Orientia tsutsugamushi. In this study, the epidemiological characteristics of scrub typhus in Taiwan, including gender, age, seasonal variation, climate factors, and epidemic trends from 2010 to 2019 were investigated. Information about scrub typhus in Taiwan was extracted from annual summary data made publicly available on the internet by the Taiwan Centers for Disease Control. From 2010 to 2019, there were 4352 confirmed domestic and 22 imported cases of scrub typhus. The incidence of scrub typhus ranged from 1.39 to 2.30 per 100,000 from 2010–2019, and peaked in 2013 and 2015–2016. Disease incidence varied between genders, age groups, season, and residence  from 2010 to 2019. Risk factors were being male (odds ratio (OR) =1.358), age 40 to 64 (OR = 1.25), summer (OR = 1.96) or fall (OR = 1.82), and being in the Penghu islands (OR = 1.74) or eastern Taiwan (OR = 1.92). The occurrence of the disease varied with gender, age, and place of residence comparing four seasons . Weather, average temperature (°C) and rainfall were significantly correlated with confirmed cases. The number of confirmed cases increased by 3.279 for every 1 °C (p = 0.005) temperature rise, and 0.051 for every 1 mm rise in rainfall (p = 0.005). In addition, the total number of scrub typhus cases in different geographical regions of Taiwan was significantly different according to gender, age and season . In particular, Matsu islands residents aged 20–39 years (OR = 2.617) and residents of the Taipei area (OR = 3.408), northern Taiwan (OR = 2.268) and eastern Taiwan (OR = 2.027) were affected during the winter. Males and females in the 50–59 age group were at high risk. The total number of imported cases was highest among men, aged 20–39, during the summer months, and in Taipei or central Taiwan. The long-term trend of local cases of scrub typhus was predicted using the polynomial regression model, which predicted the month of most cases in a high-risk season according to the seasonal index . The information in this study will be useful for policy-makers and clinical experts for direct prevention and control of chigger mites with O. tsutsugamushi that cause severe illness and are an economic burden to the Taiwan medical system. These data can inform future surveillance and research efforts in Taiwan.Scrub typhus is a zoonotic disease caused by the bacterium  Rickettsia spp. are widespread all over the world and pose an increasingly serious threat to human health due to frequent international traffic, the global greenhouse effect, climate change, and other factors [Orientia species, is the most common rickettsial disease in the world. Scrub typhus, also called tsutsugamushi disease, is an acute infectious disease caused by Orientia tsutsugamushi, a Gram-negative bacterium that is intracellular parasite. It is transmitted to humans by the bite of certain kinds of trombiculid mites, or chiggers [the Tsutsugamushi Triangle”, and includes Japan to the northeast, northern Australia to the south, and Pakistan and Afghanistan to the northwest. Only O. tsutsugamushi causes scrub typhus in the Tsutsugamushi Triangle, and that other species of Orientia cause scrub typhus in other locations, such as South America, Africa, and the Middle East. The epidemic regions include South Korea, China, Japan, Taiwan, and the Philippines. Most cases occur in the rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia. It is spread across both the temperate and tropical zones of the world, and even the Himalayas at an altitude of more than 3000 m [O. tsutsugamushi and rodents coexist. The chance of becoming infected with O. tsutsugamushi is associated with specific occupations and activities in infected areas. When susceptible persons (such as military personnel) enter an area with endemic scrub typhus, about 20–50% of them will become ill after several weeks or months [The  factors . Scrub tchiggers ,3,4. Thechiggers . The geon 3000 m . People r months . In addir months ,11,12,13Leptotrombidium genus. In Taiwan, Leptotrombidium deliense is the main vector of scrub typhus. The animal hosts of O. tsutsugamushi infection include rodents and mammals , as well as birds. The mites’ hosts are rodents, including rats [O. tsutsugamushi can pass Orientia through transovarial transmission, and carry Orientia in seven developmental stages: egg, deutovum (or prelarva), larva, nymphochrysalis, nymph, imagochrysalis and adult. The life history of a chigger is a single stage in a mite life cycle, which is greatly affected by temperature and humidity. The most suitable temperature for their development is 20–30 °C, and they favor higher humidity. The time required for a complete generation of L. deliense is about 59–135 days (average 89 days). The 3-month (89 day) generation time may correlate with peak summer and fall months. Chigger mite larvae are parasitic, so they are the vector of O. tsutsugamushi infection in humans [O. tsutsugamushi has a variety of rodent hosts. At present, Rattus tanezumi, R. exclans, R. losea and Bandicota indica are the main rodent hosts for the infected mites. Rattus tanezumi is easy to find in environmental areas where there are human activities  [R. tanezumi had the highest prevalence of O. tsutsugamushi infections (100%), followed by R. losea (61.3%), Bandicota indica (45.8%) and R. exclans (34.6%). R. tanezumi had the highest seropositivity rate (91.7%), and O. tsutsugamushi had a positivity rate of 95.8%; TP0607a and Karp were the most widely distributed OT strain and genotype (33.6%) [O. tsutsugamushi [(1)High fever and shivering: after a week of fever, the body cadres may have a dark red papule, which expands to the limbs, and disappears after a few days.(2)O. tsutsugamushi infection cannot be excluded when the eschar is not found. According to a study conducted on patients in Taitung MacKay Memorial Hospital in Taiwan, only 69% of cases were found to have eschar [Painless eschar is produced in bitten areas; sometimes it is not easy to find the eschar. An eschar, which usually begins as a primary papular lesion later crusts to form a black ulcer with central necrosis, is a distinct feature of scrub typhus. However, the possibility of e eschar .(3)Because of the short mouthparts of chiggers, they prefer to bite the soft parts of the skin such as the waist, genitals, underarms, breasts and around the eyes . Therefo(4)Other symptoms include headache, night sweats, cough, muscle pain, conjunctival congestion and lymphadenopathy near the bite.(5)O. tsutsugamushi subsequent infections can be quite severe and even life threatening if not treated properly.Severe cases may progress to pneumonia, acute myocarditis, acute liver and kidney failure or even death, with the mortality ranging from 1% to 70%. However, tsutsugamushi disease is endemic. People living in affected areas may be infected with tsutsugamushi disease many times, and depending on the strain of Scrub typhus is spread by the chigger stage of infected mites, which belong to the class Arachnida. The larvae are quite small and almost invisible to the naked eye. At present, about 3000 kinds of chiggers are recorded globally, but the chiggers that most often transmit human scrub typhus belong to the ing rats . Transmin humans . The mais, etc.) . In addi (33.6%) . The incugamushi , and theRickettsia is not easy to diagnose clinically, as infection by many pathogens cause similar symptoms that are difficult to distinguish. The misdiagnosis or delay of the right treatment time of scrub typhus may cause a decline in the quality of life of patients, causing a further threat to their health and wasted medical resources.per capita gross domestic product (GDP) of US$27,437. Although there are effective treatment methods, cases related to scrub typhus infection still exist in Taiwan [tsutsugamushi in the Taiwanese population from 2010 to 2019.Taiwan is located at 23°4′ north latitude and 121°0′ east longitude and has a subtropical climate. The average monthly temperature ranges from 16 °C to 29 °C, and the relative humidity ranges from 75% to 90%. Taiwan has become a developed country with a n Taiwan , which iThis study did not require ethical approval because it involved information freely available in the public domain. The analysis was performed on open-source datasets in which data are properly anonymized . The autCluster infections refer to an aggregation of cases grouped in place and time that are suspected to be greater than the number expected, even though the expected number may not be known .O. tsutsugamushi by nucleic acid detection; (2) Indirect immunofluorescene assay detects acute phase  serum, with a neutralization antibody titer of IgM of more than 1:80; IgM antibody has a potency of more than 1:80, and the IgG titer was more than 1:320; (3) Using the indirect immunofluorescence staining to detect matched  serum, a ≥4-fold increase in the IgG titer against O.tsutsugamushi is observed. A confirmed case is defined as attaining a positive result [Notification is defined as a suspected patient who meets clinical conditions . In addition, those who test positive in any one of the following tests are defined as positive: (1) Clinical specimens (blood or skin wounds (eschar)) test positive for e result .2, an area of 36,188 square kilometers, and a population of approximately 23.5 million. The majority (95%) of the population lives in western Taiwan. Data in this study are divided into the Taipei area and the Gaoping area (the southern region of Taiwan between Kaohsiung and Pingtung counties), along with northern, central and southern Taiwan. Only 5% of the population lives in eastern Taiwan, and is a vulnerable population with respect to medical care and socio-economic status. In addition, the three outlying islands of Penghu, Kinmen and Matsu were considered separate areas.Taiwan has a population density of 627/kmThis study used the Taiwan National Infectious Disease Statistics System (TNIDSS), a publicly-available internet database established by the Taiwan Centers for Disease Control (Taiwan CDC) . The datp values of less than 0.05 were considered statistically significant.This study confirmed the number of local and imported cases of tsutsugamushi disease between 2010 and 2019, and investigated the differences in their epidemiological characteristics . Descriptive data are shown as means and summary statistics where appropriate. Categorical variables were compared using the chi-square test. Multiple linear regression analysis was used to test the relationships between atmospheric pressure, temperature, relative humidity, rainfall and hours of sunshine, and the number of confirmed cases. In addition, we also used the polynomial regression method to predict the long-term trend of the number of local cases of scrub typhus in Taiwan, and the trend or seasonal effects, to estimate the ratio by calculating a moving average and obtaining the seasonal index. All statistical analyses were performed using SPSS software . All statistical tests were two-sided with an α level of 0.05. During the study period (January 2010–December 2019), 4374 confirmed cases of scrub typhus were recorded . There wp < 0.001). There were 332 cases ≤ 19 years old, 1183 cases 20–39 years old, 2156 cases 40–64 years old and 703 cases ≥ 65 years old. The distribution of cases in age groups were not equal (p < 0.001). There were 659, 1684, 1262 and 769 cases in spring, summer, autumn and winter, respectively. The case number in each season showed a discrepancy (p < 0.001). The confirmed cases of scrub typhus numbered 484 in the Taipei area, 252 in northern, 413 in central and 128 in southern Taiwan, as well as 556 in the Gaoping area, 1191 in eastern Taiwan, 683 in the Penghu islands, 507 in the Kinmen islands and 160 in the Matsu islands. There was a disparity in their place of residence (p < 0.001).(1) p < 0.001). There were 309, 781, 644 and 422 cases among males in spring, summer, autumn and winter, respectively, in the 40–46 age group. The case numbers across seasons showed a discrepancy with age group (p < 0.001). In eastern Taiwan, confirmed cases of scrub typhus numbered 238 in spring, 324 in summer, 324 in autumn and 324 in winter. There was a disparity between season and place of residence (p < 0.001).(2) p < 0.001). There were 216, 141, 207, 62, 317, 635, 345, 182 and 51 males in the Taipei area, northern area, central area, southern area, Gaoping area, eastern area, Penghu islands, Kinmen islands and Matsu islands in the 40–46 age group, respectively. The case number in regions showed a discrepancy between age groups (p < 0.001). The confirmed cases of scrub typhus included 148 in the Taipei area, 76 in the northern area, 146 in the central area, 55 in southern area, 238 in the Gaoping area, 324 in the eastern area, 245 in the Penghu islands, 248 in the Kinmen islands and 105 in the Matsu Islands in the summer. There was a disparity between place of residence and season (p < 0.001).(3) (4) Trend in the distribution of confirmed cases.Incidence rate per 100,000 people peaked in 2013 and 2015–2016 during the study period A. Males (5) Distribution of the number of imported cases according to gender, age, season and region of residence. Most imported cases were 16 males . Of the imported cases, the highest numbers in each category were: nine aged 20–39 , eight in summer  and seven living in Taipei  .p = 0.005; rainfall was also significantly correlated with the number of confirmed cases, β = 0.298, p = 0.010. R2 = 0.417, Adj R2 = 0.391, F value = 16.296, df = , as shown in (6) With regard to other climatic factors, temperature was significantly correlated with the number of confirmed cases, β = 0.626, 5 + 3.159x4 − 38.476x3 + 199.15x2 – 393.85x + 619.47(1) The long-term trend of local cases of tsutsugamushi disease is shown in (2) The seasonal index of local cases of scrub typhus is shown in O. tsutsugamushi. Humans can be infected through being bitten by infected chiggers. According to the statistics used for this study, the total number of confirmed cases of scrub typhus was 4374 in Taiwan from 2010 to 2019. Many factors affected the number of cases of scrub typhus. Among them, a suitable environment, the coexistence of chiggers, O. tsutsugamushi and rodents are concluded to be the four indispensable elements for scrub typhus incidence. Among them, the environment has considerable influence on the number and distribution of the chiggers and rodents [Scrub typhus is a highly infectious disease of  rodents . The act rodents . Our stu rodents . It is iThere were incidence peaks in 2013 and 2015–2016. The possible reason for this is that the temperature in the autumns of 2013 and 2015–2016 was significantly higher than that in other years, which may have increased the number of cases of scrub typhus. The number of confirmed cases in the local area began to rise rapidly from April to May. Most of the cases were found in summer and autumn. One peak was reached from June to July in the summer, and another peak from September to October in the autumn. The reason may be that the temperature rose to about 29 °C and the summer climate is too hot and slows down the activity of chiggers. However, the temperature drops in autumn and is suitable for chigger growth ,29. OverThe results of our study showed that male cases account for a larger proportion of scrub typhus cases. The number of male cases was about 1.5–2 times that of female cases, which is opposite to studies conducted in other countries . In thisO. tsutsugamushi in the serum of the small rodent hosts in these areas. This finding highlights that the rodent hosts carry the maximum number of chiggers between October and November in eastern Taiwan [tsutsugamushi bites all the year round. The geographical area of Hualien and Taitung counties is large, and agricultural land makes up as much as 75% of the whole region. Most of the cases are in different risk areas. The findings of this study suggest that the risk of scrub typhus increased when people were engaged in agriculture or outdoor activities. The previous study showed that the annual number of scrub typhus cases was correlated with the percentage of rats carrying chigger infestation in the Penghu islands from 2003 to 2015 . A previous study succeeded in predicting the number of cases in the Penghu islands and could be used as a reference for epidemic prevention [The high risk areas for scrub typhus were found to be almost all in the eastern part of Taiwan, except from 2013 to 2016, when the highest proportion of cases were in the Penghu islands. According to the previous Taiwanese studies, there is not only a higher density of chigger mites, but also higher antibody-positive rate (70%) of n Taiwan . Therefoevention . It is wFrom the above discussion, it can be clearly seen that people living in high-risk areas are indeed key factors in scrub typhus infection. Therefore, the relationship between susceptible populations, gender, age, season and residence was explored. The most common occurrence of scrub typhus was found to be among males between 40–64 years old, and the epidemic prevailed in summer, but there are two more subtle findings worthy of particular note. First, the Matsu islands accounted for the highest proportion of cases aged 20–29 . The Matsu islands constitute a front line for the military, and soldiers are mostly young men. They often work in grass so the risk of the disease increases sharply. Secondly, the winter incidence remained high in the Taipei area, northern Taiwan and eastern Taiwan. This result might be attributed to: (1) the climate being warm in winter because of global warming, and (2) infectious vectors and wild rodents being frequently active. The winter weather was often rainy in Taipei and northern Taiwan, so people often take trips to the warmer eastern region which has many national tourist attractions. The eastern area was originally a high-risk area for scrub typhus, so that the epidemic situation extended from summer and autumn to winter, which became the hidden worry of public health disease prevention and control.If scrub typhus is untreated, the mortality rate can be as high as 70%, and if properly treated, the mortality rate can be reduced to less than 5% . AccordiO. tsutsugamushi and caused the spread of the disease.The cases of scrub typhus in Taiwan are generally sporadic, and clustering events are rare. In January 2017, people who traveled to Sandimen Township in Pingtung County led to a cluster of scrub typhus . The indO. scrub typhusis is maintained in nature through both human urban and wildlife environmental cycles involving chigger mite vectors and human or vertebrate animal hosts. In this study, the epidemiological meaning of scrub typhus transmission of zoonotic diseases was investigated.Zoonoses are any infectious diseases that can be transmitted from animals to humans or from humans to animals, directly spread between humans and animals, or can spread by vectors, bringing pathogens (such as viruses or bacteria) into another organism. The route of transmission is through contact, inhalation or ingestion of food and water containing pathogens or bites with pathogenic vectors, which endanger human health ,41. O. sO. tsutsuganushi or Borrelia burgdorferi mediated by arachnids are often disseminated between humans and mice, which accelerate the outbreak of these cross-species-spreading diseases and put humans at risk of pandemics and serious threats to health [O. tsutsuganushi, in addition to understanding the way the disease is transmitted, a comprehensive approach to disease prevention and control should be adopted. Strengthening environmental protection and preventing vector breeding may effectively stop outbreaks and protect citizens from public health crises; (2) To prevent the recurrence of a pandemic, governments or medical and public health expert groups around the world should continue to maintain vigilant disease surveillance, scientific research and education of the general population. This is the best weapon to fight disease outbreaks, and it is also the best tool for mitigating epidemics, the only way to eliminate infectious diseases common to humans and animals.Population growth, and excessive reclamation and use of land have destroyed natural spaces and disturbed the ecosystem in Taiwan so that human contact with wild animals and disease vectors has increased. Therefore, residents in Taiwan’s metropolitan or rural areas (such as the eastern region) and wild animals in the mountainous or suburban areas usually live together in the same natural geographic area. In fact, the natural geographic area is a new hotspot of modern urban living space, which is caused by arthropod vectors. According to the literature, o health ,43. It iIn Taiwan, people who visit the tombs of their ancestors to clean the grave sites, go out to the suburbs, camp or engage in mountaineering activities, etc., are more likely to come into contact with grassy environments where chiggers breed, increasing the risk of contracting scrub typhus. There is no effective vaccine for scrub typhus at present, and taking drugs for pre-prevention is not recommended . There a2), as an indicator. In regression analysis, the main function of R2 is to evaluate the explanatory degree of the change in the corresponding variables in the regression model; that is, R2 is an index to evaluate the quality of the regression model. R2 ≥ 0.75 indicates a high degree of interpretability; 0.75 > R2 ≥ 0.5 indicates a medium degree of interpretability; less than 0.5 indicates a low degree of interpretability [2 is 0.51, which means that the long-term trend prediction model can be explained to a moderate degree. The possible reason is that climate variation and other factors have resulted in an increase in the annual local cases of scrub typhus in Taiwan over the last decade. Thus, the regression model could not reach a higher level (R2 > 0.75) to explain the changes in the total number of local cases each year, and this affected the function of prediction. It is recommended that monitoring of the impact of climate influence factors on the number of confirmed cases of scrub typhus is strengthened, to stabilize the long-term trend prediction and to establish the regression model with high R2 as an effective tool for predicting the number of scrub typhus cases in the future.According to the literature, Chatterjee et al. used the polynomial regression method to establish a model and predict the incidence of malaria with a high confidence level in Chennai city, India . In thistability . AccordiIn addition, based on the periodic seasonal variations of scrub typhus that occur repeatedly every year, the monthly changes in the number of local cases of scrub typhus in Taiwan during the summer and autumn high-risk seasons was also explored. The higher the seasonal index, the higher the proportion of cases in that month of the season. In this study, the seasonal index was highest in June during summer, and October during autumn. This showed that the number of cases may be higher in June and October during high-risk seasons (summer and autumn) of scrub typhus. It is recommended that the government strengthen public health preventive measures in the above-mentioned months. People should also take measures when traveling to high-risk areas to strengthen physical protection or reduce the frequency of going out to avoid the spread of outbreaks caused by infection.O. tsutsugamushi bite rodents, causing disease in wild animals or chiggers with pathogens, and they may also be transmitted to humans. In addition, different human activities have caused environmental alteration and deterioration, causing a decline or lack of health in other organisms. Nature may counterattack and affect human society. In other words, every individual on the earth has its own role; everyone is intertwined. If a connection is broken, the operation of the ecosystem will be changed, and of course the survival of human beings will be affected. Forward-looking concepts of public health must become the basis for governments or public health experts to formulate health policies and decide the allocation of health resources.The “One World, One Health” concept has been advocated by the World Organization for Animal Health in recent years . This meO. tsutsugamushi, neither the kind of genotype of O. tsutsugamushi that is prevalent in Taiwan nor the genetic relationship when comparing the genotype of O. tsutsugamushi in this country with other countries remains unknown. However, this research has a unique advantage—that is, the information of the existing online public platform of the public sector in Taiwan is correct in real time. In addition, the database has stored data for many years, allowing researchers or institutions access to rich statistics and infectious disease data.This study has two drawbacks. First, the statistics about infectious diseases disclosed by the Taiwan CDC on the internet platform only provide basic epidemiological data about scrub typhus patients, with no clinical data. Therefore, this study cannot compare differences or trends in patient clinical symptoms. Second, the information disclosed on the platform also does not contain information about the genotype of O.tsutsugamushi that cause severe illness and are a burden to Taiwanese. The data will inform future surveillance and research efforts in Taiwan.In conclusion, this study reveals the characteristics and trends of local and imported cases of scrub typhus from 2010 to 2019. The incidence of scrub typhus was 2.30 per 100,000 population in 2013, which was the highest during the study period. Cases among those aged 40–64 years exhibited a gradual increase in incidence and a distinct pattern of seasonal variation  during the study period. Furthermore, more male cases of scrub typhus were seen than female cases and the risk areas might be the Penghu islands and eastern area of Taiwan. This study also highlighted the increased risk to 20–29 year olds living in the Matsu islands, as well as temperature, rainfall and winter in the Taipei area, along with northern and eastern Taiwan. The polynomial regression model was used to successfully predict the long-term trend of local cases of tsutsugamushi disease in Taiwan, and the seasonal index was used to predict the number of high-risk months during the high-risk season. The seasonal index was highest in June during summer, and October during autumn. This information will be useful for policy-makers and clinical experts to direct prevention and control activities to chigger mites with


Individuals affected by this disease are at risk for lifelong complications including episodes of acute pain, chronic pain and multi-organ injury that leads to reduced quality of life and a shortened life span. There is a wealth of data on acute care utilization for SCD in the United States. However, data from the Caribbean region is limited. The objective of this study is to explore Emergency Department (ED) utilization for SCD in St. Vincent and the Grenadines by describing: i) the characteristics of SCD related ED encounters; ii) the urgency of these encounters as defined by resource utilization; iii) the disposition for these ED encounters.st, 2012 - December 31st, 2016.the study was a cross-sectional study utilizing data from the ED log books at the Milton Cato Memorial Hospital (MCMH) during non-consecutive time periods between January 1there were 666 SCD-related ED encounters during the study period. Thirty-four percent of encounters resulted in hospitalization and 66% of encounters met criteria for an urgent visit. The most commonly reported diagnosis was vaso-occlusive crisis and accounted for 84% of all encounters. The most frequently documented age group was the 18-30 age category at 43%.although SCD comprised less than 2% of all ED visits, the majority of these visits could be classified as urgent visits based on resource utilization. This study adds to the emerging data on the burden of this disease in this St. Vincent and the Grenadines. Sickle cell disease (SCD) is a chronic illness that is caused by a mutation in the beta globin chain of the hemoglobin molecule . IndividData source: the study was a cross-sectional study utilizing data from the ED log books at the Milton Cato Memorial Hospital (MCMH). Milton Cato Memorial Hospital was the country´s only public secondary referral hospital during the study period. At present, there is no computerized database of ED encounters at this hospital. Instead, there are hand-written logbooks that detail all ED encounters. For each ED encounter, the patient´s name, sex, age (but not date of birth), address, diagnoses, interventions performed during the encounter and final disposition are entered into logbooks. These logbooks provided the data for this study.Study period and study population: the initial plan was to review all consecutive ED encounters from January 1st, 2012 - December 31st, 2016 and extract all SCD-related encounters. However, not all logbooks for this time period could be located. As a result, the data was limited to the non-consecutive block periods of 1/19/2012 -5/14/2012, 9/14/2013 - 12/31/2013, 1/1/2014 - 3/31/2014, 1/10/2015 - 12/31/2015 and 1/1/2016 - 1/28/2016. All ED encounters for the time periods that were available were manually reviewed and SCD-related encounters were extracted. As there are no ICD codes documented in this logbook, all encounters with SCD or a SCD-related diagnosis were manually extracted and classified using the following criteria.A confirmed SCD related encounter was defined as: i) an encounter that included documentation of SCD in the list of diagnoses OR; ii) an encounter with a SCD specific diagnosis  without a documentation of SCD.A possible SCD related encounter was defined as: an encounter that included an implied diagnosis, without a documentation of SCD , confirmed and possible SCD related encounters were included in the final analyses.Variables: for eligible encounters we collected patient age at time of encounter, address, sex, date of the encounter, diagnoses documented, interventions performed and the final disposition. Study data were extracted from the logbooks and managed using Research Electronic Data Capture (REDCAP) tools hosted at the Medical University of South Carolina [Carolina . ResearcUrgency determination: resource utilization has been used in pediatric literature to determine the urgency of an ED encounter. Previous studies have defined an urgent ED encounter as any encounter that i) results in an admission or ii) required an ED based service such as a laboratory test, a radiographic study, an electrocardiogram or an echocardiogram [rdiogram ,12,13. EStatistical analysis and outcomes: descriptive analyses were performed using the SAS version 9.4 . Frequencies and proportions were used to describe study demographics, population clinical characteristics and diagnoses. Diagnoses, encounter classifications and encounter dispositions were further analyzed by age groups and reported as frequencies and percentages.During the periods for which data were available, there were a total of 45,557 visits to the ED. Of these 666 (1.46%) met eligibility criteria and were included in the final analysis. Eighty-eight percent were classified as confirmed SCD-related encounters and 12% were classified as a possible SCD-related encounter . Patientet al. [This study utilized available national level data to describe ED utilization for SCD in St. Vincent and the Grenadines. Results of this study showed that less than 2% of all ED encounters were SCD related encounters. However, the majority of encounters could be classified as urgent visits. Similar to other published literature, VOC accounted for the majority of SCD-related encounters -16. Whenet al. . Althougst, 2012 to December 31st, 2016. It is possible that this could have affected the results of our study. However, the missing logbooks would have included all ED visits for those missing time periods. Therefore, non SCD-related encounters would have been missing as well. Given the number of SCD related encounters (n=666) that were available for analysis, we believe that this is a large enough sample size to provide meaningful results. Third, it was not always possible to determine the primary diagnosis for the encounters based on the information that was entered into the logbooks. It is possible that in some cases, SCD was a secondary diagnosis and not related to the reason for the visit. Nonetheless, our results revealed that VOC crisis was the most commonly documented diagnosis. This is in keeping with other published data suggesting that we were still able to provide a reasonable description of ED utilization for SCD in this population [Data have shown that in any given year, 50-60% of persons with SCD have no ED visits but that 20% of patients will have 3 or more acute care encounters per year ,17. Therpulation ,15,18. FIndividuals with SCD utilize the ED for a variety of reasons. The most frequently documented diagnosis was VOC, and the age group 18-30 was the most commonly documented age group. Although SCD comprised less than 2% of all ED visits, the majority of these visits could be classified as urgent visits based on resource utilization. This study adds to the emerging data on the burden of this disease in this St. Vincent and the Grenadines. It will likely inform local providers and policy makers on the ED utilization for SCD and can lead to improvements in care provided to individuals with SCD in the future.Individuals with sickle cell disease have high acute care utilization rates sickle cell disease;Data from US shows that adults >18 years of age or uninsured show highest acute care utilization rates.There is currently limited data on acute care utilization for sickle cell disease in the Caribbean;This is the first study to evaluate acute care utilization for sickle cell disease in St. Vincent and the Grenadines.


Obese patients had larger tumors compared to non-obese patients. Higher BMI was associated with recurrence and worse survival only in patients with stage I disease. NLR and PLR were classified into high and low level groups. The NLRhigh (NLR>4) was found to be an independent prognostic factor for recurrence and mortality, while the PLRhigh (PLR>150) group had no impact on survival. A subgroup of patients with NLRhigh and BMIhigh had the worst disease-free survival (P=0.046), breast cancer-specific survival (P<0.001), and overall survival (P=0.006), compared to the other groups. Patients with early-stage breast cancer bearing NLRhigh and BMIhigh had worse outcomes, and this might be explained by the dysfunctional milieu of obesity in adipose tissue and its effects on the immune system. This study highlights the importance of lifestyle measures and the immune system interference with clinical outcomes in the early breast cancer setting.Obesity has been associated with an increased risk of breast cancer recurrence and death. Some readily available biomarkers associated with systemic inflammation have been receiving attention as potential prognostic indicators in cancer, including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). This study aimed to explore the correlation between body mass index (BMI) and invasive breast cancer and the association of NLR, PLR, and BMI with breast cancer outcomes. We undertook a retrospective study to evaluate patients treated for breast cancer over 14 years. Clinicopathological data was obtained before receiving any treatment. Of the 1664 patients included with stage I-III, 567 (34%) were obese (BMI≥30 kg/m Breast cancer is the most common malignant neoplasm among women, accounting for approximately 25% of new cancer cases and 15% of cancer deaths worldwide .Clinical and pathological staging, molecular profiling, and environmental factors can influence breast cancer outcomes . Among eObesity and carcinogenesis have an important feature in common, which is the involvement of the inflammatory pathways . DysreguTwo inflammatory biomarkers recently described as prognostic factors for cancer are the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) ,12. AlthHere, we explored the association between obesity, assessed by body mass index (BMI), and early-stage breast cancer at presentation and survival. We further investigated the prognostic significance of NLR and PLR for breast cancer recurrence and survival and the influence of BMI on these biomarkers.This was a retrospective study with all patients diagnosed and treated for malignant breast neoplasms at the Breast Disease Division of Clinics Hospital of Ribeirão Preto School of Medicine, University of São Paulo (USP), between 1999 and 2013. The clinical and pathological data was obtained from the patients’ files . The variables obtained were: age, histological type and grade, TNM stage, tumor size, positive lymph nodes, immunohistochemistry (IHC), menopausal status, weight, height, and total blood count. Treatment characteristics were also collected including surgical treatments, hormone therapy, chemotherapy, and radiotherapy. The study was approved by the local ethical committee .Of the 1967 patients selected, 136 did not have available information about the height or weight and were not included in the study. We further restricted the cohort to those with stage I to III cancers. Other patients with missing variables were also excluded from the analyses; however, none of them had more than 10% of missing data. Data were collected from the date of diagnosis until death or until July 1, 2018, which was chosen as the final date of observation. In case of loss to follow-up, the time was censored at the date of the last information in the medical records. Disease-free survival (DFS) was defined as the time from the diagnosis to the development of locoregional or contralateral recurrence or evidence of distant metastasis. Breast cancer-specific survival (BCSS) was defined as the duration from the date of diagnosis until death due to breast cancer and overall survival (OS) was defined as the duration from the date of diagnosis to death, with no restriction on the cause of death. Patients with unknown menopausal status (n=129) were considered to be postmenopausal if they were ≥51 years old. This assumption was based on existing studies conducted in the same region  Figure .in situ hybridization (FISH) was used in patients with HER2 2+ IHC results. The subtype was considered to be luminal-like if the estrogen receptor (ER) and/or the progesterone receptor (PR) were positive and HER2 was negative; luminal/HER2-like if ER and/or PR were positive and HER2 was positive; HER2-like if ER and PR were negative and HER2 was positive; and triple negative (TN) when ER, PR, and HER2 were negative. For staging, we used the American Joint Committee on Cancer Staging Manual, 7th edition  and the expression of hormonal receptors were determined by IHC in accordance with specific guidelines ,19. HER2 edition .2  divided by height (in meters) squared, and obesity was defined as BMI≥30 kg/m2 . BMI wasHematologic samples collected prior to the first cancer treatment were considered in the analyses. Absolute blood counts of different cell types were determined. The ratios of NLR, which is the absolute number of neutrophils divided by the absolute number of lymphocytes, and PLR, which is the absolute value of platelets divided by the absolute value of lymphocytes, were calculated . We usedTo evaluate the differences between the groups, we used the chi-squared test for categorical variables and the Mann-Whitney or Kuskall-Wallis tests for continuous variables. Normality was tested with the Shapiro-Wilk test. We used Cox multivariate regression model for analyzing variables considered significant (P<0.05) with univariate analyses and BMI.Kaplan-Meier curves were used to estimate cancer recurrence, BCSS, and OS at 10 years, and the survival differences between the groups were tested by the log-rank test. We set the level of significance at 0.05 and conducted all analyses using the R software version 3.6.1 .2 at the time of diagnosis. Obese patients were older (P=0.03) and had a larger median tumor size  compared to non-obese patients. There were no significant differences between obese and non-obese women in terms of the histologic type and grade, cancer staging, hormone receptors, and HER2. With regard to the treatment variables, obese patients were slightly more likely to receive radiotherapy during the course of the treatment (P=0.03), but with no difference in type of surgery or stage. Overall, 1664 early breast cancer patients were included in the study, of which 567 (34%) had a BMI≥30 kg/mhigh) and PLR >150 (PLRhigh) as cut-off, since these values demonstrated statistical significance and were chosen in previously published studies . Hence, we decided to use NLR>4 .The median follow-up time was 6.7 years in obese patients and 6.9 years in non-obese patients (P=0.91). During the study period, 482 patients experienced a locoregional or distant recurrences; the proportion was 26.3% in non-obese patients and 26.5% in obese patients (P=0.93). In the total population, there were 409 deaths due to breast cancer, and 531 deaths due to all causes, with no differences between the two groups (P=0.75) (Supplementary Table S2).high. The PLR was not statistically significant on multivariate analysis and was not considered an independent predictor of worse outcomes (Supplementary Table S3). When patients were stratified by menopausal status, we found that BMI was not a predictor of more aggressive tumors or worse outcomes in the population of postmenopausal women on multivariate analysis (Supplementary Table S4).On performing multivariate analysis, including BMI and all variables with statistical significance on univariate analysis, BMI was not found to be a significant predictor of cancer recurrence, BCSS, and OS. The main independent predictors of worse outcomes were grade, stage III, HER2, TN subtypes, and NLRhigh compared to NLRlow in total population (log-rank P<0.001).Kaplan-Meier curves with log-rank tests for recurrence and overall survival at ten years showed that BMI did not influence outcomes in the total population . Howeverhigh and BMI ≥30 kg/m2 (BMIhigh) had a significantly lower DFS  and OS  compared to the other groups , plays an important role in breast cancer prognosis . In addiThis study has some limitations. Although BMI is typically used in retrospective studies, it may not be ideal to measure obesity in elderly women, who are the primary age group at risk of breast cancer. This is because with menopause and advancing age, women lose height, bone mass, and muscle mass, as well as accumulate visceral fat , all fachigh and BMIhigh had worse outcomes, and this might be explained by the obesity-associated inflammation in adipose tissue and its effects on the immune system. NLRhigh, but not PLRhigh, was an independent prognostic factor for worse breast cancer recurrence and survival, particularly, in a subgroup of patients with high NLR and obesity. This study highlights the importance of lifestyle measures and the immune system interference with outcomes in the early breast cancer setting.In conclusion, patients with non-metastatic breast cancer bearing NLR


Cardiovascular surgery in older patients with sarcopenia has high rates of major complications, long hospital stays, readmissions, and discharge transfers. However, the factors that influence the length of hospital stay are unknown. This study aimed was to identify the predictors of the prolonged hospital stay in patients with sarcopenia after cardiovascular surgery.A total of 192 patients scheduled for cardiac surgery were enrolled in this retrospective observational study. Sarcopenia was diagnosed preoperatively. Clinical data from the preoperative, intraoperative, and perioperative periods were evaluated to determine the factors influencing the length of hospital stay.The sarcopenia and non-sarcopenia groups differed significantly in age; body mass index; renal function; intubation time; transfusion of red blood cells; hospital transfer; and hemoglobin, brain natriuretic peptide, and albumin levels. Sarcopenia was the most significant factor influencing prolonged postoperative hospital stay, as well as prolonged intubation time. In the sarcopenia group, albumin levels and cardiopulmonary bypass time were the significant factors affecting hospital stay.Sarcopenia was the most significant factor associated with prolonged postoperative hospital stay in patients who underwent cardiac surgery. In addition, improving sarcopenia, nutritional status, and shortening cardiopulmonary bypass time appear to shorten the hospital stay in patients with sarcopenia who underwent cardiovascular surgery. We consecutively enrolled 192 patients who underwent cardiovascular surgery at Dokkyo Medical University Hospital between October 2015 and October 2020. The enrolled patients were able to walk independently and had no problem with activities of daily living (ADL). ADL were assessed using the Berthel Index method The study protocol was approved by the Dokkyo Medical University Hospital Ethics Committee . The study was carried out in accordance with the tenets of the Declaration of Helsinki. The need for written informed consent was waived due to the retrospective nature of the study.Blood samples were collected upon admission. Serum albumin, creatinine, total cholesterol, triglyceride, C-reactive protein, hemoglobin, brain natriuretic peptide (BNP), and hemoglobin A1c levels and estimated glomerular filtration rate (eGFR) were measured.2.22. The hand-grip strength of the right hand was measured twice, and the higher value was used. The walking speed was measured as the time required to walk 6 m. Patients were classified into sarcopenia and non-sarcopenia groups.SMI, 6-m walking speed, and hand-grip strength were measured to diagnose sarcopenia preoperatively. Sarcopenia was defined according to the Asian Working Group for Sarcopenia criteria  2.3t-test  and Mann-Whitney U test  for continuous variables, and χ2 test for categorical variables. To compare patient characteristics, factors that affect the period from after surgery to discharge, the groups were categorized according to the median time from surgery to discharge (20 days), and the variables in Data analysis was performed in three stages. First, the differences in the characteristics between the non-sarcopenia and sarcopenia groups were analyzed using the independent 33.12) than those in the non-sarcopenia group. In the sarcopenia group, 23.6% of the patients underwent hemodialysis compared with 8.3% in the non-sarcopenia group (P < 0.05). Creatinine and BNP levels were significantly higher and albumin levels, eGFR, and hemoglobin levels were significantly lower in the sarcopenia group than in the non-sarcopenia group (P < 0.05). Regarding the surgical procedures, the proportions of valvular surgery  and aorta replacement/repair surgery  were significantly different between the two groups. Postoperatively, intubation time, time in the intensive care unit (ICU), and time from surgery to discharge were significantly longer in the sarcopenia group than in the sarcopenia group. The discharge home rate was significantly different at 96.7% in the non-sarcopenia group and 84.5% in the sarcopenia group, and the mortality rate was 1.4% in the sarcopenia group. The length of hospital stay from surgery to discharge is shown in The baseline characteristics of the patients (n = 192) are shown in 3.22, hemoglobin, BNP, transfusion of red blood cells, hemoglobin, and ICU stay and found that sarcopenia  and intubation time  were significant factors , age and sarcopenia were significant factors  A. In Mod factors B. We ana4The comparison of the clinical characteristics between the non-sarcopenia and sarcopenia groups with short-term (<20 days) and long-term (≥20 days) hospitalization is shown in 5The univariate logistic regression analysis revealed albumin level , CPB time , aorta cross-clamp time , and ICU stay  as significant risk factors for long-term hospitalization . The uni5.1We conducted a multivariate logistic regression analysis with short- and long-term hospitalization as the dependent variables to identify the independent factors . After adjusting for CPB time, age, and sex (Model 1), the CPB time  was identified as an independent factor A. In Mod6First, prolonged hospital stay in the sarcopenia group was significantly associated with serum albumin levels and CPB time. The intubation time, ICU stay, and hospital stay from cardiac surgery to discharge were longer in the sarcopenia group than in the non-sarcopenia group. Furthermore, the rate of direct discharge to home was lower. Second, in the sarcopenia group, low levels of hemoglobin, low levels of serum albumin indicating a low-nutrition status, and elevated levels of BNP were observed in the sarcopenia group. In this study, 72 (37.5%) patients were diagnosed with sarcopenia. These patients were older and had impaired physical function compared with those in the non-sarcopenia group. Age-related loss of skeletal muscle mass is associated with low levels of serum albumin indicating a poor nutritional status ; however, we did not find a significant difference in the left ventricular ejection fraction between the patients with and without sarcopenia. However, further studies on cardiac dysfunction including right ventricular dysfunction are needed. In surgical patients with sarcopenia, sarcopenia generally affects the development of complications in the perioperative period and affects the postoperative prognosis This study also identified low hemoglobin levels in patients with sarcopenia. Both serum albumin and hemoglobin have been reported to be biomarkers of malnutrition in older people Sarcopenia had the most significant effect on the length of hospital stay from after surgery to discharge, followed by prolonged intubation time. Morimoto et al. Rehabilitation nutrition, which combines rehabilitation and nutritional management, is effective for sarcopenia Finally, CPB time was identified as a factor affecting the length of postoperative hospital stay. Therefore, to shorten the length of hospital stay after cardiovascular surgery, it is necessary to shorten the CPB time.7The main limitations of this study are the small sample size and retrospective design. Additionally, we excluded urgent/emergency cases and patients in whom preoperative physical function data used for sarcopenia assessment were missing. Thus, there is a possibility that our analysis excluded subjects, which may have affected some data.8Sarcopenia was the most influential factor of postoperative hospital stay; in addition, preoperative albumin level and CPB time were the independent factors associated with the length of postoperative hospital stay. Further studies are needed to clarify whether preoperative/early postoperative rehabilitation, nutrition, and shortening the artificial CPB time can reduce the length of hospital stay in the sarcopenia group.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Objective: Recent evidence shows that adults with cerebral palsy (CP) have an increased risk for kidney disease, but nothing is known about how kidney disease integrates with their overall health. To begin understanding the importance of kidney health, the objective was to determine if kidney disease is associated with mortality among adults with CP after accounting for comorbidities common to CP and kidney disease.Methods: Data from 2016 to 2018 from adults ≥18 years with CP were used from a random 20% sample fee-for-service Medicare database. Kidney disease in 2016 was ascertained as chronic kidney disease (CKD) stages 1–4, end stage kidney disease (ESKD), nephritic and nephrotic syndrome, and renal osteodystrophy. A modified version of the Whitney Comorbidity Index (modWCI) was used, which includes 24 comorbidities relevant to CP and kidney disease. Mortality rate ratio (MRR) through the year 2018 was estimated for each kidney disease and Cox regression estimated the hazard ratio (HR) of mortality after adjusting for demographics, co-occurring neurological conditions, and the modWCI.Results: Prevalence of kidney disease was 7.3% among 16,728 adults with CP. MRR was elevated for any kidney disease  and most subtypes . The adjusted HR of mortality remained elevated for any kidney disease  and ESKD .Discussion: Kidney disease, especially ESKD, is associated with mortality among adults with CP independent of comorbidities that are relevant to CP and kidney disease. Findings suggest that nephrology care should be considered as part of routine clinical care for this population. Cerebral palsy (CP) and kidney disease can have shared etiology, and the CP-related sequela can lead to or exacerbate kidney dysfunction. Pre-mature birth , stuntedThe burden of CKD is immense. Much of CKD is progressive, comes with a high degree of morbidity and mortality, and can lead to end stage kidney disease (ESKD). ESKD treatment and management is incredibly costly and time consuming, and can significantly hinder quality of life . HemodiaA grand challenge in developing clinical care pathways for adults with CP is understanding the appropriate timing for treatment and prioritization, due to the complexity of sorting through the array of diseases that pre-maturely afflict adults with CP . It is tHowever, as kidney disease is often clinically assessed by creatinine-based methods, the low muscle mass in CP leads to the erroneous interpretation that their kidney function is better than it is . This faA recent report found that kidney disease was associated with an increased risk of 2-year mortality among adults with CP . HoweverData came from a 20% random sample from the Medicare fee-for-service administrative claims data source including the calendar years 2016–2018. Medicare is a U.S. federal program providing health insurance to adults ≥65 years of age or individuals of any age with ≥1 chronic disability, including CP, or ESKD. Administrative claims data are used for billing reimbursement from healthcare-related visits. Medical conditions can be identified by specific International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes that are attached to claims. A description of data ascertainment of this cohort, variables, and the ICD-10-CM codes used to identify each medical condition, as well as a flow chart of inclusion/exclusion criteria for this cohort have been reported previously , 24, 25.The full calendar year 2016 was used to identify adults with CP ≥18 years of age (≥1 inpatient claim or ≥2 outpatient claims in 2016 for CP) that had continuous health plan enrollment in Part A and B from January 1, 2016 to January 30, 2017 to obtain a full 1-year baseline period and at least 30 days of follow-up for mortality, and without missing data for demographics. Data for all medical conditions and demographics were collected from the year 2016, and mortality data were collected from January 31, 2017 to December 31, 2018. The start date of follow-up for all participants was January 1, 2017. This allows for a 1-year baseline period and 2 years of follow-up for mortality.All-cause mortality was ascertained as the number of days from January 31, 2017 to the date of death. Medicare has validated >99% of deaths . ParticiKidney disease was identified by CKD stages 1–4 ; ESKD (including CKD stage 5), dialysis, or kidney transplant, hereafter referred to as “ESKD” ; CKD stage unspecified (ICD-10-CM code: N18.9); nephritic syndrome ; nephrotic syndrome (ICD-10-CM codes: N04.x); and renal osteodystrophy (ICD-10-CM code: N25.0). Nephritic and nephrotic syndrome and renal osteodystrophy are not mutually exclusive from one another and CKD or ESKD, but are examined separately in this study. Furthermore, renal osteodystrophy is a complication of CKD, but was included in this early phase of research to understand the association between kidney diseases and CP given the pervasive and profound bone fragility in this population , 28.A modified version of the Whitney Comorbidity Index (WCI) was used to account for comorbidities relevant to CP and kidney disease. The WCI was recently developed in a privately insured cohort of adults with CP  and valit-test for continuous variables.Baseline descriptive characteristics were summarized for the whole cohort with CP and for subgroups with or without kidney disease. Group differences between those with vs. without kidney disease for descriptive characteristics were tested using the Chi-square test for categorical variables and the independent Crude mortality rate (MR) with 95% confidence intervals (CI) was estimated for any kidney disease and the specific conditions  separately as the number of deaths divided by the number of person-years, and expressed as per 100 person years. Crude MR ratio (MRR with 95% CI) was estimated for any kidney disease and the specific conditions separately using the group without that kidney disease as the reference. Cox proportional hazards regression models were developed to estimate the hazard ratio (HR with 95% CI) of mortality for any kidney disease and the specific conditions after adjusting for two groups of covariates: model 1—age (as continuous), sex, race, U.S. region of residence, and co-occurring epilepsy and/or intellectual disabilities; model 2—model 1 covariates plus the modified WCI. Clinically relevant interactions were examined for each exposure variable with age, sex, race, and co-occurring epilepsy and/or intellectual disabilities by separate analyses for the main effect and including the product term in the Cox model.p ≤ 0.05 (two-tailed) was used to determine statistical significance.Analyses were performed using SAS version 9.4  and n = 1,215) had kidney disease, with the majority having any stage of CKD (7.2%) and 2.0% having ESKD. To put that into perspective, the prevalence in 2015 of ESKD for the general population ≥45 years of age was ~0.5%  and for the subgroups without  and with  kidney disease are presented in p < 0.01). Adults with CP with vs. without kidney disease had a higher prevalence of all comorbidities in the modified WCI (p < 0.001), except for the lower prevalence of epilepsy and intellectual disabilities  of 696 (126) days and a median [interquartile range (IQR)] of 730 (730–730) days, a total of 1,486 (8.9%) died with a mean (SD) age at death of 61.9 (15.0) years, while 27 (0.1%) were right-censored owing to a drop in health plan enrollment and 15,215 (91.0%) were right-censored owing to being alive by the end of the study period. The follow-up time was similar for the subgroups: without kidney disease, 7.8%  died with a mean (SD) age at death of 61.0 (15.1) years; with kidney disease, 273 (22.5%) died with a mean (SD) age at death of 65.5 (13.9) years.p = 0.092). The other specific conditions had too few outcome cases to perform adjusted analyses.Any kidney disease  and eachp for interaction, <0.001) and between ESKD and age , the crude MR was similar between White and Black adults with CP with ESKD  (n = 2), Asian (n = 2), North American Native (n = 0), and other race (n = 2). While the crude MR was higher for older age groups, the relative mortality risk  was higher for younger age groups when age was stratified as young, middle-aged, and elderly (While there was an interaction between ESKD and race (ut ESKD) . There w elderly .This study found that kidney disease among adults with CP, especially ESKD, was associated with mortality above the influence of other comorbidities relevant to CP and kidney disease. Furthermore, while the mortality rate was higher for older adults, the relative mortality risk was higher for younger adults with CP with vs. without ESKD. The latter finding may be due to the higher mortality rate observed among individuals with more vs. less severe forms of CP, who also have an earlier and elevated burden of disease .Inconsistent with the general population , this stThe clinical challenge for the field is not so much wrestling with the notion that kidney disease can be deadly for adults with CP, which is well-known in the general population, but rather, a lack of awareness that kidney disease may be a pervasive problem carrying a high mortality risk for adults with CP, which may be masked by the high cardiovascular-related mortality burden . PrimaryCystatin c is another biomarker that can be used for eGFR , and is Nephrologists are aware of the issues in interpreting eGFR and assessing kidney function in the context of low muscle mass conditions, such as CP. However, nephrology is currently not a routine part of clinical care for individuals with CP at any age. Importantly, advanced stages of CKD are irreversible, costly, and fatal , so delaIt is important to note that CKD and ESKD appeared in this study as the more pervasive kidney issues. While nephritic and nephrotic syndrome and renal osteodystrophy appeared to be rare in this cohort, we felt it was necessary to initially examine these non-CKD kidney conditions, to determine future directions; i.e., whether to focus future research efforts into CKD and/or other kidney conditions, although some of the non-CKD kidney conditions examined in this study can be acute and comorbid with CKD.This study has identified for the first time an independent association between kidney disease and mortality in adults with CP; yet, there remains a number of questions in regard to how integrative and deleterious kidney disease is for aging and quality of life for this population. For example, does kidney disease lead to or exacerbate cardiovascular-related morbidity and mortality among adults with CP? Are there distinct etiologies of kidney disease for different segments of the population with CP, such as those born pre-mature, or those with normal birth but develop cardiometabolic disease early in life? If there are different etiologies of kidney disease in CP, does clinical care differ in its approach to prevention and treatment? To address these and other questions, studies are first needed to identify new methods or refinements to existing methods that more accurately capture kidney function for adults with CP , which wThe limitations of this study must be discussed. First, claims data do not contain information on how diagnoses were made or by whom . It is possible that many adults with CP that have kidney disease are not being diagnosed, many of which may have died in the current study, leading to conservative estimates of mortality risk associated with kidney disease. Second, each kidney disease was examined separately for those with vs. without that condition, which may have led to more conservative estimates. For example, those with ESKD were compared to those without ESKD, but the non-ESKD group included those with CKD stages 1–4 and the other specific kidney conditions. Third, this study examined prevalent rather than incident kidney disease, which does not provide a sense of the time-related factor of having kidney disease and its impact on organ-specific or overall pathophysiology. It is difficult to make an assumption of how this impacts the mortality risk estimates in this study in conjunction with the first two stated limitations. Fourth, claims data do not contain information on the cause of death. Fifth, severity of CP cannot be reliably ascertained in claims data. Therefore, study findings can be viewed as empirical evidence to contribute to a more general discussion on the need for more nephrology services and research for adults with CP as a whole. However, the WCI estimates the overall disease status, and can be a proxy of severity of CP, which was adjusted for in the analyses. This provides some indication that findings may be present across the CP severity spectrum, but still likely differs in the magnitude and timing by severity of CP. Lastly, as data come from a single, nationwide insurance database, although large, findings may not be generalizable to all adults with CP.In conclusion, kidney disease is associated with an increased risk of mortality for adults with CP, independent of other comorbidities relevant to CP and kidney disease. Findings provide preliminary evidence for the need to consider incorporating nephrology care as part of routine clinical care for adults with CP. Future research is needed to determine if adopting nephrology care as part of routine clinical care for adults with CP improves detection, increases preventive strategies, and improves kidney and overall health for this underserved population.https://www.cms.gov/Research-Statistics-Data-and-Systems/Research-Statistics-Data-and-Systems.The data analyzed in this study was obtained from the Centers for Medicare and Medicaid Services, the following licenses/restrictions apply: The dataset analyzed in this study may be accessed through a contractual agreement with the Centers for Medicare and Medicaid Services following the payment of an administrative fee. Information about these datasets and requests for dataset access can be found at: The studies involving human participants were reviewed and approved by University of Michigan Institutional Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.DW analyzed the data and wrote the first draft of the manuscript. DW and AO conceptualized, designed the study, approve the final version of this manuscript, and agree to be accountable for the content of the work. AO edited the manuscript. All authors contributed to the article and approved the submitted version.This work was supported by the University of Michigan Office of Health Equity and Inclusion Diversity Fund (DW). The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.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.


FRG received FR treatment; MTG received MT techniques; CG received a placebo treatment. The treatment lasted one month. Outcome measures were assessed at baseline, post-intervention and follow-up. Results: Both FRG and MTG showed significant improvements in all variables after the treatment, but the intervention effect was maintained only for functional disability , overall disability  and HIT-6  at follow-up. After treatment, FRG and MTG presented a significantly higher PPT in right  and left suboccipital . MTG showed a significantly lower HIT-6 than CG (p = 0.008). No differences between FRG and MTG were found in any variable. Conclusions: Both FR and MT are effective treatments for the improvement of clinical symptoms in TTH. Further studies are needed to confirm our findings in a larger population.Background: This study compares the effect of foam rolling (FR) vs. manual therapy (MT) on pain, pressure pain threshold (PPT), headache disability (HDI) and impact of headache (HIT-6) in patients with tension-type headache (TTH). Methods: A total of 38 participants with TTH were randomly assigned to an FR group (FRG,  Tension-type headache (TTH) is a primary headache reclassified by the International Headache Society (IHS) in 2018, which describes in detail the diagnostic criteria for each type of headache. It is a typically bilateral headache that lasts from 30 min to 7 days. The diagnosis of TTH includes at least two of the following characteristics: bilateral location, pressing or tightening in quality mild or moderate intensity, and it does not worsen with routine physical activity [Overall, TTH constitutes the most common primary headache with a prevalence throughout life ranging from 30% to 78% in the general population ,2, a sliDespite numerous clinical and neurophysiological studies, the underlying cause of TTH remains unclear. It has been suggested that recurrent nociceptive stimuli from pericranial myofascial tissues result in sensitization of pain pathways in the central nervous system . PeripheAlthough drugs are considered as the first-line treatment, non-pharmacology treatments in TTH show positive results . HoweverIn addition, a protocol combining MT-based techniques on the pelvis, skull, cervical and upper thoracic spine, clavicles and upper ribs has been proven to be effective in reducing TTH frequency . HoweverFoam rolling (FR) is a novel self-administered myofascial release technique that uses a foam roller  to enhance myofascial mobility . The preWe hypothesized that both MT and FR treatments applied to patients with TTH would lead to significant improvements in different variables related to headache. Hence, the objective of the present study was to assess the effectiveness of two exercise programs based on FR and MT, respectively, on pain, PPT, headache disability and impact of headache in patients with TTH.Participants aged 20–55 years and diagnosed with FETTH (at least four episodes/month) or CTTH by a primary care physician according to “The International Classification of Headache Disorders, 3rd edition” (ICHD-3)  were recThe study was a prospective, assessor-blinded, randomized pilot study. Level of Evidence: Therapy, level 2. Randomization was undertaken by an independent research assistant not involved in the trial, who prepared a computer-generated random allocation sequence. From the randomization allocation, opaque, sequentially numbered envelopes were ready to contain the treatment group assigned for each participant. Thus, patients were randomly assigned to three groups: (1) FRG, (2) MTG and (3) Control group (CG). Group allocation was revealed to the study members once the participants completed all baseline procedures. The outcomes assessor was blinded to treatment group allocation. The physiotherapist was not informed of the type of study being conducted or the aim. Participants were reminded not to reveal their treatment group at the post-intervention examination. Blinded assessors collected all baseline and post-intervention measures and entered data. All patients were assessed before treatment, after treatment (at four weeks) and at a follow-up (one month after completion of therapy).The treatment was composed of four sessions at 7-day intervals for all groups. Treatments were performed at a university research laboratory. Interventions were delivered by the same physiotherapist experienced in the trial treatments. Before each treatment session, the physiotherapist performed the vertebral artery test bilaterally in all patients. The vertebral artery test has been widely used as one of the methods of screening the vertebro-basilar system prior to manipulative therapy . The occ(a)(1)Compression of the fourth ventricle (CV-4). The participant lay down in a supine position. The physiotherapist, situated behind the participant’s head, slightly approximated the occipital squama lateral angles toward the posterior occipital convexity while taking the cranium into extension. The compression traction was maintained until an inactive state was perceived in the cranial pulse and released when the perception of movement was noted. The duration of this technique was 10 min .(2)Suboccipital inhibitory pressure: suboccipital musculature was palpated until contact was made with the posterior arch of the atlas, and progressive and deep gliding pressure was applied, pushing the atlas anteriorly. The occiput rested on the hands of the physiotherapist while fingertips supported the atlas. Finger pressure was maintained for 10 min to produce the proposed therapeutic effect of inhibiting the suboccipital soft tissues .(3)Trigger point release (TPR) was applied bilaterally in the trapezius to relax the trapezius, since tension may influence the occipital region due to the trapezius insertion. Myofascial trigger points were identified using published criteria . Trapezi(4)Occiput-atlas-axis technique. This was applied bilaterally and performed on a vertical axis, passing through the odontoid process of the axis without extension or flexion and very little side bending. The technique was used in two stages. First, the physiotherapist performed a light decompression and then made a small circumduction. Then, the appropriate joint barrier was sought by selective tension, and high-velocity rotation manipulation was performed in a cranial helical motion without raising the participant’s head ,17. This(5)Lumbar-sacral technique. Since the relationship between a lack of mobility of cranial bones, sacrum and iliac bones, and TTH has been reported , three l(6)Cranial massage: classic massage techniques were applied based on the study conducted by Weerapong et al. . MethodsMTG. A protocol composed of six MT techniques was applied. In total, each MT session lasted 40 min. After MT treatment, all groups rested for 10 min in a supine position with neutral ranges of neck flexion, extension, lateral flexion and rotation ,27. The (b)FRG. Participants were given a brief introduction to the FR procedure. A foam roller with a length of 38 cm and a diameter of 12.5 cm was used . An exercise protocol focused on the back’s fascia  was developed . Partici(1)Middle-upper trapezius and interscapular muscles: participants were instructed to roll the FR up using flexion extension in the supine position, with the FR at the interscapular muscles until the FR was just above the upper trapezius. Then, participants were told to roll the FR back to the initial position in one fluid motion.(2)Suboccipital muscles: in the supine position, with the FR at the suboccipital region, suboccipital flexion was required until the FR was just above the upper trapezius. Then, participants were told to roll the FR back to the initial position.(3)Posterior and lateral cervical muscles: in the supine position, with the FR at the posterior cervical muscles, participants were asked to rotate the neck and then roll the FR back to the initial work, bilaterally.(4)Sacrum region: participants were in the supine position, with the FR at the proximal part of the sacrum and their body supported by the hands placed behind them. From this position, they were instructed to roll the FR down using flexion extension of the knees until the foam roller was just above the distal region of the sacrum. Then, participants were told to move the FR back to the initial position.The rolling frequency was standardized using a metronome set at 60 beats per minute (bpm). Participants were instructed to roll at a velocity of 2 metronome beats  for each rolling direction, resulting in 15 complete rolling cycles in 60 s (0.25 Hz). The intensity of pressure was controlled with a target Numerical Rating Scale rating of 7/10  during the intervention. The treatment was as follows see :(1)Midd(c)CG. In the supine position, a series of short-time and no pressure contacts with the physiotherapist’s hands was performed at several points on the head and shoulders for 10 min . Then, pA baseline clinical interview was conducted to gather demographic and clinical information. Additionally, headache-related data were self-reported by the subjects in this interview, including aspects such as the evolution of headache, frequency, severity, intensity, pain profile, associated factors and pericranial sensitivity. Medication overuse remains a key factor in the interpretation, although in our sample there was no medication overuse.(a) Pain. A visual analog scale (VAS) was used. The VAS is an 11-point rating scale (0 = no pain to 10 = intense pain), indicating an average of TTH-induced pain in the last month. The VAS has a high internal consistency (0.92) ,27,33.(b) Pressure pain threshold (PPT), i.e., the pressure at which a sensation of pressure changed to pain, was bilaterally assessed with a digital algometer , Stockholm, Sweden) over the suboccipital muscle  to determine overall pressure pain sensitivity. The pressure was applied perpendicular to the skin at a speed of 30 kPa/s. Three measurements with 1 min between measurements were averaged. This test has shown a high internal consistency (0.94–0.98) .(c) Headache disability. We used the Headache Disability Inventory (HDI). The purpose of the scale is to identify the difficulties the patient may experience due to headaches. It includes two items: headache severity  and frequency  and 25 items that assess two subscales . Participants answer each question . The maximum disability score is 100 points . (d) Impact of headache, measured by the Headache Impact Test-6 (HIT-6) , which cAn a priori power analysis was conducted in G*power (3.1.9.2 version) software to calculate the required sample size, using, as reference, the results obtained from published research with a similar approach. In previous studies, large effect sizes were obtained in all four HDI subscales (f = 1.22 or d = 2.44) and in HIT-6 scoring (r = 0.85 or d = 3.23) ,16. Ther2). All statistical analyses were performed using the IBM SPSS Statistics software . The Shapiro–Wilk test was used to evaluate the normality of the data. Descriptive data are shown as mean (standard deviation) or frequencies, as appropriate. Participants’ characteristics were compared using one-factor analysis of variance (ANOVA) or chi-square , medium  and large . Statistical significance was set at p < 0.05.A mixed 2-factor ANOVA with repeated measures in the time factor was used to determine significant differences in the measured variables between time points  and groups . When models indicated significant differences in the main effects, a Bonferroni correction was applied to avoid type I error in the multiple comparisons. The effect of the treatment in the HDI frequency and HDI severity variables was evaluated using χThe funders played no role in the design, conduct, or reporting of this study.n = 13), MTG (n = 13) and CG (n = 12). All participants completed the study and were ultimately analyzed  and HIT-6. In the rest of the PPT measures, effect sizes were close to medium.No significant differences were found in the FRG vs. MTG analysis, indicating that both treatments presented similar positive effects in the analyzed variables. For CG, pre–post significant differences were found in emotional, functional and overall HDI and HIT-6 scores, but with a medium effect size. Lastly, compared with the pre-treatment, at follow-up, the intervention effects remained significant in functional and overall HDI items for FRG and MTG and in all groups for HIT-6 scores.2 analysis  and MTG (−20.8%); thus, both groups overcame the minimal clinically significant difference (MCID)  . Similar% and MTG2; MTG: +43.3%. +0.67 kg/cm2) and left  suboccipital muscles when compared to CG. However, this outcome did not reach the MCID (1.5 kg/cm2) [With regard to PPT, we observed that FRG and MTG significantly improved this variable in both right  . This is kg/cm2) ,42. It sThis may demonstrate the importance of validating results based on absolute differences in outcomes scores against a measure of clinical relevance. As stated before, the effectiveness of FR as a valid treatment for pain relief has not been widely studied. Still, its beneficial effects on joint ROM, post-exercise muscle recovery, muscle soreness, muscle performance and PPT have been reported, especially in the sports field ,23. HoweOur novel FR protocol showed short-term beneficial effects in PPT bilaterally in patients with TTH. Currently, no other studies are demonstrating the impact of FR in patients with TTH. A recent study reported beneficial effects of a protocol including FR, mobility and stretching exercises on ROM, frequency and pain intensity, fatigue, stiffness, depression/sadness and the disease’s impact on people with fibromyalgia . On the Regarding disability, Moraska et al. assessed a 6-week suboccipital TPR-based MT protocol and obtained positive short-term and long-term results in overall and functional subscales . MoreoveFinally, we observed an effect of the placebo technique in some of the variables studied. We observed an effect of the placebo technique in some of the studied variables, specially referred to pre–post significant differences observed in emotional, functional and overall HDI and HIT- 6 score for CG, which might point to a placebo effect. We observe that, globally, these improvements were smaller  than in FRG and MTG. This placebo effect could be due to the fact that the follow-up was carried out in a very limited period of time (one month). We believe that if the follow-up period had been longer (two or three months), perhaps we would not have observed any placebo effect. This aspect should be considered in future research. Although the placebo technique was not intended to treat, the application of manual contact may have improved some of the variables. In this regard, Kaptchuk et al. stated that placebo techniques could produce statistically and clinically significant results, with the patient–therapist relationship being the most robust component . Other aThis is the first study that evaluates the effectiveness of FR on TTH from a therapeutic point of view. Our FR protocol allows health professionals to offer greater independence to patients regarding the management of TTH and an economical and accessible alternative. In addition, our protocol includes several MT techniques that have been proven to be effective separately but not together as a treatment protocol. This novel technique could be implemented in physiotherapy treatment, considering that it could be performed in person with physiotherapist supervision or as domiciliary treatment, as long as there are no contraindications for the administration. It is essential to highlight that in all cases, the FR technique should be supervised by a physiotherapist, as in the present study, to avoid self-administration errors. In this regard, the therapist should act as a guide, leading the correct way to perform the technique, while different in-person follow-up sessions should be conducted, and thus errors should be fixed. We consider that the use of both treatments may lead to beneficial effects and favor the implication and active collaboration of the participant. However, this study has limitations, such as the small sample size, although as a pilot study, it could be sufficient according to a priori power analysis. In addition, headache frequency was not registered with days of headache, which could explain the differences in results. Thus, any generalization should be made cautiously. Finally, scarce literature about the therapeutic approach of FR constitutes a difficulty when comparing the results with other studies. In this regard, further studies to confirm our findings in a larger population are needed.The results of this study suggest that both FR and MT are effective treatments to improve pressure pain sensitivity in the short term in patients with TTH, with MT showing further long-term benefits on pain. Further studies with a larger sample and a more precise diagnosis of TTH are needed to confirm these results.


Sepiidae  were collected with a portable spectrophotometer (902–1680 nm) in a wholesale fish plant. NIR spectra were treated with standard normal variate, detrending, smoothing, and second derivative before performing chemometric approaches. The random forest feature selection procedure was executed to select the most significative wavelengths. The geographical origin classification models were constructed on the most informative bands, applying support vector machine (SVM) and K nearest neighbors algorithms (KNN). The SVM showed the best performance of geographical classification through the hold-out validation according to the overall accuracy (0.92), balanced accuracy (from 0.83 to 1.00), sensitivity (from 0.67 to 1.00), and specificity (from 0.88 to 1.00). Thus, being one of the first studies on cuttlefish traceability using NIRS, the results suggest that this represents a rapid, green, and non-destructive method to support on-site, practical inspection to authenticate geographical origin and to contrast fraudulent activities of cuttlefish mislabeled as local.An appropriate seafood origin identification is essential for labelling regulation but also economic and ecological issues. Near infrared (NIRS) reflectance spectroscopy was employed to assess the origins of cuttlefish caught from five fishing FAO areas . A total of 727 cuttlefishes of the family  Seafood authenticity represents a notable feature for governments, trades, and consumers. According to European Regulation (EU) n. 1379/2013 ,5. IndeeCephalopods are considered one among the most valuable and abundant marine fishery products. Contrary to the intensive fishing of bone-fish stocks, the global biomass of cephalopods has increased; thus, greater fishing and trading of this product have been encouraged. Cephalopod world commerce has increased by 33% from 2010 to 2018 , and in Sepia officinalis and Sepiella inermis) from five different FAO fishing areas.The attribution of geographical origin in the seafood sector is generally performed in a laboratory through DNA- and protein-based techniques or isotopic measurements that require time, reagents, sample destruction, and trained personnel ,22,23,24n = 221) and frozen-thawed cuttlefishes (n = 506) with different sizes (0.1–3.0 kg), originating from five catching areas and collected during four catching seasons . The detailed specification of all cuttlefish sampled, including the varieties, is presented in The study was carried out in an Italian wholesale fish plant located in Chioggia . The sampling was conducted over 7 months (from November 2019 to July 2020), considering a total of 727 individual cuttlefish collected from 49 commercial batches. The dataset considered was composed by fresh (2) placed in direct contact with the sample surface. Each spectrum was obtained by averaging of 5 s of data acquisition at a 10-msec integration time. Spectral data were registered in reflectance (R) units and converted to absorbance units as log (1/R) using poliDATA 3.0.1 software .The NIRS data acquisition were carried out using a portable NIR spectrophotometer  that operated in reflectance mode from 900 to 1680 nm with a resolution of 2 nm. Spectra of each cuttlefish were collected on intact and refrigerated cuttlefish (0–2 °C) after the usual company procedures . NIR spectral data measurements were performed through a round scanning window . Before any statistical analysis, spectra were pre-treated with standard normal variate (SNV), detrending , smoothin = 511), and the testing set consisted of 30% of the samples (n = 216). The model was validated through the hold-out validation in which the dataset was split again into the training set (70%) and used for the repeated cross-validation (setting number = 10 and repeats = 5) and the testing set (30%), composed of samples selected maintaining the proportionality among areas.A random forest (RF) feature selection procedure based on the Boruta algorithm  with a A principal component analysis (PCA) as an unsupervised method was performed to visualize the data distribution. Whereas, as supervised models, support vector machine (SVM) and K nearest neighbors (KNN) were used to investigate the NIR classification capability. The SVM was modelled by the use of the caret package through both the SVM-Linear and SVM-Radial kernels and applied to the training dataset. The C-value (Cost) in the Linear classifier and the radial basis function sigma were customized, adopting a grid search. The KNN was used as a classification method whose principle was to predict a class for a given test observed by attributing the class of the KNN observed sample. After training the models, the predict method was applied to obtain results in testing and validation. The model performance was evaluated through a confusion matrix, and the quality of prediction was assess by the accuracy, sensitivity, specificity, and precision metrics .Nowadays, due to the increment of frauds identified in fishery sector, a strategic plan is required to detect and prevent seafood counterfeiting or mislabeling in short time due to the perishable nature of the product. Indeed, governments and food industry must take up actions against to this issue; however, in support of this claim, NIRS represent a valid approach widely applied in food control to meet the need for a rapid feedback in food authenticity. Thus, in the present study, NIRS was applied to collect spectral data and to discriminate cuttlefishes according to the origin of FAO fishing area using a total of 727 individual samples.Spectra samples was collected from 902 to 1680 nm in reflectance mode. However, among the 389 investigated wavelengths, only RF 194 resulted in significant results regarding the geographic origins that were considered for the further analyses; the most informative bands are related to the overtone and combination of some molecular chemical bonds, such as OH, CH, and NH ,38. The Subsequently to the feature wavelengths selection, the PCA and classification models have been designed using only the most informative wavelengths of pre-treated data to discard irrelevant attributes. The PCA is performed as an unsupervised approach to visualize the graphical data distribution, offering a simple method to detect a potential clustering of samples according to the caught fishing area. The cumulative contribution of the first three PCs accounts for 76% of the total variance of NIRS data; in particular, PC1 explains 39% of the total variance, whereas PC2 and PC3, 21% and 16%, respectively. The classification of foodstuff combining NIRS with chemometric approaches has already been considered as valid method to discriminate the origin of vegetable products, such as asparagus  and ricen = 18) of samples were incorrectly classified. Notably, the balanced accuracy reported for the NE Atlantic and EC Atlantic Oceans were 0.92 and 0.93, respectively. In particular, the 12% (n = 10) of samples from EC Atlantic Ocean were assigned to NE Atlantic one; thus, a spectra of samples from EC Atlantic Ocean could be characterized by traits similar to those of the NE Atlantic Ocean. However, in NE Atlantic Ocean class, we observed the lowest misclassification occurrence , with samples erroneously assigned to the EC Atlantic Ocean (n = 2) and to E. Indian and WC Pacific Oceans (1 sample per both). Among the balanced accuracy results, however, the lowest value (0.83) was attributed to WC Pacific Ocean, which showed the lowest sensitivity (0.67) in which 33% (n = 3) of samples were misclassified as belonging to the NE Atlantic Ocean  and to EC Atlantic Ocean . Moreover, the balanced accuracy reported for Adriatic Sea was 0.90, showing that the 20% of samples (n = 1) were considered to belong to the NE Atlantic Ocean. However, the best performance of the SVM algorithm was represented by the greatest balanced accuracy, sensitivity, and specificity of 1.00 observed for the E. Indian Ocean class in which samples were totally discriminated from the other groups. In detail, the results observed on Sepiella inermis show that samples (n = 8) from E. Indian Ocean were completely separated from cuttlefish of other origins regardless to the species, size, and physical status; indeed, the highest and whole accuracy of sample classification from E. Indian Ocean could be attributed to the significantly different water environments and food sources in respect to those of the Sepiella inermis from WC Pacific Ocean.The SVM gave an overall accuracy of 0.92, showing the greatest number of samples assigned correctly to their own class; on the other hand, 8% (Dicentrarchus labrax) proposed by Ghidini et al. [n = 144), or to the different model of classification considered (OPLS-DA) in their study. On the other hand, the study focused on the traceability of Chinese tilapia from four geographical origins, conducted by Liu et al. [n = 208), and different chemometric approach (SIMCA) considered in their study [Apostichopus japonicus) according to the geographic origin from nine different origins of Chinese sea reported a higher value of classification rates (1.00) for all four classes considered; this is probably due to the lower variability given by the smaller size of sample (n = 45) employed in the validation test than in the present study. Moreover, compering the results reported in this study to the ones in the previous study that were considered standard techniques to discriminate seafood according to the geographical origin, it is important to consider that NIRS technique is a fast, non-consuming, green, and easy approach. Indeed, the common techniques are generally performed on a small-sized sample and require a long analytical phase performed by skilled personnel. In particular, the findings observed in the research conducted by Varrà et al. [n = 727), evidencing the effectiveness of classification according to the geographical origin in employing a portable and fast tool in a real environment, which is a real stage of the cuttlefish supply chain. Moreover, for other approaches generally employed to discriminate according to the geographical origin, such as DNA or isotopic techniques, these are time consuming and expensive. Furthermore, the isotopic analysis shows limitation in accuracy results being affected by environmental effects, such as diet, season, and salinity [The findings observed in this study are in accordance with those observed in literature considering other sea products. In detail, the overall accuracy of the present study (0.92) was greater than one (0.89) reported in the research about the geographical classification of European sea bass  collected from five FAO fishing areas. Spectral data collection was performed in a fishing plant to replicate the real conditions of control inspection executed in a part of the supply chain. The cuttlefish discrimination according to the caught area is achievable though the environmental and geographical aspects that affect the chemical composition of samples. This result suggests that the employment of a portable NIRS instrument is a user-friendly, fast, suitable, and independent analytical approach for supporting the regulatory inspection that awards the geographic origin on-site for perishable products. NIRS approach represents an important strategy for food business operator, authorities, and regulators to meet internal traceability requirements and to implement and monitor the control of goods in full chain traceability.This study demonstrates the feasibility of NIRS in classification according to geographical origins, achieving an accuracy of 0.92 when using a large sample dataset (