Candida auris (C. auris) is an emerging fungus associated with high morbidity. It has a unique transmission ability and is often resistant to multiple drugs. In this study, we evaluated the ability of different machine learning models to classify the drug resistance and predicted and ranked the drug resistance mutations of C. auris. Two C. auris strains were obtained. Combined with other 356 strains collected from the European Bioinformatics Institute (EBI) databases, the whole genome sequencing (WGS) data were analyzed by bioinformatics. Machine learning classifiers were used to build drug resistance models, which were evaluated and compared by various evaluation methods based on AUC value. Briefly, two strains were assigned to Clade III in the phylogenetic tree, which was consistent with previous studies; nevertheless, the phylogenetic tree was not completely consistent with the conclusion of clustering according to the geographical location discovered earlier. The clustering results of C. auris were related to its drug resistance. The resistance genes of C. auris were not under additional strong selection pressure, and the performance of different models varied greatly for different drugs. For drugs such as azoles and echinocandins, the models performed relatively well. In addition, two machine learning algorithms, based on the balanced test and imbalanced test, were designed and evaluated; for most drugs, the evaluation results on the balanced test set were better than on the imbalanced test set. The mutations strongly be associated with drug resistance of C. auris were predicted and ranked by Recursive Feature Elimination with Cross-Validation (RFECV) combined with a machine learning classifier. In addition to known drug resistance mutations, some new resistance mutations were predicted, such as Y501H and I466M mutation in the ERG11 gene and R278H mutation in the ERG10 gene, which may be associated with fluconazole (FCZ), micafungin (MCF), and amphotericin B (AmB) resistance, respectively; these mutations were in the “hot spot” regions of the ergosterol pathway. To sum up, this study suggested that machine learning classifiers are a useful and cost-effective method to identify fungal drug resistance-related mutations, which is of great significance for the research on the resistance mechanism of C. auris. Candida auris (C. auris) is an emerging fungal pathogen first isolated from the external ear canal of a 70-year-old female inpatient in Tokyo hospital : South Asia (Clade I), East Asia (Clade II), South Africa (Clade III), and South America (Clade IV). A potential fifth clade of Iranian origin was described by few studies , which is involved in an important step in the biosynthesis of ergosterol. Antifungal agents effectively inhibit ergosterol biosynthesis by inhibiting the enzyme’s function, thereby compromising membrane integrity  exogenous pump transporter, which is encoded by the CDR1 gene, and duplication and overexpression of the ERG11 gene, contribute to the reduction of the sensitivity of C. auris to azole drugs  associated with FCZ resistance , micafungin (MCF), and anidulafungin (AND) are often recommended as first-line treatments for candidemia  in the FKS1 and FKS2 genes in Candida albicans and other non-auris Candida species have been associated with the echinocandins resistance. In the FKS1 gene of C. albicans, these “hot spots” lie between the amino acids 641-649 and 1,345-1,365    . Moreover S639Y) . Sharma his gene .C. auris and C. lusitaniae have shown high resistance to amphotericin B (AmB). However, the molecular mechanism of polyene drug resistance is not clear  from China and used logistic regression and random forest to find and predict new genes associated with drug resistance of seven drugs  has 796 isolates in total. Among them, 356 strains have undergone antifungal susceptibility testing. According to these results, resistant or susceptible strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) guidelines.As of April 2020, the whole genome sequencing (WGS) data of . auris strains  checked the data quality of each strain’s sequence and divided the data according to different types of sequencing adapters for quality control [Trimmomatic : the classifier on the balanced test set and on the imbalanced test set  functions in Python’s Scikit-Learn established in mutation sequencing were based on the F1 data set, which contained all candidate genes selected before machine learning modeling. All features were standardized before ranking, and the training model was the classifier above. The standardized method used was StandardScaler function in Python. The number of features discarded in each iteration was 1, indicating elimination one by one, and the model was built repeatedly through 5-CV.https://itol.embl.de/). The phylogenetic NJ tree was divided into four clades starting from the root . It was speculated that the resistance genes of C. auris were not under additional strong selection pressure, which may be related to the clinical use of drugs.Phylogenetic NJ-tree was constructed using MEGA-X , and boothe root Figure 1the root . The cluthe root . In the the root . In addithe root . AccordiThe performances of machine learning classifiers, constructed by the two algorithms described above on F1, F2, and F3, were evaluated and compared by several evaluation methods. The best model for each set and drug was listed in The model with the highest AUC value was extracted and compared Table S6–ERG11, mutations on the TAC1B . Particularly, mutations in the “hot spot” regions of the ergosterol pathway, such as I466M, G459S, and Y501H in ERG11, and R278H in ERG10, were detected. These mutations were frequently and highly ranked mutations. FKBP12 has been reported to be associated with multiple resistance in Candida spp., and the S4N mutation was detected in this gene. Two frequently occurring mutations, H771R and G995S, were identified in CDR1, the gene encoding the ATP-Binding Cassette efflux pump transporter. Two high-frequency mutations, E49D and A18P, were also found in a specific gene  of C. Auris. These mutations should be paid special attention to in the following research.Using RFECV, three antifungal drugs, including FCZ, MCF, and AmB, were ranked and predicted, respectively. The mutation ranking results are shown in he TAC1B , and S63C. auris strains C1921 and C1922 sequenced in our laboratory were classified into Clade III from the phylogenetic tree, which was consistent with the tree constructed using Internal Transcribed Spacer and D1/D2 Large Ribosomal Subunit Region in the previous study (C. auris into four clades: South Asia (Clade I), East Asia (Clade II), South Africa (Clade III), and South America (Clade IV) , and it was emphasized that each clade has a great relationship with geographical location. The clustering results from the phylogenetic tree in this study illustrated that these strains could be divided into four clades, but the conclusion of clustering according to geographical location was not very prominent.us study . PreviouMachine learning technology has great potential in classifying drug resistance of strains with WGS data and analyzing high-dimensional data sets, which is very important for predicting mutations associated with drug resistance. Our model evaluation results illustrated that the machine learning classifiers performed quite different when testing different drugs. The classifier model showed excellent performance for azoles and echinocandins such as FCZ, ICZ, VCZ, and MCF, but not for others like AmB and PZ. It was speculated that there might be more information about determinants associated with azoles and echinocandins resistance but less for AmB and PZ in the three sets. This was directly indicative of the fact that the correlation between feature sets and classification targets was stronger for azoles and echinocandins, but was weaker for the two drugs. In addition, there were some deficiencies in model optimization so that only several models were optimized in the process of constructing classifier models and adjusting parameters. Therefore, optimizing models through a large number of experiments and tests should be performed in future work in order to achieve better performance.C. auris related to antifungal drug resistance. In the RFECV process, different ranked mutation results were obtained by combining different classifiers. Overall, the results indicated that the RFECV method could not only rank several known mutations as important, especially for well-studied drugs but also predict some new important mutations on the genes closely related to drug resistance. Some of the predicted mutations were known to be important resistance mutations, which to some extent demonstrated the validity of our classification model. The model could obtain more reliable conclusions for well-studied drugs, such as azoles and echinocandins, while for amphotericin B, the model also predicted some resistance-related mutations. Based on these results, further research and verification are needed on the specific mutations and drug resistance mechanisms of C. auris.In this study, RFECV combined with a machine learning classifier was used to predict and rank the mutations of Machine learning models can improve the prediction of important genetic mutation sites related to drug resistance in fungi, particularly beneficially for less-studied drugs. The amount of test data, or sample size, is one of the keys to the performance of machine learning methods. We speculate that 500 to 1,000 fungal samples may get satisfactory results according to previous studies. Random forest, logistic regression, and K-nearest neighbors classifier performed relatively better in this study. While in another study, PM  and SVC-RBF ranked as the top two best-performing classifiers on MTB . The mosC. auris, and provide a scientific basis for developing prevention and control strategies against drug resistance and the search for possible new drug targets.This study may help to analyze the drug resistance mechanism of The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/LH and XC conceived the project. JZ and FC collected the samples. DL, YW, and WH conducted the NGS. YW and DL conducted the RNA analysis, analyzed data and wrote manuscript. LH evaluated all results. All authors contributed to the article and approved the submitted version.This study was supported by Scientific Research Project of National Natural Science Foundation of China , the State Key Program of National Natural Science Foundation of China (12031016), Project of Natural Science Foundation of Liaoning Province (20180550255) and Fundamental Research Funds for the Central Universities (GK201901008).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.


Polycystic ovary syndrome (PCOS) and hypothyroidism are the most common endocrinological disorders among women of reproductive age. Since hypothyroidism occurs more frequently in PCOS patients, it is vital to explain its clinical impact.  To evaluate the impact of subclinical hypothyroidism (SCH) and its treatment on the metabolic profile of patients with PCOS.  190 women with PCOS phenotype A were enrolled in the case-control study. They were divided into three groups: 38 women with PCOS and subclinical hypothyroidism, 76 women with PCOS and SCH under thyroid replacement therapy, and 76 women with PCOS and normal thyroid function (control group). Serum lipids, fasting glucose, and insulin, as well as oral glucose tolerance tests were performed.  In the analyzed parameters, there were no statistic differences between the groups in relation to thyroid function. BMI turned out to be the main factor dividing the patients in terms of serum lipids, fasting glucose, fasting insulin, and oral glucose tolerance test. TSH was associated with total cholesterol and LDL cholesterol levels, whereas BMI has a dominant impact on HDL cholesterol, triglycerides, glucose, and insulin resistance.  SCH is associated with mild lipid serum alterations in women with PCOS, but it is BMI to have a dominant impact on glucose and insulin. It seems that treatment of SCH in PCOS does not significantly alter lipid and glucose metabolism. Polycystic ovary syndrome (PCOS) is a disease that affects all stages of a woman's life. The full clinical picture of ovulation disorders, hyperandrogenism, and polycystic morphology of the ovaries in ultrasound is revealed in women of reproductive age , 2. The In recent years, there have been reports of a more frequent occurrence of hypothyroidism among patients diagnosed with PCOS-11–14% vs 1–2% in the control group –11. In tThyroid hormones are involved in the regulation of glycaemia at the central and peripheral levels . At the Therefore, it would seem that the coexistence of PCOS and hypothyroidism would correlate with more marked metabolic and hormonal changes. Mueller et al. described a significant dependence between the TSH value (as the most sensitive indicator of thyroid function) and insulin resistance, regardless of the age and BMI of the patients . ReportsThis study aimed to evaluate the lipid profile, glucose and insulin levels as well as HOMA-IR index in patients with PCOS and untreated SCH, and with PCOS and SCH under levothyroxine treatment, in relation to patients with PCOS and normal thyroid function.2) and overweight/obese women (BMI ≥25 kg/m2). The Ethics Committee of Medical University of Silesia approved of the use of retrospective data from the patients' files, no. KNW/0022/KB/325/18/19. All patients gave written informed consent, and their confidentiality and anonymity were protected.190 women with PCOS phenotype A, aged 18–35, hospitalized at the Department of Gynecological Endocrinology of the Medical University of Silesia in Katowice from January 2014 to December 2018, were included in the study. The exclusion criteria were overt hypothyroidism, hyperthyroidism, previous thyroid surgery, hyperprolactinemia, congenital adrenal hyperplasia, Cushing's syndrome, diabetes, oral contraceptives, steroids, or hypoglycemic drug intake. The study group included 38 women with PCOS and untreated SCH, 76 women with PCOS and hypothyroidism under levothyroxine treatment, and 76 women with PCOS and normal thyroid function (control group). The subgroup analysis was performed after dividing our patients into two groups: normal weight  . ClinicaSCH was diagnosed based on TSH concentration above 4.2 mIU/L, with the normal level of free thyroxine-FT4 (9.01–21.88 pmol/L). In patients with PCOS and hypothyroidism treated with levothyroxine, thyroid dysfunction was diagnosed in the Endocrinology Outpatient Clinic. Oral levothyroxine therapy, in the form of medications containing levothyroxine sodium salt: Euthyrox N  or Letrox , was started at least 3 months before hospitalization. The dose was chosen according to the TSH levels and body weight at the beginning of the study. To assess the equalization of thyroid function in this group of patients, the level of TSH was used as the most sensitive test reflecting thyroid metabolism . Hypothy2). Blood samples were drawn to quantify thyroid  and metabolic  parameters. Blood samples were taken after overnight fasting, between the second and fifth day of the menstrual cycle. A fasting 75 g oral glucose tolerance test was performed. Glucose and insulin levels were measured from the samples. The assessment of insulin resistance was carried out using the indirect method using the HOMA-IR index calculated from the formula:Height and weight were measured in each patient. BMI was calculated as weight (kg) divided by the square of height (mµIU/ml) x fasting serum glucose concentration (mmol/L)/22.5). Insulin resistance was diagnosed with HOMA–IR values > 2.HOMA-IR = fasting serum insulin concentration , follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, 17-hydroxyprogesterone, androstenedione, dehydroepiandrosterone sulfate and cortisol were determined.Serum concentrations of TSH, FT4, total testosterone, SHBG, FSH, LH, prolactin, dehydroepiandrosterone sulfate, and cortisol were determined by electrochemiluminescence “ECLIA” using Roche reagents on a Cobas 601 analyzer . Serum glucose, total cholesterol, HDL and LDL cholesterol, and triglycerides were determined by colorimetry  using Beckman Coulter reagents . Insulin concentrations were determined using the chemiluminescence method (CMIA) using Abbott reagents . The concentration of 17-hydroxyprogesterone and free testosterone was determined using the enzyme immunoassay ELISA from NovaTec  on a Virclia analyzer . The concentration of androstenedione was determined with the immunochemical test using the chemiluminescence method “CLIA” using Siemens reagents .p < 0.05 were considered statistically significant. Statistical analysis was performed with the use of SAS 9.2  and STATISTICA 12.0 PL .The continuous data are presented as the mean with standard deviation. The normality of the distributions was assessed with the Shapiro Wilk test. Variance homogeneity was assessed by Levene's test. To normalize the values of the selected parameters, the logarithmic transformation was used. In the analysis of the relationships between the studied variables, the Spearman nonparametric correlation test was used. The relationships between the variables are presented in the form of multivariate regression models. The results for which L (p < 0.0001). FT4 values in all study groups were within the reference standards. There was no statistically significant difference between the groups in any of the analyzed parameters of the lipid profile and carbohydrate metabolism.The group of women with PCOS and treated SCH had a BMI value significantly higher than the control group. The group of women with untreated SCH did not differ significantly in terms of BMI between the group of treated women and the control group. The analysis of anthropometric parameters, thyroid function, and metabolic parameters of the examined women, taking into account the division into groups, is presented in the table .. The mep < 0.0001)  and patients with higher BMI (BMI ≥25) . There w 0.0001) .In the study groups: untreated, treated, and control, statistically significant differences were found between patients with normal and higher BMI in terms of lipidogram components: HDL and LDL cholesterol fractions and triglycerides Figures . In all R = 0.05; p=0.04).In univariate regression models including TSH and BMI as independent variables explaining the dependent variable the value of total cholesterol, it was shown that the variable influencing total cholesterol is TSH. On the other hand, the HDL cholesterol fraction is significantly influenced by BMI, while the LDL fraction and triglycerides are influenced by both TSH and BMI. Therefore, a multiple regression analysis was performed assessing the interaction between TSH and BMI. LDL cholesterol fraction is significantly influenced by TSH, and triglycerides are significantly influenced by BMI. For the remaining variables, such as: glucose, insulin, HOMA-IR, the dominant influence of BMI was shown. Moreover, there was no evidence of collinearity between TSH and BMI  regardless of thyroid hormones  and nicoFinal univariate and multivariate regression analysis showed that BMI, not TSH, is a factor that significantly influences glucose levels and the HOMA-IR index. In 2009, Mueller et al. , 32 descp=0.01). A similar relationship was found by Trummer et al. [ μg/day, as a result, achieving TSH in the lower range of normal of the reference −0.5 mIU/L [In the obtained results, attention were drawn to the significantly higher BMI in the group of patients with compensated hypothyroidism under levothyroxine treatment compared to the control group , which made it possible to exclude the modulation of insulin resistance in the studied groups by BMI.One of the limitations of the study is the recruitment of patients for the study during diagnostic hospitalization in a hospital setting, which may cause overrepresentation of patients with more severe symptoms of hormonal disorders.In addition, the assessment of insulin resistance was carried out using the indirect mathematical HOMA-IR model, and not the “gold standard” direct method of the euglycemic metabolic clamp. It is a method that is less invasive for the patient, less time-consuming, and does not require the use of appropriate equipment.The study did not verify cigarette smoking by the patients, or the duration of hypothyroidism in the group of patients treated with levothyroxine, which could affect the parameters of thyroid function and metabolic parameters in the study group. It should be noted that the effects of treating hypothyroidism with levothyroxine in PCOS patients were not prospectively analyzed, which would enrich the cognitive value of the work.SCH causes a clinically mild deviation in the lipid profile in PCOS: higher levels of total cholesterol and LDL cholesterol fraction. However, the treatment of SCH accompanying PCOS does not significantly improve lipid and glucose metabolism. It seems that SCH is not able to significantly aggravate the already existing disorders of carbohydrate metabolism and affect the lipid profile of women with full-blown PCOS. An interesting and important direction (due to the frequency of occurrence of the mentioned endocrinopathies) of future research would be to explain the mechanisms of metabolic disorders in the case of coexistence of both endocrinopathies.The influence of subclinical hypothyroidism on metabolic parameters in PCOS is modulated by BMI. Subtle thyroid hormone deficiency has no significant clinical effects in lean women with PCOS, but in the case of obesity, even a slight hormone deficiency, superimposed on existing disorders, can produce clinical symptoms. This is an argument that justifies the regular control of the parameters of thyroid function in the group of PCOS patients, and in a conversation with an obese patient, it allows to emphasize the role of weight reduction in the case of accompanying hypothyroidism.


Vast numbers of differentially expressed genes and perturbed networks have been identified in Alzheimer’s disease (AD), however, neither disease nor brain region specificity of these transcriptome alterations has been explored. Using RNA-Seq data from 231 temporal cortex and 224 cerebellum samples from patients with AD and progressive supranuclear palsy (PSP), a tauopathy, we identified a striking correlation in the directionality and magnitude of gene expression changes between these 2 neurodegenerative proteinopathies. Further, the transcriptomic changes in AD and PSP brains ware highly conserved between the temporal and cerebellar cortices, indicating that highly similar transcriptional changes occur in pathologically affected and grossly less affected, albeit functionally connected, areas of the brain. Shared up- or downregulated genes in AD and PSP are enriched in biological pathways. Many of these genes also have concordant protein changes and evidence of epigenetic control. These conserved transcriptomic alterations of 2 distinct proteinopathies in brain regions with and without significant gross neuropathology have broad implications. AD and other neurodegenerative diseases are likely characterized by common disease or compensatory pathways with widespread perturbations in the whole brain. These findings can be leveraged to develop multifaceted therapies and biomarkers that address these common, complex, and ubiquitous molecular alterations in neurodegenerative diseases.  Neurodegenerative proteinopathies such as Alzheimer’s disease (AD) and progressive supranuclear palsy (PSP) are characterized by the aggregation and accumulation of self-proteins within insoluble aggregates . AD is ahttps://doi.org/10.1172/JCI149904DS1). Second, we applied a comprehensive model to partially account for cell type changes  as covariates, in addition to all covariates in the simple model  between AD and the control and PSP and the control. For our comprehensive model analyses, this number was 14,557 because of the exclusion of 5 cell type marker genes. x axis) and PSP versus control (y axis) DE, using either no additional filter or filtering for various q value  cutoffs. Even when examining all genes without a DEG q value filter, we found a strong positive correlation between the changes observed in AD versus control and PSP versus control TCx and CER samples  for the TCx and an R2 of 0.69  for the CER. These R2 values were increased and remained highly significant when analyzed using the comprehensive model. In the TCx, the R2 was 0.62 , and in the CER, the R2 was 0.39 . In both models, increasing the q value cutoff to 0.1, 0.05, or 0.01 reduced the number of genes but increased the strength of the correlations, with R2 ranging from 0.89 to 0.98 and slopes ranging from 0.77 to 1.13   and cerebellar cortex (CER) , 7. Supp changes . In the le model . For thele model . This fi samples . Assessm to 1.13 . We also to 1.13  and volc to 1.13 . To vali to 1.13  and perfnd ETFB)  and immund ETFB) . Using tq value filter was applied demonstrated that the transcriptomic changes for protein-coding genes were highly similar in these 2 disorders, and that DEGs selected on the basis of q value cutoffs represented the core transcriptomic changes observed during neurodegeneration. Further, as bulk RNA-Seq data from whole-brain tissue is strongly influenced by changes in cell-type composition  versus the β coefficients for AD versus control in the CER (y axis) and likewise generated plots of the β coefficients of the TCx versus the CER for PSP versus control. We plotted data from both the simple and comprehensive models. These analyses showed robust correlations. In AD, the overall R2 between the TCx and the CER was 0.35  using the simple model, and the R2 was 0.32  using the comprehensive model. In PSP, the overall R2 was 0.31  in the simple model, and the R2 was 0.15  in the comprehensive model. Again, as the stringency of the q value used to select the DEGs was increased, both R2  and the slope  of the best-fit line increased when comparing the transcriptomes for the TCx and CER within disease states  that were changed in the same direction. Thus, we first analyzed DEGs that were downregulated in AD and PSP or upregulated in AD and PSP using the Functional Mapping and Annotation (FUMA) GWAS web server (q < 0.05) for biologic processes related to chromatin modification, gene expression, chromosome organization, and metabolism of nucleotides. In the CER, the shared upregulated genes linked to biological processes relating to RNA and RNA transcription, cell-cell junctions, and heart, kidney, gland, and circulatory system development. Shared downregulated genes in AD and PSP were associated with GO cell compartment terms related to mitochondrial and ribosomal functions in both the TCx and the CER. These data and the extended GO analyses  analyses to provide some biological context to these data. In this case, we binned the input into the GO analyses by focusing on DEGs (b server . These danalyses  point toanalyses , histoneanalyses , and metanalyses  data, weanalyses .Numerous studies analyzing large-scale transcriptomic alterations in AD have revealed a large number of network abnormalities that demonstrate widespread changes in pathways including but not limited to immune function, myelination, synaptic transmission, and lipid metabolism , 16–19. Our finding that there were shared transcriptomic changes between the TCx and the CER in AD and PSP brains is noteworthy and consistent with our prior findings in transcriptional networks . As noteIn summary, the concept that AD, PSP, or any other neurodegenerative disease has a specific transcriptomic signature may be inaccurate; rather, there appears to be conserved transcriptomic alterations due to common proteinopathies or their downstream effects. This assertion will require additional large-scale transcriptomic analyses of other age-associated neurodegenerative diseases conducted in a manner that eliminates many of the experimental confounds, such as batch effects. The large number of highly perturbed networks in AD that have been established in prior studies and our analyses in this study reinforce the notion that, in the symptomatic phase, neurodegenerative diseases are characterized by incredibly complex biology that likely represents a mix of long-standing degenerative and compensatory processes. Such data reinforce the need to both develop paradigms that allow for the earliest possible intervention in these disorders that typically have long prodromal phases, and to develop multifaceted therapies that might be able to better alter the complex alterations present in the symptomatic phases of disease. Our findings also demonstrate the widespread perturbations of systems in the whole brain in neurodegenerative diseases, which requires novel biomarkers capable of tracking these changes in relatively “unaffected” brain regions and formulating therapies that address these ubiquitous alterations.Additional information can be found in Supplemental Results and Supplemental Methods.The access information for the TCx and CER transcriptomic and proteomics data is provided in This study was approved by the Mayo Clinic IRB. Informed consent was obtained from the participants or their next-of-kin as applicable.TEG, NET, and MA conceived the idea. XW, MA, JSR, YM, and SRO performed quality control and analyses. NET, TEG, MA, CF, and NDP developed the study concept. TEG, XW, and NET wrote the manuscript. DWD provided tissue from the Mayo Clinic Brain Bank and neuropathologically characterized the Mayo brain samples. NTS and AIL generated the proteomics data. TN, KGM, MA, and MMC performed sample selection and library preparation. OI, FQTN, and CCGH performed qPCR experiments. MCC and MEM performed immunohistochemistry experiments. TEG, NET, SGY, and YWA supervised the analytical aspects of the project. NET and TEG provided funding, supervision, and direction for the whole study. All authors read and approved the final manuscript.


The useability of DPIs  depends on several factors that are influenced by the patients’ subjectivity and objectivity. The short-form global usability score (S-GUS), a specific tool for the quick ranking and comparison in real life of an inhaler’s usability, was used to investigate six of the most prescribed DPIs  in consecutive asthma patients aged <18 years. A Bayesian indirect comparison (IC) was carried out to merge all pairwise comparisons between the six DPIs. Thirty-three subjects participated: eighteen tested Breezhaler, Spiromax, Nexthaler, and Ellipta simultaneously, while fifteen tested Breezhaler, Spiromax, Diskus, and Turbohaler. The estimates of the S-GUS, by the IC model, allowed us to rank the DPIs by their degree of usability: Ellipta, Diskus, and Spiromax were classified as “good to pretty good” (S-GUS > 15), while Spiromax, Turbohaler, and Breezhaler were classified as “insufficient” (S-GUS < 15). The multidomain assessment is recommended in asthma adolescents in order to approximate the effective usability of different DPIs as best as possible. The S-GUS proves particularly suitable in current clinical practice because of the short time required for its use in adolescents. The adherence to inhalation therapy, together with the personalization of respiratory treatments, have been strongly supported in the last two decades for persistent bronchial asthma needing the long-term use of active drugs, and particularly in subjects prone to insufficient compliance to inhalation, such as the elderly and adolescents ,2,3. Dry powder inhalers (DPIs) became progressively available as a result of technological engineering ,5,6. HowThe factors affecting patient adherence to inhalation treatments via DPIs have been extensively studied. In particular, they have been mostly investigated from the point of view of patients, in terms of their preference, acceptance, and satisfaction ,13,14,15The global usability score (GUS) is an anonymous questionnaire specifically developed for objectively assessing the usability of inhalation devices . The GUSThe study aimed to assess and compare the real-life usability of six of the most used DPIs in asthma adolescents.p < 0.001) [The short-form GUS questionnaire (S-GUS) was preferred for the present study because, while maintaining the same sensitivity of the extensive version, it is much faster to fill  , and it < 0.001) , the meaThe S-GUS questionnaire, reported in 0.5 L/min) [The six DPIs to compare were: Breezhaler, Diskus, Ellipta, Nexthaler, Spiromax, and Turbohaler. These DPIs were selected because they are characterized by different intrinsic resistances (ranging from 0.017–0.039 kPa5 L/min) ,22, and The methodology was previously described . Brieflyp-value lower than 0.05 was considered to indicate evidence of differences in the evaluated variables.The patient characteristics were reported as absolute and relative frequencies; age was the only continuous variable collected in the questionnaire, and it was summarized as the mean and standard deviation (SD). The nonparametric Wilcoxon test was used to check the differences in the age distribution between the subgroups of patients who tested the different sequences of DPIs, while the Fisher’s exact test was used for all the other variables. The analyses were conducted using the statistical software R version 3.6.3 , and a ij,s for Patient s; s are random terms that captures the heterogeneity among patients . The relative device usability, A Bayesian indirect comparison (IC) was conducted to merge all pairwise comparisons between the six DPIs reported in the 33 questionnaires. The model was developed by using the software package, WinBUGS 1.4.3  , and was4) for the device usability and uniform distributions, with supports between 0 and 5 for all the standard deviations. All the simulations were conducted using one chain of 100,000 iterations, and the estimates were calculated after a 50,000-run burn-it. The parameters of interest were summarized by the posterior mean and the 90% credibility intervals (CrI), i.e., the 5th and 95th percentiles of the simulated values. Noninformative vague priors for all the hyperparameters defined in the model were used: normal distribution centered in zero with a large variance (102), according to the classical definition of Higgins and Thompson [The Bayesian approach allows for establishing an efficacy ranking among the analyzed interventions. The surface under the cumulative ranking (SUCRA)  was calcThompson .A total of thirty-three consecutive asthma adolescents were included in the study: eighteen patients (Group 1) tested Breezhaler, Spiromax, Ellipta, and Nexthaler, and fifteen patients (Group 2) tested Breezhaler, Spiromax, Turbohaler, and Diskus. The general characteristics of the sample are reported in p = 0.107). Group 1 and Group 2 were similar for almost all collected characteristics . The proThe GUS values estimated for each device are summarized in According to the thresholds previously proposed , Ellipta2 = 67.4%). Finally, the S-GUS score values proved large indeed, with a total heterogeneity  equal to 24.81. However, the patients’ characteristics seem to explain almost 70% of the variability  and objective  domains. It should be considered as the discriminating parameter for choosing the proper DPI, as it defines the overall “real-word” convenience of each DPI. This was the main reason for adopting the multidimensional GUS questionnaire in the present study on asthma adolescents. Even if all the DPIs tested in the present study did not achieve the GUS top score of 50 points, their usability proved clearly ranked in asthma adolescents, simplifying their choice in real life. Moreover, the patients’ usability elaborated in the present study is consistent with those observed in a cohort of asthmatic adults previously instructed in the use of DPIs . The ranThe present study has some limitations. The study is a monocentric investigation with a small sample size. Each patient did not test all the selected DPIs simultaneously, but only four-by-four. On the other hand, this was decided on purpose because the simultaneous comparison of more than four DPIs would have affected the reliability of the patient responses. Actually, despite the strict control of the nurses’ explanations of each DPI procedure, it was possible that minimal differences occurred while delivering the educational messages. DPI usability is confirmed as a complex issue indeed. DPIs are characterized by different degrees of usability in asthma, and also in adolescents. One single parameter only, based on the patient’s perceptions and beliefs, is unable to exhaustively represent per se the usability of DPIs, and allow for the most effective choice. A multidimensional score should be preferred in asthma adolescents in order to approximate the effective usability of the different DPIs presently available at the best possible level. The current conviction that “one size fits all” is clearly misleading in clinical practice when using DPIs, particularly in asthma adolescents. The opportunity to quickly rank the usability of DPIs should be regarded as a value, and should then be carefully considered before prescribing or switching a DPI in asthma adolescents.


Background: Hirschsprung-associated enterocolitis (HAEC) is a major contributor in the mortality of Hirschsprung disease (HSCR) patients that can occur both preoperatively and post-operatively. Several cut-off values of HAEC score have been used, i.e., ≥10 and ≥4. Here, we compared the HAEC frequency after transanal endorectal pull-through (TEPT) using two cut-offs of scoring system and associated them with the risk factors.Methods: Cross-sectional analysis was conducted using medical records of HSCR patients who were aged ≤18 years old and underwent TEPT at our institution, Indonesia between 2009 and 2016. HAEC was determined using the scoring system with cut-off values of ≥10 and ≥4.Results: Seventy subjects were used in the final analysis, consisting of 44 males and 26 females. There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p = 0.002). The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off values of ≥10 and ≥4 (p < 0.0001), respectively. We found that patients with anemia  had a higher risk of HAEC after TEPT than patients with normal hemoglobin level with OR of 3.77 , while no associations were found between other variables, including sex, age at diagnosis, age at definitive therapy, albumin level, and nutritional status and HAEC following TEPT . Also, no associations were observed between maternal education level, mother's age at pregnancy and gestational age and HAEC after definitive surgery .Conclusions: This report is the first study comparing two different cut-off values of scoring system to evaluate the HAEC frequency after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT. Hirschsprung-associated enterocolitis (HAEC) is a major contributor of mortality for patients with Hirschsprung disease (HSCR) , 2. It cThe objective of surgical treatment for HSCR is to remove the aganglionic colon and to anastomose the ganglionic colon above the dentate line , 5. TranVarious risk factors of HAEC after TEPT have been reported, such as sex, age at HSCR diagnosis and pull-through performed, however, they are still limited , 11. MorWe conducted a cross-sectional analysis using medical records of patients with HSCR who were aged ≤18 years old and underwent TEPT at our institution, Indonesia. Our institution is an academic and tertiary referral hospital for patients from two provinces, i.e., Special Region of Yogyakarta and southern part of Central Java, Indonesia. Medical records with incomplete data were excluded from analysis.This study received prior approval from the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital .The surgical procedure was conducted based on previous reports , 7, 18. Diagnosis of HAEC was determined by scoring system, and included patient history, physical examination, radiologic, and laboratory findings –15. We uWe gathered data on sex, age at HSCR diagnosis, age at TEPT performed, weight and height before TEPT, preoperative albumin, and hemoglobin level.z < -2) and normal (+2> z >-2)  and normal , and hyp> z >-2) , 21.We also collected the gestational age, mother's age during pregnancy and maternal education level. For maternal education level, we categorized it into low (no education—elementary) and high (junior—high school—bachelor), while for gestational age and mother's age during pregnancy, we classified them into preterm and full-term and ≤ 35 and >35 years, respectively.Sample size estimation was determined using an anticipated incidence of HAEC cut-off value of ≥10 and ≥4 of 30 and 70%, respectively, a confidence level of 95% and a power of 80%. The calculated minimum size required was 46 samples. Data were presented as number and percentage for categorical variables. Univariate analysis using Chi-squared or Fisher's Exact tests were performed for each categorical variable to evaluate the association between risk factors and HAEC incidence.We collected 75 medical records which fulfilled the inclusion criteria and excluded 5 medical records due to incomplete data. Thus, data from 70 subjects were used in the final analysis, consisting of 44 males and 26 females. Most of our patients were diagnosed (71.4%) and operated on (75.7%) at the post-neonatal period . All patp = 0.002, There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p < 0.0001), respectively.Next, we compared the HAEC incidence after TEPT using two cut-offs of scoring system. The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off of ≥10 and ≥4 (p = 0.027) when we used cut-off value of ≥4 .We found that patients with anemia had a higher risk of HAEC after pull-through than patients with normal hemoglobin level with OR of 3.77 .We also observed no associations between maternal education level, mother's age at childbirth and gestational age and HAEC occurrence after TEPT ] should be used rather than 10  to prevent under-diagnosing patients with HAEC . Thus, lp = 0.027, Interestingly, the hemoglobin level was significantly associated with HAEC incidence after TEPT (p = 0.15 and 0.33, respectively, Our results show that the incident of HAEC after TEPT was not associated either with age at HSCR diagnosis nor age at TEPT performed (One study showed that patients with underweight status have higher proportion of colitis/enteritis after colorectal resection when compared to normal or obese patients . AlthougWe found that hypoalbuminemia during TEPT procedure did not correlate with HAEC incidence after TEPT procedure . HoweverAnother novelty of our study is we evaluated maternal variables as possible risk factors of HAEC . AlPrevious studies suggested that infants born preterm have looser tight junction, less goblet cell secretion, lesser Paneth cells number and secretory function, and lack of IgA secretion and this lack of immunity can lead to higher risk of developing HAEC . But, weInfants born from mothers with age more than 35 years old have higher tendency to have trisomy 21, while trisomy 21 might increase the incidence of HAEC . It mighLimitations of this study include its retrospective nature and data were subjected to different confounding variables such as variation of follow-up times and various surgeons performing TEPT. Since the medical records were used, our study might bias toward patients with post-operative HAEC and exclude patients with fewer HAEC criteria. Moreover, further prospective multicenter study is necessary and important to clarify and confirm our results.This report is the first study comparing two different cut-off values to evaluate the frequency of HAEC after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.The studies involving human participants were reviewed and approved by the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital. Written informed consent to participate in this study was provided by the participants' legal guardian/next of kin.G, RL, BA, and FA conceived the study. RL, SK, BA, FA, RP, and G collected and analyzed the data. SK drafted the manuscript. GS, AR, GA, AD, AM, and G critically revised the manuscript for important intellectual content. G, AD, and AM facilitated all project-related tasks. All authors have read and approved the manuscript and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.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.


Diabetes has been associated with the increased risk of erectile dysfunction (ED). However, previous studies evaluating the association between prediabetes and ED showed inconsistent results. We performed a meta-analysis of observational studies to systematically evaluate the above association.Relevant observational studies were retrieved by search of PubMed, Embase, and Web of Science databases. A random-effect model which incorporated the potential intra-study heterogeneity was used for the meta-analysis. Subgroup analyses were performed to evaluate the influences of study characteristics on the outcome.2 = 78%). Subgroup analyses showed that the association was not significantly affected by definition of prediabetes, diagnostic tool for ED, or controlling of additional variables besides age (both P for subgroup difference > 0.05). However, the association between prediabetes and ED seemed to be stronger in case-control studies than that in cross-sectional studies, and in studies with younger men (mean age < 50 years) than in those with older men .Nine studies  were included. Age were adjusted or matched in all of the studies. Pooled results showed that compared to men with normoglycemia, men with prediabetes were associated with higher prevalence of ED (odds ratio = 1.62, 95% confidence interval: 1.28 to 2.07, P < 0.001; IPrediabetes is associated with higher prevalence of ED, which may be independent of age of the males and may be stronger in young men. Erectile dysfunction (ED) is a common sexual dysfunction in men, which is defined as the failure to achieve or maintain an erection for satisfactory sexual intercourse , 2. The In recent decades, the intensive care for patients with hyperglycemia has introduced the concept of prediabetes. Currently, prediabetes is defined as an intermediate metabolic state between normoglycemia and DM, which includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and mildly raised glycated hemoglobin (HbA1c) , 8. AlthThe meta-analysis was performed in accordance with the MOOSE   and Cochvia systematic search of electronic databases of PubMed, Embase, and Web of Science databases via the following terms: (1) “prediabetes” OR “pre-diabetes” OR “prediabetic state” OR “borderline diabetes” OR “impaired fasting glucose” OR “impaired glucose tolerance” OR “IFG” OR “IGT”; and (2) “erectile dysfunction” OR “erectile function” OR “sexual dysfunction” OR “sexual function” OR “ED”. The search was limited to human studies published in English or Chinese. The reference lists of related original and review articles were also analyzed using a manual approach. The final literature search was performed on May 5, 2021.Studies were identified The inclusion criteria for the studies were: (1) observational studies published as full-length articles; (2) included adult male participants; (3) evaluated the association between prediabetes and ED; and (4) reported the relative risk for this association as compared men with normoglycemia after adjustment or control of potential confounding factors, at least for age. The definition of prediabetes was based on the criteria of the original articles, and the diagnostic criteria for ED were consistent with those of the original studies. Reviews, editorials, preclinical studies, and studies irrelevant to the aim of current meta-analysis were excluded.Literature search, data extraction, and quality assessment of the included studies were performed independently by two authors according to the predefined inclusion criteria. Discrepancies were resolved by discussion with the corresponding author. The extracted data included: (1) name of first author, publication year, and country where the study was performed; (2) study design characteristics; (3) participant characteristics, including health status, sample size, and mean age; (4) definition for prediabetes and numbers of men with prediabetes; (5) diagnostic methods for ED and numbers of men with ED; and (6) confounding factors adjusted or controlled when the association was reported. The quality of each study was evaluated using the Newcastle-Ottawa Scale  which ra2 statistic were used to evaluate the heterogeneity among the include cohort studies  and their corresponding 95% confidence intervals (CIs) as the general measure for the association between prediabetes and ED as compared with men with normoglycemia. Data of ORs and their corresponding stand errors (SEs) were calculated from 95% CIs or P values, and were logarithmically transformed to stabilize variance and normalized the distribution . The Coc studies . A signi studies . Sensiti studies . Predefi studies . We usedvia initial literature search of the PubMed and Embase databases after excluding of the duplications. Among them, 356 were excluded through screening of the titles and abstracts mainly because they were not relevant to the purpose of the meta-analysis. Subsequently, 25 potential relevant records underwent full-text review. Of these, 16 were further excluded for the reasons listed in The process of database search was summarized in The characteristics of the included studies were summarized in 2 = 78%). Sensitive analysis by excluding one study at a time did not significantly change the results . In particular, sensitivity analyses excluding the two datasets from the study published in Chinese showed consistent results . Besides, sensitivity analyses excluding the study in which diagnosis of ED was based on self-reported symptoms also showed similar result . Subgroup analyses showed that difference in definitions of prediabetes did not seem to significantly affect the results  than that in studies with older men (mean age ≥ 50 years). In addition, subgroup analyses showed that difference in definitions of prediabetes, diagnostic methods for ED, and controlling of additional variables besides age did not significantly affect the association. Taken together, these results showed that prediabetes is associated with higher prevalence of ED, which is independent of age and may be stronger in younger men.To the best of our knowledge, this study is the first meta-analysis which summarized the association between prediabetes and ED. The study has several strengths which should be mentioned for better interpretation of the results. First, since advanced aging has been related to both hyperglycemia  and ED , it is iInterestingly, results of the subgroup analysis showed that the association between prediabetes and ED seemed to be stronger in studies with younger men than that with older men. The potential reasons for the results remain unknown. However, compared to older male participants, younger males were less likely to have various comorbidities that were associated with pathogenesis of ED, such as metabolic syndrome, hypertension, obesity, coronary artery disease, and multiple concurrent medications . Accordivia impairment of sensory impulses from the penis and parasympathetic activity for relaxation of the smooth muscle of the corpus cavernosum (The potential pathophysiological basis for the association between prediabetes and ED may be similar to that between DM and ED. Persistent hyperglycemia is associated with systematic inflammation and endothelial dysfunction, which represents the common denominator leading to vascular ED , 39. Besvernosum , 41. Morvernosum . Similarvernosum . AccordiOur study also has limitations. Firstly, all of the included observational studies were cross-sectional, and no longitudinal data was available for the association between prediabetes and incidence of ED. Accordingly, results of the meta-analysis should be validated in large-scale prospective cohort studies. Moreover, the meta-analysis was based on data from study level rather than data of individual patient. Therefore, results of subgroup analysis should be interpreted with caution. In addition, although age was controlled for all of the included studies, we could not exclude the possibility that other factors may confound the association between prediabetes and ED. In this regard, large-scale prospective cohort studies with careful adjustment of possible confounding factors are needed. Finally, a causative relationship between prediabetes and ED should be derived based on the finding of the meta-analysis because this is a meta-analysis of observational studies.Taken together, results of the meta-analysis showed that prediabetes is associated with higher prevalence of ED, which may be independent of age of the males and may be stronger in young men. Although these findings should be validated in large-scale prospective cohort studies, these results may highlight the possible importance of screening ED in men with prediabetes, particularly in young male population with prediabetes.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding author.MJ, SY and CW designed the study. MJ and SY performed literature search, data extraction, and quality evaluation. MJ, BW, and LY performed statistical analyses and interpreted the results. MJ wrote the manuscript. All authors reviewed and revised the manuscript, and approved the manuscript for submission.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.


South Korea dairy farmers are less interested in improving milk production-related traits for various reasons, including the milk production quota system. Consequently, they have become more interested in improving traits associated with longevity. Therefore, the purpose of this study was to analyze the culling patterns and survival rates of Korean Holstein cows and evaluate genetic characteristics related to parity and longevity of each lactation by using test data collected in South Korea. This study presents evidence that individuals’ genetic backgrounds differ with respect to differences in the individuals’ survival periods. Three lactation periods in each parity were split according to lactation days: 0–90 days (1), 91–299 days (2), and 300 days to the next calving (3). The heritability of the first, second, and third parities were 0.020, 0.028, and 0.039, respectively. In all parities, the heritability in late-lactation was higher than that in early- and mid-lactations. Most genetic correlations for survival in the first parity were higher than those in the second and third parities. The genetic correlation in the same lactation in the first and second parities were lower than those in the intervals in the second and third parities. The results of this study may serve as a basis for developing a more accurate model for evaluating longevity traits in South Korea.Longevity is closely related to the survival rate of dairy cattle and refers to the period during which the cow has economic value, from first calving to culling. The purpose of this study was to analyze the culling patterns and survival rates of Korean Holstein cows and evaluate genetic characteristics related to parity and longevity of each lactation by using the test day milk yield collected in South Korea. The performance data of the dairy cattle were collected from 2004 to 2019 by the Nonghyup Dairy Cattle Improvement Center. The collected 1,702,304 records were used as pedigree data through the Korea Animal Improvement Association. The lactation period was divided into early-lactation , mid-lactation , and late-lactation . The heritability of longevity for the first, second, and third parity was 0.020, 0.028, and 0.039, respectively. In all parities, the heritability in late-lactation was higher than that in early- and mid-lactation. Most genetic correlations for survival in the first parity were higher than those in the second and third parities. The results of this study may serve as a basis for developing a more accurate model for evaluating longevity traits in South Korea. The purpose of the Dairy Cattle Improvement Project of South Korea is to increase the income of farmers by improving their productivity and enhance the competitiveness of sire in South Korea. Domestic dairy farmers are less interested in improving milk production-related traits for various reasons, including the milk production quota system. Consequently, they have become more interested in improving traits associated with longevity, which have been introduced in regions that have made the most advancements in dairy technology such as North America.Longevity is closely related to the survival rate of dairy cattle and refers to the period during which the cow has economic value, from first calving to culling. In general, longevity is a desirable trait affecting dairy farmers’ profitability ,2. The mIn the dairy industry, it has also been reported that genetic evaluation for longevity has been conducted in all advanced countries . LongeviCalculating the survival probability for each parity and lactation is possible in South Korea using the milking and culling records collected as test records. The survival lifetime can be explained by the different reasons for culling collected from dairy farmers this way, and the reasons for culling vary by parity and lactation in days . TherefoThe performance data related to milk production and udder health of dairy cattle were collected from 2004 to 2019 by the Nonghyup Dairy Cattle Improvement Center. The 1,702,304 records collected through the Korea Animal Improvement Association were used as pedigree data.The records of 190,773 cows were used for estimating genetic parameters after removing censored data, cases with unknown parent records, and data with less than five contemporary groups (herd-year). The genetic evaluation was using 298,975 records, including censored  and uncensored  data among the test records collected for breeding value estimation. The uncensored data refers to cases with known culling time. The censored data refer to the data that cannot measure the exact productive life because it is unknown if an individual has survived, or the exact date of culling is unknown. The detailed reasons for culling and records are in The lactation period was divided into early-lactation , mid-lactation , and late-lactation .When an individual survived in the subsequent lactation period from the current lactation period, the individual was coded as 1. If an individual did not move to the next lactation period because of culling or death, it was coded as 0. Moreover, for late-lactation cases (more than 300 milking days), if a test record existed for the subsequent parity, it was set to 1. If not, it was set to 0 .Y is the survival of each lactation (1 or 0), HY (herd-year) is the effect of the contemporary group, Season with four levels  is the calving season effect, and FCa is the first calving age (<25 months of age: 0 and ≥26 months of age: 1), a is a random genetic effect, and e is a residual effect.The following animal model was used for estimating genetic parameters.Although the contemporary group used for the genetic evaluation model of production traits and conformation traits is usually set to herd-year-season (HYS) and analyzed, this study used HY and season separately because the Korean dairy cattle population was too small to use HYS. A previous study also showed that the contemporary group of using HYS as a fixed effect and that of using HY and season as fixed effects had the best fit, respectively .The multiple trait model that evaluates nine traits simultaneously demands a computer with high computation power. Therefore, because of computing power limitations, the parameter estimation was conducted by converting the nine traits  into 83 combinations of three traits. Afterward, the results were combined. The genetic parameters used in this study were estimated using the WOMBAT Program .The genetic and phenotypic parameters of economic life by parity  were calculated using the following equations.When making a genetic variance–covariance matrix using the diagonal mean of the genetic variances estimated from 83 combinations and the off-diagonal using the mean genetic correlation, it does not form a positive definite matrix. Therefore, this study generated a genetic variance matrix for estimating the breeding value through the following process for producing a positive definite matrix from a genetic variance–covariance matrix .(1) Genetic variance–covariance matrix was calculated using the mean of genetic parameters and mean correlation coefficients estimated from the initial variance component (3) If an eigenvalue of (4) The genetic variance matrix to be used for the genetic capacity evaluation was calculated as follows in this study.The off-diagonal matrix of In this study, the BLUPF90 Program  of the BThe following equation was used to estimate the direct herd life (DHL) for the longevity trait by combining the breeding values for each parity and lactation while considering the mean survival rate of daughters for the sire estimated above sI=mean i , and i until the culling of the individual.And the cumulative survival rate of the trait In this study, the calving interval was calculated by setting the 1st–2nd calving as 426 days, the 2nd–3rd calving as 426 days, and the 3rd–4th calving as 432 days.This study used the result of the national genetic evaluation published by the National Institute of Animal Science(NIAS) in April 2020 to compare breeding values between the longevity traits estimated above, milk production traits , those between 25 conformation traits (stature (ST), chest width (CW), body depth (BD), angularity (ANG), rump angle (RA), rump width (RW), rear leg side view (RLSV), foot angle (FA), fore udder attachment (FUA), rear udder height (RUH), rear udder width (RUW), udder suspensory (US), udder depth (UD), front teat placement (FTP), teat length (TL), overall conformation score (OCS), loin strength (LS), udder texture (UT), rear teat placement (RTP), heel depth (HD), bone quality (BQ), rear leg rear view (RLRV), height at front end (HFE), locomotion (Loc), and body condition score), and those between Udder Composite Index, Feet and Leg Composite, Milk, Fat, Protein composite, and Korean Type Production Index. This study used 383 sires with at least 50 daughters from DHL evaluation and 90% or higher reliability in EBV (adj-305 milk yield and OCS) for the accuracy of analysis .https://www.vit.de/, accessed on 22 May 2020) reported that the culling rate was 17–24%, 31–35%, and 44–49% during early-, mid-, and late-lactation period, respectively. The culling rate in Korean Holstein was slightly different with 8–13%, 19–29% and 56–71% during early-, mid-, and late-lactation periods, respectively  which were significantly affected by the survival period are presented in ectively .9. Heise  reported9. Heise ,11. ConsThe multiple trait model is a method to utilize genetic and environmental correlations between traits by analyzing two or more traits simultaneously. The multiple trait model including traits with low heritability is useful when the difference between genetic and environmental correlations is high  or when the heritability of one trait is considerably higher than that of another trait . In thisIt is not easy to directly compare the genetic parameters of longevity between countries because the lactation period is set differently between countries. Therefore, if the heritability and genetic correlations by parity are unified, it will be possible to compare countries directly and the results are shown in When cows survived in all three parities, heritability was estimated as 0.085, and it was 0.020, 0.028, and 0.039 in the first, second, and third parities, respectively. The heritability of this study was lower than that of Boettcher, et al. , and HeiThe correlation between the DHL and the breeding value for longevity of each parity ranged between 0.76 and 0.96, showing a highly positive correlation. In all parities, the breeding value correlation between late lactation and DHL was always 0.9 or higher, which is a strong correlation .Sewalem, Miglior, Kistemaker, Sullivan, Huapaya and Van Doormaal  reportedIn this study, the correlation between early-lactation and mid-lactation in the first parity, early-lactation in the second parity and mid-lactation in the third parity was 0.9 or lower, which was different to the results of the previous studies. However, it could be explained by the differences in the culling rates in South Korea between early-, mid-, and late-lactation periods. It could also be because the heritability of early- and mid-lactation (0.003–0.014) was different to that of late-lactation (0.022–0.028). The analysis results of this study indicated that DHL included survival rates for all lactation periods. Moreover, it may be possible to compare different evaluation traits using these results.In addition, this study analyzed the correlation of DHL with four traits related to milk production evaluated in South Korea, the breeding value of conformation traits, and four indices using these traits’ breeding value A–C. The The results of Heise, Liu, Stock, Rensing, Reinhardt and Simianer  showed tThe breeding value correlation between DHL and conformation traits is shown in The correlation between ST and breeding value by lactation was negative. Like milk production-related traits, it showed the highest breeding value correlation in early and mid-lactation of the first parity. However, the correlation between these traits was negative. The breeding value correlations of lactation with CW, BD, AN, and RW were negative (−0.44 to −0.05). CW and BD showed a moderate negative correlation (−0.43 to −0.34) in all parities. ANG also showed a negative correlation in all periods. In particular, correlations in late-lactation showed relatively stronger negative relationships. Similar to ANG, RW also showed a relatively high negative correlation in late-lactation of each parity. FA showed a strong breeding value correlation with early-lactation in most parities.Breeding value correlations of traits related to udders mostly showed moderate positive correlations. In FUA, early-lactation in all parities was the highest with 0.10, 0.17, and 0.14, respectively, and the breeding value in mid-lactation had the strongest correlation. RUH, US, and UD showed positive correlations ranging from 0.22 to 0.52. In particular, UD was 0.36–0.52, showing a moderate correlation. In addition, correlation tended to be stronger in later lactation and later parity.In particular, the results of this study revealed that the breeding value correlations with TL, OCS, and LS, which South Korean dairy farmers were keen on understanding, were not high (−0.10 to 0.13), unlike the expectations previous to the study. LS showed a negative correlation in the range of −0.12 to 0.07.Moreover, UT was 0.28 (L1.1), 0.26 (L1.2), 0.14 (L2.1), 0.20 (L2.2), and 0.10 (L3.1) in early- and late- lactation of each parity. In late-lactation, the correlations of the first parity, second parity, and third parity were low with −0.01, −0.01, and 0.03, respectively. In RTP, which farmers paid much attention to during milking, there were positive correlations in all periods, but they were weak (0.04–0.12). HFE showed a negative correlation (−0.35 to −0.29) in all parities and lactation periods.This study calculated the breeding value correlations between longevity-related DHL by applying UDC, FLC, MFP, and KTPI estimated by combining the breeding value estimated from Korea Genetic Capacity Evaluation . As shown above, along with the results showing relatively stronger positive correlations with udder-related traits, the udder index calculated by combining udder traits showed intermediate correlations in the range of 0.30–0.44. In addition, as parity increased, the correlation between the breeding value and the udder index tended to increase from 0.29 to 0.44. FLC also showed a positive correlation. In the case of MFP, relatively high breeding value correlations were found in early- and mid-lactation of the first parity, similar to milk production traits. Lastly, KTPI, composited using milk production traits and body shape-related traits, showed positive correlations (0.25–0.36) in early- and mid-lactation of all parities with a small culling rate.The breeding value correlation between DHL and conformation-related traits revealed that the correlations with RUH, US, and UD among traits-related to udder were relatively high (0.25– 0.52). In particular, the correlation with UD was the highest at 0.52. It appeared to be related to the heritability of udder-related traits associated with milk production after calving to the subsequent breeding. It is possible to improve the longevity of the individuals by improving these traits.In contrast, the results of this study showed that longevity had a negative correlation with traits directly related to body size . Specht, et al.  reportedVacek, et al.  reportedDHL showed positive correlations (0.14–0.42) with UDC, FLC, MFP, and KTPI, calculated by combining these traits. It is possible to, directly and indirectly, select the longevity of Korean dairy cattle using these indices.In addition, this study analyzed both censored and uncensored data. The results of this study will provide baseline information for estimating life expectancy solely by using censored data.This study presented evidence that individuals’ genetic backgrounds differed with respect to differences in the individuals’ survival period. It provides the basis for developing a more accurate genetic evaluation model for traits related to longevity that will coherently explain the genetic correlation structure. It will also be possible to provide information on the economic aspects to Korean dairy farmers by comparing breeding value between milk production-related traits, conformation-related traits, and reproduction-related traits.DHL and each lactation period showed a strong correlation. Milk production traits, udder-related traits, and composite indices  had positive correlations. The results indicate that these traits are closely related to the longevity and survival of cows. It is believed that it will be possible to select a sire based on these traits.The results of this study may serve as the basis for developing a more accurate model for evaluating longevity traits in South Korea.


Objective: Studies have consistently found a positive relationship between social support and a sense of purpose; however, less is known about the underlying mechanisms of this relationship. The present study bridges this gap by proposing and testing a path model illustrating the mediating effects of personal growth initiative and academic self-efficacy on the linkage between social support and a sense of purpose.Method: A total of 2,085 Chinese college students completed the revised versions of the Social Support, Personal Growth Initiative, Academic Self-Efficacy, and Sense of Purpose Scales.Results: The results show that social support, personal growth initiative, and academic self-efficacy were all significantly associated with a sense of purpose. As predicted, personal growth initiative and academic self-efficacy mediated the relationship between social support and a sense of purpose, respectively. The results also support the hypothesized serial mediating effect.Conclusion: Individuals who feel more social support have a higher level of personal growth initiative, their academic self-efficacy is stronger, and their academic self-efficacy further enhances their sense of purpose. Additionally, comparisons among the three indirect effects indicated that the effect of personal growth initiative was significantly greater than those of the other two measures. Thus, it can be concluded that personal initiative plays a greater role in enhancing a sense of purpose. These findings not only help to understand how social support enhances the sense of purpose, but also provide insight into the underlying mechanism. A sense of purpose reflects the degree of individual feeling regarding a particular aim . It doeshow does social support affect that sense of purpose? What is the internal mechanism? Unfortunately, there is as yet no relevant research on this topic. The present study used Chinese college students as participants to explore the ways in which social support affects one’s sense of purpose. This research will not only enrich the existing body of theoretical work on the factors influencing a sense of purpose, but also provide effective suggestions for enhancing it in college students.It is an important resource that affects college students’ performance in school and future development, and includes the care received from parents, professional guidance from teachers, and mutual help among schoolmates. One study found that social support and its utilization significantly negatively predicted college students’ learning burnout . Social Social support refers to material or psychological resources from individuals’ social networks that help them cope with challenges . Social Research has shown that it is more important to perceive social support from parents and teachers than it is to simply be connected to them . A crossAccording to the theory of self-determination, individuals generally have three basic needs: autonomy, relationships, and ability . The neePersonal growth initiative includes four dimensions: preparation for change, planning, use of resources, and conscious behavior . Cross-cAcademic self-efficacy is the specific application of self-efficacy in the field of learning. It refers to students’ expectations and judgments about their ability to complete specific learning tasks . StudiesStudents’ academic self-efficacy is affected by the expectations, guidance, and social support given to them by important others . A longiPeople with higher personal growth initiative have long-term plans, are better at allocating resources to achieve established goals . They haSelf-efficacy is a dynamic construct, which is expected to change with changes in the environment , whereasThe present study was designed to explore the mechanisms underlying social support and a sense of purpose in Chinese college students. Further, a serial mediation model was built to reveal the unique effects of mediators and compare the strengths of the three indirect effects. Thus, according to previous studies, three hypotheses were proposed, as follows:Hypothesis 1. Social support, personal growth initiative, and academic self-efficacy are significantly positively correlated and significantly positively associated with a sense of purpose.Hypothesis 2. The relationship between social support and a sense of purpose is mediated by personal growth initiative and academic self-efficacy.Hypothesis 3. Personal growth initiative and academic self-efficacy play a serial mediating role between social support and a sense of purpose.Via convenient sampling methods, a total of 2,085 college students were recruited from seven universities in five provinces in China. Questionnaires were distributed among them, incomplete and missing questionnaires were eliminated, 1,912 valid questionnaires were returned, and the recovery rate was 91.70%. Among them, female accounted for 62.7% and male accounted for 37.3%. Freshmen, sophomores, juniors, and seniors accounted for 34.4, 30.7, 32.2, 20.4, and 13% of the total number, respectively. Literature and history, science and engineering, accounting for 44.8 and 55.2% of the total, respectively. Urban, town and rural areas accounted for 24.5, 25.6, and 49.8% of the total, respectively. They were 18–23 years old, with an average age of 19.32 (SD = 1.58). Participants completed the self-report questionnaire during class time, which was presided over by well-trained researchers. Before the participants took the questionnaire, they obtained informed consent and ensured the anonymity of the answers. The Academic Ethics Committee of XX Normal University approved this study.Social support was accessed by the Multidimensional Scale of Perceived Social Support . We use The Personal Growth Initiative Scale-II  consistsThe Academic Self-Efficacy Scale  was usedThe self-compiled Sense of Purpose Questionnaire was used in the present study, including three dimensions: purpose awareness, purpose recognition, and purpose strategy. The questionnaire consists of 14 questions, with responses recorded on a 5-point Likert scale, “1” means strongly disagree, and “5” means strongly agree. The higher the score, the stronger the sense of purpose. E.g., “My purpose of life is clear.” The Cronbach’s alpha of the scale for the current study was 0.88.In this study, measures such as anonymous measurement and reverse scoring of some items were used to control the bias effect of the common method procedurally. Before analyzing valid data, we used the Harman single factor test method , there aFirstly, SPSS 25.0 was used for descriptive statistics and Pearson correlation analysis, to investigate the intercorrelations among social support, personal growth initiative, academic self-efficacy, and sense of purpose. Then, T test showed that the total score range of college students’ sense of purpose is 3.48 ± 0.51, which was significantly different from the middle score of 3 , indicating that the overall level of college students’ sense of purpose was relatively high. College students’ sense of purpose had no significant differences in gender, major, and grade. There were significant differences in the scores of sense of purpose among college students from different places. The sense of purpose of urban college students was significantly higher than that of rural college students .The normality assumption was checked after removing outliers, with all variables approximating a normal distribution. The single-sample p < 0.001) and academic self-efficacy . In addition, social support, personal growth initiative, and academic self-efficacy all positively predicted a sense of purpose . Moreover, personal growth initiative positively predicted academic self-efficacy .The results see  show thaWe conducted a pairwise comparison of the three indirect effects. The results indicate that the indirect effect of social support on a sense of purpose through personal growth initiative was significantly greater than the serial mediating effect, β = 0.27, SE = 0.02, 95% CI = , and the indirect effect through academic self-efficacy, β = 0.25, SE = 0.02, 95% CI = . The serial mediation effect was stronger than the mediation effect of academic self-efficacy, β = −0.03, SE = 0.01, 95% CI = .p < 0.001). This study is consistent with the results of previous research; that is, a sense of purpose was found to be significantly related to the influence of important others (p < 0.01). This showed that personal growth initiative and academic self-efficacy played a partially mediating role in the relationship between social support and a sense of purpose.This research investigated the influence of social support on college students’ sense of purpose, as well as the mediating mechanism of personal growth initiative and academic self-efficacy from the self-determination theory, self-efficacy theory, and the Model of Proactive Motivation Process. The results show that the direct effect of social support on college students’ sense of purpose was significant . Future work could be verified by longitudinal research and an experimental design. Third, the current study investigated the impact of social support on a sense of purpose, ignoring whether support coming from parents, teachers, or friends might have a stronger influence. Previous work has documented that teachers can foster a sense of purpose in their students in their mid to late adolescence . TherefoThis study found that a high level of social support perception could increase a sense of purpose, reminding educators and parents to intervene in college students’ sense of purpose, especially when guiding goal setting and goal pursuit. Furthermore, the present study found that personal growth initiative and academic self-efficacy can enhance the relationship between social support and a sense of purpose. In particular, the current study found that personal growth initiative had a stronger impact than academic self-efficacy on the linkage. Therefore, it is important to strengthen college students’ personal growth initiative and academic self-efficacy, especially to enhance their initiative. For instance, educators should stimulate students’ interest in learning, set challenging tasks, and give evaluative feedback, all of which should promote college students’ academic confidence and initiative, further enhance the sense of purpose of college students.lrong1122@126.com.The data analyzed in this study is subject to the following licenses/restrictions: This research is a part of the first author’s Ph.D. thesis, the datasets generated and analyzed during the current study are not publicly available, because she is preparing her doctoral dissertation, but is available from the corresponding author on reasonable request. Requests to access these datasets should be directed to RL, The studies involving human participants were reviewed and approved by the Academic Ethics Committee of Fujian Normal University, China. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.RL proposed the research framework. JC designed the entire process, distributed and collected questionnaires, and analyzed the datas. Both authors participated in the compilation and verification of the manuscript, and approved the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The current study quantitatively assessed research trends in tropical medicine in China via a bibliometric method, which used the Web of Science database to analyse the research-based literature related to tropical medicine published from 2010 to 2019.  Articles were analysed according to the output and research performance of institutes and countries that collaborated with China. Distribution of keywords was applied to evaluate research trends. , which published 707 papers, emerged as the top journal according to the number of publications.  Our findings showed that 3372 articles in the field of tropical medicine have been indexed under the Web of Science database during the past 10 years, indicating that studies pertaining to tropical medicine have been growing from 2010 to 2019. The Chinese Center for Disease Control and Prevention (China CDC) system, which published 549 articles on tropical medicine, may be considered as the flagship of tropical medicine in China. The United States ranked first in internationally collaborative articles with China. Furthermore, Parasite & Vectors This study highlights the key institutes and topics pertaining to tropical medicine research in China. Although there has been rapid progress in research on tropical medicine in China, some gaps still remain. Tropical diseases are prevalent in 149 countries and regions worldwide. Approximately half of the global population is threatened by tropical diseases . In westWeb of Science is a web-based database of citations maintained by the American Institute of Scientific Information. It enables bibliometric analysis of retrieved results. The bibliometric method allows quantitative analyses to be conducted on retrieved documents from multiple perspectives, leading to a better understanding of the status quo of academic research and provides a reference point for exploring a topic in scientific research . A comprThe present study was designed to evaluate the current status as well as the potential for the development of the Chinese component of published research in the field of tropical medicine from 2010 to 2019. A bibliometric method was used to analyse tropical medicine trends and performances.th, 2020.The current study, which involved bibliometric research, analysed all articles registered under the subject of “tropical medicine” in the Web of Science between 2010 and 2019. All literature from 2010 to 2019 with “China” in the address field and the words “tropical medicine” was used as a topic within the Web of Science Core Collection database. A total of 3372 records were eventually revealed. This search was performed on June 5Using bibliometric statistical functions provided by the Web of Science, statistics on the volume, citation, distribution of literature, and distribution of publications, as well as external cooperation between different institutions, were collected. VOS viewer 1.6.11 was used for keyword analysis. ArcGIS 10.1 was used for international collaboration analysis.h-index was 59. These findings further indicated that a relative growth had taken place in the number of studies conducted on tropical medicine in China over the past 10 years . The sum of times cited was 32592, while the 10 years . The numThe distribution of document types, as identified by the Web of Science, was analysed. The 3372 publications produced during the 10-year study period were categorised into nine document types. Articles (2758), comprising 81.79% of total publications, were the most frequently used document type, followed distantly by letters , meeting abstracts , and reviews . Other documents showing less significance were editorials , corrections , book chapters , retractions , and new items .Collaboration with different countries was estimated via the location of affiliation of at least one author of a published paper. Of the 3372 articles with author addresses, 122 were involved in research. A total of 1254 (37.19%) were internationally collaborative articles and 2118 (62.81%) were China-independent articles. Participation of China in publications involving other countries is shown . The toph-index  and PLOS Neglected Tropical Diseases (386). The top 10 journals accounted for about 90% of all articles, and the impact factors (IF) of journals ranged from 2.5 to 4.5. According to the JCR Category of Tropical Medicine, there were two journals in Quartile 1, two journals in Quartile 2, and one journal in Quartile 3 .Schistosoma mansoni and Soil-Transmitted Helminths” published in the journal PLOS Neglected Tropical Diseases in 2010 is considered by the Web of Science as the most highly cited article  [Schistosoma japonicum in the Philippines, enabling the elimination of S. japonicum in the Philippines [In addition to cooperating with developed countries and institutions in Europe and the United States, Chinese scientists also cooperated closely with Asian countries, such as Thailand, India, Japan, Philippines, South Korea, Myanmar, and Indonesia, leading to the formation of the Regional Network for Asian Schistosomiasis and Other Helminth Zoonoses (RNAS+) . RNAS, flippines . Leonardlippines .In the first five years of the past decade, most researchers focused exclusively on a single topic or at most a few topics. This trend has gradually evolved into one which focused on diversified studies during the last five years. A comprehensive analysis of high-frequency words and keyword clustering revealed that “malaria,” “schistosomiasis,” and “toxoplasmosis” were the top three tropical diseases studied.In 2010, the Action Plan of China Malaria Elimination (2010–2020) (APCME) was officially endorsed by the Ministry of Health in conjunction with 12 other ministries including those of Finance, Education, Science and Technology, Entry-Exit Inspection and Quarantine . The goaS. japonicum infection, including the innovation of snail control methods, and created methods for detecting and monitoring S. japonicum infection [China has conducted schistosomiasis control work for more than 70 years including the work done during the past 10 years. In response to the epidemic nature of schistosomiasis in China, scientists have developed methods to control the source of nfection –26. In tnfection .Toxoplasma infection in animals, such as cats, pigs, civet cats, sika deer, and horses, in different regions [T. gondii, demonstrated a mechanism that may induce autophagy in the host, thus showing potential as a target in anti-Toxoplasma therapy [Toxoplasmosis is a highly infectious zoonotic parasitic disease. In the past 10 years, researchers have investigated and assessed the risk of  regions –32. In t regions . In rega therapy .T. gondii [An analysis of research topics indicated that “vaccine” was the research hotspot during the first 5 years. For example, M. RCAg-1 developed by Chinese scientists proved to be effective against . gondii . The RTS. gondii . However. gondii . China s. gondii .H. contortus, A. sinensis, A. albopictus, E. granulosus, and the Zika virus had been attracting attention from 2015 to 2019, initial studies related to E. granulosus began relatively late. However, in 2016, the Chinese government implemented the “National Echinococcus granulosus Disease Prevention and Control Plan” (2016–2020), as a result of which funding for E. granulosus research has increased. The prevalence of E. granulosus in China has been confirmed, and at the molecular level, proteins including Eg-TSP1, EG95, EgM, and TPx have been studied in relation to various aspects associated with new drug targets and vaccine development [Although studies conducted on emerging diseases caused by elopment , 40–43.A. albopictus, as well as the mitochondrial genome sequence of A. sinensis, have been revealed [A few occurrences of dengue fever and Zika virus have been confirmed in China, and monitoring and researching vector-borne diseases such as these are ongoing in many Chinese research institutes. An increasing number of studies have been carried out on vector-borne diseases, and piRNA and miRNA profiles of revealed –46. In arevealed –49.Chinese researchers are closely following current topics pertaining to tropical medicine-based research and are focusing on solving urgent issues. Meanwhile, in conjunction with the “Healthy China 2020” and “the Belt and Road” initiatives, China is seeking global collaboration while continuing to invest in medical research. In particular, in the field of tropical medicine, investments made towards developing overseas research centres, such as the China-UK-Tanzania malaria field control project and the China-Australia-Papua New Guinea malaria laboratory project, come to mind. China provides practice sites for research, development, and application of tropical medicine.However, compared with international research on tropical medicine, there is still a certain gap in China, such as the lack of basic research on tropical medicine, the slow development of diagnostic reagents for related diseases, and the lack of professional personnel for tropical medicine research. These gaps encourage China to increase investment in tropical medicine to reduce the threat of tropical diseases to people's health.th, 2020. Different organizations have different database permissions available, so the retrieved data may be different.Our article was beset with several limitations. Our search relied only on the Web of Science database and excluded papers published elsewhere, because of which some articles were likely missed due to not being included in the web of Science. Additionally, among the 3372 articles retrieved from the Web of Science Core Collection Database, relevant retrieval was completed on June 5Malaria,” “Schistosoma japonicum,” “Toxoplasma gondii,” “prevalence,” and “schistosomiasis” were found to be the most popular terms used by Chinese authors. “Haemonchus contortus,” “Anopheles sinensis,” “Aedes albopictus,” “Echinococcus granulosus,” and “Zika virus” dominated as new research topics in recent years. The findings of this study may contribute significantly to the advancement of tropical medicine in China.The current study investigated tropical medicine research on the Web of Science database and made several significant determinations related to trends and performances in Chinese tropical medicine research from 2010 to 2019. This study provided a systematic overview of the impact of various topics related to tropical medicine related research projects. A total of 3372 articles were published in 38 journals. The highest number of articles was published in Parasites & Vectors. The United States ranked first among countries that published collaborative articles with China. The CDC system was the flagship of tropical medicine in China, distantly followed by ACCA. In China, research pertaining to tropical medicine is yet in its formative stages. However, some research studies have reached international standards. Keyword analyses indicated that the status of tropical medicine research had evolved from one of single discipline to an interdisciplinary one in China. “