We assessed trends in physical fitness by age group and nutrition status among children and adolescents in Xinjiang during 1985–2014. The data of 49,357 participants aged 7–18 were extracted in 1985, 1995, 2005, and 2014. Growth and nutritional status were defined using World Health Organization definitions. A physical fitness indicator (PFI) was calculated as the sum of six components measured in every survey. The relationship between body mass index (BMI) and PFI was investigated using nonlinear regression. Taking 1985 as a reference, PFI increased to 2 in 1995 and then fell sharply to −2.8 in 2005 and −3.8 in 2014. The prevalence of normal weight increased from 87.5% in 1985 to 89.4% in 1995 and then decreased to 75.2%, consistent with the change in PFI. The relationship between BMI and PFI showed an inverted U-shaped curve. The largest increment occurred in boys aged 13–15 and girls aged 16–18 during 1985–1995; the largest decline occurred in boys and girls aged 10–12 during 1995–2005. Our research provides a reference for local governments providing nutrition subsidies and projects in southern Xinjiang, indicating that greater attention is needed for children aged 7–12. Physical fitness can be considered the ability of the body systems to work effectively and efficiently, allowing our bodies to be healthy and to perform the activities of daily living with ease . As a tyAs a physiologic characteristic, physical fitness is affected by both genetic and environmental factors. The available literature suggested that physical inactivity, increased sedentary time, and emerging obesity contributed to poor physical fitness . EvidencThe Xinjiang Uygur Autonomous Region is an economically underdeveloped region located in northwest China, 2768 km from Beijing, China’s capital. Xinjiang covers an area of 1.66 million square kilometers and has 24.86 million inhabitants. Xinjiang is a multi-ethnic province comprising 46 ethnic groups, with Uyghur as the main population . Ethnic Owing to genetic and environmental differences from Han ethnicity, the Chinese national average physical fitness level may not represent the true physical fitness level among children and adolescents in Xinjiang. In the present study, we aimed to describe age and sex differences in physical fitness levels among young people in Xinjiang during 1985–2014 using data from four successive national surveys. We sought to assess future interventions designed to improve fitness levels at the population level and to increase our understanding of the relationships between fitness and health.Data for the current study were drawn from the Chinese National Survey on Students’ Constitution and Health (CNSSCH), which is a nationwide survey that has been conducted every 5 years since 1985 by six government departments of China, including the Ministry of Education, the General Administration of Sport of China, and the National Health Commission of the People’s Republic of China, among others. In each survey, a thorough medical examination is conducted before taking measurements to exclude physical deformities or mental diseases. Participants in the CNSSCH include children and adolescents aged 7–18 across all 31 provinces of China. Considering socio-economic development level and geographic location, representative cities were selected from every province. Then, multistage stratified cluster sampling is used to select schools that have been relatively stable since 1985 and classes. The CNSSCH has been approved by the Medical Research Ethics Committee of Peking University Health Science Center (IRB00001052-18002). Written informed consent was obtained before the survey and all participants’ names were digitally coded to protect personal information.In the present study, the data of a total 49,357 children and adolescents in Xinjiang were extracted from the CNSSCH in 1985 , 1995 (n = 7198), 2005 , and 2014 .All research technicians in this study, recruited from among middle and high school physical education (PE) teachers, were trained using a standardized testing manual illustrating all test guidelines, procedures, and protocols. Measurement of all items followed a standardized procedure and was performed by trained technicians, according to CNSSCH guidelines . All tes2) was calculated as weight (kg) divided by height (m) squared.Portable stadiometers were used to measure the height (cm) to the nearest 0.1 cm, and standardized scales were used to measure weight (kg) to the nearest 0.1 kg, with participants wearing light clothing and no shoes. Body mass index , standing long jump, sit-and-reach, body muscle strength, 50-m dash, and endurance running. FVC was measured to reflect respiratory function using a rotary spirometer in 1985; a needle spirometer and electronic spirometer were added in 1995. Although different spirometry methods have been used owing to the updating of instruments, the principles underlying the methods and instruments are the same. Body muscle strength includes lower limb strength and upper body strength. We used a standing long jump to assess lower limb strength and oblique body pull-ups for boys aged 7–12, pull-ups for boys aged 13–18, and 1-min sit-ups for all girls aged 7–18, to assess upper body muscle strength. The cardiopulmonary function was assessed with long-distance running . The 50-m dash was used to assess speed of movement.BMI-for-age Z-scores and height-for-age Z-scores were calculated by the sex and age group, with reference to the 2007 World Health Organization BMI standards. Stunting was defined as height-for-age Z-score < −2 to represent growth status. Nutritional status was classified as underweight (< −2 for BMI Z-score), normal (≥ −2 and ≤ 1 for BMI Z-score and ≥ −2 for height Z-score), overweight (> 1 and ≤ 2 for BMI Z-score), or obese (> 2 for BMI Z-score).To overcome difficulties during comparisons caused by the different units and sexes, sex-specific and age-specific standardized values for each core item were calculated using the 1985 survey year dataset as the reference population. The PFI was then obtained by combining Z-scores of the six core items, to assess physical fitness at both individual and population levels ,21. It s2 + bBMI + c; where a, b, c are constants. PFI was used as the dependent variable, and BMI was considered the independent variable. The level of statistical significance was set at 0.05. All analyses were conducted using IBM SPSS version 23.0  and GraphPad Prism 8.0.2.Missing data or extreme values for height, weight, and physical fitness items were excluded on the basis of the logical check boundary provided by the CNSSCH association . DemograThe data of a total of 49,357 children and adolescents in Xinjiang, aged 7–18, for 1985, 1995, 2005, and 2014, were extracted from the CNSSCH for the current study. Comprising the six core physical fitness items, the PFI increased to 2 in 1995 and then fell sharply to −2.8 in 2005 and continued to decrease to −3.8 in 2014, taking the 1985 dataset as reference. In terms of specific items, the trend in FVC, standing long jump, sit-and-reach, 50-m dash, and body muscle strength were consistent with the PFI except for FVC and pull-ups in boys aged 13–18, which increased from 2005 to 2014 but remained worse than in 1985. The performance of endurance running remained relatively stable during 1985–1995 but was worse in 2005 and 2014 .P < 0.001).Trends in the six core items of physical fitness among children and adolescents in Xinjiang during 1985-2014, according to nutritional status, are shown in We also estimated the relationship between BMI Z-score and PFI Z-score for children and adolescents aged 7–18 in Xinjiang from 1985 to 2014 and revealed inverted U-shaped curves. This result indicates that higher or lower BMI had a negative effect on the PFI of children and adolescents .We assessed secular trends in the PFI of children and adolescents aged 7–18 in Xinjiang from 1985 to 2014 using the data of 49,357 individuals extracted from four rounds of the CNSSCH. The current study’s findings suggest that the PFI of this group of children and adolescents reached its peak in 1995, with the largest increment in boys aged 13–15 and girls aged 16–18. We also observed a sharp decline (by 290%) in the PFI of these children and adolescents in 2014 as compared with 1995, with the largest decline occurring in both boys and girls aged 10–12. Consistent with the trend in PFI, during 1985–2014, the prevalence of normal weight also peaked in 1995. Children and adolescents with both overnutrition and undernutrition had poorer physical fitness than those with normal weight and height. The inverted U-shaped curves obtained for the relationship between BMI Z-score and PFI Z-score indicated that PFI can improve with normal weight status.Our study’s findings suggest that, from 1985 to 2014, the PFI of children and adolescents aged 7–12 in Xinjiang showed a greater decline than in those aged 13–18. This might be explained by the inclusion of PE in both senior high school entrance examinations (students participate at age 15) and college entrance examinations (students participate at age 18); however, primary school entrance examinations were not included (students participate at age 12). This also reveals the shortcomings of China’s PE classes and exam-oriented PE curriculum. Recently, the Chinese healthy PE curriculum model ,23, deveThe present study showed that both malnutrition and overnutrition have adverse effects on physical fitness, which is consistent with previous studies ,28. The Given the low rates of participation in physical activity globally, the decline in physical fitness in the current study is partly affected by physical inactivity in children and adolescents, which has profound implications . Strong With a heavy schoolwork burden and college entrance examination pressure, the sedentary time has increased rapidly in recent years, which may be the cause of physical decline among Chinese children and adolescents, especially during 1995–2005. This continuous decline in physical fitness among children and adolescents has attracted the attention of the Chinese government, which has established many policies to promote physical health, such as the “Healthy China 2030” program , seeking12.An advantage of having fitness measures from the four surveys is the consistency among measurement protocols. However, there are some limitations to the current study. First, we only evaluated the impact of nutritional status on physical fitness, whereas other factors, such as diet, physical exercise, and family environment were not included; these may be important factors affecting physical fitness among children and adolescents in Xinjiang. Second, a standardized and accepted method is lacking for assessing physical fitness at present. The PFI was assessed using the combination of performance results for FVC, standing long jump, sit-and-reach, body muscle strength, 50-m dash, and endurance running in the present study. The physical fitness level of children and adolescents in Xinjiang may not be comprehensive and accurately evaluated using PFI; however, this indicator can still represent physical fitness levels to some extentThis study provides an update regarding the physical fitness of children and adolescents in Xinjiang, China. The results demonstrate that physical fitness levels reached their peak in 1995, followed by continuous declines in 2005 and 2014. The lack of progress in physical fitness suggests that efforts to improve fitness and behaviors of healthy, active living among children and adolescents in Xinjiang have been insufficient; thus, ongoing enhanced efforts are required. Students with overnutrition and children age 7–12 require special attention. Effective new teaching models are also needed, such as the Chinese healthy PE curriculum model, rather than focusing solely on PE examinations.


Mexican spices are used in the supplementation of the human diet and as medicinal herbs for the particularly high amounts of compounds capable of deactivating free radicals. In addition, these spices can have beneficial effects on chronic, no-transmissible diseases such as type II diabetes and hypertension arterial. The objective of this study is to determine the content of phenolic compounds on the antioxidant activity and inhibitory enzymes of α-amylase, α-glucosidase and angiotensin-converting enzyme in melissa, peppermint, thyme and mint, which are subjected to microwave drying, conventional and freeze-drying to be used as alternative treatments. Spices were evaluated to determine total phenols, flavonoids, tannins, 2,2-Diphenyl-1-picrylhydrazyl (DPPH),  (ABTS) and Ferric Reducing/Antioxidant Power (FRAP), enzymatic activity. The investigation showed that conventional drying caused a decrease in antioxidant properties and inhibitory activity, in some species, while remained preserved in microwave drying and freeze-drying. The activity of polyphenol oxides and peroxidase decreases with high temperatures and these increase with the use of cold temperatures. This study aims to determine the extent of optimal drying required to preserve phenolic compounds, and the positive effect on antioxidant activity and enzymatic activity in in vitro models, which will produce benefits for the infusion processing industry and the pharmaceutical industry. Melissa officinalis), thyme (Thymus vulgaris L.), peppermint (Mentha spicata), and mint (Mentha x piperita). Its aerial parts, especially the leaves and flowers, are rich in secondary metabolites, such as tannins, rosmarinic acid, flavonoids, luteolin, apigenin, and phenolic compounds, essential oil, among other phytochemical compounds [The use of traditional medicinal herbs has become of daily use today. Most people prefer to use medicinal herbs that contain especially high amounts of compounds, capable of deactivating free radicals and generating health benefits, safety and efficacy, compared to pharmaceuticals. Some pharmaceutical products use plant extracts as raw material, in order to produce new medicines or as an active ingredient of existing medicines. On the other hand in developing countries, approximately 80% of the population depends on medicinal herbs for primary care, as well as in Oriental or Native American medicine . One of ompounds ,3,4. Theompounds ,6. The compounds . Therefoompounds ,10,11. Tompounds ,13. Herbompounds ,15. The ompounds . Drying ompounds ,18,19. Dompounds . It is aompounds . Polypheompounds .Research efforts have been currently oriented to the use of natural products, particularly plant foods or extracts in the management of chronic-degenerative diseases, such as the management of diabetes, high blood pressure, and other health-related challenges, as well as the conservation of these plant foods, which has deepened in the drying processes ,23,24. TData collected for phenolic compounds, which corresponded to the samples, were analyzed in the different drying treatments applied to the species. The identification of phytochemicals nowadays appears to be central in detecting the set of bioactive compounds in plants, as well as elucidating their antioxidant capacity and their bioactive capacity. Phenolic compounds are an efficient way to describe the interpretation of plant protective metabolites and the effect they can have on some chronic non transmissible diseases. With respect to the origin of the data shown in On the other hand, the results for the concentration of flavonoids, between drying methods, are shown in In the case of tannin extraction, significant differences were found between the drying methods evaluated. For most of the plant materials evaluated, freeze-drying was the better drying method. Thyme showed a concentration of 0.00224 mgCE/g DW . In peppermint, thyme, and mint, fresh plant material showed the highest concentrations. Unlike the phenolic and flavonoid compounds, none of the drying methods, used in the extraction of tannins, resulted an increase in the concentration of these compounds, and otherwise showed that the tannins are more sensitive to any drying method.Data collected from the three different techniques were analyzed to determine antioxidant capacity, as shown in The analysis of the phytochemical compounds allowed us to identify the different compounds that were maintained after applying the drying method by plant material, the phytochemical compounds were the first analyzed by PCA, separating compounds by drying method. The analysis of the phenolic compounds is shown in . The twoM. Officinalis  twice a day for 12 weeks, a significant reduction in HbA1c (hemoglobin A1c) (P = 0.002) was seen [The different types of drying that are carried out in the spices have an influence on the content of bioactive compounds. Some may favor the detection of biologically active constituents that were not present in the raw material . The reswas seen . On the was seen . On the was seen . Howeverwas seen . Numerouwas seen . It is awas seen . On the was seen . It is ewas seen , the loswas seen . Some auwas seen . The res2 gas to eliminate O2 in the headspace and stored in fresh and dry spaces for analysis. On the other hand, fresh samples were only frozen with liquid nitrogen and kept frozen at −18 °C for further analysis. The preparation of the sample for the analysis of phytochemical compounds the extraction will be carried out according to the methodology described by Cardador [The herbs or spices  analyzed for this study were grown free of fertilizers and pesticides. The selection of these spices was made considering their good phytosanitary state (the spices should not have mold or any visible pest) and in a fresh state; the leaves and stems of the plants will be taken as part of the sample. In all cases, 1kg of flowering stems were collected. Samples were collected in a full flowering period, in the experimental de la Autonomous University of Queretaro campus Amazcala. The collected samples were divided into four parts and different drying methods were applied. Once selected, they were freeze-dried, conventionally dried and microwaved, as well as subsequently stored in closed containers, thereby eliminating oxygen with NCardador , 25 mg oThree drying methods were performed on each of the herbs and spices. Conventional drying will use a food dehydrator  a temperature of 58 °C for a period of 25 h . The micThe total phenol content was determined using the Folin-Ciocalteu spectrophotometric method  modifiedThe spectrophotometric method used for the quantification of total flavonoids in methanolic extracts was determined by Oomah, et al. . 50 μL ov/v)  at 492 nm. Expressed in mg equivalent of (+) catechin/g DW and the samples were analyzed in triplicate.The quantification of total condensed tannins was performed following the procedure described by Feregrino–Pérez, et al. , modifieThe quantification of DPPH antioxidant capacity  was carried out as described by Zenil, et al. . A totalThe spectrophotometric method for the quantification of antioxidant capacity by ABTS  was performed following the Re method . For quaThe quantification of antioxidant capacity by FRAP (Ferric Reducing/Antioxidant Power) was carried out following the Olaya method . The antThe quantification of pancreatic α-amylase  was performed following the procedure described by MezaandValdés , modified-nitrophenyl-α-glucopyranoside solution is then added and placed at 25 °C/5 min, again its absorbance at 405 nm is recorded. Each experiment was performed in triplicate.The α-glucosidase inhibition was performed following the procedure described by Ranilla et al. , modifieN-(3-(2-frapgglacryloy)) 5 × 10−4 M  solution, 125 µL of the methanolic extract, 15 µL of the TRIS-HCl buffer and 10 µL of ACE were mixed. The absorbance at 345 nm was measured for 5 min in a plate reader . Analyzing the samples in triplicate.Inhibition of ACE (angiotensin-converting enzyme) was performed following the procedure described by Salazar Aranda, et al. , modifiep < 0.05. Principal component analysis (PCA) with a self-scaling using the medium centering method and hierarchical clustering analysis (HCA) with centroid link grouping for the responses of the identified compounds were performed in order to characterize the effect of the treatments in the content of bioactive compounds, using XLSTAT 2014.05.03 (XLSTAT and Addinsoftare Registered Trademarks of Addinsoft. https://www.xlstat.com)All the results obtained in this investigation were shown as the mean ± standard error. Data were evaluated using unidirectional ANOVA and changes between processing were evaluated by comparing means using the Tukey test. The level of statistical significance was considered at This study shows that the preliminary phytochemical analysis of the extracts demonstrated the presence of different groups of secondary metabolites . Therefore, in this paper, the vegetative material shows significant differences superior to the fresh vegetative material after applying the microwave drying and freeze-drying methods. On the other hand, the conventional method a thermal and/or enzymatic degradation of phenolic compounds was observed in the vegetative material. This effect was due to the leaves drying up at temperatures between 50 and 100 °C suffered an enzymatic and thermal degradation in the main factors of the reduction of phenolic compounds. Regarding the results obtained, it is concluded that the biological activity is affected by the type of drying with which the vegetative material. These drying methods significantly influence both positively and negatively the properties of the plant material, altering the amounts of phytochemicals present as Phenolic compounds and play an important role in enzyme inhibition and antioxidant capacity. Therefore, we can conclude that microwave drying, and freeze-drying have positive effects by increasing the percentages of inhibition of ACE, α-glucosidase, and α-amylase that contribute to the treatment of HTA and DMII. For all the herbs analyzed, drying was carried out mainly with decreasing rates. Initially, there was a relatively short phase with a higher moisture removal rate, with a high moisture content in the material. This phenomenon resulted from a greater ability to absorb microwave energy typical of material that contains more water. On the other hand, freeze-drying is used for the reliable preservation of a wide variety of heat-sensitive products and demands the highest standards of reliability and control. Unfortunately, the high porosity of dry materials has a negative effect on storage stability. Therefore, freeze-drying materials need to be stored in an airtight package. The freeze-drying process remains expensive, which restricts its application.


Chitosan (CS) is a hemi-synthetic cationic linear polysaccharide produced by the deacetylation of chitin. CS is non-toxic, highly biocompatible, and biodegradable, and it has a low immunogenicity. Additionally, CS has inherent antibacterial properties and a mucoadhesive character and can disrupt epithelial tight junctions, thus acting as a permeability enhancer. As such, CS and its derivatives are well-suited for the challenging field of ocular drug delivery. In the present review article, we will discuss the properties of CS that contribute to its successful application in ocular delivery before reviewing the latest advances in the use of CS for the development of novel ophthalmic delivery systems. Colloidal nanocarriers  will be presented, followed by CS gels and lenses and ocular inserts. Finally, instances of CS coatings, aiming at conferring mucoadhesiveness to other matrixes, will be presented. Ocular diseases affect a growing number of people across the globe. Some pathological ophthalmic conditions, such as glaucoma, diabetic retinopathy, or age-related macular degeneration, cause severe visual impairment that can ultimately lead to blindness. In spite of their relative accessibility, or rather because of it, eyes are well-protected organs and successful ocular drug delivery is one of the important challenges the pharmaceutical industry has to face.Ocular tissues are protected from foreign substances by a series of static and dynamic barriers and protective mechanisms, as illustrated in Eye drops are the most frequently prescribed form of ocular treatment . This isN-acetyl-D-glucosamine units, linked via β-(1→4) glycosidic bonds. It is synthesized by the deacetylation of chitin, which is a naturally occurring polysaccharide. CS is water-soluble in acidic pH due to the protonation of the free amino groups. It is an easily accessible polymer, but most importantly it is non-toxic, highly biocompatible, and biodegradable, and it has a low immunogenicity . C. C155]. 6 in PLGA is a well-established candidate for the preparation of NPs due to its biodegradability and FDA approval. However, PLGA as a vehicle suffers from a variety of downsides, namely weak protein stability, loading efficiency, and abrupt release profile. An attractive method to bypass those drawbacks is described by Elsaid et al., who formulated a ‘system-within-system’ matrix for the treatment of age-related macular degeneration . SpecifiFinally, CS NPs have also been introduced into ocular lenses and inserts for a prolonged retention on the ocular surface. In their work, Han et al. formulated surperficially modified contact lenses with a hydrophilic exterior, intending to decrease the occurrence of posterior capsular opacification: a basic complication faced after cataract surgery ,148. ForAnother study based on the merits of CS/TPP NPs was planned by Behl et al., who synthesized NPs laden with an anti-inflammatory agent, namely dexamethasone sodium phosphate, administrated in numerous ophthalmic diseases . Drug-loBadiee et al. inserted bevacizumab-loaded CS NPs in an HA/zinc sulfate implant . The NPsHydrogels are three-dimensional polymer networks, generated by physical  or chemical  crosslinking. They are hydrophilic, yet insoluble in water, as a result of their crosslinked structure. Hydrogels can swell to a high extent by absorbing large amounts of water, becoming soft viscoelastic gels that can be used for ocular controlled drug release ,224. WatIn ocular delivery, hydrogels present advantages compared to eye drops, as their higher viscosity allows for a longer residence time on the ocular surface and thus a higher therapeutic effect. However, gels have been linked to blurred vision and other discomforts. In situ gelling systems are systems that undergo a sol–gel phase transition in response to external stimuli . In situ gelling formulations have garnered important interest as, additionally to the advantages presented by hydrogels, they can be instilled in the eye as a solution, thus facilitating administration. Indeed, in situ gelling formulations undergo phase transition in the ocular cul de sac to form viscoelastic gels. Most of these gels exhibit a pseudoplastic or non-Newtonian behavior. In other words, their viscosity decreases when the shear stress increases. This is particularly important for ocular delivery, as it prevents creating discomfort to the patient during blinking. The ocular shear rate is low at rest and increases importantly during blinking; a shear-thinning behavior ensures a low viscosity during blinking, thus avoiding patient discomfort.Numerous polymers are extensively used for hydrogel preparation in pharmaceutical technology, as well as for ocular drug release, including natural polymers such as polysaccharides, gellan, ALG, HPMC, carrageenans, CS, and their derivatives, as well as some synthetic polymers, such as poloxamers and polyacrylates ,228,229.Proniosomes are vesicular systems bearing a bilayer made from non-ionic surfactants, such as cholesterol or sorbitan esters. They are generally more stable and easier to handle than liposomes or other vesicular formulations. Fouda et al. investigated the ocular delivery of dorzolamide HCl for the treatment of elevated IOP in glaucoma patients . The dorw/w concentration exhibited the highest viscosity and mucoadhesion time. In vitro drug release study indicated a progressive release via a diffusion-controlled mechanism. According to in vivo studies, IOP was lowered to normal levels within 45 min after the administration of the formulation and showed a prolonged therapeutic effect for 24 h. The oral administration of a commercially available acetazolamide tablet led to a decrease in IOP 1.5 h after administration and only for 5 h. In their work, Mohammed et al. used another phosphate: β-glycerolphosphate (β-GP) chitosan chloride, 24 in In Huang’s et al. research, hydrogel contact lenses with unified anti-fungal properties were prepared and assembled as a drug delivery system for the management of fungal keratitis . More sp2)/, which was covered with an ultimate alginate–CaCl2 layer, intending to prevent CS disintegration by tear liquid proteins, and it is quite noteworthy. The coating managed to reduce the initial burst release and afforded a 7-day sustained release. Additional investigation in CS functionalization for a better control over the drug release is required. Hu et al. also applied the layer-by-layer deposition to prepare HA/CS multilayers on PHEMA/β-cyclodextrin lenses aiming at the delivery of orfloxacin and puerarin [26 in Silva et al. capitalized upon the layer-by-layer deposition method to combine CS and alginate for the coating of three kinds of lenses, as shown in puerarin . The lenKazemi Ashtiani et al. reported the surficial conjugation of PHEMA lenses with the cationic, and thus friendly to anionic pharmaceutical agents, CS for the delivery of ascorbic acid . ProteinThe development of novel coatings using CS and borneol for ocular contact lenses was proposed by Mehta et al. . In thatHoyo et al. developed effective biocompatible and antibacterial coatings on contact lenses via a single-step sonochemical process, in order to enhance their convenience and improve their biological properties . The forSaher et al. prepared porous levofloxacin-loaded semi-sponges for ocular bacterial infections . The semMirzaeei et al. examined CS-based electrospun nanofibers as ocular inserts for the delivery of triamcinolone acetonide . HydrophCS is a biocompatible polymer that, among others, can be used to enhance the mucoadhesion of drug formulations to tissues. Furthermore, the thiolation of CS can improve the penetration of NPs or their content through the tight junctions of mucus layers. Numerous studies have been conducted on the use of CS or its derivatives as coatings in order to deliver drugs encapsulated in liposomes, solid lipid matrixes, or NPs to the eye.Li et al. encapsulated triamcinolone acetonide, which is an intermediate-acting glucocorticoid applied in inflammatory, edematous, and angiogenic ocular diseases, in liposomes, and the resulting NPs were further coated with CS . The coaw/v, their size increased to 100, 170, and 176 nm. In vivo studies were conducted in a rat model showing that after 15 days, the drug was present in the posterior chamber of the eye, which is a conclusion that is in accordance with the studies conducted by Li et al. [Tan et al. developed CS-coated liposomes for the ocular delivery of timolol maleate . The drui et al.  and Cheni et al. .w 50 kDa, degree of deacetylation: 95%) in three different concentrations . It was found that the coated NPs were larger than the uncoated ones, and the ζ-potential changed from negative to positive. A corneal penetration study showed that deformable liposomes had a 1.5-fold increased penetration compared to non-deformable ones, while their penetration ability was further enhanced by the CS coating. Indeed, CS can improve the permeability of the cornea by opening the tight junctions among corneal epithelial cells or by intracellular routes (vide supra). A notable observation was that the penetration rate was different for the different formulations: all uncoated formulations showed a constant penetration rate, while the coated ones showed a reduced rate after 160 min. The cumulative penetration remained higher for the coated particles. In vivo pre-corneal retention showed that the CS coating significantly prolonged the residence time of deformable liposomes in the cornea and improved the drug bioavailability by increasing its transport time across the cornea.Chen et al. prepared CS-coated deformable liposomes for the ocular delivery of flurbiprofen . The prew/v) NaOH solution for 1 h once and for 1.5 h twice at 100 °C under a nitrogen atmosphere to obtain deacetylation degrees of 84% and 94%, respectively. FTIR and gel permeation chromatography showed that deacetylation did not affect the initial molecular weight. Crystallinity increased as the degree of deacetylation increased, which was due to the absence of acetyl groups. An important issue revealed by the study is that the degree of deacetylation affected cell adhesion, i.e., an increased deacetylation degree resulted in enhanced cell adhesion  as a lipid carrier for the nanoencapsulation of acyclovir, which is a drug that is used in the therapy of herpes keratitis: the most common infectious cause of blindness [w/v CS was used. No significant difference was observed between CS concentrations of 0.5% and 1% w/v. Drug release was studied in PBS pH 7.4. It was found that coating with CS led to a reduction of about 25% in acyclovir release rate compared to uncoated NPs, regardless of the CS concentration used for coating. The cellular uptake of NPs was enhanced by CS coating while the concentration of fluorescein increased with CS concentration and exposure time in the cytoplasm of the epithelial cells. In ex vivo penetration studies, conducted in bovine eyes, the coated NPs had enhanced properties, with the coating obtained from the 0.5% w/v CS concentration showing the best results. The quantification of acyclovir in cellular uptake was higher for the coated NPs.Seyfoddin et al. used a blend of different esters of behenic acid with glycerol , 6 in Li et al. studied three different CS derivatives—Salama et al. used PLGA 50/50 or 75/25 in NP formulation of fluocinolone acetonide (FA), which is an anti-inflammatory corticosteroid drug used for the treatment of intermediate, posterior, and pan uveitis . NPs werN-succinyl modified CS, 2 in N-hydroxysuccinimide. CS was grafted to the micelles via the reaction of the amine groups of the micelles with the carboxylic acid groups of modified CS. Additionally, a crosslinking reaction among amine and carboxylic groups within CS chains took also place. Core–shell spherical NPs were obtained with sizes from 40 to 82 nm depending on the molecular weight of PBA. Commercial eye drops released their drug content within 10 h. In contrast, loteprednol etabonate release from the crosslinked core–shell NPs was extended over 50 h.Pandit et al. studied CS-coated PLGA NPs for bevacizumab delivery . Drug-loCS is a versatile polymer due to its favorable biocompatibility, biodegradability, mucoadhesive, and penetration enhancement properties. Numerous applications and different drug delivery systems have been reported in the field of ocular drug delivery with promising results in terms of increased drug bioavailability and improved therapeutic effect. Not surprisingly, CS nanoparticles dominate amongst the different kind of delivery formulations. NPs have shown their superiority in drug delivery, generally speaking. In the challenging field of ocular delivery, the advantages of nanoparticles, such as their small size, high surface area, and high mucoadhesivity, are even more crucial. Ionotropic gelation, especially with TPP, is a convenient and easily accessible method to prepare CS nanoparticles and as such has attracted much attention. The importance of the experimental protocol, and more specifically the CS/TPP ratio and the CS and TPP concentrations, on the size, the dispersity, the ζ-potential (and thus stability), and the entrapment efficiency have been extensively discussed. Interesting performances have been obtained in terms of sustained release, and more are yet to come. In situ hydrogels are another type of formulation with encouraging results that have the advantage of being instilled as eye drops but that can form a hydrogel with a higher retention time once on the ocular surface. Innovative, more complex designs and architectures have started to emerge, combining complementary delivery vehicles; these need to be further investigated. These systems hold the promise of more efficient delivery as they combine multiple advantages. For example, NPs loaded in hydrogels or contact lenses can combine the controlled delivery of the NPs with a higher corneal retention time offered by the ocular lens or hydrogel, decreasing the necessity of frequent treatment. CS coating is another method to confer CS advantages to other matrices, without compromising their own advantages. The increase of therapeutic efficiency is the primary objective of any drug delivery system; nonetheless, patient’s comfort is almost as critical, since it heavily affects compliance to a treatment. This is especially true when it comes to ocular delivery. Thus, it should always be kept in sight when designing a drug delivery system.


We proved the viability of the general hypothesis that biological motion (BM) processing serves as a hallmark of social cognition. We assumed that BM processing and inferring emotions through BM (body language reading) are firmly linked and examined whether this tie is gender-specific. Healthy females and males completed two tasks with the same set of point-light BM displays portraying angry and neutral locomotion of female and male actors. For one task, perceivers had to indicate actor gender, while for the other, they had to infer the emotional content of locomotion. Thus, with identical visual input, we directed task demands either to BM processing or inferring of emotion. This design allows straight comparison between sensitivity to BM and recognition of emotions conveyed by the same BM. In addition, perceivers were administered a set of photographs from the Reading the Mind in the Eyes Test (RMET), with which they identified either emotional state or actor gender. Although there were no gender differences in performance on BM tasks, a tight link occurred between recognition accuracy of emotions and gender through BM in males. In females only, body language reading (both accuracy and response time) was associated with performance on the RMET. The outcome underscores gender-specific modes in visual social cognition and triggers investigation of body language reading in a wide range of neuropsychiatric disorders. Emotional valence of BM affects the sensitivity to point-light gait masked by an additional set of dots taken from the same walker, with highest sensitivity , to angry and lowest sensitivity, to neutral walking . The senSome aspects of BM processing and/or body language reading are aberrant in psychiatric, neurological, psychosomatic, and neurodevelopmental disorders  BM tests are often based on videotapes of only one  or two  performers. For example, many studies on emotion recognition from BM in psychiatric populations use videos of only one actor . As performance on the RMET  requires language command of high proficiency, German as a native language served as an inclusion criterion. All observers had normal or corrected-to-normal vision. None had head injuries or a history of neuropsychiatric disorders , or regular drug intake (medication). They were run individually and were naïve as to the purpose of the study. None had previous experience with such displays and tasks. The study was conducted in line with the Declaration of Helsinki and was approved by the local Ethics Committee at the University of Tübingen Medical School. Informed written consent was obtained from all participants. Participation was voluntary, and the data were processed anonymously.Forty participants  were enrolled in the study. No age difference occurred between them: males were aged 26.5 years , and females were aged 25 years  with higher accuracy on revealing emotions than gender, Actor Gender  with higher accuracy in recognition of movies of male than female actors, and Emotion  with better performance for neutral than angry displays on both tasks together. The main effect of Observer Gender only tended to be significant  with a non-significant interaction between Observer Gender and Task . All interactions are summarized in Post hoc analysis indicated a lack of gender differences in accuracy on both BM tasks . Similarly, no gender differences in response time were found .Individual rates of correct responses on both BM tasks were submitted to a mixed model 2 × 2 × 2 × 2 repeated-measures omnibus ANOVA with within-subject factors Task (gender/emotion recognition), Actor Gender , and Emotion , and a between-subject factor Observer Gender . The outcome revealed main effects of Task . Response time of correct responses between the BME and BMG tasks positively correlated with each other in both gender groups . Notably, we found that females tended to surpass males in recognition of female images , with no gender difference in recognition of male images . No gender difference on the RMET task was found in response time . No gender difference in recognition accuracy occurred on the RMET_G task , presumably because the task turned to be far too easy to perform. There was also no gender difference in response time on this task . No correlation occurred between recognition accuracy on the RMET and RMET_G task .As expected from previous work , femalesr(18) = 0.186, p = 0.216, n.s], whereas in females accuracy of BME and RMET positively correlated with each other [r(18) = 0.445, p = 0.025, one-tailed; ρ(18) = 0.483, p = 0.016; ρ(18) = 0.287, p = 0.11, n.s., one-tailed; Based on earlier work , we expeThe present study was aimed at the proof of concept in accord with which body motion perception and visual social cognition are intimately tied . KeepingThe outcome provides further support for the general concept according with which BM processing serves a hallmark of social cognition . PreviouBy contrast, females likely bank on tightly interconnected general mechanisms of social cognition for emotion recognition through BM and mindreading through eyes. In males, the link in performance between these tasks is absent. At first glance, bearing in mind previous reports  on the aIn agreement with previous work  that poiThe present study was conducted in the student sample that affords group homogeneity. Although such a population is commonly used in the field, this may represent a limitation in terms of the outcome generalizability. However, since the study was focused on the association between performances on the tests, one would expect that, in general population, perceivers who are proficient on one task may be expected to be more proficient on the other and vice versa.Gender specificity of the link between BM processing and visual social cognition may be of value for better understanding a wide range of psychiatric, neurologic, neurodevelopmental, and psychosomatic conditions. Some aspects of BM processing are atypical in ASD e.g., , schizopBM processing relies on a large-scale neural network . For undResearch on the brain networks dedicated to affective body language reading in normalcy and pathology is extremely sparse . This woThe present study was aimed at providing a proof of concept that BM perception and visual social cognition are intimately tied . Here, wThe raw data will be made available by the authors, without undue reservation, to any qualified researcher.The studies involving human participants were reviewed and approved by the Ethical Committee of the University of Tübingen Medical School. The participants provided their written informed consent to participate in this study.MP, SI, and AF conceived and designed the study experiments. SI performed the experiments. MP, SI, and AS analyzed the data. MP and AF contributed reagents, materials, and analysis tools. SI and MP wrote the paper. MP supervised the whole project. All co-authors contributed to the writing of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Noise peak level showed an opposite effect, which was significant for Total Power , and for Triangular index . Further investigation is warranted to clarify the effect of the concurrent exposure to UFPs and noise on early changes of cardiac autonomic regulation.Airport activity causes the emission of particulate matter and noise, two environmental contaminants and potential health hazards, particularly for the personnel operating nearby taxiways. We explored the association between exposure to fine/ultrafine particles (UFPs) and noise with heart rate variability (HRV), an early indicator of cardiovascular autonomic response, among a sample of airport ground staff. Between May and June 2018, thirty-four male operators (mean age = 43 years and SD = 6.7) underwent personal monitoring of exposure to nanoparticles and noise, and HRV during their work activity. We conducted univariate and multivariate analysis to test the effect of UFP and noise exposure HRV. Total Lung Deposition Surface Area (LDSA) was significantly associated with a decrease in HRV Total Power and Triangular index ( Several studies have suggested airports as a potential source of emission of particulate matter and noise in the surrounding environment ,2. ThereParticulate matter has been associated with cardiovascular and respiratory effects ,5, and wSeveral studies have evaluated the autonomic balance of the cardiovascular system, in relation to exposure to fine/ultrafine particulate, in both animal  and humaLong-term exposure to environmental noise is known to affect the cardiovascular system, by contributing to the development of hypertension, ischemic heart disease, and stroke ,14. AcutHeart rate variability (HRV) is a valid method for measuring the response of the autonomic heart control to noise, through the changes induced in some HRV parameters ,17.Environmental noise is a well-known risk factor for the airport ground staff and for the general population in the airport surroundings . SeveralStudies on the combined effects of noise and air pollution showed largely independent effects, in relation to the different mechanisms by which either exposure can cause detrimental effects on human health ,21,22. SThe present study aimed to investigate whether environmental exposure to fine/ultrafine particulate and noise might affect HRV, as an early indicator of cardiovascular effects. To match the objective, we did the following: (i) performed personal monitoring of exposure to ultrafine particles (UFPs) during flight attendance; (ii) assessed personal exposure to impulsive and continuous noise; (iii) monitored heart rate variability (HRV) during the working shift; and (iv) evaluated the impact of UFPs and noise exposure on HRV changes.To the best of our knowledge, the study herein presented is the first exploring potential early effects on the cardiovascular system, due to the combined exposure to fine/ultrafine particles and noise in a sample of airport ground staff.Between March 16th and May 18th 2018, we conducted a single, simultaneous personal monitoring of noise and airborne UFPs and HRV lasting no less than two hours, between 7:30 a.m. and 8:00 p.m. during a regular working day in the local airport. Every operational day, we monitored two or three study subjects.With the aim of reducing, if possible, any interference with the operational activities, the monitoring program was planned with one-week intervals, and after consulting the supervisor for the internal organization and the scheduled airport activities. The study was conducted as an observational, cross-sectional study on subjects recruited among the ground operating airport personnel, through an in-site recruitment accorded with supervisors. Study subjects had to be engaged in the following tasks: Aircraft Ground Staff (AGS), firefighting officer, flight security agent, and aviation fuel’s attendants (AFA). Participation was on a volunteer basis, following the signature of an informed consent form about the purpose of the study, prior to interview and the tests according to the study protocol. The study was conducted in accordance with the Helsinki Declaration. Subjects suffering from any cardiovascular, endocrine, or neurologic disease were ineligible for study. Overall, 34 male subjects  were enrolled.All participants had an electrocardiogram (ECG) at rest and their anthropometric and lifestyle  recorded by a trained medical doctor, before undergoing the study protocol, during the regular working hours. Participants had to wear portable devices to monitor personal exposure to UFPs and noise, and a Holter ECG device while working. After setup, participants had to rest in the room for at least 5 min, to register background HRV parameters before exposure. Each subject received also a diary, for a step-by-step registration of the activities performed during the monitoring hours, with the corresponding time of starting and ending each.The monitoring phase covered no less than two hours of a regular working day, after which participants had to return to the room and to rest for no less than 10 min, to register HRV at the end of the test. Data from the Holter ECG were saved on a dedicated laptop PC that was set up with the specific acquisition software. Afterwards, memory of the device was deleted, to allow for the recording of a new ECG.The method for measuring noise and personal exposure to UFP was described elsewhere . Briefly2/cm3), the average particle size (nm) in the 10–300 nm range, and the particle count (particles/cm3). UFP was collected with a Diffusion Size Classifier instrument . DISCmini is based on the electrical charging of the aerosols to determine the alveolar Lung Deposited Surface Area  digital Cardiette Holter System equipped with the ECG Pilot and giOtto v.7.0.1.26 software.-Standard Deviation of normal-to-normal (NN) intervals ;-Root Mean Square of successive differences in adjacent NN intervals ;-Triangular index (T-index), corresponding to the integral of the density distribution divided by its maximum value;-2) in the range 0.003–0.04 Hz;Very low frequency power  in the range 0.04–0.15 Hz;Low-frequency power  in the range 0.15–0.40 Hz;High-frequency power ;LF/HF ratio (Ratio LF [ms-2): variance of NN intervals over the temporal segment, approximately in a range ≤ 0.4 Hz.Total Power  were extracted from the archive, by the software giOtto; converted in a “.data” file; and then analyzed with the Kubios HRV standard v. 3.1.0 software, applying a medium-intensity filter to eliminate artifacts. The following HRV parameters were calculated:HRV parameters were determined over the first five minutes of registration (background activity), along the entire monitoring period, and for the last 5 min . If moreDescriptive statistics of the UFP and noise parameters were presented elsewhere . The nort-test for paired data. Final HRV parameters were individually predicted by linear regression modeling, as a function of the UFP and noise-exposure parameters, adjusted for age, BMI, smoking habit, and hypertension, as the covariates. Finally, we tested the interaction effect of UFP and noise exposure by including the interaction term between total LDSA and Laeq8hr and Lc peak, respectively. Due to an instrument failure, the HRV was not correctly measured in one study subject, leaving the records of 33 subjects available for analysis.The correlation between UFP parameters, noise exposure levels, and HRV parameters was calculated with the Pearson’s correlation test or the Spearman’s rho, as appropriate for parametric and non-parametric data, respectively. Background and final HRV parameters were compared with the The analyses were conducted by using SPSS . The null hypothesis was rejected when associated with an α-error of 0.05.3 particles/cm3 , while mean Total LDSA was 15.29 mm2 (SD = 23.08). Continuous noise levels did not exceed 80 dB , and mean peak noise levels was 129.3 dB (SD = 4.3).p = 0.001), RMSSD (p < 0.001), and HF power (p = 0.049) were significantly decreased at the end of the sampling period, while VLF power showed a significant increase (p = 0.047).r = 0.382; p = 0.031) and impulsive noise , but not with UFP exposure levels  and age , but not with continuous noise level . HRV Triangular index was significantly correlated with age  and BMI , but not with continuous or impulsive noise nor UFP exposure.There was a significant correlation between the HRV T-index and exposure to continuous , but not with impulsive noise parameters. Laeq8hr and Lc peak values were strongly correlated  (UFP parameters showed a significant correlation with continuous noise parameters (= 0.001) . β = −0.038, p = 0.016) and HRV T-index  on reducing HRV Total Power, and of Lc Peak on increasing both . (β = −92.95 p = 0.024), and marginally so for a decrease in T index . The multivariate analysis did not reveal any significant effect of UFP and noise on the SDNN, RMSSD, VLF, LF, HF, and LF/HF HRV parameters (data not shown).The multivariate linear regression model predicting HRV parameters showed a significant effect of Total LDSA ( index). . Age was2 value, from R2 = 0.476 to 0.292 for HRV Total Power, and from R2 = 0.512 to 0.443 for HRV T index (not shown in the Tables). Including the interaction terms between LDSA and Lc peak did not reduce the residual variance of the regression model predicting HRV Total Power and Triangular index. Only the noise parameter and age confirmed their effect, suggesting that the effect of UFP exposure in this working population was confounded by concurrent exposure to noise.The purpose of our study was to test the association of the concurrent exposure to nanoparticles and noise and early changes in cardiac autonomic regulation, as detected by continuous monitoring of HRV parameters, during working activity in an airport.Our findings suggest that impulsive noise may contribute to changes in the autonomic regulation of the heart immediately after exposure. We could not confirm the short-term effect of UFP on HRV previously reported in human studies ,25,26, aThe comparison between background and final HRV parameters showed a significant decrease for several time domain HRV indicators, such as SDNN and RMSSD, and a significant shift in frequency domain parameters, with an increase in VLF power and a decrease of HF power. Vagal activity is the major contributor to the HF component. A decrease in HF power might depend on a reduction in vagal activity .3), with a much larger Standard Deviation [UFP exposure in our study was higher than in similar studies , which requires a level of energy expenditure between 2.0 and 2.8 metabolic equivalents of task (METs), corresponding to a light-intensity activity . Workers3 and mean impulsive noise of 129 dB, conducted during a work shift, allowed us to highlight an association between exposure to impulsive noise and changes in HRV parameters, while concurrent exposure to noise would explain the observed association with UFP exposure. A decrease in HRV Total Power and Triangular index associated with impulsive noise exposure supports its influence on short-term cardiac autonomic control.In conclusion, our study of airport ground staff exposed to mean UFP concentration of 61,000 particles/cmFurther studies are warranted on monitoring personal exposure and early changes in cardiovascular control patterns, extended for several hours after exposure, to confirm the results of the present study.


Improving quality of life (QoL) has been one of the goals of health care for people living with oral cancer. This study aimed to assess QoL and investigate the effects of stigma, hope, and social support on QoL among Chinese oral cancer patients.A cross-sectional study was conducted at the Department of Stomatology, Shengjing Hospital of China Medical University and Stomatology Hospital of China Medical University in Liaoning Province, China, between May 2016 and October 2017. A total of 230 oral cancer patients were recruited to complete a questionnaire including the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), the Social Impact Scale (SIS), the Herth Hope Index (HHI) and the Multidimensional Scale of Perceived Social Support (MSPSS). Univariate one-way ANOVA/t-test, Person’s r and hierarchical linear regression analysis were conducted to explore the factors influencing QoL and the relationships between stigma, hope, perceived social support and QoL.The mean QoL score was 90.85 ± 20.15 among the patients with oral cancer. Stigma was negatively related to QoL, explaining 39.3% of the variance. In addition, hope and perceived social support were positively associated with QoL, explaining 8.1% of the variance.Overall, Chinese patients with oral cancer suffer from low QoL. Stigma was significantly and negatively associated with QoL, while hope and perceived social support were positively associated with QoL. Oral cancer patients’ psychological states should be addressed, and adequate intervention based on positive psychological resources should be provided to improve the QoL of patients with oral cancer. Oral cancer is a broad term for malignant tumours in the oral cavity, which may arise as a primary lesion in any part of the oral cavity or oropharynx, such as the lip, cheek, gingiva, tongue and floor of the mouth . AccordiQuality of life (QoL) for oral cancer patients is a reflection of patients’ life status after this disease diagnosis. In addition, QoL has also become a significant factor in monitoring treatment and therapeutic procedure success in recent decades . Poor QoIn fact, several studies have reported on the prevalence of cancer stigma . It has In the past decade, positive psychological resources such as hope and perceived social support have become increasingly important in clinical practice. During treatment, hope can be regarded as one of the most important and effective coping styles when patients face cancer. A systematic review reported that hope was associated with better quality of life and spiritual well-being in Asian patients with cancer . In addiHowever, to the best of our knowledge, extant studies have not yet explored the relationship of patients’ QoL with stigma, hope and social support in China. Therefore, in the current study, we aimed to assess QoL and the association of QoL with stigma, hope and social support in patients with oral cancer.A cross-sectional study was carried out from May 2016 to October 2017. All participants were recruited from the Department of Stomatology of Shengjing Hospital of China Medical University and Stomatology Hospital of China Medical University. Once patients agreed to participate in this cross-sectional study, they were distributed questionnaires and an informed consent form to read and sign. Patients were included if they met the following criteria: (1) were at least 18 years old, (2) were diagnosed with oral cancers, (3) were post-surgery, (4) were aware of their own diagnosis, (5) were well enough to answer the questionnaires, and (6) were able to accurately and fluently answer questions. Patients with the following criteria were excluded: (1) had a history of psychiatric or cognitive disorders, (2) were illiterate and unable to complete the survey, and (3) had other oral diseases or other cancers. Investigators were responsible for helping them to read questionnaire items and providing explanation without any inducement. Of the 271 patients who met the inclusion criteria, 41 patients were excluded because the missing values exceeded 30% in the questionnaire. Finally, completed questionnaires were obtained from 230 individuals, including 135 males and 95 females. The effective response rate was 84.8%.The study was approved by the Committee on Human Experimentation of China Medical University, and the study procedures were in accordance with ethical standards.Demographic characteristics consisted of age, gender, marital status, education level, monthly income, work status, and residence. Clinical characteristics included the type of treatment, mandibulectomy (resection of the mandible), distant cancer metastasis, and familial inheritance (family history of cancer).In this study, QoL was measured by the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), which comprises 39 questions and consists of five dimensions: physical well-being, social/familial well-being, emotional well-being, functional well-being, and head and neck cancer-specific subscales. Each item was rated on a five-point Likert scale from 0 for “not at all” to 4 for “very much”. The total score ranges from 0 to 144, with a higher score indicating a higher level of QoL. FACT-H&N as a specific instrument has been translated into many languages and validated in previous studies, including with Chinese patients –20. In oThe Social Impact Scale (SIS), developed to assess the level of stigmatization for individuals with cancer or HIV/AIDS , has beeThe Herth Hope Index (HHI)  was usedSocial support was assessed using the 12-item version of the Multidimensional Scale of Perceived Social Support (MSPSS), which was developed by Zimet et al. . This scR2, adjusted R2, R2 change, F-value and standardization regression coefficient (β). SPSS for Windows (version 22.0) was used to perform the statistical analyses, with a two-tailed P-value of < 0.05 considered to be statistically significant.This study used one-way ANOVA/t-test to describe the mean scores of QoL for different categorical demographic and clinical variables. Pearson’s correlation analysis was used to analyse the correlation among QoL, stigma, hope, and perceived social support. Hierarchical multiple regression analysis was conducted to investigate the effects of influencing factors on QoL. In hierarchical regression analysis, gender, age and potential variables  were entered in step 1. Stigma was added in step 2. Finally, the independent variables hope and social support were entered in step 3. The indicators provided in the regression models included t = 7.060, p = 0.008), marital status , residence , educational background , mandibulectomy , and distant metastasis ; however, the differences in the other variables were not statistically significant.Demographic and clinical characteristics of the patients and the FACT-H&N scores for different categories of variables are shown in Table r = −0.700, p < 0.01) and positively and significantly correlated with hope  and perceived social support .The results of correlation analyses between the continuous variables are presented in Table p < 0.05) were entered into the hierarchical multiple regression model. Each step of independent variables made a significant contribution to the variance in QoL. In step 1, demographic characteristics, including gender, marital status, residence area, and education level, and clinical variables, including distant metastasis and mandibulectomy as a whole, accounted for 9.9% of the variance in QoL. In step 2, after controlling for demographic and clinical characteristics, this study found stigma to be significantly and negatively associated with QoL. Stigma exerted a significant effect on the QoL of oral cancer patients . In step 3, positive psychological resources, including hope and perceived social support, were added into the model, and they were significantly positively associated with QoL. The two independent variables accounted for 8.1% of the variance in QoL. In addition, all variables in the model could explain 58.5% of the variance in QoL.As shown in Table This relatively large-scale cross-sectional study of patients with oral cancer was conducted in the northeastern region of China and was the first study to examine the effects of stigma, hope and social support on QoL in China. Our findings showed that the mean QoL score among Chinese patients with oral cancer was 90.85 ± 20.15, which is lower than that of patients with other head and neck cancers in China  , 28. In Among all the demographic and clinical variables, some variables were related to QoL, including marital status, residence area, educational level, undergone mandibulectomy and distant metastasis. These factors in combination explained 9.9% of the variance in the QoL of patients with oral cancer. The findings of our study showed that patients with a college education or higher had a higher QoL score, which echoed the findings of Liu’s study . On the One of the core findings in this study was that stigma alone explained more than one-third of the variance in QoL. Specifically, stigma was found to be significantly negatively associated with QoL, which was consistent with previous studies , 40. TreIn this study, perceived social support and hope were found to be positively associated with the QoL of patients with oral cancer. Patients with a high level of hope were likely to experience high QoL, which is consistent with a previous study . FurtherThe most important value of this study is that we identified that stigma was significantly negatively associated with QoL in oral cancer patients. In addition, our study has added to the evidence that the positive resources of hope and social support were positively associated with QoL in oral cancer patients. Based on our findings, some implications should be mentioned. First, Chinese medical institutions and government should pay more attention to oral cancer patients with low levels of QoL. Second, it is important for clinicians and nurses to pay more attention to patients with distant metastasis. Third, more attention should be devoted to patients with high stigma. Some studies have confirmed that contact with health professionals and the community , peer coNonetheless, there were some limitations in our study. First, because of the cross-sectional design and self-report measures, no conclusions could be drawn about a causal relationship between psychosocial resources and QoL. Second, this study was conducted in one city from a province of the northeastern region of China. The representativeness of the sample might thus be affected. Third, a control group should be included in our study. Thus, the interpretation of the results would be more convincing. Last, several potential factors, such as recurrence and pathological stage, may affect the QoL of patients with oral cancer, which we did not include in our study. A larger and longitudinal study should be conducted in future research.In conclusion, our study shows that patients with oral cancer in northeastern China suffer from relatively low QoL. Stigma was significantly and negatively associated with QoL, while hope and perceived social support were positively associated with QoL. Thus, in clinical practice, more attention should be devoted to patients’ psychological status, and more social support from family, friends or clinical workers should be provided to Chinese oral cancer patients. More importantly, more psychological intervention based on positive psychological resources should be introduced to improve QoL.


However, eyes with pachydrusen were not clustered with eyes from other AMD groups; instead, they were classified in the same cluster as eyes from the PSD group . In the PSD group, eyes with pachychoroid neovasculopathy were grouped in the same cluster of those with polypoidal choroidal vasculopathy (p < 0.001). The cluster analysis based on the CT profiles, including subfoveal CT, peripapillary CT, and their ratio, revealed a clustering pattern of eyes with AMD and PSDs. These findings support the suggestion that pachydrusen has the common pathogenesis as PSD.Choroidal changes have been suggested to be involved in the pathophysiology of both age-related macular degeneration (AMD) and pachychoroid spectrum diseases (PSD). To find out the choroidal characteristics of each disease groups, various groups of AMD and PSD were classified into several clusters according to choroidal profiles based on subfoveal choroidal thickness (CT), peripapillary CT, the ratio of subfoveal CT to peripapillary CT and age. We retrospectively analyzed 661 eyes, including 190 normal controls and 471 with AMD or PSDs. In the AMD groups, eyes with soft drusen or reticular pseudodrusen were belonged to the same cluster as those with classic exudative AMD (all  Vision can be preserved in the early stage of the disease in eyes with drusen. However, in the late stage, visual prognosis is poor due to the development of center-involving geographic atrophy (GA) or exudative maculopathy from macular neovascularization (MNV). In recent studies, various forms of exudative maculopathy have been presented in old age3. In addition to pachychoroid neovasculopathy (PNV), polypoidal choroidal vasculopathy (PCV) was presented as a main cause of exudative maculopathy in Asians7. Additionally, several diseases that share the characteristic of choroidal vessel engorgement or thickening6, are classified into pachychoroid spectrum diseases (PSDs). However, it is unclear whether the PCV and PNV are variants of AMD or a distinct disease entity8, and it is often difficult to differentiate PCV and PNV from typical neovascular AMD9.Typical age-related macular degeneration (AMD), which is characterized by the development of drusen, is a chronic degenerative disease of the photoreceptors, retinal pigment epithelium (RPE), Bruch’s membrane, and the choriocapillary in the human macula11. In many studies, both AMD and PSDs, which occur in the macula and are characterized by drusen or pachyvessel12, have been suggested to be associated with choroidal changes in their pathophysiology12. With the development of the enhanced depth imaging technique and swept-source optical coherence tomography (SS-OCT), the choroidal thickness (CT) can be measured in vivo, making it possible to measure macular CT in eyes with AMD and PSDs15. Previous studies with OCT showed variation of macular CT in eyes with AMD and PSDs15.The choroid is a vascular coat that supports the retina to maintain stable blood flow, nutrition, and temperature, and enters the back of the eye from the posterior and anterior ciliary artery19. In addition, it has been noted that the macular choroid is highly variable due to physiological or pathological reactions21. It has been suggested that the thickness of the choroid at the extra-macular area, as well as the macular area, reflects the characteristics of the patient's choroid23. In addition to the macular area, studies on the measurement of CT at the extramacular area have been performed, since the characteristics of the whole body of the patient may also be reflected in the choroid outside of the macula26. In addition, measurement of CT at the macular area, and outside of the macula, allows observation of the relative changes in the choroid of the macular area in macular disease29. Although many studies have shown changes in macular CT in eyes with AMD or PSDs, few studies have focused on changes in CT outside the macular area29. In this study, we hypothesized that CT profiles, including subfoveal CT, nasal peripapillary CT, and the ratio of subfoveal CT to peripapillary CT, can be the surrogate variables of the choroids in eyes with AMD and PSDs. And, we classified the eyes based on CT profiles into several clusters and compared the distributions of eyes between clusters with various groups of AMD and PSD.AMD and PSDs are diseases that occur in the macula, but that are not limited to the maculaA total 661 eyes of 661 subjects were included  , pachydrusen group (69 eyes), classic exudative AMD group (88 eyes), PPE group (36 eyes), PNV group 128 eyes), and PCV group (92 eyes). Age and gender were different among groups . In normal controls, subfoveal and peripapillary CT were correlated with age . The ratio of subfoveal CT to peripapillary CT was 2.24 ± 0.85 and was not correlated with age . Subfoveal CT, peripapillary CT, or the ratio of subfoveal CT to peripapillary CT was not different between males and females .In 190 eyes of normal controls, the mean subfoveal CT was 279.5 ± 99.5 µm and the peripapillary CT was 136.3 ± 56.6 µm, respectively, and they were correlated with each other . Subfoveal and peripapillary CT were correlated with age . The ratio of subfoveal CT to peripapillary CT was 1.98 ± 0.87. Subfoveal and peripapillary CT of males  was greater than that of females  . However, the ratio of subfoveal CT to peripapillary CT was not different between males and females (p = 0.551).In 471 eyes of with AMD or PSD, the mean subfoveal CT was 234.2 ± 108.8 µm and the peripapillary CT was 128.8 ± 64.7 µm, respectively, and they were correlated with each other  (see Supplementary Table S1). The mean subfoveal CT of the classic exudative AMD was also lower than that of normal controls, as well as in the pachydrusen group, PPE, PNV, and PCV groups . The subfoveal CT of the pachydrusen group was greater than that verified in the early AMD, classic exudative AMD, and PCV groups . However, it was not different from those in normal controls, PPE, and PNV. The mean subfoveal CT of the PSD groups was not different from normal controls. The mean subfoveal CT of the PSD groups, except PCV, was greater than that of the AMD groups, except pachydrusen group . The subfoveal CT of PCV was significantly greater than the classic exudative AMD group (p < 0.001), but lower than the pachydrusen group (p = 0.014). When considering the difference between age and gender, the estimated marginal means of subfoveal CT were different between groups. Bonferroni-adjusted post hoc tests showed that the mean subfoveal CT in eyes of AMD groups, except the pachydrusen group, was lower than those in normal controls and PSD groups Table . The meap = 0.032, p < 0.001, respectively). The peripapillary CT of PSD groups except PNV group were not different from those of normal controls. However, the peripapillary CT of PNV group was significantly greater than those of normal controls (p < 0.001). The peripapillary CT of PNV group was significantly greater than those of classic exudative AMD group (p < 0.001), while the peripapillary CT of PCV group was not different from those of the classic exudative AMD group (p = 0.527).The estimated marginal means of peripapillary CT in eyes of the AMD groups were not different from those of normal controls. The peripapillary CT in eyes of the AMD groups, except classic exudative AMD group, was not different from those in the PSD groups. Peripapillary CT of classic exudative AMD group was significantly lower than those of PPE and PNV , but not different from the PSD groups. However, the ratio of subfoveal CT to peripapillary CT in eyes of the pachydrusen group was not different from normal controls but was greater than those in the AMD groups . The ratio of subfoveal CT to peripapillary CT in eyes of the PSD groups, except the PNV group, was not different from those of normal controls and AMD groups. The ratio of subfoveal CT to peripapillary CT in eyes of the PNV group was greater than those of normal controls (p = 0.002).The estimated marginal means of the ratio of subfoveal CT to peripapillary CT in eyes of the early AMD and classic exudative AMD groups were significantly lower than those in normal controls  (Table p < 0.001); however, it was independent of age (p = 0.168).In a total 661 eyes, ANCOVA, including age, gender, and groups of AMD or PSDs, showed a correlation between subfoveal and peripapillary CT and age and groups of AMD or PSD (y) Table . The ratIn addition to age, subfoveal CT, peripapillary CT, and the ratio of subfoveal CT to peripapillary CT was selected for CT profiling.Choroidal thickness profiles from 661 eyes were categorized into 2, 3, or 4 clusters Table . When thp < 0.001) . In the PSD groups, most eyes of the PNV and PCV groups tended to be in the same clusters, independent of the number of clusters set to 2, 3, or 4 . When the number of clusters were set to 2, the distribution of eyes in the PNV or PCV group was not clearly separated from the cluster of eyes in the early AMD or classic exudative AMD groups. However, when the number of clusters increased to 3 or 4, eyes in the PNV or PCV groups were distinguished in different clusters from eyes in the early AMD or classic exudative AMD groups. Eyes of the PPE group belonged to clusters with the ratio of subfoveal CT to peripapillary CT > 2.0, independent of the number of clusters.Among the AMD groups, most eyes of the early AMD and classic exudative AMD groups belonged to the same clusters, independent of the number of clusters set to 2, 3, or 4  and OCT findings for the diagnosis of drusen and used the evaluation and consensus of independent researchers for the classification of drusen. However, the limitation persisted regarding the lack of an absolute standard for classifying soft drusen and pachydrusen. Because of the cross-sectional nature of this study, it does not provide longitudinal information about whether each disease group will retain or change its characteristics of choroid. For PSDs, we only included eyes with PPE, PNV, or PCV. But we did not include other types of PSD such as peripapillary pachychoroid syndrome, focal choroidal excavation, or CSC. Therefore, the results of this study may not be applicable to all PSDs. We included only one symptomatic eye for each patient. It was not confirmed whether the results of this study could be applied to contralateral eyes of patients. Further research is required.In conclusion, we showed that CT profiling using subfoveal CT, peripapillary CT, and the ratio of subfoveal CT to peripapillary CT was useful to show a variation in CT at the macula and outside of the macula in eyes with various degrees of AMD and PSDs. Classification of the CT profile showed specific clustering patterns among various AMD or PSD groups. However, eyes with pachydrusen were not clustered with eyes in other AMD groups; they were clustered with those in the PSD groups. Therefore, CT profiling may help determine the effect of choroid on the development and progression of AMD and PSDs.The Institutional Review Board of Korea University approved this study (IRB number: 2020AN0280), and all research and data collection were conducted in accordance with the tenets of the Declaration of Helsinki.In this retrospective cross-sectional comparative study, patients with AMD or PSDs in the SS-OCT database were reviewed between March 2016 and May 2020 at the Korea University Medical Center. From the database, we included eyes with AMD or PSDs. For age-related PSDs, we only included eyes with PPE, PNV, or PCV. We also included a group of normal controls who had eyes with bilateral normal fundus or eyes with epiretinal membrane in their fellow eyes. In cases with MNV in one eye and drusen in the contralateral eye, we selected eyes with MNV. Only one eye per patient was selected for this study in other groups of AMD or PSDs. Other exclusion criteria were as follows: eyes with disciform scar or center involving geographic atrophy, eyes with both soft drusen and pachydrusen, patients who underwent photodynamic therapy, laser photocoagulation or an intraocular surgery, except cataract surgery, and prior history of intravitreal injection of anti-vascular endothelial growth factor within 6 months.All normal subjects underwent FP, and SS-OCT . And, all patients with soft drusen, reticular pseudodrusen, pachydrusen and PPE underwent FP, fundus autofluorescence (FAF), near infrared reflectance (NIR) images and SS-OCT and SS-OCT angiography. All patients with MNV also underwent fluorescein angiography (FA) and indocyanine green angiography (ICG) . Classification of neovascular lesions and drusen was performed independently by two retina specialists (Y.K. and B.L.) who evaluated the FP, FAF, NIR, OCT, OCTA, FA, and ICG images.38, and they were classified as reticular pseudodrusen, soft drusen, and pachydrusen. Subsequently, the eyes with various types of drusen were grouped into early AMD group with soft drusen or reticular pseudodrusen60 and group with pachydrusen61. Eyes with MNV were classified as a classic exudative AMD group.The extracellular deposits (drusen) were determined using FP and SS-OCT, based on the criteria used in previous studies62. We defined PNV by modifying the definitions from previous studies34 and diagnosed these cases after reviewing the medical records of patients with neovascular AMD using the following criteria: (1) definite neovascularization on OCT and ancillary images, including OCTA and FA/ICG images; (2) no soft drusen or reticular pseudodrusen in both eyes ; (3) with or without pachydrusen in either eye; (4) PPE or CSC characteristics: choroidal vascular hyperpermeability on ICG, the presence of dilated outer choroidal vessels (pachyvessels) with attenuation, and thinning of the choriocapillaris and Sattler’s vessels, or a history of CSC. PCV was diagnosed by ICG showing single or multiple polypoidal aneurysmal bulges with or without a branching vascular network. A third supervising grader (J.O.) evaluated the lesion type in the presence of significant discrepancies.We classified eyes with PSDs into PPE, PNV, and PCV groups based on previous studies. PPE was determined when eyes had PPE with characteristic RPE alterations, except pachydrusen, and either a focally or diffusely thickened choroid seen with SS-OCT63, the subfoveal CT and peripapillary CT were measured to represent the CT in the macular area and CT on the outside of the macular area, respectively. We measured subfoveal CT from a 9-mm line scan, which was centered on the fovea and averaged 96 B-scans to improve the signal-to-noise ratio. Additionally, we measured peripapillary CT from a 12-mm by a 9-mm volume scan image, which was centered between the fovea and the optic disc  for normally distributed continuous variables. Analyses of covariance (ANCOVA) with adjustments for age and gender were performed to assess differences in the measurements between groups. In the analysis of covariance tests, we estimated marginal means of CT as calculated and compared between groups. We considered results to be statistically significant at p values < 0.05. All statistical analyses were performed using SPSS software version 20.0 .To determine the parameters comprising the CT profile, we compared various parameters, including age, gender, subfoveal CT, peripapillary CT, and the ratio of subfoveal CT to peripapillary CT between AMD and PSD groups. Additionally, we determined the factors that comprise the CT profile. We compared the characteristics of the groups by using the independent t-test for continuous variables, and the chi-square test for categorical variables. We analyzed linear correlations with Pearson’s correlation coefficient , and adhered to the tenets of the Declaration of Helsinki.This retrospective study involves no more than minimal risk to subjects and the IRB of Korea University Hospital approved our request to waive of informed consent.Supplementary Information


Colon cancer is a common malignant tumor of the gastrointestinal tract. Therefore, a clear diagnosis is particularly important for the treatment of colon cancer. Ultrasound and spiral computed tomography (CT) can both be used in the diagnosis, but each has its own advantages and disadvantages, which could cause confusion in clinical choice. The purpose of this study was to systematically evaluate the practicability of spiral CT and ultrasound in the diagnosis of colon cancer.A systematic search was performed by retrieving on English databases  and Chinese databases . Besides, manually search for Google and Baidu academic of diagnostic experimental study of ultrasound and spiral CT in the diagnosis of Colon Cancer. The retrieval time limit was from the establishment of the database to October 2020. Two researchers independently extracted and evaluated the quality of the data in the included study. A meta-analysis was performed using Meta Disc1.4 and RevMan5.3 software.Sensitivity, specificity, positive Likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were used to determine the diagnostic efficacy of ultrasonography and helical CT in colorectal cancer.This study will compare the practicability of CT and ultrasound in the diagnosis of colon cancer and provide reliable evidence-based basis for clinicians to choose the appropriate or best evidence-based basis.The private information from individuals will not be published. This systematic review also will not involve endangering participant rights. Ethical approval is not required. The results may be published in a peer-reviewed journal or disseminated in relevant conferences.DOI 10.17605/OSF.IO/WAJHQ As the early symptoms are not obvious, hematoma, diarrhea, change of bowel habits, local abdominal pain, anemia, and other symptoms occur along with the increase of cancer, and most of the patients’ early symptoms are not easily detected. In the past 20 years, about 20% of the patients have reached the late stage of clinical diagnosis and lost the best time for treatment. The 5-year survival rate of colon cancer after radical resection is 60% to 80%, so early detection and treatment are of great significance for improving prognosis. Colonoscopy and barium meal examination are commonly used in the diagnosis of colon cancer. However, it is difficult to determine the depth and range of invasion, which may cause discomfort to patients in the meanwhile. Clinical studies have shown that the depth of invasion of colon cancer, the presence or absence of lymph node metastasis and distant metastasis are the key factors affecting the clinical prognosis of rectal cancer. Therefore, the application of imaging methods to fully demonstrate the anatomical relationship of the pelvic cavity, accurately evaluate and summarize the tumor stage, surrounding anatomical relationship and metastasis is of great value for the reasonable formulation of treatment and improvement of clinical prognosis. CT is currently the main method for the diagnosis and staging of colon cancer. However, due to the limited contrast of soft tissue, its staging of primary tumor (Stage T) or detection of extramural invasion are generally unsatisfactory, with an accuracy rate between 60% and 80%.–9 Meanwhile, it has a low accuracy in detecting nodal involvement, and is expensive and cannot be widely used in the early stages of the disease. Ultrasound is widely used in the general survey and screening of parenchymal organs due to its advantages of low price, non-invasiveness, simplicity, and strong repeatability. Due to the interference of gas, ultrasound has long been considered as a difficult examination method to determine the details of the lesions. With the progress of technology and the improvement of image quality, ultrasound is becoming both convenient and affordable, and the diagnosis of colon cancer by ultrasound technology has once again attracted the attention of clinicians.Colon cancer is a common malignant tumor of digestive system with high morbidity and mortality. In the United States, colorectal cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer death.–14 the conclusions are not consistent. The purpose of this systematic evaluation is to evaluate the reliability of 2 imaging methods in the diagnosis of colon cancer and to provide an evidence-based basis for clinicians.Although a number of experimental studies have compared the practicality of ultrasound and CT in the diagnosis of colon cancer,22.1 And, it has been registered on the open science framework (OSF) on October 24, 2020. (Registration number: DOI 10.17605/OSF.IO / WAJHQ).This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols (PRISMA-P).2.2Since this is a protocol with no patient recruitment and personal information collection, the approval of the ethics committee is not required.2.32.3.1We will collect case–control studies and cohort studies of ultrasound compared with spiral CT in the diagnosis of colon cancer. Regardless of blinding, publication status, region, but Language will be restricted to Chinese and English.2.3.2Patients were diagnosed with colon cancer by ultrasound or CT and confirmed by pathological examination as the gold standard. There were no restrictions on nationality, race, age, sex, course of disease, etc.2.3.3The observation group and control group were examined by ultrasound and CT respectively, and there was no limitation on the type of examination equipment. All patients underwent pathological examination to evaluate the accuracy of the imaging examination.2.3.4Sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (–LR), diagnostic odds ratio (DOR), summery receiver operating characteristic curve (SROC), area under curve (AUC) of ultrasound, or spiral CT in the diagnosis of colon cancer.2.4Studies published repeatedly; studies whose literature are abstract or data are incomplete, or whose data could not be obtained after contacting the author; abstracts, comments, reviews, case reports, etc; studies with obvious data errors; studies without gold standard verification.2.5“Ultrasound” (chao sheng), “Spiral CT” (luo xuan CT), “Colon neoplasms” (jie chang zhong liu), “Colon cancer” (jie chang ai), “Colorectal cancer” (da chang ai) were used for retrieval in Chinese databases, including CNKI, Wanfang Data Knowledge Service Platform, VIP Information Chinese Journal Service Platform, and China Biomedical Database. English retrieval words such as “Ultrasound,” “Spiral CT,” “Spiral Computed Tomography,” “Colonic Neoplasm,” “Colon Cancer” were used for retrieval in English databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library. The retrieval time was from the establishment of the database to October 2020, and all the domestic and foreign literatures about the diagnosis of colorectal cancer by ultrasound contrast spiral CT were collected. Take PubMed as an example, and the retrieval strategy is shown in Table 2.6Referring to the method of research selection in version 5.0 of the Cochrane collaboration Network system Evaluator Manual, according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow chart, the 2 researchers used the EndNote X9 document management software to independently screen and check the literature according to the above inclusion and exclusion criteria, and check each other, if there were different opinions, negotiate with a third party to resolve the differences. According to the inclusion and exclusion criteria of the literature, 2 researchers independently extracted relevant data from each eligible study and recorded them through Excel 2013. Basic features of the included studies, including first author, year of publication, language, research country, number of experimental cases, imaging method, gold standard, etc. Key elements of bias risk assessment. The outcome measurement index data concerned, such as true positive value, false positive value, true negative value, false negative value, etc. The literature screening process is shown in Fig. 2.7 were used to evaluate the risk of bias in the included literature. The tool consists of 2 aspects: bias evaluation and applicability, including case selection, trial to be evaluated, gold standard, case flow, and progress. The choices of “high risk,” “low risk,” and “unclear” are given respectively for the items covered by all areas. Risk bias evaluation was given by the 2 researchers according to the performance of the included literature in the above evaluation items, and cross-checked after completion respectively. In case of any disagreement, discussion was required. If no agreement could be reached, a decision would be made in consultation with researchers from the third party.QUADAS-2 quality evaluation criteria2.82.8.1I2 values. If , there was low inter-study heterogeneity, and the fixed-effect model was adopted to conduct a meta-analysis. If , it indicated inter-study heterogeneity and should explore the source of heterogeneity. Calculate the sensitivity (SEN), specificity (SPE), positive likelihood ratio (+LR), negative likelihood ratio (–LR), diagnostic odds ratio (DOR), and its 95% confidence interval (CI), draw summary receiver operating characteristic curve (SROC), and obtain area under curve (AUC). At the same time, the sensitivity analysis of the literature was excluded one by one to evaluate the stability of the research results.Meta analysis was performed using RevMan 5.3 software and Meta Disc 1.4 software. Heterogeneity was determined by 2.8.2If there is missing data in the article, contact the author via email for additional information. If the author cannot be contacted, or the author has lost relevant data, descriptive analysis will be conducted instead of meta-analysis.2.8.3This study will carry out a subgroup analysis based on the different patient characteristics, index and reference tests, and outcome indicators.2.8.4If there are >10 studies, the Deek funnel plot will be used to assess potential publication bias. Moreover, Egger and Begg test were used for the evaluation of potential publication bias.2.8.5 The evaluation includes bias risk, indirectness, inconsistency, inaccuracy, and publication bias. The quality of evidence will be rated as high, medium, low, or very low.We will use Grading of Recommendation Assessment, Development and Evaluation (GRADE) scoring method to grade the evidence of the outcome index.3 and is highly sensitive to tumor invasion of colon cancer beyond the intestinal wall (T1–T2 vs T3–T4). However, it remains a challenge to detect tumor invasion of 5 mm or more (T1–T3ab vs T3cd–T4). There are also problems of radiation damage and high cost.Due to the lack of typical clinical symptoms and signs in the early stage of colon cancer, early diagnosis and differentiation is relatively difficult. CT is a common method for the diagnosis and staging of colon cancer. It has advantages in detecting extramural invasion and lymph node metastasis of colon cancer For patients with clinical findings of abdominal mass, the location, shape, size, internal echo, boundary, mobility, and the relationship with surrounding organs of the mass can be clearly displayed, as well as whether there is invasion and metastasis.The advantages of ultrasound diagnosis of colon cancer are as follows: as a non-invasive examination method, ultrasound is relatively inexpensive and is not limited by time and place. It is easy to be accepted by patients and can be used as the preferred screening method for colon cancer.Both ultrasound and spiral CT have their own advantages in the diagnosis of colon cancer. How to choose an appropriate examination scheme to maximize the benefit of both patients and decision-making doctors is an urgent problem to be solved. This systematic review hopes to provide effective information for clinicians to understand the practicability of the 2 imaging methods, and to provide the best way for the diagnosis of colon cancer patients.However, this systematic review has some limitations. Different types of equipment, frequency of ultrasound probe, and thickness of spiral CT scan used in the included studies may cause some clinical heterogeneity. In addition, due to the limitation of language ability, we only search English and Chinese literature and may ignore studies or reports in other languages.Data curation: Fan Zhao, Qingya Yang.Funding acquisition: Qingya Yang.Literature retrieval: Fan Zhao and Qingya Yang.Resources: Fan Zhao, Qingya Yang.Software: Cunzhong Meng.Supervision: Tao Jiang.Writing – original draft: Fan Zhao, Tao Jiang.Writing – review & editing: Fan Zhao, Qingya Yang.