of these, 71 patients (54%) were categorized as those with PD (PD group) and the other 61 (46%) as those without PD (non-PD group). Pulmonary vein isolation was performed in a standard fashion.p = 0.024) during a median follow-up period of 3.0 (interquartile range: 1.1–6.4) years. Cox regression analysis revealed PD as a significant predictor of arrhythmia recurrence , after adjusting for age and gender.Kaplan–Meier curve analysis revealed worse atrial arrhythmia recurrence-free survival probabilities after CA for PAF in the PD group than in the non-PD group (64.8% versus 80.3%, respectively; Periodontitis was independently associated with an increased risk of arrhythmia recurrence after the first CA for PAF. Our results may suggest that the periodontal status is potentially a modifiable determinant of the outcomes after PAF ablation, and further prospective studies are warranted. Periodontitis (PD) is a chronic inflammatory disease primarily initiated by the response to periodontopathic bacteria in the periodontium surrounding and supporting teeth . The gloThe prospective observational registry for the assessment of the association between cardiovascular disease and periodontal disease was conducted between May 2012 and August 2015 at Tokyo Medical and Dental University Hospital. The registry enrolled 1,000 consecutive patients with written informed consent who were admitted to the Department of Cardiovascular Medicine. The original protocol was approved in March 2012 by the institutional review board (IRB) of the Tokyo Medical and Dental University (MD2000-1165). All participants underwent a periodontal examination during hospitalization to assess their periodontal status. The ancillary protocol, which was additionally approved by the IRB in 2020 (M2020-020), was performed to collect the long-term clinical follow-up data of the participants from the original protocol by reviewing the clinical records in 2020. Of the 1,000 enrolled patients, a total of 135 patients who were hospitalized to undergo first CA for PAF were identified. After excluding three patients in whom the periodontal status was not examined (insufficient number of teeth), 132 patients were investigated in the present study. This study complies with the ethical principles of the Declaration of Helsinki.Periodontal examinations were performed before CA by three independent periodontists (certified by the Japanese Society of Periodontology) who were blinded to the patients’ characteristics and cardiovascular disease statuses. The number of remaining teeth were counted. The probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BoP), and Community Periodontal Index (CPI) at six points per tooth  on six representative teeth  were measured using a manual probe . When the corresponding tooth was missing, the adjacent tooth was used instead. PPD was defined as the distance from the gingival margin to the bottom of the periodontal pocket, CAL was defined as the distance from the cementoenamel junction to the bottom of the periodontal pocket, and BoP was defined as bleeding from the gingiva at the probe tip. CPI is a screening measurement of the periodontal condition that assesses the presence or absence of periodontal pockets, calculus, and gingival bleeding, and it is scored from 0 to 4. In this study, patients were diagnosed with PD when the maximum PPD was equal to or greater than 4 mm with positive BoP.Porphyromonas gingivalis, Prevotella intermedia, and Aggregatibacter actinomycetemcomitans) in the periodontal pocket and saliva were evaluated using real-time polymerase chain reaction. Furthermore, the serum immunoglobulin G (IgG) titer against each bacterium was measured.The presence of three major periodontal bacteria , and brain natriuretic peptide (BNP). The left ventricular ejection fraction and left atrial diameter were evaluated by transthoracic echocardiography before CA.All procedures were performed under moderate or deep sedation and continuous heparinization to maintain the activated clotting time >300 s after the transseptal puncture. All patients in the current study underwent pulmonary vein (PV) isolation with a radiofrequency catheter under the guidance of a three-dimensional mapping system , cryoablation , or hot balloon  at the operator’s discretion. The procedural endpoint was defined as the electrical isolation of the PV. Additionally, a majority of the patients underwent cavotricuspid isthmus ablation, and some patients underwent adjunctive ablation  at the operator’s discretion.Clinical outcomes after CA were assessed by reviewing the medical records. Atrial arrhythmia recurrence was defined as an episode of AF, atrial flutter, or atrial tachycardia lasting 30 s or longer after a 3-month blanking period, with or without the use of antiarrhythmic drugs. 12-lead electrocardiogram was recorded at every visit to the outpatient clinic, and 24-h Holter monitoring or 1-week event loop recorder was encouraged to be performed at 3- and 6-months and every 6-month thereafter. If patients were symptomatic suggesting atrial arrhythmia recurrence, an electrocardiogram, Holter monitoring, or event loop recorder was performed in addition.t-test or Mann–Whitney U test, as appropriate. Categorical variables were presented as numbers with percentages and analyzed using the chi-squared test or Fisher’s exact test, as appropriate. Kaplan–Meier analysis was performed to compare clinical outcomes between the patients with and without PD. To provide separate descriptions of the short- and long-term risks of recurrences, a landmark analysis with a landmark set at 1 year was performed. Cox proportional hazards model was used to identify the independent predictors of recurrent arrhythmia after CA. The associated variables showing a p-value < 0.150 in univariate analysis were entered in the multivariate model with patients’ age and gender, and stepwise regression was performed using the Akaike information criterion to fit the regression model.All statistical analyses were performed using R software . Continuous variables are presented as mean ± standard deviation or median with interquartile range (25th–75th percentile) and analyzed using the Student’s p = 0.046; BNP: 57 [24–98] and 33 [15–59] pg/mL, p = 0.016). The patients’ age, white blood cell counts, and left atrial diameter showed non-significant trends toward higher values in the PD group than in the non-PD group .Of the 132 patients, 71 patients (54%) were included in the PD group, and 61 (46%) were in the non-PD group. The baseline patient characteristics are shown in P. gingivalis and P. intermedia were more frequently detected in the periodontal pocket and in the saliva in the PD group than in the non-PD group. The serum IgG titer for P. gingivalis was significantly higher in the PD group than in the non-PD group.The baseline periodontal conditions in the two groups are summarized in The procedures performed on each patient are shown in p = 0.024) (p = 0.048) (p = 0.305). After 1 year, there was a continuous separation of the curves in the Kaplan–Meier analysis, with a significantly worse atrial arrhythmia recurrence-free survival rate in the PD group (Log-rank: p = 0.020)  arrhythmia recurrences were observed in 132 patients at a median follow-up period of 3.0 (1.1–6.4) years. In the Kaplan–Meier analysis, worse atrial arrhythmia recurrence-free survival rate was observed in the PD group than in the non-PD group  . In the = 0.024) , while m= 0.048) , which w= 0.048) . The mul= 0.048) . In the = 0.020) . The mulTo the best of our knowledge, this is the first study which demonstrates a significant association between PD diagnosed by performing periodontal examinations and the recurrence of arrhythmia after CA. The main finding of this study was that concurrent PD was an independent predictor of recurrent atrial arrhythmia after the first CA for PAF in multivariable Cox regression analysis adjusting for other clinical factors.Periodontitis is a common and well-known chronic oral inflammatory disease. Previous studies reported that subjects with PD are more susceptible than those without PD to the infiltration of periodontal pathogens into the systemic circulation, which potentially causes bacteremia through oral interventions, such as dental treatment or tooth extractions, and even through activities in daily lives, including chewing, biting, toothbrushing, and flossing , 13. It A variety of factors, such as the age, other structural heart diseases, the blood pressure, the alcohol intake, obesity, and genetic factors, have been reported to play a role in modifying the electrophysiological substrate of AF , 18. SysIn animal models, induced PD led to an inflammatory response and remodeling of the atrial myocardium, facilitating AF inducibility . In addiPeriodontitis is a common disease worldwide, and at the same time, it is preventable and modifiable with oral health care , 30. PreThere are several limitations in this study. First, this is a single-center observational study. Although consecutive patients were enrolled in the study, potential selection bias cannot be ruled out. Further studies are required to prove a causal relationship between PD and AF. Second, this study comprised relatively small number of patients which precluded the assessment of the impact of each component of periodontal status on the arrhythmia recurrence after CA. In addition, because of limited sample size, it was difficult to determine the interaction and collinearity of PD with other clinical factors related with arrhythmia recurrence. Likewise, relatively small number of cases in our study may not have had sufficient statistical power to demonstrate significant associations of known risk factors with AF recurrence. Future studies will have to prospectively explore collinearity and interaction of PD and known predictors of recurrent AF with sufficient sample size. Third, arrhythmia recurrence after CA was diagnosed based on electrocardiogram documentation or recording of a 24-h Holter or a 1-week event loop recorder. Thus, asymptomatic recurrence may have been missed by examinations, and the recurrence rate might have been underestimated. Fourth, changes in the periodontal status before and after index CA were not assessed, and the information on the periodontal treatment was also lacking, which may have affected the clinical outcomes. Fifth, strategies in CA procedures were left to the operators’ discretion, which may have affected the outcomes. Finally, this study excluded patients with persistent AF because of a different recurrence rate from PAF.In this study, we investigated the patients who underwent periodontal examinations during admission for fist CA due to PAF. The presence of PD diagnosed by periodontists at baseline was a significant risk factor for recurrent atrial arrhythmia in long-term follow-up. Future studies are required to confirm whether oral health care may reduce the recurrence of PAF after CA.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the IRB of the Tokyo Medical and Dental University. The patients/participants provided their written informed consent to participate in this study.AT was responsible for the data collection, investigation, analysis, and original draft writing. TY participated in the conceptualization and methodology of the work and edited the manuscript. NA, YS-W, and TN contributed to the data collection and investigation. SM, YM, MG, MI, and TI reviewed and edited the manuscript. TS supervised the work. All authors listed have made a substantial contribution to the work and approved the final version of the manuscript.


As one of the countries with the most serious degree of aging, the incidence of potentially inappropriate drug use among the elderly is as high as 30. 4% in Chinese communities, and the lack of effective medication management and poor medication compliance at home are the main factors. Given these situations, we constructed a Rational Medication Management Mode based on family physician service, carried out an empirical research and evaluated the implementation effect.A prospective cohort study was conducted from September to December 2021 to analyze the implementation effect of the Rational Medication Management Mode by comparing the outcome indicators between the intervention group and control group. The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days. The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use.P < 0.001). Patients with medication reminders, intermittent medication and adverse drug reactions were achieved in 294 (95.15%), 47 (15.21%), and 51 (16.51%) respectively in the intervention group (P < 0.001). The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days (P < 0.0001).A total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. At 90 days, the number of medications was achieved by 3.88 (1.48), and patients with polypharmacy were reduced by 59.55% in the intervention group, having a significant difference compared with the control group (The Rational Medication Management Mode based family physician service, which provides the support of manuals and pillboxes, can decrease the elderly patients' number of drugs with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication usage behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China. The elderly have a high prevalence of chronic diseases, and often suffer from multimorbidity, requiring long-term medication . As the etc. Worldwide, more than 50% of all medications are inappropriately prescribed, dispensed, or sold, while 50% of patients fail to take them correctly  put forward the concept of rational medication use in 1985, which refers to patients receiving medications appropriate to their clinical needs, in doses that meet their requirements, for an adequate period, and at the lowest cost to them and their community . Irratioorrectly . Technol reviews . Some st reviews , such as reviews , 12, whi reviews .As one of the countries with the most serious degree of aging, there are 182.17 million elderly people aged 65 and over who suffer from at least one chronic disease in China, with an average of 3.1 diseases per capita , 15. RelGiven these situations, we constructed a rational medication management mode based on family physician service, carried out empirical research and evaluated the implementation effect, improving elderly patients' health outcomes and providing a reference for the policy-making of rational medication management for the elderly in China.Based on family physician service, the Rational Medication Management Mode in this current study specifically refers to the joint participation of family physicians, pharmacists, family physician assistants, nurses, elderly and their family members to carry out medication reconciliation and drug use guidance through medication management manual and pillbox.The medication management manual (tool) in this study contained “Basic information”, “Diagnosis and treatment”, “Medications list”, “Health care products list”, “Medications record weekly table”, “Health-related index record weekly table”, “Self-evaluation of medication use compliance” and “Medication management evaluation from family physician” eight functional modules, which are jointly recorded by the family physician team, elderly patients and their families  complete functions with medication management, health monitoring, health education, etc; (ii) the family physician signing rate of the elderly aged 65 years old is more than 90%; and (iii) the family physician team organized well, equipping with general practitioners, nurses, pharmacists, family physician assistants, etc.The selected community healthcare centers have the following characteristics:  of an average number of drugs was 1.71 (σ), and the difference value between the two groups was 0.49 (δ), so the calculated sample size was 256 per group. In this study, convenience sampling was used to select contracted elderly patients with comorbidity by family physician, and the propensity score matching was used to perform 1:1 matching on the baseline data of age, gender, living areas, marital status, education, living pattern, monthly income, insurance type, number of diseases and number of medication. Ultimately, 618 elderly patients with multimorbidity were enrolled in this study (309 in the intervention group and 309 in the control group) after propensity score matching. Considering the drop-out rates of 10%, the sample size still meets the calculation requirements. The flow chart of implementation effect research of the Rational Medication Management Mode is illustrated in where α is 0.05, Z value is two-sided, so ZThis study was approved by the Ethics Committee of School of Public Health, Fudan University .i) aged 65 ~ 75 years old; (ii) suffering from 2 or more common chronic diseases currently ; (iii) taking 2 or more drugs (including over-the-counter drugs); iv) require long-term medication; v) the condition is stable without acute symptoms; (vi) having health records in the community healthcare center and continuously visiting and prescribing drugs for more than 3 months; (vii) voluntarily participate in intervention projects and obtain informed consent.Referring to the screening criteria of relevant modes , this st(i) consciousness disorders or communication difficulties; (ii) currently using medication reminder software; (iii) unstable condition; (iv) those who have plans to go out in the last 3 months, and the time of going out is more than 1 month; (v) not suitable to participate in this study from a specialist point of view (such as incapacity).Patients with the following conditions were excluded: Those participants who dropped out and lost follow-up were excluded. If the subjects did not arrive at the community healthcare center within 3 months and could not be contacted, they were regarded as lost to follow-up.The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days.i) medication reminders and its methods, (ii) intermittent medication and its reasons, and (iii) occurrence and handling of adverse drug reactions (ADRs).The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use. The behavioral self-management included the indicators of , the cumulative variance interpretation rate was 67.30% when the eigenvalue is > 1, indicating good validity.The adapted scales were used for the evaluation of knowledge-belief-behavior for the rational medication see  21, 22), 2221, 2t-test for normally distributed measures, non-parametric tests for non-normally distributed measures, and chi-square test and Fisher exact probability method for counting data. A P value < 0.05 was considered significant.IBM SPSS Statistics 23.0 was used for data analysis. The data normality test was performed on the measurement data; the mean ± standard deviation was used to describe the measurement data with normal distribution; the quartiles were used to describe the measurement data with non-normal distribution; the composition ratio (%) was used to describe the count data. The differences between groups were analyzed by A total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. Baseline characteristics of demographic and health status of the study participants are presented in P > 0.05). There was a statistical difference in the type of medical insurance between the two groups (P = 0.01). The homogeneity of baseline characteristics for the two groups is strong, especially the indicators of disease and medication, which were comparable.There was no significant difference between the intervention group and the control group in age, gender, living area, marital status, education, living pattern, household income per capita monthly, the number of diseases, and the number of medications (P = 0.001) (P < 0.001). The Rational Medication Management Mode had a positive effect on medication reconciliation (P = 0.024), while the conventional medication management was less effective (P = 0.91). Data on indicators are presented as the absolute change and percent change at 90 days from the baseline in each table.At 90 days, the number of medications was achieved by 3.88 (1.48) in the intervention group, while 4.32 (1.87) in the control group, which had a significant difference between the two groups (= 0.001) . And patP < 0.001)  and 182 (58.90%) in the intervention group and control group respectively, which had a significant difference between the two groups (< 0.001) . For theP < 0.001) .Patients with intermittent medication were reduced to 47 (15.21%) from 148 (47.90%) in the intervention group at 90 days, having a significant difference compared with the control group (< 0.001) . For theP = 0.01) (P < 0.0001).At 90 days, patients who occurred on ADRs were reduced to 51 (16.51%) from 88 (28.48%) in the intervention group, having a significant difference compared with the control group ( = 0.01) . For theP < 0.0001), which was statistically different compared with the control group (P < 0.0001), explaining the Rational Medication Management Mode had a positive effect on health education for elderly patients. Data on these measures are presented as the absolute change and percent change at 90 days from the baseline in The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days .Ensuring medication safety in polypharmacy is one of the key challenges for medication safety today. All stakeholders, including physicians, nurses, pharmacists, and even patients and their families, could have a vital role to play in driving change for the management of multiple drugs. Patients should be viewed as shared decision-makers on the use of medication, and health care professionals need to encourage and support patients and their families to disclose all the medications they are taking, including over-the-counter, traditional and complementary medicines, especially if they are suffering from multiple conditions and are being treated with polypharmacy –29. FamiP < 0.05).Elderly chronic diseases and medication management need to pay attention to the establishment of an efficient interactive relationship with patients, strengthening the persistence of drug records and the self-management ability of patients –35. For P < 0.0001). It is worth noting that, for the evaluation of knowledge and behavior compliance, the proportion of low levels in the control group is significantly reduced compared with the baseline (P < 0.05), while there is no statistical difference in high levels. The evaluation of medication behavior security also showed a similar situation, the reduction degree of dangers level was greater than the improvement degree of the relatively safe level. This indicates that with the improvement of living standards and various health education, elderly patients began to enhance their awareness level of medication use, paying attention to knowledge learning and behavior improvement. However, in this process, it is difficult for elderly patients to find a scientific path of improvement by relying on their own experience and learning. Rational Medication Management Mode based on family physician services can help the elderly to learn drug use knowledge and adopt healthy behavior scientifically, and improve the long-term management efficiency of family physician teams, to maximize health effect gain and reduce the disease burden.If the elderly have weak awareness of rational drug use, it is hard to fully realize the value of medication management to improve their health status. Health education for patients plays a key role in the prevention and early detection of medication use and related health problems by raising their awareness of irrational drug use , 36–38. This study still has some limitations. First, some information on secondary outcomes was obtained through the self-reported questionnaire, which may constitute a reporting bias. However, this is likely to be an undifferentiated bias. Second, the experimental time of this study is short. And the mode needs certain application conditions, such as economically developed areas, mature family physician services, pharmacist equipment. However, after the effectiveness of this mode has been confirmed, we have begun to pilot promotion, and started to optimize the applicability of the mode, attempting to promote and apply it to other regions and key populations.To sum up, this study constructed a Rational Medication Management Mode and carried out an empirical research to evaluate the implementation effect. The mode-based family physician service, which provides the support of manuals and pillboxes, can decrease the drug numbers of elderly patients with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication use behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China.tangqi@fudan.edu.cn.The datasets presented in this article are not readily available because the datasets generated during and/or analyses during the current study are available from the authors on reasonable request. Requests to access the datasets should be directed to QT, The studies involving human participants were reviewed and approved by the Ethics Committee of School of Public Health, Fudan University . The patients/participants provided their written informed consent to participate in this study.JuL and GC conceived and designed the research and critically reviewed the manuscript. QT analyzed the data, wrote the initial manuscript and generated the tables and figures. LW revised the manuscript critically for important intellectual content. JiL, WW, and ZL helped in data collecting. SZ proofread the manuscript. CL supervised the research. All authors approved the final version of the paper and take responsibility for its content. All authors contributed to the article and approved the submitted version.This study was supported by the Major Project of National Social Science Foundation of China (Grant No. 17ZDA078), National Natural Science Foundation of China (Grant No. 72004030) and Policy Research Project of Shanghai Municipal Health Commission (Grant No. 2022HP53).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.


This outcome was also verified by other methods including weighted median , simple mode , and weighted mode . No heterogeneity and directional pleiotropy was observed upon sensitivity analysis, indicating the stability and reliability of the result. In summary, the present study showed that RA potentially increases the risks of complications of prosthesis, which might provide guidance in arthroplasty on RA patients.The causal effects of rheumatoid arthritis (RA) on complications of arthroplasty are yet to be established. This study was the first to explore the causal effect of RA on mechanical complications of prosthesis through two-sample Mendelian randomization (MR). In the MR analysis, RA was selected as the exposure in this study while single-nucleotide polymorphisms (SNPs) from a genome-wide association study (GWAS) were selected as the instrumental variables (IVs). Summary statistics data on mechanical complications of prosthesis was extracted from publicly available GWAS data, including 463,010 European descent individuals. MR analysis was performed using the standard inverse variance weighted method (IVW). Furthermore, other methods  were also done to verify the results. Finally, the sensitivity analysis was executed. Results of the standard IVW showed that RA possibly increases the risk of mechanical complications of prosthesis [OR = 1.000255; 95% CI = ;  Arthroplasty is a common surgical strategy in the management of end-stage arthritis, with the aim of restoring joint function and improving the patient’s quality of life . HoweverRheumatoid arthritis (RA) is a chronic systemic autoimmune disease characterized by joint synovitis . RA poteMendelian randomization (MR) is a novel approach in which genetic variants serve as instrumental variables to determine the causal effect of exposure on the outcome. The observational research results were unable to provide strong evidence for the causal effects and the formulation of prevention and control strategies secondary to confounders and biases . On the The aim of this study was to explore the causal effect of RA on arthroplasty complications, specifically mechanical complications, through two-sample Mendelian randomization. To the best of the author’s knowledge, this was the first study to explore the causal effect of RA on mechanical complications of arthroplasty through Mendelian randomization.via a direct correlation. It was evaluated by using many MR methods  in MR analysis. In this study, single nucleotide polymorphism (SNP) was selected as the IV. Three conditions had to be fulfilled for MR analysis: first, SNPs which were strongly associated with RA (exposure) must be strictly screened and weak IVs have to be removed according to F-static; second, selected SNPs must be independent of confounders. It was verified using the pleiotropy test; third, SNPs must affect mechanical complications of prosthesis (outcome) only by RA (exposure) rather than  methods .p < 5 × 10−8) SNPs were extracted as instrumental variables, and linkage disequilibrium was tested (r2 < 0.1). Harmonizing was conducted to ensure that the effect allele of IVs in the exposure and outcome are consistent across different databases. To avoid the reverse causality in MR analysis, the Steiger filtering test was also performed to exclude SNPs that explain more of the variance in the outcome rather than the exposure.This two-sample MR study was performed based on GWAS summary data. In addition, both the GWAS summary data were based on European ancestry. RA summary statistics data published by https://gwas.mrcieu.ac.uk/datasets). The data had a total of 463,010 European descent individuals, including 1,178 cases and 461,832 controls of European descent. The mechanical complication of internal joint prosthesis conformed to the main ICD10: T84.0 diagnosis criteria. All studies that contributed data in the analyses were approved by relevant ethics committees, and all participants have provided written informed consent.For the outcome data, summary statistics for mechanical complications of prosthesis were obtained from a recent, publicly available GWAS data  method . The WalFurthermore, other MR methods, including MR Egger, weighted median, simple mode, and weighted mode, were also used to estimate the causal effect of RA on mechanical complications of prosthesis .p < 0.05). A web-based application (https://sb452.shinyapps.io/power/) was used to calculate the power of the MR analysis.Considering that biases might be caused by IVW in the presence of horizontal pleiotropy, sensitivity analysis, including the heterogeneity test, pleiotropy test, and leave-one-out sensitivity test, was also performed to assess the reliability and the stability of MR results. In addition, the MR-PRESSO  test was conducted to detect potential outliers and pleiotropy . The intp < 0.05 considered to be statistically significant. Since publicly available summary data was used in this study, no ethical approval was needed.All statistical analysis were performed in R software (Version 3.6.1) with the R package “TwosampleMR.” The calculations are available in p < 5 × 10−8) and independent (r2 < 0.1) SNPs were selected for MR analysis. A total of 115 SNPs were found to be significantly associated with RA. Twenty-six SNPs were selected as IVs after harmonising and steiger filtering for further MR analysis with a resulting mean F-statistic of 193.16 and average R2 of 0.007. The details of these SNPs are provided in To assess the causal effect of RA on mechanical complications of prosthesis, the significant ; p = 1.41 × 10−3], simple mode , and weighted mode  showed similar results.The MR analysis results are summarized in p = 0.085) . Furthermore, the MR-PRESSO test was used to validate the absence of outliers and potential pleiotropy. Finally, the leave-one-out sensitivity test was performed, and the results showed that the causal effect of RA on mechanical complications of prosthesis was not significantly fluctuated with any single SNP leave-out  . The MR-eave-out , suggestWith the advent of an aging society, arthroplasty surgery is performed on more patients. According to Steven et al., the number of total hip arthroplasties in the United States is estimated to be 572,000, while the number of total knee arthroplasties is estimated to reach 3.48 million by 2030 . Total kRheumatoid arthritis (RA) is an autoimmune disease, which potentially results in joint deformities at the end stage. With this, several patients would opt to undergo arthroplasty as a last resort to recover joint function. Due to the systemic nature of RA, its postoperative complications differ from other articular diseases. Christoph Bohler et al. have suggested that compared to patients with osteoarthritis (a disease without systemic inflammation) who receive total knee arthroplasty, RA potentially increases the risk of aseptic loosening and the number of patients who require revision surgery . Grzelecp = 9.69 × 10−4], and this result was considered stable and reliable upon verification by sensitivity analysis. Based on this result, greater attention should be given to RA patients who are going to receive arthroplasty. In addition, the treatment of RA and the specific-type prosthesis should be taken into consideration for these patients.As far as the authors are aware, this was the first study to use the Mendelian randomization to explore the causal effects of RA on mechanical complications of prosthesis after arthroplasty. Mendelian randomization was utilized to investigate the causal effects by using SNPs as IVs and has been widely used in epidemiological studies of various diseases. The present study showed that RA potentially increases the odds of complications of prosthesis [OR = 1.000255; 95% CI = ; A number of limitations are present in this study. First, the present study only focused on the causal effects of RA on mechanical complication of prosthesis; however, it is still unclear whether the course and disease activity of RA, social health determinants such as mental health and economic circumstances of RA patients have a role in this relationship. Second, this study was based on European ancestry and such a causal effect might be different in other races. To increase the reliability of this result, further MR analysis based on different ancestries should be performed. Third, the power of MR analysis could not be calculated since the SD of the GWAS analysis of the RA was not included in the study. Finally, weak instrument bias might arise in MR and result in weak relationships.In summary, the present study performed a two-sample MR analysis for the first time to investigate the causal effect of RA on mechanical complications of prosthesis. Results of this study showed that RA potentially increases the risk of the mechanical complications of prosthesis after arthroplasty.


Immunothrombosis is a mechanism of defense of the organism against pathogenic microorganisms that increases their recognition, limitation, and clearance and is part of the innate immune defense. Physiological immunothrombosis is beneficial to the body against the invasion of pathogenic microorganisms, but when immunothrombosis is out of control, it is easy to cause thrombotic diseases, thus, causing unpredictable consequences to the body. Neutrophils play a pivotal role in this process. Understanding the mechanism of neutrophils in immune thrombosis and out-of-control is particularly important for the treatment of related thrombotic diseases. In this review, we studied the role of neutrophils in immune thrombosis and each link out of control . Neutrophils are phagocytes derived mainly from bone marrow and extramedullary myeloid progenitors, which mainly play a role in resisting the invasion of pathogenic microorganisms in normal bodies and belong to the innate immunity of the body . Recent α, and so on), chemokine , adhesion molecules  to activate and recruit neutrophils in circulation [V. harveyi, P. fluorescens, and E. tarda) are not completely killed and can still replicate slowly and continuously stimulate inflammation and complement activation [Endothelial cells (ECs) belong to monolayer flat epithelial cells, which mainly regulate plasma-tissue material exchange, participate in blood coagulation, regulate vascular tension and recruit related blood cells . In addiculation . Sepsis culation . Activatculation . When thculation , which pculation . Moreoveculation –15. In ativation . Proinfltivation , exacerbtivation . Furthertivation –21. The α) and other substances, ultimately leading to an increased inflammatory response [α9β1 was also found to be highly expressed on activated neutrophils and to play an important role in mediating platelet aggregation, in which the authors prepared myeloid-specific integrin α9−/− mice and found a significant reduction in neutrophil-mediated platelet aggregation in these mice [α granules and increase the expression of P-selectin on its membrane surface. Through P-selectin binding glycoprotein ligand (PSGL), neutrophils directly bind to neutrophils and activate neutrophils to form neutrophils-platelet complexes  [Platelets are key molecules in the process of physiological hemostasis and pathological thrombosis in the body and are fragments of nucleated cells produced by the lysis of bone marrow megakaryocytes. Recent studies have shown that platelets also play an important role in the immune system . Under normal physiological conditions, platelets in the blood exist independently of neutrophils, and when a pathogen invades the body, it first causes local inflammation by pattern-recognizing receptor activation and destruction of endothelial cells. The formation of inflammation will lead to the deposition of fibrinogen in the plasma, and some circulating platelets are activated by the deposited fibrinogen and form platelet pseudopods that continuously scan and promptly detect sites of bacterial infection within the vascular endothelium, subsequently recruiting more platelets to activate and rapidly recruit and migrate via integrin receptors to accumulate on the endothelial cell surface at that site, trapping the pathogen and preventing its further spread . Activatresponse . In addiresponse . In addiresponse . Maugeriresponse –30. Platresponse . Moreoveese mice . In contese mice , 34, Andese mice . In addies, PNC) . On the es, PNC) . The fores, PNC) –40. In cαMβ2 on the surface of neutrophils and increasing their intracellular calcium ion concentration and extracellular DNA release, as verified by Stavrou EX et al. Using an FXII −/− knockout-deficient mouse model [Streptococcus pneumoniae or Klebsiella pneumoniae pneumonia, thus, increasing the immune function of neutrophils [αMβ2 and promote the production of reactive oxygen species by neutrophils and the release of NET [α-defensins (α-defs) when they are activated. Under pathological conditions, the substance can directly bind to fibrin, promote the polymerization of fibrin, increase the quality of fibrin, and hinder the dissolution of fibrin [α can also promote TF expression in endothelial cells, and the authors found that 15-epi-lipoxin A4 can inhibit this process [Similar to platelets, coagulation factors also play a role in hemostasis and thrombosis in the body, forming an exogenous coagulation pathway with TF as the trigger and an endogenous coagulation pathway with factor XII (FXII) as the trigger, through which the coagulation cascade in the body is triggered, leading to the formation of fibrin and cross-linking with platelets to promote hemostasis or thrombosis. Recent studies have shown that coagulation factors also have immune-related functions and can interact with neutrophils to promote immune thrombosis. FXII as a trigger condition for the endogenous coagulation pathway was found to promote neutrophil recruitment and migration and NET release by upregulating the expression of integrin se model . FXII ortrophils . In a sttrophils . In addie of NET . It is cf fibrin . In a stf fibrin . In addif fibrin , In addi process . It is w process , and tha process . Coagulat-PA), urokinase plasminogen activator (u-PA), and nucleoside diphosphate hydrolase-1 (CD39) [γ receptor subtype FcγRIIa on the cell membrane, promote platelet release of particles and related procoagulant factors, stimulate neutrophils to form NET, and enhance their interaction [β2 integrins on the surface of neutrophils and increase their affinity, ultimately increasing neutrophil recruitment and infiltration at the site of damage [In addition to the participation of the cells and molecules mentioned above, the dysfunction of the anticoagulation system and the fibrinolysis system is also involved in the process of immunothrombosis. As mentioned above, when a large number of pathogens invade the body through the vascular system, a large number of neutrophils are recognized and recruited by endothelial cells, resulting in inflammation, and eventually a large number of endothelial cells are damaged. The integrity of endothelial cells is an important part of the anticoagulant system. It can express a large number of natural anticoagulants such as glycosaminoglycan, endothelial protein C receptor, tissue factor pathway inhibitors and thrombomodulin and secrete anticoagulant molecules such as tissue plasminogen activator (1 (CD39) , 51. Mas1 (CD39) . In addi1 (CD39) . Howevereraction , 55. In eraction . One stueraction , suggesteraction , it can f damage . Tissue f damage . In addif damage . During f damage . It has f damage , 64. UltThe formation of immunothrombosis belongs to the normal physiological phenomenon of the body against harmful stimuli (such as pathogens), which can limit the further spread of pathogens, which is undoubtedly beneficial to the body. After exerting immune function, a small amount of NET in immunothrombosis can be cleared by macrophages and DNA enzyme , 66, and


As a major source of added sugar, the consumption of sugar-sweetened beverages (SSBs) continues to increase worldwide. The adverse health effects associated with SSBs are also risk factors for cognitive development, but studies on the relationship between SSBs and adolescents' cognitive function are limited. We used data released by the National Health and Nutrition Examination Survey (NHANES) III (1988–1994) to explore the association between the consumption of SSBs and cognitive function among children and adolescents aged 12–16 years in the United States.A nationally representative population sample included 1,809 adolescents aged 12–16 years who participated in the United States NHANES from 1988 to 1994 and provided samples for the dietary intake frequency questionnaire and measures of cognitive function. Binary logistic regression was used to estimate the association between the frequency of SSB consumption and scores on cognitive function tests.P for trend 0.02). Stratified analyses showed that compared with normal or below BMI, among overweight or obese individuals, the frequency of SSB intake had significant ORs for abnormal digit span scores .This study of 1,809 adolescents aged 12–16 years comprised 963 girls  and 846 boys , with a weighted mean (SE) age of 13.99 (0.05) years. Compared with adolescents who intake SSBs 0–1 times per week, those who drank 4–7 times per week had better scores in arithmetic, reading, and digit span tests, with odds ratios (ORs) of 0.36 (95% CI = 0.16–0.82), 0.35 (95% CI = 0.18–0.70), and 0.19 (95% CI = 0.08–0.44), respectively. The ORs for abnormal block design scores increase with the frequency of SSB intake after being adjusted for potential confounders (The positive associations of SSBs at moderate level intake with better scores in arithmetic, reading, and digit span were observed, but no dose-response relationship was identified at the overall level. Additionally, with the increasing frequency of SSB consumption, the risk of anomalous block design scores increased among US adolescents. Further investigation is warranted to confirm the association and mechanism between SSBs and cognitive function among adolescents. Sugar-sweetened beverages (SSBs) are the major source of added sugar, representing a nutritionally poor, calorie-dense but palatable type of drink that is appealing to children and adolescents . The conCurrent studies indicated that increased consumption of SSBs is associated with a number of health risks, including cardiometabolic burden, increased risk of obesity, type 2 diabetes, hypertension, and metabolic syndrome among people of all age groups –7. MoreoDuring adolescence, the brain is undergoing rapid structural and functional development, and the neurofunction of adolescents can easily be disturbed by external factors during the special period , 12. AltThe cognitive function plays an essential role in learning, daily life, and academic performance in early life, which is affected by multifactor including diet . It has However, an early meta-analysis from the 90s concluded that sugar did not affect children's behavioral or cognitive performance . In addiTherefore, in this study, we used data published by NHANES III (1988–1994) to examine the association between the consumption of SSBs and cognitive function among adolescents aged 12–16 years in the United States.Our analysis was based on 1988–1994 cross-sectional data from the NHANES III database, a nationally representative survey regularly conducted by the US Centers for Disease Control and Prevention. A stratified multistage clustered probability design involving two 3-year phases was used to select a sample of the civilian noninstitutionalized US population at and above 2 months of age. Detailed descriptions for the survey are available elsewhere .N = 1,825). After excluding 9 intellectually disabled and 7 children and adolescents who attended or needed special schools due to health conditions, 1,809 adolescents remained for the primary analysis.NHANES III included medical and cognitive examinations and interviews conducted with survey children and proxy respondents. The primary purpose of this study was to examine the relationship between SSB intake and cognitive function in adolescents. In the original study, cognitive examinations were administered to children and adolescents aged 6–16 years, and dietary intake frequency questionnaires were administered to adolescents aged 12–16 years, therefore, restricted our study population to those aged 12–16 years and had cognitive function test results and SSB consumption data  and the Wide Range Achievement Test-Revised (WRAT-R). The Mobile Examination Center (MEC) interviewers were trained to conduct the WISC/WRAT examination. During annual site visits, test administration was evaluated, and retraining was performed where necessary. Two subcomponents of the WISC-R test, namely, a verbal component (Digit Span) and a performance exam (Block Design), were administered and are considered relatively culturally unbiased. In addition, two subcomponents of the WRAT-R test, namely, math and reading, were conducted. The WISC-R test was administered first and was followed by the WRAT-R. The scores for all four subcomponents used a common scale and were derived for each child relative to his/her age group based on test-specific standardization samples created by the test developers. This study used scaled scores, which were determined using calculations provided in the WISC-R Manual and WRAT-R Administration Manual , 27. Theectively .During the home interview, intakes of SSBs were determined from responses to the food-frequency questionnaire that was administered to participants to assess their usual consumption over the prior month . Food-frth percentile), an overweight BMI stratum (85th to 94th percentile), or a normal BMI stratum (<85th percentile). The grams of total carbohydrates include sugars and complex carbohydrates. The total carbohydrate figure is the difference between 100 and the sum of the protein, fat, ash, and water ], physical activity, and dietary intake was collected using questionnaires. Race/ethnicity was categorized as non-Hispanic white, non-Hispanic black, Mexican-American, and other races/ethnicity. Family income was classified as the ratio of family income to the federal poverty level  . The edund water . Accordind water . TherefoFollowing the NHANES III analytic guidelines , we applMeans and proportions of baseline characteristics were compared using ANOVA for continuous variables and chi-square tests for categorical variables. We used binary logistic regression to estimate the association between the frequency of SSB consumption and four cognitive functions. Model 1 adjusted for adolescent sex and age, whereas model 2 additionally adjusted for sociodemographic and lifestyle characteristics. In a fully adjusted model, we adjusted for age, sex, race/ethnicity, education level and marital status of family reference person, household income level, physical activity, BMI, and carbohydrate intake. Furthermore, we performed a stratified analysis to examine whether this association differed by sex, ethnicity, and BMI.P-value < 0.05 was considered statistically significant.All statistical analyses were conducted using the survey modules of SAS software, version 9.4 (SAS Institute). A 2-sided The characteristics of participants according to their frequency of SSB consumption are described in P-values for trend were 0.049, 0.04, and 0.02, respectively).The odds ratios (ORs) of SSB consumption with cognitive function in adolescents are listed in P for interaction = 0.01]. The association did not significantly differ by sex or ethnicity  vs. ; thnicity .P for trend = 0.02), and even after full adjustment, the association remained significant.To the best of our knowledge, this is the first study examining the association of SSB intake with the subset score of WISC-R and WRAT. Based on a nationally representative population sample of the United States, we observed no significant association between the frequency of SSB intake and the scores of arithmetic, reading, and digit span at the overall level in adolescents. However, consuming SSBs 4–7 times per week was positively associated with arithmetic, reading, and digit span scores, with increasing frequency of SSB consumption, the risk of anomalous block design scores increased  can be found at: The studies involving human participants were reviewed and approved by the National Center for Health Statistics Research Ethics Review Board. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.WY has full access to all the data in this study and assumes responsibility for study supervision. WY and QC conceptualized and designed the study, collected and analyzed data, carried out the initial analyses, and reviewed and revised the manuscript. XY, YX, and JZ acquired, analyzed, interpreted the data, and drafted the initial manuscript. All authors critically revised manuscripts of significant intellectual content. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.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.


This study aims to evaluate whether a nomogram based on comprehensive CT texture analysis of primary tumor and peritoneotome combined with conventional CT signs can preoperatively predict peritoneal occult metastasis in gastric cancer patients.A total of 1,251 patients with gastric cancer (GC) were retrospectively analyzed in Fujian Province Hospital between 2008 and 2020. Patients from the occult peritoneal metastasis (PM) group were initially diagnosed as PM-negative on CT and later confirmed as PM-positive through laparoscopy or surgery. The group without PM was randomly sampled from patients without PM. The preoperative CT signs and texture features and clinical characteristics of patients were retrospectively analyzed. Hazard factors of occult PM were identified by univariate analysis and multivariate logistic regression analysis, which were intended for creating prediction models. A nomogram was established based on the model with the highest predictive efficacy and clinical application value.p<0.05). A forecast nomogram was subsequently established from the model above-mentioned. The calibration curves of the nomogram indicated a good consistency (a concordance index of 0.807) between the projection and the actual observation of occult PM.A total of 31 patients with occult PM and 165 patients without PM were enrolled in this study. The maximum size, thickness, enhancement, serous involvement of primary GC tumor and ascites on CT, and texture features such as inhomogeneity of the primary tumor, standard deviation, and inhomogeneity of the peritoneum were determined as independent predictors that could be jointly applied to predict occult PM. We separately constructed five forecast models using CT signs, primary tumor texture, peritoneum texture, primary tumor texture + peritoneum texture, and their combination for predicting occult PM. These five prediction models achieved an AUC value of 0.832, 0.70, 0.784, 0.838, and 0.941, respectively. The DeLong test and Decision Curve Analysis (DCA) showed that the joint model, containing three meaningful CT signs  and two meaningful texture parameters (inhomogeneity of the primary tumor and inhomogeneity of the peritoneum), possessed the best predictive performance and clinical application (A practical projection nomogram based on the comprehensive CT texture analysis of a primary tumor and peritoneotome combined with conventional CT signs was constructed in our study, which can be conveniently used in preoperative personalized prediction of occult PM for GC patients, and acts as a recommendation for the optimization of clinical management. Gastric cancer (GC) is one of the leading causes of death in China. It is the fifth most common malignancy and the third deadliest tumor in the world, and it remains a major challenge to public health on a global scale –3. MoreoOccult PM is defined as PM that cannot be preoperatively recognized using conventional computed tomography (CT) until it is diagnosed after surgery or pathological results, which may cause patients to undergo unnecessary surgical injury due to the difficulty of obtaining the most vivid imaging interpretation about occult PM before the elective surgery. This often leads to a precarious situation because of the uncertain state concerning occult PM . Thus, pNevertheless, CT, MRI, and gastroscopy have poor sensitivity to detecting occult PM of GC. Currently, only laparoscopic exploration is able to diagnose peritoneal micrometastases. However, because it is an invasive and costly procedure, it has not been widely used in clinical practice .A great deal of imaging studies has revolved around the PM state in GC. CT should be the most appropriate image evaluation method for detecting PM  because Texture analysis is a type of comprehensive medical image analysis that is now at a stage of rapid progress. It is applied when performing quantitative analysis of tumor heterogeneity by analyzing the distribution and the relationship of pixels or voxel gray levels in the target region. The ease of obtaining texture information from routinely acquired images without additional imaging procedures is required, and accumulating data showing the correlation between heterogeneity and adverse tumor biology is a major advantage of the technique . PrelimiTherefore, it may be possible to provide more information for occult PM by excavating the CT images of the whole peritoneal and primary tumor of GC patients, which is an interesting issue that deserves further research.Hence, in order to judge the independent predictor of occult PM more comprehensively, our study aims to retrospectively investigate whether a nomogram model based on texture analysis of the whole peritoneal area combined with the entire primary tumor and conventional CT signs can preoperatively predict occult PM in GC patients.This retrospective study was approved by the institutional review board of Fujian Province Hospital, and the requirement of patients’ informed consent was waived.A total of 1,251 patients with GC who underwent surgery or laparoscopic exploration at our hospital from January 2008 to December 2020 were analyzed retrospectively. Among them, 95 (7.59%) were found to have PM on histologic examination. A total of 196 patients with GC were enrolled , in which 31 cases were occult PM. The flowchart Figure 1Patients generally underwent contrast-enhanced CT of the entire abdomen, which is from the dome of the diaphragm to the pubic symphysis according to the standard clinical scanning protocols  on CT machines . All CT scans were reconstructed into slices of 3-mm thickness and interval. After fasting from food for at least 6 h, each patient ingested about 600–1000 ml of water for more than 15 min to achieve gastric distension before scanning. All patients were trained to hold their breath in the supine position during CT scanning. After the plain CT, a 1.5 ml/kg iodinated contrast agent  was injected with a pump injector  at a flow rate of 3 ml/s into the dorsal hand vein. The CT images were obtained during the arterial phase (25–30 s after the initiation of the injection), the portal venous phase (60–70 s), and the delay phase (180 s). The acquired images were analyzed on a PACS station .The portal-venous-phase images were evaluated by two radiologists , who were blinded to the clinical and histopathological data. They retrospectively analyzed and reached a consensus for the following CT signs: GC lesion location ; tumor maximum size (the longest diameter measured at the largest cross-section of the mass); tumor thickness; degree of lesion enhancement ; serosal involvement (rough); enlarged lymph nodes ; and ascites and definitive CT findings of PM . When two physicians had different opinions, a third physician (X-fC) would evaluate the images and take the average value as the result. Discrepancies were resolved through a consensus after the joint reevaluation of the images.https://firevoxel.org) for texture analysis. The lesions of GC and peritoneotome were manually recognized under the consensus of two radiologists who were both blinded to the clinical and pathological information of the patients. They reviewed all slices of the CT images and manually drew the polygonal region of interest (ROI) along the margin of the GC lesion and the peritoneotome slice by slice; the gastric lumen, blood vessels, other organs, and artifacts were carefully avoided . A two-tailed p value of <0.05 indicated statistical significance. The Mann–Whitney U test was used to assess the differences in continuous variables, whereas the Wilcoxon rank-sum and chi-square tests or Fisher’s exact test was used for categorical variables.Data analysis was performed using SPSS 22.0 , MedCalc 15.2.2, and R software version 3.6.3  curves were applied to assess all continuous variables and then were divided into different subgroups according to the cutoff values. Subsequently, statistically significant predictors were included in the stepwise logistic multivariate regression and were used as the parameters to build the prediction model.The efficiency of the models was tested by the AUC of the ROC curve and compared by the DeLong test in MedCalc.Independent risk factors for occult PM were confirmed by multivariate logistic regression analysis as mentioned above and were used to create a model that graphically represents these risk factors. To provide a visually quantitative tool to predict occult PM in GC patients, subsequently, we developed a nomogram based on the prediction model with the best AUC value and clinical utility. Moreover, we constructed a calibration plot to reduce the overfit bias of the nomogram.A total of 196 consecutive patients with gastric cancer who underwent surgery or laparoscopy in our institution were included in the retrospective study between January 2008 and December 2020, as shown in the flowchart of the study subject selection Figure 1p< = 0.05) between the occult PM group and the group without PM in terms of the differentiation degree and serosal involvement as confirmed by pathology; CT signs of a primary tumor in terms of size, thickness, enhancement, and ascites; primary tumor texture features of standard deviation, inhomogeneity, and entropy; and peritoneum texture features of standard deviation and inhomogeneity. On the other hand, no significant difference (p> = 0.05) was found between the two groups with regard to sex; age; pathological and Lauren feature types; lymph node metastasis as confirmed by pathology; primary tumor texture features of the mean, skewness, and kurtosis; and peritoneum texture features of the mean, skewness, kurtosis, and entropy.Clinical, pathological, and texture characteristics of patients are shown in The ROC curves were applied to evaluate the continuous variables. The cutoff value for the ROC curve was determined by the Youden index, in which the highest Youden index was the most optimal level to discriminate the occult PM group from the group without PM, as shown in A total of five CT signs and three texture features were extracted from enhanced CT images during the venous phase of the 196 GC patients, and there was a good consistent agreement between the two radiologists (readers 1 and 2) for the texture features . Then, the average measurement value from the two radiologists was applied for further investigation.The preoperative CT characteristic features included the CT signs of the primary tumor size, thickness, enhancement, and ascites; the primary tumor texture features standard deviation, inhomogeneity, and entropy; and the peritoneum texture features standard deviation and inhomogeneity, which are shown in p> = 0.05). There was no statistical significance between peritoneum texture, primary tumor texture, and Total Texture + CT signs in diagnosing occult PM (p> = 0.05). On the other hand, the Total Texture + CT signs model based on the whole peritoneal area texture analysis combined with the entire tumor and conventional CT signs showed better diagnostic efficacy than the CT signs, primary tumor texture, peritoneum texture, and Total Texture models (p<0.05). Which are shown in The diagnostic performance of the model was assessed using the ROC curve. The Total Texture model showed slightly better diagnostic efficacy than the primary tumor texture model and the peritoneum texture model  as shown in The Total Texture + CT signs, Total Texture, and CT signs models have considerable predictive capabilities, with a C-index of 0.807, 0.917, and 0.829, an AUC value of 0.941, 0.838, and 0.832, and a 95% confidence interval of 0.899−0.970, 0.779−0.886, and 0.772−0.882, respectively. Which are shown in The nomogram includes risk factors that may predict the likelihood of PM, as shown in In the present study, we separately developed five prediction models using CT signs, primary tumor texture, peritoneum texture, primary tumor texture + peritoneum texture, and their combination to predict occult PM. The DeLong test and DCA indicate that the combined model, consisting of three meaningful CT signs  and two meaningful texture parameters (inhomogeneity of the primary tumor and inhomogeneity of the peritoneum), held the best predictive efficiency and clinical utility (p < 0.05). A quantitative prediction nomogram was accordingly established based on the combined model. The calibration curves revealed a nice consistency between the actual results and the nomogram predictions of occult PM in GC patients.The peritoneum is the most frequent site where GC spreads, and this is strongly associated with poor prognosis. The classic theory of tumor metastasis is the “seed-and-soil” theory , which tRecently, many CT radiomics studies focused on the PM of GC. Liu et al.  reportedThe advantages of the nomogram based on the combined model include the following: it provides convenience in clinical application to preoperatively identify occult PM; it serves as a reference for optimizing clinical management, such as regular follow-up; and the progression may be suggested. In addition, patients with a high risk of occult PM who were filtered by the nomogram may benefit from the preoperative neoadjuvant therapy. This can reduce the cost of subsequent diagnosis and help avoid improper surgical procedures, develop more reasonable and effective treatment plans, such as determining optimal candidates for laparoscopy exploration, and prevent patients from having a poor prognosis, which is significant to improving patients’ prognosis and quality of life.However, although the results are encouraging, there are several limitations of the study. First, CT images were retrospectively analyzed and obtained from multiple scanners, and the inconsistency in scanning the parameters might affect the feature extraction and cause some measurement bias for the analysis. Notwithstanding, a good interscanner agreement of the CT texture analysis was confirmed when using different scanners with different vendors and acquisition processes . Second,Nevertheless, despite these limitations, CT texture analysis over the peritoneum and the primary tumor still deserves further investigation. We believe that this nomogram can still help clinicians to develop personalized treatment options for patients with GC and may have significant clinical implications in the early preoperative diagnosis of GC PM and the development of a personalized treatment plan.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by the institutional review board of Fujian Province Hospital. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. Written informed consent was not obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.S-xC, H-jZ, and HW conceived of and designed the study. S-xC drafted the original paper. S-xC, H-jZ, HW, Y-xT, and X-fC extracted all data and performed the statistical analysis based on the data. S-xC and H-jZ supervised the project and provided direction and guidance throughout the preparation of this manuscript. S-xC revised the final manuscript. All authors contributed to the article and approved the submitted version.This research was funded by Startup Fund for scientific research, Fujian Medical University [grant number: 2018QH1138]and Guiding project of Science and Technology of Fujian Province [grant number 2022Y0050].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.