Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children's ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention. Autism spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are two disorders that stem from a disruption in the development of the brain and share the same genetic etiology, which largely explains the complexity of the impairments that characterize them  refers to the mental operations that underlie social interactions and involve interpersonal sensitivity in real social settings. It is a broad, complex, and multifaceted construct that reflects a wide variety of psychological processes, highlighting affect recognition (AR) and theory of mind (ToM). On the one hand, AR consists of identifying emotionally salient information in the environment, including verbal  and nonverbal  cues about other people's emotions , group differences in intelligence, and the diagnosis of the type of presentation of the ADHD participants. Thus, one important area for future research is the continued investigation of these two neurodevelopmental disorders. This study builds on the previous one, focusing on the analysis of similarities and differences between the implicit and explicit ToM systems and possible links between ToM and EF in children with HFASD and children with ADHD. In order to obtain reliable conclusions, critical factors have been controlled, specifically the intelligence level (IQ) and verbal ability, given the degree of overlap between IQ and EF and the relationships between verbal ability and the capacity to represent mental states Happé, .Considering the significance of these findings about similarities and differences between ASD and ADHD in the conceptualization of these two disorders, the first objective of this study is to compare the AR and ToM abilities, both explicit (laboratory tasks) and applied , in children with HFASD, ADHD, and TD, matched on chronological age, mental age, and vocabulary. Children with HFASD are expected to have worse performance on all the measures of social cognition than the children with TD. Children with ADHD are expected to show a more variable performance, depending on the type of measure, and occupy an intermediate position between the children with HFASD and the children with TD.The second objective consists of exploring in the two clinical groups, children with HFASD and children with ADHD, the interplay between AR and ToM skills and “everyday” components of EF measured by the BRIEF. Based on the limited literature examining the relationship between executive and social functioning in children with ASD and children with ADHD, we predict that the EF components that have a significant relationship with the ToM in both disorders will differ. Specifically, we expect that EF behavioral regulation index subdomains, a characteristic deficiency seen in individuals with ADHD Barkley, , will man = 52), a group with ADHD (n = 35), and a group with TD (n = 39). Mean age of children with HFASD, M = 8.59, SD = 1.38; children with ADHD, M = 9.14 SD = 1.41; children with TD, M = 8.46, SD = 1.27. The decision on the age range was motivated by developmental reasons  and due to the importance of Primary Education in the Spanish education system that coincides with this developmental period. All the participants had an overall IQ equal to or above 80, measured with the K-BIT  = 2.61, p = 0.078, total IQ, F = 0.865, p = 0.423 and semantic language level, assessed with the vocabulary subtest of the WISC-IV  = 1.03, p = 0.350. In addition, 91.42% of the HFASD group and 94.3% of the ADHD group were male.Participants in this study were 126 children from 7- to 11-years old, distributed in three groups: a group with HFASD . The clinical diagnoses of HFASD and ADHD were confirmed before applying the battery of tests selected for the present study. Specifically, to confirm the HFASD diagnosis, strict cut-off points recommended for the Social Communication Questionnaire  and two children with ADHD (5.7%) were attending school in regular classrooms full time; 29 children with HFASD (55.7%) and 33 with ADHD (94.3%) attended regular classrooms but received educational support for their specific needs in the school; and finally, 20 children with HFASD (38.5%) were placed in the Communication and Language classrooms modality.Participants with TD were all attending school in regular classrooms in the same schools where the children with ADHD and HFASD attended. They had no history of psychopathology or referral to children's mental health units (USMI), according to the information from the school records, and they did not meet the DSM 5 criteria for ADHD or HFASD on the screening carried out by SCQ before beginning the evaluation.The exclusion criteria for the children who participated in the study were evaluated through an extensive prior anamnesis carried out with the families. They included severe or genetic neurological diseases, brain lesions, psychosis, visual, auditory, motor, or sensorial deficits, and an intelligence coefficient <80. The administration of psycho-drugs was only an exclusion criterion for the TD group. By contrast, 32.7% of the children in the HFASD sample were taking antipsychotics (mainly Risperidone), and 71.4% of the children in the ADHD sample were receiving psychostimulants, generally time-released (mainly Methylphenidate).The study was approved by the Ethics Committee of the University of Valencia . It obtained the approval of the Consellería de Educación de la Generalitat Valenciana to locate children who had received a previous diagnosis of HFASD or ADHD by professionals in specialized childhood mental health services. The families were personally told about the aims of our research and asked for their informed consent. Oral permission from the children and written informed consent from their parents were obtained before beginning the evaluation, which took place in the schools in which they were enrolled.The intelligence test and the two tests from the social perception domain were administered to all the children individually by trained examiners in prepared classrooms in the different schools. The parents provided information about their children's ToM skills in daily life contexts, and the teachers-tutors filled out the questionnaire selected to assess the EF.The subtest from the social perception domain of the NEPSY-II battery  and specificity (0.9) when used to examine children with ASD, although its purpose is not to perform a differential diagnosis . The items are grouped in 8 scales: Inhibit (“Interrupts others”); Shift (“Becomes upset with new situations”); Emotional control ; Initiate (“Is not a self-starter”); Working Memory (“Has a short attention span”); Plan/Organize (does not finish long-term projects); Organization of materials (“Leaves playroom a mess”); and Monitor (“Does not check work for mistakes”).The scales make up two indexes. The Behavioral Regulation Index (BRI) is composed of the Inhibit, Shift, and Emotional Control scales, assessing the child's capacity to make cognitive changes and adjust his/her emotions and behavior through appropriate inhibitory control. The Metacognition Index (MI) is composed of the Initiate, Working Memory, Plan/Organize, Organization of materials, and Monitor scales. This index reflects the child's ability to initiate, plan, organize, self-monitor, and maintain working memory. It could be interpreted as the ability to self-manage cognitive tasks and supervise their performance. This index is related to the capacity to actively solve problems in a variety of contexts.The direct scores can be transformed into T-scores, with higher scores indicating worse EF. The questionnaire's reliability and validity have been adequately demonstrated , version 22.00 . Multivariate Analysis of Variance (MANOVA) was conducted to analyze differences between the HFASD, ADHD, and TD groups on the AF and ToM (explicit knowledge) subscales of the NEPSY-II and the ToMI inventory (applied knowledge). For the additional ANOVAs, the level of significance was set at F = 13.76, p < 0.001, η2p = 0.48]. ANOVAs showed significant differences in the NEPSY subscales: Affect recognition, F = 18.57, p < 0.001, η2p = 0.23; Verbal-ToM, F = 13.91, p < 0.001, η2p = 0.18; Contextual-ToM, F = 5.84, p = 0.004, η2p = 0.08, and Total-ToM score, F = 17.28, p < 0.001, η2p = 0.22. Statistically significant differences were also shown in the applied knowledge task (TOMI): Early-ToMI, F = 35.65, p < 0.001, η2p = 0.36; Basic-ToMI, F = 64.25, p < 0.001, η2p = 0.51; Advanced-ToMI, F = 116.04, p < 0.001, η2p = 0.65 and in the ToMI total score .The MANOVA conducted to assess the main group effect on the conceptual knowledge  and applied knowledge (ToMI) indicators was statistically significant [Wilk's Lambda (Λ) = 0.26, post-hoc analyses showed statistically significant differences between the TD group and both clinical groups on AR, Verbal-ToM, and Total-ToM (p < 0.001), with no significant differences between clinical groups. On the contextual task, the HFASD group showed significantly worse performance than the TD group (p < 0.001), and performance of the ADHD and TD groups was similar. However, there were no significant differences between clinical groups on this task. A different pattern was observed for ToM applied knowledge, where there were statistically significant differences among the three groups, HFASD, ADHD, and TD, on the three subscales of the ToMI and on the Total score (p < 0.001). The HFASD group had the lowest score, whereas the TD group had the highest, according to parent estimations. See Table Bonferroni p < 0.001), Shift (p < 0.001), Emotional control (p = 0.012), and the BRI (p < 0.001). There were also significant correlations between AR and Monitor (p = 0.016). There were no significant correlations between AR and EF in the HFASD group, as Table p = 0.009) and Total-ToM (p = 0.020), both from the NEPSY-II battery. Similarly, there were significant correlations between Initiate and Basic-ToMI (p = 0.033), Advanced-ToMI (p = 0.046), and Total-ToMI (p = 0.040). There were also significant correlations between Organization of materials and Basic-ToMI (p = 0.033), advanced-ToMI (p = 0.030), and Total-ToMI (p = 0.016), and between MI and advanced-ToMI (p = 0.043) and Total-ToMI (p = 0.026).In the ADHD group, AR significantly correlated with Inhibit (p = 0.034), Basic-ToMI (p < 0.001), and total-ToMI (p = 0.027), as well as between emotional control and Early-ToMI (p = 0.045). The same pattern was observed between the BRI and the Early-ToMI (p = 0.014), Basic-ToMI (p = 0.013), and Total-ToMI (p = 0.049). Regarding the metacognitive processes, there were statistically significant correlations between Organization of materials and Early-ToMI (p = 0.026), Basic-ToMI (p = 0.012), and Total-ToMI (p = 0.049), as well as between Monitor and Early-ToMI (p = 0.018), Basic-ToMI (p = 0.013), and Total-ToMI (p = 0.022).Correlation analyses in the ADHD group did not show significant associations between ToM tasks on the NEPSY-II and BRIEF subscales. However, there were significant negative correlations between inhibit and Early-ToMI : Parents perceived that the ASD group had more difficulty than the other two groups in understanding basic emotions, distinguishing between physical and mental, making second-order inferences, or making complex social judgments. In addition, there appeared to be a symptomatic continuity, such that the ADHD group was found in an intermediate position between TD and ASD in the practical application of ToM abilities. The results agree with the trend found in previous work (Demurie et al., When the achievement levels of children with HFASD and ADHD are compared on the two types of ToM tasks, explicit and applied, the results are not fully consistent with the work of Hutchins et al. . In the Our results suggest the existence of more severe impairments in social cognition in the HFASD group compared to the ADHD group, although both neurodevelopmental disorders involve difficulties in processing social information. Furthermore, deficits are found on the AR task, which requires perceptual skills, as the children do not have any other information apart from what is contained in the facial expressions, and on the ToM tasks, which require higher thought processes such as logical skills, pragmatic language, and the recognition that one's mind is different from the minds of others. Deficits are also shown in both structured ToM test situations and multidimensional real-life situations, which require more complex and sophisticated skills. Moreover, the worse performance of the group with HFASD on ToM abilities, compared to the group with ADHD, does not seem to be due to language limitations, considering that the two groups were matched on expressive vocabulary. HFASD difficulties may be linked to a more severe meta-representational deficit, an idea that future research will have to verify.The second objective of this study was to explore the interplay between AR and ToM abilities and “every day” EF in children with HFASD and children with ADHD to find out whether ToM deficits are related to different EF subdomains in these children. A first analysis showed that, in both groups, significant relationships were found on scales measuring the application of ToM skills in the real world. Social interactions in daily life where we must respond spontaneously to a variety of events require more EF resources than laboratory tasks performed in contexts with greater control and stimuli isolation. Hence, it is important to complement the evaluation of ToM performance tasks by measuring how children cope with real-world social interactions that can result in success or failure and have emotional consequences.As expected, the interrelationships between EF and ToM abilities presented a different profile in ASD and ADHD. In children with ADHD, Inhibit, Shift, Emotional control, and the Behavioral regulation index presented high and significant correlations with AR and Early TOMI. Inhibitory control and the Behavioral regulation index also correlated significantly with the Basic TOMI. Finally, Monitor presented correlations with AR and Early and Basic TOMI scales, underlining the ongoing control that the integration of emotional cues requires in the constantly changing social environment. The findings coincide with previous literature (Yang et al., The correlations in the ASD group show a quantitatively and qualitatively different situation. This group shows a somewhat worse profile that focuses on the EF of Initiate. A poor decisive attitude, or difficulty in thinking of alternatives to solve problems, correlated negatively with performance on the verbal ToM task and, especially, with two scales that assess the application of ToM abilities in the context of everyday life, that is, Basic and Advanced TOMI. Organization of materials was significantly associated with the Basic TOMI, whereas the Metacognitive index was associated with the Advanced TOMI. Previous studies have demonstrated a link between ToM and EF in children and adolescents with ASD, specifically on set-shifting skills (Joseph and Tager–Flusberg, Our findings add to existing knowledge about deficits of children with ADHD and HFASD in AR and understanding others' mental states, which reflects a certain symptomatological continuum where HFASD shows greater severity. However, the social impairments of these two neurodevelopmental disorders cannot be explained solely on the basis of ToM failures. According to a recent meta-analysis (Imuta et al., The present study has several methodological limitations. Sample size and the fact that most of the children in the ADHD group have a combined presentation may affect the generalizability of the results. Moreover, the low number of females and the recruitment of participants from families with middle-class income levels may not adequately represent the general population. A high percentage of children with ADHD were medicated. Another limitation is related to the ToM measures used. Although, an effort was made to integrate measures of a different nature, it would have been desirable to also incorporate measures based on direct observation protocols. In addition, the present study relied only on teachers' reports of EF, without including supplemental laboratory performance measures. Future work should combine laboratory and informant-based measures for a more in-depth investigation. In particular, the unexpected lack of significant relationships between working memory and ToM in both the HFASD and ADHD groups may be due, at least in part, to the measurement methodology used. It would have been advisable to use other memory indicators such as performance tests. Furthermore, the results of the correlation analyses have an exploratory nature, due to the many variables that intervene in the analyses. However, the application of the Bonferroni correction in this situation would involve a greater possibility of committing a Type II error and rejecting relationships that may exist. Finally, the cross-sectional design does not allow us to conclude whether the interrelationships between mental abilities and EF follow a different course in ASD and ADHD. A longitudinal research design would make it possible to test the directionality of the influence.Despite these limitations, this study provides evidence about deficits in social cognition processes in children with ASD and ADHD and the differential role of EF. It supports the importance of incorporating EF measures in the evaluation and treatment of children with these two neurodevelopmental disorders. A better understanding of the individual differences in this interdependence will lead to greater possibilities of carrying out successful interventions. Inhibition and behavioral regulation deficits need special treatment that might differ from interventions for metacognitive deficits. Above all, interventions on social problems will be more successful if they are developed from the point of view of performance, the family, and the school, and introducing multimodal components of EF and ToM, given the relationships between these skills.AM, CB, BR, IB, and CC each made substantial contributions to the conception and design of the work, to the acquisition, analysis, or interpretation of data for the work, drafting the work or revising it critically for important intellectual content, final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.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.


Background: The article is devoted to an analysis of leisure-time (amateur) table tennis in Poland, its practitioners and the regularities of their activity. Methods: The study examined 12,406 persons in 4689 households (representative for the population). We used binary logistic regression and descriptive statistics in order to identify the patterns and determinants of table-tennis practice in Poland. Results: Table tennis is practised by 2.8% of population, and by 6.6% of physically active Poles. Among adults it is predominantly an occasional recreational game, not performed as a sport per se. Among children, it is often the part of physical education (PE) classes. Statistically significant predictors of contact with table tennis are: gender, age, income, place of residence, children in the household and being a student. Conclusions: Due to the undeniable benefits of table tennis , the sport is recommended for use as a tool in increasing the  physical activity of Poles. Its popularization requires promotion in the media  and using various channels, including public places, the workplace  and physical education classes at school. Sport is not a favourite leisure-time activity for adult Poles. Even though they declare insufficient time for relaxation 50%), they rarely turn to sport 7%). Non-working days are spent on watching TV 52%) or on passive relaxation (27%), but seldom on sports activities 11%) [1% [1]. A% or on p0%, they %. Non-woIn contrast to physical activity, passive watching sport on TV has many supporters. 70% of adult Poles were interested in the Rio Olympics , of whomStudies of table tennis are multifaceted. They have mostly focused on elite character of this sport and analysed physiological performance of athletes (energy expenditure during a training session or a match) ,14 and tIn this context, one can ask the reasonable question whether the desired increase in LTPA can come through table tennis. This measure should be taken under advisement. There is strong evidence that leisure-time table tennis training, with the potential for permanent implementation, is associated with beneficial effects on body composition and lipid profile in older male adults , that taBearing this context in mind, the aim of this study was to analyse participation of adult Poles in table tennis and factors that determine involvement in the sport in leisure time. We would like to identify people who tend to choose such an activity and what the patterns of the involvement in table tennis are among Poles. In our opinion, this knowledge can be critical to planning the strategies for promotion and popularization of the sport . It should become a basis for promoting and restoring interest in this sport, and as a result, may support increasing leisure-time physical activity in Poland. In this article we make use of the survey ‘Participation of Poles in sport and physical recreation 2012’ (‘Uczestnictwo Polaków w sporcie i rekreacji ruchowej w 2012 roku’). The survey was commissioned, designed and carried out by the Central Statistical Office of Poland . Its ID number is DS-52. This paper-and-pen interview (PAPI) was originally designed to analyse the participation in sport and physical recreation as an indicator of the quality of life of Poles. The primary objectives of this survey included the identification of: (1) preferred sport and physical recreation activities, (2) participation of individuals in them, (3) the level of skills, (4) reasons for activity and obstacles leading to inactivity, (5) household sports equipment and estimates of sport- and recreation-related expenditure. The survey analysed the abovementioned issues over the period of one year (October 2011–September 2012) and is representative for the entire population of Poland. In order to capture both household and individual perspectives, two questionnaires were used. The former (DS-52 G) covered the characteristics of the household, sports equipment and expenditures, physical condition of its members, as well as barriers to sport and physical recreation (if an insufficient level was declared). The latter, individual questionnaire (DS-52 I) was filled in by all household members, except for children aged 5–9, whose answers were provided by parents, and children below 5, for whom neither sport nor physical recreation was measured. Individual questionnaire included: skills, participation in training, description of the practice of selected disciplines, and motives for performing sport or physical recreation. Thirty-one (groups of) disciplines were distinguished, of which one was table tennis. Moreover, a wide range of demographic and socio-economic characteristics was captured: gender, age, marital status, education, income and its source, place of residence, size and structure of the household, socio-economic status, and labour market status.It was possible to gather this level of detail due to the fact that ‘Participation…’ is a spinoff survey of the Polish ‘Household Budget Survey’ . Originally, HBS used two sub-samples: one drawn in 2011 for 2012–2013 and another one drawn in 2010 for 2011–2012. The ‘Participation…’ survey uses only the latter sub-sample, namely the part surveyed for the last time in the third quarter of 2012. The sampling procedure in both surveys is based on a two-stage stratified sampling scheme with various probabilities of selection at stage one. At the first stage, the strata are field survey points representing six categories of place of residence, at the second-flats. The sampling frame is based on updated registers from the national census. The method of generalization includes the probability of choosing the household based on the two-stage stratified scheme described above and census-derived data on the household structure by size (post-stratification by multiplication of two weights). The standard error estimation utilized the balanced half-samples (BRR) method. For detailed information see . Patterns of activity). Moreover, as table-tennis rackets were put into one category with other types of rackets , we refrained from expenditure estimates. The sample characteristics are presented in the The sample in the ‘Participation…’ survey was 4689 households and 12,405 individuals, of which 4642 and 12,183 (respectively) answered all the questions. Two out of three interviews were carried out with the surveyed respondent, while for one-third they were substituted by a family member due to absence or other reasons. 5504 respondents (44.4%) declared performing LTPA, either on regular or sporadic basis. These people are further referred to as physically active. Out of the extensive questionnaire, and large sample, we made use of all aspects related to table tennis that are clearly distinguishable. Thus, 346 individuals declared that they practised table tennis during the year analysed . Several modules were subject to more in-depth analysis of 201 respondents  who decided to include table tennis as one of five chosen disciplines and elaborated more on their practice . However, as the criterion for choosing it was not clearly specified, we had to use these modules only for statistical purposes  to estimate the probability of practising table tennis within a year on the basis of demographic, socioeconomic and fitness predictors. The dependent variable equals 1 for individuals declaring that they practise table tennis within a year, and 0 otherwise . Independent variables include: gender (dummy variable), age , place of residence , natural logarithm of income per capita in a household ; the survey provides reliable and detailed information on objective income, refusals and missing values are non-existent; in the model we took the natural logarithm of the (income + 1 PLN) in order to reduce the variability of income. One PLN is added to avoid having zeros, since applying a logarithmic transformation would result in missing values then, while one PLN (approx. 0.25 EUR) is a negligible value in this context and all respondents had their incomes increased by one PLN equally), subjective financial situation of a household , studying (dummy variable), and number of children in a household . Due to the overrepresentation of children among table-tennis practitioners , adding labour market status did not improve the overall model fit—children aged 15 and below were not asked about their labour market status. p-value < 0.001), a default choice for logit models, and supplemented with post-estimation classification (64.51% correctly classified respondents). We assume Despite the large sample, the fraction of table-tennis practitioners is low. This makes quantitative analysis challenging, as small fractions usually impose several restrictions on the potential methods, especially due to computational problems. As logistic regressions are sensitive to small sub-samples and fractions (lack of convergence of maximum likelihood estimations), we implement a penalized maximum likelihood estimation method proposed by Firth  for redurthlogit  and firtrthlogit  STATA moIn the last year, the involvement in table tennis was declared by 2.8% of the Polish population, which accounts for 6.6% of all physically active. It is far below the data for the most popular activities, such as cycling (66.0%), swimming (39.9%) or football (20.3%). By contrast, the combined category of tennis, badminton and squash was performed by 9.3% of all physically active. In general, individuals practising table tennis have a higher propensity to all sports categories distinguished by the questionnaire, particularly team sports , as well as tennis and related sports (41.8%). The observed increase also refers to highly saturated disciplines, such as swimming (62.8%) and cycling (81.3%), as well as seasonal activity , and recreational games, such as bowling (6.5% vs. 30.0%). p-values < 0.001). The relationship with age is non-linear—to a first approximation, per each year the odds of practice increases, on average, by 7.9%. However, the effect is unevenly distributed between life stages—we found that it is decreasing . When comparing only the physically active, peak popularity of the discipline is noted between 10 and 19 years old (12%), between 20 and 45 it oscillates from 6 to 8% and decreases thereafter. Moreover, there is no clear age-related pattern to the gender gap (from 10.9 p.p. for men to 1.2 p.p. for women). Place of residence also visibly differentiates the likelihood of interest in the discipline—city dwellers (over 200 K inhabitants) are characterized by, ceteris paribus, 88–200% higher odds of practice than rural area dwellers, while for small town dwellers the odds do not exceed 3.5%. The categories of objective and subjective wealth provide some valuable insights: natural logarithm of per capita income (objectively measured) is statistically significant, doubling the income increases the odds of table tennis practice by roughly 13% . The subjective financial situation indicates that poor financial conditions visibly hinder the propensity to practise table tennis—for all other categories the odds are over twice or even thrice higher, all else equal. Studying (as a pupil or student) increases the odds of practice by three times. Large families (with at least three children) are characterised by 2.39 higher odds of participating in table tennis games, compared to households without children, while for families with a child or two the odds do not rise by more than 22.5%.According to the model estimates , demograp < 0.001) indicated their contact with the discipline as either occasional  or infrequent (max. once per month), with playing time in 83% of cases not exceeding 2 h. Table tennis games are rarely organized , even though the table is not basic household equipment (only 2.5% of households have one). At the same time, 56% of adult respondents have been practising table tennis for over 10 years, but the declared skills are described in 77% of cases as moderate. Among table tennis players, hedonistic motives for overall physical activity are even more frequent that in the general population (65.1% vs. 59.7%), while health issues are significantly underrepresented (7.3% vs. 13.8%). For individuals who decided to describe their table tennis practice in detail, 75%  than as a pure sports discipline. Several observations lead to this conclusion. Firstly, there is a significant overrepresentation of hedonistic motives among those considered as dominating ones in the sports practice in general . Unfortunately, the questionnaire cannot assign motives to each discipline practised by an individual (which would provide direct proof). Secondly, the table tennis practice is either occasional or infrequent and short per unit . Table tennis competitions are rarely organized, even though they take place in sport clubs, parks, etc. Consequently, even though the majority of adult respondents indicated that they had been practising table tennis for years, this does not translate into acquired skills.The fact that Poles consider table tennis a leisure-time sport can be an asset. Physically active Americans claim that it is necessary to experience some benefits in order to be convinced and start regular physical activity . Table tApart from its obvious health advantages ,60, flexThe advantages of table tennis have been appreciated by local authorities in England: the Outdoor Table Tennis Initiative (OTTI) implemented in London, as well as in other cities (the PING! project), aims at restoring egalitarian sports in their natural environment. In Poland only small-scale projects are undertaken, if at all, in locations such as playgrounds  or holidOur analysis provides a unique description of who practises table tennis in Poland and how. The survey we make use of is the largest quantitative database in this area representative for the Polish population. Despite these obvious advantages, we are fully aware of its limitations. First of all, the relatively low interest in sports disciplines means that less popular disciplines cannot be described precisely. Moreover, a comparison of the results of subsequent, more up-to-date, waves of this survey would be highly recommended.Our study showed that 2.8% of the Polish population  practised the sport at least once within a year. Among adults table tennis is predominantly performed as an occasional recreational game whereas among children, it is often the part of physical education (PE) classes. Due to its sports characteristics , there is space to make use of this sport as a tool to increase LTPA of Poles, which is very low. Pleasure, relax and emotions during recreational playing table tennis can be an initial point and provide an impulse for crossing the threshold of inactivity. The most important health gains come from moving from passive to low physical activity. In order to popularize the sport, actions should first include the purchase of tables as part of CSR measures, investments in tables in public places, better teacher training to incorporate table tennis in PE curricula and promotion of table tennis in media as a health-oriented sport.


The emergence of China’s Beidou, Europe’s Galileo and Russia’s GLONASS satellites has multiplied the number of ionospheric piercing points (IPP) offered by GPS alone. This provides great opportunities for deriving precise global ionospheric maps (GIMs) with high resolution to improve positioning accuracy and ionospheric monitoring capabilities. In this paper, the GIM is developed based on multi-GNSS  observations in the current multi-constellation condition. The performance and contribution of multi-GNSS for ionospheric modelling are carefully analysed and evaluated. Multi-GNSS observations of over 300 stations from the Multi-GNSS Experiment (MGEX) and International GNSS Service (IGS) networks for two months are processed. The results show that the multi-GNSS GIM products are better than those of GIM products based on GPS-only. Differential code biases (DCB) are by-products of the multi-GNSS ionosphere modelling, the corresponding standard deviations (STDs) are 0.06 ns, 0.10 ns, 0.18 ns and 0.15 ns for GPS, GLONASS, BeiDou and Galileo, respectively in satellite, and the STDs for the receiver are approximately 0.2~0.4 ns. The single-frequency precise point positioning (SF-PPP) results indicate that the ionospheric modelling accuracy of the proposed method based on multi-GNSS observations is better than that of the current dual-system GIM in specific areas. The ionosphere can be defined as the part of the upper atmosphere where the density of free electrons and ions is high enough to influence the propagation of electromagnetic radio frequency waves2345789http://www.gsa.europa.eu/galileo/programme). BeiDou is a new system that China started constructing in 2000. It has already provided positioning, navigation, and timing services for the entire Asia Pacific region since 2012, and the ultimate aim of BeiDou is to have the capability of global coverage with its unique constellation consisting of five GEO (Geostationary Earth Orbit), three IGSO (Inclined Geo-Synchronous Orbit), and 27 MEO (Medium Earth Orbit) satellites in 2020 (http://www.beidou.gov.cn). At present, there are more than 80 satellites in orbit. When the four systems are all in full operation, there will be nearly 120 satellites available. Meanwhile, IGS has established a new MGEX network to collect and analyse data from GPS, GLONASS, BeiDou and Galileo. This network currently includes about 140 monitoring ground stations. Other GPS networks will be upgraded to multi-GNSS observation networks in a few years24The Global Positioning System (GPS), which can provide global coverage with simultaneity, time continuity, low operating expense and high temporal resolution for the users, has become an effective tool which is widely used to continuously monitor the Earth’s ionosphere with high spatial and temporal resolution7111213141516111114192118Thanks to the development of BeiDou and Galileo, there are many recent studies of ionospheric modelling using GPS/BeiDou2616f2, where f is the carrier frequency, ignoring very small higher-order terms. For a dual-frequency GNSS receiver , taking the frequencies f1 and f2 as examples, the ionospheric delay measurement of the pseudorange code and carrier phase can be obtained as follows:Because the ionosphere is a dispersive medium, the ionospheric refraction depends on the frequency of the signal. To be more specific, the ionospheric refraction is proportional to1/j and r represent satellite and station, respectively; P and L are the pseudorange and carrier phase observations, respectively; TEC is the slant total electron content along the propagation path (in TECu); f1and f2 are the frequencies of the carrier phases of L1 and L2, respectively; Brand Bj stand for the receiver and satellite hardware delay of the pseudorange code (in m), respectively; br and bj are defined as the receiver and satellite hardware delay of the carrier phase (in m), respectively; N is carrier-phase ambiguity (in m).where The ionospheric observations can be obtained directly by pseudorange code or carrier phase measurement. However, because of the pseudorange measurement noise, the precision of the carrier phase is much higher than that of the pseudorange, but there is an ambiguity parameter in carrier phase measurements, which would cause high complexityThe ionospheric observables of multi-GNSS  can be obtained as follows:G, AC and AE represent the constants that are used to convert TEC (in TECu) to length (in m) for GPS, BeiDou and Galileo, respectively. j,G, Bj,R, Bj,C and Bj,E represent the DCB of jth satellite for different satellite systems, respectively.where G, AC and AE represent the constants that are used to convert TEC (in TECu) to length (in m) for GPS, BeiDou and Galileo, respectively. TEC, j,G, Bj,R, Bj,C and Bj,E represent unknowns.In equation (2), When all of the satellites in the four GNSS systems are observed, NG, NR, NC and NE are the total number of observed satellites of the GPS, GLONASS, BeiDou and Galileo systems, respectively.where To model the spatial distribution of TEC, the spherical harmonic expansion model based on the Single Layer Model (SLM) is used in this paperwhere φ and λ are the geomagnetic latitude and solar-fixed longitude of IPP, respectively; VTEC is the vertical ionospheric TEC at the IPP VTEC, which is converted from slant TEC using a mapping function; N is the max degree of the spherical function  observations, more than 300 stations  were selected. The station distribution is shown in The characteristics of IPP and the accuracy of ionospheric observables for GPS, GLONASS, BeiDou and Galileo are analysed in this section. The ionospheric observables are a sum of the true line-of-sight ionospheric slant total electron contents (STEC), DCB and other non-modelling errors, such as multipath. To clearly understand the magnitude of these errors, an experiment using the single-difference of ionospheric observables between two very close receivers  were performed by CiraoloTo assess the accuracy and reliability of ionospheric observations from the four systems, we selected a set of data over a short-baseline CUT2-CUTC  at Curtin University in Australia. To further evaluate the estimated VTEC products, we processed multi-constellation ionospheric observations over sixty days (DOY 141 to 200 in 2015) to produce 5° * 2.5° global ionosphere maps at the School of Geodesy and Geomatics (SGG) of Wuhan University. This section mainly demonstrates the performance of SGG’s multi-GNSS GIM products and the model differences between SGG, JPL, UPC, ESA and CODE. The results are shown in The statistical VTEC differences with respect to CODE during DOY 141 to 200, 2015 are presented in To further validate the estimated ionosphere products from multi-GNSS observations, we perform a kinematic single-frequency precise point positioning (SF-PPP) test using 41 global distributed stations. These stations are excluded in the GIM calculation. The average RMS of 41 stations for the north, east and up directions from DOY 141 to DOY 200 2015 are shown in DCB is the difference of the instrumental delays  between two signals. Because DCB couples with the TEC, its accuracy and stability greatly affect the accuracy of estimated TEC. Therefore, DCB can be used for evaluating the accuracy of the ionospheric model. In this section, the variation characteristics of DCB in satellite and receiver for different GNSS systems are compared and assessed.et al.29The daily DCB estimates of GPS, GLONASS, Galileo and BeiDou during the period from DOY 140 to 200, 2015 are shown in The comparison of the estimated satellite DCB with CODE/IGG products during the study period are presented in The STD of receiver DCBs of 18 four-system MGEX stations are shown in In this paper, the global ionosphere map based on multi-GNSS observations was produced, and its modelling method was also described. By using 60 days of data  from the MGEX and IGS networks, we first analysed and compared the IPP distribution and accuracy of the ionospheric observables obtained from different systems. The accuracy and reliability of the estimated multi-GNSS ionosphere map and its by-product of DCB estimates were then assessed and analysed with respect to solutions from other institutions .The results showed that the IPP distributions of GPS and GLONASS have a good global coverage. However, the IPP distributions with only observations from the BeiDou and Galileo systems, the distributions are uneven and mainly cover specific regions because of the limited numbers of satellites and stations. Despite all of this, the total number and spatial resolution of IPP are still improved to some extent. The accuracy of GPS ionospheric observables is the best while the accuracy with only BeiDou is much poorer than GPS and GLONASS. The DCB estimates of GPS, GLONASS, BeiDou and Galileo have good stability for both satellite and receiver DCBs, where the stability of GPS DCB is the best. The STD values for GPS, GLONASS, BeiDou and Galileo DCB are approximately 0.06 ns, 0.10 ns, 0.18 ns and 0.15 ns in satellite, respectively, and the corresponding STD values are all approximately 0.2~0.4 ns in the receiver, which is consistent with the DCB products of CODE/IGG. For the ionospheric model, the results show that our ionosphere products based on multi-GNSS observations are in good agreement with other institutions’ products based on GPS-only or GPS + GLONASS observations. The SF-PPP results indicate that the ionospheric modelling accuracy of the four-system is better than that based on single or dual systems. With the increased numbers of BeiDou and Galileo satellites and the upgrading of the IGS tracking networks, they are expected to further increase the capacity of ionosphere monitoring.How to cite this article: Ren, X. et al. Global Ionospheric Modelling using Multi-GNSS: BeiDou, Galileo, GLONASS and GPS. Sci. Rep.6, 33499; doi: 10.1038/srep33499 (2016).


Pinus massoniana Lamb), as well as ensure effective development of Masson’s pine needles as a medicinal agent, we investigated the spatial distribution of habitat suitability and evaluated the optimal ranges of ecological factors of P. massoniana with 280 samples collected from 12 provinces in China through the evaluation of four constituents known to be effective medicinally. The results of habitat suitability evaluation were also verified by Root Mean Square Error (RMSE). Finally, five ecological factors were chosen in the establishment of a habitat suitability evaluation system. The most suitable areas for P. massoniana growth were mainly concentrated in the middle and lower reaches of the Yangtze River basin, such as Sichuan, Guizhou, and Jiangxi provinces, while the best quality needles were from Guizhou, Sichuan, and the junction area of Chongqing, Hunan, and Hubei provinces. This information revealed that suitable areas for effective constituent accumulation of Masson’s pine needles accounted for only 7.41% of its distribution area.Pine needles have been widely used in the development of anti-hypertensive and anti-hyperlipidemic agents and health food. However, the widespread distribution of this tree poses great obstacles to the quality control and efficacy evaluation. To facilitate the effective and rational exploitation of Masson’s pine ( Pinus massoniana Lamb), in the family Pinaceae, is a traditional herbal medicine first recorded in Collective Notes to the Canon of Materia Medica3457in vivo10in vivo inhibitory effects of platelet aggregation1213Masson’s pine needle, leaf of Masson’s pine  was 69.7%, much higher than precipitation (precipitation in April and June combined), which was 17.3%, suggesting temperature is the most important factor in accumulation of the aggregative indicators in P. massoniana.Contributions of the evaluated ecological factors, as shown in P. massoniana, as shown in P. massoniana production, and that the area of suitable habitat allowing for the aggregative indicator  accounts for only 7.41% of the area where P. massoniana is distributed in China, as shown in The results of the quality suitability analysis, as shown in The RMSE value of the model for habitat suitability analysis was 0.1329, indicating feasibility of the model.P. massoniana is widely distributed in sub-tropical areas in China. Its northern range is from Henan and the southern part of Shandong to Guangdong, Guangxi, and Taiwan in the south. It is found throughout eastern coastal areas of China to central Sichuan and Guizhou, and is abundant in middle and lower reaches of Yangtze River1920P. massoniana18P. massoniana is currently distributed in China, with areas in Guizhou and Sichuan provinces being some of the most suitable habitats. The prediction results also suggested the area suitable both for P. massoniana growth and high-quality needle production was not large. Therefore, with the development of Masson’s pine needles for medical use, along with use of the wood for other economically valuable products, it appears to be problematic to ensure the sustainable utilization of P. massoniana.P. massoniana cultivation.Newly emerging studies on habitat suitability analysis and quality prediction under different geographical conditions for medicinal plants mostly use one method, such as the mathematical method, model of induction, and maximum entropy model for analysis. This study was the first to combine several methods effectively to investigate the spatial distribution of habitat suitability, avoided the inherent problems of using a single method, and the result can provide a reference for the selection of suitable areas for P. massoniana, nature reserves in suitable habitats should be established2324It has been suggested that for the sustainable utilization of P. massoniana is distributed in China, including the provinces of: Guizhou, Hunan, Guangxi, Fujian, Hubei, Guangdong, Sichuan, Zhejiang, Henan, Jiangxi, Chongqing, and Anhui.Masson’s pine needles were collected from all 12 provinces where On site sampling was conducted at 140 sites and 280 fresh pine needle samples were collected, the sampling distribution is shown in http://www.tcm-resources.com/) were selected as candidates including 43 climate factors , 8 soil factors, 3 topographic factors , and vegetative covers. The most influential factors were chosen out of 55 ecological factors using a maximum entropy model for the establishment of habitat suitability evaluation system.Climate, soils, topography, and vegetative covers are 4 major classes of ecological factors that influence plant growth27In order to decide which functions to use, function selection was based on the specific relationship between the contents of constituents and ecological factors; characters of the subject and the functions; and first curve fitting between the contents of constituents. Finally, values in the functions were worked out with MATLAB. Using this method, the content of constituents and the ecological factors were established. Then a suitability value ranging from 0 to 1 was defined for each ecological factor based on function. In a Fuzzy set, 0 means a certain element has absolutely no function to a Fuzzy set (unsuitable), 1 means a certain element completely belongs to a Fuzzy set (entirely suitable). 0 means the ecological factor is completely unsuitable for its growth, while 1 means the ecological factor is completely suitable for its growth, and a value between 0 and 1 represents partial suitability293031The selection of functions and parameter estimates of the ecological factors were conducted by a curve fitting from 5 available candidates shown below (1–5). The ecological factors were standardized by choosing K-t function (i.e. function 1) according to the curve fittinga, b, c, d, α, β and K represent the a, b, c, d, α, β and K in K-t function, respectively.P. massoniana, thus expertise in this subject is insufficient. Therefore, weighing coefficients were evaluated by the maximum entropy model in objective weight method.Habitat suitability can be evaluated by many approaches, e.g. analytic hierarchy processUsing RMSE to test the results of habitat suitability evaluation30383940Based on weighing of each evaluation factor, diagram layers of evaluation factors were calculated by a weighted mean and grid computing in ArcGIS, grid size was set as the maxim value of input grids. A spatial distribution diagram of habitat suitability with grid size of 1 km × 1 km was generated by computation. The superposition of the diagram and the coniferous forest cover type was made in order to eliminate unsuitable land-cover types including farmland, rivers, lakes, urban ares, etc., and to yield the final version of spatial distribution diagram of habitat suitabilityHow to cite this article: Zhou, X. et al. Regionalization of Habitat Suitability of Masson’s Pine based on geographic information system and Fuzzy Matter-Element Model. Sci. Rep.6, 34716; doi: 10.1038/srep34716 (2016).


Nowadays there is increasing interest in identifying–and using–metabolites that can be employed as biomarkers for diagnosing, treating and monitoring diseases. Saliva and NMR have been widely used for this purpose as they are fast and inexpensive methods. This case-control study aimed to find biomarkers that could be related to glioblastoma (GBL) and periodontal disease (PD) and studied a possible association between GBL and periodontal status. The participants numbered 130, of whom 10 were diagnosed with GBL and were assigned to the cases group, while the remaining 120 did not present any pathology and were assigned to the control group. On one hand, significantly increased (p < 0.05) metabolites were found in GBL group: leucine, valine, isoleucine, propionate, alanine, acetate, ethanolamine and sucrose. Moreover, a good tendency to separation between the two groups was observed on the scatterplot of the NMR. On the other hand, the distribution of the groups attending to the periodontal status was very similar and we didn´t find any association between GBL and periodontal status . Subsequently, the sample as a whole  was divided into three groups by periodontal status in order to identify biomarkers for PD. Group 1 was composed of periodontally healthy individuals, group 2 had gingivitis or early periodontitis and group 3 had moderate to advanced periodontitis. On comparing periodontal status, a significant increase (p < 0.05) in certain metabolites was observed. These findings along with previous reports suggest that these could be used as biomarkers of a PD: caproate, isocaproate+butyrate, isovalerate, isopropanol+methanol, 4 aminobutyrate, choline, sucrose, sucrose-glucose-lysine, lactate-proline, lactate and proline. The scatter plot showed a good tendency to wards separation between group 1 and 3. NMR spectroscopy analysis provides information on both the structure and the composition of low-molecular-mass metabolites in biological fluids and is a rapid and low-cost technique for exploring pathological metabolic processes. The major advantages of NMR spectroscopy include its unbiased metabolite detection, quantitative nature, and high reproducibility. NMR-based metabolomics could be appropriate as a cost-effective solution for high throughput analysis . Saliva Glioblastoma (GBL) (2016 WHO classification of CNS tumors) is one of the most lethal primary malignant tumors of the central nervous system, as the mean survival is under 15 months and the five-year rate is under 10%. The risk factors for GBL are unknown, although constant exposure to ionizing radiation or chemical agents can increase its development. GBL is mainly diagnosed at advanced ages, with a mean age on diagnosis of 64 years [Chronic periodontitis (CP) is an inflammatory disorder characterized by the progressive and irreversible destruction of the tissues surrounding the tooth. It affects approximately 50% of the adult population and its incidence and severity increase with age, reaching a prevalence of 70% of over-65 years-old in the USA , and pro1H NMR to identify whether saliva contained greater concentrations of any particular metabolites which could serve as biomarkers for diagnosing and monitoring GBL and PD and to study a posible association between both diseases.The aim of this study was to use This case-control study was approved by the Ethics Committee of the Hospital Clínico Universitario of Valencia, Spain  in accordance with the Declaration of Helsinki of 1964 and subsequent amendments by the World Medical Association. The case group comprised hospitalized patients with brain tumors awaiting surgery in the neurosurgery unit of this hospital. Following the operation, the suspected diagnosis was confirmed. The control group was composed of patients from the University of Valencia dental clinic. Oral examination and saliva sampling were performed in both groups.All the participants of legal age (18 years or over) were given an informed consent document with all the information concerning the study, to be signed voluntarily before taking part. For the control group, those who had taken antibiotics in the past six months, had fewer than eight teeth (excluding third molars), were pregnant or, in general, presented any condition that could lead to error like cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, chronic obstructive pulmonary disease, pneumonia, chronic kidney disease, metabolic syndrome, obesity and Alzheimer´s disease, were excluded from the study . The casSaliva samples were obtained in the early morning to avoid the introduction of exogenous agents into the oral samples. The participants had not ingested any food, or chewed gum, or brushed their teeth or used any oral hygiene product in the two hours before the sample was taken, and had not smoken for at least one hour before. To collect the saliva samples, we used the “draining method”: the participants were seated comfortably for a few minutes in a resting position with their heads tilted slightly forward, in a quiet environment to avoid non-test stimuli. The slightly parted lips allowed the saliva to fall into a wide-necked sterile container. The liquid collected was then transferred with a pipette to a sterile 1.5 mL Eppendorf tube and was frozen immediately at -80°C until the NMR measurements were made ,20.http://www.hmdb.ca) and the Chenomx spectral database contained in Chenomix NMR Suite 8.1 .The data acquisition and processing were conducted as previously described by Galbis-Estrada et al. . Forty-eChemometrics statistical analyses were performed using in-house MATLAB scripts and the PLS Toolbox 6.7 . Metabolite levels were computed from the raw (untransformed) data and expressed as mean ± SD (standard deviation). T-Student’s test was used to determine the statistical significance of differences between the means in both of the cases, and the control group and ANOVA to estimate the differences between the three categories of periodontal status. A chi- squared was used for comparative proportions. The significance level was p < 0.05. Principal component analysis (PCA) and projection to latent structures for discriminant analysis (PLS-DA) were applied to the NMR spectral datasets. Results were cross-validated using the leave-one-out to evaluate the accuracy of each classification model ; in eachTen participants met the requirements for assigning the case group. This was performed by 1 male (10%) and 9 females (90%) in which the average age was 54.7 years old, range 26–78. In contrast, the control group comprised 120 participants of whom 49 were males (40.8%) and 71 were females . The average age was 51.8 years old, range 19–81 .http://www.hmdb.ca) and the Chenomx spectral database contained in Chenomix NMR Suite 8.1 sofware . The databases compare metabolites together with their respective concentrations based on a known reference signal, in this study we used TSP, 32 mM. A sample 1H NMR spectrum of saliva from a participant is shown in The identification and quantification of the saliva metabolite concentrations were made using the Human Metabolome Database , a total of 39 subjects were placed in group 1 , 59 in group 2 (gingivitis/early periodontitis) and 32 in group 3 (moderate/advanced periodontitis). A total of 68 metabolites were assigned, quantified and included at an ANOVA test . On compNumerous metabolites have been proposed for diagnosing, monitoring and treating inflammatory diseases. Identification and quatification leves of N-acetyl aspartate (NAA), choline, glutamate, glutamine, lactate, alanine, glucose, inositol, creatinine and lipids have been useful in previous studies to separate glial tumors by type and grade, and determine the choice of therapy and treatment efficacy to evaluate the progression or remission of GBL –25. The Short chain fatty acids such as butyrate, caproate, isocaproate, propionate, isovalerate and lactate play an important role in periodontal disorders. They are end-products of bacterial metabolism and have been strongly linked to deep periodontal pockets, loss of insertion, bleeding and inflammation. The acids prevent cell division, making repair difficult and favoring junctional epithelium degeneration processes, which in turn allows the entry of pathogens and the formation of periodontal pockets. These bacterial metabolites stimulate an inflammatory response and the liberation of cytokines. At cell level, they inhibit leukocyte apoptosis and cell proliferation in the gingival epithelium and endothelium, preventing their repair. . As has 1H NMR or LS-MS to identify metabolites related with PD, collect and analyze saliva samples seems to be a good and useful method to follow-up different diseases due to the fact that it is an easy, fast and non-invasive option, and its results are similar to those obtained from serum analysis or tissue cells cultures. There are a lack of studies in screening saliva to find biomarkers of GBL. In this study, we used 1H NMR but other complementary analytical platforms from the same sample, as such Mass Spectrometry, would be necessary to conclude if saliva could be used in the screening of GBL.The present study found significant differences in some metabolites in saliva of GBL and PD patients but any association between GBM and periodontal status was found. Sucrose and propionate in GBL patients and caproate, isocaproate-butyrate, isovalerate, lacatate+proline and proline in PD patients, were very significantly increased . Previous studies have analyzed saliva using S1 TableThe statistically significant ones are marked * p < 0.05 and ** p < 0.01.(DOCX)Click here for additional data file.S2 TableThe statistically significant ones are marked * p < 0.05 and ** p < 0.01.(DOCX)Click here for additional data file.


P < 0.01) and had fewer number of remaining teeth (P < 0.05) and impaired chewing ability (P < 0.05). These results demonstrate a significant link between the number of teeth, chewing ability, and cognitive function. However, this pilot study had its limitations and was the first of its kind in the UAE and Gulf region; therefore, future research addressing the limitations is needed to further explore this association.Cognitive decline is one of the major causes of disability among the aging population. The aim of this study was to explore the relationship between oral health parameters  and cognitive function in the elderly across the UAE. Fifty persons  were enrolled in the study. Cognitive status was assessed using the standardized mini-mental state examination (SMMSE) and accordingly, cognitively normal subjects scoring ≥24 were considered as the control group and cognitively impaired individuals scoring ≤23 were considered as the low scoring group. Chewing ability was examined, number of teeth was noted, and demographical data was collected. The results of this pilot study showed that individuals with low SMMSE scores were significantly less educated ( On a global scale, according to the United Nations, by mid-century, the number of people over 60 years will represent 32% of the world population . ConsideDementia, a neurocognitive disorder, is a broad term used to describe a range of symptoms associated with a decline in cognitive function and is one of the most common age-associated diseases. It is characterized by memory loss, neurological symptoms, disorientation, impaired judgement, personality changes, and loss of motor function . DiagnosAmong the literature, links have been established between certain systemic factors such as diabetes , 7 and cTo the best of our knowledge, no similar studies have been conducted within the Middle East or Gulf region. Therefore, the objectives of this pilot study are to (1) examine the relationship between the number of remaining teeth and cognitive ability, (2) examine the relationship between chewing status and cognitive ability, (3) examine the relationship between the presence of a denture and cognitive ability, and (4) test whether other demographic characteristics may be related to cognitive function.The Medical Ethics Committee of the University of Sharjah, UAE, approved data collection for this study. The sample consisted of 50 participants, 25 males and 25 females, all 60 years and above within the UAE. Written informed consent was obtained from each of the participants prior to their involvement in the study. The exclusion criteria included any disorders interfering with psychometric assessment such as severe blindness or terminal illness and/or conditions such as depression or history of cerebrovascular accident.The Standardized Mini-Mental State Examination test (SMMSE)  was tran the Index of Chewing Ability (ICA) [Three parameters were explored and data was collected for each participant, number of teeth present, presence/absence of denture, and chewing ability usingty (ICA)  which waQuestionnaires were administered through interviews to collect the data. Demographic variables , lifestyle variables (smoking status), and the presence of chronic medical diseases such as cancer, cerebrovascular disease, myocardial infarction, diabetes mellitus, and hypertension were noted.t-tests and the chi-square test. The Pearson correlation was conducted to analyse correlations between cognitive impairment, dental health status, chewing ability, and denture presence. Two-tailed P values were calculated in all the analyses. Differences were considered statistically significant at P < 0.05.Statistical analyses were performed using SPSS® Ver. 24.0 for Mac OS X. Clinical variables were analysed using independent n = 31 or SMMSE ≥ 24, n = 19; control). The subjects were divided into two groups according to their SMMSE scores . The prevalence of low SMMSE score was 86.4% in subjects with 0–10 remaining teeth, 54.5% in those with 11–21 teeth remaining, and 35.3% in those with 22–32 remaining teeth.r = 0.320, P < 0.05). The prevalence of low SMMSE score was 45.8% in persons with competent chewing ability and 76.9% in those with impaired chewing ability.This cross-sectional pilot study was designed to explore the relationship between number of remaining teeth, chewing ability, denture presence, and cognitive function in an elderly UAE population.P < 0.05)  . These r . These P < 0.05)  . With thAlthough a lower number of remaining teeth and decreased chewing ability were significantly correlated with lower SMMSE scores, it must be noted that individuals from the elderly population usually present with other risk factors which may have affected their cognitive function. Hence, the decreased number of remaining teeth and impaired chewing ability may not alone lead to cognitive decline but may be markers of comorbidities , 61.P > 0.05), which may be justified by the insignificant number of denture wearing individuals within the study sample.In this pilot study, no significant relationship was found between denture presence and cognitive function (P > 0.05), which may be related to the nationals' difficulty in accessing schools until the late 1950's [A significant difference in SMMSE scores was noted between nationals and expatriates (e 1950's .P < 0.05). These results are in accordance with the cognitive reserve hypothesis, which assumes some aspects of life experiences such as education and knowledge act as markers of cognitive reserve and protect against age-associated cognitive decline in later life [Education was significantly correlated with higher SMMSE scores (ter life .Limitations of the present study merit consideration. The primary limitation arises due to the nature of cross-sectional study; hence a casual inference is difficult to make regarding the relationship between teeth remaining, chewing ability, denture presence, and poor cognitive function. Future studies with longitudinal designs would help investigate these associations. Additionally, cognitive function was assessed using only the SMMSE and although it is the most widely used means for examining cognitive function, the education level of an individual may influence it. Finally, due to the small sample size and since most of the participants were volunteers residing in elderly homes, the results of this pilot study may not represent the general population.In conclusion, this pilot study revealed a significant finding whereby persons with fewer number of remaining teeth and impaired chewing ability demonstrated poor cognitive ability. The results draw attention to the possible role a person's oral health may play on their cognitive function. However, the interpretation of the results was hindered by the lack of longitudinal observation and the use of a single examination for cognitive function. Therefore, future research investigating the associations is required and the limitations need to be addressed.


The development of sepsis after abdominal surgery is associated with high morbidity and mortality. Due to inflammation, it may be difficult to diagnose infection when it occurs, but measurement of C-reactive protein could facilitate this diagnosis. In the present study, we evaluated the predictive value and time course of C-reactive protein in relation to outcome in patients admitted to the intensive care unit (ICU) after abdominal surgery.We included patients admitted to the ICU after abdominal surgery over a period of two years. The patients were divided into two groups according to their outcome: favorable  and unfavorable . We then compared the highest C-reactive protein level on the first day of admission between the two groups.A total of 308 patients were included: 86 patients had an unfavorable outcome (group D) and 222 had a favorable outcome (group F). The groups were similar in terms of leukocytosis, neutrophilia, and platelet count. C-reactive protein was significantly higher at admission in group D and was the best predictor of an unfavorable outcome, with a sensitivity of 74% and a specificity of 72% for a threshold of 41 mg/L. No changes in C-reactive protein, as assessed based on the delta C-reactive protein, especially at days 4 and 5, were associated with a poor prognosis.A C-reactive protein cut-off of 41 mg/L during the first day of ICU admission after abdominal surgery was a predictor of an adverse outcome. However, no changes in the C-reactive protein concentration, especially by day 4 or 5, could identify patients at risk of death. Sepsis, defined as a clinically suspected or proven infection associated with an inadequate systemic immune response, is characterized by hemodynamic, metabolic, and both pro- and anti-inflammatory derangements. In less severe cases, these derangements are defined as non-specific signs . More severe cases, with dysfunction of at least one organ, are called severe sepsis or are termed septic shock if there is associated hypotension requiring vasopressor therapy to maintain the mean blood pressure at 65 mmHg or greater and if the serum lactate level is greater than 2 mmol/L Considerable effort is being placed on identifying biomarkers that can be used to detect sepsis in an early and reversible phase to decrease mortality from this disease 2=92%), limiting understanding of the contribution of CRP to prognosis Despite its routine clinical use, few studies have examined the CRP concentration as a biomarker of infection in critically ill patients, and the results have not been consistent. In a recent review of studies performed in critically ill patients, Lelubre et al. The development of sepsis in critically ill patients after abdominal surgery, even if scheduled surgery, is associated with high morbidity and mortality This study was conducted in the 36-bed medicosurgical ICU of CHU-Charleroi, Belgium. We retrieved data for all adult (≥18 years) patients admitted to the ICU after major abdominal surgery between January 1, 2011, and December 31, 2012. Patients without complete biological or clinical data were excluded. The local ethical committee approved the study but waived the need for informed consent because of the retrospective nature of the study.2/FiO2, and diuresis. For each day during the ICU stay, we retrieved the platelet, white blood cell and neutrophil counts and the hemoglobin, fibrinogen, urea, creatinine, bilirubin, lactate and serum CRP concentrations. We calculated the delta CRP concentration as the highest value of CRP on a particular day minus the CRP concentration on the day of admission. Any antibiotherapy administered during the ICU stay was noted.Demographic data at admission were recorded, including age, sex, height, weight, type of abdominal surgery, timing of surgery (scheduled or emergency), APACHE II Hemodynamic management of these septic patients was in agreement with the Surviving Sepsis Campaign recommendations We defined a patient with a favorable ICU outcome as a patient who was discharged alive from the ICU, without modification of antibiotherapy. In contrast, an unfavorable outcome was defined as requiring a modification of antibiotherapy during the ICU stay, a new abdominal surgical intervention for uncontrolled sepsis with or without modification of the initial antibiotic regimen, or ICU death.®). The data are presented as the median +/- IQR or the count (percentage), unless stated otherwise. All tests were two sided, and a p-value<0.05 was considered statistically significant. Comparisons between groups were performed using a Mann-Whitney test for continuous variables or Fisher’s exact test for dichotomous variables.Statistical analyses were performed using XLSTAT2013  were admitted after major abdominal surgery. After exclusion of 25 patients because of a lack of data (particularly no measurements of CRP concentrations), the final analysis included 308 patients .The patient’s characteristics are summarized in p<0.0001).We compared, on ICU admission, patients admitted for scheduled or emergency surgery. The patient’s characteristics are summarized in vs 7 deaths, p=0.001). Empirical antibiotherapy was altered during the ICU stay for 37 patients , and 24 patients  needed a new abdominal surgical intervention with or without modification of their antibiotic regimen during their ICU stay  had a favorable outcome . Among tICU stay .vs 0.20 [0.12-0.29] mcg/kg/h for patients with a favorable outcome, p=0.024) and were more likely to have pulmonary  or renal  organ dysfunction and lower urinary output  on the first ICU day. Lactate concentrations were also more elevated in the patients with an unfavorable outcome .We observed a weak correlation between ICU SOFA scores and CRP concentrations only in the group with an unfavorable outcome . In contrast, leukocytosis , neutrophilia  and temperature  did not have significant predictive value  and day 5/day 0 (p=0.05) between patients who only had modification of their antibiotic regiment and patients who died  . There wwho died .Sepsis complicating major abdominal surgery is associated with high morbidity and mortality In this study, we showed that CRP concentrations during the first ICU day were a good marker of outcome. In particular, a value greater than 41 mg/L had high specificity for an unfavorable outcome. Moreover, the time course of the CRP concentration, as assessed based on the delta CRP, differentiated between patients who died and those who only needed a change in their antibiotic treatment.These findings have already been reported for ICU patients, and notably patients with community- or ventilator-acquired pneumonia Regarding ICU patients after abdominal surgery, the number of studies is limited. Indeed, Schmit and Vincent p=0.028). Nevertheless, an increase in the CRP level did not lead to higher odds of complications , even after adjustment for the SOFA score . Hence, the authors concluded that an increase in the CRP concentration was a poor marker of complications in surgical patients. There are several differences between our study and the study by Meyer et al. In a prospective, monocentric observational study that included 174 surgical patients, Meyer et al. Our study also has certain limitations. First, we excluded 25 patients (2%) from the final analysis due to a lack of data; this was necessary because of the retrospective nature of the study. Although a prospective study design would have prevented this issue, the percentage of patients excluded was still low. Similarly, the absence of a fixed rule for ICU admission of these patients may have biased the results. Nevertheless, the relatively long study period of 2 years should have limited the potential effects of periods of lower or higher ICU admission rates. Second, the group of patients with an unfavorable outcome was heterogeneous , although we analyzed these subgroups separately to determine the delta concentrations . HoweverFifth, given the design of the study , we cannot exclude the possibility that the judgment of the clinicians was influenced by the CRP values, including their decision to change the antibiotic regimen or to perform new surgery or drainage. Sixth, due to the retrospective design of our study, we used the definition of SIRS, rather than the new definition of sepsis In conclusion, a CRP threshold of 41 mg/L during the first day of ICU admission after major abdominal surgery is a good predictor of an unfavorable outcome. However, no changes in the CRP concentration over time (delta CRP), especially at day 4 or 5, can help to identify patients at risk of death.Sapin F and Piagnerelli M were in charge of data collection. Sapin F, Biston P and Piagnerelli M collaborated on the data analysis. All of the authors participated in the study design, study coordination and drafting of the manuscript.


The aim of this article is to assess prevalence, awareness, treatment and control of hypertension in rural Senegal (Sahelian Ferlo region).This study was carried out in 2015 on a population sample of 500 individuals living in the municipality of Tessekere, constructed using the quota method. Sociodemographic characteristics, hypertension, hypertension awareness, treatment and control, and body mass index of individuals were collected during face-to-face interviews. Statistical analyses used were Chi-square tests and binary logistic regressions.Prevalence of hypertension was 31.40%. Prevalence of awareness, treatment and control among hypertensives, were 43.31%, 24.84% and 11.46% respectively. Logistic regression showed that the prevalence and awareness of hypertension increased with age. Overweight and obese subjects were more often hypertensive, but did not differ from others in awareness and treatment.Given the very high prevalence of hypertension in the region, a strategic approach to prevent and control hypertension is critically needed. Epidemiological transition in Sub-Saharan Africa (SSA) began several years ago and is currently underway in Senegal. This transition, together with demographic transition, are the two major determinants of the increased burden of non-communicable diseases (NCD) in SSA , 2. ClosMuch of the primary literature on NCD risk factors is based on studies conducted in economically advanced countries or among urban sedentary populations in Africa . Few pubFurthermore, in SSA, despite the increasing prevalence of hypertension, rates of awareness, treatment and control remain low , 12–14. In order to carry out this study, a comprehensive survey was conducted from February to August 2015 in the municipality of Tessekere . In 2015, according to Senegal’s National Agency for Statistics and Demography (ANSD), a total of 8,999 individuals were living in Tessekere municipality . The popSociodemographic variables: the socioeconomic and demographic variables collected were: age (20-29 /30-39 /40-49 /50 and over); gender ; education level; defined in accordance with the educational system in Senegal; (0/1-5/6-9/10-12/over 12 years of school).The selection of variables for the current analysis was hypothesis-driven based on previous literature on blood pressure awareness, treatment, and control in Africa. Biological Health Variables: the biological health variables collected were:®, s’Hertogenbosch, Netherlands) to take the participants’ blood pressure. Measurements were made on the upper right arm using an appropriate sized cuff while the participant was sitting and had rested for five minutes. Three readings were taken during the interview. The first was discarded, and the mean of the last two readings were used in the analysis. The first measurement was taken on both arms to detect a difference in blood pressure between arms. Hypertension was defined as a systolic BP ? 140 mmHg and/or a diastolic BP ? 90 mmHg or reported treatment for hypertension.26 Awareness of hypertension was defined as any self-reported prior diagnosis of hypertension by a health care professional among the population defined as having hypertension. Hypertensive aware participants were classified as being on treatment if they reported current use of drugs prescribed by a health professional which they had taken within the past two weeks prior to the study. Control was defined as the proportion of the sample on antihypertensive therapy with BP <140/90mmHg.Blood pressure (BP): we used an OMRON M5-I digital automatic blood pressure monitor  (measurement accuracy of 100g). To measure height, we used a Stature (Height) Measuring Stand . Following World Health Organization recommendations, body mass index (BMI) was calculated by dividing weight (kg) by the square of the height (m²). Overweight was defined as 25 ? BMI < 30; obesity corresponded to a BMI of ? 30; underweight to a BMI of <18.5.Body Mass Index: anthropometric measurements were obtained with the participant in the standing position, wearing light clothing and no footwear. Weight was measured using a digital scale (SoehnleData was entered in Excel (2013), cleaned and exported to SPSS (v. 20) for analysis. The proportion of the study subjects with hypertension, subjects who were aware of their condition and who were receiving treatment was determined by sex, age group, education level and body mass index. Crude differences in these proportions across participant characteristics were determined using ?² tests. A logistic regression was then conducted to identify independent factors associated with prevalence, awareness, and treatment of hypertension. These were reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs) of hypertension prevalence, awareness and treatment (as dependent variables) after adjustment for age, sex, education level and body mass index (as independent variables). All analyses were performed using SPSS software, version 20. A p-value of < 0.05 was considered statistically significant.Characteristics of the study sample In our 2015 survey, more than 60% of the participants were aged < 40 years. Forty-eight percent of the participants had no formal education and < 2 % had attended university (i.e. > 12 years).2 = 1.656; p = 0.198)  and among the older age brackets . In the general population, hypertension is significantly related to body mass index . In men, hypertension is only related to age  and body mass index , whereas in women, only age is significantly associated to hypertension  . Prevalence of hypertension does not differ by gender (Chi= 0.198) . However< 0.001) .2 = 11.015; p = 0.001), among women  and among overweight and obese subjects . No difference in hypertension awareness by education level was noticed  . The general rate of awareness is higher after 50 years of age (Chi= 0.288) .2 = 5.221; p = 0.022). However, no difference in hypertension treatment by age, body mass index and education level was noticed  (= 0.705) .Lastly, almost half of treated hypertensives fulfilled criteria for control, corresponding to a prevalence of control among all of the hypertensives of 11.46% (95% CI: 6.48% to 16.44%). Unfortunately, the small number of individuals with controlled BP prevented us from testing the effect of sociodemographic variables and BMI on hypertension control. The previously identified relationship between hypertension prevalence, awareness and treatment and sociodemographic variables or BMI was tested by binary logistic regression. The results of the binary logistic regressions are presented in Results show that actually only age and BMI were associated with hypertension prevalence. People aged 50 years old or more were more likely to have hypertension, as well as overweight or obese people . After a“About 30% of hypertension is attributable to increased salt consumption and about 20% is attributable to low dietary potassium ” and “High dietary salt is especially important in Sub Saharan Africa, as black populations are more salt sensitive, i.e., sensitive to the BP-increasing impact of sodium.”Our study is the first to address the prevalence, awareness and control of hypertension on a representative sample of Tessekere’s population. We observed a very high prevalence of hypertension. More than one-third of Tessekere adults aged 20 years and more were hypertensive, and despite the limitations of direct comparison due to methodological heterogeneity, the prevalence observed in this rural Senegalese setting is high, in the upper range of prevalence rates detected in Sub-Saharan Africa , 19. Hig2 tests, was no longer a risk factor for hypertension in logistic regression. This could be explained by the direct link between age and education level, older Tessekere inhabitants being more illiterate than younger ones.The Fulani populations in Senegal’s Ferlo region consume few fruits and vegetables. These factors may explain the high prevalence of hypertension among this population. As observed elsewhere, and notably in Dakar, the prevalence of hypertension increases with age , 21–23 aFurthermore, the prevalence of awareness is higher than in other parts of sub-Saharan Africa, with only 56.69% of individuals unaware of their status, a result that approaches the findings obtained in Nigeria by Karaye et al.  in a FulFurthermore, in this study, among hypertensives, nearly one in four people are treated. This treatment rate is comparable to that observed in a recent study of the Fulanis in Nigeria  and in GLastly, the control rate note among Fulani hypertensives in the Ferlo is relatively high, particularly compared to other studies conducted on the African continent , 28, 31,The study has some limitations. First, as in many surveys, our BP levels were based on the average of two measurements during a single visit, which may have overestimated the prevalence rates. Second, its cross-sectional design did not allow us to exclude reverse causation as the main explanation for some of the associations reported. Third, we were only able to consider pharmacological treatment. This is reductive, as lifestyle changes are a fundamental part of blood pressure control and should be considered as part of treatment. Fourth, we did not include in the study data on nutritional status and physical activity, which are major risk factors of hypertension. Finally, the small absolute number of hypertensive subjects with controlled blood pressure made it impossible to perform trend analysis on control of hypertension in age/sex subgroups.Combretummicranthum (commonly known as kinkeliba) and Hibiscus sabdariffa help to reduce hypertension and contribute to controlling it [In conclusion, our study shows that 31.4% of Tessekere adults aged 20 years and more are hypertensive. The epidemiological transition currently underway in Senegal, associated with a high prevalence of HTA, also strongly affects the Senegalese rural setting examined for this study. Moreover, the prevalence observed in this rural Sub-Saharan African population is especially high, whereas individuals’ lifestyles and biometric characteristics are considered to be protective factors for hypertension; we call this the Fulani paradox. Two questions should thus be explored in the course of further studies. The first is to identify the causes of such a high prevalence of HTA in such a population . It is also essential to determine to what extent the use of local medicinal plants such as lling it  in this lling it , the verHypertension is already a major public health issue in Sub-saharan Africa, particularly in urban areas;Awareness, treatment and control of hypertension depends largely on people’s availability to access health care.Hypertension is becoming a major public health issue in rural Sub-saharan Africa, notably in Fulanis;The prevalence observed in this rural Sub-Saharan African population is especially high, whereas individuals’ lifestyles and biometric characteristics are considered to be protective factors for hypertension.


Background and Aims. Gastrointestinal surveillance is a requirement prior to liver transplantation (LT), but small intestine examination is not generally undertaken. The aim of the present study was to evaluate the safety and efficacy of capsule endoscopy (CE) for patients with end-stage liver disease. Methods. 31 patients who needed LT were enrolled, and 139 patients who underwent CE over the same period of time acted as controls. Results. Frequency of successful achievement of evaluation of the full length of the small bowel, the mean gastric transit time, and the mean small bowel transit time were not significantly different between the two groups. Abnormalities in the small bowel were found in 26 patients. Comparative analysis revealed that history of EV rupture, history of EV treatment, red color sign of EV, and presence of PHG or HCC were significantly associated with patients with >2 two such findings (high score group). Conclusions. Small bowel examination by CE in patients before liver transplantation could be performed safely and is justified by the high rate of abnormal lesions detected particularly in patients with history of EV therapy or bleeding, red color sign, and presence of PHG or HCC. This study was registered in the UMIN Clinical Trial Registry (UMIN 000008672). P < 0.001). Moreover, these investigators found that esophageal varices ≥ grade 2, portal gastropathy, portal colonopathy, and Child–Pugh class C cirrhosis were all significantly associated with PHE.Liver transplantation (LT) is now routinely performed for various end-stage liver diseases. With improved early-term management, 10-year survival rates of patients transplanted for several different indications exceed 70% . LT is aDespite the frequency of small intestinal lesions in cirrhotic patients, to the best of our knowledge, there have been no studies evaluating the clinical significance of small bowel CE examination in patients before LT. The aim of the present study was to determine the safety of CE and to determine the prevalence of small bowel lesions in these patients.000008672). We affirm that all authors had access to the study data and reviewed and approved the final manuscript.This study was a nonrandomized, controlled, prospective cohort study. Exclusion criteria were (1) patient's age < 18 years, (2) postponement of LT, (3) emergent LT case, (4) difficulty in performing CE because of severe hepatic encephalopathy or risk of retention, and (5) absence of patient's informed consent for CE. This prospective study was approved by the Ethics Committee of our hospital. Written informed consent was obtained from all patients before CE. This study was registered in the UMIN Clinical Trial Registry (UMIN N = 73), abdominal pain or discomfort (N = 25), diarrhea (N = 18), anemia (N = 13), or other symptoms . All control patients had normal liver biochemistry, viral markers, prothrombin time, and renal function test results. Moreover, they had no history of GI tract surgery, and no gastrointestinal lesions were found by abdominal ultrasonography, upper GI endoscopy, and colonoscopy.From April 2012 through March 2015, a total of 38 consecutive patients who needed LT and were treated at Okayama University Hospital were enrolled. The control group consisted of 139 patients who underwent CE during the same period as this study at the same hospital because of obscure gastrointestinal bleeding (All patients underwent computed tomography (CT) and abdominal ultrasonography (US) to rule out bowel obstruction as well as to confirm the presence or absence of hepatocellular carcinoma (HCC), portal vein tumor thrombus, and ascites. Upper GI endoscopy and colonoscopy were performed independently, and the presence or absence of esophageal varices (EV), gastric varices (GV), portal hypertensive gastropathy (PHG), and portal hypertensive colonopathy (PHC) was determined. CE was later performed with a video capsule endoscopy device . The capsule was swallowed with a solution of dimethicone after an overnight fast, without any other preparation. Two and four hours after swallowing the capsule, patients were allowed to drink clear liquids and to eat a light meal, respectively; after eight hours, the sensor array and recording device were removed. Images were analyzed with Rapid Reader 6 software on a RAPID 6.5 workstation (software and workstation from Given Imaging Ltd.). Two experienced endoscopists made diagnoses after reaching an agreement with each other.First, to elucidate the suitability and safety of CE in the study group, the rates of successful achievement of evaluation of the full length of the small bowel, mean gastric and small bowel transit times, and incidence of adverse events were recorded and compared with the control group. Second, the number, type, and location of small bowel lesions found by CE were determined in each patient. The entire small bowel was divided into three regions based on the transit time: the proximal, middle, and distal small bowel. Clinical factors and their association with small bowel lesions were examined; these included sex, age, liver function (Child–Pugh score), etiology of the cirrhosis , laboratory test results , model for end-stage liver disease (MELD) score, and presence or absence of EV, GV, PHG, PHC, hepatocellular carcinoma (HCC), portal vein tumor thrombus, or ascites.In this study, we used a modified scoring system with CE, as originally proposed by Abdelaal et al. , helpful t-test or the Mann–Whitney test. Assessment scores were regarded as ordinal scale scores and analyzed by the Mann–Whitney test. Categorical variables were tested using the corrected chi-squared test. Multivariate analysis was performed using multiple backward stepwise logistic regressions. JMP version 8  was used for all statistical analyses. P values <0.05 were considered statistically significant.Continuous data were compared using the unpaired StudentN = 3), refusal to participate in the study (N = 2), and emergent LT for fulminant hepatitis (N = 2). Consequently, 31 patients were enrolled and CE was performed. One patient was unable to swallow the capsule and canceled the procedure. Then, finally, 30 cases could be analyzed.The study's participant flow plan is shown in N = 22, 73%), GV , PHG , and PHC . Furthermore, 13 patients had a history of endoscopic treatment for EV. In particular, 8 of them required emergent endoscopic treatment for EV owing to bleeding.The patients' baseline characteristics are shown in Complete evaluation of the small bowel was accomplished in 26 of the 30 patients (87%). The mean gastric transit time was 34.2 ± 10.9 min, and the mean small bowel transit time was 320.5 ± 24.2 min. These results were not significantly different in the study and control groups. One patient only in the study group was unable to swallow the capsule and canceled the procedure, but no other adverse events occurred in either group .n = 20), red spots (N = 17), angioectasia (N = 8), erosion (N = 5), and varices (N = 2). We evaluated in this study that red spots , we found that history of EV therapy or bleeding, red color sign, and PHG were more often present in the high score group . El-KhayWe had no case in this study that had to postpone LT due to the CE findings. However, one patient did have active bleeding from PHE of the jejunum . TherefoSeveral earlier studies documented the feasibility of colonoscopy for screening colorectal tumors before LT. This is a concern because immunosuppressive agents after transplantation might worsen malignant tumors , 18. HowThere are some limitations to this study. First, our data were obtained from a single center and the number of patients was relatively small. Currently, most of LT has been performed from living donors in Japan, as cases of cadaver donor transplantation are insufficient to meet demand. Hence, subject accumulation is relatively challenging.Second, in this study, we could not perform follow-up CE. The most important reason was an ethical problem. In all likelihood, after LT, most portal hypertension issues would improve. Therefore, the Ethics Committee of our hospital refused CE after LT. We predict that changes of endoscopic findings could be detected if follow-up CE was performed.In conclusion, we provide evidence that small bowel examination by capsule endoscopy for patients before liver transplantation can be performed safely and is justified because of the detection of a high rate of abnormal lesions specific to PHE, especially in patients with history of EV therapy or bleeding, red color sign, and presence of PHG or HCC.