Results: A total of 566 surgeries including single-port laparoscopic hysterectomy , single-port robotic hysterectomy , single-port laparoscopic ovarian cystectomy , single-port robotic ovarian cystectomy , single-port laparoscopic myomectomy , and single-port robotic myomectomy . The SPRH, SPRC, and SPRM groups had a shorter operation time than the SPLS group, although the results were not statistically significant . Incisional hernia occurred as a postoperative complication in two patients only in the SPLH group. Postoperative Hb changes were lower in the SPRC and SPRM groups than in the SPLC and SPLM groups . Conclusions: Our study demonstrated that the SPRS had comparable surgical outcomes when compared to the SPLS. Therefore, the SPRS should be considered a feasible and safe option for gynecologic patients.Background: The aim of this study is to compare the surgical outcomes of single-port laparoscopic surgery (SPLS) and single-port robotic surgery (SPRS). Methods: We retrospectively analyzed patients who underwent a hysterectomy, ovarian cystectomy, or myomectomy with SPLS or SPRS from January 2020 to July 2022. Statistical analyses were performed using the SPSS chi-square test and student’s  Minimally invasive surgery (MIS) in gynecology requires only a small incision in the abdomen to insert a laparoscopic camera and various surgical instruments, unlike conventional open surgery with a large incision site. MIS includes laparoscopic, robotic, and natural orifice transluminal surgeries ,2. From Although single-site surgery has cosmetic benefits, single-port laparoscopic surgery (SPLS) has surgical limitations in angulation and device manipulation. Moreover, the training period for SPLS is longer than for robotic surgery or open surgery ,6,7. On In many studies comparing the surgical outcomes of SPLS, multi-port laparoscopic surgery (MPLS), SPRS, and multi-port robotic surgery (MPRS), there were no statistical differences in operation time, postoperative hemoglobin (Hb) changes, hospital stay, and additional pain medication ,8,9,10. We retrospectively evaluated data from 566 women who underwent a hysterectomy, ovarian cystectomy, and myomectomy using SPLS or SPRS at the Korea University Anam Hospital from January 2020 to July 2022. Finally, 148 patients underwent single-port laparoscopic hysterectomy (SPLH), 35 patients underwent single-port robotic hysterectomy (SPRH), 207 patients underwent single-port laparoscopic ovarian cystectomy (SPLC), 108 patients underwent single-port robotic ovarian cystectomy (SPRC), 12 patients underwent single-port laparoscopic myomectomy (SPLM), and 56 patients underwent single-port robotic myomectomy (SPRM).All procedures were performed by six gynecological surgeons at the Korea University Anam Hospital. There may be differences in surgical proficiency and surgical experience of the six surgeons, and the SP entry system and energy device used during the operation may be different depending on the surgeon’s preference. However, the overall surgical procedures for hysterectomy, ovarian cystectomy, and myomectomy using a single port is not very different for all six surgeons. In SPLS, approximately a 1.5-2.0 cm umbilical vertical incision was made with the Hasson method. One of the SP entry systems including LAPSINGLE , ONE-PORT plus , and Glove Port  was used for instrument application. Hysterectomy was defined as completely removing the patient’s uterus and suturing the vaginal stump. Ovarian cystectomy was defined as peeling and the removal of the cystic tumor lesion from the ovarian tissue and suturing residual normal ovarian tissue. Myomectomy was defined as the removal of fibroids from the uterus and suturing of the myometrium layer and serosal layer of the uterus. After surgery, such as a hysterectomy, myomectomy, or ovarian cystectomy, the umbilical incision was closed layer-by-layer from the fascia to the skin.A da Vinci SP surgical system  was used for SPRS including SPRH, SPRC, and SPRM. In SPRS, approximately a 2.5 cm umbilical vertical incision was made with the Hasson method. One of the SP entry systems, such as Lapsingle Vision SP , UNI-PORT SP , and Glove Port SP , was used for instrument application. The SP entry system used in SPRS has space for a 25 mm da Vinci SP cannula that was different from the SP site instruments used in SPLS. The surgical procedures including SPRH, SPRC, and SPRM were not different from those of SPLH, SPLC, and SPLM.We retrieved the hospital medical records of the study subjects. Surgical time was defined as the time from the first skin incision to the final skin closure, which included docking time for SPRS. The robot-docking time was defined as the time required to place the robotic instruments on the port placement inserted into the patient after the robot patient cart was driven. The robot-console time was defined as the time it took for the surgeon to sit on the robot console and perform the surgery. Robot-docking time and robot-console time were included in the surgical outcomes of SPRS groups. Postoperative Hb change-value was obtained by comparing the difference between Hb reported in complete blood count on postoperative day 1 and preoperative Hb.t-test was conducted to compare and analyze continuous variables between the SPLS and SPRS groups, and categorical variables were analyzed using a chi-square or Fisher’s exact test. Statistical significance was defined as a p-value < 0.05. All analyses were performed using SPSS Statistics for Windows .A student’s The study protocol and waiver of informed consent were approved by the Institutional Review Board (IRB) of the Korea University Anam Hospital (IRB number: 2022AN0556). All procedures were performed in accordance with the relevant guidelines and regulations of the institution.p = 0.087), and largest ovarian cyst . However, the rate of previous abdominal surgery history was higher in the SPRC group than in the SPLC group . In the SPLM and SPRM groups, there was no significant statistical difference with respect to the number of myomas  and the size of the largest myoma . The two most common locations of the largest uterine myoma in SPLM and SPRM were anterior  and posterior .The patient demographics are shown in p = 0.555). However, the pathology result was different between the SPLC and SPRC groups (p < 0.001). The two most common histologic results in the SPLC group were teratoma (54.6%) and endometriosis (45.4%), and in the SPRC group were cystadenoma (38.9%) and others such as abscess or inclusion cyst (43.5%). In the SPLM and SPRM groups, the most common type of myoma was the intramural type, but there was no significant statistical difference .The surgical outcomes are presented in Surgical outcomes including surgical time, postoperative Hb change, hospital stay, operative complications, and postoperative transfusion were analyzed. In this study, there was a statistically significant decrease in postoperative Hb in the SPRC and SPRM groups compared with the SPLC and SPLM groups. Although not statistically significant, the surgical times were shorter in the SPRS group than in the SPLS group. Except for an incisional hernia that occurred in two cases of the SPLH group, there was no other operative complication and no conversion to laparotomy.Single-site surgery has a cosmetic advantage because it leaves a single scar on the umbilicus. However, there are disadvantages, such as limited space for surgery and collisions between surgical instruments. Since the laparoscopic hysterectomy using a single umbilical puncture performed by Pelosi in 1991 , surgicap < 0.001) [p = 0.01 vs. pain score at 36 h in the SPLH group, 1.7 ± 1.2; pain score at 36 h in the MPLH group; 2.9 ± 1.1, p = 0.01) [Two studies have compared the surgical outcomes of SPRH and multi-port robotic hysterectomy (MPRH). There were no statistically significant differences with respect to the characteristics of participants, surgical time, and hospital stay in both the study conducted by Park et al.  and the < 0.001) . The ope< 0.001) ,12. In t< 0.001) . However = 0.01) . In this = 0.01) . In one  = 0.01) . On the  = 0.01) . There wIn a retrospective study of 25 patients who underwent SPLC, the surgical time (67.2 min) was shorter than the surgical time (92.10 ± 55.06 min) in our SPLC group . BecauseLee et al., analyzed surgical outcomes in patients who underwent SPRM . In a stAs a result of this paper, there was no statistical difference, but the surgical time of the SPRC group was shorter than that of the SPLC group. Although the rate of the previous abdominal surgery history was higher in the SPRC group than in the SPLC group, the rate of bilateral ovarian cystectomy was higher in the SPLC group and the rate of adhesiolysis was higher in the SPLC group than in the SPRC group. These factors may have affected the outcome of shorter surgical time in the SPRC group than in the SPLC group. Most previously published papers compared the surgical outcomes of patients who underwent single-site surgery and multi-site surgery throughout laparoscopic surgery or robotic surgery. However, few studies have compared the outcomes between SPLS and SPRS. In a study comparing the surgical outcomes of SPLC and SPRC conducted by Kim et al. in 2020, the surgical outcomes of the SPRC group were comparable to those of the SPLC group. In addition, Kim et al., reported that the learning curve was faster in the SPRC group than the SPLC group [This study has several limitations. First, heterogeneity could be reflected because the outcomes of surgery performed by several surgeons were compared and analyzed for each group. Second, as the study was conducted at a single institution, the number of study participants was small compared to studies conducted at multiple institutions. Third, there was a limitation in the longitudinal follow-up of each patient in the retrospective study. Fourth, the selection bias might be reflected in the process of selecting patient information for study participants because the information was obtained retrospectively from patient medical records.Nevertheless, the strength of this study was that it is one of the few studies that has compared the surgical outcomes of hysterectomy, ovarian cystectomy, and myomectomy performed using SPLS or SPRS.The surgical outcomes of SPRS including the SPRH, SPRC, and SPRM groups, were comparable to those of SPLS, such as the SPLH, SPLC, and SPLM groups. Especially, postoperative Hb change was significantly decreased in the SPRC and SPRM groups compared to the SPLC and SPLM groups. There was no operative complication except for two cases in the SPLH group. Therefore, this study is meaningful in that it suggests that SPRS can be proposed as a relatively safe and feasible surgical method for patients who desire to undergo single-site surgery.


The goal of this study was to see if electroacupuncture was effective and safe in the management of cerebral infarction. PubMed, Embase, Cochrane Library, and Web of Science were used to conduct a comprehensive literature survey.  Basic features of 7 studies were identified using the searching strategy. The investigation was found in PubMed, Embase, and Web of Science, with the most recent search being in March 2022. “Electroacupuncture,” “cerebral infarction,” and their permutations were among the MeSH terms and free words used. As literature, two reviewers independently used a standardized form to gather pertinent data from qualifying research. p = 0.04). Electroacupuncture enhanced BI score in individuals with cerebral infarction . The effects of electroacupuncture increased Fugl-Meyer index in patients with cerebral infarction . Electroacupuncture effects decreased CSS in patients with cerebral infarction in the experiment group . Electroacupuncture also reduced CSS individuals with cerebral infarction in the control group; however, there was no statistically significant .  157 literatures were identified and evaluated. Electroacupuncture improved the BI score in individuals with cerebral infarction (mean difference = 0.10, 95 percent CI: 0.00-0.20,  This study demonstrated that electroacupuncture helped decreased CSS in patients with cerebral infarction. Acute cerebral infarction (ACEI) is a devastating cardiovascular and cerebrovascular disorder that affects millions of people every year .The deatTraditional Chinese medicine classifies cerebral infarction, also known as ischemic stroke, as a type of stroke . Wind, fα in the blood. Through detecting the plasma HCY level and serum IL-1β in depressed and nondepressed patients with primary cerebral infarction β, TNF-α is in correlation with the occurrence of depression in individuals that possess in individuals experiencing primary cerebral infarction depression, and the severity of depression is related to the initial cerebral infarction. The author will explore the level of plasma Hcy, and serum IL-1β/TNF-α level is used as a monitoring index of the severity of depression after primary cerebral infarction and to guide the feasibility of clinical treatment and prognosis of patients with primary cerebral infarction [One of the most prevalent cerebrovascular illnesses seen in clinic is primary cerebral infarction, which seriously threatens the life of the elderly . Poststrfarction .Acupuncture and moxibustion is a unique treatment method of traditional medicine in China, which has been applied for thousands of years . ChineseThe investigation was found in PubMed, Embase, and Web of Science, with the most recent search being in March 2022. “Electroacupuncture,” “cerebral infarction,” and their permutations were among the MeSH terms and free words used. To locate new papers of interest, the reference lists of prior relevant reviews were manually searched. English or Chinese was the only languages allowed in the publications.To determine which studies were eligible, the relevant inclusion criteria were used: (i) a cerebral infarction diagnosis was confirmed pathologically; (ii) the Barthel Index (BI), Fugl-Meyer index, Chinese Stroke Scale (CSS), and national institute of healthcare score (NIHSS) were evaluated in this study; and (iii) if multiple articles from the same patient cohort were found, the most comprehensive one was chosen. The following items were excluded from the study: (i) abstracts, reviews, case reports, or comment letters; (ii) animal research; (iii) duplicate publications; and (iv) articles that were not written in English or Chinese.Q test, with I2 indicating the level of heterogeneity. Low heterogeneity was defined as I250 percent or P heterogeneity >0.1. P < 0.05 was considered as significant statistically.As literature, two reviewers independently used a standardized form to gather pertinent data from qualifying research . Review This study was identified through systematic literature searching. 157 literatures were identified and evaluated. The Cochrane Collaboration's technique for measuring risk of bias was used to assess the quality of the literatures Figures . Numeroup = 0.04).The benefits of electroacupuncture on the BI rating of cerebral infarction were investigated in this study. Electroacupuncture enhanced BI score in individuals with cerebral infarction, as demonstrated in p < 0.00001).The present study analyzed the effects of electroacupuncture on Fugl-Meyer index of cerebral infarction. As shown in p = 0.12).The benefits of electroacupuncture on the CSS of cerebral infarction were investigated in this study. Electroacupuncture reduced CSS in individuals having cerebral infarction; although, the difference was not statically important after therapy .The impacts of electroacupuncture on the NIHSS of cerebral infarction were investigated in this study. Electroacupuncture reduced NIHSS in individuals with cerebral infarction, as seen in Funnel plots for meta-analysis of BI, Fugl-Meyer index, CSS, or NIHSS of cerebral infarction were shown in Figures 3Cerebral infarction is a form of ischemic stroke that happens when the blood supply to the functioning part of the brain is cut off . The blop = 0.04), according to the findings of a meta-analysis.Acute cerebral infarction has always been a high incidence rate, high mortality, and disability rate . EspeciaElectroacupuncture is to transmit stable and continuous electrical stimulation to acupoints through filiform needle . Electrip < 0.00001).Electroacupuncture therapy prefers a method of stimulating and adjusting the Qi of meridians and collaterals to prevent and treat diseases by applying a micropulse current to the needle after the filiform needle is inserted into the acupoints to get Qi. Previous studies have shown that different acupuncture points, different density, frequency, and intensity of electrical stimulation will bring different therapeutic effects . ElectroThe present study has some limitations. Firstly, all citations only researched that the effects of electroacupuncture presented cerebral infarction. Second, due to a relatively low number of studies included which depicted the relationship between electroacupuncture and the therapy of a stroke in the brain, it is an important reason for the heterogeneity of this results. To corroborate our findings, we would need to conduct high-quality, large-scale investigations with more diverse patient populations. Furthermore, we found significant heterogeneity for multiple factors; nevertheless, we employed a fixed-effect ability to estimate for the heterogeneity, which was also present due to differences in included research.


Gynecological cancer is one of the most common cancers in women. The quality of life (QoL) or psychological impact has emerged as an outcome indicator in many clinical trials of gynecological cancer and gained much concern in the clinical setting at the start of the 21st century. Our paper conducted a bibliometric analysis of QoL or psychological impact on gynecological cancer patients to show the status and hotspots.Related publications from 2000 to 2022 were included by screening from the Web of Science Core Collection (WOSCC) on 26 June 2022. The bibliometrics was analyzed and visualized by bibliometrix R-package, VOSviewer, and CiteSpace V.Gynecologic Oncology and Journal of Clinical Oncology were the most relevant and most cited sources, respectively. The article written by Bray F et al. has the highest citation. Kim J and Aaronson NK ranked first in most productive author and most co-cited author, respectively. The keywords “mortality”, “fertility preservation”, and “palliative care” have bursts till 2022, which represented the frontiers of this field.A total of 6,479 publications were included in our study. The publications in this field were increased annually. The United States  was the country with the most published papers. Sydney University (n = 167) was the most productive affiliation. Our study provides an overall analysis of QoL or psychological impact on gynecological cancer patients, which can serve as a reference in future research. In 2020, gynecological cancer accounted for 14.4% of new cancer cases of women among 9.2 million new cases (source: GLOBOCAN 2020). Cervical cancer is the fourth most common cancer in women, followed by endometrial cancer ranking sixth, and ovarian cancer ranking eighth –5. In adMany instruments and scales are applied to help gynecologists assess their patients’ QoL or mental health, such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 30 Version 3 (EORTC QLQ-C30), Hospital Anxiety and Depression Scale (HADS), Female Sexual Function Index (FSFI), and Functional Assessment of Cancer Therapy-General Version 4 (FACT-G). These questionnaires are usually used in combination to score patients –14.Bibliometrics analyzes publication records and presents them visually through the application of mathematical and statistical methods , 16. BibSince the start of the 21st century, more and more articles and reviews have emerged on QoL or psychological impact on gynecologic oncology patients. In this paper, we did a bibliometric analysis to identify the global trends, the network of collaboration, research directions, etc., of this field from 2000 to 2022. As we know, this is the first bibliometric analysis targeted at QoL or the psychologic impact of gynecologic oncology patients.22.1On 26 June 2022, an advanced document retrieval was performed on the Web of Science Core Collection (WOSCC database). The publication date was limited from 1 January 2000 to 1 June 2022. The search formula was listed as follows:#1 ) OR TS=) OR TS=) OR TS=) OR TS=(HRQOL)) OR TS=) OR TS=) OR TS=) OR TS=#2((((((TS=(gynecology oncology)) OR TS=(gynecologic cancer)) OR TS=(gynecologic neoplasm)) OR TS=) OR TS=(ovarian cancer)) OR TS=) OR TS=Publication date 2000-01-01 – 2022-06-01#1 AND #2The detailed search process is outlined in 2.2http://www.bibliometrix.org) provides tools for quantitative bibliometrics and scientometrics research. It runs on RStudio v.4.1.2 software . It can produce a descriptive analysis of a bibliographic data frame, as well as build a network for analyzing bibliographic coupling, co-citation, collaboration, and co-occurrence ) is a software tool for the creation of maps based on network data and for visualizing and exploring these maps. VOSviewer can be used to construct networks of publications, journals, authors, research institutions, countries, keywords, or terms. With VOSviewer, bibliographic database files (such as Web of Science files) can be used to build a network. This software can be freely downloaded from ewer.com . In thisrdinates .http://cluster.cis.drexel.edu/~cchen/citespace/download/. The new version 6.1.R2 was built on 20 June 2022. It can be used to build a cooperative network of authors, institutions, or countries; co-occurrence analysis of terms, keywords, or categories; co-citation analysis of references, authors, or journals; and coupling analysis of the paper  is a Java application for analyzing and visualizing co-citation networks . It can he paper . In this2) represents the proportion of variance in the dependent variable that can be predicted. The closer the R2 value is to 1, the better the fitting; and the closer it is to 0, the worse the fitting.GraphPad Prism 9.0 was used to draw the line graph of annual production and perform a linear regression based on this line graph. The coefficient of determination . Among the top 10 relevant lists, the Journal of Clinical Oncology has the highest impact factor (IF = 50.769), and it also ranked first in the top 10 most cited journals . The journal with the highest IF in the cited source list was the Lancet (IF = 202.731), followed by the New England Journal of Medicine (IF = 176.079) and JAMA-Journal of the American Medical Association (IF = 157.335). Moreover, it could be seen that four journals are in both the most relevant list and most cited list, namely, Gynecologic Oncology, Cancer, International Journal of Gynecological Cancer, and Journal of Clinical Oncology.3.5The citation of the document network is shown in The top 20 references with the strongest citation bursts are shown in 3.6The network of authors and the cluster by keywords are presented in 3.7A cluster of keywords was made by CiteSpace V software and presented as a timeline view of keywords , with about four times as many publications as China  and the United Kingdom . Among the top 10 countries, only China is a developing country. As for institutions, although the University of Sydney  ranked first with 167 papers, the following two institutions were from the United States with a similar number of publications as the top 1, Memorial Sloan Kettering Cancer Center—the world’s largest private cancer research center (n = 166)—and the University of Texas MD Anderson Cancer Center (n = 164). Moreover, six of the top 10 active institutions were from the United States. The other three institutions also came from developed countries, i.e., Canada, the Netherlands, and the United Kingdom. As we can observe, the distribution of countries and institutions was extremely unbalanced, and the United States dominated in this field. Institutions in those developed countries usually have sufficient funding and sound management. They can organize large clinical trial projects, and their patients may have high follow-up rates due to advanced online communication. In addition, most of the standardized scales for QoL or mental health were developed in western contexts , so it mThe most cited publications listed in Women of childbearing age who are diagnosed with gynecological cancer represent approximately 21% of those diagnosed . As survNowadays, multiple effective treatments for gynecologic cancer have increased the survival rate of patients and improved their QoL. However, this cannot change the fact of incomplete reproductive organs, sexual dysfunction, the side effects of treatments, or the variable recurrence rate, which each patient of gynecological cancer has to face. The psychological impact caused by these facts can be heavy. Patients may suffer from stress, anxiety, depression, sexual dysfunction, and sleep deprivation . Many clOur study has some strengths: first of all, it is the first to perform a bibliometric analysis of QoL or psychological impacts of gynecologic cancer patients, and it provides a general view of this field and shows the hotspots and trends. In addition, this study used various bibliometric tools such as bibliometrix R-package, VOSviewer, and CiteSpace V, which enabled better visual analysis. However, there are also some limitations:We only retrieved publications from the WOSCC database, and publications from other databases such as Scopus and PubMed were not included in our local dataset.Only one author screened the publications and extracted information from the database, which may cause bias. However, these works were automatically generated through the website or map tools, which were not manually processed, so there was less chance of error.Using the most cited publications to judge papers may have limits. The highest cited publication is Global Cancer Statistics , which is less relevant to our topics, while some other valuable papers published recently may not be on our list due to the low citations.5Overall, our study provides a bibliometric analysis of QoL or psychological impact on gynecological cancer patients. For survivors of gynecologic cancer, attention should be focused on the recovery of their sexual function, the preservation of their fertility, and the maintenance of their feminine image as an important part of improving their QoL and promoting their psychological health. Our study can provide an overview and research hotspots in this field for future studies. It is hoped that further research will provide strategies for improving the QoL and psychological health of women with gynecologic cancer.JZ participated in data collection, data analysis, and drafting of the paper. YK participated in putting forward the idea, and the drafting and editing of the paper. YX and JY participated in the editing of the paper. All authors contributed to the article and approved the submitted version.


We devised a novel dressing system to accelerate the recovery after total knee arthroplasty (TKA). The purpose of this study was to assess the clinical outcomes and economic expenses of the new dressing system.In this randomized and controlled trial, we enrolled 98 patients who underwent the first unilateral TKA between September 2020 and June 2021. The patients were randomly assigned to one of two groups: the intervention (the new dressing system group) or the control  group. We gathered and evaluated patient data including age, gender, body mass index, surgical side, number of dressing changes, post-operative hospital stay, dressing-related expense, satisfaction, pain and function scores, wound scores and wound-related complications.p = 0.000, p = 0.002). Satisfaction in the intervention group was significantly higher than in the control group's (p = 0.000). There were no significant differences between the two groups in dressing-related expense, pain and function scores. During the one month follow-up, the intervention group's Stony Brook Scar Evaluation Scale (SBSES) was considerably higher than the control group's (p = 0.012).The number of dressing changes and post-operative hospital stay in the intervention group were significantly less than in the control group (The new dressing system can reduce the number of dressing changes and post-operative hospital stays while increasing patient satisfaction with no difference in medical costs in TKA. This wound dressing system has potential for application in TKAhttps://clinicaltrials.gov, identifier ChiCTR2000033814. Total knee arthroplasty (TKA) is currently one of the most successful procedures. TKA can effectively reduce pain in patients , 2. The Many aspects of surgical wound management are involved, including the management of patients' basic diseases , 5, propAt the moment, smart dressings, especially Aquacel Ag Hydrofiber, can be used in the novel wound care strategy, which is successful in encouraging wound healing and preventing bacterial colonization infection . HoweverThis prospective randomized controlled study (RCT) was conducted to confirm the benefits of this new dressing system over traditional gauze dressings. The number of post-operative dressing changes, post-operative hospitalization days, wound score and complications, functional recovery, medical costs and self-evaluation of satisfaction were all recorded in this study.This RCT was carried out under the principles of the Helsinki Declaration (as revised in 2013) and was authorized by the medical ethics committee of the Xiangya Hospital of Centre South University (No. 202010128). All individual participants in the study gave their informed consent. This RCT was conducted following the CONSORT guidelines and was registered at the Chinese Clinical Trial Registry (ChiCTR2000033814).Patients with clinically and radiographically confirmed osteoarthritis were eligible to participate. The inclusion criteria were as follows: (I) diagnosed with osteoarthritis; (II) first-time TKA; (III) age 18–85 years; and (IV) operation on one side alone. Patients who were unable to complete the regular follow-up, had skin diseases, like psoriasis or eczema, or other serious systemic diseases, had previous open knee surgery on either knee, had previous major trauma to either knee resulting in deformity or scarring or had allergies to skin adhesives were excluded. According to relevant research , 12, a mn = 49)  (n = 49). The computer-generated randomization technique was carried out using opaque envelopes, which were opened intraoperatively before skin closure of the knee. One patient in the intervention group was removed because he changed his dressings after being discharged. One patient in the control group was excluded after failing to complete the regular one month follow-up was excluded. Finally, 96 patients were included in the analysis   was applied.Cefoxitin, a prophylactic antibiotic, was regularly administered 30 min before surgery. Tranexamic acid  was given intravenously twice before exposure and wound closure. Duration the operation, all patients had a standard three-layer continuous suture approach performed in about 45° flexion of the knee. The incision was closed by two fixed residents. The articular capsule was sutured continuously with 2# absorbable knot-free unidirectional barb suture , while the subcutaneous tissue was sutured continuously with 0# absorbable knot-free bi-directional barb suture . We used 3-0 absorbable knot-free bi-directional barbed sutures in the skin .The new dressing system was used as follows in the intervention group:After suturing the surgical incision, thoroughly deiodinase the skin of 10 cm around the incision with 75% alcohol.Fold the calcium alginate dressing  into three layers in the long axis direction and keep it slightly longer than the notch 1 cm.Based on the length of the incision, 3 to 4 pieces of IV3000 film  were selected when the knee flexion was about 45°, Following that, glue the middle one first and then the film from the distal end to the proximal end. The two ends of the films were roughly 4 cm longer than the incision and the overlap between the two films was about 1 cm in length. There were no air bubbles between the films and the skin, thus they adhered to the skin.In the control group, suturing of the surgical incision, cover the wound with eight layers of aseptic gauze, then one layer of aseptic cotton pad and finally, secure it with plastic tape along the long axis of the wound .Following the operation, all patients used the same nursing measures. All patients were given antibiotics within 24 h of surgery and 1 g intravenous TXA 3 h later. Patients were given oral thromboembolic prophylaxis in the form of 10-mg rivaroxaban tablets once daily for 14 days beginning 6 to 8 h after surgery. All patients should have their dressings changed when the dressing has been soaked through, the dressing has become loose or fallen off, or the patient felt uncomfortable. Patients using the new dressing system were allowed to bath as usual based on their lifestyle. Patients with traditional gauze dressing can only brush their bodies 2 weeks following the operation, and they are not allowed to take showers or bubble baths to avoid wetting the dressings. All patients were not covered with dressing 2 weeks after the operation. After discharge, the patient was assigned to a chat group and the dressing was photographed and evaluated under the guidance of a fixed medical staff.Each patient's preoperative, intraoperative and post-operative data were collected, including age, gender, body mass index (BMI), surgical site, the times of dressing changes, post-operative hospital stay, the dressing-related cost, satisfaction, pain and functional recovery scores, wound scores and wound-related complications.Patients were discharged from the hospital if they met specific criteria, such as the ability to perform independent personal care, walk at least 70 m on crutches, get in and out of bed and get up from chairs and were treated with oral pain relief . The posThe dressing-related cost was the total cost of the dressing during the treatment cycle. To perform a satisfaction survey, we created a satisfaction survey . The satWe use the visual analog scale (VAS) score , 15 and The Stony Brook Scar Evaluation Scale (SBSES), proposed by Singer et al. , is a wot-test. Qualitative data were analyzed by the chi-square test. Statistical analyses were performed using SPSS 25.0 software . P values < 0.05 were thought to be statistically significant.The mean ± standard deviation was used to express all quantitative data. Quantitative data was analyzed by the independent samples p = 0.000, p = 0.002). The intervention group's satisfaction was significantly higher than that in the control group (p = 0.000) (= 0.000) . There wp = 0.012) in terms of wound score and wound-related complication. There was no significant difference in ASEPSIS between the two groups. However, one patient in the control group had a subcutaneous hematoma on day 2 post-operatively and required pressure dressing and antibiotics for an extended period  for the publication of any potentially identifiable images or data included in this article.DZ and PL conceived the original ideas of this manuscript. SS, JH, and FG executed the follow-up examination and materials collection. DZ, CW, and PL read the examination results, participated in the surgical, and medical treatment. SS prepared the figures. PL and SS prepared the manuscript. All authors contributed to the article and approved the submitted version.This study was supported by the National Natural Sciences Foundation of China (Grant Nos. 81974360 and 81902308) and the Innovation Foundation of National Orthopedics and Sports Rehabilitation Clinical Medicine Research Center (Grant No. 2021-NCRC-CXJJ-PY-37).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.


In the male group, smoking was positively associated with MD , while alcohol consumption was negatively related to MD . Being underweight was related to a lower risk of MD. In adult men, smoking was predicted to increase, while alcohol consumption was predicted to decrease the risk of MD.A few prior researchers presumed the impacts of smoking and alcohol on the risk of Meniere’s disease (MD). This study investigated the relationship between smoking, alcohol consumption, and obesity with Meniere’s disease in an adult population. The ≥40-year-old population in the Korean National Health Insurance Service-Health Screening Cohort 2002–2019 was analyzed. A total of 15,208 patients with MD were matched with 499,658 comparison participants. The current smoking, alcohol consumption, and past medical histories were collected. Body mass index (BMI) was grouped into underweight, normal, overweight, obese I, and obese II. The odds of histories of smoking and alcohol consumption and the BMI group for MD were analyzed using conditional logistic regression analysis. These associations were further analyzed in subgroups of age, sex, smoking, alcohol consumption, and BMI. In the overall adult population, smoking and alcohol consumption did not show an association with MD. Being underweight was linked with lower odds for MD (adjusted OR [aOR] = 0.80, 95% CI = 0.68–0.93,  Obesity is a common disease whose prevalence is estimated to be approximately 36.9% in Meniere’s disease (MD), a peripheral vestibular disorder that can be diagnosed based on the cochleovestibular symptom complex with a relapsing nature. Its prevalence has been estimated to be approximately 0.043–0.22% in Western countries ,2 and 0.p < 0.001) [For instance, the presence of allergies and immune dysfunction were related to a higher rate of MD  . Various< 0.001) . The mod< 0.001) ,8,9.Lifestyle modification can be an initial management option for MD . Due to This study aimed to estimate the impact of lifestyle factors on the occurrence of MD. To test the associations of a few main lifestyle factors recommended for modification in patients with MD, particularly smoking, alcohol consumption, and obesity, the occurrence of MD was analyzed for the relation to these lifestyle factors. This study is novel in concurrently analyzing a number of lifestyle factors in patients with MD compared with a matched comparison group.The ethics committee of Hallym University (2019-10-023) permitted the current research. Written informed consent was waived by the Institutional Review Board.Participants with MD (ICD-10 codes: H810) were enrolled from among 514,866 participants with 895,300,177 medical claim codes from 2002 to 2019 in the Korean National Health Insurance Service-Health Screening Cohort . The comparison group was enrolled if participants were not diagnosed with MD from 2002–2019 . The participants who were diagnosed in 2002 were excluded .The exclusion criteria were as previously described . In brieComparison participants were excluded if they were diagnosed with MD without audiometric examination or diagnosed with MD once .MD participants were 1:4 matched with control participants for age, sex, income, and region of residence. The comparison participants were selected in a random number order.The index date of each MD participant was the date of diagnosis of MD. The index date of comparison participants was set as the index date of their matched MD participants. Ultimately, 13,620 MD participants were 1:4 matched with 54,480 comparison participants .MD was defined if the participants were diagnosed with ICD-10 codes H810 (MD), ≥2 times of treatment histories, and with audiometric examination . The dia2) was categorized as <18.5 (underweight), ≥18.5 to <23 , ≥23 to <25 (overweight), ≥25 to <30 (obese I), and ≥30 (obese II) based on the Asia-Pacific criteria following the Western Pacific Regional Office (WPRO) 2000 [The status of smoking was classified as nonsmoker, past smoker, and current smoker based on the self-reported survey questionnaire. The frequency of alcohol consumption was divided into <1 time a week and ≥1 time a week based on the self-reported survey questionnaire. The group of body mass index  2000 .Age was grouped into 10 groups. The levels of income were classified into five groups. The region of residence was divided into urban and rural areas. The blood levels of total cholesterol (mg/dL), systolic blood pressure , diastolic blood pressure , and fasting blood glucose (mg/dL) were collected.The prior histories of benign paroxysmal vertigo (BPPV), vestibular neuronitis (VN), other peripheral vertigo, and dyslipidemia were defined based on the ≥2 times of treatment records.To estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of past medical history for MD, conditional logistic regression analysis was applied. In these analyses, crude (simple) and adjusted models  were used. The standardized difference (sd) was calculated for the general characteristics between the MD and comparison groups.p-value < 0.05 was set as the statistical significance. SAS version 9.4  was utilized.For the subgroup analyses using conditional logistic regression, we stratified participants by their age and sex. We conducted additional subgroup analyses using unconditional logistic regression according to obesity, smoking, and alcohol consumption. Two-tailed analyses were conducted. The A total of 12.7%  of the MD group and 11.9%  of the comparison group were current smokers . On the other hand, a history of alcohol consumption was related to lower odds for MD in the crude model . However, this association was also not maintained in the adjusted model . According to the BMI group, being underweight was linked with lower odds for MD in both the crude and adjusted models .Current smoking was associated with higher odds for MD in the crude model . On the other hand, a history of alcohol consumption was negatively related to MD in the male group . The women group did not demonstrate a significant association between MD with smoking or alcohol consumption. However, the women group showed low odds for smoking and high odds for alcohol consumption related to MD, which was the opposite direction from those of the men group. Thus, interaction analyses were conducted between sex and smoking or alcohol. The results indicated the significant interaction between sex and alcohol consumption . There was no significant interaction between sex and smoking . Being underweight was negatively associated with MD in the ≥ 55-year-old and female groups .The age and sex groups were analyzed for the association of smoking, alcohol consumption, and obesity with MD . A histoCurrent smoking and alcohol consumption and the BMI groups were analyzed for the association of smoking, alcohol consumption, and obesity with MD . The nonThis study delineated the relation between being underweight, smoking, and alcohol consumption with the occurrence of MD. Being underweight was associated with a lower risk of MD. Although there was no association between smoking and alcohol consumption with MD in the overall population, these factors were related to MD in the male group. Specifically, smoking was linked with a higher risk of MD, while alcohol consumption was linked to a lower risk of MD. The current study improved previous knowledge on the associated factors of MD by concurrently assessing multiple lifestyle factors, including smoking, alcohol consumption, and obesity. As these are modifiable factors, lifestyle modifications can be clinically valuable management strategies for patients who suffer from MD.Being underweight was negatively associated with MD in the overall adult population in our cohort. Although there has been no supporting evidence for the association between being underweight and the occurrence of MD, a few previous reports suggested the risk of MD in patients with obesity . The proCurrent smoking was related to a higher risk of MD in the male group in the present study. Ever smokers had a 2.22-fold higher risk of peripheral vestibular disease, including MD . AnotherOn the other hand, a history of alcohol consumption was associated with a lower risk of MD in the male group in this study. This result was somewhat contrary to the routine recommendation by a physician to relieve the symptoms of MD. However, a few previous studies suggested supportive evidence for the inverse association between alcohol consumption and MD. It was supposed that alcohol can delay the onset of MD by reducing vasopressin synthesis . AlcoholThis study used a large, nationwide population cohort. A large comparison population can be randomly selected with matching variables of age, sex, income, and region of residence. The history of MD and other morbidities were collected from the health claim codes, which were objectively diagnosed by a physician. However, our cohort data did not include laboratory data, such as vestibular function tests and pure tone audiometry. As the diagnosis of MD can be mixed with other vestibular disorders, the histories of BPPV, VN, and other peripheral vertigo were adjusted in the analyses. In addition, a number of organic diseases, including head trauma, brain tumors, disorders of acoustic nerves, and benign neoplasms of cranial nerves, were excluded. Another shortcoming of the present study was the potential confounders, which were not considered in the analyses. For instance, stress levels and nutritional uptakes of salt and caffeine could influence the risk of MD. Last, the cross-sectional study design limited the causality between MD and these lifestyle factors.Being underweight was inversely related to the occurrence of MD. In the male group, smoking was associated with a higher risk of MD. On the other hand, alcohol consumption was likely to be involved in a lower risk of MD. In patients with MD, lifestyle modification can be recommended for the cessation of smoking.


To characterize the changes in gut microbiota during pregnancy and determine the effects of nutritional intervention on gut microbiota in women from sub-Saharan Africa , South Asia (India and Pakistan), and Central America .Pregnant women in the Women First (WF) Preconception Maternal Nutrition Trial were included in this analysis. Participants were randomized to receive a lipid-based micronutrient supplement either ≥3 months before pregnancy (Arm 1); started the same intervention late in the first trimester (Arm 2); or received no nutrition supplements besides those self-administered or prescribed through local health services (Arm 3). Stool and blood samples were collected during the first and third trimesters. Findings presented here include fecal 16S rRNA gene-based profiling and systemic and intestinal inflammatory biomarkers, including alpha (1)-acid glycoprotein (AGP), C-reactive protein (CRP), fecal myeloperoxidase (MPO), and calprotectin.n = 157; India, n = 102; Guatemala, n = 276; and Pakistan, n = 105). Gut microbial community structure did not differ by intervention arm but changed significantly during pregnancy. Richness, a measure of alpha-diversity, decreased over pregnancy. Community composition (beta-diversity) also showed a significant change from first to third trimester in all four sites. Of the top 10 most abundant genera, unclassified Lachnospiraceae significantly decreased in Guatemala and unclassified Ruminococcaceae significantly decreased in Guatemala and DRC. The change in the overall community structure at the genus level was associated with a decrease in the abundances of certain genera with low heterogeneity among the four sites. Intervention arms were not significantly associated with inflammatory biomarkers at 12 or 34 weeks. AGP significantly decreased from 12 to 34 weeks of pregnancy, whereas CRP, MPO, and calprotectin did not significantly change over time. None of these biomarkers were significantly associated with the gut microbiota diversity.Stool samples were collected from 640 women  and alpha-diversity among all sites were consistent and suggested that the effect of pregnancy on the maternal microbiota overrides other influencing factors, such as nutrition intervention, geographical location, diet, race, and other demographical variables. Proteobacteria, in the third trimester. Of note, participants in this study received probiotics and diet counseling , and time of sample collection. These discrepancies warrant additional comprehensive and systematic assessments of gut microbiota changes during pregnancy, particularly in low-resource settings where data are lacking and health status, environment, and diet may differ from high-resource settings, and in relation to other health indicators that are reported to change over pregnancy, such as inflammation.The Women First (WF) Preconception Maternal Nutrition Trial recruited women of reproductive age living in resource-limited environments  to participate in a preconception lipid-based nutrient supplementation trial . As partclinicaltrials.gov (NCT01883193).The WF trial aimed to determine whether a preconception nutrition supplement promotes better length and other anthropometric outcomes at birth . Women oWomen of child-bearing age were recruited from the four sites based on the following inclusion criteria: age 16–35 years; parity 0–5, with site-specific strategies to include nulliparous participants; no current or planned contraceptive use; and expectation to conceive during the following 18 months. Informed consent was obtained from all participants. All participants who entered the pregnancy phase of the study consented to provide blood and fecal biospecimens. Hence, the women in the current study were primarily those who were the first to conceive.® needles and serum S-Monovette® blood collection tubes . The blood clotted for 30 min, was centrifuged, and then transferred to cryovials (Sarstedt). Serum was stored in –80°C freezers located at each site until shipment on dry ice to the University of Colorado Pediatric Nutrition Laboratory for analysis. Upon receipt, all samples were stored at –80°C until aliquoted and analyzed.Blood samples were collected at 12 weeks (Arms 1 and 2) and at approximately 34 weeks  of gestation. Specimens were collected using Sarstedt blood collection Safety-MultiflyTwo stool samples were collected from each participant during pregnancy. A pre-labeled fecal bag, Ziploc bag, a black cryogenic pen, and a Styrofoam storage box containing ice or ice packs were provided to each participant. The stool was collected into the fecal bag using a sterile scoop and then placed into a second Ziploc bag by participants. The bag was then placed into the Styrofoam storage container until picked up by the research team on the day the stool was passed. When receiving samples, the research team labeled the sample date and time of stool passage. The research team scooped about a teaspoon of stool and transferred the sample to a sterile stool storage tube with 3 mL RNAlater™, ensuring that the specimen was coated with RNAlater™ and that the label was complete. The stool samples were then frozen at –20°C or at a colder temperature. Samples were shipped to the University of Colorado on ice packs or at ambient temperature. Upon receipt, all samples were stored at –80°C until aliquoted and analyzed. Some samples were initially stored at –20°C but were transferred to permanent storage at –80°C. An additional fecal sample was collected without RNAlater™ for inflammatory biomarker analysis; this sample was frozen at –80°C, shipped on dry ice, and stored at –80°C at UCD until analysis.Bacterial profiles were determined by broad-range amplification and sequence analysis of the 16S rRNA gene following our previously described methods , 2019. Ivia barcodes in the paired reads with a python script  and feces  were analyzed. C-reactive protein (CRP) was measured in serum samples from Guatemala and Pakistan using a sandwich immunoassay with electrochemiluminescent detection . The limit of detection was 0.034 mg/L, and within-day and between-day precisions were 5 and 6.4%, respectively. Samples from India were analyzed by immunoturbimetry  at the KLE Hospital Clinical Lab . The limit of detection was 0.6 mg/L, with a within-day precision of 1.1% and the between-day precision of 1.4%. Serum α-1-acid glycoprotein (AGP) was measured using a sandwich enzyme-linked immunoassay . For samples from Guatemala and Pakistan, the limit of detection was 0.001 μg/mL, and the within-day and between-day precisions were 4.8 and 14.2%, respectively. The limit of detection of the method used in India was 0.002 μg/mL, while the within-day sensitivity was 7.5% and the between-day sensitivity was 10.7%. To minimize potential batch effects, samples from Guatemala and Pakistan were balanced across runs by randomizing within the site, arm, and longitudinal time points in Excel. Samples from India were not randomized but instead run chronologically by participant ID, starting with 12-week and then 34-week time points. The study design, however, randomized participant ID across arms, which minimized batch effects.g for 10 min at 4°C, then aliquoted, snap-frozen, and stored at –80°C until analysis. The amount of time between extraction and analysis was minimized and consistent to minimize the confounding of stability issues (1 day for MPO). To minimize the potential batch effects, samples were balanced across runs by site, arm, and time point.The levels of calprotectin and myeloperoxidase were measured in the fecal samples. Calprotectin was measured using a two-step sandwich enzyme-linked immunoassay  without changes in the protocol. The within-day and between-day precisions were 4.6 and 12%, respectively. The limit of detection was 1.8 ng/mL. Myeloperoxidase was measured using a sandwich immunoassay with electrochemiluminescent detection , with the limit of detection of the method being 0.03 ng/mL, within-day precision being 4.5%, and between-day precision being 9%. We used cold 1% v/v 100× protease inhibitors  in PBS  as the extraction buffer. For the detection of both calprotectin and MPO, 5 mL of extraction buffer was added to 100 mg of stool, and the sample was vortexed at 1,500 rpm for 30 min. Extracts were then centrifuged at 3,000 t-test was used to determine if these baseline characteristics were different among the two groups. Likewise, the distributions of SES and maternal education were compared at the site level between the two groups using the Cochran–Armitage test.The longitudinal microbiome data were available for a subset of mothers. The mean age and BMI of these mothers were compared within each site to the mean age and BMI of all mothers from the respective site. A difference of means Data presented here were analyzed cross-sectionally and longitudinally. Analyses were performed stratified by the site for both alpha- and beta-diversity, and individual OTUs and results were combined using meta-analysis as described below. Statistical analyses were completed at the genus level. Across the entire dataset, OTUs present in at least 5% of all samples and with a relative abundance greater than 0.001 in at least one sample were retained for analysis. Microbiome information for the control arm (Arm 3) was not collected at 12 weeks of gestation. As a result, analyses comparing mothers across arm status could not be conducted. Instead, an intervention arm in the form of supplemental status at each time point was used to investigate the relationship between nutritional supplements and the microbiome. In this way, mothers from Arm 2 served as a control group at 12 weeks of gestation allowing for meaningful statistical comparisons. To be clear on how supplement status was assigned, at 12 weeks, women in Arm 1 had supplement status equal to 1, and women in Arm 2 had supplement status equal to 0. At 34 weeks, women in Arms 1 and 2 had supplement status equal to 1, and women in Arm 3 had supplement status equal to 0. When possible, we tested the interaction between supplement status and time. There were no samples from women in Arm 3 for India, thus it was not possible to test for the interaction between supplement and time for this site at 34 weeks of gestation. Given the assumption of no interaction, we were able to test for association between the microbiome and supplement and between the microbiome and time. All models included standardized read depth and batch as covariates.Generalized estimating equations (GEEs) were used to model the association between time and supplement status and the interaction between time and supplement and four measures of alpha-diversity  when controlling for site-specific covariates and repeated measures over individuals. PERMANOVA using 1,000 permutations with adjustments for repeated measures was used to assess the association of time or supplement status with beta-diversity controlling for site-specific covariates using the Bray-Curtis metric.Individual OTUs were regressed on time and supplement status controlling for site-specific covariates using a negative binomial generalized linear model. Significance testing was performed by using 1,000 bootstrap samples to generate the distribution for effect estimates and then testing the hypothesis that the mean was equal to zero. The code used for this analysis is available on GitHub and can be accessed through the URL in the resources section.p-value below 0.1 for at least one time point, it was considered further. The pairwise Pearson correlation for these putative covariates was then estimated within each site to avoid collinearity issues in the final models. Only one covariate was retained from covariate pairs with a correlation greater than 0.7. Within each pair, the putative covariate associated with most sites was kept. If the putative covariates were associated in the same number of sites, we considered whether the highly correlated covariates represented similar characteristics and selected the covariate that was more general  to make our final list of covariates. As there were too many possible covariates to include for stable models and to account for differences between countries, we selected site-specific covariates as follows. Ninety-eight putative covariates were considered. Each covariate was assessed separately for each site and timepoint by using PERMANOVA to model beta-diversity as the outcome and the putative covariate of interest as a predictor. Each model was also adjusted for batch, regional cluster, and supplement status by including these parameters in the model. For each site, if the association between the covariate and beta-diversity had a p-values were adjusted within site and analysis type  using the Benjamini–Hochberg method to control the false discovery rate (FDR) at 0.05  with the relative abundance, then the pairwise comparisons are performed using the additive model.The differences in the relative abundance of the four most abundant phyla with respect to site location  and time (12 weeks of gestation compared to 34 weeks of gestation) are analyzed on the complete dataset . All models at this taxonomic level are conditioned on the batch in which samples were analyzed, but no other covariates are used for adjustments. Two linear mixed-effects models are constructed for each phylum: one to fit the relationship of relative abundance with the interaction of time and site, the other to fit the relationship of relative abundance with time and site without considering the interaction of the two. ANOVA on the mixed-effects models is used to assess the strength of the association between the relative abundance and the factor of interest, starting with the interaction model and then moving to the additive model if the P = 0.01), SES indicator in Pakistan , and maternal education in India .The recruitment of participants took place between December 2013 and October 2014. Out of the 3,251 participants who entered phase 2 (pregnancy) of the WF trial, stool samples were collected from 640 participants. These 640 participants were those who consented to biospecimen collection and were representative of the WF cohort. p-values of 0.289, 0.688, and 0.603 for richness, evenness, and overall diversity, respectively). There was evidence of a consistent lower overall diversity (Shannon H diversity index) in women taking the nutritional supplement compared to women not taking the supplement . Additionally, there was evidence for a consistent decrease in the Shannon H diversity from 12 to 34 weeks of gestation . In the stratified analysis of the Guatemalan cohort, there was strong evidence to conclude that richness, evenness, and overall diversity decreased from 12 to 34 weeks of gestation  , evenness (Shannon H/Hmax), and overall diversity of richness and evenness combined (Shannon H diversity index). Overall, there was insufficient evidence to conclude women taking the nutritional supplement had a different trend in alpha-diversity from 12 to 34 weeks than the control group  . To summP = 0.0009), Pakistan (P = 0.0009), Guatemala (P = 0.0009), and India (P = 0.034)]. Additionally, beta-diversity was seen to have a significant association with the supplement status in DRC (P = 0.003) and Pakistan (0.0009). However, there was insufficient evidence to conclude that the interaction between time and supplement status is associated with beta-diversity in any of the sites. These results are better understood through a PCoA plot  were more similar than the values between the time points in all four sites  were analyzed in a subgroup of participants from whom stool samples were collected. Inflammatory markers were not measured in the DRC due to limited access to the cold chain facility. The extent to which gut microbiota changes during pregnancy remains an open question, and most existing studies have been conducted in high-resource settings. Our study included low-resource settings in four countries with distinctive cultural and dietary backgrounds . For exaAlpha-diversity values, as assessed by the Shannon H index, showed a statistically significant decline from the first to third trimester across all the study sites. Earlier research has been inconsistent regarding alpha-diversity changes during pregnancy. A Finnish cohort showed a significant reduction in richness from the first to the third trimester . HoweverQ1−3*IQR or aboveQ3 + 3*IQR where Q1 is the 25th percentile of the residuals, Q3 is the 75th percentile of the residuals, and IQR is the inter-quartile range (Q3−Q1) of the residuals. After removing outliers, results were consistent in all sites except for the DRC where there was evidence for changes over pregnancy in several measures when outliers were removed but not when outliers were included: Chao 1 , Shannon H/Hmax . This finding suggests that outliers in the DRC cohort may be masking the association between alpha-diversity and weeks of pregnancy (gestation). The decline in alpha-diversity between the first and third trimesters was consistent with the overall decrease in the abundance of several genera , which are a key source of nutrients to the host . Further investigation is needed to identify the unclassified genera in the Ruminococcaceae and Lachnospiraceae families that decreased during pregnancy.Consistent with our findings at the sites in DRC and India before pregnancy , Prevoteoccaceae , and thepiraceae . Many spthe host  and can the host . The popse women . In contsh women . NeverthBlautia, a probiotic and SCFA producer, also decreased in Guatemalan participants during pregnancy. In the Italian GDM cohort, both Blautia and Lachnospiraceae increased from the second to third third trimester ; inclusion of a relatively large sample size from four different countries across Africa, Asia, and Central America; and comprehensive analysis of covariates, including the LNS nutrition intervention of the primary trial. Limitations include lack of control arm for the site in India at 34 weeks of gestation; lack of blood from the DRC site; and only two time points of assessment.In summary, the longitudinal reduction of individual genera  and alpha-diversity were consistent among all sites and suggests that the effect of pregnancy on the maternal microbiota overrides other influencing factors, such as geographical location, diet and nutrition supplement, race, and other demographical variables. Future research is needed to explore the associations of gut microbiota with other health indicators during pregnancy and in the offspring.https://www.ncbi.nlm.nih.gov/, PRJNA553183.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: The studies involving human participants were reviewed and approved by the Colorado Multiple Institutional Review Board (COMIRB). Local ethics approval was obtained at all research sites. The patients/participants provided their written informed consent to participate in this study.KMH and NK conceived the original idea and designed the initial protocol. AG, LF, AT, AL, JW, SG, MS, SA, and SS conducted the procedures. DF, DI, CR, and JK analyzed the stool samples and processed the microbiota data. NW, AH, DF, MT, and EM performed the statistical analysis. MT wrote the report with close collaboration with NK, DF, AH, JW, and NW, and with input from all authors. All authors read and approved the final version 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.


There is insufficient evidence regarding the efficacy and safety of stem cell therapy for autism spectrum disorders. We performed the first meta-analysis of stem cell therapy for autism spectrum disorders in children to provide evidence for clinical rehabilitation.The data source includes PubMed/Medline, Web of Science, EMBASE, Cochrane Library and China Academic Journal, from inception to 24th JULY 2021. After sifting through the literature, the Cochrane tool was applied to assess the risk of bias. Finally, we extracted data from these studies and calculated pooled efficacy and safety.p < 0.0001). The Clinical Global Impression score consolidated effect size RR = 1.01, 95%CI , Z = 0.14 (p = 0.89), the effective rate for The Clinical Global Impression was 62% and 60% in the stem cell group and the control group, respectively. The occurrence events of adverse reactions in each group , there was no significant difference in the incidence of adverse reactions between the stem cell group and the control group.5 studies that met the inclusion criteria were included in current analysis. Meta-analysis was performed using rehabilitation therapy as the reference standard. Data showed that the Childhood Autism Rating Scale score of stem cell group was striking lower than the control group (WMD: −5.96; 95%CI ; The results of this meta-analysis suggested that stem cell therapy for children with autism might be safe and effective. However, the evidence was compromised by the limitations in current study size, lacking standardized injection routes and doses of stem cells, as well as shortages in diagnostic tools and long period follow-up studies. Hence, it calls for more studies to systematically confirm the efficacy and safety of stem cell therapy for children with autism spectrum disorders. Autism spectrum disorder (ASD) is a group of neurodevelopmental disorders characterized by social deficits, communication inabilities and stereotypic behaviors . The incGiven the potential effects of sustained immune disorders and inflammation in ASD and known paracrine , homing Collectively, we aim to rigorously screen and extract all preclinical trial data on stem cell therapy for autism, objectively evaluate and summarize evidence concerning the effectiveness of stem cell therapy for autism symptoms through systematic review and meta-analysis.https://www.crd.york.ac.uk/prospero/).The study design was developed by the steering group, followed by the standard Cochrane Neonatal Review Group methods and PRISMA reporting guidelines. We have already submitted a registration application at Prospero  were diagnosed with autism, regardless of region, gender, or race.Multiple kinds of stem cells interventions on children with autism were investigated within the current systematic review and meta-analysis, with no limitations on injection times, administration route and dose. Studies of stem cells in combination with other treatments, such as antipsychotic drugs, are also being considered.Rehabilitation therapy includes sensory integration therapy, auditory training, behavioral intervention, occupational therapy, speech therapy and music therapy.The main indicators are the scores of Clinical Global Impression (CGI) and Childhood Autism Rating Scale (CARS) or any other evaluation tools suitable for ASD in the corresponding studies.Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were included in this study, both paralleled or crossover. For trials that had a crossover design, we included all the data before and after the crossover.The following English and Chinese databases were searched from their inception to 24th JULY 2021: PubMed/Medline, Web of Science, EMBASE, Cochrane library, China Academic Journal  and Clinicaltrials.gov. A detailed illustration of search strategies is available in Supporting information 1 (S1. Search Strategy). No date restrictions or language restrictions are used for retrieval. Finally, references were tracked and included in the study to ensure that no RCTs and CCTs were missed by the search strategy.All prospective controlled clinical studies of stem cell therapy on autism patients were included, as were trials in which stem cells were part of a complex intervention. We excluded qualitative studies, uncontrolled trials, case studies and case series, as well as trials that developed between different cell types, and studies that failed to provide detailed results.Two independent reviewers evaluated the retrieved studies for inclusion and assessed the methodological quality of included studies. Elements extracted included study characteristics , participant characteristics , intervention details , outcome measurement, follow-up time and adverse reactions. The risk of bias was assessed using the Review Manager 5.3. The disagreements were thrashed out by the two reviewers.et al.'s study). When studies of multiple intervention groups are compared, the “shared” control group is split equally in each comparison . The random effect model or mixed effect model was selected according to the size of heterogeneity. With high heterogeneity, sensitivity analysis or subgroup analysis was used to detect the source of heterogeneity; if the source of heterogeneity cannot be found, a descriptive analysis was conducted.Data entry and analysis were performed using Review Manager 5.3 software. The data required for meta-analysis were obtained by direct input or indirect calculation based on the original data  databases, PubMed/MEDLINE (n = 12), Cochrane (n = 7), Embase (n = 36), CNKI (n = 11), Wan fang Data (n = 30), Cqvip (n = 19), Sino Med (n = 4), Clinicaltrials.gov (n = 3). We also included 1 latest research reports through citation searching to ensure that the retrieved literature includes all the studies in the published meta-analysis , the primary caregiver does not speak English (n = 1)] after randomization, thus were excluded from the efficacy analysis. Collectively, only 315 subjects were included in the efficacy analysis.The characteristics of the included studies are listed in et al was considered high quality and low risk of bias. Lv et al. 's study was high risk in the field of random sequence generation and have “Some concerns” in multiple domains that substantially lowers confidence in the result. The other three studies should be considered “Some concerns” according to Cochrane's book in their one or two domains.The Five eligible articles were meta-analyzed using a random effects model, with CARS  and CGI p = 0.14; I2 = 42%, indicating moderate heterogeneity. Data showed that the CARS score of the stem cell group was significantly lower than the control group  .As can be seen from the forest diagram in  0.0001] . A higheet al.'s study was low. Afterward, we conducted a subgroup analysis based on the methodological quality, and found that the combined results of CARS in the high-quality group were stable  ; p = 0.29; heterogeneity test p = 0.02; I2 = 82%] , the effective rate for CGI was 62 and 60% in the stem cell group and the control group, respectively. Heterogeneity test I2 = 0%, p = 0.72, indicating no heterogeneity.We found that the forest plot of CARS had moderate heterogeneity. According to the results of the methodological quality assessment, we concluded that the research quality of Lv  I2 = 0] . The res2 = 82%] . Therefop = 0.36; p = 0.28; I2 = 22%. Based on the forest map, we have visual outliers. The sensitivity analysis found that the study of Dawson et al was an outlier and the cause of heterogeneity. Whereas, after Dawson et al's study was excluded, the results were more stable .The forest plot in etc. As expected, more and more researchers are attempting to determine the efficacy of stem cell therapy for ASD.Stem cells are defined as tissue units of biological systems which is responsible for the regeneration and development of organs and tissues. Stem cells are capable of self-renew and differentiate into multiple cell line ages, therefore, these cells can also be units that evolve through natural selection , 29. HemMartínez  publishe8 cells in the first injection and 0.3-0.5 × 108 cells in the second injection. In other studies . The Science and Technology Project of Jiangxi Provincial Health Commission (20191079). The Open Project of Key Laboratory of Prevention and treatment of cardiovascular and cerebrovascular diseases, Ministry of Education (XN201913). The Foundation of Technology Innovation Team of Gannan Medical University (TD201806). Key Project Foundation of Gannan Medical University (ZD201831). First Affiliated Hospital of Gannan Medical University, Doctor Start-up Fund (QD076), and Jiangxi Provincial Natural Science Foundation (20212BAB206075).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.


This study aimed to assess the motives of dental students to study dentistry, their specialty preferences, and their empathy scores by motives and specialty preference.this cross-sectional study utilized a self-administered questionnaire designed to assess the empathy measured by the Jefferson Scale of Empathy-Health Professions Student version, motives to study dentistry, dental specialty preferences among students of a dental school in Nigeria. Differences in mean empathy across gender, motives to study dentistry, and specialty preferences were analysed with t-test and ANOVA. P-values of <0.05 were considered significant.a total of 211 students participated fully in the study with a mean age of 21.19 years ± 2.43 and 140 (66.4%) females. Personal interest (27.0%) and failure of admission to other undergraduate programmes (20.9%) were the top two motives for studying dentistry. Oral and maxillofacial surgery (OMFS) was the most preferred specialty (44.1%) and community dentistry and periodontology were the least preferred (2.8%) respectively. The total mean empathy score was 104.06 ± 19.1. The highest empathy score for motivation was for high income from dentistry (112.33 ± 13.34). The participants who preferred paediatric dentistry had the highest empathy score (108.73 ± 13.68).knowledge of the empathy levels, the motivation for studying dentistry, and preferences for particular specialties may encourage trainers to ensure the development of a positive attitude among dental students that is professional and empathetic. Dentistry is a highly skilled profession that involves years of intense and demanding undergraduate and postgraduate specialist training. Thus, it requires that both undergraduate and postgraduate students, as well as practicing dentists be committed and dedicated to providing quality patient care. Identifying the motives which drive the decision to study dentistry is important. This helps in understanding the psychological makeup and professional expectations of the students as well as the potential job satisfaction as dentists . SeveralThe different dental specialties aim to provide holistic and specialized oral healthcare to the community. However, there is an uneven distribution of these specialties among dentists in Nigeria -6. Oral The information on the motives and specialty preferences of undergraduate and practicing dentists in Nigeria can be further enriched ,5,6,14. Study setting: this study was conducted in the University of Lagos, which is one of two government-owned universities in Lagos State, Nigeria with a dental school. Lagos State is situated in the South-West of Nigeria in West Africa.Study design, population, and sampling: this was a cross-sectional study that utilized a self-administered questionnaire to acquire information from the first to sixth year dental students. The study population consisted of undergraduate dental students of the Faculty of Dentistry, College of Medicine, University of Lagos, Lagos, Nigeria from December 15th, 2015 to January 12th, 2016. All students in the first to sixth year were eligible for the study. Permission to use the Jefferson Scale of Empathy-Health Professions Student (JSE-HPS) version for this study, allowed for only a maximum of 250 participants. Participants were sampled using a proportion to size method based on the number of students in each year of study as described in a previous publication [Study instrument and data collection: a self-administered questionnaire consisting of four sections was utilized to collect information from the subjects. Section A obtained information on the demographic variables such as age, gender and, year of study. Section B of the questionnaire was used to obtain information on the motivations to study dentistry as an undergraduate course and required a “yes” or “no” response, allowing for multiple responses. Section C was to obtain information on their specialty preferences from a list of nine dental specialties. Section D of the questionnaire was the structured JSE-HPS, which was obtained from the Center for Research in Medical Education and Health Care, Thomas Jefferson University, Pennsylvania, USA. It is a 20-item 7-point Likert scale , with an individual score range of 20 to 140. The scoring system has been described previously [eviously ,16. The Data analysis: data were analysed with the IBM SPSS version 23.0.0.0 . Incomplete entries were excluded from the analysis. Information on the year of study, age, gender, motives to study dentistry, specialty preferences, and the JSE-HPS to assess empathy were the variables analysed. Categorical variables such as gender, year of study, marital status, motives for studying dentistry, and specialty preference were summarized as frequencies and proportions. Continuous variables such as age and JSE scores were expressed as means and standard deviations. A chi-square test was used to determine any association between gender and motives to study dentistry. Independent t-test and analysis of variance (ANOVA) were used to analyse differences in mean empathy across gender, motives to study dentistry, and specialty preferences. P-values of <0.05 were considered significant.Ethical consideration: the study protocol was approved by the Lagos University Teaching Hospital Health Research Ethics Committee (ADM/DCST/HREC/APP/573). Permission to use the JSE-HPS version was obtained from the Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Pennsylvania, USA. Participants´ consent was also obtained.Sociodemographic characteristics of the participants:Motivations for studying dentistry: the motives for choosing to study dentistry are illustrated in 2= 8.339, df = 1, P = 0.004).Specialty preferences of participants: overall, 199 (94.3%) students indicated a specialty preference. Oral and maxillofacial surgery  was the most preferred dental specialty overall. The second most preferred specialty was orthodontics . The least preferred specialties were community dentistry and periodontology, in which only 6 (2.8%) of the students respectively, expressed an interest. The female to male ratio for preference for paediatric dentistry was 14: 1 (as 14: 1 . The majEmpathy levels, motives for studying dentistry, and specialty preferences:There were more females than males studying dentistry in this population. The higher number of female students studying dentistry has also been reported in another study among Nigerian dental students some years ago . ConversSocial status was seen to have the least influence in studying dentistry in this study. Prestige, which can be akin to social status was reported as the second highest motivating factor in a study among clinical dental students in Nigeria . In anotA desire to help people which is an altruistic trait was not a priority in this population. A similar finding has also been reported in other studies in which altruism was not a major factor influencing the students´ choice of dentistry rather, professional status, financial rewards, and security were stronger motives ,24. AltrOral and maxillofacial surgery was shown to be the most popularly preferred specialty in this study. This corroborates previous reports among both undergraduate students and practicing dentists -6. PossiIronically in this study, students whose motive to study dentistry was helping people improve their oral health had the second to the least mean empathy score. It is expected that this altruistic motive would manifest with a higher empathetic orientation. Disconcertingly, high income which may be regarded as a pecuniary motive had the highest empathy score. In contrast, it has been shown that humanistic, positive attitudes towards doctor-patient relationships and altruistic motivations have a positive relationship with empathy among students of other healthcare professions ,28.The higher empathetic orientation in the students who prefer paediatric dentistry may be due to the proportionally higher number of females among them. Behaviour management of the child dental patient aims to establish effective communication, alleviate fear and anxiety and develop a trusting relationship with the patient that will ultimately allow a positive experience for both dentist and patient, ensure the provision of quality dental care and promote a positive attitude towards dental care and oral health in the child . A high Limitations: some of the limitations of this study include its single institutional sampling which constraints the generalization of the findings. Another is the use of a self-administered questionnaire. Although this is quick and practical, there is the tendency for obtaining socially acceptable responses which may be invalid [ invalid . FurtherKnowledge of the empathy levels, the motivation for studying dentistry, and preferences for particular specialties among dental students may guide the admission process and the development of a curriculum that enriches the learning experience, enhances interpersonal skills, and encourage the development of a positive attitude among dental students, that is professional and empathetic and promotes patient-centred oral healthcare delivery.The motives for studying dentistry are complex and dynamic;Oral and maxillofacial surgery is the most common specialty preference among dental students;Empathy is crucial to a patient-centered oral healthcare delivery.Altruistic motivations and thus empathy seems to have little influence on choosing to study dentistry;Empathetic orientation is higher for those who prefer paediatric dentistry;The role of empathy in study motivations and specialty preferences among Nigerian dental students need further exploration.


Participants with heart disease did not differ significantly in terms of satisfaction or performance; their frequency of engagement in meaningful activities was significantly lower than without heart disease (p = 0.041). These results suggest that heart disease and social frailty are associated in community-dwelling older adults, and that this demographic is inclined to engage in meaningful activities less frequently.Patients with heart disease are more likely to experience social frailty due to physical inactivity, which may affect meaningful activities such as hobbies. This study aimed to investigate (1) the association between heart disease and social frailty in community-dwelling older adults and (2) the characteristics of meaningful activities in community-dwelling older adults with heart disease. Data from 630 older adults who participated in a community-based health survey were obtained, including clinical history, meaningful activities, social frailty and psychosomatic functions. Participants were divided into two groups: those with heart disease (n = 79) and those without (n = 551), and comparisons were made. Social frailty was observed in 23.7% of participants with heart disease, and logistic regression revealed significant associations with heart disease and social frailty after adjusting for potential covariates (OR, 1.97; 95% CI, 1.06 3.67;  In Japan, the incidence of heart diseases such as angina pectoris, heart failure, and valvular heart disease is low compared to that in western countries . HoweverThere has been increasing recognition of frailty in the field of heart disease. Frailty is a state of decreased physiological reserve and resistance to stressors ,5. It isWhile older adults with heart disease are encouraged to increase activity frequency, it has been reported that shortness of breath, fatigue, and the associated increase in rest periods may lead to a change to less demanding activities and a decrease in frequency ,13. ThesFew studies have been conducted on social frailty in those with heart disease, and no studies have been conducted on meaningful activities to reduce social frailty in this demographic. Therefore, this study aims (1) to investigate the relationship between heart disease and social frailty in community-dwelling older adults and (2) to determine the characteristics of meaningful activities in community-dwelling older adults with heart disease. It is hoped that the findings of this study will contribute to the development of strategies that will facilitate social engagement among older adults with heart disease.This cross-sectional study used data from the Tarumizu Study held during June 2019 to December 2019. It recruited participants aged 40 years or older, living in Tarumizu City at the time of the survey (during 2019) by mailing them reply cards. A total of 1028 participants were enrolled, and 690 of them aged 65 years or older and not requiring support or care according to the Japanese public long-term care insurance system were included this study. The exclusion criteria included: (1) history of dementia, cerebrovascular accidents, or depression, and (2) missing data on social frailty assessments, meaningful activity assessments or other measurements. After these exclusions, our final sample consisted of 630 community-dwelling older adults aged 65 years or older  . The ethHeart disease data were obtained from the questionnaire, which asked about medical diagnoses that the participant had received from a doctor . A curreIn this study, social frailty is defined as “social domains of frailty,”, i.e., social characteristics or social factors that are often expressed in frailty individuals . Social In this study, meaningful activities were operationally defined as ‘activities that individuals consider important in their daily life’ . The AidData on sociodemographic and clinical variables, including age (years), sex, marital status, education (years), medications (n/day), history of hypertension, cognitive function, physical frailty, higher-level competence and depressive symptoms, were collected. Licensed doctors or nurses measured the resting blood pressure of participants at the study site. Education, medical history and medication data were obtained during face-to-face interviews. Cognitive function was assessed using the National Centre for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT). This measures four cognitive domains: memory, attention, executive function, and processing speed . A scoret-tests for continuous variables, Mann–Whitney U tests for ordinal variables and Pearson’s χ2 tests for categorical variables. The relationship between heart disease and social frailty was examined by logistic regression analyses. There were three regression models: a crude model, adjusted model 1 and adjusted model 2. The presence of social frailty was set as the dependent variable in all models. In the crude model, the presence of heart disease was set as the independent variable. Adjusted model 1 was adjusted using demographic variables  as covariates, whereas adjusted model 2 was adjusted using demographic variables, history of hypertension, medications, poor cognitive status, physical frailty, higher-level competence and depressive symptoms as covariates. Pearson’s χ2 test was used to compare the five aspects of social frailty addressed by the five questions on the social frailty measure between the with and without heart disease groups. Effect size was estimated using Cramer’s V, Cohen’s d, and r to determine the degree of difference.Statistical analyses were performed to compare the characteristics of community-dwelling older adults with and without heart disease. Data were analyzed using student’s The number of meaningful activity categories selected by individuals with and without heart disease were compared using Pearson’s χ2 test, Mann–Whitney U test for satisfaction and performance, and student’s t-tests for frequency.p-value of <0.05 was considered statistically significant.All statistical analyses were performed using the IBM SPSS Statistics version 26.0 . A p = 0.004), and its members were significantly older (p < 0.001), had lower higher-level competence (p < 0.001), a higher rate of physical frailty (p = 0.011), social frailty (p = 0.002), poor cognitive functions (p = 0.018) than those in the group without heart disease.The demographic and clinical characteristics of the study participants are shown in p = 0.001)]. After adjusting for potential covariates, heart disease has remained significantly related to social frailty .The logistic regression models showing the relationship between heart disease and social frailty are presented in p = 0.010) and to ‘not talking with someone every day’ (p = 0.041) than those without heart disease.The relationships between heart disease and the five aspects of social frailty measured by the social frailty scale are presented in p = 0.041). The frequency of both groups’ participation in meaningful activities by category is shown in p = 0.020) and interpersonal interaction (p = 0.019) significantly less frequently than those without.The main findings of this study were as follows: (1) heart disease is independently associated with social frailty in community-dwelling older adults, and (2) community-dwelling older adults with heart disease engaged in meaningful activities significantly less frequently than those without heart disease. To the best of our knowledge, this is the first study to examine the relationship between heart disease and social frailty and the characteristics of the meaningful activities of community-dwelling older adults with heart disease.Among the 79 (12.5%) participants in this study with heart disease, 26 32.9%) met the criteria for social frailty. This was a higher rate than that seen in previous studies (10.2–20.5%) that have used a similar operational definition of social frailty in community-dwelling older adults .9% met t. In addiIn this study, there were no significant differences in satisfaction with performance of meaningful activities in community-dwelling older adults with and without heart disease, but those with heart disease engaged in these activities significantly less frequently. Allowing for the fact that different activities involve different frequencies of engagement, these results underscore the importance of frequent social engagement through meaningful activities for older adults with heart disease. Meaningful activities provide a sense of purpose and increase life satisfaction for older adult . In receHowever, this study has several limitations. First, heart disease was ascertained from pre-existing self-reported data. This may have led to an underrepresentation of the proportion of heart disease (12.5%) in the general population of older adults and to the large difference in the size of the groups of those with and without heart disease. However, the prevalence of heart disease in this study was at a reasonable rate among the general community-dwelling older adults. Secondly, the cross-sectional design prevented inference of a causal relationship between heart disease and social frailty. Future longitudinal studies are needed to establish this relationship. Third, Makizako’s social frailty scale items have not been validated in heart disease patients. However, the measurements of social frailty in this study were all clinically applicable and are simple, inexpensive, and are increasingly used in patients with heart disease. Nevertheless, these instruments should be externally validated in future studies. Fourth, the lack of data on factors such as poverty and deprivation, which are potential interactions of social frailty. A more detailed investigation of these points is needed in the future. Fifth, we did not investigate the degree of frequency in this study, and it is difficult to examine each category of activity. In the future, we believe it is necessary to investigate in detail not only the frequency of meaningful activities, but also the degree and each category of activity. Sixth, the participants in this study were community-dwelling residents undergoing a health check-up, so they were not selected randomly. Only those able to participate in the health check-up were included, and the number of participants was not determined based on sample size calculations. Finally, the data were from a single city, and social frailty may be affected by cultural and regional differences. Further studies in other regions are needed to consider regional characteristics. However, despite these limitations, this study is still useful in identifying the association between heart disease and social frailty in community-dwelling older adults and the characteristics of meaningful activities among community-dwelling older adults with heart disease.This study found that community-dwelling older adults with heart disease may be more likely to have social frailty. Since this demographic is inclined to engage in meaningful activities less frequently, they should be supported and encouraged to engage in such activities on a regular basis. Promoting social participation through meaningful activities may reduce re-admissions and maintain the quality of life of older adults with heart disease. However, since this was a cross-sectional study, further longitudinal research is needed to support our findings and establish a causative relationship.