P < 0.001). In both HD and PD patients, dialysis staff played the most significant role as educators on the importance of exercise and enablers of exercise. The most important barriers to exercise were poor motivation and fatigue in both modalities. HD patients exhibited greater differences in HRQoL scales across two physical activity levels, compared to PD patients. Our study showed that the barrier to exercise and the enablers of exercise were poor motivation/fatigue and encouragement from dialysis staff, respectively.Data regarding the status of physical activity or understanding of the importance of exercise, such as barriers of exercise or enablers of exercise, in dialysis patients were insufficient. This study aimed to evaluate the status of physical activity and the understanding of the importance of exercise in Korean dialysis patients. The study participants were recruited from 27 hospitals or dialysis centers (n = 1611). Physical activity was evaluated using the Korean version of the International Physical Activity Questionnaire-Short Form. High physical activity was defined as ≥ 600 metabolic equivalent of task (MET). Knowledge about the importance of exercise, enabler for regular exercise, benefits of exercise, and barrier to exercise was evaluated. Health-related quality of life (HRQoL) was assessed by the Kidney Disease Quality of Life version 1.3. The number of participants in the hemodialysis (HD) and peritoneal dialysis (PD) groups was 1247 and 364, respectively. The intensity of physical activity did not differ between the two modalities. The time of physical activity was longer in HD patients than in PD patients, which resulted in greater MET values and the number of high physical activity. There were 762 (61.1%) HD patients and 281 (77.2%) PD patients who heard of the importance of exercise ( Most end-stage renal disease patients have undergone dialysis because of organ shortage2. High mortality and morbidity rates are observed in dialysis patients3. Advances in dialysis technologies can lead to improved long-term survival in dialysis patients. However, a uremic condition in dialysis patients is a well-known premature aging process4. Improvement in the long-term survival of dialysis patients increases exposure duration to a uremic condition, leading to an increased prevalence of physical disability5. This may result to another medical care burden.End-stage renal disease is an advanced stage of chronic kidney disease requiring renal replacement therapies such as hemodialysis (HD), peritoneal dialysis (PD), or kidney transplantation6. Therefore, knowledge about the importance of exercise to attenuate this problem has been addressed. Previous studies have evaluated knowledge about the importance of exercise in dialysis patients. A recent meta-analysis evaluated 21 randomized trials, and merged data showed that exercise improved the muscle mass and/or muscle strength7. However, all studies showed inconsistent results. Data regarding the current status of physical activity or understanding of the importance of exercise, such as barriers of exercise or enablers of exercise, in dialysis patients were insufficient. In addition, dialysis modality, region, or ethnicity can affect these associations, but there were insufficient data regarding dialysis modality and few data on Korean dialysis patients. This study aimed to evaluate the status of physical activity and the understanding of the importance of exercise in Korean dialysis patients.It is well known that the prevalence of physical disability in dialysis patients is higher than that in the general population8. Briefly, the study participants were recruited from 27 hospitals or dialysis centers in Daegu/Kyungsangpook-do between July and December 2012. In total, 2737 participants who received dialysis were included. Participants were excluded if they met the following criteria: age < 20 years (n = 12), history of hospitalization during the past 3 months except for vascular access problems (n = 351), dialysis duration < 6 months (n = 164), unable to walk with or without an assistive device (n = 79), lack of laboratory findings (n = 117), refusal to participate (n = 254), or unable to communicate with interviewer (n = 149). Finally, 1611 participants were ultimately included. This study was approved by the institutional review board of a tertiary medical center . Informed consent was obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.The study participants were initially enrolled in a previous study8. Briefly, demographic and laboratory data collected upon enrollment included the following: age, sex, body mass index , diabetes mellitus (DM), coronary artery disease (CAD), cerebrovascular disease (CVD), dialysis vintage (years), education level, and hemoglobin (mg/dL), blood urea nitrogen , creatinine (mg/dL), calcium (mg/dL), phosphorus (mg/dL), total cholesterol (mg/dL), serum potassium (mEq/L), intact parathyroid hormone , and high-sensitivity C-reactive protein  levels, dialysis modality (HD or PD), and type of dialysis or access (arteriovenous fistula [AVF] or arteriovenous graft [AVG] in HD patients and continuous ambulatory PD [CAPD] or automated PD [APD] in PD patients).The study variables have been previously describedDM was evaluated using three indicators: (1) a patient-reported history of DM, (2) the medical record of DM diagnosis or medication, and (3) a fasting glucose level ≥ 126 mg/dL. We evaluated all three indicators for all the patients and DM was diagnosed if one or more indicators among the three were positive. CAD was evaluated using two indicators: (1) a patient-reported history of angina, myocardial infarction, or congestive heart failure, and (2) the medical record for the presence of angina, myocardial infarction, or congestive heart failure. CVD was evaluated using two indicators: (1) a patient-reported history of stroke, and (2) the medical record for the presence of stroke. We evaluated all two sources of evidence for all patients and CAD or CVD were diagnosed if one or more among two indicators were positive.9. Briefly, physical activity was evaluated regardless if it was leisure or working. Total physical activity was calculated by metabolic equivalent of task (MET) values using the intensity and time of the physical activity. A 3.3 MET was identified for low-intensity physical activity such as walking, 4.0 MET for moderate-intensity physical activity such as moving lightweight materials or cycling in moderate speed, and 8.0 MET for vigorous-intensity physical activity such as aerobics, running, or cycling in high speed. Total MET values were calculated as the sum of MET values × time of physical activity (minutes/week). High physical activity was defined as ≥ 600 MET regardless of intensity or time of physical activity.Physical activity was evaluated using the Korean version of the International Physical Activity Questionnaire-Short FormAll participants were provided with the following questions: “Has the participant ever heard the importance of exercise?” The answer was either “yes” or “no.” If the participant answered “yes,” the next question was “Who told you of the importance of exercise?” The answers were physician, nurse, other dialysis patients, social or mass media, family, friend, nutritionist, social worker, or others. For all participants, the next question was “What is the enabler for regular exercise?” The answers were encouragement from physician; encouragement from nurse; encouragement from family, relatives, or friends; participation in a specialized exercise program; encouragement from other dialysis patients; or presence of an exercise facility.Further questions were evaluated according to the performance of exercise. If the participant exercised, the question was “What are the benefits of exercise?” The answers were mood, strength, overall vitality (VT), sleeping, confidence, blood pressure, doing the things that the patient wants for himself/herself, muscle cramping, intradialytic hypotension, or others. If the participant did not exercise, the question was “What is the barrier to exercise?” The answers were poor motivation, fatigue, lack of time to exercise, pain, uncertain on how to exercise, depressive mood, fear of injury, lack of equipment or place to exercise, or unsure about the importance of exercise. The answers were in multiple choices.10.We evaluated disability using four questions with regard to the activities of daily living to assess whether the participants currently needed help from another person to have a meal, dress/undress, get in or out of bed, or take a bath or shower. For each question, they answered one of three responses: “No help needed”; “Some help needed”; “Complete help needed”. Disability was defined as the inability to perform at least one of the four activities of daily living domains without help11: (1) I felt that everything I did was an effort and (2) I could not get going. Then the following question was asked: “How often did you feel this way?” The answer was rarely or none of the time, some or a little of the time, a moderate amount of the time, or most of the time. The participants answering moderate or most of the time to either or both of the two questions were identified as those experiencing exhaustion. A fall was defined as an event that resulted in a participant coming to rest unintentionally on the ground or a lower level with or without losing consciousness during the last 12 months12.Exhaustion was measured using two questions from the Center for Epidemiological Studies Depression (CES-D) Scale15. Components included slowness, poor endurance, physical inactivity, and unintentional weight loss. Slowness and poor endurance were determined by the physical functioning (PF) scale of the Short-Form-36 (SF-36)  and the VT scale of the SF-36 , respectively. Participants who were physically inactive were defined as inactive group . Unintentional weight loss was defined as unintentional body weight loss > 4.5 kg or 5% of the baseline value over the past year (1 point for weight loss). All points of scoring of each frailty component were summed. Those participants who scored with ≥ 3 points were defined as having frailty. Cut-off values for PF, VT, or weight loss were defined from the Cardiovascular Health Study, Women’s Health Initiative Observational Study, and the Dialysis Morbidity and Mortality Study Wave 215. These studies diagnosed frailty using items on the SF-36. Previous studies used a cut-off value dichotomized at the 25th percentile of PF or VT. The cut-off of PF was highly associated with slow walking speed and that of VT was associated with poor endurance. Therefore, 75 < PF and 55 < VT were used to identify slowness and poor endurance, respectively. In addition, the Cardiovascular Health Study and Women’s Health Initiative Observational Study defined unintentional weight loss as the loss of > 10 pound (4.5 kg) over the past year, or more than 5% of the body weight in the previous 2 years. Therefore, we used a similar cut-off value for unintentional weight loss.Frailty was defined using the modified criteria previously described elsewhere16. KDQOL version 1.3 includes the SF-36 scale (36 items) and kidney disease-specific scale (11 items). The SF-36 scale includes the following eight domains: PF, role limitations due to physical health problems (RP), body pain, general health, VT, social functioning, role limitations due to emotional problems (RE), mental health (MH), and overall health rating. A total score of 0–100 is calculated for each domain. A low score means a low HRQoL. These scales have been used to calculate the physical component scale (PCS) and mental component scale (MCS)18. The 11-item kidney disease-specific scale consists of symptoms/problems, kidney disease effects, kidney disease burden, work status, cognitive function, quality of social interaction (QSI), sexual function, sleep, social support, patient satisfaction, and dialysis staff encouragement.Health-related quality of life (HRQoL) was assessed by the Kidney Disease Quality of Life (KDQOL) version 1.3 Korean versiont-test. For continuous variables with non-normal distribution, values were compared using Kolmogorov–Smirnov z test. Categorical data was expressed as numbers (percentage) and Pearson’s χ2 or Fisher’s exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the impact of the dialysis modality for high physical activity. Multivariate analysis was performed using the analysis of covariance or logistic regression analysis and adjusted for age; sex; BMI; DM; CAD; CVD; serum albumin, BUN, creatinine, total cholesterol, i-PTH, and hs-CRP levels; and dialysis modality (PD or HD) or type of dialysis or access . The level of statistical significance was set at P < 0.05.Data were analyzed using the statistical software SPSS version 25 . Categorical variables were expressed as both counts and percentages. Continuous variables were evaluated for the distributional assumption of normality using Kolmogorov–Smirnov test. Continuous variables are expressed as mean ± standard deviation for those with normal distribution and median (interquartile range) for those with non-normal distribution. For continuous variables with normal distribution, means were compared using Student’s The number of participants in the HD and PD groups was 1247 and 364, respectively (Table P = 0.409). The time of physical activity was 30 (120) minutes in HD and 30 (87.5) minutes in PD patients, respectively (P = 0.014). The MET value was 90 (360) in HD and 90 (270) in PD patients, respectively (P = 0.021). The two groups had different distributions in time of physical activity and MET. The number of HD or PD patients with high physical activity was 140 (11.2%) and 20 (5.5%), respectively (P = 0.001). The proportion of patients with high MET was greater in HD patients than in PD patients. Multivariate analysis-adjusted covariates showed that MET values in HD and PD patients were 325.1 ± 1.1 and 241.8 ± 1.1, respectively (P = 0.002). Multivariate linear regression analyses showed that old age, female sex, and high BMI levels were inversely associated with MET levels , 427 (34.2%), 219 (17.6%), and 34 (2.7%) in HD patients and 161 (44.2%), 135 (37.1%), 63 (17.3%), and 5 (1.4%) in PD patients, respectively (ls Table . High BUP = 0.002). The odds ratio for high physical activity in HD patients was 3.01 (1.64–5.54) compared to that in PD patients on multivariate analysis (P < 0.001). In addition, multivariate logistic regression analysis showed that those are old in age was associated with lower odds ratio for high physical activity. Those that have high serum albumin, creatinine, or total cholesterol, and undergo HD, were associated with higher odds ratio for high physical activity.Logistic regression analysis showed that the odds ratio for high physical activity in HD patients was 2.18 (1.34–3.53) compared to that in PD patients (Table P < 0.001), 421 (33.8%) in HD and 136 (37.4%) in PD (P = 0.204), 225 (18.0%) in HD and 60 (16.5%) in PD (P = 0.493), and 347 (27.8%) in HD and 124 (34.1%) in PD (P = 0.021), respectively. Table The numbers of patients with disability, frailty, fall, or exhaustion were 195 (15.6%) in HD and 109 (29.9%) in PD (P = 0.451). MET values in CAPD or APD patients were 90 (270) and 90 (310), respectively (P = 0.385). There was no significant difference in the proportion of high physical activity and MET values between CAPD and APD.The numbers of PD patients who had undergone CAPD or APD were 196 (53.8%) and 89 (24.5%), respectively. There were no data for PD modality in 79 patients (21.7%). The numbers with CAPD or APD performing high physical activity were 9 (4.6%) and 6 (6.7%), respectively (P < 0.001). In both HD and PD patients, dialysis staff (physician and/or nurse) played the most significant role as educators on the importance of exercise and enablers of exercise (Table There were 762 (61.1%) HD patients and 281 (77.2%) PD patients who heard of the importance of exercise  or distance to the HD facility can be associated with physical activity, and physical activity can also influence the selection of dialysis modality, HD facility, or the traveling method. However, our study did not include the data regarding traveling method or interval between home or workplace and HD facility. Additional studies using these data would be useful in identifying the association between these variables.In our study, more PD patients recognized the importance of exercise than HD patients. However, HD patients had more time for physical activity than PD patients, but the intensity of physical activity was similar in both modalities. Clinical practitioners or patients may misunderstand that HD patients consume more time for dialysis than PD patients. However, in Korea, most HD patients have undergone HD in a dialysis facility adjacent to their home or workplace, and a number of PD patients have selected the PD modality due to limitation of access to a dialysis facility such as a distant HD facility20. They compared two groups, one with low and the other with high physical activity. Although the most commonly reported barrier to exercise was fatigue, statistical significance was not achieved using multivariate analysis. Lack of motivation, many medical problems, and not having enough time, a safe place to exercise, or an exercise partner were significantly associated with low physical activity. An integrative review study was performed using data from 14 studies regarding data for barriers to exercise in chronic kidney disease21. Although questionnaires regarding barrier to exercise were inconsistent and the patients’ reports on barriers were complex and diverse, the most frequently identified barrier was fatigue or lack of energy. Further, studies evaluated barriers to exercise or physical activity, but certain limitations remained. First, most of the studies had a relatively small sample size between 22 and 269 (the median sample size from 14 studies was 88). Second, most studies focused on HD patients alone. The 12 of 13 studies using dialysis patients were performed using HD patients alone and a total sample size of 1 study using both HD and PD patients consisted of only 78 responses (including 19 from PD patients). Third, 7 of 14 studies were carried out on multiple ethnicities, 2 studies evaluated only a single ethnicity, and 5 studies did not present ethinicity as a variable. Although multiple ethnicities might be useful in studies in terms of generalizability, this may be confounding element in small sample size studies. Our study enrolled both HD and PD patients and had both a large sample size and a single ethnicity . Our results showed that poor motivation and fatigue were most common barriers to exercise in HD patients (similar results compared to previous results) and same trends were also observed from PD patients.Delgado et al. investigated the recognition to exercise in 100 HD patients25. In our study, almost all scales associated with physical health and MH were greater in HD patients with high physical activity than in those without high physical activity. Dialysis patients also understood the impact of exercise on mood, strength, or VT. For the kidney disease-specific scale, symptoms/problems, cognitive function, and QSI were greater in HD patients with high physical activity than in those without high physical activity. However, there were no statistically significant differences in PD patients with high physical activity compared to in those without high physical activity (except body pain). Two issues may be associated with this non-difference. Sustained peritoneal dialysate in the abdomen can attenuate the impact of physical activity on some physical health/MH scales or the kidney disease-specific scales, and a small number of PD patients on high physical activity also led to statistical non-significance. In addition, disability, frailty, fall, or exhaustion was greater in HD patients without high physical activity than in those with high physical activity. Moreover, in PD patients, frailty alone differed between the two groups. However, trends for disability, fall, or exhaustion were similar with the results from HD patients.Although there are few high-quality studies regarding the association between exercise and HRQoL scales in dialysis patients, many clinical practitioners suggest that exercise can improve both physical health and MH26. In our study, all dialysis patients were ambulatory and medically stable. Therefore, only a few patients had difficulty in exercising due to a medical problem such as shortness of breath, except pain.In our study, clinical symptom was not an important barrier to exercise. Moorman et al. showed that the barrier to exercise was excessive tiredness or weakness or shortness of breath8. In addition, our study was analyzed using data collected at approximately 10 years ago. Many factors, including patients’ characteristics, social, or environmental conditions at onset of data would be different compared to those using recent patients, which may lead to different results. In addition, social, educational, cultural, and environmental factors can influence outcomes related to physical activity, quality of life, and awareness of the need for exercise. However, we did not perform analyses using these data. Second, the present study did not include data from physical performance measurements as an accurate indicator, and the presence of physical activity and understanding of the importance of exercise were evaluated using questionnaires alone. In addition, our data did not include the data regarding bicarbonate, Kt/Vurea, and dialysis treatment adherence and we did not perform a multivariate analysis including these variables. Our results were evaluated without adjusting these variables as possible confounding factors. Current guidelines recommend Kt/Vurea ≥ 1.2 for HD and weekly Kt/Vurea ≥ 1.7 for PD28. Previous data from a representative sample of Koreans showed that the proportion of patients with inadequate HD was 8.5%29. Mean weekly Kt/Vurea for PD was 1.9 ± 0.8 in Korea and a significant portion of PD would be adequate2. Most of the patients from our study may be undergoing adequate dialysis and these may attenuate the effects on physical disability or activity resulting from significantly inadequate dialysis. Third, our study, as a cross-sectional analysis, did not evaluate the causal relationship between physical activity and outcome measurements such as HRQoL scales, disability, frailty, fall, or exhaustion. Fourth, high physical activity was defined as participants ≥ 600 MET, and the number of participants with MET values ≥ 3000, which was classified as a high amount of physical activity, was only 5 (0.4%) in HD patients and 0 in PD patients. Therefore, we did not evaluate the impact of the amount of physical activity. Fifth, exhaustion in our study was defined using two of 20 questions from the CES-D scale for the diagnosis of depression. These 2 questions were classified as indicators of somatic activity30. Evaluation of exhaustion using two questions saves time and is simple. These are originally derived from a questionnaire for the diagnosis of a depressive mood and may not accurately reflect an experience of physical exhaustion. However, Vestergaard et al. evaluated the presence of exhaustion using two questions and observations of physical functioning31. They demonstrated that there was a positive association between the presence of exhaustion and physical activities, including handgrip strength, gait speed, disability, and a short physical performance battery. In addition, Fried et al. used these two questions as a component in their diagnosis of frailty14. A prospective study including additional parameters such as physical performance measurements and interventions for exercise is warranted to overcome these limitations.The present study had a few limitations. First, it had a retrospective design and used data on participants enrolled in a previous studyIn conclusion, our study showed that the barrier to exercise and the enablers of exercise were poor motivation/fatigue and encouragement from dialysis staff, respectively. The frequent contact with medical staff in a HD facility may be associated with a greater amount of high physical activity in HD patients than in PD patients.Supplementary Tables.


Group V rats were treated in the same way as the DOX group also, left for one week without medication, and then injected with MSC+HPE. A significant decrease in serum testosterone, FSH, and LH levels was observed in rats treated with DOX compared to the control group. A significant elevation was recorded in rats treated with DOX+MSC or DOX+HPE when compared with the DOX group only. Rats that were given MSC+HPE after DOX intoxication showed a significant increase in hormone levels when compared to rats treated with either MSC or HPE. Light and electron microscopic examinations revealed that DOX intoxication initiated degenerative and necrotic changes in seminiferous tubules associated with partial or complete cessation of spermatogenesis. These effects were reversed by the effect of MSC or HPE. Coadministration of MSC and HPE even showed further improvement. Finally, we can say that doxorubicin has a deleterious impact on rat testes; however, therapeutic effects can be induced through MSC and/or HPE administration.Oncotherapeutics like doxorubicin can affect male gonads; as a result, it leads to infertility. This work was conducted to demonstrate the toxic effects of doxorubicin on testes of male albino rats. Fifty male albino rats aged 5-7 weeks were used in this study. The animals were randomly separated into 5 sets (each set containing ten rats). Group I received saline (i.p.) for 4 weeks. Group II was given doxorubicin (DOX), 5 mg/kg BW (i.p.) once/week for 4 weeks. Groups III and IV were treated in the same way as the DOX group, left for one week without medication, and then injected with mesenchymal stromal cells (MSCs) or human placental extract (HPE) therapy in a single dose of 5 × 10 Oncotherapy includes systromalatic administration of agents that have cytotoxicity on cells . Most ofMale albino rats (200-220 g) were 5-7 weeks old (mature) and were obtained from the Laboratory of Schistosome Biological Supply Program (SBSP), Theodor Bilharz Research Institute. The study was conducted at the Stem Cell Research Laboratory at Faculty of Science, Al-Azhar University, Nasr City, Cairo, Egypt. Animals were housed in animal houses under controlled conditions (12 hrs light) at room temperature and were fed a standard diet. Animal care and housing are in accordance with the Guide for Care and Use of Laboratory Animals.27H29NO11, molecular weight: 543.525 g/mol), purchased from Sigma-Aldrich Corporation .Doxorubicin is a red-orange powder; its brand name is Adriamycin . Cyclo-trans-4-L-hydroxyprolyl-L-serine  is isolated from hydrolysates of placental extract.Other chemicals and reagents used in this study are as follows: thiopental sodium 500 mg ; sodium heparin; Dulbecco's low glucose modified Eagle's medium ; antibiotic-antimycotic ; Ficoll-Paque 1.077 g/mL ; Minimum Essential Media (MEM) ; penicillin 100 mg/mL of streptomycin 100 units/mL ; L-glutamine (Gibco/BRL); phosphate-buffered saline (PBS); trypsin/EDTA; trypan blue; and NaCl 0.9% .μm cell strainer. In a cell strainer, the fragments of bone were washed by mixing them with an added 10 ml of buffer and letting the remains relax for 3-4 minutes. Filter wash via 70 μm sieves that connect to the cells previously collected.MSCs were isolated according to a protocol modified from . Flushing (~1200 rpm) and 4°C for 10 min with the brake on; the supernatant was discarded, and the pellet was resuspended in 10 mL of DMEM.The cell suspension was homogenized by pipetting up and down and then centrifuged at 300 × 6 cells/ml. Incubation with primary antibodies  was followed by exposure to the secondary conjugated antibody at 4°C for 30 min, and the complex was analyzed by flow cytometry.The cells were subcultured twice to have a number of cells for characteristics and cell therapy. Cells in passage no. 3 were collected and counted using a hemocytometer. They were cryopreserved through the conventional method by dimethyl sulfoxide until use. After that, the cells in a fresh medium were cultured and subcultured. The cultured cells were suspended in cold DPBS at the dilution of 106 in 200 ml PRP/week for 4 weeks via the caudal vein [μl placental extract/week for 4 weeks via the caudal vein [6) in 200 μl PRP+placental extract (40 μl) in a single dose/week for 4 weeks via the caudal vein. The treatment protocol was designed to start MSC and HPE one week after the last DOX injection to ensure adequate elimination of DOX from rat bodies so as to not damage introduced stromal cells with its cytotoxic action [Fifty male rats were divided into five groups consisting of ten animals in each group. Group I (control group) rats received 0.1 ml/day saline (i.p.) for 4 weeks. Group II (DOX group) received 5 mg/kg BW (i.p.) of doxorubicin (DOX) once/week for four weeks to reach a cumulative dose of 20 mg/kg . Group Idal vein . Group Idal vein . Group Vc action , 43. Thec action .Blood samples (5 ml/rat) were withdrawn by cannulation via the jugular vein by adapting the technique of . CollectSerum samples were stored at −70°C until use. Levels of LH, FSH, and T were measured in serum using RIA kits according to the manufacturer's protocol.μm) were stained with hematoxylin and eosin [An automated tissue processor was used to process the formalin-fixed testes. The processing began with two steps (fixation and dehydration): fixation: tissues were immersed in 10% buffered formalin for 48 hours, then washed in distilled water for 30 minutes to remove the fixative; and dehydration: the tissues were dehydrated by putting them through a graded series of alcohols . The tissue was first subjected to 70% alcohol for 120 minutes, then to 90% alcohol for 90 minutes, and finally to absolute alcohol, each for one hour. After dehydration, the samples were cleared in several xylene changes. It consisted of immersing the fabric in a mixture of 50% alcohol and 50% xylene for one hour, followed by an hour and a half of pure xylene. The samples were then embedded and masked after being impregnated with molten paraffin wax. Paraffin sections .The fresh tissue was primarily fixed by immersion in 2.5% glutaraldehyde, then secondarily fixed by immersion in 1% osmium tetroxide, and then washed in 0.1 M cacodylate buffer. Fixed and washed samples were dehydrated by increasing alcohol content. The absolute alcohol was replaced by propylene oxide. Dehydrated samples were penetrated with the resin mixture via a tiered series in glass vials with polypropylene caps and then transported to an oven.μm thick) were cut with glass knives and stained with toluidine blue. Ultrathin sections (50-80 nm thick) were cut with glass knives, and the sections floated on the water surface, which was recorded on copper grids. The sections were double-stained in uranyl acetate then by lead citrate. Stained sections on grids were washed with 0.02 N NaOH followed by distilled water and left on filter paper in a petri dish [The mounting blocks were trimmed with razor blades using an ultramicrotome. Semithin sections . Cells after examination showed CD45 to be negative while CD90, CD105, and CD166 to be positive , respectively, as shown in p < 0.05) in serum testosterone, FSH, and LH levels in rats treated with DOX, compared to the control group. In contrast, rats treated with DOX+MSC and DOX+HPE showed a significant increase (p < 0.05) when compared with intoxicated groups. DOX+MSC+HPE-treated rats showed a significant increase (p < 0.05) as compared to rats treated with DOX in addition to MSC or HPE , while no significant indication for G5 when compared with the control group. However, the S. epithelial height in rats of G4 and G5 was not statistically different (p > 0.05) with the normal control group. But the seminiferous epithelial height in the group treated with doxorubicin (G2) showed a markedly significant decrease (p > 0.05) when compared to the control group (G1). Finally, the interstitial space diameter of the rats in G2 and G3 was significantly elevated compared to the control group (p < 0.05) (Figures  Figures –9.DOX administration affected testicular ultrastructure; testes demonstrated marked thickening of the basement membrane and complete disappearance of spermatogonia with the presence of Sertoli cells, a few mitochondria, electron-dense bodies, apoptotic spermatocytes, myofilaments, and irregular ill-distinct vacuoles. Marked necrosis and apoptosis of deformed spermatozoa, spermatocytes and spermatids, multiple macro- and microvesicles, a few electron-dense bodies and mitochondria, early apoptotic spermatogonia and Sertoli cells, and shrunken myoepithelial cells were characteristic. Some sections revealed the disorganized basement membrane of the seminiferous tubules, the marked necrosis and apoptosis of the spermatocytes and spermatids, and the presence of vesicles and electron-dense bodies  as compaα, and cyclooxygenase-2 in lipopolysaccharide-stimulated RAW264.7 macrophages [DOX caused toxicity in germ cells by triggering oxidative stress and apoptosis . Previourophages . In our In conclusion, the current study indicated that DOX carries the risk of severe testicular damage. The addition of MSC and HPE can provide a marked therapeutic effect which may draw attention that these agents can be used as a potential therapeutic adjuvant that could protect testicular tissue from DOX-induced testicular toxicity.


The diagnosis and treatment of patients with bronchiectasis and nontuberculous mycobacterium (NTM) pulmonary disease are challenging issues and the treatment is also prolonged and depends on the species. There is limited information on patients with bronchiectasis and NTM pulmonary disease in Mainland China.This cross-sectional study was conducted at the China–Japan Friendship Hospital, Beijing, China. Those adult patients who met the diagnostic criteria for bronchiectasis and obtained a culture result of mycobacteria from lower respiratory tract specimens or lung tissue were included in this study. A logistic regression model was used to identify the related factors in patients with NTM pulmonary disease.Mycobacterium avium complex was the most common species (66.0%), and 72.3% of them were initiated on standard anti-NTM treatment within 3 months after the diagnosis of NTM pulmonary disease. A larger proportion of patients with NTM pulmonary disease had acute exacerbations of ≥ 3 times within 1 year and were diagnosed bronchiectasis ≥ 50 years among patients with NTM pulmonary disease. The HRCT chest images revealed higher proportions of nodular shadow (100% vs. 35.3%), tree-in-bud sign (97.9% vs. 29.0%), cavities (29.8% vs. 5.8%), and airway dilation of the right middle lobe or the left lingular lobe (63.8% vs. 23.9%) in patients with NTM pulmonary disease than in those without NTM pulmonary disease . The multivariable logistic regression model indicated that three and more abnormal features  and main lesions of bronchial expansion in the middle or lingual lobe  in HRCT chest images were independently associated with NTM pulmonary disease .A total of 202 patients with bronchiectasis from 19 cities, 155 without and 47 (23.3%) with NTM pulmonary disease, were included. In all the 47 patients with NTM pulmonary disease, In a single center of Mainland China, > 23% of patients with bronchiectasis had NTM pulmonary disease, and most patients were started on standard treatment within 3 months after the diagnosis of NTM pulmonary disease. These findings suggest that patients with bronchiectasis should be thoroughly examined for the presence of NTM pulmonary disease.NCT03594032. Pseudomonas aeruginosa has been associated with worsening lung function, increased frequencies of acute exacerbations, and poor prognosis [Aspergillus fumigatus in the airways of patients with bronchiectasis is associated with risks for severe disease, worse lung function, and acute exacerbations [Bronchiectasis of noncystic fibrosis origin or noncystic fibrosis bronchiectasis is a chronic structural lung disease characterized by recurrent episodes of lung infection . The colrognosis , 4–6. Thrognosis . Detectirbations . Over thrbations –13.Mycobacterium tuberculosis complex, and M. leprae, are widely distributed in natural environments. More than 190 species of NTM have been discovered, of which only a few are pathogenic and conditional pathogens [Mycobacterium avium complex (MAC) have a higher risk for death [NTM, mycobacteria other than the athogens . The humathogens , 16. Theathogens . The 5-yathogens . Currentathogens , 19. In athogens –22. Althathogens , 24. PatThe relationship between bronchiectasis and NTM pulmonary infection is complicated. It is well known that NTM infection can cause bronchiectasis. In recent years, accumulating evidence has confirmed that NTM infection can cause severe bronchiectasis –27. HoweTherefore, we conducted this cross-sectional study to evaluate the prevalence, clinical characteristics, and treatment status of patients with NTM pulmonary disease, to evaluate their clinically predictive significance, and to provide evidence for the management of bronchiectasis with NTM pulmonary disease.This cross-sectional study was conducted at the China–Japan Friendship Hospital in Beijing, China, from August 2018 to December 2020. Patients were included if they met the following inclusion criteria: (1) age ≥ 18 years, (2) diagnosed with bronchiectasis according to the 2010 British Thoracic Society guideline for non-CF bronchiectasis , and (3)Details regarding age, height, weight, smoking status, marital status, medical history, comorbidity, drug use, and treatment were self-reported and recorded. The characteristics of sputum among patients with previous acute exacerbations were also self-reported and recorded. All the included information and data were independently collected by two physicians separately and subjected to a consistency test to check the discrepancy of the recorded information.Nontuberculous mycobacterial pulmonary disease (NTM-PD) was diagnosed according to the 2007 American Thoracic Society guideline for Nontuberculous Mycobacterial Lung Disease  and NTM The duration of bronchiectasis diagnosis was calculated as the duration between the time of enrollment (year) and the diagnosis time of bronchiectasis (year). The time of bronchiectasis diagnosis was defined as the time for the patient to be first diagnosed with bronchiectasis by physicians according to symptoms and imaging findings (chest CT or chest radiograph).The etiology of bronchiectasis was determined if the patient met any one of the following conditions: (1) postinfection: a definitive history of tuberculosis or measles pneumonia or a history of hospitalization due to lower respiratory tract infection or a first diagnosis of bronchiectasis with NTM infection; (2)immunodeficiency: a decrease in blood immunoglobulin level confirmed by twice laboratory tests within 2 weeks; (3)idiopathic: without specific causes or without tests performed to screen for the causes; and (4) others: history of COPD or rheumatoid diseases.P. aeruginosa), radiological (number of infected lobes), and clinical syndromes . Based on the total FACED score, we divided the patients into the following three grades: mild bronchiectasis , moderate bronchiectasis , and severe bronchiectasis . The bronchiectasis severity index is a scale that evaluates the severity and prognosis of noncystic fibrosis bronchiectasis through the following nine related variables [P. aeruginosa along with other microorganisms, and radiological extension.The modified Medical Research Council (mMRC) dyspnea scale, the FACED score, and the bronchiectasis severity index were evaluated by professional physicians under the standard operation procedures. The mMRC dyspnea scale is a 5-point (0–4) scale used to evaluate dyspnea, disability, and functions, which is rated for the following five categories: grade 0/1 (patient does not experience dyspnea except on intensive exercise), grade 1/2 , grade 2/3 , grade 3/4 , and grade 4/5 (being too breathless to leave the house or to undress themselves). The FACED score evaluates the severity and prognosis of noncystic fibrosis bronchiectasis according to the following five characteristics of patients : lung fuariables : age, boBronchiectasis was diagnosed based on the evaluation of chest high-resolution computed tomography (HRCT) images if any one of the following criteria was met : (1) broAll microbiological examinations of specimens collected from the lower respiratory tract, including smears using standard methods, bacterial culture, fungal culture, acid-fast bacilli smears, and mycobacterial liquid culture, were conducted at the Clinical Microbiological Laboratory of the China–Japan Friendship Hospital, Beijing. The automated BACTEC MGIT 960 mycobacteria culture system was used, and the NTM species were identified by PCR-reverse dot blot.t-test for two independent samples. Categorical variables were expressed as frequency and percentages, and the chi-square test or Fisher’s exact test was used to compare the frequencies between two groups. Both univariate logistic regression models and multivariable logistic regression models were used to evaluate the relationship between the conditions of NTM. For the multivariable model, variables, including age, gender, BMI, age at diagnosis of bronchiectasis (≥ 50 and < 50 years), times of bronchiectasis exacerbations in the previous year (≥ 3 and < 3 times), HRCT-based bronchiectasis involving bilateral lungs, HRCT-based branch expansion main lesions in the middle or lingual lobe, and HRCT-based ≥ 3 abnormal imaging features, were selected and included into the model using a stepwise method.Continuous variables with normal distribution were expressed as mean ± standard deviation and analyzed by All statistical analyses were conducted using the SPSS21 software . A two-tailed P value of < 0.05 was considered to be statistically significant.M. abscessus/M. chelonae-PD). MAC comprised the most common species (66.0%), followed by the M. abscessus/M. chelonae complex (27.6%) and then M. kansasii (6.4%)  Table . There w%) Table .Fig. 1StThe majority of demographic characteristics, including smoking status, past medical history, and most comorbidities, were similar between patients with NTM infection and those without NTM infection  Table . CompareP values > 0.05). Compared with non-NTM infectious patients, a greater proportion of patients with NTM infection tended to have acute exacerbations of ≥ 3 times within 1 year . Those with NTM infection tended to be of older age with a diagnosis of bronchiectasis, and based on a diagnosis age of ≥ 50 years, there were 74.5% of patients with NTM and 56.8% of patients without NTM (P = 0.029). The results of spirometry showed that 185 patients (91.6%) had lung function results (FEV1%) within 6 months of enrollment, whereas a nonstatistical difference was observed between patients with NTM pulmonary disease and those without NTM pulmonary disease , and the positive isolation rates of other bacteria and fungi were also similar , and among the 30 patients with NTM infection, 8 did not provide sputum specimens. The proportion of BALF specimens were similar between patients with and without NTM pulmonary disease, Among all positive patients, 20 showed NTM-positive results in both sputum and BALF specimens, and 2 showed NTM-negative results in sputum specimens but NTM-positive results in BALF specimens. The specimens collected from the lower respiratory tract of all patients were examined using bacterial and fungal cultures. The positive isolation rate of Patients with NTM pulmonary disease showed higher proportions of nodular shadow 100% vs. 35.3%), tree-in-bud sign (97.9% vs. 29.0%), and cavities (29.8% vs. 5.8%) and more than three abnormal imaging features (89.4% vs. 21.3%) than those without NTM pulmonary disease . Patients with NTM pulmonary disease had greater proportion of airway dilation of the right middle lobe or the left lingular lobe  and less proportion of lower lobe airway dilation   but not in the multivariable logistic regression model .We used univariable and multivariable logistic regression models to evaluate the possible associated factors and found that more than three thoracic HRCT abnormalities of imaging features and bronchiectasis main lesions in the middle or lingual lobe were independently associated with NTM pulmonary disease among all patients with bronchiectasis , and their ORs were 33.8 (95% CI 11.1–102.8) and 6.4 (2.4–16.6), respectively  were initiated on standard anti-NTM treatment. Nodular bronchiectasis was identified as the primary feature on the HRCT images of patients with bronchiectasis with NTM pulmonary disease. Chest HRCT scans revealed that three and more abnormal imaging features  or bronchiectasis main lesions in the middle or lingual lobe were independently associated with NTM pulmonary disease. Our findings suggest that it is necessary to clearly consider the presence of NTM pulmonary disease and better management strategies in patients with bronchiectasis.


There is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP).Cohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 . Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery .The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus . Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.2The online version of this article (10.1007/s00405-020-06398-6) contains supplementary material, which is available to authorized users. Peripheral facial palsy (FP) is a most common cranial nerve damage presented to otolaryngologists, neurologists, general practitioners, pediatricians. The most frequent diagnosis for FP remains idiopathic FP  , i.e. a In contrast, less is known on the outcome of non-idiopathic FP. Temporal bone fractures and facial wounds are a common cause for traumatic FP  due to geniculate ganglionitis by reactivation of Varicella Zoster Virus (VZV) is another common diagnosis of non-idiopathic peripheral FP. Outcome is much worse than in Bell palsy [–7% due tAcute otitis media, cholesteatoma and necrotizing otitis externa can also cause FP . An impoBeginning with 2007, the diagnostic and therapeutic procedures including a standardized therapy regime for all patients with acute FP were conformed in the Departments of Otorhinolaryngology and Neurology of Jena University Hospital, Germany. A prospective data registration of these patients was started. In the present study, we analyzed the recovery rates for the different causes and identified prognostic factors of complete recovery.The institutional ethics committee approved the study protocol for a data collection of routine and anonymized hospital data.A standardized prospective data collection was started in 2007 in the Departments of Otorhinolaryngology and Neurology of Jena University Hospital, Germany. The present study focused on patients with non-idiopathic peripheral FP in the acute phase. All patients received an otorhinolaryngologic examination including ultrasound of head and neck and a neurological examination. Laboratory tests included serum and cerebrospinal fluid (CSF) and were analyzed for IgM and IgG antibodies against borrelia, varicella zoster virus (VZV), herpes simplex virus (HSV) using enzyme-linked immunosorbent assays (ELISA).3, CSF/serum index > 1.5.In case of a positive borrelia ELISA, a borrelia IgM and IgG line immunoblot assay was performed. Two or more diagnostic criteria were needed to fulfill the diagnosis of Lyme borreliosis: Recent erythema migrans, borrelia antibodies in serum or CSF, CSF pleocytosis > 5 WBC/mmThe presence of mucocutaneous vesicles in the external auditory canal, on the tympanic membrane or on the base of the tongue, or IgM or IgA antibodies against VZV or HSV detected in serum qualified for classification as virally associated FP.Eight hundred and six patients (805) patients with peripheral FP were admitted between January 2007 and December 2017, i.e. within a period of 11 years. One hundred and seventy-three patients (173), presenting for the first time after > 2 months after onset, were excluded. All patients with Bell´s palsy (368) were excluded. A causal origin was already known or could be found in 264 patients. These patients were included in this study.All patients were hospitalized. Treatment followed the underlying disease and the German guideline for the treatment of FP . As sympOn the day of first presentation, the FP was graded by the admitting physician according to the House-Brackmann (HB) six-point facial grading system , and alsThe electrodiagnostic tests to evaluate the facial motor function are described in detail elsewhere . BrieflyThe other facial nerve function tests were categorized as follows: Ipsilateral stapedius reflex test normal (yes/no); complete loss of gustatory function on ipsilateral side using three-drop-test (yes/no); lacrimal function by Schirmer test (< 10 mm/ ≥ 10 mm); vestibular function represented by normal caloric stimulation (yes/no), and pure tone audiometry for hearing test .Follow-up examinations included always an otorhinolaryngologic and an EMG examination. Two physicians examined all patients. The first follow-up examination was performed after 6 weeks and then every 3 months until complete recovery. In case of incomplete recovery, recovery with defective healing, the patients were followed in 3-month intervals until pathological spontaneous activity disappeared and/or the patients did not show any improvement for further 3 months.p < 0.05.If not indicated otherwise, data are presented with mean values ± standard deviation (SD). All statistical analyses were performed using IBM SPSS, version 25. Primary outcome criterion was complete recovery of non-idiopathic FP defined as a grade I on the HB scale indicating normal facial function. Kaplan–Meier curves were constructed to calculate the probability of complete recovery over the time Fig. . The prop = 0.016), i.e. the highest rate of severe cases. In connection with this, traumatic FP was associated more often with pathology spontaneous activity in the first EMG examination  and less often with voluntary activity in the first EMG examination (58.8%) in comparison to the other reasons . There was no significant side predominance (48.1% right and 51.9% left side). Two-thirds were classified at baseline to have an incomplete palsy (59.5%) and one-third a complete palsy (31.4%). The median score on HB scale at baseline was III. The median Stennert indexes at rest and during voluntary activity at baseline were 2 and 4, respectively. 17% of the patients had a diabetes mellitus. The most often reason for a non-idiopathic FP was a herpes zoster oticus (36.4%). FP was occurred after surgery in 25.4%  of the cases. Lyme disease (11.7%), otogenic reasons (7.2%), trauma (6.4%) and other diagnoses (12.9%) were other reasons for non-idiopathic FP (Table p = 0.038) than in other causes. Patients with otogenic FP were younger  than the others .On average, House-Brackmann scale and the Stennert index at rest improved after the mean follow-up time of 9.6 ± 18.0 months (p = 0.001), higher initial Stennert index in motion (p = 0.002), no voluntary activity in first EMG (p < 0.0001) and the some causes of FP (p < 0.0001) were negative predictors for complete recovery (Table S2).The median recovery time was 5 months. 39.8% showed a complete recovery, 32.2% a partial recovery and 9.8% no recovery, respectively (18.2% data missed). Higher initial House-Brackmann grading , whereas patients with FP after surgery and other reasons had a significant lower recovery rate .Patients with reactivation of VZV, Lyme neuroborreliosis or otogenic peripheral FP had a significant higher recovery rate . In 25.4% of the cases, FP was occurred after surgery. Lyme disease (11.7%), otogenic (7.2%), traumatic (6.4%) and other diagnosis (12.9%) were less frequently reasons. Traumatic reasons had a higher proportion of complete facial palsies (52.9%), associated more often with pathology spontaneous activity in the first EMG examination (35.3%) and less often with voluntary activity in the first EMG examination (58.8%). Furthermore, in traumatic FP the interval with onset of prednisolone therapy was longer (5.6 ± 6.2 days). After analysis the recovery time to normal facial function the onset of prednisolone therapy, the House-Brackmann scale at begin, the Stennert index in motion at begin, voluntary activity in first EMG and cause of FP had influence on the recovery time. Patients with infection with VZV, Lyme neuroborreliosis or otogenic peripheral FP had a significant higher recovery rate in comparison to non-idiopathic FP, whereas patients with FP after surgery and other reasons had a significant lower recovery rate. Lyme disease is associated with better and post-surgery cause with worse recovery rate.A strength of the study is the consequent registration of all new patients with non-idiopathic peripheral FP treated in one tertiary university hospital in a register with standardized data set since 2007. All cases were treated together by the department of otorhinolaryngology and the department of neurology in the Facial Nerve Center of the university hospital. Another strength is the comprehensive diagnostic work-up  including the most relevant electrodiagnostic tests and other tests originally used as topodiagnostic tests in the era before introduction of high-resolution radiologic imaging. As facial grading is subjective and has a limited reliability , it is iPatients were not treated within a randomized prospective clinical trial. Therefore, a selection bias cannot be ruled out. The duration of follow-up of the patients was variable. No defined times of investigation during the follow-up for all patients, like in a prospective clinical trial, were available. To overcome this limitation, Kaplan–Meier statistics were used to determine the probability of complete recovery over time.It is important to compare the outcome of non-idiopathic FP to the outcome of idiopathic FP: EMG evaluation for pathological spontaneous activity is in non-idiopathic FP and also in Bell`s palsy  an imporChang et al. analyzed the characteristics of patients with acute peripheral FP showing Varicella Zoster Virus DNA in saliva  and showJowett et al. demonstrated, that there was an association between corticosteroid use in acute Lyme disease associated FP and worse long-term facial function outcomes . In our Ping et al. analyzed possible prognosis factors of systemic steroid in managing traumatic facial nerve palsy after a blunt craniofacial injury retrospectively . The outEspecially early-onset FP after vestibular schwannoma surgery had a bad prognosis of recovery . In caseTraumatic reasons of non-idiopathic peripheral FP seem to be associated with severe disease histories. The higher proportion of diagnosis of degenerative axonal lesion could be one point of worse outcome. Furthermore, the late onset of prednisolone therapy could be another. Especially in case of traumatic reasons, a fast onset of prednisolone therapy and/or facial nerve decompression by surgery should be considered. It would be worthwhile to analyze if patients with worse prognosis would profit from an intensified therapy (higher prednisolone dose). The addition of the EMG result is very helpful to identify as early as possible the patients with high risk for incomplete recovery and development of synkinesis. Because of the functional and psychosocial impairments that might occur, these patients need early education about treatment options, and short follow-up visit intervals. Still many patients with facial synkinesis are undertreated. High-risk patients might profit from an early referral to a specialist center for facial nerve care .In our study infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.Supplementary file1 (DOCX 21 kb)Below is the link to the electronic supplementary material.


Rapid spread of COVID-19 forced the public to turn to community pharmacies as the most accessible points of primary healthcare, overloading pharmacy services. The objectives of this research were to detect and describe the changes in work environment of community pharmacists in Vojvodina during the state of emergency due to COVID-19 pandemic. Moreover, the COVID-19 pandemic effects on job related stress were assessed.Community pharmacists from Vojvodina completed an online questionnaire on work environment changes related to COVID-19 .Out of the 1574 licenced pharmacists in Vojvodina, 392 completed the survey. Workload increase, reported by 90.8% of pharmacists, was caused mostly by higher demand for safety equipment, antiseptics and disinfectants, dietary products and medicines. Most pharmacists (93.1%) considered pharmacy workflow to be more complex than before the pandemic. Clients’ behavior was described as less pleasant since the start of the pandemic by 67.6% of the community pharmacists. Many were concerned for their health and the health of their families (68.9%). Community pharmacists rated their stress levels higher if they i) were working in larger chains, ii) experienced clients’ behavior as less pleasant or/and iii) were concerned for their/their family health.Current research pointed out the need for a more robust healthcare system which would allow rapid introduction of new activities and roles for community pharmacists that could possibly decrease job-related stress. Legal steps to improve the work environment in community pharmacies are necessary and urgent in order to fully utilize their skills and knowledge.The online version contains supplementary material available at 10.1186/s12913-021-06327-1. Severe acute respiratory syndrome caused by coronavirus 2 (SARS-CoV-2) was first identified in December 2019 in China. The first case of COVID-19 in Serbia was reported on March 6, 2020. On March 11, 2020, the World Healthcare Organization (WHO) declared coronavirus disease (COVID-19) outbreak a global pandemic  causing In Serbia, state of emergency that was in effect from March 15 to May 6, 2020, affected many community pharmacies’ activities, from procurement to provision of pharmaceutical care, due to limited movement and imposed curfew. At the moment of submission of this article, there were 271,364 of registered cases of COVID-19 and 2380 death cases in Serbia , according to the official data . HoweverThe aims of this study were to detect and describe the changes in work environment of community pharmacists in the Autonomous Province of VojvodinaThis research was an observational, cross-sectional study, carried out in a sample of 392 pharmacists working in community pharmacies in Vojvodina in April and May 2020, during the state of emergency due to COVID-19 pandemic.A 36-items questionnaire was developed to assess the changes in work environment of community pharmacists during the COVID-19 pandemic  pharmacists currently working in community pharmacies in Vojvodina and 2) willing to participate in the study (eligibility criteria). It was clearly stated that answering “yes” was considered as a consent for their participation. Upon confirmation, the participants answered questions on general information, workload, workflow, interactions with clients, work conditions and personal perceptions of different aspects of their job. Skip logic was used to ensure participants get to answer only questions that are relevant to them according to their previous answers.According to the data of the Pharmaceutical Chamber of Serbia (PCS), there were 1574 registered pharmacists in Vojvodina licenced for work in community pharmacies at the moment of the study (study population). Using power analysis, the minimum sample size for the said population was determined to be 309 (confidence level 95% (α = 0.05), margin of error 5%).An invitation e-mail was sent by a representative of the PCS to all 1574 registered community pharmacists from Vojvodina (using the PCS register) in compliance with the current national Law on the Protection of Personal Data. Over a period of 3 weeks, 392 community pharmacists completed the survey .Statistical analysis was performed using SPSS Statistics for Windows, ver. 24 (IBM Corporation).Categorical variables were characterized using frequencies, while means and standard deviations were used to describe continuous variables. Where appropriate, numerical variables were transformed into categorical for the purpose of interpretation. χ2 test was used to assess differences in categorical variables between groups, followed by post hoc testing using the proportion test. Ordinal regression analysis was used to assess the dependence of the perception of job-related stress  on a set of 10 predictor variables .p value of < 0.05 was considered statistically significant.A Out of the 1574 eligible pharmacists, 392 community pharmacists were included in the sample. Most of the participants were females, working in community pharmacies that are part of large pharmacy chains and in urban areas (Table p = 0.032), age (p = 0.003), years of experience (p = 0.031) and type of pharmacy (p = 0.002). Increase in workload was more often reported by women (p = 0.033), by younger pharmacists (<35y) in comparison to 45+ (p < 0.001), respondents with < 10 years of experience (p = 0.021) and those working in chains of 15+ pharmacies compared to independently owned (p < 0.001)  as shown in Table N = 356) higher demand for safety equipment  (97.8%), antiseptics and disinfectants (96.9%), dietary products (83.7%) and medicines (62.9%), followed by disinfecting procedures, higher prescription load, counseling and compounding.The dominant reasons for the increased workload were , antimalarials (44.1%), antivirotics (21.9%), antihypertensives (18.8%) and extemporaneous medicines (17.7%) and antibiotics, namely azithromycin. Stocking up on medications for chronic conditions by clients was also reported.Dietary products/supplements reportedly in high demand were vitamin C (noted by 97.8% of the respondents), zinc (97.8%), multivitamin-multimineral supplements (71.9%), beta-glucans (57.9%), germanium and ganoderma (46.1%), bee product-based supplements (45.8%), as well as echinacea, alkylglycerols, valerian, melatonin, aloa, noni, vitamin D and selenium-containing antioxidant supplements.Shortages of safety equipment were reported by 98.0% of community pharmacists, of antiseptics and disinfectants by 96.6%, dietary products and medicines by 59.6 and 58.7%, respectively. To overcome the shortages, surveyed community pharmacists reported setting/limiting the number of product units per purchase for clients (85.4%), communicating with suppliers more often (68.3%) and compounding of solutions and gels in 36.5% of the cases.p = 0.028) and job position (p = 0.023). Females claimed that workflow was affected more often than males (p = 0.023), as well as responsible pharmacists when compared to pharmacist in non-managing positions (p = 0.028). New processes were interpreted as more complex than before the pandemic by 61.4% of pharmacists  considered pharmacy workflow to be affected by the COVID-19 pandemic Table . Reporti.1% consip = 0.011, p < 0.001, respectively). Respondents with 10+ years of experience observed more pleasant clients’ behavior than pharmacists with < 10 y experience (p = 0.005). Pharmacists working in chains of ≤4 pharmacies rated their clients’ demeanor as pleasant more frequently than those in chains with 5–15 and >15 pharmacies   Table . Those fSafety equipment was always available to 48.0% of the participants, while the other 52.0% had experienced occasional shortages . Physical barriers were available in pharmacies of 75.5% of respondents.Majority of the respondents were concerned for their/their families’ health (68.9%) during the pandemic. Inaccurate and incomplete reporting about COVID-19 related issues in the media affected the work of 75.0% of surveyed pharmacists. Many noticed the lack of time to devote to patients (72.7%). Most (95.4%) considered physical barriers between pharmacy employees and clients to be necessary.The possibility of compounding during the pandemic was perceived as an activity that could improve pharmaceutical care by 74.4% of pharmacists. Pharmacists believed they should be authorized to independently renew prescriptions for stable chronic conditions in 46.2% of the cases, while 40.8% were opposed to the idea. The potential role of pharmacists in immunization against COVID-19 was supported by 29.6% of respondents.2 = 77.669, p < 0.001) and explained 24.1% of the results variance  in comparison to pharmacist working in independently owned pharmacies. Pharmacists reporting their clients behavior as less pleasant were 2.079 more likely to rate their job-related stress higher (p = 0.029). Pharmacists expressing low concern for their/their families’ health were less likely to report high levels of job-related stress during the pandemic .Ordinal regression model was used to assess the effect of community pharmacists’ characteristics and changes in work environment on job-related stress perception. The model was statistically significant  varied considerably across countries . Almost Pharmacists across the world were highly concerned for their/their families’ health , 39–41, Worldwide PPE shortages pressured many pharmacies to install physical barriers in order to reduce the risk of coronavirus infection of pharmacy teams and clients . MajoritDispensing of repeat prescriptions by community pharmacists could relieve some of the burden off the other healthcare workers . Due to Community pharmacists present a great potential in increasing the number of administered doses of vaccines and reducing the time to achieve high coverage . Active Community pharmacists in Vojvodina rated their job-related stress higher if they worked in larger pharmacy chains, if they believed their clients behavior was less pleasant than before the pandemic and if they were more concerned for their/their families’ health. Pharmacists working in larger chains have been shown to be under more stress, mainly due to high prescription volumes, time constraints, overtime etc. . ClientsMain advantage of the presented research is a unique perspective on the changes in work environment of community pharmacies in the state of emergency during COVID-19 pandemic. Direct feedback from surveyed pharmacists provided invaluable insight into genuine thoughts regarding the pharmaceutical care provided by community pharmacists during the pandemic.Due to rapidly changing circumstances, our research used a non-standardized questionnaire. Our results have limited generalizability, due to sampling method, as well as specific regional demographic and social characteristics. All limitations of the cross-sectional study design, as well as positive and negative aspects of online surveying apply to our study .To the best of authors’ knowledge, this is the first study of this kind conducted in Serbia.The global COVID-19 pandemic increased the workload and altered the workflow of community pharmacists in Vojvodina. Pharmacists working in larger chains, reporting clients’ behavior as less pleasant and those who were more concerned for their/their families’ health during the pandemic reported higher levels of job-related stress.Presented findings highlight the opportunity for pharmacists to be recognized as healthcare providers on the frontline of the healthcare system. Current research pointed out the need for more robust healthcare system which would allow rapid introduction of new activities/roles for community pharmacists in order to fully utilize their skills and knowledge. Legal steps to improve the work environment in community pharmacies and better definition of community pharmacists’ role in the healthcare system are necessary and urgent.Additional file 1.Additional file 2.Additional file 3.Additional file 4.Additional file 5.


Glutathione (GSH) is a major endogenous antioxidant. Several studies have shown GSH redox imbalance and altered GSH levels in Alzheimer’s disease (AD) patients. Early detection is crucial for the outcome of AD. However, whether GSH can serve as a biomarker during the very early-phase of AD, such as mild cognitive impairment (MCI), remains unknown. The current prospective study aimed to examine the longitudinal change in plasma GSH concentration and its influence on cognitive decline in MCI. Overall, 49 patients with MCI and 16 healthy individuals were recruited. Plasma GSH levels and cognitive function, measured by the Mini-Mental Status Examination (MMSE) and Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog), were monitored every 6 months. We employed multiple regressions to examine the role of GSH level in cognitive decline in the 2 years period. The MCI patients showed significant decline in plasma GSH levels and cognitive function from baseline to endpoint (month 24). In comparison, the healthy individuals’ GSH concentration and cognitive function did not change significantly. Further, both GSH level at baseline and GSH level change from baseline to endpoint significantly influenced cognitive decline among the MCI patients. To our knowledge, this is the first study to demonstrate that both plasma GSH levels and cognitive function declined 2 years later among the MCI patients in a prospective manner. If replicated by future studies, blood GSH concentration may be regarded as a biomarker for monitoring cognitive change in MCI. Alzheimer’s disease (AD) is the most common cause of dementia; further, the number of patients with AD has been rapidly rising globally . There hGlutathione (GSH), a major endogenous antioxidant present in all mammalian cells and peripheral blood, plays a vital role in protecting neuronal cells from oxidative stress ,15. GSH Several studies have shown GSH redox imbalance in AD and decreased GSH levels in AD animal models as well as in the brain and blood of AD patients ,17,18,19Patients and healthy controls were screened and enrolled from Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, which is a major medical center in Taiwan. The study was approved by the institutional review board (IRB) of the hospital and conducted in accordance with the current revision of the Declaration of Helsinki. All participants  were evaluated by research psychiatrists after a thorough medical workup.Participants were enrolled into this study if they (a) were ethnic Han Chinese, aged 50–100 years; (b) agreed to participate in the study and provided informed consent; (c) were physically healthy and had normal laboratory assessments ; (d) had sufficient education to communicate effectively and ability to complete the assessments of the study. We excluded participants if they had the following: (a) a history of significant cerebrovascular disease; (b) Hachinski ischemic score > 4; (c) major neurological, psychiatric, or medical conditions other than MCI; (d) delusion, hallucination, or delirium symptoms; (e) substance  abuse or dependence; (f) severe visual or hearing loss; (g) inability to follow the study protocol.Patients with MCI fulfilled the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS–ADRDA) criteria for aMCI  of a preHealthy individuals had a CDR score of 0.All participants recruited were fully informed of all the procedures performed during the study and gave their written informed consent.We used the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog)  and the The MMSE is a commonly used cognitive test to screen and measure cognitive impairment in older people . Its scoThe ADAS-cog is a popular cognitive assessment instrument used in cognitive aging studies. It consists of 11 tasks including word recall, naming, commands, constructional praxis, ideational praxis, orientation, word recognition, instructions remembering, spoken language ability, word-finding difficulty, and comprehension. Its scores range from 0 (best) to 70 (worst).2O, and 0.45 mL reconstituted DTNB. The plate cover was then removed and 150 μL of the freshly prepared assay cocktail was added to each well. The cover was replaced, and the plate was incubated in the dark on a shaker for 25 min. The absorbance at 405 nm was assessed with the Benchmark Plus Microplate Reader . The GSH levels in plasma were determined using a standard curve, and all GSH analyses were repeated twice.GSH concentration in plasma was measured at months 0, 6, 12, 18, and 24 using commercially available assay kits according to the manufacturer’s recommended protocol . Briefly, 50 μL standard or plasma sample was added to each well of a 96-well plate and covered with the plate cover. The assay cocktail was prepared by mixing 11.25 mL MES Buffer, 0.45 mL reconstituted cofactor mixture, 2.1 mL reconstituted enzyme mixture, 2.3 mL ddH2 test. All subjects’ clinical characteristics and GSH levels were presented as the mean (SD) or number (percentage). We compared mean values between two groups by using the Mann–Whitney U test and percentages using the χt test. The GSH levels and cognitive function assessments (MMSE and ADAS-cog scores) at baseline and at endpoint (at 2 years later) were compared by paired Multiple linear regressions were used to discover independent factors associated with cognitive change in MCI patients (stepwise). p < 0.05 was considered statistically significant.All analyses were performed using IBM SPSS, version 20 , and a two-tailed Overall, 65 subjects were enrolled, and they included 16 healthy individuals and 49 patients with MCI. The demographic, clinical, and laboratory data of both groups at baseline are summarized in p = 0.003), lower MMSE score , and higher ADAS-cog score . As to plasma GSH, the healthy individuals and the MCI patients had similar levels .Gender  and age (68.9 ± 5.9 years vs. 69.9 ± 8.4 years) distributions were similar in the two groups. Female gender was the predominant gender of both groups. Compared to healthy individuals, MCI patients had shorter education duration (9.6 (mean) ± 2.7 (SD) vs. 6.7 ± 4.4, p < 0.001) and cognitive function  and MMSE  scores) from baseline to endpoint.In comparison, the MCI patients showed significant decline in plasma GSH levels  GSH concentration at baseline and (2) GSH concentration changed from baseline to endpoint (endpoint–baseline) were able to affect cognitive decline during the two-year period among the MCI patients, respectively. p = 0.068). That is, higher GSH concentration at baseline was associated with more cognitive decline at endpoint among the MCI patients.Firstly, p = 0.067). That is, female and higher GSH level changes from baseline to endpoint were associated with better cognitive outcome at endpoint among the MCI patients.Secondly, To the best of our knowledge, this was the first study to explore the role of GSH concentration in very early-phase AD (herein MCI), and the first one to prospectively follow GSH levels during the AD-related illness course. p < 0.001)) and cognitive function (mean ADAS-cog score from 9.4 ± 7.1 to 11.1 ± 9.1 (p = 0.035); and MMSE from 25.3 ± 3.8 to 24.0 ± 4.1 (p = 0.006)) declined 2 years later among the patients with MCI  , therebyc– [c– and cysteine is the rate-limiting substrate in the biosynthesis of GSH [c– inhibition attenuates GSH synthesis, perturbing cellular redox balance [c– was lower in patients with other neurodegenerative disorders, such as schizophrenia, than healthy controls [c– also gradually reduce during the very-early AD phase deserves study in the future.The etiology of the gradual decline in GSH levels during the 2 years MCI period  remains c– , which ic– . Cystines of GSH . Of note balance . It has controls ,33. Sincp = 0.003), while the healthy individuals and the MCI patients had similar GSH levels   . The finp = 0.040 in Finally, being female appeared to be another protective factor of cognitive decline, especially with controlling GSH level change from baseline to endpoint (The major strength of the current study is that we examined both cross-sectional and longitudinal effects of GSH levels in cognitive function in the MCI patients. Second, we employed not only MMSE  but alsoThere are also limitations in the present study. First, our study did not evaluate other endogenous antioxidants, which may also reduce oxidative damage in the cognitive aging process . Second,MCI represents the transitional state between healthy aging and dementia . TherefoFurther studies with large sample sizes and longer duration are warranted to adequately elucidate the role of GSH in cognitive aging.This study demonstrated that both plasma GSH levels and cognitive function declined 2 years later, and that both GSH level at baseline and GSH level change from baseline to endpoint significantly influenced cognitive decline over 2 years among the MCI patients. Nevertheless, further studies with a larger sample size and longer follow-up duration are required to evaluate the temporal relationship between GSH levels and the MCI progression. If replicated by future studies, blood GSH concentration may be regarded as a biomarker for monitoring cognitive change in MCI.


Phoenix dactylifera L. and a common plant Prosopis cineraria L. (Druce) in the Arabian Peninsula. The results showed that inoculation with certain AMF species enhanced the growth of both plants, highlighting the potential of these fungi as part of sustainable land use practices in this region.The vegetation in the Arabian Peninsula experiences drought, heat, soil salinity, and low fertility, mainly due to low phosphorus (P) availability. The beneficial mycorrhizal symbiosis between plants and arbuscular mycorrhizal fungi (AMF) is a key factor supporting plant growth under such environmental conditions. Therefore, AMF strains isolated from these soils might be useful as biotechnological tools for agriculture and revegetation practices in the region. Here we present a pioneering program to isolate, identify, and apply AMF isolated from rhizosphere soils of agricultural and natural habitats, namely date palm plantations and five native desert plants, respectively in the Southern Arabian Peninsula. We established taxonomically unique AMF species as single-spore cultures as part of an expanding collection of AMF strains adapted to arid ecosystems. Preliminary experiments were conducted to evaluate the abilities of these AMF strains to promote seedling growth of a main crop  The application of arbuscular mycorrhizal fungal (AMF) inocula in agriculture and revegetation programs has recently become more prominent, largely due to the increasing number of studies demonstrating improved plant growth after inoculation  and Prosopis cineraria L. (Druce)  were selected for inoculation with AMF species from the culture collection. Date palm is the main crop in Arabia and in many other desert areas of the world , Septoglomus africanum (strain G14), Claroideoglomus drummondii (strain F41), Desertispora omaniana (strain F69), Pervetustus simplex (strain C49), and P. simplex (strain C57). One consortium inoculum that included all five species was also used. The inocula, added as substrate inocula, included a total of 250 spores and a volume of 15 g pre-weighed into 15 ml reaction tubes. Those single-strain inocula with high spore numbers were diluted with sterilized inocula to reach a total volume of 15 g. While transplanting the seedlings into 3-L plastic bags filled with peat moss  and vermiculite  the inocula was homogeneously spread onto the root system. Two controls were included: a non-mycorrhizal (NM) control, to which no AMF inoculum was added, and a non-mycorrhizal fertilized (NM-fert) control that was the only treatments receiving foliar-fertilizer  weekly. The latter represented the conventional handling practice of date palm seedlings at the Research Station. Plant growth performance after 12 months was estimated by measuring the total lengths of all leaves of a single plant  and the number of leaves. No destructive harvest was performed as plants were later transplanted to the field.The date palm inoculation experiment was conducted in the Agricultural Research Station of Jemah, Oman Ministry of Agriculture, Fisheries and Water Resources. The date palm seedlings  were tissue-cultured. Seedlings were established for 28 months at the callus stage under tissue culture conditions, then transplanted into 100-mL pots filled with peat moss  and vermiculite  and grown for 5 months in a shade house . Date palm seedlings for the experiment were selected based on their homogeneity of total height and leaf number. Six AMF strains were used as single-species inocula, www.omanbotanicgarden.com; Patzelt et al. P. cineraria seeds were soaked in water overnight before being sown in compartmented germination trays. Each seed was placed in a 50-mL pot filled with a mixture of peat moss  and vermiculite  and supplemented either with mycorrhizal inocula or one of the control treatments. Seven single-species inocula were used, P. simplex (strain C49), Septoglomus nakheelum (strain G90), Di. spurca (strain K46), Rhizophagus arabicus (strain F80), De. omaniana (strain F69), Di. aurantia (strain G5), and S. africanum (strain G14). In addition, four different consortia were used as inocula. These were consortium 1 (P. simplex strain C49 and C56), consortium 2 (C. drummondii strain F41 and De. omaniana strain F69), consortium 3 (S. africanum strain G14 and De. omaniana strain F69), and consortium 4 . Additionally, four non-mycorrhizal control treatments were applied: microbial wash (control 1), autoclaved inoculum carrier (control 2), microbial wash and autoclaved inoculum carrier (control 3), and a negative control (control 4). Eight seeds were used as replicates for mycorrhizal treatments and 20 seeds for the control treatments. Higher numbers of seeds in the control treatments were used as there were low germination rates in preliminary experiments (data not shown). For inoculation, 5 g of substrate inocula containing a total of 250 spores was homogeneously mixed into the growing substrate using a sterile spatula. Those single-strain inocula with high spore numbers were diluted with sterilized inocula to reach a total volume of 5 g. Each pot, except control 2 and control 4, received 5 mL of the microbial wash to correct possible differences in microbial communities .Claroideoglomus drummondii, Diversispora aurantia, Diversispora spurca, and Septoglomus africanum  = 5.9, P > 0.0001; numbers of leaves: F  = 4.3, P = 0.0012) was significantly affected by AMF inoculation. The total leaf length of date palms were significantly higher for all AMF strains and the NM-fert control plants except nts Fig. . Also thnts Fig. . SimilarRhizophagus intraradices increased leaf area, root length and shoot and root dry weight. Meddich et al.  that lack AMF. At this stage, mineral fertilizers are used to increase seedling growth. After being transplanted into the field, it is difficult for date palms to establish AMF symbiosis due to the low infect ion potential of most desert soils , which had a germination rate of 38%. In addition, all mycorrhizal seedlings survived in contrast to almost all control treatments  = 4.165, P < 0.001). After 3 months of growth, seedling height was significantly enhanced in 9 of the 11 mycorrhizal treatments compared with that in all control treatments , Di. aurantia (strain G8), Di. spurca (strain K46), P. simplex (strain C49), R. arabicus (strain F80), S. africanum (strain G14), S. nakheelum (strain G90), consortium 3, and consortium 4. It is worth mentioning that the superior growth of plants inoculated with S. africanum (strain G14) was consistent in both experiments. This study is an important step towards the integration of native AMF into sustainable agriculture and revegetation programs in the Arabian Peninsula and may serve as a model approach for other arid lands.In this study, native AMF from agricultural and natural habitats in the Southern Arabian Peninsula were isolated, propagated, and identified. Some of the AMF strains that were functionally evaluated represent good candidates for biofertilizers, due to their ability to enhance the growth of two local plants,


Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, community non-medical anti-epidemic workers have played an important role in the prevention of COVID-19 in China. The present study aimed to assess sleep quality and its associated factors among community non-medical anti-epidemic workers.A survey was conducted using anonymous online questionnaire to collect information from 16 March 2020 to 24 March 2020. A total of 474 participants were included, with a 94.23% completion rate. The questionnaire contained demographic data, physical symptoms, and contact history with COVID-19. The researchers assessed perceived social support by the Multidimensional Scale of Perceived Social Support (MSPSS), assessed perceived stress by the Perceived Stress Scale (PSS), and measured sleep quality by the Pittsburgh Sleep Quality Index (PSQI) questionnaire.Among the participants, 46.20% reported poor sleep quality. A binary logistic regression revealed that having educational background of junior college or above, being a member of the police force, having contacted individuals with confirmed or suspected COVID-19 infection, having chronic disease(s), having illness within 2 weeks, and having high or moderate perceived stress were significant factors associated with an increased risk of poor sleep quality.Demographic factors, physical symptoms, history of contact with COVID-19, and perceived stress are significantly associated with poor sleep quality of community non-medical anti-epidemic workers. Thus, targeting these factors might be helpful in enhancing sleep quality of community workers. Since the outbreak of Coronavirus Disease 2019 (COVID-19) in December 2019, around the world, the disease’s social consequences of mass confinement at home have caused much stress , 4. HoweThe existing literature regarding associations among individuals’ stress, social support, and health outcomes indicates the potential influence of moderating factors . The comRecent studies on the epidemic of COVID-19 have been concentrated on clinical epidemiology, prevention, and treatment –15. Few The survey was conducted from 16 March 2020 to 24 March 2020 by anonymous online questionnaires. The convenience-sampling method was used. The researchers randomly selected 15 communities in Wuhan, China. Considering the scale of each community, the researchers selected 30 members for each. The sample size was amplified according to the inefficiency of 10%, and the final expected sample size was 495. The inclusion criteria and exclusion criteria were as follows: (a) Inclusion criteria: (1) The worker had at least 1 month’s experience in anti-epidemic work. (2) The worker had not suffered from mental illness and had not been stimulated by major adverse life events. (3) The worker was willing to participate in the survey. (b) Exclusion criteria: (1) The worker had less than 1 month’s experience in anti-epidemic work. (2) The worker was a shift worker. (3) The worker was unwilling to participate in the survey.A total of 503 community non-medical anti-epidemic workers in Wuhan, China, participated in the survey. After excluding the questionnaires with repeated filling (ID and basic information are completely consistent) or suspected false answers, the study finally included a total of 474 valid samples, with a 94.23% completion rate.The structured questionnaire comprised of six areas: (1) Demographic variables, including sex, age, educational background, marital status, occupation, and work experience. (2) Contact with an individual with confirmed or suspected COVID-19 infection. (3) Health-related factors, including chronic disease and illness within 2 weeks. Chronic disease was evaluated through the participant’s response (“yes” or “no”) to the question “if you have been diagnosed with diabetes, hypertension, heart disease, arthritis, migraine, asthma, thyroid disease, heart disease, thrombosis, bronchitis/emphysema, osteoporosis, cancer, stomach/peptic ulcer, cerebrovascular disease or other major physical diseases”, which was similar to what Scott described in a previous study . The prep < 0.05 were included in the binary logistic regression analysis (Forward: LR). Finally, the present study identified variables that had a significant association with poor sleep quality on the basis of odds ratio (OR) and 95% confidence interval (95% CI). The independent variables included sex, age category, marital status, educational background, occupation, work experience, contact with individuals with confirmed or suspected COVID-19 infection, chronic disease, illness within 2 weeks, perceived social support, and perceived stress. The dependent variable was sleep quality. All variables were treated as categorical factors, and p < 0.05 (two-sides) was considered as statistically significant.The present researchers conducted all data analysis by using SPSS version 20.0 . Data were presented by frequencies and percentages. Chi-squared tests were used to examine the rate of poor sleep quality in different groups and to choose independent variables for a binary logistic regression analysis. Independent variables with Of the participants, 63.71% were male, and 36.29% were female. Ages ranged from 20 to 65 years with an average of 38.94 ± 10.18 years. The percentage of participants whose educational background was junior college or above was 73.42%. The percentage of participants who were married was 68.14%. The percentage of participants who had at least 10 years of work experience was 35.44%. A majority of participants were in the police force (81.01%). A majority of participants did not report a problem with social support (83.76%). Almost half of the participants (48.95%) perceived their stress level as low. Furthermore, the percentage of participants who had contact with the individuals with confirmed or suspected COVID-19 infection was only 16.24%. About a quarter of the participants had one or more chronic diseases (25.53%). Less than a third of the participants had an illness within 2 weeks (28.06%) (Table p = 0.000), occupation (p = 0.021), work experience (p = 0.037), contact with individuals with confirmed or suspected COVID-19 infection(p = 0.002), chronic disease (p = 0.000), illness within 2 weeks (p = 0.000), and perceived stress (p = 0.000) were all associated with sleep quality; participants with educational background of junior college or above, members of the police force, participants with at least 10 years of work experience, participants who had contacted with individuals with confirmed or COVID-19 infection, participants who had chronic disease, participants who had been ill within 2 weeks, and participants with high perceived stress were more likely to report poor sleep quality.The results of the chi-square test are shown in Table p < 0.01). Compared with volunteers, the members of the police force were 2.07 times more likely to report poor sleep quality (p < 0.01). Participants with at least 10 years of work experience were 1.61 times more likely to report poor sleep quality than those with ≤3 years of work experience (p < 0.05), and they were 2.22 times more likely to report poor sleep quality than those with 7–9 years of work experience (p < 0.05). Participants who had contacted with an individual with confirmed or suspected COVID-19 infection were 2.19 times more likely to report poor sleep quality as those who had not (p < 0.01). Participants who had chronic disease were 2.37 times more likely to report poor sleep quality than those who did not (p < 0.01). Participants who had been ill within 2 weeks were 4.17 times more likely to report poor sleep quality than those who had not (p < 0.01). Compared with the participants with low perceived stress, those with high perceived stress were 8.60 times more likely to report poor sleep quality (p < 0.01), and those with moderate perceived stress were 3.99 times more likely to report poor sleep quality(p < 0.01).The present researchers included all significant variables in the binary logistic regression analysis. As Table In the present study, the researchers explored the associated factors of poor sleep quality among community non-medical anti-epidemic workers in Wuhan, China, during the COVID-19 epidemic. The percentage of the participants who reported poor sleep quality was 46.20%, which was higher than the previously reported among the residents aged 15–69 years in China (35.74%) . Poor slThe present researchers found that the participants whose educational background was high school or technical secondary school were less likely to report poor sleep quality than those whose educational background was junior college or above. Moreover, the members of the police force were more likely to report poor sleep quality than volunteers. This finding is different from the based on a general population of Italian participants in a previous study . A possiConsistent with the previous findings from community residents , the preThe present study not only supplements previous studies, but also offers information about the community non-medical anti-epidemic workers. It examined multiple factors that are associated with sleep quality, such as demographic variables, health-related factors, social support, and perceived stress. Meanwhile, the questionnaire (PSQI) used in this study is reliable and can reflect individuals’ real sleep quality of the past month.Nevertheless, the present study also has some limitations. First, although the sample size is not sufficient, with 15 communities were being included. Second, because the survey was conducted during the COVID-19 epidemic, the present researchers could not perform face-to-face interviews, and the data may not reflect the real situation of the participants. Third, the cause-effect relationship cannot be established because of the nature of cross-sectional design. Fourth, sleep quality can be influenced by occupation and life stresses, which no information on common variables were collected to assess the occupational impact.The present study revealed that community non-medical anti-epidemic workers who were members of the police force, workers with educational background of junior college or above, workers who had contact with individuals with confirmed or suspected COVID-19 infection, workers who had chronic disease(s), workers who had an illness within 2 weeks, and workers who had high or moderate perceived stress were more likely to report poor sleep quality. Therefore, the community non-medical anti-epidemic workers are required to follow appropriate personal-protection procedures and conduct psychological interventions through psychological lectures.