Radiation enteritis (Re) is one of the most common complications of radiation therapy for abdominal tumors. The efficacy of cancer treatment by radiation is often limited by the side effects of Re. Re can be acute or chronic. Treatment of acute Re is essentially symptomatic. However, chronic Re usually requires surgical procedures. The underlying mechanisms of Re are complex and have not yet been elucidated. The purpose of this review is to provide an overview of the pathogenesis of Re. We reviewed the role of intestinal epithelial cells, intestinal stem cells (ISCs), vascular endothelial cells (ECs), intestinal microflora, and other mediators of Re, noting that a better understanding of the pathogenesis of Re may lead to better treatment modalities. The intestine is particularly sensitive to ionizing radiation (IR).Vomiting, diarrhea, abdominal pain, bleeding, obstruction, perforation, and nutrient absorption disorder are common radiation toxicities in the intestine, which may lead to the decline of the patients’ quality of life and even death . SeveralThe function of the intestinal barrier is for the absorption of nutrients through the mucosa and the prevention of injury from other toxic substances . The mucAt present, studies on the mechanism of Re focus on the following aspects: the destruction of the intestinal epithelium, intestinal stem cell (ISC) injury, intestinal microvascular changes, and intestinal microflora disruption, among others.Radiotherapy can lead to an increase in intestinal epithelium barrier and permeability, which is closely related to the destruction of the TJs’ structure by IR. Morini et al. found that the expression of occludin, claudin, ZO-1, and ZO-2 was related to Re. They believed that when Re occurred, ZO-1, claudin-1, and occludin in TJs would recombine or break, resulting in the destruction of the intestinal barrier .The adherent junctions (AJs) located below TJs are multiprotein complexes that indirectly regulate the TJs’ maturation and integrity. Gupta et al.  found thAutophagy plays an important role in maintaining intestinal barrier homeostasis and regulates the apoptosis and necrosis of IECs . It has Resveratrol is a polyphenol synthesized in grape leaves and grape skins . Qin et IECs can renew themselves rapidly every 4–5 days . The abiThe main cause of Re is ISC death, which leads to the loss of key cells and destruction of crypt structures , 26.Thiazolidine hydrochloride (TCZC01) is a novel compound synthesized by Zingerone. This paper concludes that pretreatment with TZC01 can significantly improve intestinal crypt apoptosis, increase the number of Lgr5+ ISCs, and even reduce intestinal cell apoptosis, thus protecting the intestinal barrier from IR damage. However, the mechanism of TZC01 is not explained in this paper .The ISCs’ niche is not a constant, but a complex and dynamic environment. The stem cell zone is surrounded by enteric neurons, endothelial cells (ECs), smooth muscle cells (SMCs), intraepithelial lymphocytes, macrophages, and fibroblasts/myofibroblasts together with the extracellular matrix (ECM). Wnt, Notch, bone morphogenetic protein (BMP), and Hedgehog are the major signaling pathways involved in the maintenance of the ISCs’ niche .The Wnt/β-catenin pathway plays an important regulatory role in intestinal tissue homeostasis . The staAs reported by Li et al., epicatechin can salvage the ISCs’ activity and activate the Wnt/β-catenin pathway to induce crypt regeneration .Podophyllotoxin combined with rutin (G-003M) is considered to reduce intestinal damage caused by radiation, and the main mechanism may enhance β-catenin nuclear translocation-promoted Lgr5 (+) ISC renewal through the Wnt/β-catenin signaling pathway .Salmonella typhimurium (HKST) upregulated the nuclear localization of ß-catenin through the Wnt/b-catenin pathway. Moreover, pretreatment with HKST greatly increased the value of intestinal cells, significantly improved the structure and function of crypts, and reduced intestinal damage caused by ionizing radiation to prevent radiation enteritis  superfamily . BMP binMartín-Alonso et al. found thaThe Hedgehog (Hh) signaling pathway is a paracrine in the strict sense. In humans, three Hh ligands are expressed: Sonic Hedgehog (Shh), Indian Hedgehog (Ihh), and Desert Hedgehog (Dhh). Ihh is one of the important ligands of the Hedgehog pathway and maintains the stability of the ISCs’ niche . Ihh is Endothelial cell damage mediated by IR is also a pathophysiology of Re. Radiation intestinal epithelial injury is the main cause of acute radiation enteropathy, while chronic radiation enteropathy is caused by vascular endothelial injury. Vascular endothelial cells are sensitive to IR . IrradiaShao et al.  reportedEndothelial thrombomodulin (TM) is a multi-domain transmembrane receptor protein with anti-inflammatory, cytoprotective, antifibrinolytic, antioxidant, and anticoagulant functions . The higYan et al.  reported14 species of resident microorganisms that live in the human intestinal tract with bacteria, viruses, fungi, and protozoa  is a metabolite of intestinal microflora. Zhang et al.  found thCancer therapy continues to improve, but radiation therapy remains an important part of cancer treatment, and Re is an inevitable side effect of radiotherapy. Interventions for Re often determine the efficacy of radiation therapy in patients. The occurrence of Re is usually not determined by unilateral factors, and the complex interaction between intestinal epithelium, ISCs, capillary endothelium, and luminal bacteria is considered to be the basis of Re pathogenesis. Resveratrol, TZC01, HKST, etc. could reduce Re in animal experiments, which needs to be confirmed by clinical trials.JF and BL drafted the manuscript, and MF, TN, FG and BT participated in the data review and collection for the study. XD conceived the study and participated in its design and coordination. All authors read and approved the final manuscript.This work was financially supported by the NHC Key Laboratory of Nuclear Technology Medical Transformation  and Natural Science Foundation of Sichuan Province (grant no. 2022NSFSC0849).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.


Ankle-brachial index and arterial stiffness are associated with leg function in the elderly and in patients with peripheral arterial disease. Little is known about the meaning of these parameters in young and trained subjects and how they are related to physical performance. The main objective was to evaluate the mediating role of arterial stiffness and ankle-brachial index in physical performance. In a cross-sectional, case-control study, 240 male athletes were consecutively enrolled from the Laboratory of Cardiology and Sports Medicine, “G. d’Annunzio” University . All the subjects underwent the examination protocol for the annual medical evaluation for sport participation. Soccer  players compared to runners showed a lower level of ankle-brachial index, higher arterial stiffness, and lower systolic and diastolic blood pressure. In the treadmill stress test, soccer players compared to runners showed a greater maximal aerobic capacity. Differences in cardiovascular performance between soccer players and runners were mediated by better arterial stiffness and low level of ankle-brachial index; the estimated effect was 0.11 ± 0.05 and 0.24 ± 0.06, respectively. Vigorous strength training drops blood pressure and increases arterial stiffness. Taken together, our findings would seem to suggest that ABI and CAVI could be used as markers for athletes’ performance. There is scarce evidence on the physiological and/or performance differences that could help to identify top-level athletes, therefore, the determinants that predict and contribute to high-level performance in sports remain largely unknown . SeveralOur hypothesis considers arterial stiffness and blood pressure as potential cornerstones of the pathway that links the type of exercise training (aerobic vs. mixed aerobic-anaerobic) to physical fitness . TherefoFrom the Centre of Sports Medicine of the “G. d’Annunzio” University , 240 male top-level athletes (mean age 34.4 ± 14.2) were prospectively selected and recruited, who underwent the annually compulsory medical examination for sport participation and for planning a dietetic and physical training program. Among the study population enrolled, 111 (46.3%) were soccer players  and 37 (15.4%) were futsal players . Both groups, underwent a prevalently mixed aerobic–anaerobic training at least 4 times per week  and were, therefore, collapsed into a single group for further analysis. The remaining 92 subjects were runners, who had a specific aerobic training program, at least 4 times per week, and in the year before, participated in at least at two competitive marathons.The study was designed by the laboratory of Medicine and Sports Cardiology of the University Centre of Sports Medicine of the “G. d’Annunzio” University . According to Italian law, all the agonist athletes that are referred to the center for their annual medical visit undergo a clinical examination, a physical performance assessment, and an interview on dietary and lifestyle habits. The research protocol was not submitted to the local ethics review board, since this is the standard assessment in the routinely practice of the center, according to Italian law; nevertheless, written informed consent was obtained from all participants enrolled in the study.CAVI was measured using Vasera VS-1000 . Cuffs were applied to the 4 extremities, and electrocardiographic electrodes were attached to the upper arms. A microphone was placed on the sternal angle for phonocardiography. Two amorphous pulse wave sensors were placed symmetrically at the femoral and carotid artery. The subjects rested in the supine position for 5 min. To minimize cuff inflation-effects on blood flow dynamics, pulse waves were measured with cuffs inflated to lower than the diastolic blood pressure (50 mmHg). Then, the extremity blood pressure (BP) was measured by oscillometry. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) were obtained by measuring the BP at the right brachial artery ,15. VaseBody weight and height were measured, to the nearest 0.1 kg and 0.1 cm, respectively, in a standardized position, using a stadiometer with a balance-beam scale ; subjects were dressed in light clothing and without shoes. Body mass index (BMI) was calculated as weight (kg)/height (m2). The body composition  was assessed by means of the electrical bioimpedance technique, using leg-to-leg 50 kHz frequency bioelectrical impedance scale . The test was executed in a standing position, without socks, after emptying the bladder, and after at least two hours of fasting. Participants also abstained from alcohol consumption within 24 h of the test.An exercise treadmill test was performed during the morning hours, preceded by a one-minute warm-up at a speed of 1.0 mph, with no slope, and adapted for a tilt treadmill with gradual and moderate increases of speed and slope. The patients were continuously monitored with a 12-lead ECG. The Treadmill exercise test was conducted according to a modified for athletes Bruce protocol, using standard criteria for stopping. The exercise capacity, resting, maximum, and recovery measures of heart rate (HR) were derived from the treadmill test results. Exercise duration was used as an estimate of physical fitness; HR and BP were recorded during each stage of exercise and for each minute of recovery. The rate-pressure product (RPP) was obtained by multiplying the maximum HR by the SBP at peak exertion.Continuous variables were reported as mean ± standard deviation, and differences between types of sports were analyzed with general linear models. Categorical variables were reported as frequencies and percentages, and the Chi-square test was applied to evaluate statistically significant differences between the groups considered; moreover, logistic regression was applied to produce estimates and to calculate odds ratio (O.R.) and 95% confidence interval (95%CI). Analyses were conducted using growth curve models (linear mixed models) to examine trajectories of BP, HR, and RPP, across time spent on the treadmill test. This analytical procedure address within-person and between-person variability simultaneously. In the p = 0.01 on the right and p = 0.009 on the left side), lower DBP measured at the ankle at the brachial, lower SBP at the ankle, and lastly a lower ABI, on both sides  and soccer players, all athletes were male. Soccer players compared to runners, showed statistically significant lower levels of CAVI (th sides .p =0.01).Between the two groups, no differences could be demonstrated in the body composition and in rest rate metabolism. Compared to runners, soccer players showed more frequently, in both legs, an ABI < 0.9  or an ABI ranging from <1 to >0.9 . In a sub-analysis considering only soccer players and clustering them according to classic soocer (11 players for every team) compared to Futsal (5 players for every team), the ABI was in the normality range (>1.0) in both legs only in 7/37 (18.9%) for Futsal players and in 48/111 (43.2%) for classic soccer , and RPP . Moreover, the trajectory of the SBP and the RPP showed a less pronounced increase in those athletes with an ABI < 0.9  even if they showed a statistically significant higher point when the maximal aerobic capacity was reached  and in the threshold at the maximal aerobic capacity ; but athletes with an ABI > 0.9, compared to all others, showed a more pronounced increase in heart rate  at every step (p = 0.09); but at every step for a lower level of CAVI, the increase in HR was less pronounced , and the threshold at the maximal aerobic capacity was higher .Heart rate did not show any significant differences between the two groups considered in the stress test .In In this study of a well trained and active young population, we found that lower ankle-brachial index, and lower level of Cardio-ankle-vascular index, could mediate differences in physical performance between soccer players and runners; moreover, in those subjects who play football, it could be demonstrated a more prevalent lower level of the ankle-brachial index compared to runners.In our theoretical model, ABI and CAVI were considered as mediators of physical performance, therefore rather than hypothesizing a direct causal relationship between the independent (type of exercise) and the dependent variable , the role of a third variable, the mediator, was analyzed to clarify the nature of this relationship. Endothelial function, measured by ABI and CAVI, together explains 35% of the difference in physical performance between “pure” aerobic training (runners) compared to concurrent training (soccer players). Numerous cross-sectional and longitudinal intervention studies have demonstrated the influence of regular aerobic training on vascular function in different populations ,20. ContAnkle-brachial index, particularly in the elderly, was largely recognized as a good predictor of physical function. In a case-control study, McDermott demonstrated that ABI has a direct and independent association with walking endurance and both usual and maximal walking velocity . In the A reason that can explain this inverse relationship could be related to the type of exercise that soccer players did, and the consequent modification on the type of metabolism, on body composition, and lastly on cardiovascular system adaptations. During exercise training, soccer players alternate high-speed runs, sprints, turns, jumps, and tackles, which provide a high impact on muscles and bones. From a metabolic point of view, this kind of exercise enhances fat oxidation during activity and results in a fat mass reduction  with a pIn our data, we could not find statistically significant differences between endurance and concurrent training in body composition and basal metabolism, therefore variation in rate and type of metabolism could not be demonstrated and consequently could not be considered as a keystroke in our model, even if the beneficial effect of soccer training was largely proved in young as in the elderly and in both sex .The exercise type done by soccer players could determine a reduction of BP, and in our data, particularly in the lower limb. Several mechanism could be considered in this process in response to physical training in soccer players: modulation in the autonomic nervous system, reductions in systemic vascular resistance, and plasma hormonal level ,30. In aSome limitations of this study must be acknowledged. A selection bias could be hypothesized; indeed, the soccer players were almost all pro or semi-pro, whereas among runners, almost all were amateurs, therefore, the former group could be less trained, or alternatively, be trained without a specific help of a qualified coach. Moreover, no standardized information was available about the intensity and regularity of the runners’ training. In any case, in this study, we enrolled only runners that belonged to a sportive association, and in the year before the enrolment in the study, had participated in at least two competitive marathons, ensuring regular and constant training.Another limitation that must be considered was the lack of a direct measurement of cardiac oxygen consumption. In all the analyses, we used the rate-pressure-product, that was largely used in the literature and reported to correlate quite well with maximal oxygen consumption in a wide variety of circumstances .In those subjects with an ABI level < 0.9, it was not possible to have a computed tomographic scan or magnetic resonance angiography because none of the athletes reported a paradigmatic symptom of peripheral-arterial-disease, nor was it possible to identify any significant reduction in blood flow at the Doppler and ultrasound images. Lastly, we did not consider in our analysis several well-known cardiovascular risk factors such as smoking habits, cholesterol, or vitamin D levels, as those data were not available for all the enrolled subjects. However, arterial stiffness is now regarded as an important biomarker of vascular function and a predictor of cardiovascular events more accurate than well-established traditional risk factor scores .Concurrent aerobic–anaerobic exercise compared to pure aerobic training appear to improve endothelial function; moreover, arterial stiffness (CAVI) and ankle-brachial index exert a positive effect on performance in the treadmill stress test. Lastly, CAVI and ABI could be suggested as determinants that could predict and contribute to high-level performance in sports.


Dementia is a term that represents a set of symptoms that affect the ability of the brain’s cognitive functions related to memory, thinking, behavior, and language. At worst, dementia is often called a major neurocognitive disorder or senile disease. One of the most common types of dementia after Alzheimer’s is vascular dementia. Vascular dementia is closely related to cerebrovascular disease, one of which is stroke. Post-stroke patients with recurrent onset have the potential to develop dementia. An accurate diagnosis is needed for proper therapy management to ensure the patient’s quality of life and prevent it from worsening. The gold standard diagnostic of vascular dementia is complex, includes psychological tests, complete memory tests, and is evidenced by medical imaging of brain lesions. However, brain imaging methods such as CT-Scan, PET-Scan, and MRI have high costs and cannot be routinely used in a short period. For more than two decades, electroencephalogram signal analysis has been an alternative in assisting the diagnosis of brain diseases associated with cognitive decline. Traditional EEG analysis performs visual observations of signals, including rhythm, power, and spikes. Of course, it requires a clinician expert, time consumption, and high costs. Therefore, a quantitative EEG method for identifying vascular dementia in post-stroke patients is discussed in this study. This study used 19 EEG channels recorded from normal elderly, post-stroke with mild cognitive impairment, and post-stroke with dementia. The QEEG method used for feature extraction includes relative power, coherence, and signal complexity; the evaluation performance of normal-mild cognitive impairment-dementia classification was conducted using Support Vector Machine and K-Nearest Neighbor. The results of the classification simulation showed the highest accuracy of 96% by Gaussian SVM with a sensitivity and specificity of 95.6% and 97.9%, respectively. This study is expected to be an additional criterion in the diagnosis of dementia, especially in post-stroke patients. Dementia is a common symptom of neurological disorders that represents a decreased cognitive function in the brain . These sStroke is a significant cause of physical disability and cognitive impairment. However, the decline in cognitive function is often negligible compared to physical disability. Though cognition ability also significantly contributes to patients’ quality of life. Minor strokes can even affect executive and cognitive function, consequently affecting participation, quality of life, and ability to work. Approximately 30% of stroke patients develop dementia within six months of stroke . It is aThe VaD diagnostic process is quite complex, starting with the patient’s or family’s complaints, and then having to go through the stages of clinical diagnosis of cognitive impairment that is severe enough to meet the criteria for dementia. It must be proven that dementia results from cerebrovascular disease, including stroke, as evidenced by brain imaging. According to the Vascular Impairment of Cognition Classification Consensus Study (VICCCS) , mild vaScreening tests for neurocognitive disorders that can be used are the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) . FurtherTo the best of our knowledge, EEG studies on cases of vascular dementia, especially in post-stroke patients, are still few. The EEG characterization of VaD was reported by Sheng et al. by measuring signal strength using the S-transformation. EEG theta waves in VaD patients have high energy . AnotherThis study proposed an EEG wave characterization method to classify VaD in post-stroke patients with mild cognitive impairment and dementia by calculating and analyzing QEEG parameters. The proposed feature extraction method is spectral analysis, coherence, and signal complexity. The result of this calculation becomes a feature vector to be validated using machine learning. Simulations were conducted to classify normal elderly, post-stroke patients with mild cognitive impairment, and post-stroke dementia. Support Vector Machine (SVM) and k-Nearest Neighbor (k-NN) are used to evaluate the performance of the proposed feature extraction method. Combining these characterization methods is expected to provide a complete description of the analysis to increase detection accuracy and, ultimately, become a reliable additional diagnostic instrument.The classification scheme of vascular dementia in post-stroke patients using EEG signal analysis is presented in This study ran from November 2019 to April 2022. The recruitment and data collection of subjects were carried out at the neurological clinic and diagnostic center of Hasan Sadikin General Hospital, Bandung. The subject criteria used in this study were based on the recommendations of a neurologist (neurobehavior consultant) and the Indonesian Neurologist Association (PERDOSSI) after clinical examination, neuropsychology, and brain imaging were carried out. The inclusion criteria for patients included stroke after three months, with a lacunar or subcortical infarct, age 50–64 years, and minimum education in junior high school or equivalent. The MoCA-Indonesia (INA) score is less than 19, and has impaired basic and instrumental activities of daily living for post-stroke patients with dementia. Meanwhile, for patients with mild vascular cognition, if the MoCA-INA score is between 19–25, there are no disturbances in basic daily activities or mild disturbances in daily instrumental activities. The normal control inclusion criteria included an age between 50–64 years, a minimum junior high school education, an MoCA-INA score ≥ 26, and ability to read and write. Neurological physical examination results did not find focal neurological deficits on neurological clinical examination by a neurologist. Exclusion criteria for both sample groups were subjects with aphasia and no sensory disturbances in hearing, vision, movement disorders, and a history of cerebral diseases, such as epilepsy, severe head injury, multiple sclerosis, brain tumor, history of brain surgery, and alcoholism, determined by a neurologist. The total number of participants was 50 subjects, consisting of 18 subjects with normal categories, 19 post-ischemic stroke patients with MCI, and 13 post-ischemic stroke patients with dementia. All subjects involved in this study were asked to fill out an informed consent form. Clinical data from each group are presented in The next step was recording the EEG signal using the Cadwell EasyIII clinical standard EEG device. EEG was recorded on 19 channels, including Fp1, Fp2, F7, F3, Fz, F4, F8, T3, C3, Cz, C4, T4, T5, P3, Pz, P4, T6, O1, and O2 with electrode placement following the 10–20 international system. The signal was recorded with a sampling frequency of 250 Hz, a sensitivity of 0.5 µV, and an ADC resolution of 18 bits. Line noise with a frequency of 50–60 Hz was removed using an analog front end with a power of >110 dB. EEG recording was carried out under several conditions, namely relaxed with eyes closed, relaxed with eyes open, given a photic stimulus, and undertaking cognitive tests, including memory. However, the focus of signal processing was on the memory state. In the memory recording, subjects were given verbal instructions to memorize five words and were then asked to recall the words they remembered. The design of the EEG recordings during the memory work referred to previous studies ,23. FiguIn this study, signal characterization was also carried out in the Alzheimer’s case dataset, which consisted of EEG recordings from normal elderly subjects and elderly with MCI. This dataset was sourced from research at the Sina and Nour Hospital, Isfahan, Iran. The dataset was collected from 11 healthy elderly subjects and 16 elderly subjects with MCI . All subThe EEG signal was recorded using Galileo NT EEG, EBneuro. Resting EEG recordings with eyes closed were performed for 30 minutes. Nineteen channels were recorded, including Fp1, Fp2, F7, F3, Fz, F4, F8, T3, C3, Cz, C4, T4, T5, T5, P3, Pz, P4, T6, O1, and O2, with a sampling frequency of 256 Hz.Signal pre-processing was performed on the raw EEG signal to remove eye artifact noise, baseline wandering, and line and muscle noise. Signal pre-processing is one of the critical issues in preparing the EEG signal for the next processing stage, where the EEG signal is free from noise. Low-frequency and high-frequency noise commonly contaminate EEG signals, even with high power. Line and muscle noise comes with a high frequency, while eye noise has a low frequency. At this stage, two approaches are used to eliminate the noise: Independent Component Analysis (ICA) and a digital BPF filter at a cut-off frequency of 1–30 Hz. The ICA process is carried out using the EEGLAB toolbox in MATLAB. The topographic plot of the channel containing noise representing non-cortical activity  is shown in Meanwhile, In the coherence and signal complexity calculation phase, previously, the signal was filtered with a range of 1–30 Hz. This step aims to obtain the fundamental frequency from delta to beta of the EEG signal. A high pass filter with a cut-off frequency of 1 Hz and a low pass filter with a cut-off of 30 Hz is applied at this stage. Both high and low pass filters are designed using Butterworth, with a passband ripple of 1 dB and a stopband attenuation of 80 dB.In this study, feature extraction computes essential information to differentiate normal EEG, MCI, and dementia. The proposed feature extraction methods include spectral analysis, coherence, and complexity. The results at this stage are used as a predictor in the classification scheme.Spectral analysis is one of the most common methods used in EEG signal quantification. This analysis measures the power spectral density (power spectrum), which reflects the power distribution of a signal over frequency. Furthermore, in this study, the power spectral density was estimated using the Welch method with a window of 2 s and an overlap of 75%. Power spectral estimation using Welch, calculated in each EEG band, is expressed by Equation (1) below.U = window functionThe delta, theta, alpha, beta, and gamma bands were segmented using wavelet decomposition with Daubechies-2 (DB2) as the basis or mother wavelet. The Daubechies family was chosen for its good performance, as reported in ,25. In mfL, fH] are the delta, theta, alpha, beta, and gamma bands.Welch estimates the absolute power that depends on the amplitude value of each individual. So, it gives very varied results. Therefore, it is necessary to normalize the absolute value, called relative power. The relative power is the ratio between the absolute power of the frequency bands to each other, written in Equation (2) below.EEG signal coherence analysis was performed to observe the functional connectivity of the brain . In quanf is frequency.Coherence is a measure of synchronization between two signals mainly based on phase consistency. A high coherence value occurs when the phase difference between channels tends to be constant. Coherence can be expressed by dividing the square of the cross-spectral density of the two channels by the product of the power spectral density of the two channels. Coherence (oherence .(3)CabfThe feature extraction of the EEG signal at this stage is carried out with a complexity approach to calculate the degree of signal irregularity/randomness. The complexity approach in this research is based on entropy theory. The complexity of the EEG signal is estimated using spectral entropy and a new method called spectral dispersion entropy. These methods are described in the following sub-section.Pf is power spectral density of the specified frequency band, while fi and fh is the limit frequency of the signal.Spectral entropy estimates the randomness of the signal based on the spectral amplitude over a specified frequency range . Spectram template; the number of classes c represents the number of patterns, and the time delay d.Recently, dispersion entropy (DisEn) has received significant attention, where DisEn has been shown to outperform sample entropy and permutation entropy. DisEn was first proposed by Azami in 2016 ,35. Dispc from 1 to c. The normal cumulative distribution function (NCDF) is used to map m members, and each member is an integer from 1 to c.Take a number of linear and nonlinear approaches to mapping The number of possible dispersion patterns for each time series is defined as The number of dispersion pattern Based on the probability of occurrence of the dispersion pattern, DispEn is calculated using the following mathematical expression.The DispEn algorithm includes four main steps for univariate signal m template = 2; the number of classes c = 6, which represents the number of patterns, and the time delay d = 1.Spectral dispersion entropy is an extension of spectral entropy where the spectral amplitude of the signal is calculated using dispersion entropy. Previously, the probability of the appearance of the amplitude in the direct power spectral was calculated using Shannon’s theory. In spectral dispersion entropy, the power spectral randomness level is calculated by estimating the similarity of the dispersion pattern from a number of spectral series. Dispersion entropy is calculated with length p-value < 0.05.In testing the significance of the difference between normal, post-stroke MCI, and post-stroke dementia, post hoc multiple comparison with analysis of variance (ANOVA) was used. In this study, the pair test of the two groups had a significant difference if the The feature extraction method proposed in this study was also evaluated by classification simulation using the SVM and k-NN algorithms. The goal is to obtain the accuracy value as an additional analysis of the significance test. The calculated EEG features, including spectral power, coherence, and complexity, are then referred to as predictors in the stage classification. The cross-validation method divides the training and test features with k = 5 iterations, as illustrated in This section describes the study results related to the feature extraction results from each method. The results are presented in graphs and tables, followed by relevant clinical explanations. This chapter also presents the results of the validation of the proposed method in the form of classification accuracy.The results of relative power measurements on 19 EEG channels for each group are shown in p < 0.05 is shown in The average relative power of each group showed significance in the delta rhythm, where post-stroke dementia and MCI groups tended to be higher than the normal group. While it was significantly higher in the beta rhythm, the normal group was higher than the post-stroke MCI and dementia. Decreased strength of beta rhythms in MCI and dementia is associated with reduced focus or concentration on working memory tasks. The power of the delta and beta rhythms showed a correlation with the severity of dementia, where patients with dementia had the highest delta power and the lowest beta power. The significance of the difference with Power spectral characterization of the Alzheimer’s dataset has been reported in a previous study , represep < 0.05) were found in the frontal, central, and temporal regions, pairs F7-F8, T3-T4, T5-T6, and P3-P4, as shown in The signal coherence of the eight and twenty-eight electrode pairs, as shown in p-value < 0.05, as shown in p < 0.05 are shown in The mean right intrahemispheric coherence for each pair of electrodes is presented in The average measurement results show that the coherence of the post-stroke patient group with cognitive impairment is generally lower than the normal group. This condition occurs in almost all interhemispheric and intrahemispheric electrode pairs.Coherence measurements in the Alzheimer’s dataset have been reported in a previous study . The cohThe signal complexity analysis method is expected to provide differentiating characteristics between the observed groups so that quantitative EEG analysis can be used as a supporting criterion for early diagnosis of post-stroke vascular dementia. The signal complexity calculation method in this study is entropy-based. This calculation is performed on a time series function signal using spectral entropy (SpecEn) and a new method called spectral dispersion entropy (SpecDE).The average results of SpecEn and SpecDE measurements on 19 electrodes for each group are presented in The results of the SpecEn calculations in the Alzheimer’s dataset are presented in p-value < 0.05 showed a significant difference between groups.The results of the different tests on SpecEn and SpecDE are presented in p-value < 0.05 were found across channels for SpecEn and SpecDE. The average complexity value also indicates a relationship between the decrease in signal complexity and the severity of dementia. Therefore, multiple comparison post hoc testing is needed to test the significance between groups, specifically the normal vs. post-stroke MCI and post-stroke MCI vs. post-stroke dementia groups.Based on the significance test, the degree of signal complexity based on SpecEn and SpecDE showed a significant difference between the normal and post-stroke cognitive impairment groups. Significant differences with p < 0.05, were more in SpecDE than in SpecEn. The post hoc multiple comparison test results for SpecDE showed significant differences between groups at the Fp1, P3, O1, C4, and P4 electrodes. These results will significantly affect the accuracy at the classification stage.Tukey’s post hoc t-test was used for the multiple comparison tests in this study. The test results are presented in In the previous section, the characterization of the EEG signal was discussed in both the primary dataset and the Alzheimer’s dataset. Power spectral, coherence, and complexity analysis methods can produce discriminatory features between classes based on the tests carried out. The main objective of this study is to detect early-stage cognitive impairment in post-stroke patients using the proposed method. The feature extraction result from each method presented in the previous sub-section becomes a feature vector or predictor in the classification stage. The proposed methods are evaluated using automatic classification algorithms, including k-NN and SVM. This test was carried out with several scenarios, as presented in Several SVM kernels and k-NN types are also used to obtain the highest accuracy. SVM kernels include linear, quadratic, cubic, and gaussian. The penalty parameter used is equal to 1 for all kernels. Specifically, for the gaussian kernel, the parameter scale is set to sqrt (number of predictors). Meanwhile, k-NN includes fine, medium, and cubic k-NN with Euclidean and cubic distance metrics. The number of neighbors for the fine, medium, and cubic k-NN are 1, 10, and 10, respectively. The results of the evaluation of system performance in the EEG classification of normal, post-stroke MCI, and post-stroke dementia for all test scenarios are presented in The proposed method was also tested using the ten-cross validation technique. The aim is to test the robustness of the method compared to five-cross validation. The confusion matrix for the highest accuracy is presented in Performance evaluation of the proposed method on the Alzheimer’s dataset was not limited to a significance test. Evaluation using classifier techniques was also applied to determine the performance of the proposed method. Coherence and spectral entropy features were used as predictors in classification. The results were compared with similar studies using the same dataset. Details of the test results and comparison with previous studies are presented in In this study, EEG signal processing was carried out in post-stroke patients to characterize patients with cognitive impairment. The feature extraction method can describe brain activity changes so that EEG signals can be estimated that describe normal conditions, mild cognitive disorders, and dementia.The power spectral characterization showed the differences in the power of the delta, alpha, and beta waves. The group with cognitive impairment showed a higher delta wave power pattern than the normal group, followed by a decrease in the power of alpha and beta waves. The average relative power of each group showed that the highest significance was found in the delta and beta rhythms. The delta power in dementia and mild vascular cognitive groups tended to be higher than in the normal group. These results confirmed the study by Meghdadi et al., that there is an increase in the delta and theta power in the elderly with dementia . p < 0.05 were found in the fronto-temporo-parietal region [Meanwhile, the beta wave power of the normal group was higher than mild vascular cognitive impairment and dementia. In the studies by Seokbeen Lim et al. and Hendrayana et al., beta waves increased during concentration ,41. Signl region . Decreasl region . Jang etl region . The strl region . EEG patl region ,46. p < 0.05). These represent the temporo-parietal lobe region. Our findings confirm that the study by Al-Qazzaz et al. [Interhemispheric observations showed that the mean coherence values in patients with cognitive impairment tended to be lower than in normal subjects  for all electrode pairs; significantly in pairs F7-F8, T3-T4, T5-T6, and P3-P4  and . Another issue of observing SpecEn and SpecDE values is that there is an association between decreased signal complexity and dementia severity, as reported in the study of Al-Qazzaz et al. This finding confirms the results of previous studies, that a worsening of dementia will be followed by a decrease in signal complexity. The results of the analysis of memory-related brain activity recordings showed similar network dynamics [The complexity calculation results show that post-stroke patients with cognitive impairment tend to have lower signal complexity than the normal group  can be an essential tool to simplify the analysis of digital EEG tools. QEEG, in this study, uses power spectral, coherence, and complexity analysis. The quantification results show the characteristics of discrimination between normal, post-stroke mild cognitive impairment, and post-stroke dementia. Spectral analysis, coherence, and complexity can describe the condition of the brain with decreased cognitive function. From the proposed characterization method, it can be estimated whether there are brain abnormalities related to cognitive function. Furthermore, with a combination of EEG characterization methods, the severity of dementia can be classified as a diagnostic support tool in the early detection of post-stroke vascular dementia. Future research can perform feature selection of coherence and spectral dispersion entropy to obtain essential features to reduce the number of features, while still producing optimum classification accuracy.This study developed a quantitative EEG (QEEG) method to characterize EEG waves in post-stroke patients at risk of developing vascular dementia. QEEG methods used for analysis included spectral power, coherence, and signal complexity. These methods were used to improve the function of a digital EEG device that described the brain’s functionality for early identification of cognitive impairment due to vascular disease that leads to cerebral blood vessels.In developing the method, this study involved three test groups: normal subjects, post-stroke patients with mild cognitive impairment (MCI), and post-stroke dementia patients. The subject criteria used in this study were based on recommendations. They were selected by a neurobehavior consultant neurologist after clinical, neuropsychological, and brain imaging examinations were carried out. The recommendations for normal and impaired cognition were based on neuropsychological examination by a neurologist using the MoCA assessment. Clinical examination, psychology, and EEG recordings were conducted at Hasan Sadikin Hospital, Bandung. This research received ethical approval from the hospital ethics committee; number LB.02.01/X.6.5/272/2019.p-value < 0.05). This characterization also demonstrated an association between EEG signal strength and dementia severity.Power spectral characterization showed that patients with cognitive impairment had higher delta relative power and decreased alpha and beta relative power than the normal group. The most significant differences in delta and beta waves were found at the frontal, temporal, and parietal electrodes (p < 0.05) was found in the frontal-temporo-parietal lobe electrode pair. In the investigation of intrahemispheric coherence, a decrease in coherence was found in patients compared to normal subjects. Significant differences existed in the local and distal intrahemispheric coherence electrode pairs, including frontal, central, and temporal. These results represent the consistency of interhemispheric coherence measurements, where the central and temporal regions experience decreased coherence due to the failure of functional connectivity. Thus, the decrease in coherence values between brain regions strongly correlates with disorders related to cognitive function.Another analysis was the interhemispheric and intrahemispheric coherences, which describe the connectivity of brain tissue. Observations of interhemispheric coherence showed that the mean coherence value in patients with cognitive impairment was lower than in normal subjects . Significance (p-value <0.05 in normal cases vs. post-stroke MCI, and post-stroke MCI vs. post-stroke dementia was more commonly observed.Meanwhile, the SpecEn and SpecDE analyses showed that the post-stroke patient group with impaired cognition tended to produce a lower signal entropy than the normal group. Physically, the patient group had more regular EEG signals than the normal group. The multiple comparison tests showed that the SpecDE analysis provides discriminatory significance for the case of three groups that are superior to SpecEn. It was indicated by a Characteristic differences between normal conditions and patients with impaired cognition may be due to different brain conditions due to neuronal degradation. Delta waves with dominant strength occur when the state of deep sleep or the conscious state of someone with a brain disorder. The explanation for the lower coherence in this group of patients is the death of large numbers of neurons and the degeneration of synapses, leading to a decrease in cortical connectivity function. It can underlie disturbances in functional interaction or coordination between brain regions.At the classification stage to test the proposed method, prediction simulations were carried out using SVM and k-NN. This study succeeded in classifying normal EEG, mild cognitive impairment, and dementia, with the highest accuracy of 96%. The highest accuracy was achieved using Gaussian SVM by combining coherence and SpecDE features. Cases classified as normal and dementia could be perfectly classified. Meanwhile, for the classification of normal vs. post-stroke MCI and post-stroke MCI vs. post-stroke dementia, the accuracy of each was 94.4%. From the QEEG method developed, the EEG tool could be used to evaluate vascular dementia in post-stroke patients. This study could support clinical diagnosis in the early detection and evaluation of the severity of vascular dementia in post-stroke patients. In future research, it is recommended to collect data on a larger population so that the reliability of the proposed method can be analyzed.


Silicosis, as an important type of pneumoconiosis, leads to progressive and irreversible conditions from the beginning of inflammation and fibrosis. However, the data on the global burden of silicosis and long-term trends were limited.Derived from the Global Burden of Disease study 2019 , data on both crude and age-standardized rates (ASR) per 100,00 people of mortality and disability-adjusted life years (DALYs) due to silicosis was collected and analyzed. The burden and trends of mortality and DALYs due to silicosis was assessed by 204 countries and territories, by 5-year interval of age group and by sex from 1990 to 2019. And all the regions were divided into 5 categories according to Sociodemographic Index (SDI). Temporal trends in mortality and DALY were evaluated only to ASR by the Joinpoint regression model.More than 12.9 thousand  death cases occurred due to silicosis worldwide, and 655.7 thousand  DALYs were attributed to silicosis in 2019. From 1990 to 2019, global number of mortality and DALYs in countries with high SDI quintile decreased by 0.35%  and 0.32% , respectively. There was a greater burden in low- and middle-income countries were estimated in 2019 according to ASRs. The global number of mortality and DALYs among males accounted for over 95% of all in 2019. Both age-sex-specific mortality and DALY rate were increasing with aging and reached their peak at 85–89 age group. During the past 30 years, ASR of mortality and DALYs showed a decreasing trend with average annual percentage change at -3.0%  and − 2.0 , respectively.Silicosis remains an important health issue and causes a potentially serious burden worldwide. Attention should be paid to making preventable, affordable and effective measures in lower SDI regions.The online version contains supplementary material available at 10.1186/s12890-022-02040-9. Silicosis is a major type of pneumoconiosis, caused by inhalation of silica particles or free crystalline silicon dioxide , which ePneumoconiosis remains a public health issue around the world that cause huge health and economic damage  in both http://ghdx.healthdata.org/gbd-results-tool), according to GBD’s operation instruction.GBD study 2019, covering 369 diseases and injuries in 204 countries and territories from 1990 to 2019 , provideSilicosis belongs to the quaternary level of GBD cause hierarchy, which was defined as a chronic lung disease typified by lung scarring and other interstitial damage caused by exposure to silica . AccordiThe 204 countries and territories were divided into 5 categories according to Sociodemographic Index (SDI): low, low-middle, middle, high-middle, high SDI regions. SDI ranges from 0 to 1, calculated based on the lag-distribution income per capita, education, and total fertility rates .Age-standardized rates (ASR) were generated based on the World Health Organization World Standard Population Distribution, which allowed comparisons across groups with different age demographics compositions. The GBD used both crude and age-standardized rates to describe the burden of silicosis across regions, years and genders.th and 75th percentile values in the draws. It could address the possible heterogeneity from both sampling error and non-sampling variance.The GBD computed final estimates by using the mean estimate across 1000 draws, and 95% uncertainty intervals (UI) were determined on the basis of the 25Firstly, we present crude numbers and rates of burden by sex and SDI regions in 1990 and 2019. The global distribution of ASR of burden was depicted by the heat map (R package: ggplot2). Secondly, we applied the population pyramid (R package: plotrix) to show the difference of mortality and DALYs between age and sex in 2019. Lastly, the joinpoint regression model was conducted to evaluate the temporal trend in the ASRs of mortality and DALYs. Based on the Joinpoint regression software version 4.9.0.0 , the best-fitting points were identified by the slope of changing trend and connected a set of statistically linear models on a logarithmic scale . And the corresponding crude rate of mortality decreased by 0.41%  from 1990 to 2019 ] and crude rate [0.23 ] of mortality in 2019. From 1990 to 2019, global deaths increased by 0.32%  in countries with low SDI quintile, while countries with high SDI quintile showed a decreasing number of mortality [− 0.35% ] ], followed by North Korea, Palau, and Chile where rates were estimated to exceed 10 per 100,000 people  deaths among males, and it took up 95.72% of all the deaths  and 103.7 per 100,000 people ], and the rates were much greater in males than females across all age groups. From 65 years old onwards in males, the mortality rates of silicosis were estimated over 1 per 100,000 and presented an exponential growth. However, from the onset of 30–90 years old, the DALY rates due to silicosis increased monotonically at a steady pace. For mortality rate of silicosis among females, it didn’t show a substantial upward until 65 years old. DALY rates among females stopped increasing until 90 years old . Apart from males, ASRs for mortality among females had a variable trending during the 30 years. The decreasing trend wasn’t observed significantly  from 1997 to 2000, although the rest of the period descended with a different slope. As for ASR DALY overall, there is a relatively stable period for the first 4 years of observation , and it had gone through a drastically descending from 2014 to 2017 . From 1990 to 1994, ASR DALY had an increased slope at 1.9%  among females. A continuous declination occurred during the whole study period in ASR DALY among males , almost twice as many as females (Figs. This study reported recent trends of the numbers and ASRs of mortality and DALY due to silicosis by region, age and sex over the last three decades. Using GBD 2019 data, this study found that while mortality and DALYs due to silicosis have shown an overall decreasing trend since 1990, countries with low SDI faced a heavier disease burden. Compared to females, males with silicosis had higher mortality and DALY rates at all ages. Notably, from 1990 to 2019, the disease burden for both males and females with silicosis showed an overall decreasing trend, more pronounced in males.There are some differences in the disease burden of silicosis between patients in terms of gender. In the past, the traditional perception was that males’ health was affected by their occupation and suffered more damage from silicosis. Statistically, ASR for mortality also showed a decrease in the number of males and a constant trend in females. However, in terms of actual deaths, the number of female mortality and DALYs were on the increase against a background of decreasing annual deaths in males with silicosis. This leads us to take into account the impact of silicosis on females. Firstly, females in traditional occupations have the same potential for silicosis exposure as males . SecondlIn terms of healthcare resource consumption, the consumption of resources for silicosis patients had also decreased in recent years compared to the 1990s . Based oThe reason for this problem is that silicosis can lead to serious consequences. For people with silicosis, the presence of silicosis can lead to the development of diseases such as lung cancer . In addiThere are some limitations to this study. Firstly, similar to most GBD studies, the robustness of the results is affected by the potential quality of the raw data. Secondly, this study was unable to estimate the situation of people with silicosis that was masked by other lung diseases, and the true burden of silicosis may be underestimated. Finally, these data were based on calculations of surveillance data, and these indicators may have a lag in the estimation of the actual disease burden.Silicosis continues to be one of the most important occupational health issue and causes a potentially serious disease burden worldwide. Although the ASR of mortality and DALY for silicosis have trended downwards globally from 1990 to 2019, they have increased in women and in low- and middle-income countries. Therefore, attention should be paid to the disease burden in lower SDI regions, and preventable, affordable and effective measures are urgent to make globally.Additional file 1.Table S1. Global age-standardized mortality and DALY rate of silicosis for both sexes in 2019. 204 countries are arranged by GBD 7 super regions and 21 regions ASR: age-standardized rate; DALY: disability-adjusted life years. Table S2. Global age- and sex-specific rate for mortality and DALY due to silicosis in 2019. DALY: disability-adjusted life years. Table S3. Global trend of age-standardized mortality and DALY rates of silicosis by Joinpoint regression, 1990-2019. APC: annual percentage change; CI: confidential interval; AAPC: average annual percentage change.


However, significant differences were found in static balance measured subjectively using the Berg Balance Scale . Although some differences were not significant, the studies included in this systematic review consider that specific trunk exercises or balance training combined with muscle strengthening in patients with idiopathic PD should be a complement to pharmacological treatment for improving balance dysfunction and postural instability, preventing falls and promoting wellness.Parkinson’s disease (PD) is a neurodegenerative pathology classified as a movement disorder. Physical exercise within a physiotherapy program is an important element to improve postural stability, balance and mobility in order to reduce falls in people with PD. The aim of this work was to determine the efficacy of specific balance and trunk mobility exercises, as well as their benefits for and effects on patients with idiopathic PD. A systematic review and meta-analysis was conducted according to PRISMA standards. The search was performed in five databases: Cochrane Library, SciELO, PEDro, Scopus and PubMed, in February 2022 with the following descriptors: Parkinson’s disease, trunk, exercise, therapy and physical therapy. The inclusion criteria were randomized controlled trials (RCTs) over the last ten years. A meta-analysis on static and dynamic balance was conducted with the software Review Manager. Nine articles met the objectives and inclusion criteria, with a total of 240 participants. The trials had moderate methodological quality according to the PEDro scale. The studies included differed with regard to intervention protocol and outcome measures. Finally, eight studies were included in a quantitative analysis in which it was shown that trunk-specific exercises interventions did not significantly improve static balance (SMD = −0.10, 95% CI = −0.29, 0.08;  Parkinson’s disease (PD) is a neurodegenerative pathology classified as a movement disorder ,2,3. TheParkinson’s disease is the second most prevalent neurodegenerative disease among the adult population following Alzheimer’s. By 2040, it is forecasted that more than 12 million people in the world will be affected by PD, having a severe impact not only on their quality of life, but also economically, as a result of the healthcare resources devoted to this issue ,6. The aThere is no test capable of distinguishing PD from other disorders with similar clinical symptoms; its diagnosis is mainly based on clinical criteria ,7. The mPD patients can display motor symptoms (MS) such as bradykinesia, rigidity, tremors, gait freezing, movement disorders, postural instability, abnormal axial posture, axial rigidity and NMS  ,10. ThesAs the disease progresses, MS increase the risk of falls and recurring falls . MoreoveThe trunk plays an important role in combatting the threats of PD to postural control. Static balance performance and poor gait can be related with trunk muscles in these patients . AccordiThe beginning of postural instability in PD affects postural control and balance, as it retards the automatic postural responses, primarily due to body rigidity  .Managing PD is complex, depending on the stage of the disease and its diverse symptomology. For this reason, therapy must be individualized and adapted to each patient . The phyThe upper part of the body is responsible for two thirds of body weight and its centre of gravity . Other aThus, the objective of this review is to determine the effectiveness of specific trunk exercises, as well as their benefits and impacts on static and dynamic balance among idiopathic PD patients.A systematic review was carried out in February 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standards . It was An exhaustive search was conducted to find articles published in the last 10 years in five databases , which were written either in English or Spanish, using the following descriptors: Parkinson’s disease*, “trunk”, “exercise”, “therapy” and “physical therapy”, combined with the boolean operator “AND”.The following PICOS eligibility criteria were used for the selection of the articles :The participants were individuals clinically diagnosed with idiopathic Parkinson’s disease, at stage ≤4 on the Hoehn and Yahr scale, who were also over 18 years of age.The main intervention consisted of trunk-specific exercises  carried out alone or integrated with other interventions in the experimental group (EG). The dose, frequency and type of the exercises were not limited.The selected studies compared the specific trunk exercises (EG) with the control group (CG), which took part in any type of intervention based on other parts of the body but the trunk, or no therapy. The primary outcomes were static and dynamic balance; secondary outcomes were motor status, gait and falls.Regarding the study type, all were randomized controlled trials (RCTs).Inclusion criteria: RCTs between 2012 and 2022. It is important to search for the most recent evidence for specific trunk exercises in PD, particularly those studies published during the 10 years prior to the protocol for this systematic review, as well as including important outcomes in relation to balance dysfunction. Those articles were accepted in which the EG conducted specific trunk exercises with or without complementary therapy in the cited body segment.Exclusion criteria: Observational or descriptive studies. Not written in English or Spanish.Two independent authors (RLL and SVT) selected the titles and abstracts of the articles that fulfilled the inclusion and exclusion criteria. When discrepancies arose between the researchers, a third party was consulted (MVM). Finally, the characteristics from each study were extracted independently.The assessment of the methodological quality of the articles included was carried out using the PEDro scale .p-values or 95% confidence intervals, the Review Manager calculator was used to calculate them [The meta-analysis was performed using Review Manager . Changes from the pre-to post-intervention assessment were obtained directly from the study results. When the data presented in the studies were insufficient for meta-analysis purposes , the trial authors were contacted for additional data. When authors did not provide standard deviations but did provide ate them .Continuous outcomes were analysed using standardized mean differences because all scales were assumed to measure the same underlying symptom or condition, but some studies measured outcomes on different scales ,42. For 2. In addition, we searched for outlier studies using a visual inspection of forest plots. The I2 value can be interpreted as the proportion of the total observed variation between studies that can be explained by differences between studies and not by sampling error [2 value of less than 75%, a fixed-effect model was used. Otherwise, it was considered a heterogeneous meta-analysis and a random-effects model was used. Statistical significance was set as p < 0.05, indicating that the effects differed significantly between the intervention and control groups [Statistical heterogeneity was examined using Ing error ,43. Whenl groups . Furtherl groups .The meta-analysis used the following centre of pressure (COP) variables in two different postural conditions (double-leg stance with eyes open and eyes closed): sway area, and total, medio-lateral (ML) and anterior-posterior (AP) path lengths and velocities. To improve the statistical power within the meta-analysis, the length and velocity variables were combined, as these are two mathematically analogous variables due to constant trial times within the studies .Having conducted the search, 2146 items were initially obtained. After eliminating any duplicate articles, 2045 were analysed for their title and abstract. After a first screening of those studies that were considered potentially relevant, a full-text critical reading of 14 articles was performed, paying special attention to the study and treatment type. Finally, a total of nine articles were determined when meeting the objective and criteria proposed for this review . Eight oThis section presents the most relevant information for each RCT in relation to the characteristics of the participants, intervention, variables and results .The study sample ranged from 23 to 44 participants, with a total of 240 analysed (EG: 123 and CG: 117). As for gender, 163 were men and 91 were women, with an age range between 65 and 77.2.The individuals were diagnosed according to the UK Brain Bank criteria for idiopathic Parkinson’s Disease ,32,33,34Both static and dynamic balance were evaluated in eight of the nine articles included using posturography with strength platforms ,34,37,38p < 0.02, p = 0.011 and p = 0.017, respectively. In the case of the protocol in Cabrera [As for the measurement using the Mini BesTest (MBT) for dynamic balance, the studies by Cabrera , Terrens Cabrera , the par Cabrera  and the  Cabrera .Mobility was generally measured using Timed Up and Go (TUG), obtaining conflicting results ,34,35,36Gait was evaluated by different analysis systems, including movement analysis, cameras, platforms and markers attached primarily to the trunk and lower limbs ,32,34.Falls, balance confidence and self-perception upon falling were assessed using two self-efficacy instruments: the Activity-Specific Balance Confidence Scale  and the modified Falls Efficacy Scale (mFest) ,34,37.Motor status was evaluated in all the studies using the Unified Parkinson’s Disease Rating Scale (UPDRS III) ,36,37,38The specific trunk exercises were based on different methods, such as Halliwick aquatic exercises, the Mezieres method or Global Postural Re-education . More spSeven of the selected studies ,36,37,38The reporting data from eight RCTs obtained in static and dynamic balance were included in the meta-analysis. The results of the first meta-analysis  revealedThe results of the second meta-analysis  revealed2 = 65%, p < 0.001), a statistical fixed effects model was applied. Patients’ static balance was not significantly improved in the EG in comparison with CG . However, significant differences were found in favour of EG in static balance measured by a subjective measure using the BBS .2 = 95%, p < 0.001), a statistical random effects model was applied. Patients’ dynamic balance was not significantly improved in the EG in comparison with CG .p = 0.04); however, these changes are not significant nor greater than other interventions if measured with other scales . As for other aspects, upon comparing the dynamic balance parameters on the pooled effect, no significant differences are found among the groups, albeit the results clearly show that trunk-targeted exercises in the EG are superior to the conventional therapy in the CG in most studies .This systematic review evaluates the efficacy of trunk-targeted exercise and improvements in balance and mobility in PD persons, motivated in part by the current scarcity of research directly assessing this potential link. The results of the meta-analysis suggest that this intervention can generate changes in static balance measured by the BBS with respect to the CG . Future studies should include larger sample sizes with follow-up studies (short intervention can lead to ineffective outcomes) and explore whether trunk exercise can benefit people with more advanced Parkinson’s disease. Furthermore, the studies were heterogeneous in the intervention protocols and measurements of results. The strength of this review lies in the methodological quality of its RCTs, since most of them (77.78%) obtained a score between 6 and 8 on the PEDro scale.As for the practical implications, the benefits obtained through trunk stability training were in general higher than those achieved through non-specific exercise, offering clinical benefits that could have an economic impact, by avoiding falls and their costly expenses. Nevertheless, it is necessary to continue work in this line of research focused on exercises related to central stabilization, trunk strengthening and mobility, in order to verify their long-term effects and at more advanced stages of the disease .Although the specific trunk exercises failed to show significant differences in all the variables that measured static and dynamic balance, it is worth noting that the studies included in this systematic review are committed to the use of these exercises as a complement to conventional treatment, as they have been observed to have a considerable impact on both balance and central mobility in PD patients. However, more studies need to be conducted, ones with detailed treatment protocols and similar results measurements to support the effectiveness of this intervention on balance and motor status in PD in the short and long term.


To investigate whether there is a curvilinear relationship between burnout and work engagement among staff in Chinese community services for the elderly.A stratified whole-group random sampling method was used to survey 244 staff members from eight communities in two cities. Data were collected using the Maslach Burnout Inventory scale (MBI) and the Utrecht Work Engagement Scale- 9 (UWES- 9). The curve estimation method explored the functional model of burnout and work engagement scales.R2 = 0.166, P < 0.05), , and , respectively. There was no statistically significant relationship between emotional exhaustion (EE) and work engagement (P > 0.05). “Personal Accomplishment” is related to work engagement in a U-shaped curve.Two hundred forty-four staff members completed the survey. Burnout, depersonalization (DP), and personal accomplishment (PA) were found to be related to work engagement in a cubic function (There was a cubic function relationship between burnout and work engagement, where “personal accomplishment” was related to work engagement in a U-shaped curve. Therefore, the government and related service organizations should understand the impact of different levels of burnout on work engagement and take targeted measures to alleviate burnout and improve work engagement by targeting emotions and stroke. In China, as the number of elderly people increases and the demand for elderly services increases, society demands more staff for community services for the elderly. As a result, the Chinese government and related service organizations pay more attention to staff burnout in community services for the elderly and place higher demands on their work engagement. The staff needs to reduce burnout and increase engagement to ensure the elderly satisfaction and build harmonious relationships with the elderly. Burnout is a negative emotional response to long-term work stress that can directly or indirectly affect workers' mental and physical health . BurnoutIn addition, the dissatisfaction of the elderly with staff caused by burnout or the lack of diligence noted by supervisors can stimulate staff to work hard . This isThis study conducted a questionnaire survey with community staff in two cities, Guangzhou and Suzhou, from September to October 2021. This study used a multi-stage sampling method to ensure that the sample was representative. In the first stage, two provinces were randomly selected from 12 provinces in the eastern region, namely Jiangsu Province and Guangdong Province. Secondly, one municipality was randomly selected from within each province. Suzhou in Jiangsu Province and Guangzhou in Guangdong Province. In the second stage, a county/district was randomly selected within the jurisdiction of each city. Suzhou was chosen as Kunshan County, and Guangzhou was chosen as Yuexiu District. Next, two streets were randomly selected from each city/district. Finally, four communities were randomly selected from each street. In the third stage, staff were randomly selected from each community. Two hundred and forty four questionnaires were collected from 274 staff in eight elderly communities, excluding those with logical errors and missing data, with an effective response rate of 89.05%. Among the participants, 169 (69.3%) were surveyed in Suzhou, and 75 (30.7%) were surveyed in Guangzhou. The participant recruitment process is shown in Using self-designed basic information questionnaire (Chinese version), including (1) Basic personal information: gender, age, education, salary, title, etc. (2) Work situation: promotion and salary increase time, continuing education, job satisfaction, career prospects, etc.* 0.4 + depersonalization * 0.3 + personal accomplishment * 0.3. The Cronbach's alpha coefficient of this scale in this study was 0.697, which effectively assessed the burnout level of staff in the community.The MBI, developed by Maslach et al.  and reviThe UWES- 9, developed by Schaufeli et al.  and withSPSS 21.0 was used for data analysis, normally distributed measures were expressed as (P < 0.05). Different age, salary and continuing education influenced burnout (P < 0.05). The timing of different promotions and salary increase was a factor influencing work engagement (P < 0.05).The percentage of staff in each variable is shown in P < 0.05). See Most study participants had a negative correlation between burnout and work engagement dimensions . The models constructed in different regions are not quite the same. The cubic function model in the Suzhou region is the best, and the inverse function model in the Guangzhou region is the best, as shown in Model formula 1, See The curve estimation results show that constructing a cubic function model with work engagement as the dependent variable and burnout as the independent variable is the best-fit model (P > 0.05), as shown in Model formula 2, See The curve estimation results showed that the fitted model constructed with work engagement as the dependent variable and “emotional exhaustion” as the independent variable was not statistically significant , as shown in Model formula 3, See The best-fit model was constructed as a cubic function model with work input as the dependent variable and “depersonalization” as the independent variable , as shown in Model formula 4, See R2 (0.287) was found in Suzhou, and the graph of the curve function is shown in Finally, with work engagement as the dependent variable and “personal accomplishment” as the independent variable, the best-fit model was constructed as a cubic function model . The patients/participants provided their written informed consent to participate in this study.YH received the grant, participated in the interpretation of the results and critical revision of important intellectual content of the manuscript, and approved the final version of the manuscript. GY and YH designed the study. GY wrote the main manuscript text. LW, HD, and XL collected the data. GY and HW analyzed the data. All authors reviewed the manuscript.This study was supported by National Key Research and Development Program Projects of China (2020YFC2006100) and 2021 Henan Province Science and Technology Research Project (212102310814).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.


PA was associated with a higher likelihood for depression (OR = 2.6), somatization (OR = 2.1), as well as worse physical health (OR = 2.1) in women but not in men. This study is the first to present data on the gender-specific detrimental effect of PA on physical and mental health in adulthood. Especially for women, PA poses a significant health risk. Thus, we should be aware of these effects and offer adequate support for affected individuals.Peer abuse (PA) is a widespread and gender-sensitive form of Adverse Childhood Experiences (ACEs). However, research on its influence on physical and mental health in adulthood remains scarce. The aim of this study was to investigate gender-specific associations between PA and physical and mental health in adulthood in a sample of general hospital patients. A cross-sectional study at the University Hospital of Innsbruck was conducted. Data on ACEs, physical and mental health were collected using self-report questionnaires. We compared patients with no ACEs, PA only, ACEs without PA, and ACEs with PA using gender-specific binary logistic regressions to investigate the association of PA with physical and mental health. A total of 2,392 patients were included in the analyses. Women reported more emotional PA (13.1% vs. 9.4%;  A constantly growing body of evidence has documented the detrimental effect of Adverse Childhood Experiences (ACEs) on physical and mental health in adulthood ,4,5,6,7.emotional  or physical  acts of violence by same-age children or adolescents. A cross-sectional study including 202,056 children from 40 countries reported an overall prevalence of peer abuse of 12.6%, with girls being more at risk of experiencing peer abuse than boys ). In the first step, we separately tested the influence of sociodemographic variables  and other ACEs  on peer abuse. Significant predictors in each block were selected using the backward elimination method (likelihood ratio test) and were entered into the final model (forced entry). Odds ratios (OR) are presented with 95% confidence intervals (CIs).lower number or comorbidities’ and ‘higher number or comorbidities’ . The analyses were calculated for men and women separately. Odds ratios are presented with 95% CIs. p-values < 0.05 (two-sided) were considered statistically significant. Statistical analyses were performed with IBM SPSS  and SPSS AMOS .To investigate the independent influence of peer abuse on physical and mental health outcomes, patients were divided into four groups: (a) no abuse, (b) peer abuse only, (c) any other form of abuse, and (d) peer abuse + at least one other form of abuse. The influence of these groups on health outcomes was estimated using logistic binary regression analyses. Patients with no reported abuse (group a) were used as reference category, and all analyses were controlled for the patients’ ages, living situation , level of education (dummy: low vs. high level of education), and relationship status (dummy: living in a relationship vs. not living in a relationship). The number of physical disorders was dichotomized into ‘n = 3220), 84.1% (n = 2708) were willing to participate in the study. Individuals with missing data relating to ACEs, age, or sex (n = 401) were excluded from the analyses, resulting in a final sample of n = 2307 patients. Patients who reported peer abuse were younger, more often single, living alone, currently living in an urban environment, and had a higher level of education. Most frequently reported physical diseases were chronic pain , followed by respiratory , musculoskeletal , neurological , metabolic , and gastrointestinal diseases , cancer , cardiological , skin , urogenital , and gynecological diseases . For details on sociodemographic data, see Of all the patients approached (n = 339) of the patients reported experiences with general peer abuse, with higher rates for emotional peer abuse (11.0%) than physical peer abuse (6.4%). Of the patients who had experienced peer abuse, 64.6% reported emotional peer abuse, 23.1% physical peer abuse and 12.2% both forms. While no sex difference was found with regard to general peer abuse , we found significantly higher rates of emotional peer abuse among women  as well as significantly higher rates of physical peer abuse amongst men . In addition, patients who had experienced peer abuse reported experiencing a significantly higher number of other forms of abuse with a medium effect size as compared to patients who had not experienced peer abuse .Overall, 14.2% (p = 0.001), having a lower age , experiencing emotional abuse , witnessing intrafamilial violence , and sexual abuse  were associated with a higher risk for falling victim to peer abuse.In the logistic regression analysis, living in an urban region  were experienced after the age of six. In our sample, there was a clear peak in the early teenage years: While 29.2% of all patients who had experienced peer abuse reported this to have taken place between the age of 6–10 years, 63.7% reported experiencing peer abuse between 10–14 years of age, while the numbers declined to 33.6% between 15–18 years of age. About half of the patients (53.5%) reported experiencing peer abuse during one of those age periods, while 37.1% reported it during two and 9.5% during all three age periods. For male patients, having experienced peer abuse only (in the absence of other ACEs) was not associated with an increased risk for any of the assessed health outcomes. Still, the cumulative effect of peer abuse and other forms of ACEs was not only associated with a significantly increased likelihood of depression (OR = 6.1), anxiety (OR = 5.6) and somatization (OR = 2.2), but also with a 2.6-time higher likelihood of having more comorbidities in adult life. For details, see p < 0.001) and lower levels of anxiety , lower level of education was associate with higher levels of depression  and somatization , and living alone with higher levels of depression .While higher age was associated with more physical diseases  and lower levels of anxiety , not being in a relationship was significantly associated with higher levels of depression  and somatization . For details, see For women, on the other hand, experiences of peer abuse only were associated with a significantly increased likelihood for depression (OR = 2.6) and somatization (OR = 2.0) and more comorbidities (OR = 2.1). The cumulative effect of peer abuse and other forms of ACEs was associated with the highest likelihood for more comorbidities (OR = 2.5), depression (OR = 5.3), anxiety (OR = 5.5) and somatization (OR = 2.3). While higher age was associated with more comorbidities  without ACEs, (b) with peer abuse only, (c) with other forms of ACEs, and (d) with peer abuse and other forms of abuse with regard to their physical and mental health in adulthood. These analyses were conducted for men and women separately. While ACEs were generally associated with worse physical and mental health outcomes in both samples, no significant influence of peer abuse only was found for the male sample. For the female sample, on the other hand, peer abuse was associated with a two-fold increased risk for worse physical health and somatization, a 2.6-time higher risk of depression.Overall, approximately 14% of all patients reported experiencing peer abuse. This is in line with recent studies, which report a prevalence of 13 to 16% for peer abuse ,11. As wIt has however to be critically reflected at this point, that retrospective studies on ACEs come at the cost of potential bias: for one, the magnitude of potential memory bias which may result in both underreporting and overreporting of actual experiences, cannot be fully accounted for . SecondLike the results reported by Khan, McCormack, Bolger, McGreenery, Vitaliano, Polcari and Teicher , our resResearchers have previously noted that chronic exposure to stress during childhood and adolescence may lead to alterations in the nervous, endocrine and immune systems ,52 and tMore than half of the patients who experienced peer abuse in adolescence suffered from other adverse childhood experiences. Although our data do not allow us to infer causal relationships, we can assume that peer abuse and other forms of ACEs are associated. Exposure to ACEs such as physical violence, sexual abuse, or emotional neglect by the individual’s caregiver(s) may strongly compromise the development of mentalizing capacities . The affThus, based on the results of our study that highlight the long-term detrimental associations of peer-abuse with physical and mental health several issues should be considered in future research. For one, we need to get better in identifying and properly reacting to children and adolescents who suffer from peer abuse. Research indicates that teachers often perceive the gravity of the abuse as less intense than affected students  and thatSecondly, more knowledge on how to best support individuals with peer-abuse experiences later in life. Peer abuse typically takes place at a time when the individual breaks away from the family of origin and begins to identify with a new social group. In this developmental phase appropriate social roles outside the nuclear family must be found and identified with, which can be seen as both an opportunity and a challenge. f this process is characterized by exclusion, rejection and devaluation, deep insecurity arises. If there is a lack of epistemic trust and mentalizing ability, which arises in an environment characterized by arbitrariness, neglect and violence, this developmental opportunity cannot be seized, epistemic mistrust, restricted social learning and further relationship difficulties are the consequences. As we have described above, it can be assumed that both the epistemic trust and mentalization ability of affected individuals may be reduced . FosteriThis study has several strengths: The study has been conducted in a comparably large and diverse sample of hospital patients. As we have not focused on at-risk samples, such as psychiatric or psychosomatic inpatients, the results of our study may be more clearly applicable to a general hospital population. However, this study also had some limitations: The assessment of physical and mental health was patient-rated, which is a subjective measure. However, as this approach was taken to assess subjective impairment due to disease, the findings provide a picture of the health problems that were the most important to the individual patient at the time. The main limitation of this study is that the data on ACEs were collected retrospectively. A recent meta-analysis found only limited agreement between retrospective and prospective reports of ACEs . While tThe results of our study underscore the detrimental effects of peer abuse on the physical and mental health of individuals who experienced this peer abuse in adulthood. Our results should be understood as a call to action to improve both the prevention and treatment of health issues associated with peer abuse. While peer abuse is a ubiquitous experience, our results indicate a clear pattern of gender differences: The female members of our sample were significantly more often confronted with peer abuse and also seem to experience a more pronounced, long-term impact of abuse, both physically and emotionally. Based on our findings we strongly encourage readers to recognize the role of peer abuse for future mental and physical health and thus to intervene rather than dismiss concerns of affected children, adolescents and young adults. We highlight the need for gender-sensitive prevention services, especially in schools. To ensure the long-term efficacy and effectiveness of bullying prevention programs in schools, it will be necessary to create structures with sufficient resources to implement the programs continually as part of the normal class routines .


Primary angiosarcoma of the breast is a rare aggressive tumor characterized by high grade and poor outcome. Histologic grade appears to be a reliable predictor of survival. There are no standard treatment guidelines; thus, optimal R0 surgical resection remains the best approach. The roles of neoadjuvant, adjuvant chemotherapy, and radiotherapy remain unclear.Due to the rarity of primary angiosarcoma of the breast, optimal management is based on expert opinion. The aim of this study was to review all primary angiosarcomas of the breast obtained from a single center in terms of clinicopathologic characteristics, treatment, and survival outcomes. From 1997 to 2020, 15 patients with primary angiosarcoma of the breast underwent either mastectomy or wide excision. We analyzed the clinicopathologic data to assess disease-free survival and overall survival. Fifteen women with primary angiosarcoma of the breast were identified. The mean age at diagnosis was 33 years (range: 14–63 years). The overall mean tumor size was 7.7 cm (range 3.5–20 cm). Upon histological grading, there were three cases of low grade, five intermediate grade, six high grade, and one unidentified grade. The five-year disease-free survival rate was 24.4%, and the five-year survival rate was 37.2%. The survival rate of the low-grade patient group was statistically higher than that of the intermediate- or high-grade patient groups ( Angiosarcoma of the breast is a rare entity with poor prognosis, comprising less than 1% of all soft-tissue tumors ,3. BreasPrimary angiosarcoma of the breast is rarer than secondary angiosarcoma and has no known risk factors . It usuaDue to the rarity of these tumors, optimal management is based on expert opinion. Complete surgical resection with optical margins (R0 resection) is the most common treatment . The besThe role of radiotherapy and chemotherapy remains unclear. Some studies have insisted that radiotherapy before surgery is not recommended, and that adjuvant radiotherapy conveys better local control ,9. HowevThe aim of this study was to review all cases of primary angiosarcoma of the breast diagnosed from 1997 to 2020, in a single center, and to describe a single-institution experience with primary angiosarcoma of the breast, including clinicopathologic characteristics, treatment, and survival outcomes.This retrospective study included 15 patients with primary angiosarcoma of the breast who were treated at Samsung Medical Center from 1997 to 2020, accessed through the electronic medical recoding system of the institute. This study was approved by the institutional review board  of the Samsung Medical Center.We reviewed the demographic data, tumor size, histologic grades, treatment modality, and survival data. Tumor size was defined as the largest dimension recorded on the pathology report. If excisional biopsy was performed and followed by operation at Samsung Medical Center, the largest length was recorded by adding to the previous excision size. Tumor grade was categorized as low, intermediate, or high.Overall survival (OS) was measured from the date of surgery to the date of last follow-up or the date of death, as recorded in Statistics Korea records. Disease-free survival was measured from the date of surgery to the date of any recurrence or death. Overall survival and disease-free survival (DFS) were evaluated using the Kaplan–Meier method with the log-rank test. All statistical analyses were carried out using IBM SPSS v 27.0 .From 1997 to 2020, 15 patients who were diagnosed with primary angiosarcoma of the breast were treated at Samsung Medical Center. All patients presented with a palpable mass and were diagnosed with a core needle biopsy. Radiologic imaging such as via mammograms, ultrasound and MRI, was performed for patientsAll cases were defined as primary angiosarcoma without prior diagnosis of breast cancer or radiation treatment. All patients were female, and the mean age at diagnosis was 33 years (range: 14–63 years).The overall mean tumor size was 7.7 cm (range 3.0–25 cm). For histological grade, there were three patients of low grade, five of intermediate grade, six of high grade, and one unidentified grade .Thirteen patients underwent mastectomy, eight of whom also received axillary surgery . HoweverRecurrence was detected in 10 patients (66.7%). We described the site of the first recurrence. Some patients were found to have distant metastasis after first local recurrence. The median follow-up period was 29 months (5.6–89 months). The last follow-up was observed in July 2021. Local recurrence occurred in four patients and local contralateral breast recurrence was observed in two patients. Distant recurrence was noted in three patients and one who had both local and distant recurrence. In distant metastasis, one was pulmonary, three were bone metastases . Wide exAs shown in In terms of adjuvant therapy after surgery, three patients received both chemotherapy and radiation therapy, five patients received radiation therapy only, and one patient received chemotherapy alone. Only one patient underwent mastectomy after neoadjuvant chemotherapy . The adjp = 0.096).Overall survival and disease-free survival are shown in p = 0.024)Overall survival by tumor grade is shown in At the time of last follow-up, six patients were alive without distant metastatic disease. Only one of the 6 patients experienced local recurrence and was alive until the last follow-up .As in previous studies ,4,5,13, Several studies reported breast angiosarcoma as a more aggressive malignancy of the vascular endothelium, and the overall prognosis is poor compared to that of other invasive breast cancers ,16. In op = 0.024). Other studies reported that histological grade was associated strongly with clinical presentation and overall prognosis. They noted an improved DFS for low- and intermediate-grade tumors compared to high-grade ones [Several studies suggested that the grade seemed to be the most consistent prognostic factors for primary angiosarcoma of the breast in regard to both OS and DFS ,17,18. Iade ones ,20.p = 0.096). Although we did not find statistical difference of survival rate related to tumor size due to our small sample size, we did find the trend of the difference in survival rate according to size.Several studies have suggested that tumor size is a prognostic factor ,18,21,22In terms of adjuvant treatment, survival was associated not favorably with administration of adjuvant chemotherapy or radiation therapy in our study. Other studies reported unclear roles of neoadjuvant and combined adjuvant chemotherapy and radiotherapy ,19. HoweThe best treatment for primary angiosarcoma of the breast is surgery with R0 resection ,18,22. IThe role of axillary lymph node dissection in primary angiosarcoma of the breast is unknown, as breast angiosarcoma is due primarily to hematogenous spread . AccordiThis study is limited by the very small sample of breast angiosarcoma and retrospective nature of this analysis, which prevents any definite conclusions. Some findings that failed to reach statistical significance might be due to lack of statistical power.In conclusion, breast angiosarcoma is a rare aggressive tumor characterized by high grade and poor outcome. Histologic grade appears to be a reliable predictor of survival. There are no standard treatment guidelines, and optimal R0 surgical resection remains the best approach. The roles of neoadjuvant, adjuvant chemotherapy, and radiotherapy remain unclear.