Based on work-family border theory and work-home resource theory (W-HR), this paper examines the impact of border keeper’s support  on work-family enrichment and whether or how work-family boundary flexibility mediates the relationship between border keeper’s support and work-family enrichment. A sample of 504 preschool teachers in Guangdong province, China completed questionnaires. The research results show a two-way process of work-family enrichment for preschool teachers in China. Organizational support was directly and significantly correlated with work-to-family enrichment (WFE), and family support was significantly and directly correlated with family-to-work enrichment (FWE). Organizational support had no significant positive predictive effect on work boundary flexibility which has a significant positive predictive effect on WFE. Family support had a significant positive predictive effect on family boundary flexibility which had a significant positive predictive effect on the FWE. In addition, the study found that family boundary flexibility mediates the relationships between family support and FWE whereas work boundary flexibility did not mediate the relationships between organizational support and WFE. The above research results are partly consistent with the existing research, and partly inconsistent, which is related to the profound influence of traditional culture in Chinese society and the current situation of preschool teachers in China. Such findings have important implications for improving the work-family enrichment of preschool teachers. Work-family border theory is a theory that explains how individuals manage and negotiate the work and family spheres and the borders between them in order to attain balance. Central to this theory is the idea that work and family, constitute different domains which influence each other . Since wNot only is there disagreement between individuals about the borders, including how flexible and permeable they are or should be, there is also disagreement about what constitutes each domain . Border Studies have suggested that a supportive workplace is very important, as it is intrinsically related to various organizational and employees’ positive outcomes, including financial, emotional, instrumental, psychological resources or social-capital support  to increLastly, it has also been noted that most of the work-family studies were conducted in a western context . HoweverThe current research drew on the work-family border perspective to expand existing theoretical understanding of the relationship of the border keeper’s support and work-family enrichment. In particular, it examined the process by which support affects enrichment through a chain mediation model involving work-family boundary elasticity. Therefore, by testing the hypothesized theoretical model , this reAccording to work-family border theory, different roles that individuals acting in work and family domains need role transitions as a boundary-crossing activity, where one exits and enters roles by surmounting boundaries based on border theory . AlthougSince enrichment often refers to positive spillover, it is necessary to analyze the concept of spillover. Spillover conceptually represents the process whereby behaviors, moods, stress, and emotions from one realm of social life affect those in another and vice versa . The spiPositive spillover refers to the process by which what happens in one domain often spills back over to the other domain. These processes imply a transference of the acquisition of gains in one domain  to the use of these gains in the other domain  , enrichmWork-family enrichment provides employees with sufficient resources to meet their work and family needs, so that they feel motivated to participate in various activities in the workplace and tend to show more creative work behaviors . A meta-According to previous studies, the antecedents of work-family enrichment include: role input , resource accumulation, functional improvement (improvement of means and skills to solve corresponding problems), family-friendly organizational culture , job characteristics such as job decision-making autonomy and flexible working hours . Others Organizational support, both formal policies and informal organizational and supervisory support including family-supportive organizational culture has been suggested to not only help employees balance work and family domains, but also has been shown to benefit the organization  and the Previous studies have mainly explored the effects of family-friendly/supportive organizational culture, job autonomy, flexible working hours, supervisor support, career support and other organizational support factors on work-family enrichment. There is a positive correlation between family supportive organizational culture or work atmosphere and work-family enrichment . Family-In addition, work autonomy and flexible working hours are positively correlated with work-family enrichment . Having ;Finally, previous research shows that supervisor support is positively related to work-family enrichment , employees can save more time and energy from the family field to deal with their own work responsibilities, thus reducing the interference of family to work and reducing the risk of work-family conflict . Family Boundary theory argued that in the process of role transformation between work and family, individuals must negotiate with important members in the two domains on the boundaries between roles and domains. In the negotiation process, those members who have influence on determining the border are the border keepers . In geneBased on the existing research, this study puts forward the following hypothesis:Hypothesis 1: Organizational support directly affects WFE.Hypothesis 2: Work boundary flexibility mediate the relationships between organizational support and WFE.Hypothesis 3: Family support directly affects FWE.Hypothesis 4: Family boundary flexibility mediates the relationships between family support and FWE.The research assumptions are shown in In this study, preschool teachers in Guangdong Province of China were selected as the research participants, and 674 questionnaires were collected. In total, 504 valid questionnaires were obtained, and the effective recovery rate was 74.77%. The questionnaire includes demographic variables, work-family enrichment, border keepers’ support and boundary flexibility. In the sample, there are 14 male preschool teachers (2.78%) and 490 female preschool teachers (97.22%). And the sample consisted of 228 (45.24%) preschool teachers are living in rural areas. The specific distribution of other demographic variables of the participants, such as age, marital status is shown in bianzhi (budgeted post), residence of kindergartens, and types of kindergartens. As unique features of teacher management system in China, bianzhi means legitimate access to governmental subsidies and benefits. Considering the possible link between demographic variables and teachers’ work-family enrichment, all the demographic variables were included as covariates.The demographic questionnaire was to collect the teachers’ basic information, including teachers’ age, gender, professional title, position, marital and fertility status, 2  = 40.214, CFI = 0.969, TLI = 0.941, SRMR = 0.043, RMSEA = 0.089, and the 90% confidence interval of RMSEA was . In this study, the Cronbach’s α coefficient of the questionnaire is 0.796.The work-family enrichment scale developed by 2  = 250.580, CFI = 0.962, TLI = 0.954, SRMR = 0.047, RMSEA = 0.056, and the 90% confidence interval of RMSEA was . In this study, the Cronbach’s α coefficient of the questionnaire is 0.790.This study adopts the boundary flexibility scale , which c2  = 5.588, GFI = 0.997, TLI = 0.99, SRMR = 0.016 and RMSEA = 0.015. In this study, the Cronbach’s α coefficient of the questionnaire is 0.789. The family support scale of this study adopts six items selected from 2  = 124.273, CFI = 0.912, SRMR = 0.041, and the 90% confidence interval of RMSEA was . In this study, the Cronbach’s α coefficient of the questionnaire is 0.875.According to the work-family border theory, border keeper’s support includes organizational support and family support. In this study, Rickett scored 5 points, 1 means “very inconsistent” and 5 means “very consistent.” The higher the score, the higher the support level of border keepers. The organizational support scale in this study is compiled based on five items in the perceived organizational support scale (POSS) developed by Eisenberger  and the 1 in Guangdong province, China. The questionnaire link was distributed via the social media APP WeChat  primarily by sending survey postings in the preschools’ communication WeChat Groups and by sharing the survey postings on the personal WeChat Moments of preschool principals and teachers so that potential participants could see the positing.Data were collected by a digital anonymous parent-reported questionnaire through an online crowdsourcing platformIt took about 6–10 min to fill out the entire internet-based survey. The anonymous e-questionnaires were filled on smart mobile phone or computers. And a questionnaire can be successfully submitted only when the entire questionnaire was filled out without missing any item; responses from each unique assigned ID on an electronic device could not be repeatedly submitted; and pausing and resuming the survey at any time were allowed. As soon as the questionnaire was submitted, preschool teachers would receive a reward of Chinese ¥ 2 (approximately US $ 0.3). Ultimately, 674 questionnaires were collected. We removed 170 questionnaires that took less than 350 s to complete and in which teachers gave invalid information. All procedures were approved by the authors’ home institution ethics review committee.2, CFI, TFI, SRMR and RMSEA. When CFI and TLI were greater than 0.90 and SRMR and RMSEA were less than 0.08, the fitting of the model was good  = 6266.681, CFI = 0.332, TLI = 0.289, SRMR = 0.141, RMSEA = 0.147  With Harman single factor test , explora = 0.147 . TherefoSD = 0.505), and the average score of family support is 3.92 (SD = 0.707), which is higher than the median value of 3, indicating that the organizational support and family support of preschool teachers are at a high level, and the strength of family support is higher than organizational support; The average score of WFE was 3.21 (SD = 0.858), and the average score of FWE was 3.851 (SD = 0.767), which was higher than the median value of 3, indicating that the work-family enrichment of preschool teachers was at a high level, and the level of FWE is higher than that of WFE. The average score of work boundary flexibility is 2.02 (SD = 0.73), which is lower than the median value of 3, and the average score of family boundary flexibility is 3.50 (SD = 0.787), which is higher than the median value of 3, indicating that preschool teachers’ work boundary flexibility is at a low level and family boundary flexibility is at a high level.The mean (M), standard deviation (SD) of each variable and the correlation coefficient between variables are shown in r = 0.284, p < 0.001), and negatively correlated with work boundary flexibility ; WFE was positively correlated with work boundary flexibility ; Family support was positively correlated with FWE and family boundary flexibility ; There is a positive correlation between FWE and family boundary flexibility , as shown in Organizational support was positively correlated with WFE  was significantly higher than who under 25 years old . There were significant differences for marital and fertility status, F = 2.611, p < 0.05. Post hoc analysis showed that the score of married preschool teachers with children  was significantly higher than that of unmarried preschool teachers . The WFE was significant in the residence of preschool, t = 5.042, p < 0.05, score of preschool teachers from rural areas  was significantly higher than that of preschool teachers from urban areas . In terms of FWE, there was significant difference for age, F = 3.778, p < 0.01. Post hoc analysis showed that the score of preschool teachers under 25 years old  was lowest. There was significant difference in marital and fertility status, F = 3.506, p < 0.01. Post hoc analysis indicated that score of married preschool teachers with children  was significantly higher than that of unmarried preschool teachers .The mean difference test was conducted for the two dimensions of work-family enrichment (WFE and FWE). In terms of WFE, there were significant differences for age, 2  = 158.909, CFI = 0.934, TLI = 0.908, SRMR = 0.033, RMSEA = . After controlling the covariates such as age of preschool teachers, the direct predictive effect of family support on FWE was significant , with a 95% confidence interval . In the second step, the family boundary flexibility (FBF) was added to the original model. The results showed that the model also fitted well, χ2  = 354.204, CFI = 0.947, TLI = 0.937, SRMR = 0.050, RMSEA = 0.065. As shown in p < 0.001), with 95% confidence interval . The predictive effect of family boundary flexibility on FWE was also significant , with 95% confidence interval . The predictive effect of family support on FWE was still significant , with 95% confidence interval . The mediating effect quantity was 0.108, p < 0.001, the 95% confidence interval was , the mediating effect ratio (ab/c) was 17.06%, the direct effect ratio was 82.94%. Therefore, the family boundary flexibility has a significant mediating effect between family support and FWE, and the hypothesis holds. See The confidence interval of each coefficient was estimated by the non-parametric percentile Bootstrap method with deviation correction. In the first step, the direct effect of family support (FS) on FWE was examined. The results showed a good fit, χ2  = 53.389, CFI = 0.991, TLI = 0.988, SRMR = 0.033, RMSEA = 0.026. After controlling for demographic variables such as the age of preschool teachers, the direct predictive effect of organizational support on WFE was significant , with a 95% confidence interval . In the second step, the working boundary flexibility was added to the original model. The results showed that the model also fitted well with χ2  = 235.555, CFI = 0.962, TLI = 0.955, SRMR = 0.054, RMSEA = 0.046. As shown in p > 0.05), while the predictive effect of work boundary flexibility on WFE was significant . The 95% confidence interval was . The predictive effect of organizational support on WFE was significant , and the 95% confidence interval was . The mediating effect dose was −0.030, p > 0.05, the 95% confidence interval was . Therefore, the mediating effect of work boundary flexibility between organizational support and WFE is not significant, and the hypothesis is not valid, as shown in In the first step, the direct effect of organizational support on WFE was examined. The results showed a good fit with χThe present study investigates the current situation of work-family enrichment in Chinese preschool teachers and the relationships among border keepers’ support, boundary flexibility and work-family enrichment. As expected, organizational support was positively correlated with WFE directly; family support was positively correlated with FWE; the family boundary flexibility has a significant mediating effect between family support and FWE; the mediating effect of work boundary flexibility between organizational support and WFE is not significant. The results mostly confirm our hypotheses.This study found that the work-family enrichment of preschool teachers is on the upper-middle level, and the score of FWE is higher than WFE, which is consistent with the existing research results. Work boundary flexibility is moderately low, while family boundary flexibility is moderately high. There are not only cultural reasons, but also the characteristics of preschool teachers’ profession. There is a blurring of the boundary between work and family roles in Chinese workplaces due to the influence of traditional culture . The ChiIt is found that there is a significant direct influence between family support and FWE of preschool teachers, and the intermediary role of family boundary flexibility between family support and FWE exists. There is a significant direct influence between organizational support and WFE of preschool teachers, but the mediating effect of work boundary flexibility between organizational support and WFE does not exist.First of all, family support has a significant positive predictive effect on FWE. Previous studies have also confirmed that family support, such as sharing housework or picking up children, or showing understanding and providing emotional support, can reduce individual guilt toward the family. At the same time, it will make individuals have positive feelings about family life and work, which will help them better perform their duties and promote their work development . SimilarSecondly, family support has a significant positive predictive effect on family boundary flexibility. According to the work-family border theory, family support can make the boundary between family domain and work domain flexible . In otheFinally, the family boundary flexibility has a significant positive predictive effect on the FWE, which is consistent with the previous research results . AccordiFirstly, organizational support has a significant positive predictive effect on WFE, which is consistent with previous research results . French Secondly, organizational support has no significant positive predictive effect on job boundary flexibility, different from previous research results. Previous studies believe that organizational support, as an important resource, can make the boundary between family domain and work domain more flexible . The reaThirdly, the elasticity of work boundary has a significant positive predictive effect on WFE. Similar to previous studies, job flexibility helps employees to better manage their family life, resulting in higher productivity and satisfaction, and then affecting individuals’ positive emotions, emotions and behaviors in the family field . AccordiTheoretically, this study is based on the W-HR theory focusing on the positive synergistic potential of the work-family interface. Due to personal resources accumulated from border keeper’s support, employees achieved more flexibility and ability to deal with demands from work and family domain. This study has several implications: according to the resource-demand matching theory, the needs from work, family and the cross-border involve time-based demands, strain-based demands  and role blurring. Organizational support  and family support can increase the resources that individuals may obtain. If the resources that individuals obtain can match the needs from the two fields of work and family, individuals are more likely to obtain mutual benefits between work and family. The present study extends the range of antecedents and outcomes of WFE by examining its relationship with border keepers’ support and border flexibility. The process and mechanism is summarized as shown in The importance of the beneficial effects of border keepers’ support and border flexibility on work- family enrichment is supported by this study. Kindergartens should incorporate the concept of work-family reciprocity into the human resource management process, and use these results to teach their employees to deal with the relationships between work and family.First of all, the study points out that the heavy work leads to the fuzzy work family boundary for preschool teachers, especially urban preschool teachers. And the low elasticity of work boundary which shows that preschool teachers need to deal with the increasing professional requirements with the performance reform and professional movement in recent years. Preschool teachers, especially those in urban kindergartens, are required to undertake multiple roles such as instruction, observation, doing research, writing articles and so on at the same time, with a large workload. It is suggested to reduce pressure and burden, increasing their abilities or power to realize the mutual gain of the two domains. Since Chinese society is a reasonable society, it is emphasized to give consideration to emotion and rationality, taking precedence over rationality. Therefore, the organization should first give teachers more professional autonomy, respect, emotional care, and instrumental support to improve teachers’ ability to use resources across borders by giving more professional development opportunities and various demand-based training.the woman warrior (1976), Chinese women have long been suppressed by male chauvinism  with reliable measurements to evaluate border keeper’s support, work-family enrichment, border flexibility.While women and men differ in their experiences of WFE , this stThis study puts forward and tests the influence of border keeper’s support  on work-family enrichment (WFE and FWE) based on samples of 504 preschool teachers in China. Results showed that work-family enrichment of preschool teachers is on the upper-middle level, and the score of FWE is higher than WFE which is originated from the expectation of individual’s role in Chinese society that individuals should be career-oriented. This study confirms that family support has a direct and significant positive predictive effect on FWE, and organizational support has a direct and significant positive predictive effect on WFE. In addition, the study found that family boundary flexibility mediates the relationships between family support and FWE whereas work boundary flexibility did not mediate the relationships between organizational support and WFE. The above research results are partly consistent with the existing research, and partly inconsistent, which is related to the profound influence of traditional culture in Chinese society and the current situation of preschool teachers in China. Such findings have important implications for improving the work-family enrichment of preschool teachers.The data are not publicly available due to privacy or ethical restrictions. The data that support the findings of this study are available on request from the corresponding author.The studies involving human participants were reviewed and approved by South China Normal University. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.QP designed the research and drafted the manuscript. CL collected and extracted data for analysis. LZ provided important ideas and substantial feedback for the study and edited the manuscript. All authors have approved the final version of this article.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The purpose of this work was to investigate the relationship between animal welfare (AW) and antimicrobial use (AMU) in dairy farms due to limited knowledge in this sector. AW was assessed using a survey in 79 Italian farms housing over 15,000 cows. The average AW level was good. Nevertheless, a wide difference among farms emerged, both in terms of AW and AMU, which underlined the importance of creating a monitoring system to identify problem farms as well as virtuous farms (as positive examples). The use of antimicrobials deemed critical for human medicine by the European Medicines Agency was frequent, particularly in farms with good management. This could be due to a tendency to choose those perceived as the best antimicrobials. Nevertheless, it is possible to reduce the use of critical antimicrobials without affecting animal health and production. Farms with better management used more intramammary products for dry cows; thus, reducing AMU may require selective dry cow therapy in several herds. Two of the farms involved in the study did not use any antimicrobials, but their AW was poor, suggesting a management review including a possible reintroduction of AMU. Our study highlights the importance of implementing a tailored antimicrobials stewardship.Information regarding the relationship between animal welfare (AW) and antimicrobial use (AMU) in dairy cows is limited. The current study aimed to investigate this relationship on Italian farms and to identify potential targets of AMU reduction. The study was performed at 79 Italian dairy farms housing over 15,000 cows during 2019. AW was scored with an on-farm protocol assessing farm management and staff training, housing systems, and animal-based measures. AMU was estimated using a defined daily dose per kg of animal biomass (DDDAit/biomass) for Italy. The median AW score was 73% (range: 56.6–86.8%). The median AMU was 4.8 DDDAit/biomass (range: 0–11.8). No relationship between the total AMU and AW was found. Management and staff training were positively associated with the use of the European Medicines Agency’s category B antimicrobials, which are critical for human medicine, and with intramammary products for dry cow therapy. In those farms, antimicrobial stewardship should aim to reduce the category B antimicrobials and selective dry cow therapy. Our results underline the importance of implementing both an integrated monitoring system  and antimicrobial stewardship tailored to the specific needs of each dairy farm. Animal welfare (AW) has multifaceted dimensions; thus, AW should encompass an integrated approach that includes animal health, food security, and public health .The relation between AW and animal health in dairy production is well-known. When farming conditions are poor, they can exacerbate health issues that lead to a reduction in AW. For instance, inadequate management and poor udder hygiene increase the risks of intramammary infection . Poor hoAMU in livestock can provide several benefits regarding animal health, disease control, and production. Nevertheless, excessive or inappropriate AMU in food-producing animals increases the risk of antimicrobial resistance, therapy failures, and, therefore, the persistence of a state of disease . NationaIn the dairy sector, various studies have been performed to estimate the level of AW ,22 and twww.vetinfo.it, accessed on 15 July 2021), more than 40% of Italian dairy cows are housed.Courtesy of cooperation with a dairy consortium, it was possible to include in the study 79 free-stall dairy farms that delivered milk for cheese production. All the selected farms had joined a voluntary AW improvement program. The study was conducted in the Lombardy region  in which, according to the Italian Veterinary Database . The visits were performed by a total of four evaluators (two groups of two) and all of the farms were audited between October and December 2019.Data on AMU from the beginning of July 2019 to the end of June 2020, approximately six months before and after the visits, were collected via the National Electronic Prescription System, in which data entry is the responsibility of the farmer and the prescribing veterinarian. The average number of animals housed during the study clustered by age group  was provided by the farmer during the visit.www.classyfarm.it, accessed on 15 July 2021), a national monitoring system of the Italian Ministry of Health. This protocol was developed by the CReNBA and founded by the Italian Ministry of Health [The AW level of the involved farms was assessed using a protocol included in ClassyFarm  as a standard metric. This metric was established during the development of the ClassyFarm system. The DDDAit has already been described in detail in previous studies on beef  and pig The weights at risk for cows, heifers, and calves were also established during the development of ClassyFarm, and they were set at 600, 300, and 100 kg, respectively. As one year of AMU was considered and animals up to six months of age were classified as calves, the average number of housed calves was multiplied by two.The daily dosage of intrauterine (IU) and intramammary products for milking (IM-LC) or dry cows (IM-DC) is usually defined in the SPCs as units per animal instead of mg per kg of live weight. In the case of IU or IM-LC products, the DDDAit was established as the number of units that should be administered per cow per day of treatment, as stated in the SPC. As this standardized approach could not be applied to IM-DC for such products, a DDDAit of 1 was considered, as described in previous studies ,35. FinaAntimicrobials administered in other forms, such as sprays, were not included in the study because assigning a DDDAit was not viable.Data collected on-farm and from existing databases  were managed and exported for further statistical analysis using Microsoft Excel .Firstly, the variation in the total AMU (DDDAit/biomass) in dairy farms was analyzed through two separate linear models (LMs) with a normal error distribution. In a first model (i), we included as an explanatory variable the total AW score, whereas in a second model (ii), we considered separately all of the AW areas . Secondly, we analyzed the consumption of antimicrobials belonging to the category B (“Restrict”) of the European Medicines Agency (EMA)  , 8698 heifers , and 4644 calves .The median AW score was 73.0%, ranging from 56.6–86.8%. The median score of farm management and staff training was 77.4% (range: 53.8–92.3%). The median score of housing systems was 68.6% (range: 47.6–86.7%). The median animal-based measures score was 73.3% (range: 44.3–89.8%). The distributions of the 79 farm scores are shown in Antimicrobials were used in 77 of 79 farms (97.5%) and the median DDDAit/biomass was 4.8, ranging from zero to 11.8. Injectable products were the most used antimicrobials, representing 45.7% of the total AMU, followed by IM-DC (30.0%), IM-LC (15.5%), oral (5.7%), and IU (3.1%).Antimicrobials included in EMA’s category B were administered in 52 of 79 farms (65.8%). The median DDDAit/biomass of category B antimicrobials was 0.1, ranging from zero to 5.2. Detailed AMU by antimicrobial class is reported in p > 0.05). Conversely, the probability of using category B antimicrobials, not related to the total AW score, varied significantly with the scoring of farm management and staff training (p = 0.016); the full results of the logistic regression models are reported in The total AMU on the examined farms was neither related to the overall AW score  nor to ap = 0.017 and p = 0.011, respectively). In this case, a 0.1 increase in the score led, on average, to an AMU increase of 0.25 ± 0.09 DDDA/biomass. Detailed results of the linear model are reported in Finally, the use of IM-DC increased with farm biomass and was positively related to the score of farm management and staff training  and the sample was not randomly selected. Hence, the results may not be representative of Italian dairy farming in terms of AW or AMU.Measures used to assess welfare may range in precision. For example, variability can be high among the observers and among the days of observation. Environment-based measures often tend to be more reliable than animal-based measures. Any protocol requiring human assessors increases the risk of intra and interobserver measurement variability compared to an automated system ,44. To rAnother important limitation of this study was the lack of information on AMU by age group because such data were not often available from the investigated sources. Nevertheless, it is reasonable to assume that AMU was not evenly distributed in the three age groups but was concentrated in calves because their young age increases their susceptibility to infections, and in cows, mainly due to mastitis. Thus, future studies investigating AMU in Italian dairy farms should also consider the consumption per age group.In this study, we generally found good levels of AW but with sizeable differences between farms. AMU also varied widely among farms and the use of category B antimicrobials, particularly third and fourth-generation cephalosporins, was frequent. Although no direct relationship emerged between overall AMU and AW, a group of farms that excelled in both was found, which may serve as a positive example for other farmers. Finding these examples, as well as problematic farms, is possible only when a monitoring system is in place. Farms that paid particular attention to management tended to consume a larger number of IM-DC products and to administer category B antimicrobials more frequently. Our results underline the importance of implementing both an integrated monitoring system  and an antimicrobial stewardship tailored to the specific needs of each dairy farm .


Aspergillus and Penicillium spp. in feeds or foods. OTA has been proved to possess nephrotoxic, hepatotoxic, teratogenic, neurotoxic, genotoxic, carcinogenic and immunotoxic effects in animals and humans. OTA has been classified as possibly carcinogenic to humans (Group 2B) by the IARC in 2016. OTA can be mainly found in animals as a result of indirect transmission from naturally contaminated feed. OTA found in feed can also contaminate pigs and produced pork products. Additionally, the presence of OTA in pork meat products could be derived from the direct growth of OTA-producing fungi or the addition of contaminated materials such as contaminated spices. Studies accomplished in various countries have revealed that pork meat and pork meat products are important sources of chronic dietary exposure to OTA in humans. Various levels of OTA have been found in pork meat from slaughtered pigs in many countries, while OTA levels were particularly high in the blood serum and kidneys of pigs. Pork products made from pig blood or organs such as the kidney or liver have been often found to becontaminated with OTA. The European Union (EU) has established maximum levels (ML) for OTA in a variety of foods since 2006, but not for meat or pork products. However, the establishement of an ML for OTA in pork meat and meat by-products is necessary to protect human health.Ochratoxin A (OTA) is a mycotoxin that is produced after the growth of several  Aspergillus and Penicillium in a wide variety of agricultural commodities during the field period or storage worldwide. OTA was found to possess a carcinogenic effect in animals and poultry, in addition to its nephrotoxic, hepatotoxic, teratogenic, neurotoxic, genotoxic and immunotoxic effects in animals -(R)-isocoumarin. OTA consists of an isocumarin nucleus bonded to an L-phenylalanine unit by an amide bond [After OTA ingestion in human or animals, several OTA derivatives are transformed. Certain OTA derivatives are hydroxylated, while others lack phenylalanine moiety or are conjugated . Among the OTA metabolites are the dechloro analog ochratoxin B (OTB), the dechloro analog ochratoxin β (OTβ), the ethyl ester ochratoxin C (OTC) and the isocoumaric derivative OTα . The OTAOTA is stable to heat treatments and low pH conditions. Typical heat treatments of foods such as boiling, baking, frying and roasting do not cause any important decrease in OTA levels ,105. PleInnovative food-processing methods such as irradiation, cold plasma (CP) and high-pressure processing (HPP) may be an effective means of OTA decrease in foods by controlling the growth of OTA-producing fungi ,108. DesSeveral studies have indicated that OTA has nephrotoxic, hepatotoxic, teratogenic, neurotoxic, genotoxic and immunotoxic effects and can cause tumors in organs and tissues such as the kidneys, liver, intestine, ureters, lung, oculi and muscles of animals and humans ,60,110. In humans, dietary exposure to OTA represents a serious health issue, including endemic nephropathies and urinary tract tumors . OTA hasIn many animal species and in humans, the primary target organ of OTA is the kidney . The nepAmong food-producing animals, pigs are the most susceptible animals to OTA exposure ,11. In pP. polonicum, P. aurantiogriseum and P. commune have been also associated with the etiology of BEN [In humans, even though the epidemiological evidence was inadequate, OTA exposure was associated with Balkan Endemic Nephropathy (BEN), Chronic Interstitial Nephropathy (CIN) and other kidney diseases ,125. ΒΕΝy of BEN . It has y of BEN ,133.In humans, two other forms of CIN nephropathy observed in Tunisia were associated with OTA . HoweverApart from the kidneys, the liver is one of the major target organs of OTA biotransformation . SignifiThere are remarkable differences in legal regulations of the presence of OTA in feeds or foods among various countries. In the USA, no limits on OTA in foods or feed have been set . The US Legislation differences exist in various countries in Asia. In China, Indonesia, Korea, Malaysia and recently in Singapore, legislative limits have been set for OTA in foods and feed, but not in meat and meat products . In JapaThe EU, based on the scientific opinion of the scientific panel on contaminants in the food chain of the EFSA, established maximum limits for OTA in a variety of foods in Commission Regulation (EC) No. 1881/2006 ; for exaHowever, in pork meat and meat products and other foods of animal origin, OTA limits have been not set yet. Instead, in many EU member countries, to protect consumers from OTA-contaminated pork meat, edible offal and derived products have been subject to regulations or guidelines to limit exposure, such as in Denmark , Estonia (10 μg/kg in pig liver), Romania  and Slovakia (5 μg/kg in meat), Italy (1 μg/kg in pork meat and derived products) . The difSeveral analytical methods have been used for the detection and measurement of OTA in feeds and foods ,141,142.Meat is a complex compound matrix and poses difficulties in OTA analysis due to the strong bonds between proteins and OTA and the presence of fat, which may be also co-extracted . TherefoHPLC with fluorescence detector (HPLC-FLD) has shown good analytical performance for OTA determination in pork tissues and organs, as the limits of detection (LOD) and limits of quantification (LOQ) values were found to be quite low. In pork meat, low levels of LOD at 0.01 μg/kg  and LOQ The ELISA method is also an effective quantitative method for OTA screening in pork meat products ,57,151. The use of enzymatic digestion (ED) extraction significantly reduces matrix interference with the OTA in meat, leading to more reliable results of the OTA analytical methods ,153. ForUltra-performance liquid chromatography (UPLC) has been also used for OTA detection in meat ,160, witIn order to detect potentially ochratoxinogenc fungi and quantify the genes involved in the biosynthesis of OTA production, tge quantitative real time PCR (qPCR) method was also used .In pigs, the highest concentrations of OTA are usually found in the blood, followed by the kidneys, liver, muscles and fat ,17,18,19Accomplished data on the occurrence of OTA in edible pig tissues from published studies conducted in various countries worldwide are summarized in The presence of OTA in kidneys is considered to be a good indicator of overall exposure of pigs to the toxin . SeveralVarious levels of OTA have been found to be present in the livers or muscles of slaughtered pigs. In the livers of pigs, OTA levels as high as 100% and 33% were found by using HPLC-FD or LC-MS/MS, respectively ,153. OTAOTA is the most common mycotoxin found in processed pork meat products ,67,70,83High differences in the occurrence of OTA in pork meat products have been observed in various countries . High vaStudies on the OTA levels in fermented sausages produced from pigs fed with OTA-contaminated feed were also conducted. In a study conducted in Croatia, pigs were fed with OTA-contaminated feed (300 μg/kg of feed) for 30 days . The meaP. nordicum yielded significantly higher amounts of OTA than those inoculated with A. ochraceus [P. verrucosum and P. nordicum and found that the OTA levels ranged between 2.30–4.37 μg/kg, using different aw values. In a recent study, Delgado et al. [P. nordicum, and after 26 days of ripening, the OTA levels were in the range of 1.02 to 51.06 μg/kg.The occurrence of OTA in contaminated meat products may also be due to the growth of OTA-producing fungi in these products ,29,30,94chraceus . Sánchezchraceus  inoculato et al.  inoculatA. westerdijkiae on the salami surface produces high levels of OTA on the casing and allows its diffusion through the casing to the outer parts of sausages [A. westerdijkiae resulted in high levels of OTA of 1.959 μg/kg [P. nordicum and P. verrucosum, the OTA level was found to be between 30.58 μg/kg and 66.91 μg/kg [P. nordicum, and OTA was detected on the fourth day (10 μg/kg) and increased significantly on the seventh day, reaching the maximum level of 135 μg/kg after 10 days of storage [It was also found that the growth of sausages . Further59 μg/kg . In saus91 μg/kg . Fresh p storage .There are only a few studies on the assessment of the human exposure to OTA due to the consumption of pork meat and derived products. The Joint FAO/WHO expert committee on food additives (JECFA) established a Provisional Tolerable Weekly Intake (PTWI) of 100 ng/kg bw based on the lowest-observed-adversed-effect level (LOAEL) for renal effects in pigs ,197. EFSAccording to the results of two research projects (1997–1999 and 2000–2002) ,191 on tHuman exposure to OTA seems to be associated predominantly with the consumption of contaminated plant-derived products and only to a minor extent with foods of animal origin . HoweverAspergillus and Penicillium spp. in a wide variety of foods and feeds. OTA is toxigenic to animals and humans and has been classified as possibly carcinogenic to humans (Group 2B) by the IARC. In humans, OTA exposure was associated with Balkan Endemic Nephropathy, Chronic Interstitial Nephropathy and other kidney diseases, although this is not epidemiologically evident.OTA is produced by grown Pigs are the most susceptible animals to OTA exposure. Among foods of animal origin, pork meat and meat products are considered as important sources for chronic dietary exposure to OTA in humans. The EU established maximum limits for OTA in a variety of foods since 2006, but not for meat or meat products.Various levels of OTA have been found to be present in pork meat and offal from slaughtered pigs in various countries. According to several studies of slaughtered pigs accomplished in many countries, the OTA levels were particularly high in blood serum and kidneys.High differences in the occurrence of OTA in pork meat products have been observed in various countries. Pork products made from pig blood or organs such as the kidney or liver have often been associated with the presence of OTA. Results from these studies highlight the need to apply control OTA measures in pig feeds and establish an ML for OTA in pork meat by-products to protect human health and to constantly monitor OTA occurrence in animal-derived products.


Linear mixed models indicated no between-group differences for reductions in intensity or distress over the course of the week. These findings highlight an important boundary to the benefits of such visuospatial tasks, in that while they may be associated with reductions in intrusion memory frequency, individuals may nonetheless continue to experience distress when intrusions do occur.Cognitive interventions involving visuospatial tasks, such as the game “Tetris” have demonstrated efficacy in reducing the frequency of intrusive memories. However, it remains unclear whether these tasks also reduce the perceived intensity and distress of these memories. We investigated whether either of two visuospatial tasks: a Tetris intervention or Digital Corsi task, following the viewing of an analog trauma (film) resulted in decreased intensity and distress for intrusive memories over the following week, when compared to a control condition. Participants ( Intrusive memories are a characteristic feature of acute stress disorder and posttraumatic stress disorder (PTSD). They are involuntary, repeated, and distressing recollections following exposure to a trauma event that most commonly take the form of visual mental images , 2. IntrCognitive interventions involving a taxing visuospatial task , such as the Tetris intervention and complex pattern tapping, have demonstrated efficacy for reducing the trajectory of intrusive memory frequency following exposure to an analog traumatic event, when administered in the memory consolidation phase –8. MemorThe “visuospatial hypothesis” As trauma processing appears to be hampered by avoidance strategies associated with the distress of recalling trauma memories , an incrPromising findings in relation to the influence of visual and spatial tasks on reduced emotionality for intrusive memories have been indicated in studies that used either eye-movements or spatial tasks to assess emotional outcomes in relation to intrusive memories. Andrade et al.  asked paAlthough few studies have investigated the influence of visuospatial tasks on the intensity of intrusive memories, Englehard et al.'s  study shPrevious studies that utilized visuospatial tasks during memory consolidation have tended to assess levels of distress for the trauma event e.g., , 22, 23], 2322, 2https://osf.io/snp8g) beyond our previous replication paper  and all participants provided informed consent. Participants who completed all components of the study received a $30 e-gift voucher.d = 0.91, 7; d = 0.62 and 0.70, 8). In the present study, 26 participants were needed per group condition in order to detect a large between-group effect size with a two-tailed α of 0.05 and 80% power, though we oversampled to allow for attrition and smaller than expected effect sizes.Medium to large between-group effect sizes have been reported in previous studies that investigated the influence of the Tetris intervention on intrusion frequency following exposure to analog trauma  were used to assess levels of attention to the Trauma Film Paradigm; mood ratings  before and after viewing the Trauma Film Paradigm; attention given to the film; emotionality for intrusive memories following the 4-h break; task enjoyment; and diary accuracy.Consistent with previous studies e.g., , 8], pri, pri8)],The three-part cognitive intervention including Tetris involved mental rotation practice of blocks in the game, a reminder cue for the trauma event, and Tetris gameplay where the player has visibility of the upcoming blocks and imagines rotating them for optimal placement. The computer game Tetris (UTS Research Version)  involvesA 12-min adaptation of the original Corsi tapping task  was admiIntensity and distress, as indicated by levels of “upsetting”, were measured using online visual analog scales (VAS), which allowed participants to drag the slider along a continuum anchored from 0  to 10 (extremely) to indicate their endorsement level.Intrusive memory characteristics were assessed using the Metricwire app (Version 4.1.2)  on partiThe use of this ecological momentary assessment method meant participants could repeatedly capture data while in their natural environment, thereby supporting ecological validity of the information gathered , 31. ThiAfter providing informed consent, participants completed the self-report measures, VAS , and measures for rumination, dissociation, and intolerance of uncertainty. All participants practiced both of the task conditions with Tetris gameplay running for 2 min and D-Corsi for six rounds. The researcher then left the room so that each participant could view the Trauma Film Paradigm on their own. The VAS were then re-administered along with attention to film ratings. Participants then went about their day as usual and returned to the lab after 4-h.After returning to the lab, measures were completed for activity involvement during the 4-h gap, intrusive memory frequency, perspective, cause, and ratings for intensity and distress associated with the memories were also obtained. During the lab session, participants were asked, “How intense were the intrusive memories? That is, how strongly did you experience them?” and “How distressed were you by the intrusive memories? That is, how upsetting were they for you?”With the researcher in the room, a film reminder cue was viewed, after which participants were randomly allocated to one of the three experimental conditions: Tetris, D-Corsi, or Control [silence], for 12-min. Next, VAS were administered for intrusive memory frequency and task enjoyment, and participants registered for the Metricwire diary phone app. Instructions were provided for the phone app and study overall, and participants completed a checklist to confirm their understanding of task requirements tasks over the next week.Using the Metricwire app, participants monitored intrusive memory intensity and distress at night on Day 0, and then three times daily on Days 1–7. An email link with the final online questionnaires was sent to participants on Day 8. Participants who completed all components of the study were sent the e-gift voucher and thanked for their participation it the study.Between group differences for attention to the film, diary accuracy and number of entries, task enjoyment, self-report measures, VAS for levels of distress and being bothered by the film, re-experiencing, intensity, and distress ratings following the 4-h break were analyzed using one-way ANOVAs with Bonferroni-corrected pairwise comparisons. Data for changes in VAS scales from pre- to post-film viewing for sad, hopeless, fearful, horrified and depressed were analyzed using ANCOVAs with Bonferroni-corrected pairwise comparisons, with the pre-film rating entered as the covariate. Data for intensity and distress scores were collected at 22 time points across Days 0–7, and were analyzed using Linear Mixed Models (LMM) with Bonferroni-correct pairwise comparisons. A first order autoregressive covariance structure was specified. Timepoint, condition and the interaction of timepoint by condition were included as fixed effects and a random intercept was specified. Bonferroni adjustments were used to control the type 1 error rate for pairwise comparisons. Prior to running the LMM, correlational analyses between the key variables of total intrusive memory frequency, and average intensity and distress scores were conducted using data from Days 0–7. Outcomes are reported in n = 36; Tetris, n = 35; D-Corsi, n = 36. Data for demographic characteristics, task and compliance ratings, self-report questionnaires, and pre- and post-Trauma Film Paradigm measures are reported in Data for 107 participants aged 18–68 were analyzed. The group sizes were Control, Group equivalency analyses were undertaken prior to hypothesis testing. Increased negative emotional valence was reported across all conditions from pre- to post-Trauma Film Paradigm. No between-group differences were indicated for attention to the film, diary accuracy or number of entries, self-report measures, VAS scores for distress or being bothered by the film, or VAS score changes for emotionality associated with viewing the film.Intensity and distress levels for participants who reported the presence of intrusive memories for the Trauma Film Paradigm during the 4-h break did not differ between groups. Outcomes for rumination, dissociation, and intolerance of uncertainty are beyond the scope of this paper and will be reported elsewhere.Participants in the Tetris condition reported greater task enjoyment than those in the Control group but no other between-group differences were reported.p > 0.05) across Days 1–7. Mean scores for the conditions were: Control = 2.86 (SE = 0.25); Tetris = 2.89 (SE = 0.26); D-Corsi = 2.74 (SE = 0.25).There were no between-group differences for the mean intensity scores (p > 0.05) across Days 1–7. Mean distress scores for the conditions were: Control = 2.40 (SE = 0.26); Tetris = 2.32 (SE = 0.27); D-Corsi = 2.18 (SE = 0.25).There were no between-group differences for mean distress scores  = 0.19, p = 0.83.There were no between-group differences on the IES-R, Our central hypothesis pertained to the main effects of the visuospatial task conditions on reducing the perceived intensity and distress of intrusive memories over the course of a week, as compared to the control condition.F = 14.50, df = 1, 344.23, p = <0.001), but not for condition  or the interaction of condition by time .For intensity, results indicated a significant main effect for time , but not for condition  or the interaction of condition by time .For distress, results indicated a significant main effect for time ].Our hypotheses that participants in either of the visuospatial task conditions (the Tetris intervention or D-Corsi) would report lower levels of intensity and distress for intrusive memories as compared to participants in the control condition was not supported. This finding is broadly similar to the results of Meyer et al. ; at leasInstead, it remains possible that differences in the intervention between our study and that of others explain the discrepancy in results. The visuospatial tasks of the present study presumably tax working memory to a greater extent than the eye movement only tasks of Lilley et al.  and otheLimitations of the current study include the use of a single-item measure for intensity and upsetting, rendering each variable's reliability indeterminate. However, the need for brevity given that these measures were administered at three time points daily, as well as the absence of validated assessment tools for these constructs, resulted in our reliance on single item assessments, much as in previous studies , 20. A fIntrusive memories are a core feature of PTSD and have been associated with overall symptom severity , 33. Thehttps://doi.org/10.17605/OSF.IO/VUTCW.The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found below: Study protocols, materials and de-identified data are accessible at Ethical approval was obtained from the Human Research Ethics Committee at the University of Technology Sydney (ETH17-1455). The patients/participants provided their written informed consent to participate in this study.AB developed the study design under the supervision of, and in consultation with DB. Testing and data collection were performed by AB. AB and DB contributed to the development of the study concept, performed data analysis and interpretation, and drafted the paper, and ZS provided critical revisions. All authors approved the final version of the paper for submission.This research was supported by an Australian Government Research Training Program Scholarship awarded to AB and by a National Health and Medical Research Council (NHMRC) Early Career Fellowship (GNT1122203) awarded to DB. The NHMRC had no role in the design of the study, data collection, data analysis, interpretation of data, or in the writing or revision of the manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Furthermore, we identified that the mean hippocampal gray matter density of aMCI subjects with anosognosia was not statistically different than that of AD subjects. The groups of aMCI and AD subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex compared to subjects without anosognosia, but these differences were not statistically significant. No statistically significant differences were found in the fractional anisotropy or mean diffusivity of the hippocampus or cingulum between subjects with and without anosognosia in aMCI or AD groups. While these findings are derived from a small population of subjects and are in need of replication, they suggest that anosognosia in aMCI might be a useful clinical marker to suspect brain changes associated with AD neuropathology.Although the presence of anosognosia in amnestic mild cognitive impairment (aMCI) may be predictive of conversion to Alzheimer’s disease (AD), little is known about its neural correlates in AD and aMCI. Four different groups were compared using volumetric and diffusion magnetic resonance imaging metrics in regions of interest : aMCI subjects with anosognosia ( Anosognosia is defined as the loss or decline in a subject’s awareness of problems in daily functioning, behavior, cognition, or mood . This coAnosognosia can appear in amnestic mild cognitive impairment (aMCI), a diagnosis that implies a heightened risk for developing AD dementia, in which memory performance is diminished but autonomy in daily life is preserved . InteresAccording to a recent systematic review, anosognosia in AD is associated with a reduction in gray matter density, cerebral blood flow, and metabolism in several regions: the anterior and posterior cingulate cortex, the medial temporal lobe, the inferior, superior and medial frontal gyri, the orbitofrontal cortex, and the insula . Most ofClinical rating, in which the clinician’s judgment is used to rate the level of anosognosia on a scale after an interview with the patient and the caregiver. (2) Patient-informant discrepancy, in which after parallel interviewing of the patient and caregiver, a “discrepancy score” of the patient’s symptoms is calculated, and finally. (3) Performance discrepancy, in which the performance of a patient on a neuropsychological test is compared to their own estimation of how well they think they performed on said test. Taking this into consideration, a multi-method magnetic resonance imaging (MRI) morphometric study showed that all three anosognosia measurement methods were independently associated with gray matter atrophy in the medial temporal lobe including the right hippocampus in AD participants  Cliicipants . The conicipants . Howevericipants .A sound approach for the assessment of anosognosia has been developed under the more general construct of the behavioral dysexecutive syndrome . This syIn light of this evidence, we aimed to provide further evidence on the neural underpinnings of anosognosia in aMCI and AD using the BDSI in a clinical sample. To our knowledge, no previous studies have used this anosognosia measurement to study structural brain changes. We hypothesized that subjects with aMCI or AD dementia with anosognosia would exhibit volumetric and white-matter integrity changes in the bilateral hippocampus and cingulate cortex, relative to aMCI or AD subjects without anosognosia.Eighteen participants with aMCI and sixteen participants with AD were recruited from the outpatient consultation of the Dementia Laboratory of the National Institute of Neurology and Neurosurgery of Mexico in Mexico City. aMCI and AD dementia were diagnosed by certified specialists following current clinical criteria . InclusiGeneral cognitive functioning was assessed using an adapted version of the MMSE widely used in Mexico . For theMagnetic resonance imagings were acquired using a 3 Tesla SIEMENS Skyra scanner  with a 20ch head coil.2; matrix: 256 × 256; voxel size: 1 mm3). Preprocessing included denoising and intensity inhomogeneity correction . DWI image preprocessing included a first denoising step using a blockwise non-local means filter (Diffusion-weighted images (DWI) were obtained using an echo-planar spin-echo sequence with 64 directions , and Chi-square tests for dichotomous variables (sex).Results are presented in means (M), medians (Mdn), interquartile ranges (IQR), and value ranges (Rng). For the description and comparison of demographic and clinical characteristics, Mann-Whitney U tests were used. An alpha of 0.05 was defined for statistically significant findings. In the case of statistically significant findings, we conducted a False Discovery Rate analysis, and present the Benjamini-Hochberg adjusted p value. The rank-biserial correlation (rrb) is reported as a non-parametric effect size for the Mann-Whitney U test  of the averaged GMD or white matter FA in each ROI, Mann-Whitney y U test . Statisty U test  and IBM y U test .Additional analysis assessing the correlation of the severity and frequency of anosognosia with the MRI metrics can be consulted in the This study was approved by the research and ethics committees of the National Institute of Neurology and Neurosurgery of Mexico after independent, blinded review (protocol number: 116/16) and carried out according to the Declaration of Helsinki. All participating subjects, as well as first-grade family members in the case of subjects with AD dementia, were informed about the study in detail and consented to it.n = 18), subjects displaying anosognosia  had a Mdn of 72.0 years of age (IQR = 3.0) and a Mdn of 12.0 years of education (IQR = 5.3), obtained a Mdn MMSE score of 26.5 (IQR = 1.8), and had a Mdn ICV of 1358.4 (IQR = 147.0) cm3. aMCI subjects not displaying anosognosia  had a Mdn of 69.5 years of age (IQR = 7.0) and a Mdn of 12.0 years of education (IQR = 7.0), obtained a Mdn score of 28.0 in the MMSE (IQR = 1.3), and had a Mdn ICV of 1292.0 cm3 (IQR = 64.5). Between-group differences were not statistically significant in any of these variables, median, ranges, test statistics, and p values are presented in In the aMCI group (n = 16), subjects displaying anosognosia  had a Mdn of 72.0 years of age (IQR = 6.0), and a Mdn of 9.0 years of education (IQR = 3.5), obtained a Mdn score of 21.0 in the MMSE (IQR = 4.0), and had a Mdn ICV of 1358.1 cm3 (IQR = 137.6). AD subjects not displaying anosognosia  had a Mdn of 64.5 years of age (IQR = 6.0) and a Mdn of 12 years of education (IQR = 7.0), obtained a Mdn score of 22.0 in the MMSE (IQR = 4.0), and had a Mdn ICV of 1293.4 cm3 (IQR = 117.3). Between-group differences were not statistically significant, and mean, ranges, test statistics with p values are presented in In the AD group  than subjects without anosognosia . This difference was statistically significant, showing a large effect size .In the aMCI group, subjects with anosognosia had a lower GMD in the bilateral hippocampus ROI  than subjects without anosognosia , but this difference was not statistically significant .The group of aMCI subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex ROI  than aMCI subjects without anosognosia , but this difference was not statistically significant . In an exploratory analysis, we identified that the Mdn hippocampal GMD of aMCI subjects with anosognosia  was not statistically different than that the whole subset of AD subjects , this is illustrated in In the AD group, subjects with anosognosia had a lower GMD in the bilateral hippocampus ROI  than subjects without anosognosia , but this difference was not statistically significant .Alzheimer’s disease subjects with anosognosia also displayed a lower GMD in the bilateral cingulum cortex ROI  and without anosognosia . This was also the case in the cingulum FA, with no significant differences between aMCI with anosognosia  and without anosognosia .No statistically significant differences in hippocampal FA were found between aMCI subjects with anosognosia  and no anosognosia groups , and also no significant differences in cingulum FA between the groups .Subjects with AD had similar results, with no significant differences in hippocampal FA between the anosognosia  and without anosognosia . This was also the case in the cingulum MD, with no significant differences between aMCI with anosognosia  and without anosognosia .No statistically significant differences were found in hippocampal MD between aMCI subjects with anosognosia  and no anosognosia groups , and also no significant differences in cingulum MD between the groups .In the AD group, no significant differences were found in hippocampal MD between the anosognosia (One of the main findings in this study, where we assessed volumetric and white matter tract changes associated with anosognosia, is that a group of aMCI subjects displaying anosognosia had a lower hippocampal volume than a group of aMCI subjects without anosognosia. These groups did not differ significantly by age, sex distribution, MMSE score, or ICV, which suggests that these groups were comparable. However, even more interestingly, aMCI subjects with anosognosia had a similar hippocampal volume to subjects with AD in our study. In the following, we will discuss the implications in the clinical characterization of aMCI and anosognosia assessment, neural and cognitive mechanisms underlying anosognosia, limitations of our study, and suggest future lines of research.First, taking a clinical perspective, the association of reduced hippocampal volume with the presence of anosognosia in aMCI is in line with previous studies that place anosognosia as a risk factor for progression to AD dementia . HippocaRegarding the neural and cognitive mechanisms underlying anosognosia, it has been hypothesized that because subjects affected by AD suffer from an inability to form new memories, they depend on remote personal semantics to evaluate their present performance, with inadequate self-appraisal . This miSome limitations of the current study are worth commenting on. The small sample size warrants caution in the interpretation of the results, which are thus in need of replication in larger samples. In addition, this implies that more subtle brain changes related to anosognosia might not have been detected. Another limitation that might explain the lack of differences in white matter tracts in our sample, is the concern that diffusion methods such as FA might be insufficient to study structures such as the cingulum bundle, where crossing-fiber anatomy might necessitate more specific measurements that track white matter-fibers more reliably .Our findings are in contrast to recent studies that identify a link between poor awareness of memory performance and a loss of white-matter integrity in the corpus callosum, frontal-striatal fibers and anterior thalamocortical radiations, as well as in the full right hemisphere . Beyond In sum, our preliminary findings, if replicated, suggest that anosognosia might be a relevant clinical marker for the suspicion of structural brain changes within the AD continuum in subjects with aMCI. Future studies assessing larger populations are necessary in order to contribute both to the characterization of aMCI subtypes and the understanding of the neural changes underlying anosognosia.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by National Institute of Neurology and Neurosurgery Mexico City. The patients/participants provided their written informed consent to participate in this study.JF-V: study design, data collection, statistical design, data processing and analysis, and drafting of the manuscript. GR-G: data processing and analysis, and drafting of the manuscript. OM-M: study design, data collection, and the manuscript revision. RA-L: statistical design and manuscript revision. ML: study design, statistical design, and the manuscript revision. YR-A: study design and data collection. GA-C: study design and data analysis. RR: study design and the manuscript revision. AA: study design, acquisition of funding, and the manuscript revision. SE-G: theoretical background, study design, and the manuscript revision. AS-O: theoretical background, study design, acquisition of funding, and drafting of the manuscript. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Psychosocial factors may play an important role in the etiology of sleep and awake bruxism. The purpose of this study was to assess the relationship between emotional stress and bruxism in male and female dental students at various stages of their education. Dental education in Israel is based on a six-year curriculum, divided into three stages: pre-medical studies (yr. 1–2), manual skills (yr. 3–4), and clinical experience (yr. 5–6). Each stage requires different capabilities and skills. Questionnaires regarding psychological state (SCL-90) measuring depression, anxiety, and somatization as well as stress evaluation questioners  were completed by 387 dental students in the 1st to 6th years. Sleep and awake bruxism were evaluated based on the respondent’s awareness. During the manual stage of studies, a significant increase was identified, albeit with weak correlations, between stress scales, depression, anxiety, somatization, and the prevalence of awake bruxism, particularly among males. Only in females was sleep bruxism correlated with emotional parameters, whereas no significant difference in sleep bruxism was observed in males throughout the stages of the study. The manual years of dental education were found to be linked to higher levels of emotional distress and awake bruxism, particularly in men. Sleep bruxism, on the other hand, was not directly linked to emotional factors, implying a distinct etiology. Stress is concurrently a stimulus and a reaction that includes both physiological and psychological components, which might affect normal functioning . MedicalThe side effect of stress may be sleep bruxism (SB) and/or awake bruxism (AB), which are masticatory muscle activities that occur during sleep (characterized as rhythmic or non-rhythmic) and/or wakefulness (characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible), respectively. In otherwise healthy individuals, bruxism should not be considered as a disorder but rather as a behavior that can be a risk and/or protective factor for certain clinical consequences .The prevalence of AB is reported to be 20% among the adult population. The physiology and pathology of AB is unknown, although stress and anxiety have been correlated with its presence and are considered to be risk factors . It probSB can affect approximately 13% of the adult population. Its occurrence is highest in childhood, 14–20%, and decreases with age ,17,18. IHere, based on the reported differences in stress symptoms between female and male dental students , along wThe sampled population included 387 students at the Goldschleger School of Dental Medicine, Tel Aviv University. Approval was obtained from Tel-Aviv University Institutional Ethical Committee (No. 100813). Written and oral informed consent was provided by all the participants.The study consisted of self-report questionnaires delivered to students in the pre-medical, manual, and clinical stages of their dental education. All students were approached in person by an examiner who was not part of the faculty teaching staff at the time (S.M or R.S), and was asked to complete several questionnaires as detailed below. It was made clear that participation was voluntary and, in any case, would be anonymous and have no impact on their academic studies.Dental education in Israel is based on a 6-year curriculum, divided into 3 stages: the first and second years that include the Pre-medical studies (PreMed) that consist of theoretical courses ; the third and fourth years that include specific sciences related to dentistry  with a focus on developing manual skills through practicing on plastic teeth in simulation labs ; and the fifth and sixth years that mainly consist of developing clinical experience by performing various supervised treatments on patients .n = 387). The students’ mean age at the onset of their education was 24 ± 2 years, 180 males and 207 females: 173 students in the PreMed stage , 143 students in the Manual stage , and 71 in the Clinical stage . No significant difference was found between the average age of males and females.Group characteristics: 435 students were approached, and 89% of whom responded : the level of emotional stress was measured using the PSS, developed by Cohen et al., 1983 . The queSymptom Checklist-90 (SCL-90)  for Psychological State: the SCL-90 was developed by Derrogatis et al.  and desiSleep and Awake Bruxism: The measurement of SB and AB was depended solely on the respondent’s knowledge, as assessed through the following questions ,27: (1) p ≤ 0.05.The statistical analyses were performed using the IBM SPSS Statistic  software. A two-way analysis of variance (ANOVA) and a series of t-tests were used to determine significant mean differences and relationships among the variables. The ANOVA was used to assess the main effect of each independent variable and possible interactions between SB, AB, the emotional variables , period of study , and sex. Spearman correlation was used to evaluate the correlation between the emotional parameters and the prevalence of awake and sleep bruxism. Level of significance was set to Each of the psychological parameters  was evaluated according to sex and period of studies . = 17.379, p < 0.001) and sex  = 20.874, p < 0.001). A significant interaction was found between period of studies and sex  = 3.621, p < 0.03), indicating that males showed a significantly higher increase in stress parameters compared to females in the Manual period  = 11.02, p < 0.001) and sex  = 7.38, p < 0.05). A significant interaction was found between period of studies and sex  = 14.06; p < 0.001). Males and females started with similar levels of anxiety, but while men’s anxiety increased substantially during the Manual period, women remained unchanged. At the Clinical period, women’s and men’s anxiety was similar  = 18.57, p < 0.001) and sex  = 4.49, p < 0.05). A significant interaction was found between period of studies and sex  = 9.01; p < 0.001). The pattern was quite similar to that observed for anxiety, with males showing a significantly higher increase compared to females in the Manual period  = 8.22, p < 0.001) but no main effect of sex. A significant interaction was found between period of studies and sex  = 16.24; p < 0.001). The pattern was quite similar to that observed for former variables, with males showing a significantly higher increase than females at the Manual period (Somatization: the results showed main effects for the period of studies (F l period d.p = 0.01) and 39% of the males (p < 0.001) reported having experienced AB  were significantly higher in students reporting AB, mostly in females . Males, p < 0.001)  .p = 0.024) and some decrease at the Clinical stage (28.6%), which were both higher than those reported by males. Males showed a slight reduction in the prevalence of SB during the Manual and Clinical stages  yet with no significant difference . Males and females showed different patterns in SB prevalence; females showed a significant increase at the Manual stage (32.8%)  were found between students who reported SB and those who did not . Signifin = 28) reported both AB and SB, whereas out of the students reporting AB, 30.4% also reported SB.Out of the entire studied sample, 7%  in the Manual stage, especially in females. In the present study, AB occurred significantly more often than SB, in agreement with the Glaros study . This maPositive, although weak, associations between AB and elevated degrees of stress, anxiety, depression, and somatization were noted. These findings are consistent with previously reported studies ,17,19,23Unlike AB, no significant differences in the emotional parameters  were found in the current study between students reporting SB to those who were not, although weak correlations were found between most of the emotional parameters and the presence of SB in females. This correlation between SB and psychological factors is controversial in the literature. Some studies claimed that psychosocial parameters, such as anxiety and stress, are frequently associated with SB ,34, whilThe fact that different stages of the curriculum require students to demonstrate and adopt different skill sets lends credence to the notion that the students’ emotional responses may differ from phase to phase. In essence, the first stage of the curriculum (PreMed) does not require students to develop a new skill set as it is mostly theoretical. As a result, as our study demonstrated, students in the pre-medical stage do not exhibit extreme stress reactions. When students progress to the Manual stage of the curriculum, they must learn new fine motor and precision skills, and failures become more common. Indeed, our research found that both male and female students showed increased stress reactions in all the parameters studied. This reaction is expected since these students’ competence and excellence have never been challenged before, and they struggle when required to perform delicate and precise manual exercises.During the Manual stage, male students’ reactions are far more extreme/significant than those of their female counterparts, and they are more sensitive to critique and respond with increased emotional and somatic reactions to stress. The reaction of female students is milder, with only a moderate increase in stress and depression and almost no increase in anxiety and somatization. It was suggested that men outperform women in some spatial tasks, whereas women outperform men in fine motor skills assessments . This waIn the last stage of studies , students are required to implement the skills learned in the Manual phase by treating patients. During this phase, male students displayed a decrease in their stress levels and an associated decrease in anxiety, depression, and somatization measurements, aligning their measurements with those of the female students, whose levels of anxiety, depression, and especially somatization increased steadily throughout their studies period. The elevated stress reaction both in male and female students is probably associated with the stress encountered during social interactions with patients and supervisors. Our results were supported by Dedovic et al. , who sugAlthough we used a valid and reliable assessment of associated psychosocial impairments, the diagnosis of bruxism was performed via questionnaires without any clinical examination or personal anamnesis, which represents the lower grade of diagnosis (“possible”) of bruxism according to an international group of bruxism experts . In addiSignificant, though weak, correlations were found between most of the emotional parameters and the report of AB. Higher levels of emotional distress and AB have been linked to the Manual years of dental education, particularly in males. SB, on the other hand, was not directly linked to emotional factors, supporting the idea that it has a different etiology than AB.


Gestational diabetes mellitus (GDM) is quite prevalent in low- and middle-income countries, and has been proposed to increase the risk of depression. There is only a prior study assessing antenatal depression among the subjects with GDM in the Bangladesh, which leads this study to be investigated.To determine the prevalence of depressive symptoms and potential associations among pregnant women diagnosed with GDM.A cross-sectional study was carried out among 105 pregnant women diagnosed with GDM over the period of January to December 2017 in 4- hospitals located in two different cities . A semi-structured questionnaire was developed consisting of items related to socio-demographics, reproductive health history, diabetes, anthropometrics, and depression.Mild to severe antenatal depression was present in 36.2% of the subjects . None of the socio-demographic factors were associated with depression, but the history of reproductive health-related issues  and uncontrolled glycemic status were associated with the increased risk of depressive disorders.GDM is associated with a high prevalence of depressive symptoms, which is enhanced by poor diabetes control. Thus, in women presenting with GDM, screening for depression should be pursued and treated as needed. Pregnancy is a highly stressful period in a woman's life that can also be associated with mental health problems such as depression. Depression is reported in about 16% of pregnant women whereas and such prevalence can double in LMICs . In addition, gestational diabetes mellitus (GDM) has emerged as a common condition affecting approximately 10% of all pregnancies. GDM has also been associated with adverse mental health outcomes, particularly depression. GDM women with antenatal depression are not only at increased risk of poorer quality of life, but are also at increased risk of adverse pregnancy and fetal outcomes, particularly in LMIC. This study investigates the prevalence of depressive symptoms among Bangladeshi pregnant women diagnosed with GDM. It is found that depression was detectable in 36.2% subjects. In addition, a history of reproductive health-related issues  and uncontrolled glycemic status were associated with increased risk of depressive disorders. Considering the negative effects of both GDM and depression on pregnancy-related outcomes, early screening of these conditions should be pursued, preferably once every trimester over the duration of the pregnancy. Pregnancy is a highly stressful time in a woman's life and is often associated with anxiety and depression. Fear of fetal deformities, economic concerns, and motherhood expectations are the common sources of anxiety that may ultimately lead to depression . AccordiIn recent years, gestational diabetes mellitus (GDM) has emerged as a common condition during pregnancy . Indeed,GDM has also been associated with adverse mental health outcomes, particularly depression. GDM subjects with antenatal depression are not only at increased risk of poorer quality of life , but areA cross-sectional study was conducted to assess the prevalence of depressive symptoms and potential associations among Bangladeshi pregnant women diagnosed with GDM within January to December 2017 in two different cities . Two hospitals from each city were included based on the criteria of having adequate facilities to deal with GDM patients and availability of patients seeking medical assistance from remote areas and those who had GDM-related complications. Therefore, it is assumed that the vast majority, if not all pregnant women who were at risk, suspected to suffer from GDM, or those formally diagnosed as GDM patients would come to these hospitals for their treatment and antenatal check-ups. The survey was carried out in the outpatient departments of the four hospitals, namely (i) BIRDEM General Hospital (Dhaka), (ii) BSMMU Hospital (Dhaka), (iii) Sher E Bangla Medical College Hospital , and (iv) Advocate Hemayet Uddin Ahmed Diabetic & General Hospital .Before the onset of the data acquisition interviews, the semi-structured questionnaire was pilot tested on a total of 10 respondents to ascertain it was easily understandable by all interviewees. After implementing changes based on the feedback from the pre-testing phase, data were collected from the respondents through face-to-face interviews conducted in Bangla, the native language of both the research team and the participants. However, respondents were identified by purposive sampling after compiling selection criteria, which included: (i) pregnant women diagnosed with GDM by the hospital physician and (ii) women who were willing to participate. Participants were excluded from the study if they (i) had pre-gestational diabetes and comorbid conditions, (ii) were severely ill or unable to participate, or (iii) were not willing to participate. A total of 105 interviews were ultimately included for analyses.A formal ethical approval of the study was obtained from the Institutional Review Board at the National Institute of Preventive and Social Medicine, Dhaka, Bangladesh . Participation in this study was absolutely voluntary. Potential subjects were informed that they have the right to refuse to respond to any of the entire set of interview questions and that they also have the right to withdraw from an ongoing interview. Subjects were also clearly informed about the confidentiality of their data and provided complete assurance that all information would be kept confidential and their names or anything which can identify them would not be published or exposed anywhere. Participants had to provide consent by signature or thumb impression.A semi-structured questionnaire was developed in Bangla consisting of questions related to (i) socio-demographics, (ii) reproductive health, (iii) diabetes, (iv) anthropometrics, and (iv) depression. Permission for using the depression assessment instrument was granted by the developer of the Montgomery-Asberg Depression Rating Scale (MADRS). A short description of all variables included in this study is given below.The basic socio-demographic information of the participants, such as age, residence, religion, family type, family income, family expenditure, occupation, and education, were documented. In addition, the occupation and education of the participants’ spouses were explored.Data on reproductive health-related issues such as the age of marriage, duration of married status, age of first pregnancy, the total number of pregnancies, total number of children, age of the last child born, etc., were collected. In addition, a history of (i) intrauterine death, (ii) abortion, (iii) dilation and curettage, and (iv) neonatal death was obtained. Subsequently, a continuous variable was created, compiling all the history-related variables.A number of factors associated with GDM were collected in this study. First of all, the history of GDM diagnosis and hypertension in the past pregnancy was assessed. Furthermore, family history of diabetes, personal history of hypertension, and status of smoking and smokeless tobacco use were asked. The aforementioned variables were compiled to create a continuous variable on GDM related issues.To evaluate GDM glycemic control or the current use of glucose-lowering medications , recentl2 = underweight, (ii) 18.5–24.9 kg/m2 = normal or healthy weight, (iii) 25.0–29.9 kg/m2 = overweight, and (iv) ≥ 30.0 kg/m2 = obese [Measurements of the height and weight of the participants were performed. For assessing body mass index (BMI), weight in kilos was divided by the square of height in meters. The research assistants measured height and weight. The participants' weight was measured with a digital scale with an accuracy of 0.1 kg; with participants having on light clothing and without shoes. The digital weighing scale measurement accuracy was checked at various stages using standard weights. The height of the participants was measured using a tape with an accuracy of 0.1 cm that was fixed to the wall with a special tool in the different clinics. The participants took off their shoes and heels; buttocks, shoulders, and back of the head touched the wall, and the Frankfort line was parallel to the ground. Later on, the recommended BMI categories were followed: (i) < 18.5 kg/m = obese .Depression was assessed by the 10-item MADRS . Since ip-value of < 0.05 and 95% confidence interval was considered statistically significant.After data collection, individual questionnaires were edited for completion and consistency. Only fully completed questionnaires were entered into the statistical software  for analysis. Descriptive statistics  were used to describe the data. Inferential statistics  were performed to identify significant associations of the studied variables with depression as the outcome variable. A two-tailed The socio-demographic characteristics of the participants are presented in Table p = 0.027 and f = 6.05, p = 0.016, respectively) (Table p < 0.001)  , psychological , and health  have been associated with antenatal depression risk , 3, 5, tGDM subjects with a history of reproductive health-related complexities were more likely to be depressed. Such associations have been previously identified, and the present study concurs with such findings , 7, 38. In a group of GDM women, 36.2% suffered from depressive symptoms, and the depression severity was enhanced by the presence of underlying poor glycemic control. Considering the known negative impact of GDM and depression on pregnancy-related outcomes, early screening of these conditions should be pursued, preferentially once every trimester over the duration of the gestational period.


The plantarflexion torque, peak AT force, peak AT stress, and AT stiffness were significantly greater in male participants than in female participants (p < 0.05). However, no significant sex-specific differences were observed in peak AT strain and hysteresis (p > 0.05). Conclusions: In physically inactive adults, the morphological properties of AT were superior in men but were exposed to higher stress conditions. Moreover, no significant sex-specific differences were observed in peak AT strain and hysteresis, indicating that the AT of males did not store and return elastic energy more efficiently than that of females. Thus, the mechanical properties of the AT should be maintained and/or improved through physical exercise.Background: Patients with Achilles tendon (AT) injuries are often engaged in sedentary work because of decreasing tendon vascularisation. Furthermore, men are more likely to be exposed to AT tendinosis or ruptures. These conditions are related to the morphological and mechanical properties of AT, but the mechanism remains unclear. This study aimed to investigate the effects of sex on the morphological and mechanical properties of the AT in inactive individuals. Methods: In total, 30 inactive healthy participants  were recruited. The AT morphological properties  were captured by using an ultrasound device. The AT force–elongation characteristics were determined during isometric plantarflexion with the ultrasonic videos. The AT stiffness was determined at 50%–100% maximum voluntary contraction force. The AT strain, stress, and hysteresis were calculated. Results: Male participants had 15% longer AT length, 31% larger AT cross-sectional area and 21% thicker AT than female participants ( As the thickest and strongest tendon in the human body, the Achilles tendon (AT) is the key structure that connects the heel and the plantar flexor muscle . The mecOf all the tendons in the foot and ankle joint, Achilles tendinosis is the only disorder that occurs mostly in men. According to previous studies, the men–women ratio of AT rupture ranges from 2:1 to 19:1 ,6,7. OneThe mechanical properties  of the AT are affected by muscle activity, joint activity, and characteristics of the tendon and ligament, which are important parameters for evaluating AT maturation, aging, training, and fatigue. However, viscoelasticity, an evident property, was often neglected in previous evaluations of the mechanical properties of the AT . At presThe AT can be easily accessible with ultrasound due to its superficiality. In the current study, the AT was loaded on an isokinetic dynamometer synchronized with ultrasound to accurately quantify its mechanical properties. Therefore, this study aimed to investigate the effects of sex on the morphological and mechanical properties  of the AT in inactive individuals. It was hypothesized that sex differences in the morphological and viscoelastic properties of the AT were present; that is, compared with female participants, male participants had (1) longer AT length, larger AT cross-sectional area (CSA), and thicker AT, as well as (2) greater peak plantarflexion torque (PT), peak AT force, peak stress, peak strain, stiffness, and lower hysteresis.This study was a randomized controlled trial. In total, 30 inactive healthy participants  were recruited . Based oTendon morphological properties were assessed with an ultrasound device . The participants were asked to lie prone on a treatment bed with the dominant ankle (defined as the preferred kicking leg ) placed The mechanical properties of the AT were assessed during isometric plantarflexion using an isokinetic dynamometer . After a 5 min warm-up, the participants were asked to lie prone on a test bench, the waist and thighs were secured by adjustable lap belts and held in position, and the arms fell naturally to the sides. The dominant ankle joint was set at 90° with the knee joint at full extension, and the foot was securely strapped to a footplate connected to the dynamometer. Before measurements, the best maximum isometric voluntary contraction (MVC) force was determined through three trials. For the MVCs, participants were instructed to produce as much force through the ankle plantarflexion as possible. Then, each participant was instructed to develop a gradually increasing force from relaxation to 100% MVC within 5 s, followed by a gradual relaxation within 5 s . During The thickness and CSA of the AT were analyzed at the level of the medial malleolus using ImageJ software . The thickness of the AT was measured by the maximum anteroposterior diameter of the tendon, and the CSA of the AT was measured by tracing the surrounding echogenic boundary of the AT. The length of the AT was calculated as the distance between the MTJ and the insertion point. MTJ displacement was tracked from the video with semi-automatic software Kinovea (version 0.8.15). The software requires the user to place one tracking point over the MTJ. The software tracked automatically initially, and then the experimenters confirmed whether the tracking point of each frame was in the correct position—i.e., at the MTJ—and manually adjusted it frame by frame. After tracking, MTJ displacement was output. Tendon elongation was calculated by subtracting the initial tendon length at rest, and the strain was calculated by dividing the elongation by the initial length.AT):The AT force was calculated by deriving the PT on the dynamometer and moment arm of the AT . The 95% confidence intervals and effect size (Cohen’s d) of each parameter in this study was calculated. The significance level was set at 0.05.p < 0.05, Significant sex-specific differences in the morphological properties of AT were observed. Male participants had 15% longer AT length, 31% larger AT CSA, and 21% thicker AT than female participants  significantly longer AT length, larger AT CSA, and thicker AT and (2) significantly greater peak PT, peak AT force, peak AT stress, and stiffness, which all supported the hypothesis. However, contrary to the hypothesis, no significant sex-specific differences were observed in peak AT strain and hysteresis. Tendon tissue may be responsive to sex hormones, including progesterone and estrogens, as they possess estrogen receptors . However2, respectively. This finding was similar to the findings of Ying et al. [2, respectively. However, the study did not distinguish differences between sex. The present study further found that the thickness and CSA of the AT in male participants were significantly greater than those in female participants. Similarly, Schweitzer [The results of the present study showed that male participants had a longer AT length, greater AT thickness, and larger AT CSA than females. Moreover, the mean AT thickness and mean AT CSA in healthy young male and female participants were 5.1 and 4.2 mm and 60.2 and 45.9 mmg et al. , who meahweitzer  found thhweitzer ,28. The The peak AT force in male participants was significantly greater than that in female participants. The main reason for this difference was the change of PT during MVC on the dynamometer. This is because the main function of the AT was to transfer triceps surae muscle strength rather than produce force. The results suggested that men had an advantage in triceps surae muscle strength even though inactive people were recruited in this study. However, compared with the average peak AT force of male runners in our previous study (3.4 BW) , the ina−1, compared to female participants. The results were similar to previous in vivo measurements on the AT . According rate . Howevering rate . Up untiing rate . No sex ing rate , whereining rate  showed ting rate . Low hysing rate ,35. TherThe current study has some limitations. Firstly, how the activity was recorded could only count for some of the likely population variances within a group who self-categorize as inactive. Although the categorical classification of participants based on self-reporting is valid, the nuanced breakdown of sedentary and non-sedentary time in the day may contribute to the variability in your data such that “inactive” participants may vary in terms of daily steps, sedentary time, and work-based physical activity. Secondly, the method of measuring the moment arm of the ankle joint in vivo was a fixed value. The difference between men and women would not be exaggerated by using a fixed value, but the overall in vivo data may be less accurate by a few percent; however, the value obtained in this study was the same as that of Rice et al. . whose pThe results of this study showed that amongst inactive people, compared with female participants, male participants had significantly longer AT length, larger AT CSA, and thicker AT and greater peak PT, peak AT force, peak AT stress, and stiffness. The findings suggested that in physically inactive adults, the morphological properties of the AT were superior in men, but were exposed to higher stress conditions. Moreover, no significant sex-specific differences were observed in peak AT strain and hysteresis, indicating that the AT of men did not store and return elastic energy more efficiently than that of women. Results of this study indicated the sex differences in the morphological and mechanical properties of AT. A clear understanding of sex differences in the tendon mechanical characteristics would enable further generating sex-specific treatment strategies of Achilles tendinopathy in the clinic.