Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI  and duration of surgery . Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L. Peritoneal carcinomatosis (PC)  is a cliSugarbaker  found thThe metastatic peritoneal involvement that defines PC occurs at the time of diagnosis in up to 7–10% of cases in non-gynaecological neoplasms   and in uThus, the quantification of the PC degree is a prognostic factor . Among tThe Lyon classification system was first described in 1994 by Gilly . It cons-Right subdiaphragmatic region.-Left subdiaphragmatic region.-Subhepatic region.-Omentum and transverse colon.-Small intestine, including its mesentery.-Ileocecal region.-Pelvic region.The Dutch Cancer Institute  classifi-P0: No peritoneal implants.-P1: Peritoneal implants directly adjacent to the stomach’s peritoneum, including major omentum.-P2: Small scattered implants or ovarian metastases.-P3: Numerous diffuse peritoneal implants.In Japan, CP classification of gastric cancer is carried out as follows, according to the JRSGC :-P0: No This classification has been used in Japanese studies as a precise quantitative prognostic indicator.Sugarbaker’s PCI is arguably the most widely used today. Initially proposed by Jacquet and Sugarbaker , it invoThe PCI was first described by Sugarbaker in 1998 and was considered as the standard for describing carcinomatosis of colorectal cancer and mesothelioma . Llueca Hence, CRS, associated or not with HIPEC, has been developed over recent decades as a therapeutic option for selected patients with PC. The evidence supports the use of CRS to eliminate all gross disease, associated or not with HIPEC, to eradicate microscopic disease and reduce peritoneal recurrence to improve patients’ prognoses .The performance of this type of surgery is an extensive and complex procedure with a high incidence of perioperative complications ,20,21. CIn this context of complex or prolonged surgeries, cellular metabolic requirements increase. This situation can lead to an imbalance in oxygen supply and demand. This imbalance results in a state of tissue dysoxia  which isThis was a retrospective, single-centre, observational, clinical study conducted in the Reference Unit Abdomino-Pelvic Oncological Surgery (RUAPOS) of General University Hospital of Castellon (GUHC). Eligible patients were adults with PC who underwent CRS between 2014 and 2016. A total of 51 patients from 57 have been included.The main variable was the level of lactic acid at the end of surgery (mmol/L). Preoperative haemoglobin (g/dL), duration of surgery (minutes), intraoperative bleeding (mL), fluid therapy administered in the form of crystalloids and colloids (mL), administration of blood products during surgery (mL), and intraoperative PCI have been included as intraoperative variables. The absence of this information was a criterion for exclusion from this study.All procedures were performed by the same surgical team. All patients were admitted during the immediate postoperative period to the Intensive Care Unit (ICU) of our hospital.This study was approved by the Ethics and Clinical Research Committee of the General University Hospital of Castellon. All procedures performed in this study were in accordance with the ethical standards of our institutions and in accordance with the Declaration of Helsinki.The sample size required to meet this study’s objective was calculated based on Hulley et al.’s  formula An alpha risk  of 0.05, a beta risk  of 0.20, and estimated correlation coefficient of 0.4 were assumed. Considering a bilateral contrast, a sample size of 47 patients was estimated.Data on lactic acid levels, measured using arterial blood samples, were collected at the time of admission and discharge from the ICU. Sociodemographic, anaesthesia, and perioperative data were collected from patient medical records.For descriptive analysis, qualitative variables are reported with relative and absolute frequencies, while quantitative variables are presented using centrality and dispersion measures (mean and standard deviation [SD]).To evaluate the correlation between lactic acid levels after surgery and the rest of the intraoperative variables, a bivariate analysis was performed by calculating Pearson’s correlation coefficient. Spearman’s correlation coefficient was applied in the absence of normality; normality was assessed using the Shapiro–Wilk test.p-value less than 0.05 were considered statistically significant.A strong positive (negative) relationship was estimated when the correlation coefficient was close to 1 (−1), while absence of relationship was estimated when the correlation coefficient was close to 0. Results with a stepwise independent variable selection method. This method performs iterations by removing and adding the independent variables, thus obtaining a final model with the set of variables that offer a better fit.Subsequently, a multivariate analysis was performed with the level of lactic acid as the dependent variable. As independent variables, the variables of the previous bivariate analysis were included; they showed a statistically significant relationship with respect to the level of lactic acid. A multivariate lineal regression model was applied with the Additionally, the correlation between all intraoperative variables was evaluated. To accomplish this, the correlation matrix was calculated using Spearman’s coefficients.Statistical analysis was carried out using Statistical Package for the Social Sciences (version 24) (IBM Corporation) and R Statistical Software .A total of 51 cases over a two-year period (2014–2016) were included, corresponding to the initial series of patients diagnosed with PC who underwent CRS at the General University Hospital of Castellon. The mean age was 59.86 years (SD: 12.45). Patients were stratified using the American Society of Anesthesiologists’ (ASA) physical status (PS) classification system. In total, 57% of patients were in ASA II (n = 29/51). None of the patients were classified as IV or V. Recurrent tumours were treated in 18 of the 51 patients (35.29%). Less than 25% of patients had a metastatic status (22.45%) and almost 40% received neoadjuvant treatment (n = 19/49). The sociodemographic and clinical variables are shown in The mean values of preoperative haemoglobin and intraoperative PCI were 11.2 g/dL (SD: 1.5) and 14.75 (SD: 9.25), respectively. During the surgeries, there was an average of 2149 mL of blood loss and an average of 8177 mL of fluid therapy was administered . The mean duration of surgery was 8 h and 51 min; the mean postoperative lactic acid was 2.6 mmol/L (SD: 1.83). p-value < 0.001) and with duration of surgery . Statistically positive correlations were found for all other variables except preoperative haemoglobin, for which a negative correlation was calculated . p value).To analyse the relationship of operative variables with lactic acid levels, Spearman’s correlation coefficients were estimated, since no normality was found in the sample. The strongest correlations were found with operative PCI .This resulted in a model with lactic acid as the dependent variable and PCI and duration of surgery as independent variables. The details of the model and goodness of fit are described in Consequently, lactic acid level could be estimated as follows:In this way, for each minute of surgery, lactic acid would increase by 0.005 mmol/L and for each unit of PCI, lactic acid would increase by 0.060 mmol/L. These results are in line with the estimated correlations, as they are the two variables with the strongest correlations found.Additionally, the correlation between all clinical operative variables was estimated . The corThe strongest correlation was found between fluid therapy and crystalloid volume (ρ = 0.98); this relationship was expected since fluid therapy consisted mainly of crystalloids. A strong positive correlation was also found between intraoperative bleeding and blood products administered (ρ = 0.62), followed by the correlation between lactic acid and PCI (ρ = 0.53).As previously described , lactic Multiple studies have evaluated the clinical use of lactate as a predictor of morbidity and mortality in critical  and postUnder physiological conditions, various organs  produce around 1500 mmol of lactate daily . LactateThis study suggests that the intraoperative variables analysed , except preoperative haemoglobin, are significantly correlated with lactate levels, specifically highlighting PCI and duration of surgery. The findings of this study suggest that for each minute of surgery, lactic acid would increase by 0.005 mmol/L and for each unit of PCI, lactic acid would increase by 0.060 mmol/L.In a study we published in 2021, the relationship between lactacidaemia and postoperative complications after CRS was analysed. It was observed that lactic acid levels on admission to the critical care unit were significantly higher in those who suffered complications, with a relative risk of almost threefold  with respect to uncomplicated patients, with 2.5 mmol/L being the cut-off point for an increased risk of complications and death. That means serum lactate level is a predictive factor for postoperative complications in patients undergoing CRS for peritoneal carcinomatosis. The study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission to the ICU.The relationship between PCI and postoperative complications has been analysed in multiple studies, with the cut-off point of PCI varying by publication ,38,39,40The literature is variable on the duration of the surgical procedure from which an increase in postoperative risk is specified. It depends on the experience of the surgical team, the type of patients treated and the pathology that causes PC. Roviello et al. , when reAs described above, due to its complexity, the surgery is often prolonged. This results in large-volume blood loss and requires significant use of blood product support. Di Giorgio et al.  describeOur data showed that increased haemoglobin is related to lower lactate levels, although this relationship was not statistically significant in our population. Anaemia is increasingly recognized as an interventional haematological target in patients before major surgery. Preoperative anaemia increases the need for perioperative blood transfusion, and there is now a well-recognized association with increased patient complications, length of hospital stays, and worse outcomes . MultiplRegarding fluid therapy, our data coincide with other studies regarding the use of balanced crystalloids as the first fluid option . PeriopeOne of the strengths of the present study is the homogeneous cohort of patients with abdominal carcinomatosis that has been treated by the same multidisciplinary, specialized team in the context of a tertiary hospital. Further, to our knowledge, this is the first time an association has been found between the variables described and lactate levels. This is of great interest given the known association between lactic acid levels and perioperative complications.Regarding the limitations of this study, it should be noted that it is an observational study. The data come from a small series and a single centre, so the results should not be generalized. Thus, although our data indicate that there is a positive correlation between PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products with lactic acid levels, as well as a negative correlation between haemoglobin and lactic levels, the size of this study makes generalizations impossible. Moreover, this study focuses on specific intraoperative variables; however, other potential preoperative factors influencing lactic acid levels, such as a patient’s age, nutritional status, obesity, diabetes mellitus, and tobacco use are not discussed in the article. They can be studied in subsequent investigations.In the future, deepening these relationships would be an interesting way to improve the perioperative morbidity and mortality of these patients. Developing more studies with a larger number of patients that confirm these relationships, as well as investigating haemodynamic changes through minimally invasive haemodynamic monitors, which also can affect a patient’s prognosis , can be


No significant gender-related differences in balancing backward (BB), jumping sideways (JS), and moving sideways (MS) were found. When the subtests of KTK3+ were compared by age, a significant difference was observed between the groups in all subtests (p < 0.05). With respect to PAP, students with PAP had a significant advantage in all subtests of the KTK3+ (p < 0.05). The double co-effects or triple co-effects of age, sex, and PAP parameters do not influence the KTK parameters. This study presents evidence supporting sex differences in the motor skills of children within this age range and highlights the potential impact of age and physical activity on motor development.Motor coordination (MC) is an essential skill underpinning precise and controlled movements, contributing significantly to daily functioning and overall performance. The developmental trajectory of MC in children is intricately shaped by a spectrum of factors encompassing age, gender, and physical activity engagement. Delving into the complex interrelation of these variables holds the potential to unravel nuanced developmental trends and offer targeted avenues for interventions aimed at augmenting motor proficiency in the pediatric population. This study aimed to assess the differences in MC of primary school students based on sex, age, and physical activity participation (PAP). A total of 848 students from public primary schools, aged between 6–9 years, including 412 boys and 436 girls. The MC was measured using Körperkoordinationstest für Kinder (KTK3+) test battery, which included Jumping sideways (JS), Balancing backward (BB), Moving sideways (MS), and Eye–Hand Coordination (EHC). One-way multivariate analysis of variance (MANOVA) was used to determine the binary and triple interactions of sex, age, and PAP variables on the MC parameters of the participants. The study revealed that boys aged 6–9 had higher scores than girls on eye–hand coordination (EHC) ( Motor coordination (MC) plays an important role in human development . It encoThere are many factors that affect the level of MC in children. Previous research has identified various biological , behavioral , socioeconomic , and environmental  factors that affect MC in children ,11. The Research has indicated that there are often differences in MC between boys and girls. In general, boys tend to exhibit higher levels of gross motor skills, such as running and throwing, while girls may excel in fine motor skills, such as handwriting and manipulative tasks . A signiA previous study indicated that MC was the best predictor of physical activity levels in children 6 to 10 years of age . By partn = 412) aged between 6–9 years who attend official primary schools were evaluated. Children with any orthopedic, cardiological, or neurological diseases were excluded from the study. Additionally, the participants were instructed to refrain from engaging in strenuous physical activity prior to measurements and to avoid the use of painkillers or sleeping pills one day before the measurements. This protocol was enforced to maintain consistency and accuracy in the measured outcomes. A total of 864 students were initially included in the study. However, 16 students who did not meet the stated conditions for participation were excluded from the study. Thus, in this cross-sectional study, a total of 848 students between six and nine years of age who attend official primary schools were evaluated. The sample size was calculated based on accordance with Cingi’s study [In this cross-sectional study, a total of 848 students . Furthermore, a voluntary and parental informed consent form, which included details about the research’s purpose, objective, method, and permission, was sent to student families. Students who provided permission were included in the research.On the first day of data collection, the participants completed a demographic questionnaire, which captured their physical characteristics, and their anthropometric measurements were recorded . The second day of the research process involved explaining and demonstrating the measurement protocols for the KTK3+ battery in detail to the students in accordance with the original testing manual guidelines ,30. The 2) was determined by dividing their body weight (in kg) by the square of their height.The participants’ height was measured using a portable height device (Mesilife 13539) with a sensitivity of 0.1 cm. During the measurement process, the athletes were instructed to stand upright barefoot with their heads held high, feet flat on the ground, knees straight, heels together, and bodies erect . The parIn this study, the MC levels and movement competencies were determined by applying the KTK3  supplemeThe EHC task used by Platvoet et al.  requiresp-values less than 0.05 were considered to indicate statistical significance. However, to control for type I errors in all possible multiple comparisons, the Bonferroni correction was applied. In studies involving more than two groups, conducting all possible pairwise comparisons increases the risk of type I errors. The Bonferroni test adjusts the significance level in such cases. The initially accepted significance level  is divided by the number of possible comparisons . The calculated F-value is then compared not with the value corresponding to the 0.05 level in the relevant table but with the recalculated p-value (0.0166 ≅ 0.01) [The data obtained in the research were analyzed using the SPSS 18.0 program. Descriptive statistics  were used to describe the characteristics of the participants. Skewness and kurtosis values were examined to determine whether the research data were normally distributed. In addition, a three-way multiple analysis of variance (MANOVA) was used.  ≅ 0.01) . AdditioThe KTK3+ test was found to have a high degree of fit values with all sample groups and all measurement tests using the structural equation modeling . The graThe Cronbach’s alpha coefficients, which are indicators of internal consistency and reliability, were calculated to determine the reliability of the KTK3+ measurement tool consisting of four tests. The reliability coefficients for the measurement phase (n = 848) of the KTK3+ scale were shown in the following table, including all sample groups and tests, to check the appropriateness of the scale . When thp < 0.025). No significant differences were found in the BB, JS, and MS variables based on sex (p > 0.05). However, all of the KTK variables showed significant differences based on age group . Based on the Scheffe post hoc analysis, the KTK BB, JS, and MS scores increased with age (p > 0.05). However, significant differences were observed in all other age groups (p < 0.05). EHC increased with age, and there were significant differences between all age groups (p < 0.05). After applying the Bonferroni correction for PAP, the p-value was calculated as 0.025. Based on this result, all of the KTK variables differed significantly by PAP . The interaction of sex p > 0.05) (Boy participants had higher EHC scores than girl participants (with age . No sign > 0.05) .The aim of this study was to investigate the influence of sex, age, and physical activity on the MC levels of primary school students. Further, the interactions among sex, age, and physical activity in relation to students’ MC were analyzed. In this study, boys had higher EHC scores than girls, and the differences in scores among the groups were significant. No significant differences were found in the BB, JS, and MS variables based on sex. In a study involving a group of 665 students between the ages of five and seven years, it was observed that girls had a notable advantage on the BB sub-test, whereas boys had higher scores on all other sub-tests as well as a higher total MC score . SimilarIn our study, it was found that as age increased, scores on the trials also increased. This finding is in line with a study of 1276 Portuguese children aged 6–14 who had their MC measured with the KTK, which also reported an increase in raw scores with age . The KTKIn the current study, students with PAP had higher scores on all sub-tests compared to their peers without PAP, regardless of sex and age group, and there was a statistically significant difference between the groups. Schembri et al.  study onPrevious studies have shown that physical activity in childhood, including participation in organized sports, has a positive effect on the development of motor competence . CoppensIn this study, the MANOVA analysis revealed no significant differences in the combined dependent variables for the interaction of sex × age, sex × PAP, age × PAP, and sex × age × PAP. Notably, only one study utilizing the same analysis method and KTK3+ test battery was found in the literature. Coppens et al.  showed aIn practice, the results of this study emphasize the importance of participation in physical activity. The most important implication of the study is that MC elements can be developed by including children in organized physical activity programs and the combined effects of age, sex, and PAP. Future studies should examine the long-term effects of sustained physical activity on MC. Longitudinal research can help us understand how continuous participation in physical activities throughout childhood and adolescence impacts MC in adulthood. In addition, examining specific aspects of children’s physical fitness and determining their relationship with MC would provide more information about other factors affecting MC.This study has some limitations that should be acknowledged. Firstly, the design of the study cannot establish causation underlying the changes in the MC and differences based on age and sex. To gain deeper insights into the development of motor skills, conducting longitudinal and experimental studies is essential. Secondly, to better understand students’ physical activity levels, more detailed information is needed. This includes comprehensive data on participation in organized sports or non-organized sports activities. Furthermore, factors such as family sports history, socioeconomic status, and education level should be considered for a more comprehensive analysis. Lastly, it is crucial to emphasize that this particular study was conducted exclusively in a specific region of Turkey. Consequently, the conclusions reached may not be directly applicable to the broader population of Turkey or other regions that possess distinct demographic, cultural, or socioeconomic characteristics. It is recommended to conduct further research that includes diverse regions in order to obtain a more comprehensive understanding.The results of the study reveal that boys obtained higher scores in the EHC  test compared to girls. However, there were no statistically significant differences in the variables of BB , JS (Jumping Sideways), and MS (Moving Sideways) based on sex. Across all subtests, there was a positive correlation between age and test scores, indicating that as age increased, the test scores also increased. However, when comparing only the 8 and 9-year-old age groups, no statistically significant differences were found in the BB, JS, and MS tests. Moreover, students with high PAP exhibited higher scores in all subtests compared to those who did not participate in physical activity. This suggests a positive association between physical activity levels and motor skills performance among the participants.


The primary aim of the study was to assess cerebral circulation in healthy young subjects during an ultra-short (45 min) session of ground-based microgravity modeled by “dry” immersion (DI), with the help of a multifunctional Laser Doppler Flowmetry (LDF) analyzer. In addition, we tested a hypothesis that cerebral temperature would grow during a DI session. The supraorbital area of the forehead and forearm area were tested before, within, and after a DI session. Average perfusion, five oscillation ranges of the LDF spectrum, and brain temperature were assessed. Within a DI session, in the supraorbital area most of LDF parameters remained unchanged except for a 30% increase in respiratory associated (venular) rhythm. The temperature of the supraorbital area increased by up to 38.5 °C within the DI session. In the forearm area, the average value of perfusion and its nutritive component increased, presumably due to thermoregulation. In conclusion, the results suggest that a 45 min DI session does not exert a substantial effect on cerebral blood perfusion and systemic hemodynamics in young healthy subjects. Moderate signs of venous stasis were observed, and brain temperature increased during a DI session. These findings must be thoroughly validated in future studies because elevated brain temperature during a DI session can contribute to some reactions to DI. Several ground-based models of microgravity are currently widely used to mimic the effects of real weightlessness, e.g., supine bed rest, free-fall machines, unilateral lower limb suspension, parabolic flights, and “wet” and “dry” immersion (DI) ,2,3. AmoTypically, longer-term sessions of DI (from 3 days to 2–3 weeks) are chosen to study the effect of ground-based microgravity on the organism ,9,10 becSessions of microgravity, which last for hours, days, and weeks, either onboard a space vehicle or modeled, induce an increase in intracranial pressure, increase of jugular vein flow, and modification in cerebrovascular autoregulation ,17,18,19Several studies have shown that fluid shifts to the upper part of the body during a DI session ,3,4. TheOn the whole, the primary aim of the study was to assess cerebral circulation in healthy young human subjects during an ultra-short DI session. In addition, we aimed to test the hypothesis that cerebral temperature would grow during an ultra-short DI session. Laser Doppler Flowmetry (LDF) is acknowledged as a reliable method to assess local cerebral blood flow . In addiThe study group was formed in accordance with previously published criteria for safe use under the conditions of DI ,14. VoluThe study enrolled 11 apparently healthy individuals aged 18–31 years old (mean age 20.7 ± 3.5 years) without chronic diseases. The anthropometric characteristics of participants are presented in None of the subjects had a history of traumatic brain injuries, including those related to sports activities such as boxing and football. An exhaustive verbal explanation was provided to all participants, and written informed consent was obtained from each of them. The protocol of the study was approved by the Joint Ethics Committee of the Ministry of Health of the Republic of Karelia and Petrozavodsk State University . Prior the DI session, all subjects underwent an active orthostatic tolerance test ,14,28. T3 bath filled with fresh water. The bath was covered with a thin waterproof film of a large size, which allowed for the body of a subject to be wrapped. Additionally, each subject was wrapped in an individual cotton sheet for more comfort, and to avoid direct contact with rubber material of the film. To provide safety and instant monitoring of subject’s condition, at least two investigators were present in the laboratory room during the whole DI procedure.The condition of DI was induced with help of the “Medical Facility of Artificial Weightlessness” , which is located at Petrozavodsk State University. The DI procedure was previously described in detail in our earlier papers ,14,15. MTo conduct the DI procedure, the subject was immersed in the water using a movable platform, which was driven by an electric motor. The subject was immersed with their head and upper body “out of water”. The subject’s arms were freely lying non-flexed, to provide circulation. More information about the physics and the DI procedure can be found in the previous studies ,4,8,14. The room temperature was 23–24 °C and the water temperature in the bath was set at 32 °C. Prior to the procedure, the subjects were allowed to drink 200 mL of fresh water and visit the toilet, as DI has strong diuretic effect. Then, the subjects, wrapped for convenience in a cotton sheet, laid supine on the platform for 15 min to familiarize themselves with the conditions of the experiment. BP was measured at the 10th minute of the preparatory period . The beginning of the DI procedure was approved if the BP was no higher than 140/95 mmHg. Then, the subjects were immersed in water for 45 min, with the possibility to abandon the procedure at their request.Data were collected at the following study points: before (baseline test—preDI), on the 15th, 30th, 40th min of DI session , and 3 min after DI (postDI). Systolic and diastolic BP and HR were measured at these study points. ECG was monitored in standard lead II with a “VNS-Spektr” device .http://www.lazma.ru (accessed on 30 March 2023)) [To evaluate microcirculation, LDF measurements were conducted with the help of a multifunctional portable laser blood microcirculation analyzer “LASMA PF” ) ,30. For h 2023)) ,32,33. TNUTR) and shunt (MSHUNT) components of perfusion were also obtained [After data acquisition, the rhythms of oscillations were computed using the built-in wavelet analysis module. Microcirculation was characterized by the LDF signal in arbitrary perfusion units (p.u.), using the software supplied with the LDF analyzer. Mathematical processing of the results included evaluation of the following parameters for each fragment: the average value of perfusion (M), the standard deviation (σ), and the coefficient of variation KV = (σ/M)100%. Nutritive . Within the DI session, ANOVA, followed by post-hoc comparisons (Duncan test), was applied to compare LDF and hemodynamic parameters among study points. The significance was considered at −1 (At baseline condition (preDI), systolic and diastolic BP was 94–116 and 58–72 mm Hg, respectively, and HR was 59–72 min−1 . During NUTR and MSHUNT), as well as the overall perfusion variability (σ and KV), corresponded with regulatory mechanisms of perfusion and remained stable.The parameters of LDF measurements in the forehead area are presented in Frequency domain analysis revealed a significant increase in respiratory modulated activity (AR), which corresponds to oscillations in the venous vascular bed. In addition, minor changes in the neurogenic (AN) and cardiac (AC) LDF frequency ranges were revealed.NUTR). The shunt component of perfusion (MSHUNT) remained unchanged. The overall perfusion variability (σ) slightly increased, while KV did not change. Values of LDF parameters of the forearm area are presented in Frequency domain analysis revealed a significant increase in respiratory modulated (AR) and cardiac (AC) activity. The temperature dynamics in the studied areas is shown in Primarily, in this study we aimed to evaluate cerebral circulation in healthy young human subjects during an ultra-short 45 min DI session. In addition, we tested a hypothesis that cerebral temperature would grow during an ultra-short DI session in heathy subjects. It was found that only a few parameters of the LDF signal had indeed modified within a 45 min session of DI, while others had not. More specifically, the amplitude of the respiratory (AR) component of the LDF spectrum had significantly increased by roughly 30% in comparison to the pre-DI condition. The myogenic (AM), endothelial (AE), and cardiac (AC) components of the LDF spectrum in the supraorbital area did not change within the DI session. The mean value of perfusion (M) increased from 15 p.u. before DI up to 19 p.u. by the end of the DI session, though non-significantly. It has been found that the temperature, measured in the supraorbital area, indeed increased during the DI session. As for the forearm area, its perfusion was initially significantly lower by three times and it significantly increased within a DI session. Furthermore, in the forearm area nutritive perfusion increased during DI. Thus, there was a distinct difference in the reactivity of the two studied areas.The dynamics of BP in young healthy individuals is consistent with our earlier results ,14 as weThe data obtained indicate, in general, the stability of the cerebral blood flow during a DI session because most of LDF parameters did not change. Oscillations in the respiration dependent frequency range predominantly indicate the venous blood flow because the respiratory system is one of the major drivers for venous return to the heart ,39. The NUTR). Such a big, almost double, increase in perfusion corresponds with hyperemia, which in turn may be induced for the purpose of thermoregulation, more specifically, for the purpose of heat loss [In the forearm area, unlike the forehead area, the most notable change was the increase of the average value of perfusion (M) and nutritive component of perfusion , depending on age, time of day, and hormonal status . In the Several limitations to the study can be identified. First, brain temperature was evaluated with help of an LDF device in the supraorbital area of forehead. An MRS-based measurement of brain temperature would be more relevant. Due to necessity of constantly monitoring brain temperature, the LDF-based method was chosen. In addition, we did not assess whether the horizontal position per se contributed to the outcome. In our future studies, we plan to elucidate this issue. Finally, the temperature of deep and superficial areas of the brain varies, which was not considered in the study. In conclusion, our results suggest that an ultra-short, 45 min long, DI session does not exert substantial effects on cerebral blood perfusion in young healthy subjects. Systemic hemodynamics seen from BP were also stable. Nonetheless, some moderate signs of venous stasis of cerebral perfusion were observed. In addition, it was found, in accordance with the working hypothesis, that brain temperature indeed increased in the course of a 45 min DI session. This finding must be thoroughly validated in future studies because elevated brain temperature during a DI session could well have contributed to some typical reactions to DI, e.g., decreased muscle tone.These findings can be additionally tested with help of other models of Earth-based microgravity, e.g., during bed rest.


Post-operative atrial fibrillation (PoAF) occurs in ~ 30% of patients after cardiac surgery. The etiology of PoAF is complex, but a disbalance in autonomic systems plays an important role. The goal of this study was to assess whether pre-operative heart rate variability analysis can predict the risk of PoAF.Patients without a history of AF with an indication for cardiac surgery were included. Two-hour ECG recordings one day before surgery was used for the HRV analysis. Univariate and multivariate logistic regression, including all HRV parameters, their combination, and clinical variables, were calculated to find the best predictive model for post-operative AF.2DS2-VASc score . In the multivariate regression model, parameters independently associated with higher risk of AF were pNN50, TINN, absolute power VLF, LF and HF, total power, SD2, and the Porta index. A combination of clinical variables with HRV parameters in the ROC analysis achieved an AUC of 0.86, a sensitivity of 0.95, and a specificity of 0.57 and was more effective in PoAF prediction than a combination of clinical variables alone.One hundred and thirty-seven patients (33 women) were enrolled in the study. PoAF occurred in 48 patients ; the remaining 89 patients were in the NoAF group. AF patients were significantly older , and had higher CHAA combination of several HRV parameters is helpful in predicting the risk of PoAF. Attenuation of heart rate variability increases the risk for PoAF. Post-operative atrial fibrillation (PoAF) is a common complication during the early post-operative period after cardiac surgery. PoAF prolongs hospital stays and affects the subsequent post-operative recovery and prognosis. PoAF is associated with an increased risk of hospital readmission, stroke, and early and late mortality. Depending on the type of procedure, PoAF occurs in 30–60% of patients without a history of atrial fibrillation (AF). The incidence of PoAF is higher in patients undergoing valve surgery than in those undergoing coronary artery bypass grafting (CABG) –3.The exact mechanism causing PoAF has not been fully elucidated. It is generally assumed that it is an interplay of individual factors, which can be divided into acute  and chronic, which are associated with heart aging and remodeling . SeveralImportantly, sympathetic and parasympathetic activity  also plays an essential role in AF induction, particularly in patients after surgery, when increased sympathetic activity is present. Post-operative heart rate variability (HRV) studies have shown an increase in time and frequency parameters compared to pre-operative values. However, whether these changes are associated with increased sympathetic activity or loss of vagal tone is not entirely clear .Heart rate variability (HRV) analysis is a commonly used method for evaluating autonomic nervous system activity. HRV measurement is simple, non-invasive, and reproducible when performed under standardized conditions. Several studies have been published on PoAF following cardiac surgery, but few focused on the usefulness of HRV in PoAF prediction. This study aimed to determine if a comprehensive analysis of pre-operative heart rate variability could be used to assess the risk of PoAF. Identification of parameters associated with new-onset PoAF would be of great clinical importance. It would ensure adequate precautions during the perioperative period to optimize clinical outcomes.Patients without an AF history and indicated for cardiac surgery were included. The inclusion criteria were an indication for cardiac surgery due to coronary artery disease or valve disease, absence of an AF history, and sinus rhythm on admission. Exclusion criteria were urgent cardiac surgery, non-sinus rhythm on admission, the presence of an implanted pacemaker or defibrillator, a history of atrial fibrillation, and unwillingness to participate. All surgeries were completed at the Cardiac Surgery Clinic of the University Hospital Kralovske Vinohrady.All surgical procedures were performed under general anesthesia from a median sternotomy or, in selected cases, an upper partial sternotomy. Most procedures used an extracorporeal circulation device and cardioplegic cardiac arrest; rarely were cardiopulmonary artery bypass graftings without extracorporeal circulation. The use of extracorporeal circulation in CABG surgery was left to the discretion of the lead surgeon. After surgery, all patients were hospitalized in the intensive care unit (ICU) of the Cardiac Surgery Clinic. According to normal clinical practice, extubation was performed after stabilizing respiratory, circulatory, and other parameters and a gradual return of consciousness, usually within a few hours after the procedure. ECGs were monitored throughout the stay in the ICU. After extubation and in stable hemodynamic condition, patients were transferred to the standard post-operative department with facilities for continuous ECG monitoring.Post-operative AF was defined as a supraventricular arrhythmia with irregular atrial activity lasting longer than 30 s  recordedA detailed patient history was collected from all patients, with the results of blood tests  and ECGs performed one day before surgery. For the HRV analysis, 2-hour ECGs were recorded in all patients the day before surgery. The ECG recordings took place in a supine position in the afternoon prior to the day of surgery while the patient was entirely at rest.ECGs were recorded using the VLV system created by the Faculty of Biomedical Engineering, Czech Technical University. It is a multifunctional biotelemetry system to help monitor psychophysiological states. It enables simultaneous and continuous mobile sensing of multiple physiological parameters. It can record ECGs, respiratory curves, skin resistance, myopotentials, and physical activity. The system consists of a scanning unit, a translation unit (a Wi-Fi access point), and one control and collection unit (notebook). It transmits a full stream of digitized signals, not just the calculated parameters, which allows for the preservation of all information for further detailed analysis and research. For our purposes, the system was modified to scan two ECG channels.Leads were placed in the third intercostal space to the left of the sternum; leads V2, V5, and V6 were placed as usual. Thus, the system scanned two bipolar ECG leads for 2 h. The evaluation of the measured data took place offline. The information was stored in a text file with the “.csv” extension . A specially created program transformed these files into a form that could be used by the Kubios HRV  software. HRV analysis was performed following the recommendations of the European Society of Cardiology and the North American Society of Pacing Electrophysiology [In the Kubios HRV program, all recordings were visually inspected and checked before analysis. This was done to ensure that all normal QRS complexes were detected correctly and atrial or ventricular premature activities, as well as artifacts, were excluded from the analysis. Subsequently, the HRV analysis was performed in the time and frequency domains, and the non-linear analysis was performed. In the frequency-domain methods, a power spectrum density (PSD) estimate was calculated using parametric autoregressive (AR) models. The generalized frequency bands were very low , low , and high-frequency bands (HF 0.15–0.4 Hz) . MeasureStatistical analysis was performed using software R (version 4.1.2 (2021-11-01), The R Foundation for Statistical Computing). Normality was tested using the Shapiro-Wilk test. The groups were compared using the Wilcoxon test when the distribution non-normal. If the quantity met the normality condition, the F-test was used to determine the homogeneity of variances for both groups. If this condition was met, an unpaired two-sample t-test was used to compare groups; if the groups had different variances, the Welch t-test was used. Qualitative variables were tested using Pearson’s chi-squared test. A p < 0.05 was considered statistically significant. Univariate logistic regression was performed for all parameters. Subsequently, multivariate logistic regression was performed to find the optimal model for predicting post-operative atrial fibrillation. Akaike’s information criterion was used to optimize the models. The optimal multivariate model was based on parameters obtained using the ROC curve to achieve the highest possible value of area under the curve (AUC), sensitivity, and specificity.2DS2-VASc scores , all other demographic, clinical and laboratory parameters were similar between groups.One hundred fifty patients were initially included in the study; however, 13 patients had to be excluded due to poor-quality ECG recordings. Ultimately, 137 patients (33 women and 104 men) were enrolled and analyzed. PoAF occurred in 48 patients (35%). These patients formed the AF group, and the remaining 89 formed the NoAF group. The baseline parameters of both groups are shown in Table As mentioned, analyses of heart rate variability from 2-hour ECG recordings were performed. Time and frequency parameters, as well as non-linear parameters, were analyzed. The results are shown in Tables 2 in AF group vs. 1861 ± 1134 ms2in NoAF group, p = 0.04) and (2) total power , were significantly different between the AF and NoAF group.The results of the frequency domain analysis are shown in Table The results of the non-linear analyses are shown in Table 2), and recurrence rate (REC).However, several other non-linear parameters differed significantly between the AF and non-AF groups Table , i.e., AFirst, a univariate logistic regression was performed for all parameters. The following parameters were independent predictors of post-operative atrial fibrillation: age, CHA2DS2-VASc, CHA2DS2-Risc, NN50, pNN50, SD2, ApEn, Slope index, SampEn, D2, and REC. Odds ratios and p values are shown in Table Correlations between individual parameters that were used in multivariate logistic regression were tested. The results of the most significant correlations are shown in Table Post-operative atrial fibrillation after cardiac surgery occurred in 35% of patients in our study. Regarding clinical parameters, older age and higher CHA2DS2-VASc scores were associated with the presence of PoAF. In the univariate logistic analysis of HRV parameters, NN50, pNN50, SD2, ApEn, Slope index, SampEn, D2, and REC were independent predictors of PoAF. In the multivariate logistic regression, a combination of several clinical and HRV parameters was able to predict PoAF. According to the ROC analysis, the highest specificity was achieved using pNN50, Absolute power in VLF, LF, and HF area, Total power, LF/HF, and SD2 from the HRV variables, and diabetes, history of thyroid disease, and COPD from the clinical variables.PoAF in 35% of patients is consistent with results from other studies. Depending on the type of procedure, post-operative fibrillation occurs in 20 to 60% of patients. Rader  also repThe exact cause of post-operative atrial fibrillation is not known. The etiology is definitively multifactorial, with several risk factors. One of the most important risk factors is older age at surgery , 15. In 2DS2-VASc score, which comprehensively describes the patient´s risk profile. Chua [Another critical factor is the CHAle. Chua  found thRegarding other clinical variables in the multivariate model, a history of thyroid disease, diabetes, and COPD independently predicted the risk of PoAF. The relationship between thyroid disease and the occurrence of atrial fibrillation is well established; moreover, patients with no signs of acute hyperthyroidism but with a history of thyroid disease are also at a higher risk of AF .Various studies found that patients with diabetes have a 34% greater risk of developing AF than control subjects without diabetes. Diabetes is accompanied by structural, electrical, electromechanical, and autonomic activation of the atria; all increase the risk of AF . Not surThe main goal of this study was to assess whether parameters obtained from a heart rate variability analysis could predict the occurrence of PoAF. It has to be emphasized that it is difficult to compare the results of heart rate variability analysis between different studies: to compare the results of individual studies, the ECGs would have to be recorded under precisely the same conditions for the same amount of time.Parameters from the time domain are the most intuitive and the easiest to calculate. The most representative of this cluster is heart rate which did not differ between the groups. The time-domain parameter that differed significantly  between the groups was pNN50 . pNN50 is closely correlated with parasympathetic nervous system activity, and higher RR oscillations, a measure of higher vagal tone, are associated with a lower risk of PoAF. In a report by Chamchad et al. , the ave2 in the AF group vs. 2573 ± 1563 ms2 in the NoAF group). Previous studies have shown that low VLF power is associated with arrhythmic death. In other studies, inflammation was associated with a decrease in the VLF area [Regarding the parameters obtained from the frequency analysis, low values of the absolute power in the VLF area were significantly associated with a higher risk of PoAF. Furthermore, total power was significantly lower in patients with PoAF  would be useful and allow more detailed HRV analysis.Patients on different types of beta-blockers were included in the study. An analysis of patients on and off beta-blockers found no differences; however, substantially more patients would be needed for a complete comparison.Our study focused on patient demographics, medical history, and especially HRV parameters that could predict postoperative AF. However, other peri- and early postoperative parameters, such as the use of cardiopulmonary bypass, the length of cross-clamp, surgery duration, and need for inotropes after cardiac surgery also play a role in the risk of postoperative fibrillation; however, these additional parameters were not analyzed in our study.The cardiovascular system is a complex, non-linear and non-stationary system, the analysis of which constantly brings new information. This heart rate variability study shows that non-linear methods hold good promise for analyzing the underlying principles.Various HRV parameters of time, frequency, and non-linear analysis were found to be statistically different between the investigated groups. Furthermore, two models were created using logistic regression. If we include demographic data in the HRV analysis parameters, we get a more accurate model with an AUC of 0.86. However, the model-based only on HRV analysis parameters also achieved good sensitivity and specificity values. Our results, after validation, could help successfully identify patients with a higher risk of post-operative atrial fibrillation and better prophylaxis.


Delusion of pregnancy (DP) is a heterogeneous symptom that can emerge from different neuropsychiatric syndromes, including schizophrenia, bipolar disorders, but also major neurocognitive disorder (MND). According to the Diagnostic and Statistical Manuel of Mental Disorders-5 (DSM-5), DP is an unspecified type of delusional disorder present in the spectrum of schizophrenia and other psychotic disorders This type of delusion, which can affect both sexes, may have numerous determinants to its genesis and may last decades to resolve.We aim to present a case and review of DP and its association with dementia/MND, hyperprolactinemia and galactorrhea.Non-systematic literature review and case report, based on the search for titles and/or abstracts of articles that address both DP and dementia, and DP and hyperprolactinemia/galactorrhea, including articles published between 2010 and 2022 in English.A 71-year-old female patient was admitted to the Psychiatric unit due to a change in usual behavior in the past 6 months: insomnia, anterograde amnesia, delusions of ruin and persecutory and, for the past month, the belief of being pregnant with twins, supported by the galactorrhea she presented after starting Risperidone prescribed by her Family Doctor weeks prior. Shortly after admission, the patient also revealed hearing her fetuses’ voices. DP vanished briefly after admission due to the combination between the change of Risperidone to Aripiprazole (a prolactin-sparing antipsychotic) and psychotherapy to help deconstruct the patient’s cognitive misinterpretations. She was furthermore diagnosed with Alzheimer’s disease and Memantine was started.et.al. Indian J Psychol Med 2015;37:131-7) is part of the 28.6% of patients more than 50 years of age who present DP, 6.0% that report having twins and 8.3% that report hearing voices of their fetuses. No data was found correlating DP and MND directly. Hyperprolactinemia and its consequent galactorrhea represent one of the many explanations behind DP, especially in suggestible demented patients that easily misinterpret somatic sensations, in which delusional thoughts are frequent and contribute to the morbidity.This patient, according to Bera et al. (Bera None Declared


Giant fibroepithelial polyp (FP) of the scrotum in infants is a rare disease. We reported the first case of FP in China. The child was only 9 months and 12 days old and was admitted to the hospital due to rapid growth and rupture of the scrotal mass. The patient underwent scrotal exploration under general anesthesia, and the mass was cystic-solid with clear boundaries. The tumor did not invade the sarcolemma of the scrotum and testicular tissue. The intraoperative pathological frozen section tended to be benign, and the scrotum's tumor and subcutaneous pedicle tissue were removed entirely after 0.5 cm from the boundary of the mass. The operation was successful. The mass was confirmed as FP by postoperative pathology. 6 months after the operation, the incision healed well without recurrence. This case report has a detailed diagnosis and treatment process and adequate examination results. It can provide a reference for diagnosing and treating FP in infants and reduce the risk of misdiagnosis and mistreatment. Fibroepithelial polyps (FP), called soft fibromas, are a kind of pedunculated benign tumor. It is common in middle-aged or older adults , especiaHere, we report a case of a 9-month-old boy with a rapidly expanding mass in the scrotum that ruptured and was completely removed by surgery. Postoperative pathology confirmed that the child was a giant FP of the scrotum, and there was no recurrence after 6 months of reexamination.At birth, the child was found by his parents to have a light purple mass in the left scrotum, about 0.5 cm × 0.5 cm in size, protruding from the scrotal skin, with clear boundaries, tough texture, and no tenderness. The patient had no fever and was in good general condition. The family members of the children ignored it and did not go to medical institutions for treatment. The mass enlarged rapidly with age and covered most of the left scrotum. One week ago, the mass ruptured when his family changed the diaper. The scrotal mass of the patient was ruptured from a “mass” to a “cock's comb.” The ulcerated surface resembled new granulation tissue with a small amount of oozing blood. He went to our department for further diagnosis and treatment. Since developing the disease, the child has had good spirits, a good diet, regular urination and defecation, and weight gain. After admission, the relevant examinations were performed. The specialized physical examination showed a mass in the left scrotum with a size range of 6.5 cm × 5.5 cm, which was cauliflower-like growth and scattered with a broad base. There was no obvious blood oozing, redness, swelling, or tenderness, and a clear boundary with normal scrotal skin . PreoperScrotal tumor resection was performed under general anesthesia after excluding surgical contraindications. Intraoperative frozen pathology showed that the tumor tended to be benign . After eFP mainly occurs in postmenopausal women and is considered to be closely related to estrogen levels and the occurrence of polycystic ovaries . PreviouFP usually occurs in the face and neck, axilla, and groin regions. A few are located in the vulva , bladderThere are few studies on the pathophysiology and susceptibility of FP. El Safoury et al. analyzed skin sections from 15 patients with skin vegetations (TS) using enzyme-linked immunosorbent assay and reverse transcriptase polymerase chain reaction and showed that mast cells, tumor necrosis factor-α (TNF-α), and TNF-related apoptosis-inducing ligand (TRAIL) might play an important role in ST patients . Farag eTypical FP is characterized by the formation of pedunculated polypoid nodules protruding from the skin surface. According to the morphological characteristics, it can be divided into three types: (1) exanthematous soft fibromas: multiple small papules, usually occurring on the neck; (2) filamentous soft fibroma: filamentous growth of myxoid processes; (3) pedicle type soft fibroma: more common in the lower part of the trunk and inguinal region, with pedunculated polypoid processes, soft, often more than 1 cm in diameter. Giant FP refers to FP larger than 5 cm in diameter, which is rare in a clinic and mainly occurs in adults . AccordiColor doppler ultrasound and other imaging examinations have some value in diagnosing FP. FP can appear as a hypoechoic mass with clusters of hyperechoic spots on ultrasound. Abundant rod-like blood flow signals can be seen under CDFI . HoweverThe diagnosis of FP requires pathological examination. The typical gross feature of FP is a pedunculated polypoid mass protruding from the skin surface, with a gray-white or gray-yellow cut surface and soft texture . MicroscFP should be differentiated from Dermatofibrosarcoma protuberans (DFSP) and Pleomorphic fibroma of the skin (PFS). Microscopically, DFSP comprised all peripheral nerve components, including Schwann cells and fibroblasts. Most of the nuclei were slender, wavy, and serpentine. The positive expression of S-100 and SOX-10 in immunohistochemistry can confirm the diagnosis of DFSP. In contrast, however, FP was negative for both measures. In PFS, the tumor comprised a small number of spindle cells and abundant collagen fiber bundles, with characteristic multinucleated giant cells and many pleomorphic cells. Immunohistochemically, MSA and CD34 were positive and could be distinguished from FP. In this case, the immunohistochemical S-100, S0X-10, and MSA were negative, which provided a solid basis for the differential diagnosis of FP.Since FP is a benign tumor, local surgical resection is the primary means of clinical treatment. However, paying attention to the complete separation and resection of the tumor and the pedicle tissue during the operation is necessary, which can effectively avoid recurrence and obtain a satisfactory cure rate . HoweverCongenital giant FP of the scrotum in infants is clinically rare, and our center has performed the first case report from China. The lack of obvious clinical symptoms can easily cause guardian neglect, thus delaying treatment. The diagnosis of FP requires a combination of pathological HE staining and immunohistochemical results. The disease is a benign tumor with a good prognosis. However, attention should be paid to monitoring during clinical diagnosis and treatment to reduce the risk of recurrence and malignant transformation.


It is widely known that among others, a pervasive symptom characterizing anorexia nervosa (AN) concerns body image overestimation, which largely contributes to the onset and maintenance of eating disorders. In the present study, we investigated the nature of the body image distortion by recording accuracy and reaction times in both a group of healthy controls and AN patients during two validated tasks requiring an implicit or explicit recognition of self/other hand stimuli, in which the perceived size of the stimuli was manipulated. Our results showed that (1) the perceived size of hand stimuli modulated both the implicit and explicit processing of body parts in both groups; (2) the implicit self-advantage emerged in both groups, but the bodily self, at an explicit level  together with the integration and the distinction between self and other, was altered only in restrictive anorexia patients. Although further investigations will be necessary, these findings shed new light on the relationship between the different layers of self-experience and bodily self-disorders. Body size overestimation is one of the most studied controversial clinical symptoms of anorexia nervosa (AN), and it contributes extensively to the onset, maintenance, and relapse of this disorder  is supported by mental motor rotation processing, which was found to be easier and faster when participants mentally rotated the images of their own body parts compared with unfamiliar ones. It is well known, indeed, that to perform the implicit task, participants simulate a mental motor rotation of their own body parts to match that of the observed stimulus Parsons, , which sIn the present adapted version of the Implicit and Explicit Self-Other body parts recognition task, stimuli could be presented in both their original size and fattened or slimmed down. This adjustment allows us to investigate the phenomenon of body parts overestimation in relation to patients' potential deficits in body schema or body image, eliciting the implicit and explicit body parts recognition, respectively. Both healthy participants (HCg) and restrictive anorexia (ANg) patients were submitted to the experiment with either self or others' hands as stimuli.As a result, we expected a size modulation of both implicit and explicit tasks in both HCg and ANg. We hypothesized a dissociation between implicit and explicit bodily self-recognition, which was previously found in healthy participants by Ferri et al. , 2012. A*Power 3.1.9.7; Faul et al., N = 52 was adequate to test our study hypothesis.To determine the required minimum sample size, an a priori power analysis  restrictive subtype according to the DSM-IV criteria  were included in the study. They were recruited among patients hospitalized at Villa Margherita Clinic, Arcugnano, Vicenza, Italy. The control participants were recruited among voluntary students at the University of Parma by means of flyers posted at public locations and on social media. The restrictive subtype of AN is characterized by the absence, during the last 3 months, of recurrent episodes of binge eating or purging behaviors, such as self-induced vomiting or the misuse of laxatives, diuretics, or enemas. All participants were right-handed as assessed by the Edinburgh Handedness Inventory , psychiatric disorders (psychosis), severe medical illnesses , and substance dependence. A further exclusion criterion for the control group was a personal history of eating disorders, the risk to develop eating disorders, assessed by means the Eating Disorder Inventory—EDI-3 , the hands of each participant were photographed with a digital camera. This session took place in a controlled environment with constant artificial light and a fixed distance from the camera lens to participants' hands (40 cm) photographed always in the same position. Then, with Adobe Photoshop software, photographs were cut from the original picture and modified in their horizontal dimension in order to provide a “Weight Gain”  or a “Weight Loss”  effect see . SubsequParticipants sat in front of a PC screen, at a distance of about 30 cm. Stimuli presentation was controlled by E-Prime . Each trial started with a central fixation cross (500 ms duration), followed by stimulus presentation. The trial was timed out as soon as participants responded .In the implicit experiment see , particiIn the explicit experiment see , particiEach experiment consisted of 420 trials. Stimuli depicted the participant's own left or right hand in half of the trials . In the other half of the trials, stimuli depicted the right or left hand of the other three people . Each hand stimulus was presented in three different size conditions: “Weight Gain”: +2%, +4%, +6%; “Original size”: 0%; “Weight Loss” or “Thin”: −2%, −4%, −6%). This means that in the experiment, we had three levels for the variable: Thin (Weight Loss), Original , and Fat (Weight Gain). This indicates that within the Thin condition, the hand stimuli were proportionally reduced by 2, 4, and 6% of their original size. In the Original condition, the presented images remained unchanged at their original size. Lastly, in the Fat condition, the hand stimuli were proportionally increased by 2, 4, and 6% of their original size. Each weight condition was randomly presented 15 times. Tasks were always preceded by a task-specific practice block. The implicit task was always conducted before the explicit task see . Reactiopost hoc tests to investigate significant main effects and interactions, using the Holm correction for multiple comparisons.For each experiment, trials in which participants failed to respond correctly were excluded from the analysis . We used the Jamovi software for statistical analyses  = 7.88; p < 0.002; = 0.14; Greenhouse-Geisser corrected], with a significantly higher percentage of correct responses for the Original size  than both Thin  (p < 0.01) and Fat sizes  (p < 0.01).In line with our hypothesis, the main effect of Size was significant  with slower RTs for ANg  than HCg .The analysis showed the significance of Group , demonstrating for both groups better performances for stimuli depicting right (dominant)  than left hands .Coherently with the experimental effect, the main effect of Laterality was also significant: , with slower RTs in the Fat  than both Thin  (p < 0.05) and Original conditions  (p < 0.01).Even the main effect of Size was significant , showing, only for HCg, faster RTs for trials depicting right  than left hands  (p < 0.001). Such a difference did not emerge in ANg ; HCg was significantly faster than ANg (p < 0.05) responding to stimuli depicting right hands  = 4.2; p < 0.05; = 0.10], with faster RTs in the Self  than the Other condition  (p = <0.05) only for Right stimuli , but, contrarily to our hypothesis, not only in HCg but for both groups. Conversely, for stimuli depicting left hands, the difference between Self and Other conditions was not significant .The interaction between Ownership and Laterality was significant ; therefore, the performances of both HCg and ANg seem not to differ in their self-advantage for the right stimuli.The interaction among Group, Ownership, and Laterality was not significant , resulting in flattened slopes for the Original size  than both Thin  (p < 0.001) and Fat  sizes (p < 0.001).Slopes: The ANOVA showed the main effect of Size , showing significantly higher slopes for stimuli representing right  than left hands .As expected, the main effect of Laterality was significant , showing higher slopes in the Right than  Left condition  (p < 0.001) in HCg. Such a difference, interestingly, was not significant in ANg  (p > 0.9)  see . = 12.9; p < 0.001; = 0.22] showing a lower accuracy in ANg .The main effect of Group was significant . Participants gave more accurate responses in the Fat  than Thin  condition (p < 0.01)  see . = 4.1; p = <0.05; = 0.08] with higher performances for stimuli depicting other's hands in the Fat  than Thin  condition. Even the interaction between Size and Laterality was significant  resulting in higher accuracy for thinner stimuli depicting left  than right hands  (p < 0.01). Participants were also more accurate when the right stimuli were presented in a fatter than thinner size  (p < 0.001).The interaction between Size and Ownership was significant , indicating better performance when the stimuli presented were the right hands of others in a fatter size rather than a thinner size  (p < 0.01).Finally, the factors Size, Ownership, and Laterality interacted significantly  with HCg showing Faster RTs  compared with ANg .The main effect of the Group was significant  showing faster RTs when stimuli were presented in the Original  than Fat size  (p = 0.009). The thin  condition did not significantly differ from other conditions (p > 0.05).In line with our hypothesis, also the effect of Size was significant  showing better performances in both groups for Other than Self Trials . The interaction between Ownership and Size was also significant . Post hoc comparisons showed faster RTs for other's trials presented in the original size  than for thinner size  (p = 0.03).Reaction Times. The main effect of Ownership was also significant  with faster performances among ANg in response to Other  than Self  stimuli (p < 0.001). Conversely, no significant differences were found between self and other stimuli in HCg  (p > 0.1). Moreover, ANg showed significantly slower RTs than HCg for both Self (p < 0.001) and Other stimuli (p < 0.001) (The effect of Group interacted significantly with Ownership . Concerning right others' stimuli, post hoc comparisons did not detect any significant difference in RTs along the three sizes . On the contrary, concerning left others' stimuli, participants showed slower RTs for thinner than Original and fatter stimuli  (p < 0.001). Regarding self-stimuli, both for right and left hands, post hoc comparisons did not show significant differences along the three sizes .The factors, Ownership, Laterality, and Size, interacted significantly [Fp < 0.05), and to faster RTs when the presented stimuli were left  than right hands  (p < 0.001). Finally, for left stimuli presented in the original size, participants showed faster performances responding to others  than self-stimuli  (p < 0.05).Regarding others' stimuli, when they are presented Fatter and right, they led to faster RTs when stimuli belonged to Others  than Self   and PNM  .Pharmacological treatment: To assess whether the overall slowness of RTs of AN compared with HC was due to the influence of pharmacological treatment rather than the processing of the stimuli, an independent-sample t-test was carried out. A significant difference between HCg and ANg emerged  highlighting higher d prime rates for HCg  compared with ANg   see .This result aligns with our initial hypothesis.The current study investigated whether, and at which level, the overestimation of own body size, typical of people affected by restrictive AN, could affect bodily self-recognition, taking into account both pre-reflective  and perceptual cognitive and affective  levels of bodily self-processing. Furthermore, it also aimed to assess how the manipulation of the perceived size of hand stimuli could modulate both explicit and implicit self-recognition in both HCg and ANg. Participants were submitted to an adapted version of the implicit and Explicit Self-Other body parts recognition task by Ferri et al. .The results of the Implicit task corroborated previous findings showing better performances (in terms of accuracy and response velocity) for right than for left hand stimuli, confirming once again that right-handed participants took advantage of a pragmatic motor hand representation only when a laterality judgment was required , but more accurate performances for fatter stimuli . Additionally, in the explicit task, there is significant interaction among Size, Ownership, and Laterality for both accuracy and RTs, demonstrating that changes in body size modulate the explicit recognition (body image processes) in the function of the ownership and the laterality of the stimulus. These results are supported by findings of a large body of literature studying the body image of patients affected by eating disorders and healthy participants , participants were faster and more accurate when responding to the original size and showed more flattened slopes in this condition compared with thin and fat size. This finding is in line with Longo and Haggard  who, stuIn addition, also an affective involvement could be speculated to have influenced bodily self-processing, considering that our HC group included a sample of participants composed only of young female students. Devue et al. , indeed,The last point to be addressed is that during the explicit task, ANg were slower and much less accurate (regardless of taking medications), both in the overall performance and responding to self vs. others stimuli, indicating that it appears significantly easier for individuals with anorexia nervosa to respond to stimuli related to others rather than to oneself. Furthermore, signal detection analysis showed that ANg performed worse than HCg in discriminating between self and other, suggesting that the integration and distinction between self and other in anorexia patients are not effortless, spontaneous, and balanced processes as observed in healthy controls. This impairment in self/other contributed to the complex nature of body disturbances in anorexia nervosa.Potential limitations of this study include the small sample size and the restriction of HCg participants to students. Additionally, we did not measure participants' “body size estimation,” and it is possible that the stimuli used to assess it represented a more “neutral” body part than others, such as full-body silhouettes, the belly, or the thighs. Finally, despite the fact that it has been widely demonstrated that mental rotations of body parts place a stronger emphasis on the motor representation of the bodily self compared with mental rotations of objects  even small changes in body size modulate both implicit and explicit processes of body parts both in healthy controls and anorexia patients; (2) although processes associated with motor imagery of body parts seem to be stronger in healthy controls, the implicit self-advantage is preserved in anorexia patients; and (3) bodily self, at an explicit level  together with the integration and the distinction between self and other, is altered in restrictive anorexia patients.All in all, although further investigations will be necessary, these findings shed new light onto the relationship between the different layers of self-experience and how damage to one of these layers may lead to different symptomatology, opening up new therapeutic approaches for bodily self-disorders. The potential therapeutic approaches that may arise from these findings could involve interventions that aim to address the specific layer(s) of self-experience affected in each type of bodily self-disorder in a targeted way. For instance, if the proprioceptive-motor layer is affected, therapies aimed at improving body awareness and coordination, such as body-oriented psychotherapy, may be effective. If the disorder is associated with disturbances in body schema, exploring the effectiveness of motor imagery techniques in improving body representation and self-advantage in anorexia patients, as well as examining the potential benefits of interventions that focus on integrating and distinguishing self and other in the context of bodily self-disorders, could be beneficial. If body image is affected, cognitive-behavioral therapy may be more effective. In the case of disturbances at the affective level, interventions focused on emotion regulation and stress management, such as cognitive-behavioral therapy or mindfulness-based interventions, may be suggested. Regarding cognitive layer alterations, psychotherapeutic approaches focused on self-reflection and meaning-making, such as psychodynamic therapy or narrative therapy, may be more appropriate. However, further research is needed to determine the most effective and personalized interventions for each specific type of bodily self-disorder and to explore the generalizability of findings to other populations with body image disturbances.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Direzione Sanitaria della Casa Di Cura Vila Margherita represented by Dr. Giuseppe Butera. Written informed consent to participate in this study was obtained from the participants themselves, or in the case of minor participants, from their legal guardian/next of kin.MAm designed the study, collected, analyzed, interpreted the data, and wrote the manuscript. MAr involved in study design, collection of data, date analyses, and contributed to the drafting of the manuscript. ER and FD were principally engaged in the recruitment of participants and data collection, furthermore, they contributed to interpretation of results. MS, PV, PT, and SM were involved in the recruitment of participants and data collection and took part in the interpretation of the results. VG designed the study, interpreted the data, and drafted the manuscript. All the authors approved the final version of the manuscript.


This study investigates the effects of electrohydrodynamic (EHD) drying technology on the drying kinetics, microstructure, quality, and nutritional components of carrots, along with conducting experiments on EHD drying under different voltage gradients. The experimental results showed that EHD drying technology could significantly increase the drying rate and the effective moisture diffusion coefficient. Within a certain range, the drying rate was directly proportional to the voltage. When the range was exceeded, the increase in voltage had a minimal effect on the drying rate. In terms of quality, the EHD drying group’s color, shrinkage rate, and rehydration performance were superior to the control group, and different voltages had no significant effect on the shrinkage rate and rehydration performance. The retention of carotenoids in the EHD drying group was 1.58 to 2 times that of the control group. EHD drying had a negative impact on the total phenolic content and vitamin A content of dried carrot slices. Based on the results of infrared spectroscopy and scanning electron microscopy (SEM), the dehydrated carrot slices showed wrinkling due to water loss, with numerous pores, a generally intact structure, and retained functional groups. EHD drying had a significant impact on the secondary structure of proteins, where an increase in voltage led to an increase in disordered structure, with a smaller proportion of disordered structure in the lower voltage group compared to the control group, and a similar proportion of disordered structure between the higher voltage group and the control group. Results from low-field nuclear magnetic resonance (NMR) showed that EHD drying could retain more bound water compared to the control group, with the best retention of cellular bound water at a voltage of 26 kV and the best retention of cellular immobilized water at a voltage of 38 kV, indicating the superiority of EHD drying in preserving cellular structure. This study provided a theoretical basis and experimental foundation for the application of electrohydrodynamic drying technology to carrot drying, and promoted the practical application of EHD drying technology. Carrot is one of the top ten global vegetable crops and is widely popular due to its high nutritional value. Four phytochemicals found in carrots are phenolics, carotenoids, polyacetylenes, and vitamin C. These compounds possess antioxidant, anti-inflammatory, plasma lipid regulation, and anti-tumor properties, which help to reduce the risk of cancer and cardiovascular diseases .Fresh carrots have high moisture content and are prone to decay and spoilage due to their high metabolic activity and respiration rate. Therefore, drying is commonly used to extend their shelf life and maintain nutritional quality. The most common drying method for carrots is natural drying, but it is limited by weather conditions, leading to the development of various drying techniques. Mohammadi et al.  studied k et al.  studied k et al.  showed tk et al. . The advk et al. . While ek et al.  studied k et al.  studied k et al.  conductek et al. . These pThe EHD drying technique is a novel drying method that utilizes electric field energy transfer for drying . It featFresh, disease-free carrots were purchased from a supermarket near Inner Mongolia University of Technology. The carrots were washed, dried, and cut into cylindrical shapes with a thickness of 2 mm and a diameter of 35 mm. During the preparation process, the center of the circular mold was aligned with the center of the circular carrot slices to maintain consistency.As shown in The prepared carrot slices were placed in an EHD drying system. The mass of each sample ranged between 2.0 g and 2.3 g. For each experiment, a certain amount of carrot slices were placed . The voltage  was selected for the drying experiment. The mass of the carrot slices was measured every 45 min using an electronic balance , until the moisture content of the carrots fell below 1%, at which point drying was stopped. After drying, the sample mass ranged between 0.23 g and 0.26 g, with a moisture content below 1%.t time (g), and During drying, the moisture content of the carrots at certain times was measured, and the calculation formula  was as ft time and The drying rate was represented by the change in dry basis moisture content between adjacent times during the same time interval, and the calculation formula  was as ft (The moisture ratio (MR)  was calcThe Fick’s diffusion equation can be used to describe the drying characteristics of biological products. For long drying times,  follows :(5)lnMR=L), redness (a), yellowness (b), difference in color saturation (ΔC), difference in hue angle (Δα°), and total color difference (ΔE) [We used the CIE Lab color space for color measurement. An automatic colorimeter  was used to measure the color of the samples, with the color of a white plate as the standard. For each sample, five points were taken, and the average values were calculated. The measured parameters included brightness (nce (ΔE) . Each paS is the shrinkage percentage, V is the volume of the carrot after drying.In the experiment, the shrinkage was measured using the displacement method. A piece of dried carrot was placed in a 25 mL graduated cylinder filled with 18 mL of water, and the rise of the liquid level was recorded for three parallel experiments. The shrinkage was expressed as the percentage by which the volume of the carrot decreased compared to its initial volume, and the calculation formula ,23 was aIn the experiment, the constant temperature water bath was set to 37 °C (high temperatures can cause significant damage to plant tissue ). We addCarotenoids are an important class of natural pigments with vibrant colors and excellent nutritional value ,27. In t2CO3 solution was added, and distilled water was added to a final volume of 25 mL. The sample solution was placed in the colorimetry dish of the UV-visible spectrophotometer  with a wavelength of 720 nm. A volume of 2 mL of 0.25 mol/L Folin-phenol reagent was added, mixed quickly, and allowed to stand at room temperature for 30 min. The absorbance of the solution was measured and the measured absorbance value was recorded. The total phenol content in the sample was calculated using the standard curve method based on the absorbance value. The measurement was repeated three times to calculate the average value and obtain the final result.The total phenol test method utilized Folin-phenol colorimetry. Firstly, 1 g of carrot sample was accurately weighed, crushed, and added to 10 mL of distilled water and stirred thoroughly, and filtered, collecting the filtrate. The filtrate was transferred to a 25 mL volumetric bottle, 1 mL of 15% NaThe measurement of vitamin A content utilized liquid chromatography-mass spectrometry (LC-MS). One gram of dried carrot sample was crushed and screened, then added to 5 mL of methanol for ultrasound extraction for a period of time, filtered, and the filtrate was reserved. Standard preparation: vitamin A standard was dissolved in methanol to prepare different concentrations of standard solutions. The chromatographic conditions: A C18 column was used, with methanol and water as a mobile phase for gradient elution. The detection wavelength was 290 nm. Mass spectrometry conditions: Electrospray ion source (ESI), positive ion mode, monitoring the molecular ion peak of vitamin A. Vitamin A standard solution was injected into the LC-MS, recording the peak area, and preparing the calibration curve. The treated dried carrot sample solution was injected into the LC-MS , which recorded the peak area. The vitamin A content was calculated according to the calibration curve, by calculating the average value and drawing the standard curve.−1 with a resolution better than 0.4 cm−1.The dried carrot samples were ground and mixed with potassium bromide (1:100) and milled. The mixed powder was sieved and placed in a press  to form a pellet. The sample was then scanned using an FTIR spectrometer  in the spectral range of 400–4000 cmCarrot dried products were cut into thin slices using a double-sided blade. After drying in a critical point dryer with carbon dioxide, the samples were coated with a conductive adhesive and then sprayed with gold using an ion sputter coater. Scanning electron microscope (SEM)  images were obtained using SEM with an accelerating voltage of 5 kV, a working distance of 7.9 mm, and a magnification of 250×. The same location on various samples was scanned to obtain SEM images.The coil diameter of the nuclear magnetic resonance analyzer  was 25 mm, and the magnetic field intensity was 12 MHz. The experimental parameters were as follows: the 90-degree pulse width (P1) was 6 μs, the 180-degree pulse width (P2) was 9.84 μs, the repetition sampling waiting time (TW) was 3000 ms, the number of echoes (NECH) was 5000, the number of repetitions (NS) was 4, and the receiver bandwidth (SW) was 200 kHz. Finally, the obtained test data were subjected to 10,000 inversions and plotted using software to obtain the All experiments were performed in triplicate, and the results were expressed as mean ± standard deviation. One-way analysis of variance (ANOVA) was performed to determine the differences between groups, with a significance level of 0.05 to determine differences between means.As shown in Moisture ratio is an important parameter for evaluating the drying process of materials and reflects the degree of material drying. Yang et al.  found sip < 0.05).Effective moisture diffusivity is influenced by various factors. Paul et al.  studied Color is one of the key factors affecting product quality and directly impacts sales . ProblemAs shown in Rehydration rate is a crucial quality parameter for dried foods. It effectively reflects the degree of internal structural damage. Poor rehydration performance is associated with structural damage and cell shrinkage. In a study on EHD drying of banana slices, Esehaghbeygi et al.  found thThe stability of carotenoids and the degree of browning during processing and storage directly affect the quality of the product. Wellnerd et al.  studied As shown in −1 and 2932 cm−1, which corresponded to the characteristic stretching vibrations of O-H and C-H, respectively [−1 and the symmetric stretching of COO at 1415 cm−1, corresponding to carboxylate salts from pectin esters [−1 and 1139 cm−1 indicate arabino and galacto-glucomannans, respectively [−1 and 1540 cm−1, corresponding to the amide I and amide II groups, respectively [The infrared spectrum of carrot slices showed strong absorption bands at 3405 cmectively . The main esters ,49,50. Vectively ,52,53. Tectively . The amiectively  on EHD dectively  on EHD d−1 for protein analysis. After baseline adjustment, Gaussian deconvolution, second derivative, and curve fitting, the −1, followed by the random coil in the range of 1642–1650 cm−1, the −1, the −1, and the −1. As shown in Carrots contain about 1.0 g of protein per 100 g edible portion. Protein is a large molecule, and its secondary structure determines its properties . The amiparallel  in the r’s study  on EHD d’s study  on EHD dShrinkage in fruits and vegetables during drying mainly occurs in the early to middle stages and gradually stabilizes in the later stages. In this experiment, carrots were sliced crosswise, with the center part consisting of secondary xylem and the edge part consisting of secondary phloem. The secondary phloem of carrots contains many conduits for transporting nutrients. The cells in the secondary xylem of carrots are incompletely developed, with fewer organelles, and the intracellular space is almost occupied by vacuoles. The moisture content of the secondary xylem is also higher than that of the secondary phloem . In WangLF-NMR has the advantages of being simple, fast, and non-destructive, and can reveal the distribution of moisture in fruits and vegetables ,61. Simir spaces ,62. As sn et al.  in EHD dThe Pearson correlation coefficient was calculated through correlation analysis of experimental data, including average drying rate, average drying time, effective moisture diffusivity, rehydration performance, shrinkage, carotenoid content, color difference, color saturation, hue angle, To reflect the influence of different voltages on drying parameters, the data were normalized, and a heatmap was plotted, as shown in The EHD drying group demonstrated superior drying efficiency, color, shrinkage, and rehydration performance compared to the control group. EHD drying was able to retain carotenoids to a greater extent than the control group. EHD drying had a negative impact on the total phenolic content and vitamin A content of dried carrot slices. In terms of the analysis of infrared spectroscopy, no significant changes in the characteristic peak positions were observed, indicating that EHD drying could effectively retain the main components of carrots. EHD drying had a significant impact on the secondary structure of proteins, with an increase in voltage leading to an increase in disordered structures. The proportion of disordered structures in the low voltage group was smaller than that in the control group, while the proportion in the high voltage group was almost the same as that in the control group. Under scanning electron microscopy, the secondary xylem of carrots showed severe shrinkage after drying, and the shrinkage phenomenon became more pronounced with increasing voltage. The results of low-field nuclear magnetic resonance showed that EHD drying could retain more bound water compared to the control group, and thus had an advantage in maintaining cell structure.


Participants with higher TP improvement showed an increased intake of animal proteins at the baseline: fish (p = 0.022), meat (p = 0.029), and egg (p = 0.009). OF exercises for improving TP were associated with higher animal protein intake at the baseline. This study has been registered with the UMIN Clinical Trials Registry (UMIN 000050292).Oral function (OF) decline in older people is associated with nutritional deficiencies, which increases frailty risk and the need for nursing care. We investigated whether the delivery of an oral function improvement program on a tablet device was as effective as delivery through a paper-based program. We also investigated the association between tongue pressure (TP) improvement and nutritional status at the baseline. The participants involved in the study were 26 community-dwelling older people with low TP, <30 kPa, aged ≥65 years, who were enrolled in a randomized controlled trial for a month in Itoshima City, Fukuoka, Japan. Oral and physical functions and body composition were measured at the baseline and at follow-up. Two-way analysis of variance revealed that body mass index ( Globally, the number of people aged 65 years was 703 million in 2019. Moreover, the aging population rate is accelerating, especially in Asian countries  × group [tablet-based group/paper-based group]) was performed to analyze the intervention effect, following the Wilcoxon signed-rank test.To investigate the association between increased improvement in tongue pressure and nutrition intake, the participants were classified into two groups: the low improvement (LI) group and the high improvement (HI) group by a median of 1.3 kPa of the increase in tongue pressure. Moreover, we analyzed the difference in the food group intake between the two groups using the Mann–Whitney U test to determine the relationship between the extent of tongue pressure improvement and food trends.p-value of <0.05 was considered statistically significant. IBM SPSS Statistics for Windows version 28.0.1.1  was used for the analyses.A As shown in p = 0.024), skeletal muscle mass (p = 0.029), and SMI (p = 0.032). No difference was detected in the pattern of change of interaction for any other item, which indicated that the trend of change was similar between the groups.p = 0.003), BMI (p = 0.004), maximum masticatory performance (p = 0.010), maximum tongue pressure (p = 0.035), and ODK /pa/ and /ka/ .Moreover, no significant difference was observed between the two groups, that is, the tablet group and the paper-based group, either at the baseline or at follow-up. The items in which the main effects of the intervention were observed included weight (In p = 0.022), meat (p = 0.029), and egg (p = 0.009), was significantly higher in the HI group than in the LI group. In addition, a significant difference in the intake of sugar and sweeteners was found (p = 0.029). Conversely, no significant difference was noted in the intake of cereals, potatoes, beans, green-yellow and other vegetables, fruits, milk products, fat and oil, and confectioneries.One of the aims of this study was to improve oral functions with home-based exercises in participants with low tongue pressure (<30 kPa). In this study, the program for oral function improvement included six exercises to promote masticatory muscle and performance and tongue and swallowing muscles at home. In this study, we provided oral function improvement programs through two means—tablet and paper—and compared the effectiveness of these two methods. Our results suggested that both the approaches were equally effective. Only a few intervention studies have provided the same content of exercises by different means. The present study showed that tongue pressure and tongue–lip motor function were improved statistically significantly, although no difference in exercise effectiveness was found between the two groups.This study showed that the proposed exercise program enhanced the maximum tongue pressure after the intervention. Moreover, the 17 participants with low tongue pressure (<30 kPa) exceeded the reference value and had normal tongue pressure after only a month. The results of our previous study  and thosThis study also showed that masticatory performance improved after the intervention. Our previous study revealed that the physical pre-frailty status of participants was significantly associated with masticatory performance . FurtherThis study revealed that the intake of animal proteins  was significantly high in the HI group. Adequate energy intake, especially proteins, was reported to be important in preventing frailty ,27. PrevA few studies have reported associations between dietary advice, nutritional status, and oral function. Suzuki et al. reported that using a new pair of complete dentures and following simple dietary advice increased protein intake . This suBecause the estimation of nutrient intake in BDHQ was based on the Standard Tables of Food Composition in Japan, the evaluation of BDHQ may not be applicable to other races. We have to take into account that some foods, such as matcha green tea, are not included in BDHQ . In addiThis study has some limitations. First, this intervention study might have selection bias because it was conducted in a populous area in Japan. Second, the participants were relatively healthy, and this study did not include people who could not go to the venue or go out because of malnutrition. Third, because the nutrition questionnaire used in this study was designed to examine food intake in the past month, this study did not include a nutrition survey at follow-up. Fourth, we did not examine the history of hospital visits, medical history, or medications of the participants. Therefore, the results of the physical assessment may be biased.The tablet-based oral function exercises used in this study were found to improve oral functions, including tongue pressure, in community-dwelling older people. This result was comparable to that of paper-based exercises. Individuals with greater tongue-pressure improvement had a higher intake of animal proteins at the baseline.