We applied a backward stepwise multivariable logistic regression model to identify characteristics in each age group associated with unfavorable TB treatment outcomes. There were 896,314 tuberculosis cases reported during the period. Tuberculosis incidence was highest among adult males, but the young males presented the highest growth rate during the period. Directly observed therapy (DOT) was associated with protection against unfavorable outcomes in all age groups. The use of alcohol, illicit drugs, and smoking, as well as occurrence of comorbidities, were significantly different between age groups. Lack of DOT, previous tuberculosis, race, location of tuberculosis disease, and HIV infection were independent risk factors for unfavorable outcome depending on the age group. The clinical and epidemiological risk factors for unfavorable tuberculosis treatment outcomes varied according to age in Brazil. DOT was associated with improved outcomes in all age groups. Incidence according to age and sex identified adults and young males as the groups that need prevention efforts. This supports implementation of DOT in all populations to improve tuberculosis outcomes.Approximately 1.4 million people die annually worldwide from tuberculosis. Large epidemiologic studies can identify determinants of unfavorable clinical outcomes according to age, which can guide public health policy implementation and clinical management to improve outcomes. We obtained data from the national tuberculosis case registry; data were reported to the Brazilian National Program (SINAN) between 2010 and 2019. Clinical and epidemiologic variables were compared between age groups . Univariate comparisons were performed together with second-generation  Tuberculosis (TB) remains a major public health problem worldwide, accounting for 10 million new cases and 1.4 million deaths in 2019 according to the World Health Organization (WHO)  and alsoThe Brazilian National Plan to Control Tuberculosis (PNCT) was implemented in 1999. Following WHO recommendations, the program set goals of a cure rate >85% and loss to follow-up <5% . In addiThrough the SINAN database, there is valuable information for TB control in Brazil, such as clinical and demographic characteristics, proven risk factors for TB treatment outcomes, and the actual outcomes. Moreover, it is feasible to analyze such characteristics over time, enabling the understanding of TB epidemiology nationwide over several years. In the present study, SINAN data from a 10-year period (2010–2019) were analyzed to assess temporal changes in incidence, TB clinical manifestations, and clinical outcomes, in individuals stratified by age group and biological sex.All data available for the years 2010–2019 were obtained from the government platform (publicly available) pre-processed by the Ministry of Health, which included verification of duplicate registration, consistency, and completeness of registered data , followiWe performed an observational study comparing the baseline clinical and sociodemographic characteristics and outcome determinants according to four age groups, which were defined as follows: children 0–9.9 years) .9 years ; adults The present study obtained data from SINAN (access date 9/22/2020), available on the website  and implFor this study, a favorable treatment outcome was defined as cure or completed treatment; unfavorable outcome was defined as treatment failure, lost to follow-up, relapse, or death during treatment. The definitions for clinical and bacteriological cure, failure, lost to follow-up and death for both cohorts corresponded with those in the Manual of Recommendations for the Control of TB of Brazil . The out2) and χ2 test for trend), except for age and TB rates, for which the Mann–Kendall (MK) test was used to identify differences among years. During review of the data, some inconsistencies were observed, such as children from 0 to 4 years old with habits of consumption of tobacco, alcohol, and illegal drugs. Due to the lack of a way to confirm these data, consumption habits of these substances were excluded from the analysis in this age group.The TB notification rate was determined by dividing the annual number of notified TB patients by the estimated mid–year population   multipliP < 0.05 were considered statistically significant. In addition to the p-value, the second-generation p-value  and the delta-gap (Δ) (when applicable) were calculated to evaluate the outcomes  was calculated, which is defined as the distance between the intervals in δ units. The delta-gap value was directly related with the difference in distribution of values between the groups; the higher the delta value, the greater the effect size  and 44.1–56.1% were literate. The percentage of patients co-infected with HIV declined over time (χ2trend p < 0.001), being significantly lower in 2019. Over time, the frequency of patients who reported alcohol consumption, of those diagnosed with DM, and with smear-positive TB remained similar (Mycobacterium tuberculosis (Mtb) positive cultures increased over time  while abnormal findings on chest x-rays became less frequent  and women , elderly (MK-trend p = 0.121), young (MK-trend p = 0.751) and child females (MK-trend p = 0.779) remained stable. In young men, TB incidence increased significantly over the study period (MK-trend p = 0.0007), while the incidence in elderly (MK-trend p = 0.004) and adult men (MK-trend p = 0.004) decreased. The TB incidence in male children did not change significantly  and the age group most affected was 25–64 years (70.9–75.93%). Most of the patients self-reported their race as  similar . The proficantly .2trend p < 0.001), even when we did not take 2019 into account , while the proportion treated with DOT decreased over time  of TB diagnoses in Brazil during the study period were made in people 25–64 years old (2trend p < 0.008) among the four age groups evaluated in this study, as well as a higher proportion of persons living with HIV (PLWH) , alcohol consumption , and smoking  and the highest proportion of EPTB among the age groups of the study , in addition to a higher frequency of negative sputum smears , negative TB culture  and lower detection of DM , hypertension  and also had a higher mortality rate . Younger patients had a higher proportion of cure. Among unfavorable outcomes (non-cure), loss to follow-up was more frequent in young and adults, while death was more frequent in the elderly , followed by young  and elderly people , in those who did not undergo DOT  and in those who presented with simultaneously PTB-EPTB .Children diagnosed with TB between the years 2010 and 2019 maintained a similiar proportion of sex distribution over the years , as well2trend p-value = 0.048) in the distribution by sex over the years (p = 0.0007), while the TB incidence in women remained relatively stable  and no DOT indication  independently associated with unfavorable treatment outcome (p < 0.001), illiteracy , HIV infection , illicit drug use , smoking , and kidney disease .Young patients diagnosed with TB between 2010 and 2019 showed a significant change  during the 10-year study period (p < 0.001) and no DOT  independently associated with unfavorable outcome (p < 0.001) and as in young people, the following factors were also associated with unfavorable outcomes: HIV infection , illicit drug use  smoking , and kidney disease . Being male , white  black , Asian , pardo , alcohol consumption , illiteracy , abnormal chest X-ray , cancer  or COPD  were also significantly associated in this subpopulation.Adults diagnosed with TB showed a similar proportion of men and women between 2010 to 2019 , but in y period . Similary period . In aduly period . The bin outcome . As seenp = 0.121; men MK-trend p = 0.004, p < 0.001), HIV infection , alcohol consumption , illicit drugs use  and smoking , in addition to cancer , COPD , other comorbidities  and no DOT  were associated with unfavorable outcome.The changes concerning biological sex affected by TB in the elderly population between the years 2010 and 2019 showed a pattern similar to that found in the adult population, with little change in frequencies over the years  but showIn the present study, we investigated the epidemiologic characteristics of TB in the Brazilian population between 2010 and 2019 through data from SINAN. We assessed favorable and unfavorable outcomes as well as the factors associated with each. We focused on identifying the specific risk factors for unfavorable outcomes in each age group, aiming to provide more detailed information for targeted interventions in each group. Our results highlight the importance of DOT for success of TB treatment and encourages the amplification of this strategy in the country, as has been recommend by WHO since 1993. DOT was associated with a considerable increase in favorable outcomes in all studied age groups.pardo. This profile is similar to that observed in previous years in Brazil , adults, and self-reported as n Brazil . The decn Brazil . In addiAs also found in previous years, substance use  was commonly reported in the studied population, but there was a significant increase throughout the years. The increase in the prevalence of tobacco smoking in this population is a surprising finding, as it is in the opposite direction of the general population in Brazil . ConversAnother interesting finding was that the prevalence of DM in our population was similar to the general population . AlthougThe proportion of TB cases with positive cultures increased over time. This may be due to greater access to the test and to technical improvements. As an example, a study performed in a state reference laboratory found an increase of 61.5% in the positive results for Mtb after the implementation of a semi-automated procedure . It is pTB is one of the most common opportunistic infections in persons living with HIV (PLWH) and the main cause of death in this population . The preThe decline of HIV/TB follows the reduction in AIDS cases in Brazil, which is a reflection of the expansion in HIV diagnosis, HIV prevention efforts, as well as access to treatment. Since 2013, ART has been offered to all PLWH, regardless of CD4 count .In 2017,Interestingly there was no difference in treatment outcomes among the age groups, but there were risk factors for unfavorable outcomes specific for each age group; knowing them is essential to guide public health interventions . For exaFinally, we have evaluated patient characteristics according to treatment outcomes. Along the years studied, there was an increase in unfavorable outcomes, mainly caused by higher rates of treatment failure. After adjustment for confounders alcohol consumption, illicit drug use, tobacco smoking, HIV infection, kidney disease, prior TB, and having PTB-EPTB were associated with unfavorable outcomes. First, our results highlight the already known strong connection of TB and social factors, such as race and substance use , 31. It This study had some limitations. It is unclear whether reporting of information was uniform throughout the country. There was a high level of under-reporting for several variables in the questionnaire. In addition, when assessing patient outcomes, 2019 was incomplete since some patients were still in follow-up. It is important to know that, with exception of name, ethnicity, age, HIV-infection, and more “clinical” variables, other fields such as consumption habits and literacy presented a considerable number of missing data.With the above limitations noted, a study of this magnitude is extremely important to provide a national view of TB in Brazil over the past decade. This allowed us to investigate not only how public policies applied during that time period influenced the rates and treatment outcomes of TB patients in the country, but also to identify interventions that might improve TB treatment outcomes. Increased implementation of DOT in Brazil across all age groups would likely improve TB treatment outcomes in the country.http://tabnet.datasus.gov.br (in Brazilian Portuguese).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 below: the data was extracted from the public database: DataSUS (TABNET)—The studies involving human participants were reviewed and approved by Comitê de Ética em Pesquisa, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil. Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.BB-D, MA-P, MA, LS, MSR, VN, AS, and BA contributed to conception and design of the study. BB-D, MA-P, MA, MMSR, AQ, TS, and BA performed the data curation. BB-D, MA-P, and MA processed and analyzed the data, and worked on data visualization. BB-D, MA-P, MA, BN, TS, and BA wrote the first draft of the manuscript. MC-S and AK revised and contributed to the structuring of the article. TS and BA supervised the research. All authors contributed to manuscript revision, read, and approved the submitted version of the 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.


Objective: We aimed to determine the prevalence of social isolation and associated factors among adults with epilepsy in northeast China.Methods: A cohort of consecutive patients with epilepsy (PWE) from the First Hospital of Jilin University  was recruited. Demographic and clinical data for each patient were collected during a face-to-face interview. Social isolation was measured using the Berkman-Syme Social Network Index (SNI), and the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) and Quality of Life in Epilepsy Inventory (QOLIE-31) were also administered. Multivariate logistic regression analyses were used to determine the factors associated with social isolation in PWE.Results: A total of 165 patients were included in the final analysis. The mean SNI score was 2.56 (SD: 1.19), and 35 patients (21.2%) were socially isolated. In multivariate logistic regression analysis, higher depressive symptom levels  and poorer quality of life  emerged as independent factors associated with social isolation in PWE.Conclusion: Social isolation is common and occurs in approximately one-fifth of PWE. Social isolation is significantly associated with depressive symptoms and poor quality of life in PWE. Patients need to be encouraged to actively integrate with others and reduce social isolation, which may help improve their quality of life. Epilepsy is one of the most common serious brain diseases and affects more than 70 million individuals worldwide . EpilepsSocial isolation was defined as an objective lack or limitation of close personal ties to friends and family and social ties to the community , 10. SocStudies on the topic of social isolation in adults with epilepsy are limited . Thus, tThis research involved a cross-sectional study performed at The First Hospital of Jilin University, a large tertiary care hospital in Northeast China. Patients with a confirmed diagnosis of epilepsy  aged 18 Each participant had a face-to-face interview with one trained clinician (HZ) who collected the data uniformly. A structured questionnaire was employed to collect demographic, socioeconomic, and epilepsy-related data during the interview. The demographic and socioeconomic information included age, gender, marital status, employment status, and education level. The epilepsy-related variables consisted of age at onset, epilepsy duration, epilepsy type, seizure frequency during the last 6 months, and ASM therapy regimen. Patients with a high education level were those who had a university education or above. Additionally, patients were requested to complete a series of questionnaires during the interview at our hospital. The Berkman-Syme Social Network Index (SNI), Neurological Disorders Depression Inventory for Epilepsy (NDDI-E), and Quality of Life in Epilepsy Inventory (QOLIE-31) were employed to assess social isolation, depression, and quality of life in patients, respectively.The Berkman-Syme SNI was used to measure social isolation in PWE . This meThe NDDI-E is a rapid and user-friendly questionnaire used to assess depressive symptoms in PWE during the past 2 weeks . PatientWe measured quality of life using the QOLIE-31 inventory. The test consisted of 31 questions and seven subscales: (1) seizure worry, (2) overall quality of life, (3) emotional well-being, (4) energy/fatigue, (5) cognitive functioning, (6) antiepileptic medication effects, and (7) social functioning. The total score ranged from 0 to 100, with higher scores indicating a more favorable quality of life .t-test or Mann–Whitney U-tests depending on the normal or non-normal distribution of the data assessed via the Kolmogorov–Smirnov test. Additionally, Spearman correlation analyses were used to examine the relationships between SNI scores and continuous variables. Using multivariate logistic regression analyses, the independent variables associated with socially isolated categories were investigated. Variables with p < 0.05 in the univariate analyses were included in the multivariate stepwise logistic regression model. All data were analyzed using SPSS 26 . All statistical tests were two-tailed, and p < 0.05 was considered statistically significant.Categorical variables were described as numbers (percentages) and compared by chi-square tests or Fisher's exact tests. Continuous variables were expressed as the mean ± SD and analyzed by Student's n = 8), severe brain disease or other disorder (n = 5). Thus, a total of 165 PWE were included in the study, with a median age of 33.88 years and a female percentage of 50.9%. The demographic and clinical characteristics of the total participants are shown in A total of 196 patients were invited to participate in the current study. Of that group, 31 patients were excluded for the following reasons: refusal to participate , inabilidisorder , and <18p = 0.024) and less likely to be married (p < 0.001) than those in the socially connected group. Polytherapy was more common in patients with social isolation (p = 0.008). Additionally, the NDDI-E score (p < 0.001) and QOLIE-31 score (p < 0.001) showed significant differences between patients in the socially isolated group and the socially connected group. There was no significant difference in gender, unemployment, high education level, age at onset, epilepsy duration, epilepsy type, or seizure frequency between the groups with, and without social isolation. For details, see Patients in the socially isolated group were more likely to be younger . Additionally, the NDDI-E score was negatively correlated with the SNI score . No correlation was found between epilepsy duration and SNI score.The continuous variables that were significantly correlated with the SNI score are presented in P = 0.045) and poorer quality of life  emerged as independent factors associated with social isolation in PWE. The adjusted odds for social isolation in PWE increased by a factor of 1.15 with each point of increase in NDDI-E depressive scores. The adjusted odds for social isolation in PWE was 0.967 times smaller with each point of increase in QOLIE-31 scores. For details, see To our knowledge, this is the first study aimed at investigating the prevalence of social isolation and associated factors in adults with epilepsy. Findings from this study suggested that approximately one-fifth of patients are socially isolated, and that depressive symptoms and poor quality of life are independent factors associated with social isolation in PWE.The prevalence of social isolation has been previously reported to range from 20 to 67.5% in PWE , 24. TheThis study found that marital status was associated with social isolation in PWE, and married patients were less likely to be socially isolated. Marital relationships are an important component of family support. Married adults reported more family support and fewer depressive symptoms . PatientWe found that age and age at onset were also associated with social isolation in PWE. However, this significant association disappeared in multivariate analysis. Patients with social isolation were more likely to be younger and to have had an earlier age at first seizure onset. This finding was in agreement with prior investigations , 30. TheIn the current study, we found that the adjusted odds for social isolation in PWE increased by a factor of 1.15 with each point of increase in NDDI-E depressive scores. Socially isolated young adults were more likely to have depression, showing the beneficial role of social relationships in mental health . HoweverThis study faces several limitations. First, the cross-sectional design greatly limits the ability to draw any inferences regarding the causal relationship between these variables and social isolation, and regression analyses in a cross-sectional design study also have limited results. Second, the sample size in the socially isolated subgroup was relatively small, and all participants were adults with epilepsy enrolled from a large tertiary care hospital in northeast China. Thus, it cannot be claimed that this sample is representative of Chinese PWE. Third, the use of self-report for all measures in the present study may allow for response bias. Additionally, some variables that may be associated with social isolation in epilepsy  were not available and were not analyzed for our cohort. Finally, this study was performed during the COVID-19 pandemic. Social isolation and psychiatric symptoms may have been more frequent in PWE during this period.The findings suggest that social isolation is common in adults with epilepsy. Social isolation is associated with depressive symptoms and poor quality of life. Further studies should examine whether improvements in social connection can improve depressive symptoms and quality of life in these patients.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of First Hospital, Jilin University. The patients/participants provided their written informed consent to participate in this study.RZ and WL conceived of and designed the study. RZ, HZ, XG, and YH were involved in data acquisition. RZ and QC analyzed the data and wrote the manuscript. All authors contributed to the article and approved the submitted version.This work was supported by a grant from the Programme of Jilin University First Hospital Clinical Cultivation Fund (LCPYJJ2017006).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.


Patients were diagnosed between the 2nd and 5th day of the cycle. The parameters of OS were analyzed and compared with the anthropometric parameters and the lipid profile of the patients. Enzymatic activity of GPx, CAT, SOD, and MDA levels was determined in both groups. MDA levels and CAT activity differed significantly between the groups. There was a decrease in MDA levels in the IR group and the involvement of GPx in the excess weight and obesity and IR group accompanied by an increase in hip circumference. It therefore seems that IR may be the main risk factor to exposure to OS in patients with PCOS, independent from obesity. In addition, GPx is involved in every step in the development of the pathological condition in PCOS.Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies in females of reproductive age. In women with PCOS, metabolic disorders such as insulin resistance (IR), hyperinsulinemia, obesity, diabetes mellitus, and other elements of metabolic syndrome are likely to occur. Studies have shown an increase in the concentration and activity of oxidative stress (OS) markers in patients with PCOS, compared to that in unaffected women. The aim of this study was to evaluate the parameters of OS in PCOS and their activity in relation to women without menstrual disorders with a normal body weight. Then, we compared malonodialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), including overweight and obesity, hyperandrogenemia, and IR in the PCOS group. The study included 35 women aged 18–46, hospitalized for menstrual disorders in the form of infrequent menstruation. In 26 women, PCOS was diagnosed on the basis of the Rotterdam Criteria; these patients qualified for the study group. The control group ( Polycystic ovary syndrome (PCOS) is one of the most common endocrinopathies at reproductive age and may affect 5–14% of women . The etiOne of the most common abnormalities observed in PCOS is hyperandrogenism. Clinically, it manifests itself mainly in hirsutism, but also sometimes a severe, difficult-to-treat form of acne . ExcessiExcess weight and obesity disrupt ovulation and cause and/or aggravate IR and hyperandrogenism. Progressive obesity-related disorders manifest in increased adipogenesis and decreased lipolysis. Interactions between adipose tissue and ovarian function result in folliculogenesis disorders. Another consequence of obesity is the secretion of proinflammatory adipokines, which by affecting the thecal cells, have an impact on the production of androgens in the ovaries ,14. ExceA number of studies point toward the significant role chronic inflammation plays in PCOS. It can cause adipocyte hypertrophy and, consequently, tissue hypoxia. Inflammation goes hand in hand with obesity and hyperinsulinemia with excess androgen levels . MetabolOS, as well as hyperinsulinism and obesity, worsen glucose metabolism, namely its uptake by skeletal muscles and adipose tissue. Increased insulin levels secondary to IR may accelerate protein oxidation independent from hyperglycemia . AccordiPeroxidases catalyze hydrogen peroxide reduction reactions, and catalases decompose hydrogen peroxide. Peroxide accumulation can lead to the formation of free radicals. Free radicals have the ability to damage cell membranes and can contribute to atherosclerosis and cancer. Peroxidase, together with vitamin E, constitutes a part of the anti-lipid oxidation protective system .CAT is an enzyme involved in the elimination of free radicals. Reduced CAT activity indicates the presence of long-term OS ,22.MDA is another marker of chronic OS. Lipid peroxidation of polyunsaturated fatty acids generates MDA . Its conA decrease in concentrations of OS parameters can be achieved by weight reduction attained through a diet rich in antioxidants and/or a diet with reduced calorie count and lowered glycemic index (GI) ,8,24. AlIt is assumed that oxidative stress-inducing factors in PCOS include hyperandrogenemia, genetically and/or environmentally conditioned IR, and obesity, especially abdominal. OS can also be caused by infections. This thesis is not very popular, but it is possible. Whether these factors induce OS to a similar degree remains unknown ,16,24. TThe results of studies published until then on the parameters of OS are not unequivocal. In published studies SOD, MDA, CAT and GPx were not studied simultaneously. We did not find any studies in which the parameters of OS we were testing would be compared depending on overweight and obesity as well as IR.The aim of the study was to evaluate the parameters of OS in PCOS and their activity in relation to women without menstrual disorders with a normal body weight (control group). Then, MDA, SOD, CAT, and GPx were compared, differentiating between overweight and obesity, hyperandrogenemia, and IR in the PCOS group. Identification of the mechanism most involved in the protection of anti-free radicals and the sequence of involvement in the course of the development of the pathological condition were investigated.The reagents used were from Sigma-Aldrich Poznań, Poland, and COPD Gliwice, Poland.n = 26). The control group (n = 21) consisted of patients without menstrual disorders and without PCO in an ultrasound examination. The control group consisted of potentially healthy women recruited during screening. In all patients, ultrasound examination of the uterus and adnexa was performed . Diabetes mellitus, ischemic heart disease, hypertension, patients on current and past hormonal therapy, lipid-lowering or insulin-sensitizing drugs, and antioxidant supplementation constituted the exclusion criteria in both groups (study group with PCOS and control group). Patients with PCOS were diagnosed between the 2nd and 5th day of the cycle. A history was taken in all patients and a physical examination and a hirsutism assessment were performed according to the Ferriman–Gallwey scale [The study included 47 women aged 18–46. Patients were hospitalized in 2017–2019 in the Department of Endocrinology, Gynecology, and Gynecological Oncology Pomeranian Medical University in Szczecin, Poland. The approval number of the study: KB-0012/87/13. Those women who were hospitalized for menstrual disorders in the form of infrequent menstruation, with PCOS diagnosed on the basis of Rotterdam Criteria , qualifi2 were assumed to be standard and those ≥25 kg/m2 were taken as indicative of excess weight and obesity [In every patient, waist-hip ratio (WHR) and body mass index (BMI) were measured. The normal range of WHR is <0.8. Based on the 2016 guidelines of the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE), BMI values in the range of 18.5–24.99 kg/m obesity ,28,29. Bg, 4 °C, 15 min.), and plasma was separated and frozen at −80 °C.Fasting blood samples were collected by ulnar vein puncture. Concentration levels of FSH, LH, oestradiol, testosterone (T), androstendion (A), sex hormone binding globulin (SHBG), glucose, and insulin , triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TChol) were established from peripheral blood serum. Two ethylenediaminetetraacetic acid (EDTA) tubes containing 7 mL of blood in total were centrifuged  was calculated; T (nmol/L)/SHBG (nmol/L) × 100.Prior to spectrophotometric assessment of the enzymatic activity of CAT, SOD, and GPx, it was necessary to establish the contents of hemoglobin in the tested samples of hemolysates. For this purpose, the Drabkin method was applied .The enzymatic activity of GPx in the erythrocyte samples was determined by the spectrophotometric method according to the Wendel method .The enzymatic CAT activity in the erythrocytes was determined using a spectrophotometer according to the Aebi method ; SOD actMDA determination on a high-performance liquid chromatography (HPLC)  was perfp ≤ 0.05.Statistical analysis was conducted using SPSS Statistics, version 13.0 . Basic statistics, including mean, standard deviation, and ranges, were applied to the group characteristics. Normality of distribution was checked with the Shapiro–Wilk test. The analysis of group differences was calculated using the Mann–Whitney U test. Correlations between the analyzed quantitative variables were calculated using the rho Spearman correlation. The assumed level of significance was n = 26) was 28.09 ± 6.68, and that of the control group (n = 21) was 32.84 ± SD 9.92. Hirsutism of >8 points was found in 7.69% (n = 2) and acne in 57.69% (n = 15) of PCOS patients. Hirsutism and acne were not found in the control group. Six patients (23.08%) from the study group were treated for infertility. The results of anthropometric tests in the group with PCOS and the control group are given in The mean age of the study group (p < 0.0001) higher in patients with PCOS (3.61 ± 1.2) vs. the control group (2.3 ± 1.17). T values and FAI were also considerably (p < 0.002) higher in the PCOS group. SHBG values were lower in the study group, but the difference between the groups was not significant. The average Chol, LDL, HDL, and TG values in the studied groups were similar with no significant differences . Values of CAT activity were also considerably higher in patients with PCOS (374.69 ± 72.34) vs. the control group (182.14 ± 34.85). The values of the other parameters of OS did not differ significantly between the PCOS group and the control group. The values of OS parameters are presented in In the group of women with PCOS, elevated androstendion values of >3.5 and/or hirsutism of >8 pts were found in 13 patients (50%); 12 patients (46.15%) were in the excessive weight and obese category. There were seven subjects (26.9%) with IR. Four patients (15.38%) were in the excessive weight and obese category with coexisting IR. There were two patients (9.5%) in the control group with hyperandrogenism. Nine patients (42.85%) were overweight or obese. Two subjects (9.5%) were diagnosed with IR. Two patients (9.5%) were overweight or obese with coexisting IR. The OS parameters were evaluated depending on IR, obesity, and hyperandrogenism .p= 0.024) than in patients without IR. GPx activity showed a trend in PCOS patients (p = 0.067). In seven PCOS patients, IR was confirmed. In these women, MDA values  were significantly higher (p = 0.075).In 12 obese patients with PCOS without coexisting IR, GPx activity showed a trend again  values were significantly higher than in patients without IR and obesity. Moreover, the trend towards SOD was noticeable.Hyperandrogenism in the PCOS group was found in 13 women.MDA, CAT, SOD, and GPx activity were insignificantly lower in comparison to that in the PCOS patients without hyperandrogenism . Correlations between BMI values and OS parameters and between the occurrence of abdominal obesity and OS parameters in both groups of patients were examined .p = 0.014 and R = 0.433; p = 0.050 , total and LDL concentrations and MDA, respectively . In the control group, significant correlations were found between TChol LDL, and TG concentrations and GPx, respectively . The other correlations were insignificant.In the group of patients with PCOS, there were significant reverse correlations between TChol concentrations and CAT activity  . GPx is ol group .Baskol et al. showed similar results, demonstrating that GPx did not differ between a PCOS group and a healthy control group . In contIn the case of patients with PCOS and IR, significant values of MDA concentrations were found compared to the PCOS group without IR. This probably suggests a different mechanism of disorders relative to OS in patients with IR and PCOS. Moreover, MDA has been associated with an increase in TChol and especially LDL; therefore, it appears that IR and an increase in LDL are the major causes of MDA mobilization.2O2 into molecular oxygen and water, without producing free radicals. In this reaction, oxygen is formed, which is used in other metabolic transformations [2O2 has been shown to damage pancreatic b-cells, which with CAT deficiency leads to the development of diabetes [Catalase provides protection for cells from the toxic effects of hydrogen peroxide and other derivatives. It converts Hrmations . It has rmations ,56. Low diabetes ,57.In our study CAT activities were significantly higher in PCOS patients, compared to the control group, and its activities were related to TChol in the PCOS group but not to a specific parameter of the lipid profile. It seems that CAT is the least sensitive parameter among the respondents in PCOS.2), as a major oxygen radical. SOD catalyzes them to H2O2 and finally by GPx converted to water [SOD is an enzyme and an important antioxidant defense that eliminates superoxide anions (Oto water . SOD didto water ,47. Simito water . In contto water . These dThe relationship between metabolic syndrome and cardiovascular disorders is undeniable and unquestionable. Wang et al. investigated OS parameters in patients with PCOS with and without metabolic syndrome. Metabolic syndrome, due to increased TG concentration and LDL cholesterol levels, was found to not only enhance OS but also reduce antioxidative activity . In our A wide panel of measured parameters and clinical implementations of the study for the treatment of patients with PCOS are strong points of the research. A relatively small study sample, selected on the basis of inclusion/ exclusion criteria may be a research limitation. To confirm the validity of the findings, additional research on larger samples of subjects is thus recommended. Due to the small number of participants in the study and control groups, conclusions must be drawn with caution. Larger studies on this subject are needed to draw final conclusions.It seems that an increase in hip circumference stimulates the activation of GPx and SOD and is not associated with pathological processes. The development of obesity is the beginning of a pathological process involving OS in which we observed an increase in GPx activity. If obesity is added to IR, it triggers SOD. In addition, the coexistence with IR of obesity and/or lipid profile disorders activates mechanisms associated with MDA activation and catalase. At the same time, the increase in LDL lowers MDA, and GPx is involved at every stage of the development of the pathological condition.Therefore, IR may be the main risk factor to exposure to OS in patients with PCOS, independent of obesity. The implementation of antioxidants in PCOS therapy, in addition to drugs that improve the insulin sensitivity of tissues and physical activity, should have beneficial therapeutic effects on this group of patients.


Background: Bovine viral diarrhea virus (BVDV) is the causative agent of bovine viral diarrhea. It can infect cattle, sheep, pigs, and other animals, causing diarrhea, miscarriage, and stillbirth, among other symptoms, and it can result in huge economic losses to animal husbandry. There are reports on BVDV infection rates in sheep and goat herds from all over the world and this meta-analysis aimed to evaluate the prevalence of and risk factors for BVDV in sheep and goats.Results: Using the data of 41,297 sheep and goats in 24 countries/regions to calculate a comprehensive prevalence rate for BVDV. The overall prevalence of BVDV infection in sheep and goats was estimated to be 8.6% (95% CI: 5.2–12.7) by immunological methods and 7.3% (95% CI: 2.7–13.7) by molecular methods. Analysis by national income level revealed that prevalence is higher in middle-income countries than in high-income countries (P < 0.05). The study also compared prevalence rates by species of BVDV, sampling year, and test species, but did not find significant differences.Conclusion: This systematic review and meta-analysis is the first to determine the global prevalence of BVDV in ovine and caprine flocks. The prevalence of BVDV in sheep and goat populations varies from region to region, and the situation is not optimistic in some countries. Pestivirus and family Flaviviridae, it is a single-stranded, positive-sense RNA virus  is currently classified as the genus NA virus . The natNA virus . BVDV inNA virus . The maiNA virus –6. Two sNA virus . Each spNA virus . BVDV-1,NA virus . Cattle,NA virus , with thNA virus .In economic terms, sheep and goats occupy an important position in the global livestock breeding industry. For example, in the Kyrgyz Republic (Kyrgyzstan), animal husbandry  has always been the basis for supporting the livelihoods of local people. The contribution of agricultural production to the economy is vital  . AustralTo the best of the authors' knowledge, no systematic assessment of the prevalence of BVDV infection in ovine and caprine flocks worldwide has been conducted. Understanding the epidemiology and epidemic dynamics of sheep and goat BVDV will help prevent and control disease caused by BVDV infection of sheep and goats and will help to evaluate the effectiveness of vaccination. Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence of BVDV infection in sheep and goat populations worldwide. This article aims to comprehensively evaluate the prevalence of BVDV infection in sheep and goats by conducting a meta-analysis of articles that have been published around the world. Through this process, we evaluate the geographical distribution in terms of factors such as climate and altitude as well as the main factors affecting BVDV infection in sheep and goat herds to provide guidance on and suggestions for the prevention and control of BVDV.This systematic review and meta-analysis was performed strictly in accordance with the relevant requirements of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement  Supplem.A literature search in Chinese and English was conducted, searching Chinese Web of Knowledge (CNKI), the Wanfang database, the Chongqing VIP database, PubMed, Science Direct, Web of Science, and Springer Link.In Pubmed, we built Search Formula A: . We then built Search Formula B: . Finally, we used the logical “AND” with the two formulas to identify items satisfying both Search Formula A AND Search Formula B:  AND .In Science Direct, we built the Search Formula:  AND  AND . In Web of Science, we built the Search Formula:  AND  AND . In SpringerLink, we built Search Formula:  AND  AND . In the CNKI database, we used the term “BVDV” + “Viral diarrhea” AND “sheep and goats” + “small ruminants” . In the Wanfang database, we used the terms  AND  (in Chinese). The types of articles found in the Wanfang database were limited to “papers in journals, degree theses and conferences.” In the VIP Chinese Journal Database, we used the search formulas:  AND  (The words were spelled in Chinese and “OR”). The search strategies and search restrictions are reported in The following inclusion criteria were applied: (1) the research objects were sheep and goats; (2) sample size was >30; (3) research content included the number of sheep and goats infected with viruses; and (4) research reports were published in Chinese or English.The following exclusion criteria were applied: (1) reviews; (2) duplicate publications or studies with similar data; (3) incomplete, unclear, or obviously erroneous data that could not be resolved by contacting the authors; (4) research on BVDV vaccination; (5) other species besides sheep and goats; (6) the type of sample collected for the study is a fecal sample .The quality of the selected literature depends on the level of proposal evaluation, formulation, and evaluation methods . QualityThe screening of the literature was carried out by four trained reviewers. First, preliminary screening of the title and abstract of the literature was carried out, then the full text was evaluated and the statistics examined. The authors of the original studies were not contacted for more information, and no unpublished data were used. Any disagreements between reviewers were resolved by Zi-Yang Chen, the study author.https://data.worldbank.org.cn/indicator/NY.GNP.MKTP.CD?name_desc = false), with national income level divided into low-income, middle-income, and high-income; immunological method (ELISA and SNT); feeding mode (free-range agriculture and concentrated agriculture); BVDV species (BVDV-1 and BVDV-2); test species (sheep and goat); subject age ; sample classification (aborted fetuses and serum). Article quality level  was also recorded.We referred to a standardized data collection table to extract the data contained in the article . The rechttps://gis.ncdc.noaa.gov/maps/ncei/ cdo/monthly) were also extracted, including the latitude and longitude, altitude, annual average precipitation, and average annual temperature of the sampling area. We grouped latitude according to south or north, depending on position in relation to the equator. North and south were further divided into groups for every 30-degree section. The longitude subgroup was divided into west and east, with the 180-degree sections from the prime meridian to east and west each subdivided into 30-degree section groups. Altitude was divided into three groups according to international standards: 1,500–3,500 meters , 3,500–5,300 meters , and >5,300 meters   . The aveA systematic review and meta-analysis of the included studies was conducted to calculate the combined prevalence of BVDV infection in sheep and goats. A meta-analysis of the ratio was performed using R software (version 4.0.0). According to previous research, double-arcsine transformation (PFT) can be used to transform the observed rates to make them closer to (in line with) the normal distribution , 27. ThiI2 and Cochrane's Q  were used to assess variability. I2 < 50% represented low heterogeneity and I2 > 50% represented high heterogeneity, describing the percentage of difference between studies due to heterogeneity. P < 0.05 was considered statistically significant. Funnel plots, Egger's test and “trim and fill analysis” were used to detect publication bias, with publication bias and heterogeneity subjectively judged through funnel plot symmetry. A symmetrical graph was taken as representing an absence of publication bias and heterogeneity; asymmetry suggested publication bias and heterogeneity. Egger's test, based on the P-value, was used to assess publication bias. When P ≥ 0.05, the deviation was considered non-existent. P < 0.05 was taken as indicative of publication bias. The trim and fill analysis uses an iterative algorithm that removes a very small sample of studies from the positive side of the funnel plot (the side of the funnel plot with the most studies in the literature), recalculates the total effect size, and then gradually adds these originally removed studies to the formula and recalculates, repeating this until the funnel plot is left-right symmetric around the recalculated total effect size. A sensitivity analysis was conducted to further determine the stability of the results obtained. This was done by deleting one study at a time, merging the remaining studies, and judging the impact of the deleted study on the overall data by comparing the differences before and after.To investigate whether the results have obvious heterogeneity, “meta” software package was used to calculate and prepare forest plots, using a random-effects model to predict heterogeneity , 28–30. The factors we investigated included sampling year , national income level (medium and high), feeding mode (free-range agriculture and concentrated agriculture), BVDV specie (BVDV-1 and BVDV-2), species tested (sheep and goats), age of test subjects , sample classification (aborted fetuses and serum), article quality level , latitude , longitude , altitude , precipitation , and temperature .Studies were identified from 24 countries worldwide, including four countries in Africa, two countries in South America, two countries in North America, seven countries in Europe, two countries in Oceania, and seven countries in Asia. Twenty-two studies were conducted in middle-income countries, and 20 studies were conducted in high-income countries. According to our quality rating scale, nine study articles were of middle quality (2–3 points), the remaining 32 were of high quality (four or five points), and only one article was of low quality (0–1 point) .I2 = 99%) was used and visualized with forest plots (P = 0.7739 and P = 0.07888), we considered that the included articles were not biased for publication , with the prevalence of 31.8%  for animals over 2 years old being higher than that of the other age groups. There is no significant difference between subgroups by sampling year.As can be seen from Furthermore, in terms of BVDV species, the prevalence of BVDV-1 was highest . When comparing prevalence between goats and sheep, the prevalence in sheep  was higher than that in goats . In terms of feeding mode, the prevalence was higher in concentrated agriculture  than in free-range agriculture . According to quality of study, the prevalence was highest in studies of low quality , with the highest prevalence of 14.6% . When comparing viral prevalence between goats and sheep, the prevalence in sheep  was higher than that in goats . In terms of feeding mode, the prevalence was higher in free-range agriculture  than in concentrated agriculture . In terms of quality of study, the prevalence was highest in studies of middle quality  . The decP > 0.05; Our meta-analysis also looked at geographical factors. We did not find significant differences in BVDV prevalence by latitude, altitude, average annual precipitation, or mean annual temperature , Jilin Science &Technology Development Plan (20190301004NY), and the Scientific Research Planning Project of Jilin Provincial Department of Education (JJKH20200364KJ).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.


A hybrid emergency room (ER) is defined as an emergency unit with four functions—performing resuscitation, computed tomography (CT), surgery, and angiography. However, the safety and efficacy of performing CT in a hybrid ER are unclear in primary surveys. Therefore, this study aimed to evaluate the safety and clinical effects of hybrid ERs.This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. Hospitalized patients with severe trauma and an injury severity score of ≥ 16 were divided into the non-hybrid ER group (n = 134) and the hybrid ER group (n = 145). The time from arrival to CT and interventions and the number of in-hospital survivors, preventable trauma deaths (PTD), and unexpected survivors (US) were assessed in both groups. Further, the amount of blood transfused was compared between the groups using propensity score matching.p < 0.0001 and 101 vs. 41 min; p = 0.0007, respectively). There was no significant difference in the rate of in-hospital survivors , PTD (0% vs. 0%), and US  between the groups. The amount of blood transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group . This difference was maintained after propensity score matching .The time from arrival to CT and interventions was significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group (25 vs. 6 min; The study results suggest that trauma treatment in a hybrid ER is as safe as conventional treatment performed in a non-hybrid ER. Further, hybrid ERs, which can reduce the time for trauma surveys and treatment, do not require patient transfer and can reduce the amount of blood transfused during resuscitation. Hemostasis is an essential element that can save the lives of patients with severe trauma . PrimaryMassive transfusion is required for trauma resuscitation, including damage control surgery . Damage We hypothesized that trauma treatment in a hybrid ER is as safe as conventional resuscitation performed in a non-hybrid ER and that the use of hybrid ER can reduce the number of blood transfusions required. In the present study, we evaluated the safety of using a hybrid ER system for primary trauma care and assessed whether the use of hybrid ER could reduce the amount of blood transfused in patients with severe trauma.This retrospective observational study used data from the Shimane University Hospital Trauma Database from January 2016 to February 2019. This study was approved by the Shimane University Institutional Committee on Ethics (#4083). The Shimane University Hospital Trauma Database includes data collected from the medical records of patients who needed hospitalization or were transported by emergency ambulance or medical helicopter to Shimane University Hospital. Hospitalized patients with severe trauma (injury severity score [ISS] ≥ 16) were enrolled in this study. The patients were divided into the non-hybrid ER group (January 2016–July 2017) and the hybrid ER group (August 2017–February 2019)  guidelines , based oThe Shimane Advanced Trauma Center of Shimane University Hospital installed a rotation-type hybrid ER system in August 2018  score, maximum AIS score, ISS, revised trauma score (RTS), probability of survival (Ps) calculated using the Trauma and Injury Severity Score (TRISS) , 14, carp = 0.05. Propensity score matching analysis was used to match patients in the hybrid ER with non-hybrid ER groups in a 1:1 ratio to the nearest available matching based on the caliper width of 0.20. The covariates for propensity score matching included age, sex, mechanism of trauma, maximum AIS score, ISS, RTS, TRISS Ps, CPA-OA, with or without intervention and blood transfusion.Statistical analysis was performed using JMP Pro 14.2.0 . Differences in baseline characteristics between the groups were analyzed using the Wilcoxon test for continuous variables and the chi-square test and Fisher’s exact test for categorical variables. Differences in time from arrival to CT, time from arrival to interventions, and amount of blood transfused between the groups were analyzed using the Wilcoxon test. All results were assessed at a level of significance of p = 0.086) or blood transfusions  between the groups. Although the number of CPA-OA in the hybrid ER group was slightly higher than that in the non-hybrid ER group , there was no significant difference between the groups.A total of 1893 patients with trauma were identified in the Shimane University Hospital Trauma Database from January 2016 to February 2019 . Furthermore, the time from arrival to interventions (hemostatic procedures including surgery and TAE) was also significantly reduced in the hybrid ER group compared to that in the non-hybrid ER group .To determine the efficacy of the hybrid ER in reducing the trauma care time, the time from arrival to CT and interventions, including surgery and IVR, was compared between the non-hybrid ER and hybrid ER groups Table . The timp = 0.770). Further, there was no significant difference in the incidence of complications between the groups (Table p = 0.497) . In point estimation, the non-hybrid ER group had higher RBC levels  than the hybrid ER group . Furthermore, the amount of FFP transfused was significantly lower in the hybrid ER group than in the non-hybrid ER group . In point estimation, the non-hybrid ER group had higher FFP levels  than the hybrid ER group . The total amount of the whole blood transfused, including RBCs and FFP, was significantly lower in the hybrid ER group than in the non-hybrid ER group .To assess the effect of hybrid ERs on trauma resuscitation, the amount of blood  transfused from arrival to the end of the resuscitative interventions was assessed in both groups Fig. . The totp = 0.015; RBC 8 [2.75–26.5] vs. 2 [0–8.5], p = 0.020). The amount of FFP transfused was lower in the hybrid ER group than in the non-hybrid ER group . Our results indicated that the use of a hybrid ER, which shortened the time between arrival and interventions, including surgery, reduced the requirement for blood transfusion for resuscitation. There was no significant difference in mortality between the groups after propensity score matching .Propensity score matching was performed to evaluate the effect of hybrid ERs on trauma resuscitation more accurately. The results are listed in Table In the present study, we demonstrated two major findings—(1) trauma treatment in hybrid ERs did not increase the risk of mortality in patients with severe trauma compared with conventional treatment in non-hybrid ERs and (2) trauma resuscitation in a hybrid ER reduced the amount of blood transfusion required for resuscitation.The hybrid ER system is defined as an integrated system that enables four functions to be performed in the same room without patient transfer—resuscitation, CT, surgery, and IVR , 17. TraIn our trauma protocol for hybrid ERs, CT was performed instead of FAST and radiography of the chest and pelvis. Trauma surveys have emphasized that this three-point examination is simple and can be performed without patient transfer. In this regard, CT in hybrid ERs is similar to FAST and radiography of the chest and pelvis, as in conventional imaging surveys. Additionally, whole-body CT can reveal unknown findings in the primary survey, including intracranial bleeding, mediastinal hematoma, and retroperitoneal hematoma around the aorta or the kidney. This provides advantages over conventional methods; if this information is available during the primary survey, it can guide the appropriate management strategy. Moreover, patients can immediately undergo resuscitative surgery, including hemostasis, without transfer. Our results revealed that the time from arrival to CT and resuscitative interventions was significantly reduced with hybrid ER use compared to non-hybrid ER use. This may benefit patients requiring the shortest possible time from hemostasis to surgery or IVR. Moreover, if CT in the hybrid ER reveals an intracranial hematoma with concurrent massive abdominal bleeding, simultaneous craniotomy and resuscitative laparotomy can be performed in the emergency department without patient transfer. The hybrid ER has another advantage—two or more surgeries can be performed simultaneously in the ER.In a previous study, trauma workflow using the hybrid ER system decreased the mortality of patients with severe trauma . This isWe also focused on the amount of blood transfused because massive transfusion plays an important role in resuscitation during trauma treatment. Massive transfusion is a concept that forms the basis of DCR as evidence for the efficacy of DCR has been reported extensively in the literature , 16. To Our study has some important limitations. First, our study was a retrospective study conducted at a single institution. Since there may be several biases in this study, the study results should be verified in a prospective, multicenter study. Second, our study could not identify whether trauma resuscitation was a suitable criterion for admission to a hybrid ER. Although patients with severe trauma and ISS ≥ 16 were analyzed in our study, suitable clinical criteria for a hybrid ER should be assessed in the future. Third, the prehospital information was not considered in this study because our database does not have this information. Time from injury to treatment and prehospital protocol may affect our results. Although we believe that the impact of prehospital information is little, it should be assessed in the future. Fourth, a significant barrier to the installation of a hybrid ER is the cost. We did not assess the costs and benefits of using a hybrid ER for trauma treatment. A hybrid ER is typically used as a CT room in an ER. Even if surgery is not performed for all patients, it may be possible to pay for a hybrid ER by performing CT a certain number of times in a day. In Japan, a dual room-type hybrid ER has recently been developed, considering its cost merit . The cosThe new trauma workflow using whole-body CT in a hybrid ER is as safe as the conventional trauma protocol in a non-hybrid ER. The use of this protocol in the hybrid ER does not adversely affect patient prognosis, including survival and PTD. Moreover, a hybrid ER can reduce the amount of blood transfused during resuscitation, although the hybrid ER does not contribute to improved survival in patients with severe trauma and ISS ≥ 16. Importantly, the hybrid ER, which does not require patient transfer, has the advantage of reduced time to interventions. If the hybrid ER is used appropriately, early hemostasis can be achieved, and patients with severe trauma can benefit from reduced transfusion accordingly.


P < 0.05). Medical students’ state and trait anxiety was lower than that of literature students (P < 0.05). The GAD of the male was lower compared with the female. The score of family function has significant differences in gender, age, education, and region (P < 0.05). Gender, family function, state anxiety, trait anxiety, and GAD relate to others . The results of fit indices for measurement invariance models showed that the impact of family function among GAD, state and trait anxiety across gender is significantly different (each step p < 0.05). GAD and trait anxiety had a complete meditating effect between family function and state anxiety . A healthy family function may alleviate GAD and anxiety of college students during the COVID-19 pandemic.The Coronavirus Disease 2019 (COVID-19) may affect mental health. There is little research about the influence of family function on the state anxiety of college students in the context of the global pandemic. The study aimed to clarify that generalized anxiety disorder (GAD) and trait anxiety had mediating effects in family function on the state anxiety of Chinese college students following the “stay-at-home” order during the outbreak of COVID-19. This cross-sectional study was conducted online with 1,039 respondents. We analyzed demographics, The State-Trait Anxiety Inventory (ST-AI) and Chinese Family Function Scale (FAD-18), Generalized Anxiety Disorder-7 (GAD-7), and used path analysis to discuss the influence of family function on state and trait anxiety. The results showed that female students’ state and trait anxiety was higher than that of male students ( Coronavirus disease 2019 (COVID-19) is an acute respiratory infectious disease caused by the 2019 Coronavirus. As we all know, COVID-19 is such a dreadful disease that has been “raging” on earth from November 2019 up to now . Thus, mThe first cause of disability is mental health problems, a significant public health issue worldwide . In partThus, researchers believed that family function might have a significant impact on the generalized anxiety disorder (GAD), state, and trait anxiety of Chinese college students who have to stay at home during the epidemic of COVID-19. Therefore, path analysis was used in the structural equation model (SEM) to discover the relationship of family function, GAD, state anxiety, and trait anxiety.Based on these considerations, the main aim of this study was to investigate the impact of family function on state anxiety by GAD and trait anxiety during the pandemic in Chinese college students. In particular, the purpose of the study was to analyze sociodemographic characterization, the status of family function, state anxiety, trait anxiety and GAD in Chinese college students, the relationship between family function, state anxiety, trait anxiety, and GAD. Moreover, the study explored other sociodemographic variables influence of family function on state anxiety by GAD and trait anxiety. More specifically, the study intended to verify the following hypotheses:Hypothesis 1 (H1): Females are more anxious than males.Hypothesis 2 (H2): GAD and trait anxiety mediate family function and state anxiety.Hypothesis 3 (H3): Gender and major moderated the relationship between family function and state anxiety.via Wenjuanxing,1 which is an online survey platform; on WeChat  and other social platforms . The questionnaire was distributed from March 14 to 21, 2020. The questionnaire link was first sent to the students’ class group and collected by snowball sampling. Then the first respondent forwarded the questionnaire to others.This study is a cross-sectional study to survey the influence of family function on state and trait anxiety of Chinese college students during the COVID-19 epidemic. We have to choose an online survey because of the government’s requirements to stay at home. The questionnaire was distributed Specifically, based on the following criteria: age >15, college students, filling time >10 min, respondents without a history of anxiety disorders. The same Internet protocol address, WeChat ID or QQ number were excluded to avoid multiple compilations. The questionnaire with obvious logical errors was eliminated.In the sociodemographic survey, respondents were invited to answer simple questions regarding gender, age, education, region, and major. Then they were asked to answer questions related to COVID-19. For example, whom you live with during the epidemic, whether someone around you is infected with COVID-19, the frequency of going out, and the longest time spent at home.State-Trait Anxiety Inventory ST-AI;  is suitaGeneralized Anxiety Disorder-7 (GAD-7) is also suitable for evaluating the GAD of Chinese college students. GAD-7  consistsFAD-18  can effeZ-test. Measurement invariance was used to analyze group differences across gender. The mediating effect analysis was used to discover the relationship among family function, GAD, state and trait anxiety. Bootstrapping was used to analyze the mediating effect. Samples were randomly selected 10,000 times. P < 0.05 was considered statistically significant.Descriptive and correlation analysis of collected data was analyzed by SPSS23.0 Version . Path analysis in SEM used AMOS 24.0. Quantitative data were analyzed by ANOVA . Correlation analysis was used to analyze the relationship between factors. The results of the STAI scale were also compared with the healthy norm  by Z-tesOne thousand two hundred fifty nine questionnaires were submitted. We had eliminated the questionnaires that did not meet the requirements and 1,200 of them were valid. Among the 1,200 questionnaires, 161 questionnaires were excluded due to errors. Finally, there were 1,039 questionnaires left. These respondents were from 30 provinces and province-level municipalities. They were distributed in different majors, grades and living environments. Thus, we are convinced that these respondents can represent Chinese college students.p < 0.01) and trait anxiety score (p < 0.01). It could be easily found that males’ state and trait anxiety scores were lower than females’. What is more, state anxiety and trait anxiety scores were significantly different between medical respondents and other majors (p < 0.01). The scores of state and trait anxiety in other majors were higher than those in medicine. Other factors had no difference.The results showed that males and females had a significant difference in state anxiety score (p < 0.05). What is more, the older students had a better family function (p < 0.01). Those respondents with a high degree of education had a better family function (p < 0.05). Significantly, the family function was better in the region where the epidemic was not serious (p < 0.05). The score of GAD in gender was different. Similarly, the male had lower scores than the female (p < 0.05). Detailed results could be found in The family function had a significant difference in gender, age, region, and education. That of the male was better than that of the female (p < 0.05). Detailed results could be found in There was no significant difference between the respondents and the healthy norm excluded the score of trait anxiety in females. In this survey, the scores of state and trait anxiety of females were 38.36 ± 8.91 and 39.45 ± 8.90 accordingly, and those of males were 36.84 ± 10.26 and 38.04 ± 9.86. Similar to the healthy norm, the scores of females were higher than those of males in both state and trait anxiety, and the trait anxiety scores of both females and males were higher than state anxiety. Females had a lower score of trait anxiety than the norm (p > 0.05). Only gender showed significant difference in state anxiety, trait anxiety, family function, and GAD. Detailed results could be found in The results showed that interaction between gender and major had no statistical significance (r = 0.07 ∼ 0.85 (p < 0.05). A detailed description of the results could be found in There were positive correlations among gender, family function, state anxiety, trait anxiety and GAD. Correlation coefficient p < 0.05). Detailed fit indices for measurement invariance models across gender could be found in Because it was a saturated model, which means that the number of estimated parameters exactly equal to the elements in the covariance matrix (the degree of freedom is 0), researchers no longer estimated its fit indices; but only focus on its path coefficients. Considering family function as an independent variable, state anxiety as a dependent variable and GAD and trait anxiety as mediating variables across gender, the results of bootstrapping showed that GAD and trait anxiety had complete mediating effects between family function and state anxiety. Gender invariance testing yielded similar models for female and male respondents, with significant chi-square for any step difference (p = 0.306) and −0.040 in males (p = 0.263). Detailed bootstrapping results of estimated path coefficients could be found in The proportion of standard indirect mediating effect was 24.94% in females and 36.79% in males. The estimation of standard direct effect was −0.023 in females . This may indicate that females may become more anxious and vulnerable to social events, which was similar to the results of Zhong et al.  and major had no difference in multivariate ANOVA analysis. It may be indicated that gender affected family function on anxiety while major was not.The research of Although other factors were not significant, we also found some notable points. The results showed that with parents around, less anxiety was experienced. The average scores of state anxiety in respondents who went out frequently were highest. This suggested that those respondents may still be anxious about COVID-19. Our results were similar to those of others .Generalized anxiety disorder and trait anxiety had complete mediating effects between family function and state anxiety, which indicates that family function has no direct effect on state anxiety in the short term during the epidemic period. It can be significantly influenced by trait anxiety and GAD. However, the research of The theoretical implication of this study is the analysis of how family function affects state anxiety by GAD and trait anxiety across gender. In particular, trait anxiety and GAD had a positive impact on state anxiety. Besides, GAD and trait anxiety are mediating effects between family function and state anxiety. Thus, this justifies the model of this study, which links family function with state anxiety. Moreover, this may offer much evidence for further study.This study also has social implications. As an essential part of society, a family affected many aspects of family members. Especially, college students dependent on family more than others. Health education can increase the family function among the public. In addition, a healthy family function can alleviate the anxiety and depression of college students.This study also had limitations. Firstly, the collection of data was conducted by snowball resampling not based on representative sampling. Secondly, there was a significant difference in the number of people in some groups in this study, which may impact the analysis results. Thirdly, some factors had not been observed and not been included in the study, which will affect the final results. Last, among the respondents in our study, few of them had COVID-19 cases around them. Therefore, the study’s conclusion may only apply to Chinese college students who do not have COVID-19 cases around them.Some significant factors related to this study were also found. Among Chinese college students, females were more likely to be affected by social events, and aggravating their degree of anxiety. Furthermore, we also found that medical college students were less anxious about pandemic infectious diseases than literature students. Those who had a better family function had less anxiety. The family function had a significant impact on trait anxiety and GAD, and indirectly impacted upon state anxiety. Thus, the mental health of females should be paid more attention to. A better family function can alleviate the anxiety of college students during the epidemic of COVID-19. Generally, the significance of this study is profound.The raw data supporting the conclusion of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Committee of Chongqing Medical University. Written informed consent from the participants’ legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.BP and LY conceived the presented idea and performed the data analysis. LY, MW, and YW performed material preparation and assisted with the recruitment process and distribution of the surveys. LY performed data management. All authors contributed to the study’s conception and design, writing and review of the manuscript, and read 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.


As a result, the ANFIS-PSO algorithm represented the most accurate prediction of SP demand with RMSE = 0.0633, r = 0.9387 and R2 = 0.9871 in the testing phase.This paper numerically investigates the required superplasticizer (SP) demand for self-consolidating concrete (SCC) as a valuable information source to obtain a durable SCC. In this regard, an adaptive neuro-fuzzy inference system (ANFIS) is integrated with three metaheuristic algorithms to evaluate a dataset from non-destructive tests. Hence, five different non-destructive testing methods, including J-ring test, V-funnel test, U-box test, 3 min slump value and 50 min slump (T50) value were performed. Then, three metaheuristic algorithms, namely particle swarm optimization (PSO), ant colony optimization (ACO) and differential evolution optimization (DEO), were considered to predict the SP demand of SCC mixtures. To compare the optimization algorithms, ANFIS parameters were kept constant . The metaheuristic parameters were adjusted, and each algorithm was tuned to attain the best performance. In general, it was found that the ANFIS method is a good base to be combined with other optimization algorithms. The results indicated that hybrid algorithms  can be used as reliable prediction methods and considered as an alternative for experimental techniques. In order to perform a reliable analogy of the developed algorithms, three evaluation criteria were employed, including root mean square error (RMSE), Pearson correlation coefficient (r) and determination regression coefficient (R Over the past few years, several studies were carried out to investigate the relationship between the percentage of mixing pozzolanic materials with cement and water for obtaining the optimum water-to-cement ratio in different types of concrete. Many researchers have worked on the application of cement replacements, such as fly ash, silica fume and slag, in concrete mixes ,2,3,4,5.Self-consolidating concrete (SCC) is one of the common types of concrete, which has been used in structural applications due to suitable workability and the spreading ability without the need for mechanical vibration . Using aPartial replacement of cement in SCC with other materials changes the fresh and mechanical properties. Although these changes can be observed by experiments, it is not simple to identify the most influential parameters on fresh properties and predict the design parameters. To address this problem, artificial intelligence (AI) models can be employed, which are able to produce accurate results by simulating human intelligence ,22,23,24Adaptive neuro-fuzzy inference system (ANFIS) as an intelligence method can learn and adapt automatically to solve optimization problems. In contrast to most analytical approaches, ANFIS does not require identifying the system parameters and therefore can find simpler solutions for multivariable problems. ANFIS is able to produce the best estimate circumstances by eliminating the vagueness in the process via excluding some input parameters. The ANFIS network is used to transform the compound performance characteristics into a single performance index. Generally, fuzzy systems are applied to interpret and assess the experimental data. However, some shortcomings in the accuracy and versatility of ANFIS have been identified, which were addressed by incorporating classic computing algorithms and optimization techniques ,34,35,36Several AI-based models have been utilized to predict the hardened and fresh properties of concrete. Studies have revealed that using hybrid algorithms in many cases can lead to improving the performance of predictive models ,44,45,46A verified series of non-destructive test data has been derived from the literature ,19 and ePumice, fly ash, slag and silica fume were utilized as the cement alternatives at various replacement percentages and applied in binary and ternary mixtures. 2. The dry materials were mixed first, and then water and SP were added. The total time of mixing process was about 10 min. After the first three minutes, concrete was rested for about four minutes and then mixed again in the machine for three minutes. After 10 min, the slump flow test was performed.The first series of mix designs consists of fly ash, pumice and slag binaries with replacement percentages of 10%, 20%, 30%, 40% and 50% and with a water-to-cement ratio of 0.38. The second series includes ternary mixtures of pumice and silica fume with the same water-to-cement ratio, as shown in (a)As shown in (b)The flow-ability of concrete with aggregate with a maximum size of 20 mm was measured by the V-funnel flow test, as indicated in (c)The U-box apparatus c includeThe slump flow test was performed based on ASTM C1611 to assess the workability of fresh concrete in SCC at different intervals. This test measures the concrete propagation after the funnel removal. Results of slump flow examination indicate the degree of filling ability and SCC stability. To achieve the target slump flow for each mixture, J-ring, V-funnel and U-box tests were performed on fresh SCC according to EFNARC standards. In order to prepare samples for the above tests, at first, each mixture should be stirred for 20 s. Each test methodology is summarized as follows:In binary mixes of slag and pumice, slump flow drop decreases with increasing replacement percentage. According to ,19, for At the beginning of the mixing process, compared to other specimens, samples with slag represented lower viscosity due to lower water absorption . These properties of slag make the mixture highly sensitive to SP where adding only a very small amount of SP more than usual will cause concrete segregation. However, According to the results of binary designs, more SP is used by pumice compared to the other two powders for a single slump flow. SP value also increases with increasing replacement but causes less slump flow. On the other hand, adding silica fume to the mixture only causes slump loss over time and does not have a significant effect on the initial slump and amount of initial SP used. Thus, in the ternary mixes of pumice and silica fume, a mixture containing pumice with a higher percentage of replacement requires more SP. However, its slump would decrease, and the mixture containing more silica fume indicates opposite results. As seen in According to the findings of this section, it can be concluded that there is an inverse relationship between the amount of SP demand and the slump flow loss, which shows that lower SP demand causes higher slump loss. The results also suggest that 30% replacement for pumice and slag is very economical and justifiable in binary designs. In ternary designs, 45% pumice replacement with 5% silica fume could be propitious to the design requirement.2 has the smallest particle size among all powders. Therefore, it is expected that by increasing the replacement value, a further slump flow drop occurs. However, the results in the thirtieth minute show that the presence of pumice with the increasing trend of slump flow is capable of overcoming the slump flow loss induced by silica fume. In all specimens, the slump flow should not be lower than the initial control specimen.Unlike a binary mix of slag and pumice, fly ash shows the opposite result. Increasing fly ash proportion leads to rising slump loss. This behavior could be related to the fine particles of fly ash compared to the size of cement, pumice and slag aggregates, which provide more surface and lead to higher friction between particles. The increase in slump flow continues by adding silica fume to the ternary mix of pumice and silica fume, which is indicated in ANFIS is a fuzzy Sugeno model placed in an adaptive system framework to build models and then validate developed ones to facilitate training and adaptation. The fuzzy inference system is considered as the core of the ANFIS network. The inputs are received by the first layer and then converted to fuzzy values through the membership function. A combination of least-squares and back-propagation gradient descent methods are used for training parameters of membership function to simulate the given training data set. Another component of the swarm intelligence algorithm is particle swarm optimization (PSO) ,47, inspThe ant algorithm is a very powerful way to solve hybrid optimization problems. This algorithm is one of the metaheuristic methods inspired by the optimal behavior of ants . AlgoritThe DEO algorithm proposed by Price and Storn  is a popBased on vi⇀ and si⇀, the particle population tends to cluster around the best.i-th component of each input vector before and after normalization, respectively, and The data obtained by Equation (2) requires to be normalized, since the problem of prediction is non-linear. Hence, pre-processing and post-processing can be carried out , and theRMSE), Pearson correlation coefficient (r) and determination coefficient (R2) are used as performance indices of the models. These indicators are presented as follows:P and T are the predicted and target values, respectively, and S is the total number of training or testing samples. The above equations were written in MATLAB environment so that at the first stage, predicted and target values were placed in an individual file. Secondly, equations were filled with corresponding values by written the codes and finally, correlation coefficient values were derived from the MATLAB software and placed in another file.By evaluating the performance of the models, the training phase is composed of 70% of the data, and the other 30% is assigned to the testing phase. Then, root mean square error  and testing (30% of the input data). The results show that all three hybrid neural networks are reliable. However, 2 = 0.9871, for ANFIS-ACO are RMSE = 0.0864, r = 0.9073 and R2 = 0.8231, and for ANFIS-DEO are RMSE = 0.3717, r = 0.9362 and R2 = 0.8765. In the training phase, these parameters for ANFIS-PSO were RMSE = 0.0529, r = 0.9935 and R2 = 0.8811 while ANFIS-ACO provided RMSE = 0.0854, r = 0.9787 and R2 = 0.9579, and ANFIS-DEO obtained RMSE = 0.0638, r = 0.9556 and R2 = 0.9132.As shown in Given that the best result for RMSE is the lowest one, and for r, the best positive correlation coefficient is 1.0, the numbers closer to 1.0 are; therefore, better results. Considering all the conditions stated above, it is clear that the ANFIS-PSO algorithm performs better than the other two algorithms in the testing phase, as shown in The calculated regression equations for each algorithm are shown in By comparing According to As discussed comprehensively, ANFIS can be considered as a reliable predictive method to be integrated with other metaheuristics algorithms, like previous studies ,43,44 whThe developed hybrid algorithms were trained by the collected dataset and, finally, the SP demand values were predicted for specified SCC mixes. In terms of performance parameters, all hybrid algorithms obtained promising results.2 = 0.9871 in the testing phase and RMSE = 0.0529, r = 0.9935 and R2 = 0.8811 in the training phase. Prediction errors were also in an acceptable range where the ANFIS-PSO indicated the lowest ones. Additionally, test and train results of all three algorithms were presented in an analogous regression diagram for a better understanding of the accuracy and eligibility of each technique.Compared to other proposed algorithms, ANFIS-PSO represented the best evaluation criteria including RMSE = 0.0633, r = 0.9387 and RIt was found that metaheuristic algorithms, especially the PSO technique, are able to cover the prediction problems of non-linear data. In general, the best performance of hybrid models was obtained for ANFIS-PSO, ANFIS-ACO and ANFIS-DEO, respectively. In addition, it seems that ANFIS can be a good base for other metaheuristic optimization algorithms such as genetic algorithm, firefly and bee colony.Self-consolidating concrete (SCC) requires a higher dosage of cement compared to normal concrete, which is a controversial issue from an environmental point of view. In order to solve this problem, researchers studied different natural and synthetic powders as partial replacements. The remaining workability of SCC is an important factor to achieve a sustainable mix design, which is directly related to superplasticizer (SP) content in the SCC mix. SP demand is an optimum value of a dosage, which is derived from non-destructive tests. This study was aimed to investigate the application of artificial intelligence algorithms to overcome the difficulties in the prediction of SP demand through non-destructive tests including J-ring, U-box, V-funnel, 3 min slump and T50. To this end, ANFIS was integrated with three metaheuristic algorithms, namely PSO, ACO and DEO. The most important results can be summarized as follows:


Triticum aestivum L.) is the staple food crop for about 30% of the world's population and contributes over 20% of calories from food , was obtained from the Wide Hybridization Department, National Agriculture Research Center, Islamabad, and included in this study. http://wheatatlas.org/country/varieties/PAK/0?AspxAutoDetectCookieSupport=1; Accessed on 1st August 2019). A total of 104 wheat cultivars (CVs), landraces (LRs), and advance lines (ALs) were collected from different research institutes, breeders, and original collectors of landraces in Pakistan. An additional seven cultivars were collected from separate research institutes to be included as duplicate controls in agro-morphological data. A wild relative, Data were recorded in the field as well as after harvest. The field data consists of four qualitative variables. This data was based on the observation and scoring of data of entire blocks; individual plants were given the same score as that of the block for these four variables. At maturity, five plants per block were uprooted from the soil and labeled individually. The plant labeling after the harvest followed the EnRnPn scheme, where “E” showed “Entry” number , flag leaves (FL), rust count 1 (RC1), and rust count 2 (RC2). Heading data were recorded at the booting stage for most of the plants in the field, and all data were recorded in a single field visit. The data were scored as 1–8, based on the presence or absence of heads on most of the plants in the entire block. Flag leaf status was recorded as drooping to erect for the entire block and given scores as 1–4. Stripe rust was scored on a scale from 0–9, as reported elsewhere  were ready to harvest by the end of April; many LRs and some CVs were late in maturity and were harvested in the first and second week of May. Cold adapted LRs from the temperate region of Gilgit in northern Pakistan were the last to reach maturity. Fewer than five plants per block could be collected at maturity for these genotypes , leading to missing post-harvest data for the rest of the plants. Remaining plants for these genotypes did not reach maturity till the end of May 2016 (one month after the start of harvest) and were abandoned in the field. The following qualitative and quantitative data were recorded after the harvest:Qualitative data were recorded for Spikelet color (SC) and Awn color (AC). The colors were scored either 1 (red to brown) or 2 (white to amber), as reported by elsewhere , Number of nodes (NN), Number of spikelets (NS), Number of tillers (NT), Weight of tillers (WT), Number of heads (NH), Yield per plant (YP), Biomass (B), and Harvest Index (HI). A brief description of each of the quantitative data recorded is given in Based on economic importance, a sub-set of 52 genotypes  was selein silico evaluation to generate >400,000 tags per sample and were employed for digestion of DNA (0.3–0.6 ug). Adapters were ligated to DNA along with a unique barcode for each wheat genotype. All libraries were pooled and subjected to a polymerase chain reaction (PCR) for the enrichment of sequence data. The qualified libraries were sequenced using Illumina high-throughput sequencing with 144 bp paired-end run. Average insert size of 303 bp was determined for each genotype, using Bioanalyzer.At Novogene, the purity and integrity of DNA were determined with agarose gel, and Qubit® 2.0 fluorometer was used for accurate quantification of DNA concentration. For library construction, all samples contained at least 1.5 ug DNA. MseI and NlaIII restriction endonucleases were selected after Triticum aestivum TGACv1 .The sequencing data was generated on a HiSeq 2500 instrument. Adapters were trimmed from the ends. Those reads which were either contaminated with library adapters, 10% unknown bases (N) or 50% low-quality bases were not used in downstream analysis. The quality of short reads was assessed using FastQC version 0.11.6  of the NCBI repository  can be found in the article/MI: study design, sample collection, data recording in the field and after the harvest, data analyses, DNA extractions, and manuscript writing. Abdullah: data collection in the field and after the harvest, data analyses including GBS data, DNA extractions, and manuscript writing. BZ: sample collection and data analyses. NA: data collection after the harvest. RK and SW: data collection in the field and after the harvest. NS and RM: sample collection and data collection after the harvest. JT: GBS data analysis. IA: study design, field work, data collection, data analyses including GBS data, manuscript editing, and study co-supervision. MN: study design, sample collection, field work, data collection, data analyses, and study co-supervision. HA: study design and overall project supervision. All authors contributed to the article and approved the submitted version.IA and SW were employed by the company Alpha Genomics Private limited. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.