P < 0.01). Regarding kidney function at one year or two years after operation, the PU group had significantly improved mean estimated glomerular filtration rate (eGFR) levels and a remarkably decreased constitution of patients with chronic kidney disease (CKD) III or higher group (P < 0.05). There was no significant difference in PFS and OS between the RNU group and the PU group (P > 0.05). Multifactor Cox regression analysis indicated that age and the preoperative CKD stages were independent risk factors for poor kidney functions of UTUC patients. Compared to patients in RNU group, patients in PU have no significant difference in survival time but have shorter operation time, shorter hospital stay, and improved kidney functions.This study aimed to compare the oncological and renal outcomes of partial ureterectomy (PU) versus radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). UTUC patients' clinical information was reviewed, and progression-free survival (PFS), overall survival (OS), and kidney function were collected. The mean follow-up period was 59 (6–135) months in the RNU group and 34.5 (5–135) months in the PU group. The mean operation time in the PU group was 141 (64–340) min, which is significantly shorter than the RNU group ( Generalper year . It is wper year , 13. In It has become increasingly recognized that, in addition to the radical surgery, a partial ureterectomy (PU) could be used for specific UTUC patients with low risk of aggressiveness. PU could save more kidney tissue compared with radical surgery and improve the patient's renal function. Therefore, PU could reduce the risk of cardiovascular death caused by chronic kidney disease . ImportaIn this retrospective cohort study, UTUC patients who underwent RNU or PU at the Department of Urology, Beijing Chaoyang Hospital, Medical Capital University, were included. Patients' clinical information was reviewed, and the follow-up parameters include the progression-free survival (PFS) and the overall survival (OS), as well as the kidney functions. This study was approved by the Institutional Review Board of the Beijing Chaoyang Hospital, Medical Capital University. Patients' informed consent for both the collection of hospital medical records and follow-up was obtained.Between June 2005 and June 2016, UTUC patients who underwent RNU or PU at the Department of Urology, Chaoyang Hospital, Beijing Capital University, were included. The included patients were all pathologically diagnosed with primary urothelial carcinoma located at the upper tract of the ureter and underwent surgical management. Patients with distal metastasis, immune deficiency, and UTUC occurring at the transplanted urinary system or patients with severe cardiovascular disease, hepatic disease, or pulmonary disease that could not tolerate the operation were excluded from this study. As a result, complete data on age, gender, smoking status, Eastern Cooperative Oncology Group (ECOG) score, tumor stage, operation duration, and estimated glomerular filtration rate (eGFR), as well as chronic kidney disease (CKD) stage were available for all the included patients that met the inclusion criteria.According to the type of surgery, all the included patients were divided to either a RNU group or a PU group. The patient's treatment was decided by their clinician in consultation with the patient. The patients receiving PU included low-risk patients , older Pathological verification was obtained via examination by dedicated genitourinary pathologists at Chaoyang Hospital, Beijing Capital Medical University. Tumor grading was evaluated based on the 1998 World Health Organization/International Society of Urologic Pathology WHO/ISUP consensus . Tumors Hospital medical records of all the included patients were reviewed to obtain the presentation of the disease, the pathological verification, the indication for treatment, and clinical outcomes, such as postoperative complications, kidney function, the recurrence of tumors, disease progression, and survival status. Disease progression was defined as the upstaging of clinical or radiological features or subsequent pathological upgrading or upstaging in patients who underwent nephroureterectomy. The PFS in this study is defined as the length of time after the PU or RNU that a patient lives with the disease without disease progression. The kidney event was considered if patients who were not at baseline CKD III had progressed to CKD III after surgical treatment or patients with CKD III staging further worsened during the follow-up.The initial follow-up of patients who underwent RNU or PU included cystoscopy or ureteroscopy surveillance at 3 months. In the first year after operation, patients were followed up every 3 months. In the second year, patients were followed up every 6 months. From the third year after the surgery, patients were followed up once a year. The length of further follow-up intervals was determined according to the presence of tumor recurrence. The contents of follow-ups included creatinine, imaging, and cystoscopy. The oncology outcome was evaluated by intravenous urography (IVU) or computed tomography  urographt-test, and the Mann–Whitney U test was performed using continuous variables that did not conform to the normal distribution. Classification variables were analyzed by chi-square test or Fisher exact test, PFS, OS, kidney events using K-M curves, and log-rank tests. Age, sex, preoperative CKD stage, and operation were analyzed by multivariate Cox regression model.Statistical analysis was performed using SPSS version 22.0 . Continuous variables that conform to the normal distribution were expressed as means ± SD, and the median variable that did not conform to the normal distribution was expressed by median . ContinuP = 0.011). The sex constitution was comparable between the RNU group  and the PU group . Importantly, the constitution of tumor stage had no significant difference (P = 0.444). For localized tumors (Tis-T1), there were 28 (25.69%) in the RNU group and 15 (31.25%) in the PU group. For locally advanced tumors (T2-T3), there were 80 (73.39%) and 32 (66.67%) in the RNU group and the PU group, respectively. Therefore, the constitution of tumor grade between the two groups had no statistical difference (P = 0.392). Moreover, the kidney function, one of the primary outcomes for this study, was statistically compared between the RNU and PU groups based on the eGFR value (P = 0.878) and CKD stage (P = 0.912). Overall, the baseline characteristics between the RNU and the PU groups had no significant difference regarding the comparison of the main outcomes applied in this study.A total of 157 patients were included, including 109 cases who underwent RNU and 48 cases who underwent PU. The median follow-up time was 59.5 months (6–135) in the RNU group and 34.5 months (5–135) in the PU group. P < 0.001). In addition, the requirement for blood transfusion was similar between the RNU group  and the PU group . To evaluate the technical difficulty and perioperative recovery, we further compared the operation time and the length of stay at hospital for UTUC patients included in this study. Notably, the operation time of PU  was sharply reduced compared with the RNU group . More importantly, the length of stay at hospital for UTUC patients who underwent PU was also dramatically reduced to 17.5 days (5–37 days), compared to patients who underwent the RNU . Moreover, the progression-free survival (PFS) of UTUC patients who underwent RNU or PU was statistically similar as well  in the RNU group and 34.5 months (5–135) in the PU group. Nevertheless, there was no significant difference in the overall survival (OS) of UTUC patients who underwent RNU or PU . In addition, the constitution of patients with CKD III or higher in the RNU group was 53.21% (58/109), while in the PU group it was 25% . To explore the critical factors that affect the survival of UTUC patients, the multivariate Cox regression analysis was performed including potential risk factors, such as age, sex, CKD stage, and surgery. As a result, age and CKD stage were demonstrated to significantly contribute to the survival of UTUC patients in this study (P < 0.05).There were no significant differences in the odds of CKD III or higher and the mean values of eGFR between the RNU group and the PU group at three months after the operation . Regarding the kidney function at 1 year or 2 years after operation, the PU group had significantly higher mean eGFR levels than the RNU group and a remarkably decreased constitution of patients with CKD III or higher stage (P < 0.05). Importantly, there was no significant difference in PFS and OS between the RNU group and the PU group (P > 0.05). Multifactor Cox regression analysis indicated that age and the preoperative CKD stages were independent risk factors for poor kidney functions of UTUC patients. Overall, UTUC patients treated by PU and RNU have no significant difference in survival time, but PU patients have shorter operation time and hospital stay, as well as improved long-term outcomes of kidney functions.In this study, among the 157 UTUC cases included in this study, 109 patients underwent RNU and were assigned to the RNU group, while 48 cases were in the PU group. The mean operation time in the PU group was significantly shorter than the RNU group  compared with the RNU group . This is reasonable because the technical procedures for RNU are more complicated than the PU group, which do not need the excision of the kidney. In keeping with that, the trauma brought to the patients by PU is sharply decreased compared with the RNU treatment. In this case, the small resection range, short operative time, and low complication rate contribute to the decline of trauma in the PU treatment. Therefore, the hospital stay as well as the cost for patients in the PU group are significantly reduced.A limitation of our present study is the study design. Since UTUC is a relatively rare disease, we applied the retrospective cohort study to elucidate the potential role of RNU or PU in the treatment of UTUC. In addition to the retrospective design, the single institution study and limited sample size are also the limitations of the current study. Moreover, these results should be interpreted with caution for lack of subgroup analysis according to stage and grade of UTUC. Current European Urology guidelines suggest conservative treatment for low-risk patients, but in this study some high-risk patients were included in the PU group. Further perspective random controlled trails with a large sample size are needed to confirm the role of PU in the treatment of UTUC.Our study suggests that, compared with cases who underwent RNU, UTUC patients treated by PU have no significant difference in survival time but have shorter operation time and hospital stay, as well as improved long-term outcomes of kidney functions. For specific UTUC patients, PU shows more favorable benefits compared with RNU treatment. However, further perspective random controlled trails with a large sample size are needed to confirm the recommendation.


Cognitive dysfunction frequently occurs in aphasic patients and primarily compromises linguistic skills. However, patients suffering from severe aphasia show heterogeneous performance in basic cognition. Our aim was to characterize the cognitive profiles of patients with severe aphasia and to determine whether they also differ as to residual linguistic abilities. We examined 189 patients with severe aphasia with standard language tests and with the CoBaGA , a battery of nonverbal tests that assesses a wide range of cognitive domains such as attention, executive functions, intelligence, memory, visual-auditory recognition, and visual-spatial abilities. Twenty patients were also followed longitudinally in order to assess their improvement in cognitive skills after speech therapy. Three different subgroups of patients with different types and severity of cognitive impairment were evidenced. Subgroups differed as to residual linguistic skills, in particular comprehension and reading-writing abilities. Attention, reasoning, and executive functions improved after language rehabilitation. This study highlights the importance of an extensive evaluation of cognitive functions in patients with severe aphasia. Formerly, aphasia was considered exclusively as a linguistic deficit . HoweverCognitive impairments have frequently been observed in patients with aphasia . A recenAccording to some authors, the occurrence of other cognitive deficits in association with language impairment can seriously worsen the symptomatology of aphasia  and may For this reason, some authors have introduced simple nonverbal test batteries for assessing the cognitive abilities of aphasic patients. For example, Kalbe et al.  developeHelm-Estabrooks  also exaVan Mourik et al.  studied Hinckley and Nash  replicatIn summary, according to the studies mentioned above, most patients with aphasia also suffer from other neuropsychological disorders . MoreoveThe first aim of the present study was to evaluate the existence of different profiles of cognitive impairment in a large sample of patients with severe aphasia based on the severity and type of cognitive deficits (study 1). The cognitive abilities studied were attention, executive functions, logical reasoning, visual-spatial ability, memory, and visual and auditory recognition. The integrity of these functions was evaluated with a battery of simple tests that do not require verbal responses and are, thus, suitable for patients with severe aphasia. We were also interested in verifying whether patients with different profiles of cognitive deficits also differ in terms of their residual linguistic skills.The second aim of the present study was to examine whether speech therapy also improves cognitive skills and which cognitive skill is predictive of greater language recovery (study 2). For this purpose, we examined a group of patients longitudinally pre and post treatment.In this study, we assessed the existence of different profiles of cognitive impairment in patients with severe aphasia and the relationship between cognitive and linguistic skills. The linguistic skills investigated were oral and written comprehension, naming, reading-spelling, and repetition.One hundred eighty-nine patients , mean age 66 years (SD: ±11.6), were examined 126 days (SD: ±180) after a stroke. Mean educational level was 6.3 years (SD: ±4). The inclusion criteria were the presence of a selective lesion of the left cerebral hemisphere and severe aphasia. In particular, only patients with a score on the Token Test  with moderate–high school attendance , and the second group included 33 subjects  with low school attendance (≤5 years mean school attendance: 4.5). Subjects with a history of neurological impairment and developmental linguistic disorders were not included in the control sample.The study was conducted in accordance with the Declaration of Helsinki (1964) and was approved by the Ethical Committee.Lesion sites were classified on the basis of neuroradiological and clinical evidence of the cerebral arterial territory involved. In particular, the Oxford Community Stroke Project  classifThe CoBaGa  wasr = 0.71) and good internal consistency  and discriminant validity . Moreover, the CoBaGa has good convergent validity with other etero-valutative instruments  = 0.72, p < 0.001) as well as good divergent validity (with FIM motor score: r Pearson (Pearson'sr) = 0.32, p = ns). The CoBaGa also has proven sensitive in detecting follow-up changes in performance (at least p < 0.05).The CoBaGa is a reliable battery; it has a good test-retest correlation one month after it has been administered : r PearPatients' cognitive ability was tested with the CoBaGa see  and withAll patients consecutively admitted to the Neuropsychological Unit of the Department of Neurological Rehabilitation, Salvatore Maugeri IRCCS Foundation, Cassano delle Murge , from 2005 to 2010 participated in the study. Patients and their caregivers were informed about the aims of the study and gave their consent to participate. To avoid distraction, patients were evaluated individually in a quiet room. Testing was interrupted if a patient showed any sign of tiredness. Before the tests were administered, information was gathered concerning patients' clinical history and previous abilities. Any human data included in this manuscript was obtained in compliance with the Declaration of Helsinki.A cluster analysis was performed on accuracy scores of the different subtests of the CoBaGa. A hierarchical cluster analysis was performed preliminarily to determine the number of clusters in the examined population. Subsequently, a K-means cluster analysis was performed to optimize the assignment of patients to the clusters.χ2 was performed to verify gender distribution in the groups.A one-way analysis of variance (ANOVA) was performed to determine whether the clusters of the patients identified differed as to sociodemographic and clinical variables such as age (in months), time from stroke, and years of schooling. Significant differences were examined with the post hoc Tukey test. Analysis of An ANCOVA analysis was used to determine whether the groups performed differently on the CoBaGa subsets. The dependent variable was the accuracy percentage on each CoBaGa subset. The independent variable was the cluster membership of the subjects. Significant sociodemographic variables that emerged from previous analyses were used as covariates in the ANCOVA.Moreover, to better characterize the cognitive impairment in each group, an ANOVA was performed with the type of subset  as independent variable and the subset mean percentages of accuracy for each cluster as dependent variables. The significant effects were explored with a post hoc Tukey test.χ2 tests.Finally, for each group, the number of patients who performed pathologically was computed for each subset. Severity of impairment was also evaluated. In particular, performances 2 SD lower than the mean of the control groups paired for school attendance (low or high school attendance) were considered pathological. In patients who performed pathologically, the severity of the deficit was evaluated on the basis of the performance of the whole group of patients  with comAn ANCOVA was performed on the accuracy scores of both the EoL and the AAT tests to verify whether subjects who belonged to the three clusters differed as to accuracy on the linguistic tests. Significant sociodemographic variables were used as covariates. Interactions were explored by planned comparisons.Furthermore, the linguistic skills able to predict the total score on the CoBaGA were also examined separately for the AAT and the EoL score. In particular, regression analyses were performed with the total score on the CoBaGa as dependent variable and oral and written comprehension, naming, reading-spelling, and repetition as independent variables. Analyses were replicated also controlling for the effect of significant sociodemographic variables. In this case, the significant sociodemographic variables were entered first as predictors and after the other language scores.The cluster analysis showed that there were three subgroups of patients with different cognitive profiles. The first group included 34% of the patients (65 patients), the second group 40% (75 patients), and the third group 26% (49 patients). Demographic and clinical characteristics of the three groups are presented in F = 8.52, p < 0.0001). In particular, the first group had a significantly higher educational level than the second (p < 0.001) and the third (p < 0.001) groups. No gender differences were observed in the three groups .The analysis of variance revealed that the three groups of patients were comparable for mean age and time from stroke but differed for years of schooling  also when the level of school attendance of the patients was taken into account. The first group had higher percentages of accuracy than the second and the third groups for all cognitive functions. The second group had intermediate percentages of accuracy, and the third group had the lowest percentages of accuracy in all subtests, suggesting severe cognitive impairment.F = 40.7, p < 0.0001; group 2: F = 135.3, p < 0.0001; group 3: F = 27, p < 0.0001). An examination of subtest means showed that the first group had the highest percentages of accuracy in the memory test  and the lowest percentages of accuracy in the executive functions and logical reasoning subsets . The accuracy of this group in attention, visual-spatial ability, and visual-auditory recognition tests was comparable, with 80% accuracy. Subtest comparisons were also significant in the second (at least p < 0.05) and in the third group (p < 0.05). The second group was characterized by high performance in the memory test (82% of accuracy), moderate performance in visual-auditory recognition (59%), and low performance in visual-spatial ability (38%), attention (27%), and executive functions-logical reasoning (20%). The third group was characterized by generally low percentages of accuracy, that is, 7% for attention and executive functions-logical reasoning, 16% for visual-spatial ability, 25% for memory, and 33% for visual-auditory recognition.In each group, a significant difference emerged for subtest accuracy (group 1: p < 0.01) and the third (at least p < 0.0001) groups. Conversely, the percentage of patients with severe cognitive deficits increased progressively from the first to the third group (at least p < 0.01) in each subtest, with the exception of visual-spatial impairment (patients with this deficit were not observed in the first and the second group).p < 0.05 for all comparisons). The percentages of nonpathological patients were 67% for attention, 78% for memory, 56% for executive functions-logical reasoning, and 72% for visual-spatial ability. The percentages of nonpathological patients were 35.4% only for the visual-auditory recognition subset; in fact, 43.1% and 20% of patients had mild or moderate deficits, respectively. The percentages of patients with severe deficits in the first group were very low  or zero  and were significantly lower than the percentages of patients with mild and moderate deficits . Regarding the comparison between moderate and mild deficits in the first group, moderate impairment of memory (p < 0.001) and mild deficits in executive functions and logical reasoning (p < 0.05) were those most frequently observed. No significant differences were observed between patients with mild and moderate impairments of attention and visual-spatial ability.In particular, in the first group, the percentages of patients with nonpathological conditions were significantly higher than those of patients with mild, moderate, and severe deficits (at least p < 0.0001), executive functions-logical reasoning , and visual-auditory recognition  prevailed in this group. Memory abilities were normal in 55% of the patients and moderately impaired in 31% of patients; 40% and 36% of patients in this group demonstrated, respectively, severe and mild impairment of attention.The second group of patients showed heterogeneous performances. A moderate deficit of visual-spatial ability  except for visual-spatial ability. Moderate deficits were less frequently observed  in this group. Moderate impairments were frequently observed only for visual-spatial ability (79.6%), and severe deficits were rare . The percentage of patients who performed normally or had mild impairments was low (from 0% to 4.1%).According to Patients with severe aphasia can be divided into three groups according to their cognitive profile. In the first group, most patients' intellectual functions were spared and a high percentage of patients had no pathology. The second group was more heterogeneous and performances were generally worse than in the first group. The third group primarily included patients with severely impaired performance in all cognitive functions investigated.In particular, the first group showed high mean accuracy for all cognitive functions studied. In fact, this group consisted mainly of patients without cognitive impairment who had visual-auditory recognition abilities. One-third of the patients in this group had no recognition deficits, but two-thirds showed mild–moderate impairment.The second group of patients was the most heterogeneous. The best mean performance of this group was observed on the memory subtest. In fact, a large percentage of patients in this group displayed no memory deficits. Two-thirds of the patients showed moderately impaired visual-spatial ability, but none suffered from a severe deficit. Almost all patients in this group had deficits in executive functions-logical reasoning and visual-auditory recognition. In particular, half of the patients demonstrated moderate deficits of these functions and the rest showed mild or severe impairment. The attention deficit of this group was mostly severe or mild.The third group had very low mean accuracy in all subtest of the CoBaGa. This group was composed mainly by patients with severe deficits in all cognitive functions except for visual-spatial ability. In fact, most aphasic patients in this group had moderately impaired visual-spatial skills.These three subpopulations of patients did not differ for mean age and time from stroke. Therefore, it seems that these variables do not influence cognitive functioning. The three groups were different regarding level of school attendance. In particular, the group with the best cognitive efficiency was characterized by the highest level of school attendance. We can suppose that a high level of school attendance served as a protective factor for cognitive functions. These results contradict the results reported by Helm-Estabrooks et al. . AccordiThe previous analysis revealed the presence of three different cognitive profiles in patients with severe aphasia. The aim of this second set of analyses was to verify whether the groups clustered on the basis of different cognitive profiles were characterized by different residual linguistic abilities. The performance of the three groups on the EoL and AAT is presented in F = 14.98, p < 0.0001; EoL: F = 19.38, p < 0.0001) and oral-written comprehension  = 4.4, p < 0.05; EoL: F = 22.9, p < 0.0001). The first group was significantly more accurate in reading and spelling than the second  = 13.05, p < 0.001; EoL: F = 28.7, p < 0.0001) and the third  = 26.17, p < 0.0001; EoL: F = 32.56, p < 0.0001). In fact, the first group's reading-spelling accuracy was 14% on the AAT and 10% on the EoL, whereas the second  and third  groups were characterized by lower accuracy. The second and third groups were similar with regard to reading-spelling abilities. The three groups performed differently in oral and written comprehension (at least p < 0.01). In fact, in this test, the first group showed higher accuracy  compared to the second group  and especially the third group .According to the ANCOVA, the groups were comparable for repetition and naming, but differed for reading-spelling abilities , comprehension , and reading and spelling skills . When years of school attendance were added to the analysis, the variance explained by the model was 45%. In this case, comprehension was a significant predictor  and reading and spelling approached significance ; however, naming was still not significant . Years of school attendance was not significant. Repetition skill did not predict the CoBaGa performance in either analysis.The regression analysis performed on the scores of the AAT showed that linguistic skills explain 43% of the variance in cognitive performance. Significant predictors were naming , comprehension , and reading and spelling skills . When years of school attendance were added to the analysis, the variance explained by the model was 63%. In this case, significant predictors were naming  and comprehension  as well as years of school attendance . Reading and spelling skills were still not significant . Repetition skill did not predict the CoBaGa performance in either analysis.The regression analysis performed on the EoL scores demonstrated that language skills explain 60% of the variance on the CoBaGa test. Significant predictors were naming  demonstrated less marked difficulty in reading-spelling and comprehension than the second and especially the third group. In fact, the third group was characterized by the most severe deficits in both linguistic and cognitive abilities. We can suppose that linguistic difficulties and patients' general cognitive functioning were strictly related.The present study also shows that it is possible to predict the cognitive profile of patients with severe aphasia on the basis of linguistic impairments, and in particular on the basis of naming, comprehension, and reading and spelling skills. This result is in accordance with the results of Kalbe et al.  and HincTwenty patients were examined longitudinally pre and post speech therapy to investigate whether, by the end of therapy, language treatment also improves cognitive skills and which cognitive abilities are most likely to recover after speech therapy.The 20 patients  in study 1 also participated in study 2. They were tested at the end of speech therapy, which lasted about 4 months (SD = 2). They were all right handed and with global aphasia. The mean age of the sample was 65 years (SD: ±7.8) and the mean educational level was 6.6 (SD: ±3) years. The patients were examined 101 (SD: ±81) days after they had experienced a stroke. Almost all of them had partial anterior circulation infarcts (PACI), and two had total anterior circulation infarcts (TACI), following the Bamford et al.  classifiAll participants performed the CoBaGa and EoL both pre and post test.Same as that in study 1.Preliminarily, we checked whether speech therapy led to improved language skills, as expected. In particular, an ANOVA was performed with treatment (pre- versus post-) and language skills  as repeated measures.With respect to the specific aims of this study, a second ANOVA was performed on the CoBaGa scores to determine whether speech therapy also resulted in detectable improvements in cognitive performance. In particular, treatment (pre- versus post-) and type of subset (5 levels: corresponding to the five cognitive functions examined) were entered as repeated measures.All analyses were replicated also controlling for years of education and duration of speech therapy (in days) to assess whether these variables mediated the relation between cognition and language. In particular, in the ANOVAs, these variables were entered as covariates.F = 10.16, p < 0.01) and language domain  = 17.05, p < 0.0001), indicating that accuracy improved from 13.5% to 20.0% and that comprehension and repetition skills were more impaired than naming and reading-spelling skills . Also, the rehabilitation by language domain interaction was significant  = 5.16, p < 0.01), indicating a significant improvement in performance in the posttest respect to the pretest only for comprehension  and repetition , but not for naming (3.3%) and reading and spelling skills (4.0%).As expected, speech therapy led to improved language performance. In fact, the ANOVAs showed the significance of the main effects of the rehabilitation  = 8.72, p < 0.01); in fact, the language domain  = 1.50, n.s.) and the rehabilitation by language domain  = 0.97, n.s.) interactions were no longer significant, indicating that all areas of language improved with language rehabilitation if years of schooling and therapy duration were taken into account. Neither covariate was significant (Fs < 1).When education and speech therapy duration were added as covariates, only the main effect of rehabilitation was still significant  = 23.29, p < 0.0001) and cognitive domain  = 36.29, p < 0.0001), indicating that accuracy improved from 24.9% to 33.1% and that memory and visual-spatial skills were more impaired with respect to attention, executive function and visuo-acoustic recognition . The rehabilitation by cognitive domain interaction was also significant  = 7.93, p < 0.0001), indicating a significant improvement in performance only for attention  and reasoning/executive function  after speech therapy; memory (improvement = 0.9%), visual-spatial ability (improvement = 2.0%), and visuo-acoustic recognition (improvement = 4.3%) did not differ pre and post test.The ANOVAs on cognitive skills pre and post speech therapy revealed the significance of the main effect of rehabilitation  = 21.53, p < 0.0001) and cognitive domain  = 33.90, p < 0.0001) were still significant, as well as the rehabilitation by cognitive domain  = 6.58, p < 0.0001) interaction. Both covariates were nonsignificant (Fs < 1).When covariates were added to the analysis, the results did not change: both the main effect of rehabilitation  agree aIn any case, the relationship between language and other cognitive domains is still controversial and different hypotheses have been proposed to explain it . For exaIn more recent years, Jefferies and Lambon Ralph  proposedOther hypotheses considered the role of executive functions , 41, shoCahana-Amitay and Albert  incorporAccording to other authors, language and cognition are not strictly related. For example, Hauser et al.  argued tThe present study highlights that patients with severe aphasia are heterogeneous with regard to cognitive impairment, which ranges from spared to severely impaired cognitive function. In any case, in this study, we found a strong relationship between language impairment and general cognitive functioning: patients with more severe cognitive impairment also had more severe linguistic deficits. Note that in this study, the relationship between linguistic deficits and cognitive abilities was evaluated in a population of patients with severe aphasia. We do not know whether the present results can be generalized to the entire population of patients with aphasia. It might be interesting to repeat this study in a population of patients with less severe aphasia to examine the relationship between linguistic impairment and cognitive abilities and to identify cognitive profiles among these patients. Moreover, the population of the present study was characterized by severe aphasia and both language comprehension and production deficits. It would be interesting to know whether different profiles of cognitive impairment in patients with less severe aphasia are related to different syndromes of aphasia and selective deficits of linguistic comprehension/production. Moreover, we do not know the role of other variables that might affect patients' cognitive profile, such as premorbid IQ and other factors that might affect cognitive performance.In light of the present results, we can affirm the importance of assessing cognitive functions as well as linguistic deficits in aphasic patients. A correct assessment of cognitive abilities and comprehension of lost and preserved functions might be useful in programming individualized rehabilitation training. Several studies –55 found


China and Japan share numerous similarities other than their geographical proximity. Facing the great challenges of non-communicable diseases (NCDs), China and Japan have developed different preventive strategies and systems. While Japan has made great progress in primary prevention of NCDs through strong legislation, the ‘Specific Health Check and Guidance System’ and a unique licensed health professional system, China is attempting to catch up by changing its strategies in NCDs control. In this manuscript, we compared disease burden of NCDs, health care systems and preventive strategies against NCDs between China and Japan. In this light, we summarized the points that the two countries can learn from each other, and proposed recommendations for the two countries in NCDs control. China and Japan, other than geographical proximity in eastern Asia, share certain similarities in genetic origins, culture, lifestyles and some other aspects. During past decades, both countries have been facing growing burden of non-communicable diseases (NCDs) due to rapid population ageing, urbanization and lifestyle changes. These similarities indicate that the two countries would have had a similar disease burden of NCDs. However, Japan is a high-income and high-welfare developed country with Gross Domestic Product (GDP) up to $36,285 per capita in 2014 [In this review, we compared disease burdens of NCDs, health systems and preventive strategies against NCDs in China and Japan. We searched related literatures online like Pubmed, Web of Science, CNKI and Wanfang using the terms of ‘chronic diseases / non-communicable diseases / NCDs / lifestyle-related diseases’ and ‘prevention / control / health system / strategies’, and obtained NCD-related laws, regulations, guidelines or reports through accessing to the websites of both Chinese and Japanese governments. Based on the comparisons, we summarized the points that the two countries can learn from each other, and proposed recommendations for both countries.China is a middle-income country experiencing rapid economic growth and urbanization. Increasing life expectancies, tobacco use, harmful use of alcohol, obesity, lack of physical activity, and excess salt, sugar and saturated fats in the diet contribute to the growing incidence and prevalence of NCDs such as heart disease, stroke, diabetes, cancers, and chronic respiratory diseases . In 2012http://www.healthdata.org/Japandata.org/Japan). Tobacco use and high blood pressure were the two major contributors for adult mortality from NCDs and injuries [Japan, one of the most developed countries, ranked first in longevity around the world as early as in 1990, and achieved an average life expectancy of 79.9 years for men and 86.3 years for women in 2015 . JapanesObviously, the situation is severe in both countries. While the prevalence of diabetes and other NCDs in Japan remain stable after entering twenty-first century, those in China are still increasing, which means that China is under much more tremendous pressure. Effective preventive strategies are urgently needed to control NCDs, the main contributor of premature death, particularly in China.+ years, medical care at age 70+ years”, emphasizing the importance of NCDs prevention in middle-aged populations. According to the Act, anyone over 40 years old in Japan would be provided a free healthcare service package which includes: 1) personal health record; 2) health education; 3) health information sharing; 4) health check-up; 5) medical care service; 6) functional training and 7) routine follow-up and guidance by doctors. Following the Act, a series of laws were enacted as supplements. For example, the Long-term Care Insurance Act issued in 1997 stipulates that the elderly over 65 years should be provided with vital organ function evaluation and long-term care services. In 2005, the Community General Support Center was established in each municipality to provide general management of health, welfare and medical care. The Health Promotion Act was implemented in 2004, and the Health and Medical Services Act for the Aged were amended in 2008 as the Act on Assurance of Medical Care for the Elderly. Under these laws, the specific health check-up was initiated to provide service for people aged 40–74 years, greatly advocating health promotion and prioritizing primary prevention of NCDs , blood lipids and glucose, and several urine markers assayed. The specific health check-up has priority to any other physical examinations, and can be shared by other programs to save medical resources. The results of check-up will be delivered to individuals in form of report sheet by medical insurance societies.Based on the results of check-up, all participants were classified into different risk classifications and were provided with different health guidance by medical staff in designated hospitals. The factors for risk classification include cigarette use, waist circumference, blood pressure, blood levels of glucose and cholesterol measured in health check-up  Fig. 1)1). QualiGenerally, the measures of NCDs control in China mainly include three aspects, namely, surveys or surveillances of NCDs and related risk factors, health education and health promotion in general population and comprehensive interventions in high-risk population . BesidesOf the three aspects, management of high-risk population is of the most important in China. Taking CVD prevention as an example, the classified management of hypertensive patients is the central task . The claThe standardized management of NCDs in China is somewhat similar to the “specific health guidance” in Japan. However, the target populations are much different. While Japan focuses on general adult population aged at 40-74 years old, China pays more attention to 260 million prevalent patients with NCDs. Moreover, unlike Japan, China is a country with a large population and huge regional inequity in healthcare resources. It is impossible for China to implement unified policies and strategies of NCDs control with high quality across the whole country. Local governments are encouraged to develop their own strategies and measures on the condition that the basic tasks of NCDs control have been completed.In Japan, the universal health care system covers all citizens according to public health insurance plan which can be broadly divided into two subsystems . The firSocial health insurance system in China included urban employee-based basic medical insurance scheme initiated in 1998, the rural new cooperative medical scheme launched in 2003, and urban resident-based basic medical insurance scheme embarked in 2007. The system has developed and expanded very rapidly during past decades and covered almost all citizens in China . While uhttp://www.mhlw.go.jp/seisakunitsuite/bunya/kenkou_iryou/kenkou/kenkounippon21/en/kenkounippon21/).Multi-sectorial cooperation in NCDs control in Japan has been well established and practiced. “Health Japan 21” initiated in 2000 was the third national health promotion campaign aimed to establish basic-level professional health care teams. The policies, ideas, and specific goals are included in the "Basic Direction for Comprehensive Implementation of National Health Promotion" which was established by the Minister of Health, Labor, and Welfare in accordance with Article 7 of the Health Promotion Act. Based on the provisions of Article 8 of the Health Promotion Act, each prefecture has taken the country’s fundamental policy into consideration and established its own “Prefectural Health Promotion Plan” as a basic plan for advancing health promotion for its residents. Leadership of central and local governments and active participation of social organizations and individuals guaranteed achievement of the goals  in Ibaraki Prefecture, is a village located in northeast of Tokyo, Japan. In the area, the elderly aged over 65 years old accounted for 65% of population. In response to the campaign of the “Health Japan 21” promoted by the central government, the village government and department of health encouraged the villagers, especially the elderly, to participate in an exercise project focusing on muscle activity. Based on a trial including 20 participants of the exercise group averaging 65.2 years old and 23 control subjects averaging 68.4 years, the investigators found that the medical cost was only 148,178 Yen about 1326 USD) per person per year in intervention group after two-year exercise, much lower than 296,422 Yen (about 2653 USD) per person per year in control group [6 USD perIn China, the tasks of NCDs control were designed to be shared by multiple organizations, including national and local Center for Disease Prevention and Control (CDC), hospitals, Institution of Health Education, and Institute of Maternal and Children Healthcare. In addition, National Cancer Center, National Center of Cardiovascular Disease, Prevention office for Endemic Diseases and other academic organizations are also involved in NCDs control. These organizations provide services on administration, technical guidance and technical consultant in NCDs control, making a vertical networking of classified management with central authorities . All tasChina has recognized the importance of multi-sectorial cooperation in NCDs control. In 2012, fifteen Ministries in China jointly issued the "Work plan on NCDs prevention and control in China (2012-2015)"  to propohttp://www.mhlw.go.jp/wp/hakusyo/kousei/10-2/kousei-data/PDF/22010209.pdf). In 2009, a total of 45,603 registered dieticians and 55,326 dieticians in Japan worked in hospitals, schools, canteens, hotels, food industries and government departments (http://www.e-stat.go.jp/SG1/estat/List.do?lid=000001068836). These professionals are responsible for health promotion in the local, and play a central role in spreading health knowledge and directing health behaviors. The public health doctors, dietitians, and sports coaches in local civil services are also involved in health promotion as supplementary. The substantial grass-roots health workers make it easy to implement interventions among Japanese.In Japan, all professional healthcare workers are licensed and accredited by the national unified identification system. Professional medical workers including physicians, dentists, pharmacists, plant doctors, public health doctors, dietitians, sports coaches, psychologists and nurses are usually employed by national public health institutes, profit or non-profit organizations. As early as in 2008, there were 286,699 medical doctors, 99,426 dentists, 267,751 pharmacists and 139,700 nurses in Japan, mainly working in hospitals, clinics, healthcare institutes and healthcare centers . In Kanagawa prefecture, personal health record service has been launched. Each individual has his/her personal health record, named “My ME-BYO medical chart”. It includes information of health checks. Such system may solve the problem in sharing information and accelerate utilization of health examination and screening results for clinical and preventive purposes .Generally, health and medical information sharing is not well-established in Japan. Usually, Japanese have to bring a printed version of their health examination results to visit doctors, which makes it difficult for a physician to obtain sequential results of health examinations. In addition, while electronic medical charts are used in most hospitals, paper medical charts are still used in some hospitals and clinics. Moreover, the electronic medical chart system provided by different system vendors were incompatible, which makes it difficult to establish a health information sharing platform based on available systems. The government is considering to provide each citizen a unique “medical ID” by utilizing the infrastructures of the social security number system . However, almost 40% hypertensive patients detected in specific health check-up did not visit doctors. More intensive program is needed to urge these patients to visit medical institutions and receive adequate treatment.The government of Japan is planning to build a unique “medical ID” based on social security number, which can be used to follow-up NCDs patients and run record linkage .China has established a health information sharing system in Zhabei district of Shanghai and some other pilot areas , and is In Japan, the National Clinical Database has been founded since April 2010 as the parent body of a database system linked to a board certification system . ClinicaIn summary, China and Japan share certain similar strategies in NCDs control such as legislation and policy approaches, standardized management of NCDs and multi-sectorial cooperation in NCDs control, which have been proven effective in other countries and are recommended by the World Health Organization. However, the differences in health system and priorities in NCD control determined the big differences in epidemic status and disease burden of NCDs between China and Japan.With the rapid economic development, Chinese government is increasing its budget in NCDs control year by year. It is a good opportunity for China to learn from Japan to rebuilt its health system particularly at horizontal level and prioritize primary prevention of NCDs. Facing the big challenge of rapid population ageing and urbanization, Japan also needs to strengthen its health system particularly at vertical level and improve its efficiency in NCDs control. The active exploration and rapid improved situation in NCDs control in China may provide policy implications for Japan. Undoubtedly, both China and Japan can benefit from increasing exchanges in ideals, experiences, knowledge and technologies, and close cooperation in policy making, planning, novel strategies and measures exploring in NCDs control, and finally win the fight against NCDs together.


Estimates of depressive disorders in the elderly vary depending on how cases are defined. We estimated the prevalence of subthreshold depression (SD) and clinically significant depression (D) in a population of 70–74-year-olds. We also looked for associations with sociodemographic factors and perceptions of self. Participants underwent a multidimensional assessment . The estimated prevalence of SD was 15.71% (95% CI: 13.70–17.72), while that of D was 5.58% (95% CI: 4.31–6.85). Multinomial logistic regression analysis revealed that female gender and dissatisfaction with family relationships were related to SD and D. A self-perception of physical age as older than actual age (but not comorbidity) and greater self-perceived stress caused by negative life events both increased the probability of SD. The likelihood of D was decreased in those who perceived their own health as good, whereas a self-perception of mental age as older than actual age and dissatisfaction with relationships with friends were both significantly associated with D. Both SD and D emerged as key problems in our population. Female gender and self-perceptions of various characteristics, which can be explored through simple questions, are associated with late-life depression in elderly people independently of their actual physical condition and other characteristics. Depressive disorders in aging are associated with increased physical morbidity, lower functional status, and a higher risk of dementia, and they are a major economic and social burden on families and on society . Late-liMany social and clinical conditions, such as older age, female gender, low education, being single or uncoupled, living alone, physical illness, and low cognitive functions, in particular executive ones, are known to be associated with both subthreshold and clinically significant depression , 8. On tOne aspect of depression in the elderly not yet studied in depth is the role of certain perceptions of self (across a range of variables) that may conceivably be associated with mood. Indeed, even though self-perceived health has been found to reflect subjective health-related quality of life in the elderly and appears to show a strong relationship with several health and social characteristics in this population, although, not with depressive symptoms , the relThe primary aim of the present study was to estimate the prevalence rates of subthreshold depression and clinically significant depression in a section of the elderly Italian population (those aged 70–74 years) living in Abbiategrasso, a northern Italian town on the outskirts of Milan. The secondary aim was to evaluate social, medical, cognitive, and self-perception variables in this population and the influence of these factors on the presence of subthreshold depression and clinically significant depression. Brain Aging in Abbiategrasso), an ongoing longitudinal population-based study of brain aging and dementia  or single [never married]/uncoupled [separated/divorced/widowed]), living situation , and primary lifetime occupation  .The participants' general health was evaluated using the Cumulative Illness Rating Scale. This is a standardized tool for detecting multimorbidity, in which a five-level Likert scale is used to rate the severity of medical illness for each of 14 items referring to different domains , as follAs part of the neuropsychological assessment global cognition was evaluated using the Mini-Mental State Examination (MMSE), whose items investigate orientation, registration and recall, attention, language, following commands, and figure copying , executiPerceptions of self were investigated using various self-perception indices. During the social assessment, the subjects were asked to rate their overall health as poor, fair, or good. Self-perception of age was assessed considering two subindices: self-perceived mental and self-perceived physical age. Self-perceived mental age was determined by asking the patient “Do you feel mentally younger, the same as, or older than your actual age?” while the question concerning self-perceived physical age was “Do you feel physically younger, the same as, or older than your actual age?” The answers to these questions were classified as younger than actual age, equal to actual age, or older than actual age . Satisfap value of less than 0.05 was significant, except for multiple comparisons . In any case, the p value of multiple comparisons was reported to the threshold 0.05. All analyses were conducted using STATA/SE for Windows, version 12 .Mean values with standard deviation (sd), or medians with interquartile range (iqr) if data lacked normality, were used to summarize the quantitative variables, while percentages were used to describe the categorical variables. To evaluate associations between depressive status  and categorical variables, the chi-square test or Fisher's exact test was performed. Similarly, to evaluate relationships with quantitative factors, a parametric analysis of variance (ANOVA) or corresponding nonparametric test  was applied. If the associations with different depressive status were significant, then multiple comparison tests with Bonferroni's correction were applied taking noD as the reference status. Normality distribution was assessed using the Shapiro-Wilk test. A multinomial logistic regression model was performed to investigate the association of depressive status with several social, medical, cognitive, and self-perception variables using noD as the reference category in the model. The results were reported as the relative risk ratios (RRRs) with 95% confidence intervals (95% CI). Multinomial logistic regression allowed simultaneous comparison of the three categories of depressive status while adjusting for all other variables in the model. The goodness-of-fit of the multinomial model was assessed by means of the Hosmer-Lemeshow test. A The prevalence of SD among the 1254 elderly subjects was 15.71% (95% CI: 13.70–17.72), while that of D was 5.58% (95% CI: 4.31–6.85).p = 0.266). In particular, the D subjects were slightly older than the noD ones (p = 0.047). In addition, individuals with SD or D were more likely to be women (p < 0.001), single/uncoupled (p < 0.001), living alone (p < 0.001), and housewives (p < 0.001) than noD subjects . Furthermore, the D and SD subjects, compared with the noD subjects, had experienced more negative life events and recorded higher stress and feeling scores .Depressive status was differently associated with all the demographic characteristics except for years of education (subjects . Similarsubjects . Of notep < 0.001) and satisfaction with relationships with family .According to the results of the multinomial logistic regression analysis , the varSpecifically, in females with respect to males, the relative risk of having SD versus noD was increased almost threefold, while the relative risk of having D as opposed to noD was increased fivefold.In other words, females were more likely to belong to SD or D group versus noD than males. Similarly, subjects dissatisfied with their relationships with their family compared with those who declared themselves satisfied were more likely to have SD  or D (around three times) as opposed to noD status.p < 0.001) and stress score (p < 0.01). In particular, subjects who perceived their own physical age as older than their actual age with respect to those who perceived their own physical age as equal to their actual age were more likely (three times) to have SD as opposed to noD (3 times), while those with a higher stress score were more likely (1.2 times) to have SD rather than noD.Conversely, variables significantly associated only with SD, independently of other factors, were self-perception of physical age (p < 0.01), self-perception of mental age (p < 0.001), and satisfaction with relationships with friends (p < 0.001)  . Subjectp = 0.79).No other variable was associated with SD or D. The Hosmer-Lemeshow goodness-of-fit test indicated that the model described the data well (chi-square (8) = 11.36, We conducted a comprehensive investigation of late-life depression in which additional features were considered together with clinician-rated DSM diagnoses of depression. The study showed prevalence rates of 15.71% for SD and 5.58% for D in our elderly population. This result confirms that SD is a problem not only in young people and adults but also in the elderly, in line with data reported in other, similar studies [Furthermore, our data indicate that clinicians should carefully monitor elderly subjects not only for D but also for SD, given the high risk of this latter condition evolving into more severe depression . MoreoveIn accordance with previously reported findings , 8, univThe multinomial regression analysis identified three groups of variables showing associations with depressive status: those associated with both SD and D, those associated only with SD, and those associated only with D, independently of comorbidity and other characteristics.With regard to the first group, females were more likely to be classified as SD or D versus noD than males, confirming that the female gender is more prone to depressive symptoms . FurtherWith regard to the second group, having an older perceived than actual physical age, as opposed to a perception consistent with actual age, increased the probability of being classified as SD versus noD. This, together with the absence of relationships between comorbidity and SD or D in this sample, suggests that subjective but not objective physical difficulties are implicated in SD. It is well known that physical comorbidity is related to a higher level of depression , but theAs regards the third group of variables showing associations with depressive status, subjects who considered their health as good as opposed to poor were less likely to be classified as D versus noD, a result in line with the findings of others . SubjectThe results of our study show that SD and D are key problems in the elderly and that they are associated with mood independently of actual physical conditions and other characteristics; it also showed that they are subjective dimensions that can be easily explored through simple questions. Perceptions of self may offer the clinician an individualised profile of the patient with SD or D.The strengths of the present study include the fact that it is a population study with a good response rate , in whicThrough a comprehensive investigation of depressive conditions, we obtained estimates of the rates of SD and D in a sizeable sample of elderly subjects (70–74-year-olds). The results of our study confirmed that both SD and D are key problems in the elderly. They also confirmed that female gender and self-perceptions of various variables  are associated with late-life depression, independently of physical comorbidity and other factors.


Rhaphidophora pinnata is suggested to prevent or treat cancer of genetic mutations. In this study, antimutagenic activity of an ethanol extract of Rhaphidophora pinnata leaves was evaluated by using a bone marrow micronucleus assay on mice. Male mice (20–30 g) were treated for sevendays with an ethanol extract of Rhaphidophora pinnata leaves at a dose of 500, 750 and 1000 mg/kg/day/orally, prior to exposure to cyclophosphamide (i.p. 30 mg/kg), 24 h after the end of the treatment. Antimutagenic activity was determined by the decrease of micronuclei (MN). The results showed that a single administration of all variant doses of the extract had significantly decreased the micronucleus formation in bone marrow cell of mice as compared to the cyclophosphamide group. The ethanol extract of Rhaphidophora pinnata leaves had antimutagenic activity against cyclophosphamide-induced gene mutation. Cancer is a vicious tumor that arises and progresses through the accumulation of successive mutations. It involves the activation of proto-oncogenes and inactivation of tumor suppressor genes which causes out of control proliferation of the cells . Gene muCarica papaya, Solanum lycopersicum and Kaempferia rotunda, but there is a need to explore them for use as antimutagenic and anticarcinogenic food or drug additives [Rhaphidophora pinnata, a family of Araceae, has been used as a traditional medicine for the treatment of bacterial infection, cancer, rheumatism, and cough. Chloroform fraction and an ethanol extract of Rhaphidophora pinnata showed cytotoxic activity, proliferation inhibition and apoptosis induction to the MCF-7 cell line in vitro [Rhaphidophora pinnata leaves as anticancer agents in vivo due to genetic mutations. The antimutagenic activity of an ethanol extract of Rhaphidophora pinnata leaves was evaluated by using a bone marrow micronucleus assay on mice.Some plant extracts have anticancer activity due to genetic mutations, such as dditives ,3,4. Rhain vitro . This isRhaphidophora pinnata leaves were obtained from a local garden in Medan, Sumatera Utara, Indonesia. Rhaphidophora pinnata was identified in the Research Centre for Biology, Indonesian Institute of Science, Bogor, and the voucher specimen was deposited in a herbarium. Rhaphidophora pinnata were ground to a coarse powdered form, and wereextracted by the percolation method using ethanol as solvents. The extracts so obtained were concentrated under vacuum using a rotary evaporator  and dried in a desiccator  until use [The dried leaves of ntil use .Rhaphidophora pinnata leaves powder and ethanol extract was examined based on class compounds, including alkaloids, saponins, flavonoids, tannins, glycosides, anthraquinone glycosides, and triterpenoids/steroid [The phytochemical screening of /steroid ,8,9.The study was conductedon twenty-five male mice . They were kept in good laboratory conditions with temperature (25±2°C), light (12 h light: 12 h dark) and given a standard mouse pellet diet and water ad libitum. All animal experiments were used in this study after getting prior permission from the Institutional Animal Ethics Committee, Department of Biology, Faculty of Mathematics and Science, University of Sumatera Utara with the accession number 120/KEPH-FMIPA/2016.Rhaphidophora pinnata leaves at the dose of 500, 750 and 1000 mg/kg/day/orally. Cyclophosphamide (i.p. 30 mg/kg) was given as a single dose to all of the mice 24 h after being treated with the last administration of the extract. Twenty-four hours later, all of the mice were sacrificed by cervical dislocation and bone marrow cells were collected. Bone marrow cells were removed from muscle and aspirated by flushing with BSA (Bovine serum solution) with a syringe. The solution was centrifuged at 1200 rpm for 5 min. The cells in the sediment were separated with the supernatant. Then, a small drop of the viscous suspension was put on a slide and spread by pulling the material behind a polished cover glass held at an angle of 45°. The preparation was dried on the slide and fixed for 2–5 min. The fixation of cells on the slide was done by rinsing with methanol for 10 min. Then, staining was carried out in Giemsa solution for 10 min. Slides were rinsed in distilled water and cleaned with filter paper on the back side of the slide. Erythrocytes cells were scored for micronuclei under the microscope. At least 1000 cells per animal were scored for the incidence of micronuclei [Male mice 20–30 g) were divided into five groups; each group containing five animals. The first group was treated with 0.5% Sodium Carboxymethyl cellulose (CMC Na) (control). The second group was treated with cyclophosphamide (i.p.30 mg/kg). The third, fourth and fifth groups were treated for 7 days with an ethanol extract of 0–30 g weThe micronuclei data were statistically analyzed using one-way analysis of variance (ANOVA), followed by the post-hoc Tukey test, with a significance level of 95%.Rhaphidophora pinnata leaves. The result showed that the dry material and an ethanol extract of Rhaphidophora pinnata contained tannins, flavonoids, alkaloids, glycosides, saponin, and triterpenoid/steroid (Phytochemical screening of the dry material can be used as an early data to determine the compounds that are contained in the ethanol extract of /steroid . The results of the formation of micronuclei in the bone marrow erythrocytes of mice are depicted in In this study, the number of micronuclei was increasing in the cyclophosphamide group. However, it was decreased after the administration of 500, 750 and 1000 mg/kg/day extracts for sevendays. All of the variant doses of the extract showed a significant antimutagenic effect. The invivo micronucleus test is a very sensitive method to identify the clastogenic effects of chemicals and drugs or to evaluate the change of the chromosome structure using various alkylating agents such as cyclophosphamide. Cyclophosphamide is genotoxic and damages DNA by oxidative stress, transferring the alkyl cluster to the cells ,4,10. SoRhaphidophora pinnata contained tannins, flavonoids, alkaloids, glycosides, saponin, and triterpenoid/steroid. In this study, we deduce that flavonoid and other phenolic compounds in this extract are responsible for the antimutagenic effect on mice that are exposed to cyclophosphamide. This compound can prevent DNA damage due to itsability to protect the DNA from free radicals. Some studies have shown that phenolic compounds have biological activity, including antioxidant, antitumor, antimutagenic, and antibacterial properties [Based on the result, an ethanol extract of operties ,13,14. Aoperties .Rhaphidophora pinnata leavesat a dose of 500, 750 and 1000 mg/kg/day had antimutagenic activity against cyclophosphamide-induced gene mutation.An ethanol extract of


In retinitis pigmentosa (RP), loss of peripheral visual field accounts for most difficulties encountered in visuo-motor coordination during locomotion. The purpose of this study was to accurately assess the impact of peripheral visual field loss on gaze strategies during locomotion, and identify compensatory mechanisms. Nine RP subjects presenting a central visual field limited to 10–25° in diameter, and nine healthy subjects were asked to walk in one of three directions—straight ahead to a visual target, leftward and rightward through a door frame, with or without obstacle on the way. Whole body kinematics were recorded by motion capture, and gaze direction in space was reconstructed using an eye-tracker. Changes in gaze strategies were identified in RP subjects, including extensive exploration prior to walking, frequent fixations of the ground (even knowing no obstacle was present), of door edges, essentially of the proximal one, of obstacle edge/corner, and alternating door edges fixations when approaching the door. This was associated with more frequent, sometimes larger rapid-eye-movements, larger movements, and forward tilting of the head. Despite the visual handicap, the trajectory geometry was identical between groups, with a small decrease in walking speed in RPs. These findings identify the adaptive changes in sensory-motor coordination, in order to ensure visual awareness of the surrounding, detect changes in spatial configuration, collect information for self-motion, update the postural reference frame, and update egocentric distances to environmental objects. They are of crucial importance for the design of optimized rehabilitation procedures. Peripheral visual loss impairs several mechanisms involved in the interaction with the environment, including those participating in motion discrimination  heterogeneity in conditions underlying studied VF loss  with tunnel vision, using motion capture and eye movement measurements. Characteristics of the trajectory, gaze and body movements were assessed, and the sensorimotor compensatory mechanisms developed by both patients and controls were analyzed. To our knowledge this is the first study in which all these characteristics have been measured simultaneously with a high degree of precision.Two groups participated in the study:Nine subjects with RP , presenting a central residual field from 10 to 25° in diameter , with a best corrected visual acuity equal or superior to 20/20 (ETDRS). Ages ranged from 29 to 60 years (mean: 45.9 years).U = 39.5, n1 = n2 = 9, p = 0.96). Complementing Goldmann kinetic perimetry, in RP subjects, we determined the horizontal diameter of the VF, taking into account both ambient luminosity and actual appearance of spatial cues in the experimental setting. For that purpose, the horizontal VF was estimated by asking RP subject to fixate a target located in front of him and indicate when he first perceived the edge of the door frame used in the experiment (see below), that was progressively displaced from the side toward the central target, successively from the right and the left. VF horizontal angular dimension was then computed using subject and frame positionsTable The study was approved by the ethical committee  in accordance with the Declaration of Helsinki. Written informed consent was obtained from the subjects after explanation of the nature and possible consequences of the study.Motion capture of whole body kinematics has been conducted using a VICON system . Subjects wore a tight black suit allowing sticking the VICON markers close to the subject's body. Altogether, 43 markers were placed according to the “Plug-in Gait” model of the VICON system . To approximate head position, four additional markers were located over the right and left temples on the back and at the front of the head. Four markers were also positioned on each obstacle and door frame. Marker position were recorded, reconstructed and labeled using VICON Nexus 2.0 software.Eye movement recording was performed with a head-mounted video eye-tracker . The camera was located under subject's right eye, paying attention to avoid masking an important part of subject's field of vision Figure . The camTesting sessions took place in the Streetlab artificial street, an experimental room of 5.5 × 9.0 × 6.0 m (L × W × H) in size, with a controlled illumination of 235 lux. The subject started from a defined initial position and had to walk at a normal pace, either (a) straight ahead toward a visual target placed on the wall in front, or (b) through one of the two white doors, materialized by simple rectangular frames (0.73[W] × 2.05[H] m) located on the left or on the right side of the subject's initial position Figure . Two conhttp://www.python.org) equipped with NumPy 1.8.2 (http://www.numpy.org). Statistical analysis has been carried out with R 2.2.2 (http://www.R-project.org). Body motion capture data were Butterworth filtered with a cutoff frequency of 15 Hz  the preparation phase, i.e., the subject started walking  and torso (RT) reference frames were defined as in a previous study .Data analysis has been performed with Python 2.7.6 , i.e., both saccades or fast phases of nystagmus, as they cannot be automatically distinguished with the frame-rate of the eye tracker  was computed in RT: mean and standard deviation, essentially to assess the head stability. Finally, describing the fixation strategy in the environment required to pinpoint fixation phases, i.e., periods between two REMs, that were 83 ms or more in duration, corresponding to 5 successive frames in a 60 Hz recording  have been performed in order to assess the effect of the group , obstacle (with or without), and trajectory direction . A threshold of All subjects succeeded to perform the task without touching neither the obstacle nor the door frame edges. Pelvis trajectories are represented in Figure At the group level .Group-averaged trajectories are modified by the obstacle; the trajectory was more curved and longer with than without obstacle Table . HoweverTo summarize, while in each group, for no-obstacle condition, we observed some differences of averaged trajectories between subjects, these differences were reduced in presence of an obstacle. This is captured by the between-subject variability, less similar than within-subject variability, which is equivalent between groups, and lower with obstacles. Moreover, the group-averaged trajectory was identical between groups, even around the obstacles.As reported in Table We analyzed the eye movements during the walking phase, focusing on number, rate, and amplitude of rapid eye movements . As the trial duration was not equivalent for each group and experimental condition, we used REM rate  as an indicator of the exploratory behavior.F = 12.27, p < 0.001, η2 = 0.44]. The presence of obstacles on the path did not affect REM rate.REM rate has been computed for each trial of each subject, and then averaged over trials Table . Anova aU = 12, n1 = n2 = 9, p < 0.01 two-tailed).Note worthily, as shown in Figure Figure 9B), with RPs REM amplitude increased starting from the 60% of the trajectory, and peaking between 75 and 85% of the trajectory (~18°). It was significantly larger in RPs than in controls between 75 and 85% of the trajectory . This occurred both in obstacle and no-obstacle conditions.REM amplitude vary during the trial , RPs alternately fixated proximal and distal edges , presumably as both edges could not be simultaneously perceived within the residual VF. To corroborate that hypothesis, we identified the sequences of at least three consecutive fixations alternating between proximal and distal door edges. This behavior was indeed much more frequent in RPs than in controls .This indicated a large difference in oculomotor strategy when approaching the doors. Indeed, by the end of the trajectory, while controls tended to fixate the proximal edge of the door or in the door aperture  could be related to this fixation strategy. However, we found that this difference remained significant when considering only the first 60% of the trajectory, corresponding to the trajectory before the end of obstacle circumvention  = 3.29; full: F = 3.27; all n.s.]. The proportion of REMs beyond full VF was also identical for all trajectory directions , while REM proportion beyond half VF was larger in leftward (58%) and rightward (55%) than in straight ahead directions . We also examined the correlation between the VF width and the proportion of REMs beyond the full VF  or horizontal Goldmann measures . Results however were not significant when considering the vertical Goldmann measure . The same analysis with the half of VF leads to insignificant results.To further investigate the larger REM amplitude observed in RPs than controls, we computed the proportion of REMs that were larger in amplitude than half of the VF width  and REM that were larger than the VF width . All measured VFs were considered in the regression analyses , but the reported values in this section were computed using the door VF, unless otherwise specified. On average, 49 ± 20% of the REMs were beyond half of the VF, and 25 ± 18% were beyond the full VF. A two-way Anova shows that the presence of obstacle did not influence the proportion of REMs beyond the VF  showed that head variability was larger for RPs in straight-ahead tasks that in all other conditions. Finally, the head pitch variability of RPs was significantly anti-correlated with their residual VF , indicating that head orientation was less stable for subjects with a small residual VF  = 0.29; p = 0.96]. However, we found that the distributions were wider in bending trajectories than in central ones , and wider in RPs than in controls .A three-way Anova showed that the presence of an obstacle did not influence the standard deviation of the distributions . However, participants from both groups looked more often downward, i.e., toward the floor, in the obstacle condition (−18.77 ± 11.60°) than in no-obstacle condition . Moreover, the gaze was also more oriented downward in leftward (−25.29 ± 12.37°) and rightward (−25.80 ± 12.95°) trajectory directions, than when walking straight-ahead . Finally, an interaction between group and direction variables  showed that RPs oriented more their gaze toward the floor than controls, only in leftward and rightward trajectory directions . This result indicates that RPs looked in average at 2.7–4.2 m for controls—in front of them in bending trajectories.We computed the median of this vertical angle for statistical analysis. A three-way Anova showed no main effect—but a tendency—of the group, when considering all trajectory directions , and group variables  did not influence the standard deviation of the distributions. However, the distributions were wider in bending trajectories than in central ones .Finally, we computed the standard deviation of this vertical angle. A three-way Anova showed that both obstacle [In summary, when compared to controls, RPs exhibited a wider horizontal exploration of the environment, not only with eye and head movements, but also with gaze movements with respect to the pelvis. On the vertical axis, results indicate that when walking in a curved trajectory, RPs directed their gaze more downward than controls, in the direction of the floor.Over all trials and conditions, we have detected 2,034 fixations during the preparation phase  and 9,210 fixations during the walking phase . To investigate whereto in the environment subjects directed their gaze, we defined seven categories of fixation location, i.e., the intersection between the gaze vector and the 3D environment . Instead of mainly looking at the screen and the front wall, RPs also fixated the floor in the center trajectory direction, with and without obstacle (group difference p < 0.01), marginally the door in leftward/rightward conditions  and onto the obstacle when present in leftward/rightward conditions (group difference p < 0.05). In leftward/rightward conditions, when obstacles were present, RPs reduced their proportion of fixations on the front wall and the door , and increased this proportion onto the floor and obstacles . Also, for controls, the presence of an obstacle in leftward/rightward conditions reduced the proportion of fixations on the distal part of the door, to look at the obstacles .n Figure . RPs hadDuring the walking phase, subjects walked toward a goal . In the center direction without obstacles, RPs showed an increased proportion of fixations to the floor compared to controls , and consequently a reduced proportion of fixations to the front wall  than controls (13%) without obstacle. As obviously expected, when obstacles were present, both RPs and controls allocated fixations onto the obstacles . Fixation proportion was reduced for both groups on the proximal edges of the doors in the obstacle condition (p < 0.05), this reduction being lower for RPs . Finally, the aperture of the door gathered a lower proportion of fixations in RPs than controls in both obstacle conditions , this proportion being reduced only for RPs with obstacles  as compared to no-obstacle condition (22%). Moreover, no significant correlation was found between the proportion of fixations on the obstacle or the floor, and the VF extent .In summary, before starting to walk, RPs demonstrated an exploratory behavior more pronounced than controls . During locomotion, RPs directed their gaze to the floor and the door edges, with a peculiar pattern of alternated fixation on door edges, in contrast with controls who performed more fixations inside the door aperture. Finally, as expected, in obstacle conditions, participants form both groups allocated a number of fixations on obstacle edges, thus reducing the proportion of fixations to aperture and proximal edges for RPs, and to door aperture for controls.where at subjects looked in the experimental room, but not when these fixations were performed during the trial. Figure In the previous section, we indicated In no-obstacle condition, subjects from both groups fixated more often the doors at the end of the trajectory. In RPs, however, this behavior appeared only after completing ~27% of the trajectory, while it was observed all along the trial in controls. In the first quarter of the trial, RP fixations were equally distributed between floor and door, with floor fixations decreasing to become negligible around 80% of the trajectory. In controls, floor fixations were stable from the beginning to 80% of the trajectory when they become negligible, and a small proportion of their fixations were directed to the front wall and the screen before the 37% of the trajectory.With obstacles, the proportion of fixations directed to the door was lower than in no-obstacle condition for both groups until ~32% of the trajectory, replaced by fixations toward the obstacles, with a clear peak for both groups at ~22%. RPs had also a fixation peak at ~7% onto the floor, a behavior not present in controls. After 52% of the trajectory, all subjects ceased to fixate obstacles, and the door was the most fixated category.In summary, we observed some notable differences at the beginning of the trial, with a larger proportion of fixations on the floor for RPs, and on the task goal (the door) for controls. Otherwise, in both groups corresponding fixation patterns were performed roughly at the same normalized time.13, see also Supplementary Videos 1–4: https://www.youtube.com/watch?v=Li03bCdRsZs&list=PLQ8v2CHny1mPTlAnEtUfzOkifV6gIwZA3), even though subjects from the same group occasionally exhibited different sequences of fixations during a trial.A visual inspection showed that the sequences of fixation were qualitatively different between groups  than controls.RPs performed more frequent fixations on the floor , on door edges. When approaching the door, as their residual VF could not anymore include both door edges, RPs alternated fixations between proximal and distal edges.The trajectory geometry did not differ between groups, with however a slightly smaller walking speed in RPs.To assess the impact of peripheral VF loss on motor behavior during locomotion, we compared full-body, head, and gaze movements of normally-sighted and RP subjects with tunnel vision, during a goal-directed locomotor task, with or without obstacles.Numerous changes in fixation pattern were observed, including enhanced visual sampling, proactive target selection, fixation patterns including downward fixations, and synergistic head movements allowing for a successful trajectory execution. Our observations suggest that reduced awareness of the visual environment, following peripheral VF loss generated adapted gaze strategies, in order to detect changes in spatial configuration, collect information for self-motion, update the postural reference frame, and update egocentric distances to environmental objects.RP subjects exhibited a 28% increase in REM rate, compared to normally-sighted individuals. This was however only observed in eye movements from 15 to 29° in amplitude. Moreover, 25% of REMs were large enough to generate a post-saccadic fixation located beyond the limits of patient's field of view before REM initiation. This occurred especially when the residual VF was small. In contrast, no difference was found between groups regarding the range of eye movement scanning with respect to the head , both vertically and horizontally, and REM rate was not either affected by the presence of obstacles on the path. This absence of difference between groups was compensated with larger head movements in RPs, in a wider gaze exploration from the pelvis direction.In a locomotion task performed by RPs, Luo et al.  found anA study by Vargas-Martin and Peli , with RPThe substantial differences in eye movements showed by RP subjects suggest an adaptive gaze strategy developed to optimize visual sampling in goal-oriented tasks with chronically restricted VF. The absence of peripheral VF constraints and reshapes the visual exploration.As previously noted, RP subjects performed a significant number of REMs, shifting fixation beyond VF borders. This behavior was amplified in the last phase of the trajectory, when subjects approached the door. In that phase of the trial, door edges appeared to the participant more and more (angularly) distant, requiring gradually larger saccades for being alternately fixated. This expressed an adaptive fixation pattern for on-line trajectory control.As previously suggested  while normally-sighted subjects immediately fixated straight-forward . One could argue that the purpose of this behavior was obvious, namely addressing the RPs' need to explore the new environment and determine the relative position of visual clues and objects. Surprisingly however, with repeated trials in identical environments  affected individuals exhibited a similar exploratory behavior. In the preparation phase, these individuals could need to repeatedly update the spatial references  an obstacle approaching phase between the initiation and ~35% of the trajectory length, with fixations on the obstacle and the floor; (2) an obstacle circumvention phase until ~55% of the trajectory, with fixations on the floor and the door; (3) a door approaching phase until ~70% of the trajectory, with fixations mostly at the door; and (4) a crossing phase at the very end of the trajectory with fixations on the inside edge of the door. Gaze fixations were ~25% ahead of the body, or in other words one sub-phase ahead. This corresponded to 1 s anticipation in a 4 s trial , matching closely delays reported during driving  to get updated locations of environmental features. Without such a robust strategy, RP subjects would probably accumulate localization errors. Indeed, Yamamoto and Philbeck  showed tThe updating of relative object locations with gaze movements, that was noted when subjects approached the door, is an additional crucial aspect of strategical changes occurring in RP subjects. The visual angle subtended by proximal and distal edges then tends to be larger than that of the subject's VF . In such a condition, subjects did not have access to either static : “two-level visual control model. A large body of experimental results supports this hypothesis  and a visual compensation of steering deviation from the desired path . This idea was initially proposed by Donges  in the cAs observed in other disorders affecting peripheral VF  showed comparable mean orientation in both groups, but higher variability in RPs, for left and right trajectory directions, especially in affected individuals presenting a VF <15° in diameter. As a rule, head direction anticipates the torso direction, the latter anticipating trajectory direction, on the horizontal axis, as reported in several studies  rotation, RPs tilted more their head forward than controls in all experimental conditions, but with a higher variability; but in RPs, the variability was higher when performing the straight-ahead locomotion task, particularly for subjects with smaller VF. This behavior may be conditioned by the above-mentioned mechanisms of detection and avoidance of low-lying obstacles, of information collection for self-motion control, and for the updating of a postural reference frame. In straight-forward condition, increased head variability may reflect the two constraints of the task: to evaluate the distance from the screen, located at eye-height, and to check potential low-lying obstacles. A slight forward tilt of the head might facilitate the alternating gaze-check of the wall and the floor. As a consequence of this bi-modal gaze direction, head movements were more often performed around this global head orientation, subtended by natural eye-head coordination . To build-up, update the spatial referential , prepare the trajectory to follow, and control it online, RP subjects had developed a particular fixation pattern, including more frequent fixations at the floor, to monitor low-lying obstacles, and interestingly also to collect information for self-motion control and to update a postural reference frame. These adaptive gaze strategies induced a synergistic alteration in head movement. Such adaptive changes presumably allowed achieving trajectories that showed a stereotyped pattern, similar to that of normally-seeing individuals. We also noted that beside the overall characteristic trajectory observed in all affected subjects, the pattern of successive fixations was qualitatively different in each individual, and in each groups. This could reflect the occurrence of additional punctual strategies, some possibly being adapted to individual clinical features that could not be recognized in our investigation. Our findings, as well as ulterior, additional information on individual strategies using different, more elaborated tasks, are expected to provide invaluable information to optimize visual training programs.Conceived and designed the experiments: CA, AB, JS, AS. Performed the experiments: CA. Analyzed the data: CA. Contributed reagents/materials/analysis tools: CA. Wrote the paper: CA, AB, JS, AS.Commercial relationships: JS . The other 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.


There are few published studies on the relationship between occupational lumbar load and facet joint degeneration (FJD). This cross-sectional study was conducted to evaluate the effect of physical lumbar load on FJD by comparing magnetic resonance imaging (MRI) findings of firefighters (FFs) and hospital office workers (HOWs).We randomly sampled 341 male FFs and 80 male HOWs by age stratification. A questionnaire and clinical examination, including MRI of the lumbar spine (T12-S1), were conducted. FJD was diagnosed and graded by using the classification of Pathria et al., and reclassified into two groups as follows: no FJD (grade 0) and FJD . The prevalence of FJD was analyzed according to occupational group.The prevalence of FJD ranged from 31% (L1–L2) to 75% (L4–L5) in the FFs, and from 18% (L1–L2) to 69% (L4–L5) in the HOWs. After adjustment for age, body mass index, and frequency of physical exercise, the adjusted odds ratios (OR) for FJD in the FFs were significantly higher than those in the HOWs at all lumbar spinal levels, except for L3–L4 .This study shows that FFs exhibit a greater likelihood of having FJD than HOWs after controlling for other risk factors of FJD. This suggests that the physical occupational demands of FFs affect their risk of developing FJD. Facet joint degeneration (FJD) is one of the primary causes of low back pain (LBP) –3. AccorFirefighters (FFs) are known to perform more physical activities in relation to their job than the general population . EvaluatMagnetic resonance imaging (MRI) has been found to be one of the most important diagnostic tools to identify anatomical abnormalities in the spine –24. HoweIn this study, Korea was divided into five areas, and five fire stations were randomly sampled for each of the five areas. We made a request to the 25fire stations sampled, and were provided with lists of FFs including information about their sex, age, and duty from each of those departments. Male FFs on the lists were stratified according to their age  and their duties at the time of the study . Then, they were randomly sampled in proportion to their parameters (aiming for the number of 350 FFs). Among the subjects sampled, the FFs who did not give consent for participation in this study were sampled as the second or third priority in consideration of their age and duties. Apart from those who were diagnosed by a physician with back injuries or diseases, the number of the final subjects was 341, including89 in their 20s, 96 in their 30s, 86 in their 40s, and 70 in their 50s.We investigated what previous studies have done for selecting control group. Similar to our study, there was articles using “office worker” as a control. The office workers had sedentary work but were free to change posture and move around , 26. So In this study, questionnaire-based interviews, physical examination by a physician, lumbar radiography, and MRI were performed for FFs and HOWs over a 4-month period, from October 2014 to January 2015.The structured questionnaire consisted of questions regarding the general characteristics, occupational factors, and lifestyle factors known to affect FJD. The questionnaire was filled out by the subjects and then supplemented with interviews. The general characteristics included age , height (cm), weight (kg), and body mass index (BMI).The lifestyle risk factors included smoking status , drinking status , and frequency of physical exercise . Nonsmokers were defined as individuals who had never smoked, while ex-smokers were defined as individuals who had quit smoking >6 months prior to participating in the study. Based on the frequency of alcohol consumption per week (72 g/week), the subjects were divided into healthy drinkers and higher-risk drinkers. Frequent physical activity was defined as exercising more than 3 times/week. The occupational risk factors comprised the job duty performed for the longest duration  and employment duration . People with lumbar spine injury or spine surgery were excluded from the study. The questionnaire survey was conducted on the presence or absence of back pain .The subjects were interviewed about their medical history and physical measurements , and then physical examinations  were conducted.The protocol is pre-agreed format, imaging method and reading method. The protocol was created to score the facet joint degeneration reading. It also included disc herniation, foraminal stenosis, central canal stenosis and other spinal disease. It was essential to image and read in the same way. After a protocol was developed for simple lumbar radiography  and MRI, we performed medical imaging tests in accordance with the protocol, including sagittal and axial T1- and T2-weighted imaging of the spine. From the last thoracic level through the first sacral level, the MRI scans were performed on 1.5-T scanners. The slice thickness was 4 mm, and the length of the field of view ranged from 146 to 150 mm. Four radiologists and occupational environmental medicine specialists participated in the study and developed a reading paper by determining the contents to be read in simple radiographs and MR images. We determined what should be read on radiography and MRI, and developed a read sheet. By using simple radiography, we only determined the overall state in relation to the identifiable diseases and injury, such as kyphoscoliosis , spina bifida, spondylolysis, anterior or posterior spondylolisthesis, and fracture. After radiography, we used MRI to identify the degree of FJD (left and right), whether a slipped disk was present or absent (type of slipped disc and its direction), Pfirrmann grade (sign of a slipped disc and degeneration), the degree of central canal stenosis, and the degree of neural foraminal stenosis.The classification method developed by Pathria et al.  was usedWith respect to the primary outcome, this study aimed to determine the odds ratio of occurrence of FJD at each lumbar level of the FFs, with the HOWs serving as the control group. The occurrence of FJD was defined if Pathria facet joint degeneration grade is 1, 2 or 3 in either right or left side at spine segment.To compare the risk factors for FJD  between FFs and HOWs, the t-test and chi-squared test were used. The chi-squared test, Mann-Whitney test, and ANOVA were used to compare FJD between age groups.The odds ratio (OR) with 95% confidence interval (95% CI) of FJD among FFs as compared to HOWs was evaluated by binary logistic regression after controlling for age, BMI, smoking, and physical exercise.ttest, chi-square test, Mann-Whitney test, ANOVA, and multiple logistic regression analysis. With the HOWs as the control group, the FJD of the FFs was adjusted forage, BMI, smoking, and frequent physical exercise, and then compared for the odds ratio at a 95% confidence interval (CI). Statistical significance was determined as a pvalue of <0.05. R version 3.1.0 with moonBook packages was used for all the data analyses.To compare the risk factors for FJD  between the FFs and HOWs, we chose FJD as a dependent variable and age, BMI, and frequent exercise as independent variables in the p=0.027).The general characteristics of the participants in this study are shown in Table p=0.018) and the L2–3 level .The difference in the prevalence of FJD between two groups at the L3–4, L4–5, and L5-S1 levels was not statistically significant  may be both manual material handling (lifting) and lumbar bending or twisting , which mRisk factors known to cause FJD include age, sex, race, anatomically abnormal lumbar structure , individual genetic predisposition, overweight, long-time sedentary posture, occupation, nutrition, and lifestyle habits , 30, 31.According to Panjabi, FJD exacerbated as it became closer to the bottom of the lumbar, and L45 was worse than L5S1 , 32. In The authors of a previous study  argued tThis study has some limitations. First, it is a cross-sectional study and hence, we could not track change of individual FFs and HOWs. Second, the FF group might have had a healthy worker effect as that noted in FFs involved in the World Trade Center collapse . FFs areThis study has several advantages as compared to previous studies. First, the study was well designed, and used a stratified random sampling method. Second, while the existing studies examined differences in lumbar diseases among occupations, mainly with respect to LBP prevalence, this study evaluated lumbar changes using MRI, an objective diagnostic tool. FJD differences between the two groups were clearly observed by MRI. This is in contrast to previous studies that explained differences in occupational burden based on LBP alone –42, and In conclusion, the development of FJD has significant relationship with occupational lumbar load. This study demonstrated that the prevalence of FJD was higher among FFs than among HOWs. This shows a clear correlation between FFs’ occupational lumbar load and the risk of developing FJD. However, additional studies are needed to investigate correlations between activities that confer lumbar burden and lumbar degenerative diseases, occupational lumbar burden (quantification), correlations between occupational lumbar load and FJD in occupations other than firefighting, and correlations between degenerative changes and LBP.