Urine osmolality was significantly lower in DDH compared to the controls (p = 0.036), indicative of the production of a more diluted urine in DDH infants. Following adjustment for osmolality, significant differences became apparent in urinary sulphate levels in DDH (p = 0.035) whereas all other parameters were similar between the groups. This is the first study to assess the potential role of these inorganic anions in DDH. The higher levels of sulphate found in infants with DDH suggests either enhanced intake from milk, increased endogenous formation, or impaired renal reabsorption. This investigation demonstrates the power of urine metabolomics and highlights the importance of normalisation for hydration status to disentangle developmental disorders. Our results strongly suggest that DDH is a systemic disease associated with altered uptake, formation, or handling of sulphate. There is potential for new opportunities in the prevention or treatment of DDH via nutritional intervention.Developmental dysplasia of the hip (DDH) is the most prevalent congenital musculoskeletal disorder, yet its cause remains unknown. Adequate nutrient provision and coordinated electron exchange (redox) processes are critical for foetal growth and tissue development. This novel study sought to explore specific biochemical pathways in skeletal development for potential involvement in the aetiology of DDH. Spot urine samples were collected from infants, aged 13–61 days, with and without DDH. Ion chromatography-mass spectrometry was used to quantify thiosulphate, sulphate, nitrate, and phosphate, whilst nitrite was quantified using high-performance liquid chromato-graphy. Thiobarbituric acid reactive substances (TBARS) were measured as markers of lipid peroxidation. Creatinine and osmolality were determined by a 96-well plate assay and micro-osmometer to potentially normalise values for renal function, lean body mass, and hydration status. Urine samples were analysed from 99 babies: 30 with DDH and 69 age-matched non-DDH controls. Thiosulphate, TBARS, and creatinine concentrations differed between the DDH group and the controls ( Developmental dysplasia of the hip (DDH) remains the most common hip abnormality in infants, with a UK incidence of 4.9 per 1000 live births . DespiteAn important aspect of the pathogenesis of musculoskeletal disease is disruption of the physiological processes involved. This is well understood in some skeletal dysplasias such as achondroplasia, mucopolysaccharidoses, and Gaucher’s disease, with medical treatments subsequently developed. Yet for DDH, which is far more prevalent, the aetiology remains unknown. Oxidative stress/redox regulation is a rapidly evolving area of biological research. It is linked to skeletal growth and development via the sulfation of glycosaminoglycans  and otheSeveral related disorders, including osteoarthritis, are associated with altered nitric oxide (NO) formation/metabolism and oxidative stress ,10. The 2S) to the most oxidised (sulphate) forms, with thiosulphate arising as a key intermediate of H2S oxidation in mitochondria. Sulphur is responsible for the maintenance of the structure and function of tissue (glycosaminoglycans), drug detoxification, phase II metabolism (conjugation reactions), and the inactivation of numerous hormones and neurotransmitters [Sulphur is an essential nutrient, necessary for many crucial physiological functions, in particular during growth and skeletal development. It occurs in a range of oxidation states, from the most reduced  [2S) and their biological targets, known as the ‘reactive species interactome’ (RSI) [The intersection of oxygen, nitrogen, and sulphur metabolism is highlighted by the chemical interaction of short-lived ROS (mediators of ‘oxidative stress’), reactive nitrogen species , and reactive sulphur species  . A rich e’ (RSI)  are respe’ (RSI) . Althouge’ (RSI) ,18. Likee’ (RSI) . Both the’ (RSI) ,21. Phose’ (RSI) , which fe’ (RSI) .The susceptibility to developing DDH is likely to have its origins in utero. The hip joint begins to develop in the foetal phase at week 8. This, along with high nutrient and energy demands in early pregnancy by the developing foetus, prompts maternal circulating concentrations of sulphate to increase roughly two-fold. This is achieved by increased reabsorption of sulphate in the mother’s kidneys ,25. WhilIn the context of the role of the RSI in human development and the potential involvement of its biochemical mediators in the aetiology of DDH, an exploratory study into markers for oxidative stress and sulfation reactions was conceived. We hypothesised that DDH would be associated with increased oxidative stress and a reduced availability of sulphur compounds critical to sulfation reactions and cellular energy production.Enrolment, sample collection, and storage: Following full ethical approval (REC: 17/YH/0442), infants were consented from the routine hip screening clinic of a tertiary referral children’s hospital in England  was used to quantify the concentration of sulphate (SO42−), nitrate (NO3−), thiosulphate (S2O32−), and phosphate (PO43−) in urine samples due to its high sensitivity and selectivity for these metabolites [m/z for the detection of nitrate and the mono/di-protonated forms of thiosulphate, sulphate, and phosphate , respectively. The capillary voltage was kept at 2.9 kV, whilst the vaporizer and ion transfer tube temperatures were 400 °C and 180 °C, respectively. The cone voltage was 20 V for all analytes. The sheath and auxiliary gas pressures were 50 psig and 2 psig, respectively. The concentration of anions in the urine sample was calculated by comparison of peak areas in the sample to peak areas in authentic standards of known concentrations. The sensitivity of the method is 0.1 µM for thiosulphate and nitrate and 0.5 µM for sulphate and phosphate.abolites . The samNitrite: Nitrite (NO2−) levels in the urine samples were determined by high-performance liquid chromatography (HPLC) combined with a post-column diazo coupling reaction essentially as described [escribed . The uriTBARS: TBARS (thiobarbituric acid reactive substances) is an assay for estimating lipid peroxidation products that has been used extensively as a marker of oxidative stress [g for 4 min. One hundred and fifty μL of all standards and samples was added to cryovial with 75 μL of TBARS colour reagent. Sixty-seven μL of each was then transferred into half-well clear 96-well microplates after 2 h incubation at 80 °C. The MDA-TBA adduct (pink chromogen) formed from the reaction of MDA in samples with TBARS was measured, in duplicates, using a plate reader monitoring the absorbance at 532 nm.e stress . This coCreatinine: Biochemical markers are essential for providing information about kidney function. Creatinine originates from the spontaneous breakdown of creatine phosphate (in muscle) and is excreted by the kidneys at a constant rate. It is an easy and simple way of assessing kidney function and provides information about overall muscle mass. Creatinine was quantified using a commercial 96-well plate assay kit , the principle of which is based on the Jaffe reaction, according to the standard protocol using a five-fold dilution of urine. The results were confirmed using a validated tandem mass spectrometry (LC-MS/MS) method [p < 0.0001); the data depicted in the figures were from LC-MS/MS determinations.) method . While aOsmolality: Osmolality is the optimum method for normalisation of urine metabolomics analyses [analyses ,32. To aStatistical Analysis: Statistical analysis was performed using GraphPad Prism 9.2.0 . The normality of distributions was tested using Anderson-Darling and Kolmogorov–Smirnov tests; since most parameters were found to be non-normally distributed, this assumption was considered to apply for all analytes. Median and interquartile ranges were used to represent non-parametric data. Statistical significance was established using Mann–Whitney tests (non-parametric) at p < 0.05. Owing to its novel nature, the effect size of the study is unknown, and thus no power calculations could be applied.Of 231 eligible infants, consent for urine collection was received from 227 families, of which 102 infants produced urine for collection. Small numbers were excluded due to the urine volume being insufficient, for use in pilot tests, due to urine contamination, and due to statistical anomalies determined on ROUT and Grubs’ test . This lep = 0.0048), anion concentrations could not be normalised across the entire cohort for renal function using creatinine. A determination of osmolality revealed that not only creatinine but indeed the concentration of all solutes was lower in DDH urines . Since it is unlikely that the majority of non-DDH infants were dehydrated, these findings indicate that DDH and non-DDH infants differ in hydration status and/or urinary output, with the former producing more diluted urine. When urinary creatinine levels were adjusted for osmolality, differences between groups disappeared . Thus, creatinine was not used for normalisation.Significant differences in concentrations were found for thiosulphate, TBARS, and creatinine between the DDH and non-DDH groups , with a When the concentrations of other analytes were adjusted for osmolality, a different pattern of similarities and differences became apparent. Following normalisation for hydration status/urinary output, now only sulphate was significantly different between the groups, with higher urine concentrations in DDH infants compared to the controls ; all othThis novel study on potential biochemical mechanisms contributing to the aetiology of DDH has shown, for the first time, significant differences in inorganic metabolites linked to nutrition, stress sensing, and glycosaminoglycan biology in infants with DDH. The potential implications of this new information are considerable, for both screening and treatment strategies. In the UK, 1 in 200 babies are diagnosed with DDH . If DDH 2S) for redox signalling and physiology, this result represents an important new finding that promises to inform future research directions.Fitting to its novel nature, these results cannot be comprehensively compared to other studies as there is little to no literature available on these analytes in urine samples for this age group. A targeted metabolomic approach was chosen to quantify the urinary concentrations of metabolites using a combination of selective and sensitive analytical methods. Unexpectedly, osmolality was significantly lower in DDH versus non-DDH, indicating a more diluted urine in infants with DDH. We cannot explain this finding, yet its method of determination is unambiguous since it uses a physical property that takes into account all dissolved substances irrespective of structure, charge, and size. Further to the significant differences in urinary concentrations of thiosulphate, TBARS, and creatinine in infants with DDH, when the original values for the metabolites were adjusted for osmolality  only one species, sulphate, emerged to be different between groups. The lack of information on the circulating concentrations of sulphate in blood makes it difficult to assess whether alterations in excretion and/or reabsorption account for these differences and prevents the drawing of definitive conclusions from this study alone. Nevertheless, considering the importance of sulphate for skeletal development as well as its precursor . However, after normalisation of urinary creatinine for osmolality, that difference disappeared. Thus, there is no evidence for any major difference in renal function, lean body mass (muscle), or protein load in DDH. Similar to the considerations discussed for sulphate and other analytes, this demonstrates the importance of an appropriate control for hydration status (and thus urine dilution) when using spot urine samples for biochemical analyses, particularly in young children.The collected specimens were spot urines obtained at different times of the day and year; thus, we cannot exclude that chronobiological differences in production and/or excretion of the biomarkers measured may have influenced the results. No information on the nutritional status of the children, nor their mothers, was collected, including which infants were breast- or formula-fed. This information is important in further work, including a full maternal dietary and vitamin supplementation history, due to the potential dietary influence on sulphate-related pathways. Furthermore, whilst the groups were well matched for age, there was a sex discrepancy within the DDH group consisting of more females than males, in keeping with DDH being known to affect girls more than boys. Further studies must account for sex matching, lest there are unknown differences in urinary sulphate between male and female infants.DDH is one of the most common and challenging congenital skeletal disorders with an immensely unclear aetiology. To the best of our knowledge, this is the first study to investigate the potential role of specific anions in the aetiology of DDH. The significant differences between infants with DDH and age-matched infants without DDH point to a potential problem in sulphur metabolism in DDH that may translate into alterations in skeletal development. This has enormous implications for new avenues of screening for DDH or even prevention by dietary supplementation.


Numerous cardio-metabolic risk factors influence screen-related behaviors in children and adolescents. Numerous studies with inconsistent results revealed a relationship between blood pressure and screen time in the children and adolescents. This systematic review and meta-analysis summarized the data regarding the relationship between screen time and hypertension (HTN) in children and adolescents.We examined three electronic databases, including Scopus, PubMed, and Embase to find the recent research on the relationship between screen time and HTN up to 19 July 2022. Twenty papers were included in the final two-class and dose–response meta-analysis. We conducted subgrouping to identify the source of heterogeneity.P < 0.001; I2 = 83.20%] and 1.9 mmHg increase in systolic blood pressure . However, there was no significant difference in diastolic blood pressure. Moreover, screen time in hypertensive children and adolescents was 0.79 h (47.4 min) higher than normotensive subjects . A departure from linearity was observed between increased screen time [digital video discs, personal computers, and video games and HTN (Pnonlinearity = 0.049).The highest category of screen time increased the odds of HTN by 8% [odds ratio (OR): 1.15; 95% confidence interval (CI): 1.08, 1.23; This systematic meta-analysis review is the first to demonstrate a positive correlation between screen time and HTN in children and adolescents.The online version contains supplementary material available at 10.1186/s41043-023-00437-8. Hypertension (HTN) and high blood pressure have been considered major health problems among children and adolescents in recent decades . Both prHTN in childhood is associated with early cardiovascular events like congestive heart failure (CHF), left ventricular hypertrophy (LVH), and increased morbidity and mortality in adulthood , 5. AffeSedentary behaviors are well-known risk factors of non-communicable diseases and are associated with high cardiovascular-related mortalities in prospective longitudinal studies . In factMore importantly, screen time dramatically increased during the COVID-19 pandemic. In this regard, several studies warned about the health consequences of this issue and warranted the need for health programs like encouraging regular physical activity, promoting educational opportunities, and increasing social support during the COVID-19 pandemic –16.Among all the sedentary behaviors, screen-based sitting activities  need specific interventions because they are major contributors to overall sedentary time and are highly prevalent among children and adolescents –21. The Screen-related behaviors are associated with a high prevalence of HTN, particularly among boys , 24. TheSeveral studies have been conducted on the correlation between HTN and screen time in children and adolescents. However, the achieved results regarding the role of screen type, gender, age, and geographic location are highly inconsistent. There is no summarized analysis of the quantity and quality of the correlation between screen time and HTN in children. Accordingly, this systematic review study was conducted to evaluate the relationship between screen time and HTN in children and adolescents. Also, in a dose–response meta-analysis, we further investigated the role of different factors such as screen type, age group, gender, time, and geographical distributions.The results of this systematic review and meta-analysis were reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA)  phrases and free-text words. The PubMed search method was as follows:  in those with the highest versus lowest screen times; and third, the studies evaluating the comparison of screen time [mean (SD)] in hypertensive versus normotensive children and adolescents. Therefore, the OR and 95% confidence interval (CI) or the mean and SD of the variable were used to determine the unstandardized effect size calculated by the pooled estimate of the OR or the weighted mean difference (WMD) with 95% CI.P0 and P1 represent the prevalence in exposed and non-exposed groups, respectively. The approach proposed by Hozo et al. . Meanwhile, no association among girls was reported.Karatzi et al.  investig. .Hardy et al.  investig. .We found no evidence of publication bias for any of the measured variables [OR of HTN and screen time: Egger’s test  playing , and telIn subgrouping the results according to age, the relationship between HTN and screen time was only significant among children, but not adolescents; it seems that children at lower ages are at greater risk of sleep disturbance and low sleep duration due to screen-related behaviors –69, and In subgrouping by continent, the results for studies done in Europe and the United States were statistically significant, whereas the results for other groups were insignificant. This may be explained by the greater volume of investigations conducted on these two continents.Pnonlinearity = 0.049). This nonlinear association revealed the highest odds of HTN (~1.4) in 100–150-min/day screen time of DVDs, PC, and video games, which is compatible with the recommendations of the AAP on reducing the daily screen time of children and teenagers to less than two hours [The nonlinear association was observed in the correlation between high screen time for DVD, PC, and video games and HTN (wo hours .The current study had some limitations. First, we only included observational studies in the meta-analysis, which makes causal inference impossible. Second, there was no study evaluating the separate effects of video games. So, the pure effect of video games as a screen type on blood pressure could not be extracted.In conclusion, the findings of this review can be helpful because of the growing tendency to screen-related behaviors during the COVID-19 pandemic, which limited the usual physical activities of children and adolescents outdoors and made them follow their school lessons online. So, policymakers should be aware of the future health consequences of limited physical activity, even at young ages, and design programs to substitute children’s screen-addictive behaviors with regular physical activities either at home or outside. Another critical issue is the high prevalence of overeating behaviors and higher intakes of junk and fast foods during screen watching, which is a strong promoter of obesity, metabolic syndrome, and HTN independently of body weight status –77. TherAdditional file 1. Supplementary Tables and Figures.


An accessible and affordable way to deliver behavior change programs to a large proportion of the growing community of cancer patients and survivors is through web-based methods of nutritional counselling.The aim of this systematic review was to evaluate the effectiveness of web-based nutritional therapies targeting physical activity, diet, and/or weight control for cancer patients or survivors, primarily disseminated via modern technologies (mobile phone applications) or online.via a broad modality.The authors conducted a structured search of the PubMed database. Studies that have focused on physical activity (PA) and dietary change and/or weight control in adolescent and adult cancer patients and survivors have reported outcomes conducted Nine articles focused on web-based nutrition for patients with cancer and cancer survivors. They were conducted in the United States, Australia, Korea, China, and in the United Kingdom, and were published between 2018 and 2022 in a variety of scientific journals. The number of participants ranged from 20 to 159.Web-based nutrition counselling helps cancer patients and survivors improve their dietary intake, impacts their weight and quality of life, and promotes a healthy lifestyle. Future research should evaluate (1) the differences in cost and coverage between face-to-face and web-based nutrition, (2) long-term outcomes, (3) cost-effectiveness, and last but not least, (4) the effectiveness of web-based nutrition in adolescents and children who suffer from cancer or who survived cancer, as nutritional status and body composition have a marked impact on clinical outcomes during and after treatment. The strength of this review lies in the large number of randomized controlled trials, which offer a guarantee of effectiveness and objectivity compared to cross-sectional studies. RegardlIn the age of new technologies and social media, the recent COVID-19 pandemic has enabled the use of telemedicine whenever possible and feasible. This includes using the Internet and technology to educate people about nutrition through discussion forums, blogs, exams, hyperlinks, chats and wikis . AccordiFor example, during the COVID-19 pandemic, Lobascio et al.  suggeste2.Publications on web-based nutrition in patients with cancer from all geographical regions were identified by systematically searching the PubMed database. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria for reporting and implementation . The Boo2.1.A total of 33.616 articles were found when the above search terms were entered into the PubMed database, along with the publication date, article types, and language filters. Finally, 9 articles that met the eligibility criteria were included in the systematic review. 2.1.1.The following criteria were used for study inclusion: (a) the intervention aimed at changing dietary behavior, physical activity, and/or weight control  and these outcomes were reported; (b) the intervention targeted both children and adults with cancer who had either completed treatment or were undergoing treatment; (c) the intervention used telephone and/or the internet (including email and/or websites) to deliver the messages of the intervention.Studies were excluded for the following reasons: (a) they were not available in English; (b) they included participants who received only palliative care; (c) they were available only as abstracts; (d) they did not contain sufficient information on the effectiveness of web-based nutrition on diet, physical activity, or weight loss; (d) review articles, systematic reviews, unpublished articles, dissertations, commentaries, abstracts of meetings and conferences, as well as case reports, book reviews, opinions, and editorials.3.The search approach resulted in the identification of a total of 33616 articles. However, the automation tools identified 30727 records as ineligible. After reading titles and abstracts, 1172 of the remaining 2889 articles were excluded, of which 1717 were selected according to the eligibility criteria. A further 1708 articles were eliminated as follows: (a) 988 studies were not health interventions ; (b) 693 studies were not related to diet; and (c) 27 were systemic reviews. Ultimately, 9 studies  met the 3.1.n = 9). From 2018 to 2022, articles were published in numerous scientific journals with different aims and objectives: British Journal of Nutrition , Australia (n = 2), Korea (n = 2), China (n = 1) and in the United Kingdom (n = 1). The number of study participants ranged from 20 to 159. Two studies had over 100, 6 studies had between 100 and 50 and 1 study had less than 50 participants. One study was published between 2018 and 2019, and the other 8 were published more recently (2020–2022).Studies were conducted in the United States  and only two studies had a single arm. Most studies (8 out of 9) targeted a single group of cancer survivors, namely survivors of breast cancer, prostate cancer, or colorectal cancer.n = 2) were long-term studies (>6 months) and (n = 7) short-term studies (3–12 weeks) that examined the effects of nutrition counselling on a variety of nutrition-related outcomes . None of the web-based studies compared face-to-face nutritional interventions in a group setting.The identified web-based nutrition intervention studies . In the field of web-based nutrition, many tools have been used to assess the different variables of nutrition and body composition. The most common were dual-energy X-ray, abdominal computed tomography, height, body weight, body mass index, waist circumference, hip circumference, cardiometabolic biomarkers, and plasma levels of adiponectin, leptin, and resistin to name a few.The discussion is divided into 4 sections. The first part examined the effectiveness of web-based nutrition in adolescent cancer survivors. The second section discusses the impact of web-based nutrition on adult cancer survivors. The third section discusses the impact of web-based nutrition on patients with cancer. The impact of web-based nutrition on quality of life is approached in the fourth section.4.1.Adolescent cancer survivors and patients are a particularly important target group for health promotion initiatives related to nutrition, as they often have unhealthy dietary habits  that cou4.2.As the concept of long-term survivorship care intersects with many medical specialties, developing practice patterns that meet the needs of cancer survivors can be challenging. It is now well known that good nutrition and regular physical activity are important factors that can be modified in cancer survivors and are an essential part of follow-up care.via WeChat combined with telephone support from community health centers had a positive effect on weight and protein intake; general health; and physical, emotional, cognitive, and social functioning in colorectal cancer survivors. From this study, we can conclude that virtual health visits were of great benefit to participants. Moreover, this may be a long-term solution for comprehensive and personalized gastrointestinal cancer survivorship care and may retain patients at cancer centers.Wang et al.  showed tAnother study  comparinWilliams et al.  conducte4.3.In theory, lifestyle changes such as diet and exercise in combination with chemotherapy can target tumor resistance mechanisms as a potential strategy to enhance treatment efficacy .4.3.1.via telephone (synchronous) or via the internet-enabled mobile app “myPace” (random assignment) were directly compared with standard care in people with a recent diagnosis of upper gastrointestinal tract cancer made before the COVID -19 pandemic that triggered the rapid introduction of telehealth services. The findings imply that: (1) quality-adjusted life-years did not differ between the intervention group and the usual care group; (2) intensive nutrition counselling at a distance alone did not lead to adequate nutrition; and (3) service models other than face-to-face care allowed for the initiation of a nutrition intervention and contact with a dietitian at a much earlier stage. Although higher protein and energy intake has been achieved, we have learned that behavioral counselling alone is not sufficient to achieve adequate nutrition.In a three-arm study , two metYang et al.  highlighHuggins et al.  found thIn summary, two studies , 38 that4.3.2.The use of health education in patients undergoing chemotherapy for pancreatic ductal adenocarcinoma (PDAC) resulted in a remarkable improvement in their nutritional status, as shown by an objective measure (PG -SGAp score) by Keum et al. , regardl4.3.3.2 who had been diagnosed with stage I to III breast cancer in Australia in the previous 2 years had small to moderate effects on adherence to various behaviors measured by a composite score based on the 2007 WCRF/AICR guidelines but produced some improvement in diet and physical activity. The results of the study demonstrate the health benefits of programs targeting lifestyle behaviors that are consistent with recommendations for cancer survivors, as well as the potential for dissemination of such programs to women who have undergone treatment for early breast cancer.Terranova et al.  showed t4.3.4.Although obesity is known to be associated with an increased risk of diagnosis of more aggressive forms of prostate cancer as well as prostate cancer recurrence and mortality, research on weight management in men with prostate cancer is relatively new and under-researched. Based on the assumption that physical activity in men with prostate cancer receiving androgen deprivation therapy may help prevent the loss of lean tissue, Mohamad et al.  conducte4.4.Assessment of quality of life is a unique factor that is increasingly being considered when evaluating the nutrition of cancer survivors or patients. It reflects a patient’s current health status and can be used to assess the effectiveness of nutritional therapy. Perceptions of well-being across a range of dimensions, including symptoms (pain), physical abilities , psychological states , and social isolation, can impact nutrition and determine the patient’s quality of life. There are several questionnaires for evaluating the quality of life, but it is not clear which one is the most appropriate. Some researchers , 34, 37 4.5.The studies , 35 asse4.6.To evaluate the efficacy and outcomes of web-based nutritional support, we believe researchers should evaluate: (1) anthropometric data , (2) biochemical data , (3) clinical data , and (4) nutritional data . It is important to remember that certain cancer treatments, such as hormone therapy for breast and prostate cancer, may cause patients to gain weight.4.7.Patient organizations not only offer valuable services like peer mentoring, counselling, legal and financial support, but they can also encourage nutrition and physical activity by providing web-based nutritional resources, creating practical digital tools, and helping patients with the use of related applications .5.Owing to its accessibility, web-based nutrition is a desirable supportive therapy for people who have been diagnosed with cancer or cancer survivors.The last meta-review by Hanlon et al.  examinedlimitations. First, there were differences in the study design. Second, several studies did not include a description of what the control group received during the intervention, demonstrating the need for thorough research reporting. Third, the ratio of men to women was not balanced because most studies were conducted on men, implying that future studies should target women. Fourth, not a single paper has examined the comparison between face-to-face nutrition counselling and a web-based nutrition intervention. We suggest that comparative studies be conducted to highlight the strengths and weaknesses of each strategy. Fifth, it would be helpful to examine which approach has a better cost–benefit ratio, given the differences in costs and coverage between face-to-face and web-based nutrition counselling. Sixth, children and adolescents with cancer or survivors are not a target group for web-based nutritional counselling, which represents a gap in our knowledge. Finally, important health problems, such as malnutrition and anorexia associated with cancer, have not been comprehensively assessed.This review had several strengths of this review that should be highlighted. The first strength of the research papers is their attempts to offer an objective evaluation. Second, a panel of multidisciplinary experts including oncologists, psychologists, endocrinologists, and forensic scientists assessed the influence of web-based nutrition on cancer patients and survivors.Nevertheless, there are also BGI and DEL contributed to conceptualization and design. DEL, RP, and BH wrote the first draft, searched the database, read titles, and abstracts. BGI and VM supervised the elaboration of the manuscript. All authors wrote sections of the manuscript, selected articles according to the eligibility criteria, contributed to data extraction and manuscript revision, read, and approved the submitted version.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.


Goal: Artificial intelligence applied to medical image analysis has been extensively used to develop non-invasive diagnostic and prognostic signatures. However, these imaging biomarkers should be largely validated on multi-center datasets to prove their robustness before they can be introduced into clinical practice. The main challenge is represented by the great and unavoidable image variability which is usually addressed using different pre-processing techniques including spatial, intensity and feature normalization. The purpose of this study is to systematically summarize normalization methods and to evaluate their correlation with the radiomics model performances through meta-analyses. This review is carried out according to the PRISMA statement: 4777 papers were collected, but only 74 were included. Two meta-analyses were carried out according to two clinical aims: characterization and prediction of response. Findings of this review demonstrated that there are some commonly used normalization approaches, but not a commonly agreed pipeline that can allow to improve performance and to bridge the gap between bench and bedside. I.Currently, the role of medical imaging is evolving from being mainly a diagnostic tool to gaining a central role in the context of personalized precision medicine Different standardization guidelines have been proposed to address the above-mentioned problem in the case of computer tomography (CT) and positron emission tomography (PET)/CT imaging, while they are not available for Magnetic Resonance Imaging (MRI) Currently, different pre-processing algorithms have been implemented to reduce the variability The aim of this study is to systematically review normalization approaches applied to multi-center abdominal MRI, to assess whether it is possible to provide guidelines or evidences about the performances of the most frequently used methods. Even if this topic was widely addressed for the brain II.A.This review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Relevant articles were identified by searching three databases: PubMed, Web of Science and Scopus. The query used for the literature search was “MRI” AND “multicenter” AND  AND .Literature searching, study identification, and data extraction from eligible studies were performed by one investigator with experience in abdominal radiomics field research (J.P.).B.Searched studies had to further come across the following eligibility criteria to be incorporated in the present review: (i) written in English; (ii) AI radiomics-based studies; (iii) published between January 2012  papers assessing image quality, (ii) papers describing only harmonization or standardization acquisition pipelines without using them for the development of a radiomics signature or AI model for detection/characterization/prognosis, (iii) papers describing challenges or online databases, and (iv) not clearly specifying the pre-processing step.D.For all included papers, the following information was collected : organ of interest, clinical aim, publication year, database details, normalization approach and method, radiomics features extracted, developed radiomics model, distinguishing between Machine and Deep Learning (ML and DL), and performances on the validation set. We grouped clinical aims in three categories: (i) detection as the capability to detect the pathologic tissue, i.e., its presence, and, if confirmed, its localization on the medical image; (ii) characterization as the ability to predict the clinical outcome; and (iii) prediction of therapy response, only appliable on pathologic tissues.E.We conducted different meta-analyses on the model performances, according to the aim, i.e., detection, characterization, response to therapy. We considered the area under the curve (AUC) and its Confidence Interval (CI) as the performance metric, which was the most frequently evaluated parameter among the studies. We excluded papers that did not report AUC and neither its standard deviation, standard error or CI values, and that weren't validated on an external dataset, since this does not determine model reproducibility and generalizability to new and different patients 2 statistic were calculated. Cochran's Q statistic tests the studies' heterogeneity, under the null hypothesis H0 that all studies are homogeneous . The I2 value was used to quantify heterogeneity, providing an estimate of the percentage of variability among included studies: values of 25% and less are usually considered to be low, 25%–50% moderate and above 75% are considered high. In case of detected heterogeneity, a moderator analysis was carried out by dividing studies into subgroups according to the organ, for each aim. Subgroups containing only one paper were excluded from the meta-analysis. The weight of each study was calculated with the inverse variance method, in which the weight given to each study is inverse of the variance of the effect estimate, minimizing the uncertainty of the pooled effect estimate metafor package The random-effects model was used to calculate the pooled AUC and to produce the forest plot. Cochran's Q and the IIII.A.During the identification step, 4777 papers were collected from three search databases. Among them 1574 were duplicate records, therefore they were excluded resulting in a total of 3203 papers. During the screening step, 3069 were excluded as they did not meet the eligibility criteria. Of the remaining 134 papers, 60 were eliminated after reviewing the study context and design. Finally, 74 papers were included in the final analysis. Fig. B.All included papers have been published since 2015, with an increase from 2019. The most studied organs are the prostate The turning year, in which the number of papers showed a big rise also in other abdominal organs, was 2020. This might be due to the increasing number of public databases C.Fig. Of note, since 2019, 15/74 papers include clinical features, available from routine practice, into their model in order to increase the predictive potential usefulness (S-Table I–V).1)•Spatial normalization: a process that changes the spatial characteristics of the image, e.g., the pixel's resolution, the Field of View (FOV), sequences orientation, etc. All methods apply geometrical transformations , which do not need normalization parameters. This approach allows obtaining images including almost the same anatomical regions, thus avoiding histogram mismatches due to different FOVs rather than signal intensity dissimilarities. However, spatial modifications may alter the organs' morphology, undermining the clinical significance.•Intensity normalization: a process that rescales the pixel intensity values to the same range. Most methods allow evaluating the normalization parameters independently on the sequences, except those which need a normalization reference, e.g., hist_normNyulUdupa•Feature normalization: a process that rescales values of the radiomics feature extracted to the same range. On one hand, all methods allow reducing the differences between the features, without altering the clinical significance. On the other hand, a training set is needed to evaluate the normalization parameters.The following normalization approaches were used on MRI datasets:Among all, intensity normalization is applied on 61/74 (82%) papers, being the most frequent, while the feature and spatial normalizations on 27/74 (36%) and 48/74 (65%) papers, respectively. In 52/74 studies the images underwent more than one normalization approach: 6/74 (8%) both intensity and feature, 34/74 (46%) spatial and intensity, 2/74 (3%) spatial and feature, and 10/74 (14%) all three approaches. Colored boxes in Fig. registration to align the sequences and reduce the motion artefacts, resampling to obtain the same resolution, and resizing to obtain the same size for all images. The most commonly applied method is resampling (31/48), which has been used individually in 12/16 studies on the prostate, 4/5 on the liver, and 6/9 in the miscellaneous group. Moreover, it has been applied in combination with at least another spatial normalization method in 14/48 papers, i.e., resampling and resizing on the female pelvis (4/9), and the rectum (3/9). Registration is the least frequently used method (10/48) among all organs. For intensity normalization, the two most used methods are the standardization (z-score) of the intensity distribution, which is applied on 21/61, and custom algorithms on 31/61, including normalization using pre-defined values, discretization of the distributions, the use of Advanced Normalization Tools (ANTs) or filters, the application of DL methods for harmonizing the image, or the combination of more than one method. The remaining 9/61 papers applied one of the following methods: min-max or 3sigma scaling and mean centering (mean-cent), and histogram normalization (hist-norm) which matches the original distribution to a histogram reference . Most papers related to the prostate (10/20) and miscellaneous (8/10) have developed custom methods for the intensity normalization, while the z-score is frequently applied to female pelvis (5/10) and rectal (7/16), and hist-norm on the liver (2/5). More details are in S-Table I–V. Regarding feature normalization, only three methods have been found in the included papers and are almost equally used: i.e., rescaling according to the minimum and maximum feature values (min-max) is applied on 6/27 papers, standardization (z-score) on 9/27, and harmonization using ComBatComBat method can only normalize features across different centers by using values computed on a subset of data from each center that will be normalized. Therefore, it requires available and labelled data from all centers/scanners included in the dataset, not allowing the direct application of previously determined normalization parameters on external validation cohorts ComBat and z-score. Observing the S-Tables I–V, the z-score is mostly applied on the rectum (3/6), the min-max on the prostate (3/5), while the ComBat on the female pelvis (4/7).In general, three methods are currently used for spatial normalization: D.The 22 papers included in the meta-analysis are reported in the supplementary tables in bold. We did not perform the meta-analysis on detection, since there were not enough studies that could be included for this purpose.p-value < 0.01), and differences are partially explainable using the organs as the moderator .Concerning the 16 papers addressing the characterization Fig. , the stup-value < 0.01), which differ in that one of them applies features normalization in addition to spatial and intensity normalizations. This behavior might suggest that in this case normalizing the features does not improve the performance (AUC = 0.60 vs AUC = 0.87), however, the sample size is very small to strongly assume this point. It is noteworthy that the papers related to the liver, rectal and prostate show very low heterogeneity (I2 = 0% for the three organs) even though they applied very different normalization approaches. This might suggest that there is no preferable normalization strategy when dealing with these organs. Considering average results, two organs reach an average AUC higher than the overall pooled AUC, i.e., female pelvis (0.88 vs 0.81) and prostate (0.82 vs 0.81). It is noteworthy that, in studies regarding the female pelvis papers, ComBat feature normalization seems to slightly increase performances (AUC = 0.86 and 0.91 vs 0.85). However, there is not a clear correlation between the used approach and performance, therefore it is not possible to define a pathway for MRI variability reduction.Considering each organ separately, only the kidney showed high significant heterogeneity between the two included studies , partially explainable using the organs as the moderator . In this case, the performances of the two groups were statistically different , and in particular results on female pelvis were higher than rectal cancer , but both groups showed a heterogeneity higher than 75%. Focusing on the rectal area, all papers applied both spatial and intensity methods, except Song et al. z-score method, in combination with either spatial or feature normalization. In particular, the latter approach allowed reaching higher results (AUC = 0.99 vs AUC = 0.92). However, since there were only two papers in this group, we cannot strongly assume that the combination of z-score and features normalization is more suitable for this organ.Concerning the 6 papers addressing the prediction of response to therapy (Fig. Considering all the above results, it is not possible to extract clear indications on the type of pre-processing for reducing abdominal MRI variability, mainly because we found a multiplicity of algorithms and pipelines applied. Moreover, no definite correlation between normalization and performance emerges from the meta-analyses, since most of the considered subgroups were very small. Both aspects could be partially associated to the quite recent interest in multi-center studies concerning abdominal MRI, increased only from 2020.resampling for spatial and min-max for features normalizations. Conversely, intensity normalization was preferably applied using custom algorithms, tailored by each research group considering the characteristics of the organ, i.e., its heterogeneity and the presence of small lesion difficult to be detected even by experts, and clinical task. For these reasons, we strongly recommend to carefully analyze the available images and aim.The prostate was the only organ showing a low heterogeneity with a sufficiently high number of included papers: in this case, the most used methods for the characterization aim are resampling and resize have become a standard step since 2021. Moreover, the combination with z-score intensity normalization seems to lead to higher results for characterization and therapy response aims.Regarding both the rectal are and female pelvis, we noticed that In recent years, several efforts have been made toward the implementation of new approaches based on DL algorithms, i.e., transfer learning, data synthesis, thanks to their capability to learn from a given datasets This systematic review highlighted the shortage of evidences and guidelines on normalization approaches for abdominal MRI, differently from the agreed pipelines related to the brain Several insights emerge from our analyses. First, it could be useful to evaluate how the different normalizations really affect the model performances. In this review, it was not possible to carry out this evaluation per each study since most of them did not present the results without applying the normalization. Then, despite being able to identify the most commonly used normalization approaches, we could not provide precise explanations of the reason behind, since the majority of the collected papers did not justify the choice or provided evidences of pros and cons of different methodologies. Finally, the number of studies included in the two meta-analyses is lower than the reviewed articles, since not all of them evaluated the performances using the same metric and externally validated their models.Our preliminary findings should be further validated using a larger amount of paper. This could be achieved by including other normalization methods applied on different AI-based system development steps, such as feature selection and dimensionality reduction, IV.Recently the need to define a suitable and useful normalization method for the reduction of multi-center MRI database variability for all abdominal organs has increased. Thanks to the findings obtained by the systematic review and meta-analyses carried out on subgroups of papers, we observed that there are some commonly used approaches, but not clear guidelines on different methodologies. Therefore, the definition of an abdominal pre-processing pipeline is still ongoing research, and it is of crucial importance to keep working on defining a proper methodology to reduce the multi-center database variability. In conclusion, we suggest carefully selecting the proper normalization approach considering the MRI database provided, the clinical aim, and the radiomics model.


Background and Objectives: Atherosclerosis is a multifactorial process in which inflammatory markers have both therapeutic and prognostic roles. Recent studies bring into question the importance of assessing new inflammatory markers in relation to the severity of peripheral artery disease (PAD), such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR). Materials and Methods: We conducted a retrospective and descriptive study including 652 patients with PAD, who were divided into two groups according to the severity of the ankle–brachial index value: mild and moderate obstruction (257 patients) and severe obstruction (395 patients). We evaluated demographics, anthropometric data and clinical and paraclinical parameters in relation to the novel inflammatory biomarkers mentioned above. Results: Weight (p = 0.048), smoking (p = 0.033), the number of cardiovascular risk factors (p = 0.041), NLR (p = 0.037), LCR (p = 0.041) and PLR (p = 0.019), the presence of gangrene (p = 0.001) and the number of lesions detected via peripheral angiography (p < 0.001) were statistically significant parameters in our study. For the group of patients with severe obstruction, all three inflammatory biomarkers were statistically significantly correlated with a serum low-density lipoprotein–cholesterol level, the number of cardiovascular risk factors, rest pain, gangrene and a risk of amputation. In addition, directly proportional relationships were found between NLR, PLR and the number of stenotic lesions . Also, NLR  and PLR  were predictors associated with a high risk of amputation in patients with an ABI < 0.5. Conclusions: in our study, we demonstrated the importance of assessing inflammatory markers in relation to the presence of cardiovascular risk factors through the therapeutic and prognostic value demonstrated in PAD. Peripheral arterial disease (PAD) is one of the main atherosclerotic cardiovascular diseases, and its prevalence has increased, despite the large-scale implementation of primary prevention strategies in recent years . More thIn general, 3–4% of amputations that occur annually have obstructive atherosclerotic lesions as their morphopathological substrate, leading to negative prognostic effects in the medium and long term. From a pathophysiological point of view, the atherosclerotic process has a multifactorial origin, with inflammation playing an important role in mediating the processes involved in the progression and destabilization of atherosclerosis ,6.PAD is frequently associated with both classic and new cardiovascular risk factors. Of the latter factor type, the pro-inflammatory status, through new inflammatory markers with anti-inflammatory roles, has attracted the interest of the scientific community both in terms of its potential prognostic role and future therapeutic targets among patients with PAD and HF.The complete blood count is one of the most common biological determinations, and it can provide details associated with the presence of a pro-inflammatory status ,7. RecenThe possibility that easy and accessible dosing of these markers can provide meaningful clues regarding the patient’s evolution is the main incentive to explore them. The studies available in the literature to date have separately addressed the issue of pro-inflammatory status in relation to PAD or cardiovascular risk in general.Recent data from the literature bring to light a number of new, easy-to-use and reproducible inflammatory molecules, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-C-reactive protein ratio (LCR) ,12. TheiIn this study, we aim to identify a series of clinico-biological particularities by analyzing a group of patients diagnosed with PAD, as well as assess the efficiency and efficacy of using new inflammatory biomarkers, and, therefore, provide practicing cardiologists with a feasible and easy-to-apply tool with both prognostic and therapeutic roles.We conducted a retrospective and descriptive study involving 688 consecutive patients diagnosed with PAD and evaluated in the Cardiology Department of “St. Spiridon” Hospital. Thirty-six patients were excluded from the initial group due to incomplete medical records . Thus, the final study group consisted of 652 patients with PAD evaluated in a multidisciplinary manner .Inclusion criteria were being over 18 years of age, a definite diagnosis of PAD according to the clinical guidelines of the European Society of Cardiology [In the absence of a definite diagnosis of PAD established via vascular Doppler ultrasound or peripheral angiography, the presence of symptoms suggestive of PAD was assessed. Symptoms suggestive for PAD were intermittent claudication (IC), presence of paresthesia in the lower limbs, a lack of pilosity, cold and pale skin, petechiae and the presence of dermatitis or ulcers caused by decreased vascularity.We included demographic, anthropometric and paraclinical  parameters in our study. Anamnesis revealed the presence of major cardiovascular risk factors, such as hypertension , diabete2).Medical data regarding demographics, personal medical history, tobacco, alcohol consumption habits and chronic medication were obtained from the observation charts. Body mass index (BMI) was calculated as the ratio of weight (kg) to height , diastolic blood pressure  and pulse pressure .The parameters of lipid  and carbohydrate profile (serum glucose), inflammatory markers (serum fibrinogen) and renal function (serum creatinine and urea) were evaluated. In addition to the biological parameters usually evaluated in all patients with associated cardiovascular pathologies, based on complete blood counts, we calculated a series of new biomarkers with proven roles, as shown in the literature, in the assessment of inflammatory status, such as NLR, PLR and LCR. NLR was calculated as the ratio of absolute neutrophil (N) to lymphocyte (L) values. PLR was calculated as the ratio of absolute platelets (P) to L values. LCR ratio was calculated as the ratio of absolute L to hs-CRP values. All results were presented according to the International System of Units.Transthoracic echocardiography was performed at the first evaluation based on European guidelines (European Association of Cardiovascular Imaging) related to the purpose of the functional and morphological assessment of the heart . All imaPeripheral angiography is the gold standard method of diagnosis and treatment in PAD. Prior to the procedure, all patients were informed of the risks and potential complications associated with the minimally invasive procedure. Biological samples were taken from all patients , and a venous line was fitted. In diabetic patients receiving Metformin treatment, it was recommended to discontinue treatment 24 h prior to the procedure and resume it after 48 h to reduce the risk of associated nephrotoxicity.The angiography technique is the standard method used in all interventional cardiology centers ,25. Contp-value of ≤0.05 was considered to be the threshold of statistical significance. The results are presented in p-value considered to be statistically significant was 0.0041.We used the Statistical Package for the Social Science (SPSS) statistics software  to perform statistical analysis of the parameters presented above. The results obtained were reported as mean ± standard deviation (SD) for the numerical parameters or frequency and percentages for categorical parameters. We tested the normal distribution of the data using the Kolmogorov–Smirnov test. The independent T-test and ANOVA  were used to perform the analysis of continuous variables. Pearson’s and Spearman’s (r) correlation coefficients were used to test the reliability of statistically significant correlations identified in our study. A The study was approved by the Ethics Committee of the “Grigore T. Popa” University of Medicine and Pharmacy Iasi and the Ethics Committee of “St. Spiridon” Clinical Emergency Hospital, and it was conducted according to the Helsinki Declaration. All patients signed an informed consent statement, which mentioned that the results would be used for research purposes.In our study, we included 652 patients diagnosed with PAD  who were evaluated in our clinic from an inflammatory point of view. According to the ankle–brachial index (ABI) value, we formed two study groups: patients with mild and moderate obstruction (judged as an ABI > 0.5) and patients with severe obstruction . We analyzed several demographic, hemodynamic, biochemical and imaging parameters, which are presented in p = 0.333), gender  or residence (urban area 41.25% vs. 42.28%) were reported. In the case of anthropometric parameters, statistically significant differences were reported between the two groups analyzed, with patients with severe obstruction having higher mean weights  and BMI scores  than patients in the first group.In terms of demographic characteristics between the two groups, no significant differences in age  was statistically significantly correlated with the degree of obstruction assessed using ABI. Patients with PAD enrolled in this study had a variety of comorbidities or cardiovascular risk factors. Cerebrovascular disease was more commonly present in patients with mild and moderate obstruction , but it was not a statistically significant parameter.Of the vital parameters assessed, pulse pressure . Also, reporting the number of cigarettes smoked revealed a higher mean number of packs were smoked per year by patients with mild and moderate obstruction  than those with an ABI less than 0.5.Smoking, which is one of the main risk factors associated with the development and progression of atherosclerotic lesions in patients with PAD, was more frequently associated with the group of patients with mild and moderate obstruction , making it similar to dyslipidemia , hypertension  or class I obesity .Dyslipidemia was present in more than 50% of patients in both groups (p = 0.041). Regarding lipid and carbohydrate profiles, no statistically significant differences were reported based on the severity of obstruction, as shown in Regarding the number of risk factors, the majority of patients in both groups had associated two cardiovascular risk factors  and serum fibrinogen levels  were higher in patients with severe obstruction. The mean serum values of the inflammatory markers discussed in this paper were higher among patients with severe obstruction and considered to be statistically significant parameters in our group of patients .Among the biological parameters, statistical analysis revealed statistically significant values for conventional and new inflammatory markers. The mean serum of high-sensitivity C-reactive protein (hs-CRP) . Therapeutic management was performed in an integrative manner. In addition to drug treatment, a significant percentage of patients enrolled in the study received treatment via revascularization techniques. Interventional revascularization was preferred in patients with mild and moderate obstruction , while a higher percentage of patients with severe obstruction benefited from surgical revascularization . The risk of amputation was higher in patients with ABI values below 0.5 . Taking into account the staging based on the WIfl classification, patients with severe obstructive lesions had a higher mean score than PAD patients with mild and moderate atherosclerotic lesions .The number and severity of atherosclerotic lesions in the vascular axis of lower limbs were assessed and quantified using angiography. Peripheral angiography predominantly identified a stenotic lesion in both groups (37.74% vs. 32.65%). The percentage of patients with more than 6 stenotic lesions identified was higher in patients with severe obstruction , PLR  and LCR , which were associated with a more pronounced inflammatory state.The main parameters of the lipid profile, carbohydrate profile and inflammatory markers were statistically analyzed based on the number of associated cardiovascular risk factors . In patiPatients with gangrene are frequently associated with a high titer of inflammatory markers, which is why we decided to perform an analysis of the subgroup of patients without gangrene and with serum hs-CRP values below 10 mg/dL .p = 0.0006) and those with severe obstruction (p = 0.0004). The number of angiographically detected atherosclerotic lesions was also statistically significantly correlated with NLR in patients included in the first group (p = 0.0007), as well as with NLR (p = 0.0005). LCR (p = 0.0014) and PLR (p = 0.0004) were statistically significantly correlated with patients in the second group. The risk of amputation was assessed in all patients enrolled in this study, with statistically significant correlations noted between its presence and NLR (p = 0.0005), LCR (p = 0.0012) and PLR (p = 0.0010) in the group of patients with ABI values below 0.5  in our study group, as shown in elow 0.5 . The prep = 0.194 for the first group and p = 0.804 for the second group). Patients with mild and moderate obstruction, as well as those with ABI values below 0.5, showed statistically significant correlations between the risk of amputation and the presence of gangrene or intermittent claudication at rest   .p = 0.010, 95% confidence interval <CI> 0.419–0.664) and PLR  are inflammatory markers associated with a high risk of amputation, while LCR  did not prove its value as a predictor in our study. In addition to the markers presented above, we tested the predictive value associated with amputation risk for hs-CRP, with this classic marker being a statistically significant predictor in our study group, as shown in The respective values of NLR, LCR and PLR predictors associated with amputation risk in patients with severe obstruction were via receiver operating characteristic (ROC) analysis . NLR . Also, regarding medium- and long-term evolution of hs-CRP, it has been shown that in patients with PAD, high levels at the time of the first revascularization intervention and their persistence at 3.6 years of follow-up are associated with an independent increase in all-cause, cardiovascular and malignancy-related mortality, with these results being supported by other similar research [Various degrees of inflammation have been identified at all stages of PAD, with this association also being thoroughly researched. Some studies indicate a stronger association with PAD than with coronary artery disease, suggesting the presence of different predominant substrates . In our research ,32.p = 0.037), LCR (p = 0.041) and PLR (p = 0.019) were higher in patients with severe obstruction, as well as statistically significant biomarkers in our analyzed group. Similar results have been reported by other investigators in the literature, with the calculation of these biological parameters having both therapeutic and prognostic value.The mean serum values of NLR . Guetl et al. [p < 0.001), older age , elevated CRP titer  and diabetes mellitus  were independently significant predictors of chronic limb-threatening ischemia occurrence.In addition to the biomarkers mentioned above, the monocyte-to-HDL cholesterol ratio was analyzed in relation to the severity and prognosis of PAD, but the reported results have so far been contradictory . Clinical et al.  conducteGary et al.  demonstrA significant percentage of patients with associated PAD and CAD had this condition as an issue secondary to existing atherosclerotic damage, which was sometimes subclinical in nature. In this category of patients, Arbel et al.  demonstrOur study presents several limitations due to the lack of follow-up. The heterogeneity of the study group or the potential risk associated with the inclusion of patients with elevated serum CRP values due to associated infections are additional aspects that may influence the obtained results. We excluded records in which medical data were unavailable. This step was taken to minimize the risk of misclassification, introducing a limited risk of selection bias.Our future research direction will be to investigate the influence of the proposed markers  on the predictive value of amputation risk in relation to a series of biochemical or clinical models, such as PREVENT III or the BASIL model, that exist in the literature .In our study, we demonstrated the predictive value of the analyzed inflammatory biomarkers and the importance of their assessment in patients with severe obstruction and a high risk of amputation. NLR and PLR are predictors used in patients with ABI values below 0.5 and a risk of amputation, thus making them parameters with both therapeutic and prognostic value. NLR, PLR and WMR are easy-to-determine and reproducible parameters, which can be easily used in daily practice, as they also have therapeutic and prognostic value among patients with PAD.


The triple task (TT) is a method for assessing the dynamics of writing processes. It involves three tasks in one: writing a text, responding to a sound, and reporting the process. Previous research has mostly shown that the TT does not affect the writing process or the product. However, individuals with dyslexia often show difficulties in tasks that require organization, automation, integration of multiple processes, inhibition, and shifting/cognitive flexibility. The aim of this study was therefore to investigate whether TT affects the writing process and written product differently in adults with dyslexia compared to a control group of adults with typical reading skills.Two groups of adult native Croatian speakers were included in this study: 20 adults with developmental dyslexia and 20 adults with typical reading skills; evenly distributed by: age (18–38 years), gender , educational level, and nonverbal cognitive abilities. All participants wrote one text with a TT and another without. The writing of the text was tracked with a keystroke logging program – Inputlog. The two texts were compared at process and product level.The results showed that measures of writing processes and text quality in the groups of adults with dyslexia and adults with typical reading skills were unlikely to be differentially affected by TT. However, in the condition without TT, the total number of characters per minute was higher, more keys were typed per minute and more words were deleted. As expected, adults with dyslexia produced shorter texts of lower quality and with more errors; they also produced fewer characters per minute, used fewer keystrokes and typed fewer.The study suggests that TT is unlikely to have a different impact on the writing process or written product in adults with dyslexia compared to adults with typical reading skills. It was originally developed by Kellogg in 1987. According to the assumptions of In reviewing the literature on cognitive processes in writing, it is noticeable that not many studies use TT. Consequently, there are not many studies that have used TT in the last decade e.g., , yet theWriting is considered one of the most complex cognitive activities, being cognitively and emotionally demanding on its own right . TherefoSpecial care should be taken when applying such a complex method for assessing writing to a population that struggle with reading and writing, such as people with dyslexia do. While dyslexia has traditionally been defined as a discrepancy between an average or higher general cognitive ability and low reading performance, more recent understandings of dyslexia suggest that it encompasses developmental language difficulties that go well beyond reading difficulties, including difficulties with phonological processing, word use, spelling, and writing that persist into adulthood e.g., . MoreoveStudies dealing with language disabilities and writing are still very product-oriented and more interested in the developmental perspective, with children being the participants rather than high education students or adults. To date, there have been very few process-oriented studies of the writing of individuals with dyslexia. Studies of writing by adults with dyslexia have shown that: students with dyslexia made more morphosyntactic spelling errors, memory-related errors, punctuation errors, and capitalisation errors than the control group and that the quality of their writing was poorer based on text structure ; adults Therefore, for adults with dyslexia, writing itself is more challenging and the TT might be more reactive, i.e., more disruptive to writing processes than in adults with typically developed reading and writing skills; and not just because of reading and writing difficulties, but also abilities and/or skills underlying the mentioned language skills. Coordinating multiple processes when composing texts, i.e., focusing and shifting attention between (meta)cognitive processes and tasks, and making decisions when selecting alternatives are examples of executive functions that operate in the background of thinking, language, and memory processes during text composition . ReadersSuch a dual-task method is widely used in cognitive psychology e.g., , whereasTo sum up, TT reactivity to writing processes or product has not been demonstrated in most previous studies with populations with typical language skills e.g., , with thTherefore, the first goal of this study was to investigate whether the TT method affects writing processes and/or written product in adults with dyslexia compared to a control group of adults with typical reading skills. It might be expected that adults with dyslexia may have difficulty in performing concurrently three tasks fluently, which could be reflected on some writing processes characteristics or in the text quality. Although many studies have not found evidence of TT reactivity in typical readers, some have, and studies with readers with dyslexia are non-existent. The second goal was to investigate whether the TT method affects the writing process and/or written product independently of dyslexia. From previous studies, it appears that some process measures could be disrupted by TT, e.g., revisions. And the third goal is to investigate group differences, i.e., to compare adults with dyslexia and adults with typical reading skills in terms of text quality and writing process measures.2.2.1.Two groups of adult native Croatian speakers participated in this study: (1) 20 adults with developmental dyslexia (DYS), and (2) 20 adults with typical reading skills (TRS) as a control group.reading speed and accuracy (words and pseudo-words), (b) spoonerism, (c) rapid automatised naming (RAN), and (d) digit span task (forward and backward). According to the univariate t-tests, the performance of the groups differed significantly on all tasks performed, with adults with dyslexia scoring lower  reaAll participants have regular eyesight (with or without aids) and were frequent users of keyboards, i.e., they write daily using a keyboard  or several times a week .Prior to participation, all participants were asked to read and sign an informed consent form. Ethical approval for this study was obtained from the research ethics committee of the Centre for Postgraduate Studies Language and Cognitive Neuroscience, University of Zagreb .2.2.2.2.1.Text quality was assessed using text-based and reader-based measurements. Text-based measures were divided into three text quality measures: (1) productivity, (2) complexity, and (3) accuracy. (1) Productivity was measured as text length in terms of word count. (2) Complexity included measures of syntactic complexity (number and proportion of simple and complex sentences) and lexical complexity . (3) Accuracy was measured as the frequency of different types of errors, such as spelling, capitalization, punctuation, grammar, semantics, pragmatics, and others (see more in Three independent readers (students in the master’s program in Speech and language pathology) rated the texts on four reader-based measures on text quality (adapted from 2.2.2.Inputlog 8.0 (Keystroke logging (KSL) is a method of recording writing using a keyboard. The entire writing session was recorded in both conditions (writing with and without TT) using Inputlog 7.0 . Particitlog 8.0  was usedtlog 8.0 . All dat2.3.Each participant had to write two narrative texts elicited by two visually balanced drawings  in two conditions: (1) with TT, and (2) without the TT. This single structured stimulus method was used because such a stimulus has been shown to discriminate well between the performance of individuals with language disorders and the typical population e.g., . FurtherF = 0.03, p = 0.859; see The time allowed for writing the texts was limited to 25 min per text. Participants spent approximately the same amount of time writing both texts, i.e., total processing time did not differ significantly between the two conditions in either group  implying that words are longer in the condition without the TT  was significant , number of sentences , average sentence length , total number of errors , number of mechanical errors , number of grammatical errors , total text-quality (reader-based) , and all text-quality measures: content , coherence , syntax , vocabulary . When compared with TRS adults, adults with dyslexia in their texts produced less words and sentences; they made more mechanical and grammatical errors; and the overall text-quality was poorer including content, coherence, syntax, and vocabulary  (BFexcl = 0.510), number of characters per min. (excl. spaces) (BFexcl = 0.416) and total typed per min. (excl. spaces) (BFexcl = 0.215) are below 1. Ten variables show weak evidence for null hypothesis, and eight variables show moderate evidence  for writing process variables are BFF = 5.931, p = 0.021, ηp2 = 0.165, BFexcl = 1.468] and excluding spaces  was higher in the condition without TT; similarly, more keys were typed per minute including spaces  and excluding spaces  in the condition without TT. The ratio between the total number of words in the final text and the total number of words produced during the writing process was higher in the condition without TT  implying that more words were deleted in the condition with TT. For the direction of the differences see descriptive statistics in the Some of the main effects of the TT condition for the process variables cannot be interpreted validly  because they interfere with a technical aspect of the triple task implementation, i.e., the response box was the keyboard extension, and the strokes were logged as deletions or insertions. However, some main effects of the TT condition for the process variables do not interfere to this technical aspect, so they can be interpreted; and those that were found to be significant indicate the reactivity of TT regardless of group. In the typewriting analysis, the total number of characters per minute including spaces , total number of characters (incl. spaces) , total number of characters (excl. spaces) , number of characters per min. (incl. spaces) , number of characters per min. (excl. spaces) , total keystrokes , total typed (incl. spaces)  = 7.21, p = 0.011, ηp2 = 0.171, BFexcl = 0.454), total typed per min. (incl. spaces) , total typed (excl. spaces) , total typed per min. (excl. spaces) , and proportion of number of words in final text and during the writing process . When compared with TRS adults, adults with dyslexia spent less time in active writing, produced a smaller number of characters and characters per min., used less keystrokes, less typed in total and per min., and had a less words in the final text comparing to the number of words produced during the writing process . Thus, with regard to the first objective of this study, it can be assumed that the use of the triple task in adults with dyslexia compared to adults with typical reading skills probably has no effect on the writing processes or product variables measured in this study . The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.MOT contributed significantly to the concept and design of the work, as it is part of her unpublished doctoral dissertation. She conducted the research, but also analyzed, interpreted, and discussed the data. JKK and RA critically reviewed the work and enriched it with their extensive knowledge and experience in writing articles. They were involved in the entire process of conducting the research and writing the paper. As supervisors, they guided and advised the first author through the extensive research process. All authors contributed to the article and approved the submitted version.


This review covers recent developments and progress in polymer and biopolymer blending and material preparation by electrospinning. Electrospinning is a technique that is used to produce nanofibers to improve the quality of membranes. Electrospun nanofibers are highly applicable in biomedical sciences, supercapacitors, and in water treatment following metal ion adsorption. The key affecting factors of electrospinning have been checked in the literature to obtain optimal conditions of the electrospinning process. Future research directions and outlooks have been suggested to think about innovative ideas for research in this field. The production of polymer fiber with an electric field has been known since 1930 . ElectroAs mentioned above, there are two major types of electrospinning, which are melt electrospinning and solution electrospinning . Melt elVarious types of materials are used in electrospinning to produce electrospun nanofibers. The well known materials used are organic polymers, small molecules, colloidal particles, and composites. Organic polymers can be applied either in melted form or in solution form. Organic polymers are usually dissolved in solution to be used in solution form . The solThis review mainly focused on electrospinning, its techniques and affecting factors, and its recent progress and applications. Electrospinning techniques, such as needle-based electrospinning and needleless electrospinning, are being used for fiber production. Needle-based electrospinning is used for small-scale production of fibers. Needleless electrospinning is used for industrial applications. Electrospinning is a versatile and interdisciplinary technique, so it has applications in various fields, such as biomedical sciences, water treatment, and supercapacitor research. There are two standard types of needle-based electrospinning setup, either vertical or horizontal. This classification is opted due to geometric-arrangements of collecting plate and ejecting capillary .The spinneret used in single nozzle electrospinning is a single needle, and it is simplest form of needle-based electrospinning. In single-nozzle electrospinning, the formation of the Taylor cone takes place on the top of the capillary . A singlMulti-nozzle electrospinning is used to enhance nanofiber yield and the production rate. The nanofiber production rate is enhanced by introducing the number of needles, holes, and tips. The operating procedure of a multi-nozzle is similar to a basic electrospinning system, and it involves the interaction of Coulomb forces and electric field forces .Coaxial electrospinning leads to the production of core-sheath fibers. In coaxial electrospinning coaxial spinneret is used, this coaxial spinneret usually contains an inner or outer needle . SolutioThree polymer solutions are introduced by spinneret to compound the Taylor cone, and this technique of electrospinning is termed triaxial electrospinning. The loading of polymer with nanoparticles is common in triaxial electrospinning. In a dual drug delivery system, the triaxial fiber is considered to supply two different drugs due to its isolation layer . The varThe modification of electrostatic spinning by an introduction of flowing air blown to boost the fiber production process is known as electroblowing, and this flowing air blown is introduced to the spinning nozzle. Variation in flowing air properties leads to variation in the properties of fibers being produced, and properties of flowing air, such as air velocity adjustment, help to obtain fibers of desired requirements .Centrifugal electrospinning utilizes centrifugal force and electrostatic forces for fiber production. Centrifugal electrospinning devices are mainly composed of components such as the servo motor, feeding plate, holder, high voltage, collecting plate, and rotating nozzle . Rihova Nanofiber production on a larger scale is achieved by needleless electrospinning. The quality of fiber by needleless electrospinning is better than needle-based electrospinning . On otheBasic electrospinning is dependent on the spinnability of polymer solutions, and bubble electrospinning depends on geometrical properties, such as the size of formed bubbles. Rui et al.  carried Splashing electrospinning has modified the polymer solution supply system, and this polymer solution is applied in the splashed form to the metal roller spinneret. In splashing electrospinning, the solution distributor is arranged on top of a metal roller, and the splashing of the polymer solution from the solution distributor leads to a gravitational field due to height difference .Edge electrospinning is used for batch operation, and in edge electrospinning, a bowl fill is used for polymer solution . Edge elIn two-layer fluid electrospinning, the upper layer is referred to polymer solution, while the lower layer is applied to ferromagnetic suspension. A coil or wire is used to generate a magnetic field, and two layers are charged with a magnetic field. The addition of an electric field leads to the formation of nanofiber in an upward direction by a motion of the lower layer disturbing the upper layer of polymer solution .The important factors responsible for the electrospinning process can be classified into two categories, which are either polymer solution process conditions or process equipment conditions. Environmental factors also have an impact on the electrospinning process . Important affecting factors regarding polymer solution are polymer molecular weight and solution viscosity, solution concentration, solvent volatility, solution conductivity, and solution surface tension . PolymerThe molecular weight of the polymer is a representation of presence of polymeric chain entanglements, and polymers with lower molecular weight also contain polymeric chain entanglements to ensure the solution viscosity requirements. Higher molecular weight is not always the requirement for electrospinning if the polymer has enough interchain connectivity . MoleculIf the solution concentration is kept constant during electrospinning, then an increase in molecular weight will result in the formation of smooth fibers, and a decrease in molecular weight will lead to bead formation . There is a direct effect of polymer concentration on solvent evaporation and solution viscosity. If a polymer is in low concentration, then electro-spraying must be performed instead of electrospinning . If a poSolvent volatility plays an important role in influencing the electrospinning process. If a solvent is highly volatile, then the collection of dry fibers can be facilitated. When solvent with higher volatility starts evaporating, it may cause needle clogging, which results in the polymer solidification at the needle tip. If the solvent has lower volatility, then the production of fine fibers is possible because the solvent does not clog at the needle tip ,54.Solution conductivity plays a pivotal role in controlling the diameter of nanofibers. The charge density of polymer solution can be determined by solution conductivity, and charge density is responsible for controlling bending and repulsion extent during the electrospinning process. Uyar et al.  conducteWang et al.  measuredThe affecting parameters regarding electrospinning equipment are applied voltage, anode/needle distance, and fluid flow rate . These pThe formation of a stable cone from solution is dependent on a specific range of applied voltage. The pendant can be formed at the exit of the nozzle due to the dripping of two solutions in the case of low voltage. If voltage is increased to a maximum value, it also leads to clogging due to fluid jets inside the capillary ,59. The There is a direct effect of a needle-to-collector distance on the solution electric field. When needle-to-collector distance is increased, then an exponential decrease in volume charge density is observed. It is noted that, with a 5 cm to 20 cm needle-to-collector distance, the nanofiber size range was from 210 nm to 310 nm. The increase in nanofiber size was not remarkable with an increase in anode-to-collector plate distance .The flow rate of fluid has an impact on the shape/size of the droplet formed at the tip of the spinneret, nanofiber diameter, morphology, path of the jet, and transformation of the charged droplet into Taylor cone ,63. ZongNanofiber formation can be affected due to environmental factors during an experiment. Temperature and humidity are key environmental factors that influence electrospinning conditions  67]..67].Vrieze et al.  carried During electrospinning, alteration in humidity can affect fiber morphology. Casper et al.  observedProgress in the biomedical field is based on the development of biomedical applications, such as the evaluation of bio-compatibility of implants, regenerative tissue engineering, drug delivery systems, and imaging devices . BiomateCoronary heart disease (CHD) is linked with blockage of coronary arteries, and it accounts for almost 50% of cardiovascular deaths. Blood is supplied to the heart by these arteries . CHD canFor biomaterials preparation, chitosan is widely used. Chitosan is a biopolymer derivative of chitin, and it is widely used in tissue engineering and drug delivery systems. Chitosan nanoparticles were synthesized and loaded with PU to form electrospun vascular membranes ,84. For There is also a report on other blends for electrospinning. Sen et al.  preparedGraphene oxide (GO) and egg white proteins (EWPs) have applications in wound healing. Wang et al. produced wound dressing of composite GO/EWPs/PVA, and they prepared this blend with varying amounts of GO. The varying amounts were 0, 0.5, 1, and 2 mg/mL, so they used the electrospinning and crosslinking technique. They observed that the addition of graphene oxide boosted wound healing activity. Composite fibrous wound dressing with 1 mg/mL has shown excellent physiochemical properties and wound healing effects, and it also has the ability for tissue regeneration .+2 to enhance wound healing activity. This cross-linking also adds antioxidant and anti-microbial properties to the polymer blend of SA and PVA [Sodium alginate (SA) and polyvinyl alcohol (PVA) polymers are famous for biomedical applications, and a blend of these two polymers can enhance the biological, mechanical, and physical properties of the wound healing material. This polymer blend can be cross-linked with Ca and PVA .Gonçalves et al.  analyzedw/v) and chitosan (2% w/v) with polyvinyl alcohol (10% w/v). Keratin/PVA and chitosan/PVA nanofibrous scaffolds have been studied for biomedical applications, so it was a unique idea to fabricate PVA/keratin/chitosan. These three-dimensional nanofibrous scaffolds (3DENs) have the potential to be used for biomedical applications according to the results.Tajul et al.  carried L-lactic acid (PLA) and chitosan blends [Electrospinning and film casting methods are used for poly-n blends ,94. PLA/n blends . It has n blends ,97. Thisn blends , and it n blends  and for n blends ,101.CPT), polyethylene oxide (PEO), and polyethylene glycols (PEG)-poly lactide (PELA). Implantable micelle depot had great potential for cancer therapy.There are two major ways of drug delivery by electrospinning, either blending of drug with a polymer solution or chemically grafting the drug on the molecular structure of the polymer, and chemical grafting is possible with chemical bonding . RychterCancer is a threat to human health , and a mPoly-ε-caprolactone (PCL) is a semi-crystalline polymer, and it is known for its biomedical applications. The melting point of PCL is 60 °C, and it is quite low. The tensile strength of PCL is higher, and it is biodegradable ,109. TecPoly(N-vinyl-2-pyrrolidone) (PVP) is hydrophilic, and it is non-toxic, so it is considered an important component for the development of biomaterials. Processing of PVP is difficult due to its rigidity and fragility . The addPoly-γ-glutamic acid (PGA) has applications in tissue engineering due to its bio-compatibility . PGA/chiMunj et al.  developeZahra et al.  analyzedSociety and industrial energy requirements are dependent on a huge amount of consumption of depleting fossil fuel sources, such as coal and oil and gas ,131. Res2g−1. They suggested HAS for in situ activation of PCNFs for supercapacitors to achieve a high level of performance [Wang et al.  activateformance .Polyimide (PI) and polyvinyl chloride (PVC) blend are prepared by electrospinning, and electrospun fibers of PI/PCL show a specific level of phase separation. The reason behind this level of phase separation is an incompatibility of PI and PVC in N and N′-dimethylformamide (DMF). Carbon nanofibers of PI/PVC having mesoporous structure served as an electrode, and it was proven to possess fast ion mobility/diffusivity .2 at 1000 °C, which converted PAN into carbon and PMMA decomposed with generating pores.Abeykoon et al.  derived Wang et al.  used thi2O4/C for supercapacitor applications. They noticed that carbonization temperature affected the structure and morphology of the product. The dendrite-like three-dimensional MgCo2O4/C was prepared with a larger surface area of 314.027 g/m2, and it achieved unique structural properties and excellent chemical properties.Yu et al.  demonstr−1 at 0.5 A g−1 in a three-electrode system. Supercapacitor device with MnO-CNF electrodes achieved a maximum power density of 5000 W kg−1, maximum energy power of 14 W h kg−1, and excellent cycling stability  [Manganese oxide is considered a promising pseudo-capacitive material due to its cost-effectiveness, variation of oxidation states, and high theoretical capacitance. Electrospinning is applied to incorporate MnO nanoparticles with carbon nanofibers (MnO-CNFs). Carbonization is controlled during electrospinning, and it is applied as an electrode in a supercapacitor. A supercapacitor with MnO-CNF electrode obtained a high specific capacitance of 246 F g cycles) . 1−xO3 nanofibers films (SCTO-x) was prepared with a perovskite structure by using electrospinning combined with low temperature (600 °C) sintering technology. By Ce doping, the electrochemical properties of electrodes to store energy were improved. Investigation of SCTO-x samples results showed that optimal electrochemical performance is achieved by sample SCTO-0.3 in 1 M in Na2SO4 solution. The device achieved an outstanding capacitance of 174.2 F · g−1 at 1.25 A · g−1 [Flexible SrCexTi A · g−1 .Water is important for the continuation of life, and water is required for various sectors, such as industry, agriculture, and hydropower generation . Toxic c2 h−1) in water–oil emulsions. CNMs also have excellent adsorption capacity for heavy metal ions. The adsorption capacity for Pb+2 by CNMs was reported to be 346 mg/g.Guo et al.  preparedHaddad et al.  checked 2 or TiO2 metal oxide with a layer of chitosan by electrospinning. They investigated the adsorption capacity of this bilayer nanofiber membrane against lead (PbII) and cadmium (CdII) ions. This bilayer nanofiber membrane increased the adsorption capacity of cadmium by 405% more and of lead by 102% more than a single layer of PAN/MO. Alharbi et al.  produced+2) ions, with specified conditions of 46% weight gain rate and pH 5-6. This nanofiber membrane can represent concentrations of copper (Cu+2) ions with different gradient colors. Zhang et al.  incorporXu et el.  mentioneTalukder et al.  preparedPolyelectrolyte fiber was produced by electrospinning of polyacrylic acid (PAA) and polyallylamine hydrochloride (PAH) complex solutions, which was then followed by thermal crosslinking. When the pH level was 3.4, fiber mats showed 63% removal of the tested heavy metals , and 98% removal was observed at pH 7.4 from synthetic metal solutions, and this confirmed that the removal of Pb, Cd, and Cu by electrospun fiber is effective at higher pH .−2⋅h−1⋅bar−1. The evaluation was made for CS/PVP/PVA nanofibrous membrane against these ions, Cu(II), Ni(II), Cd(II), and Pb(II), and separation was also checked for methylene blue (MB) and malachite green (MG).Wu et al.  preparedMetal–organic frameworks (MOFs) are a kind of porous adsorbent, and they are well known for the removal of Cr(IV) from water. Iron-based MOFs were synthesized by solvothermal technique, and they were co-electrospun with polyacrylonitrile (PAN) to obtain composite electrospun nanofibrous membranes (PAN/MOFs ENFMs). PAN/MOFs ENFMs experienced adsorption of Cr(IV) from water, and adsorption capacity was noted at 127.70 mg/g at a pH level of 4. The fraction of Cr(IV) ion was converted into Cr(III), which was less toxic as compared to Cr(IV) .Assaifan et al.  used coaAccording to Scopus database, electrospun materials have major applications in the field of materials science, chemistry, chemical engineering, physics and astronomy, biochemistry, genetics and molecular biology, and medicine. The words “electrospun material” and “polymer” have been checked in the Scopus database with title, abstract, and keywords over the years, and they have been compared to databases with a search for the words “electrospun material” and “polymer blends”. This comparison is presented in Electrospun materials have attracted great attention due to their interdisciplinary applications. In this review paper, we have focused on electrospun materials for major applications in the biomedical field, as supercapacitors, and in water treatment in the form of metal ion adsorption of heavy metals. In the case of biomedical applications, electrospun materials are used to treat cancer, coronary heart disease, and diabetic foot ulcers. Electrospun materials also have applications to control bleeding, wound healing, and in drug delivery systems. We have noticed that electrospun polymer blends have an appreciable role in biomedical applications, but their application as supercapacitors is also increasing because fossil fuel sources are depleting, and the world is focusing on energy storage devices. Electrospun materials based on polymer blends can be used to maintain the high-level performance of supercapacitors. Blends of carbon nanofibers, polysulfone, and polyacrylonitrile have key importance in supercapacitors applications. Electrospun polymer materials enhanced the adsorption capacity of heavy metals by following the metal ion adsorption technique. Blends of polyacrylonitrile and polyether sulfone have promising contributions to heavy metal ion adsorption for water treatment.In the future, the treatment of cancer-affected cells of the human body with the electrospun polymer and biopolymer blend needs to be especially elaborated. Electrospun materials for applications in supercapacitors to achieve higher power density, maximum energy power, high capacitance, and thermal stability should be also developed. Moreover, the application of electrospun materials for effective adsorption of heavy metal ions and heavy metals is being more and more expected.