In recent years, short videos have become an increasingly vital source of information. To compete for users’ attention, short video platforms have been overusing algorithmic technology, making the group polarization intensify, which is likely to push users into the homogeneous “echo chamber”. However, echo chambers can contribute to the spread of misleading information, false news, or rumors, which have negative social impacts. Therefore, it is necessary to explore echo chamber effects in short video platforms. Moreover, the communication paradigms between users and feed algorithms greatly vary across short video platforms. This paper investigated echo chamber effects of three popular short video platforms  using social network analysis and explored how user features influenced the generation of echo chambers. We quantified echo chamber effects through two primary ingredients: selective exposure and homophily, in both platform and topic dimensions. Our analyses indicate that the gathering of users into homogeneous groups dominates online interactions on Douyin and Bilibili. We performed performance comparison of echo chamber effects and found that echo chamber members tend to display themselves to attract the attention of their peers and that cultural differences can prevent the development of echo chambers. Our findings are of great value in designing targeted management strategies to prevent the spread of misleading information, false news, or rumors. According to recent studies, the echo chamber effect of social media can promote the spread of misleading information, fake news, and rumors8. Such information usually harms people, society, or economics.Ranging from a few seconds to a few minutes, short videos have become a popular form of human’s entertainment and content sharing. Influenced by the attention economy, short video platforms have started to abuse feed algorithms to compete for users’ attention. Feed algorithms classify users’ preferences by collecting their behavioral data, thus matching users with precise and continuous information. This matching of information gradually creates a powerful driving force for group polarization, which is highly likely to lead to the formation of echo chambers. In addition, due to the nature of such short video platform that spreads information quickly and widely9. Social media has three main features that make it the perfect environment for ECs: no geographical restrictions, no social cost to sharing fringe beliefs, and fellow believers can be found no matter how fringe10. Previous research on online ECs has focused on political fragmentation and polarization in democracies12, the impact on information dissemination15, and EC identification models18. As a new type of social media, because of the scarce research on user behavior features and news consumption of short video platforms, the effects and the very existence of ECs have been questioned. In this situation, the debate around ECs is critical to understanding the impact of short video platforms on news consumption and public opinion formation.Echo chamber (EC) is one of the central areas of research in the digital age, spanning several disciplines including psychology, political science, and information scienceIn this paper, we explored key differences between short video platforms as well as user features, and how they may or may not influence the formation of ECs. As recently shown in the research on short videos, multiple platform studies can provide a new perspective on long-debated issues. We have selected three newly popular short video platforms for our study: Douyin, TikTok and Bilibili, and designed a comparison of topic dimensions. We introduced an operational definition of an EC and applied social network analysis to provide a common methodological basis to explore how different platforms influence their formation. In particular, we measured the two common elements that characterize ECs into observables that can be quantified and empirically measured: selective exposure and homophily. Then, we used these elements to compare the EC effect in terms of platform dimension and topic dimension in the following four aspects: EC size, EC type, selective exposure, and homophily. Our findings indicated that users clustered in homogeneous groups dominated online interactions on Douyin and Bilibili and that there is greater racial segregation on Douyin. Furthermore, the pattern of information dissemination within the EC is similar over time, independent of differences in platforms and topics. From the analysis of short video EC members who share common views or interests, reveals that they prefer to showcase themselves on the platform and hence elicit others’ participation. Furthermore, by analyzing user interaction data from various nations, we discovered that cultural differences among platform users could prevent the development of ECs.The rest of this paper is organized as follows. “In the second step, we give the operational definition of the EC. The EC is defined as a group of users who are involved in commenting on at least two short videos on the same topic, while including users who were @ by EC members in the same EC. To explore the key differences between the different ECs, we divide them into three types according to their main sentiment tendencies: positive, negative and controversial, respectively. We then measure the presence of an EC effect on short video platforms in terms of two critical features known to ECs. In the third step, we compare the EC effect in terms of platform dimension and topic dimension in the following four aspects: EC size, EC type, selective exposure and homophily, respectively. In the fourth step, we investigate the impact of ECs on short video propagation. So we compare the lifetime of ECs across platforms and topics. In the fifth step, we measure the difference between EC members and non-members from four perspectives: user identity, spatial distribution, age, and commenting time. Finally, we explore the relationship between users’ willingness to self-disclose and EC members. The detailed methodology and results are described in “The framework of the methodology is shown in Fig. 19. The boundary between producers and consumers of short videos is blurred, the production cost is low, and the content is easy to consume20. Short video platforms have steadily evolved from primarily entertainment platforms to new platforms with social network features that live and grow with users as they continue to better themselves19. The proliferation of short video-sharing mobile apps has led to new forms of information-sharing practices. Even the traditional social media platforms have been influenced by these popular video-sharing mobile apps because some people are drawn away from watching the news to watching short videos23.“Short video” refers to video material that is less than 5 min long and is disseminated through digital media outletsGiven the diversity of online customers, we selected the following short video platforms for our study:https://www.Douyin.com/), a short video app for musical creativity incubated by ByteDance24. The app was launched in 2016, is a short video community platform for all ages. Users can share their lives through the platform, but also here to meet more friends, to understand a variety of strange and interesting things27.Douyin (https://www.TikTok.com/) is the worldwide counterpart to the Chinese mobile short video app Douyin. The digital structure of TikTok is similar to that of Douyin, but it serves to an entirely different group of users and is governed by distinct forces. TikTok’s regionalization approach varies from that of previous social media platforms in that its user base is global in nature, and its objective is to make its product adhere to the various expectations, customs, and legislative frameworks of several nations28.TikTok (https://www.bilibili.com/), a Chinese top youth culture community and video platform, is an early video site for creating and sharing of ACG  material29. After more than a decade of development, the site has developed a big multicultural community around its users, artists, and content30. Technically speaking, Bilibili cannot be considered as a short video platform. However, it has a short video section and is popular with the majority of internet users32.Bilibili (https://ef.zhiweidata.com/library). As shown in Table 33. This website has accumulated a vast amount of hot events, involving ten categories: international, social, corporate, internet, financial, entertainment, sports, government, disaster, and crime.To identify and analyze ECs in short video platforms, we established the data collection system. The resulting dataset is divided into two parts: experimental and control groups. The experimental group contains three common topics: social, international, and entertainment. The control group is a randomly selected pan-topic dataset in each platform. To ensure the validity of the control group, the control group dataset is of the same order of magnitude as the experimental group. The selection of topic events is based on the event library section of the “Zhiweidata” platform  reduce data noise via data filtering, removing duplicates, deleting blank and invalid text, removing hyperlinks, (2) eliminate meaningless ultrashort tweets and tweets with few retweets, and (3) use the Socialbothunter algorithm37. An echo chamber is a group in which users’ opinions, political leanings, or beliefs about a topic are reinforced by repeated interactions with peers with similar tendencies and attitudes, and they tend to gravitate toward information that supports their beliefs and join in around a common discussion39. On social networks, influenced by selective exposure and confirmation bias, people tend to join clusters that conform to their beliefs, leading to the creation of homogeneous and polarized communities “ECs”. The concern over the potentially harmful effects of online social media on society sparked study interest in online ECs. In recent years, research on the spread of fake news and rumors, as well as the global Covid-19 pandemic, has pushed the EC into a new wave of research.The EC effect was first identified in research in politics and is now widely validated in the study of social networks40. Users are ensnared in tailored information by recommender algorithms, which utilise users’ prior activity to customise recommendations to their preferences10. A distinct information space is therefore created around each of us as a result of the ongoing creation and improvement of hypotheses about who you are and what you will do next by these predictive algorithms. Short video platforms have gradually increased their respective user stickiness by utilizing unique recommender algorithms based on brand positioning, such as Douyin and TikTok’s Today’s Headlines algorithm based on content interaction and Bilibili’s recommender algorithm based on community interest. Therefore, it is a fascinating study to explore whether the EC effect exists in short video platforms as well as in traditional social media.Research on the causes of ECs has suggested that, in addition to confirmation bias, cognitive dissonance related to human psychology, and homophily, recommender algorithms may have played an essential role in the development of ECs7. Given a network describing users’ interactions centered on a common topic, an EC is a subset of the network users who share the same point of view and tend to have dense connections primarily within the same group7. An EC network can be defined by a graph 41. It is important to note that a user can participate in multiple ECs, each with at least two members. Since different forms of communication on social media tend to have different effects. The retweet function plays a crucial role in promoting polarization, and comments make an important contribution in building consensus42. However, the @ function is often used to initiate a conversation with a targeted user43. Therefore, we included the @user mentioned by the echo chamber members in the same EC.To investigate the key differences between short video platforms, it is necessary to establish a formal definition of an EC. In general, an EC is a closed system or a group of users who share common interests and actively share information with others, resulting in assimilation or even amplification of opinions or memes. First, we need to identify the leaning of users at a micro level. The existing research viewed an EC as a community of people with similar viewpoints. However, determining the orientation of an individual user can be challenging, given that it is considered privacy-sensitive information. In this paper, we define an EC as a group of users who have participated in commenting at least two short videos on the same topic44. Sentiments have been discovered to influence the focus of users’ information searches as well as the information sources they select45. While negative sentiments prevent further information searching, positive sentiments cause positive information-seeking actions47.The ideal state of community communication is to be at a point of equilibrium. A strong polarization occurs when the similarity or difference reaches a certain threshold. Then the EC effect is highly likely to occur in this case. Community polarization can lead to conflict, but conflict is not always negative6. Then, the ECs are classified into three types according to their dominant affective tendencies. We use the content sentiment polarity of EC members as the judgment criterion: EC members with more than 50% positive sentiment are judged as Positive, with more than 50% negative sentiment are judged as Negative, and others are judged as Controversial ECs. The method of sentiment analysis is detailed in “To explore the key differences between different ECs, we first identify the ECs using the EC-model algorithm48. Both selective exposure and homophily can be endogenous, i.e., the result of users’ own active choices, but to some extent they can also be exogenous, i.e., they can be selectively recommended to users by algorithms. In this paper, we will verify whether EC effects of these natures are also present in short video platforms from these two aspects.In social science literature studies, ECs have the following important characteristics: First, users are selectively exposed to mostly attitudinally consistent content whose expression reinforces users’ pre-existing perceptions. Second, users are surrounded by homogeneous networks whose members are relatively similar in their attitudes or other features49. The literature on selective exposure emphasizes that social networks offer more conflicting perspectives than interpersonal conversations. Social media users tend to consume media content that aligns their preferences if given the option to do so50. In view of this, we devised a method to determine whether there is selective exposure in an EC. Specifically, the degree of selective exposure of users is measured by analyzing the sentiment and users’ stance polarity of the comment texts of EC members53.Selective exposure, which is thought to be a distinctive feature of  echo chambers, is a social phenomenon where a user tends to consume information only that he or she would like to believe. Some claimed that selective exposure dominates content consumption on social media and that different social media platforms may trigger very different dynamics56. Short video platforms generally limit comments to 100 characters or less . The length of a user’s online comment may be a word or a paragraph, depending on individual preferences. Thus, it was challenging to select the best way to analyze the sentiment of online user comments accurately.Sentiment analysis is a technology based on natural language processing (NLP) and text mining to classify text content with individual subjective sentimental tendencies of users. Sentiment analysis work related to online comments is generally divided into chapter-level, sentence-level, and word-level, depending on the scale of the research object. Chapter-level is suitable for expressing overall sentiment tendencies. Sentence-level assumes that each sentence expresses a single opinion tendency for only one entity and is not applicable to multi-feature documents. Word-level does not focus on text or sentences, but mainly investigates how to locate and analyze the sentiment of feature attributes58. In our study, we used a pre-trained multilingual BERT model, Sentence-BERT59. The pre-trained model of BERT has been effectively used in multiple areas. The input size is decreased by the model’s independent encoding and saving of entity records. Unlike conventional techniques, BERT generates dynamic word representations that are locally influenced by nearby situations60.In prior research, different kinds of NLP methods have been used for sentiment analysis of text data. Dictionary-based approaches represented by the LIWC and Hedonometer projects match the words that make up each text entry to a specific list of sentiments, which is widely used in social media research. Recently, neural network-based sentiment classification of text data like transformers or convolutional neural networks (CNN) has been successfully implemented. Moreover, they have overcome the limitation of text length and shown good performanceWe use the trained Sentence-BERT to rate the user comment text in the EC. And we set the output to take values in the range , where − 1 represents absolute negative sentiment, 1 represents absolute positive sentiment, and 0 represents neutral. However, in our actual study, we find that the majority of @users did not post comments, so we can not classify their sentiment polarity. In view of this, we refer to the average sentiment polarity score of @users’ 10 most recent comments on the same topic as the polarity of this user. Others are marked as unknown.61, argument mining62 and identifying users with opposing views in debates63. Stance detection, also known as stance classification, is a popular study topic in Natural Language Processing (NLP). Most studies use stance detection at the statement level to predict a piece of text’s attitude towards a certain problem. In this paper, we utilized a multi-task stance detection model, which effectively integrates syntactic features of sentences into the model64. We set the output to take values in the range  (absolute disagree to absolute agree). And we refer to the average score of @users’ 10 most recent comments on the same topic as the stand of this user. Others are marked as unknown.Stance detection is a key component of many tasks in the research field of social media, e.g., fake news detection65,In the interactive network, we represented a piece of user-generated content as a sentiment/stance tendency, i.e., the user-generated sentiment/stance tendency 66. We devise a method to measure heterogeneity in this work to investigate if homophily occurs among the participants in the EC. It is defined as the balance between members who hold pro- and anti-opinion views66. The measurement method is shown in Eq.  of each lifetime of short video. We plotted the PDF of the lifetime (using days as time units) of short video propagation times with EC members. Figure In this section, we analyzed the features of short video EC members in four dimensions: user’s identity, spatial distribution, age, and comment time.In Fig. 68.Next, we performed a spatial location analysis of the EC members marked with their true locations. Since TikTok geolocation access is non-public permission, we only test the variable of spatial location on Douyin and Bilibili. As shown in Table At the spatial scale of the whole China, the distribution of users of Douyin and Bilibili was similar, both relatively concentrated in developed eastern regions and surrounding provinces. From the proportion of user distribution in the figure, we can see obvious hierarchical differences in the concentration of short video EC members. The regions with denser user distribution are more consistent with the spatial pattern of national socio-economic development. As shown in Table Meanwhile, we made statistics for the age of the EC members. As shown in the third lane (green) of Fig. 69. And it is proven to be prevalent in social media. In social networks, self-disclosure is a prerequisite for the formation of various human social relationships and is the basis for communication70.Self-disclosure refers to individuals voluntarily confiding their thoughts or showing their true behavior to the target person when interacting with othersIn this section, we excluded EC members other than common users. And research on willingness to self-disclose was conducted only to the extent that platform privacy permitted. For each topic, we randomly selected 2000 EC members as the experimental group and 2000 non-members as the control group, respectively. According to the privacy setting rules of each platform, we divided the users’ willingness to self-disclose into four levels.Level 1 was the absolute private account. Strangers need to request a follow or subscribe to the user before they can view the account content.Level 2 was a relatively private account. This type of user has opened the access rights of visitors to their personal videos, but not the access rights of “following”, “follower” and “like” of their personal homepage.Level 3 was relatively public account. These users can be subdivided into two types. The first is that the user has opened all permissions except “like” and the second type is that the user has opened the “like” permission, but not the “Follow” and “Fans” module access (because the visible functions of “following” and “follower” in the Douyin permission settings are bound).Level 4 was the absolute public account. This type of account opens access to all modules.Douyin and TikTok:Bilibili:Bilibili’s privacy setting rules are very different from the other two platforms. Therefore, we selected three privacy permissions related to the short video module as the metric: open my favorites, open recently liked videos and open my following list. If the user did not open all three permissions, it was judged as level 1; if one of the permissions was opened, it was judged as level 2, and the rest could be inferred by analogy.p = 0.0082, r = 0.9756) between the correlation matrices of the EC members and non-members in TikTok. This implies that EC members are more willing to show themselves on the short video platform, which helps attract more users to follow them. In the topic dimension, we did not find any statistical correlation between the willingness to disclose privacy of EC members and non-members.Distributions of the willingness to self-disclose levels by EC members and non-members are shown in Fig. In this section, we will address our key findings as well as the academic and practical implications.In this study, we investigated the EC effect in short video distribution. To assess different user interaction behaviors, we conducted a comparative analysis of over 400,000 pieces of content from Douyin, TikTok and Bilibili on different topics . The analysis focus on four main aspects: (1) the size of EC; (2) the type of EC; (3) selective exposure among EC members and (4) homophily in EC member interactions.Our findings conclude that the EC effect maybe widely observed in some short video platforms. However, it is still related to the platform’s own functions and differences in positioning and audience groups. Both Douyin and Bilibili exhibit a strong EC effect (selective exposure and homophily), with the proportion of positive ECs dominating both platforms. In contrast, the EC effect on the TikTok platform is insignificant, and controversial ECs occupy more than half of the proportion. TikTok is a cross-lingual and cross-cultural short video platform that reaches 45 global countries and regions. In the analysis of selective exposure and homophily, we failed to find highly clustered groups, which is probably due to the language and cultural differences of users that limit the communication of like-minded groups, thus hindering the formation of ECs. On the other hand, we tried to investigate the impact of ECs on the spread of short videos. We calculated PDFs of ECs’ lifetimes, where the lifetime is here computed as the temporal distance (in days) between the first and second comment of a user in each EC. Despite the varying platforms and topics, we find that the temporal sharing patterns in each category are similar. We also tried to analyze users’ identity, spatial location, age, and comment time, but none of them were found to be significantly different from non-members. To our surprise, we found that EC members are more willing to self-disclose than non-members. They tend to actively present themselves to attract their peers to join the discussion.19. Previous studies on the EC effect have focused more on traditional social media platforms, and few studies have explored the form and extent of the EC effect during information dissemination on short video platforms. This study makes a bold attempt in this area.The theoretical contributions are as follows: first, as mobile internet technology has grown, consumers now have access to a new era of short videos as well as new social media features owing to a variety of short video platformsSecond, we compared the similarities and differences of the EC effect in the interaction behavior of users of different short video platforms and topics, broadening the study of the impact of social features of short video platforms on user behavior. Meanwhile, this study extracts positive, negative, and controversial ECs to scrutinize their contents and derive meaningful values to convey varied details on pertinent concerns.Third, our research reveals that linguistic and cultural barriers may prevent like-minded groups from communicating on short video platforms, making it impossible for users to create polarised clusters and limiting the formation of ECs.Fourth, this study enriches the literature related to ECs by exploring the impact of the EC effect on the spread of short videos in several dimensions: lifetime of EC, feature of EC member, and users’ willingness to self-disclose.The study results can provide strategic guidance for managers of short video platforms to utilize the EC effect for content optimization, expand audience reach, and improve user satisfaction, leading to stakeholder communication and cooperation.First, the EC effect can be used to create a new monitoring system that analyses web content to learn more about the feelings and concerns of the general population. This research can be applied generally to examine data from various short video platforms including Kwai, Likee, and Vimeo.Second, high-traffic short videos have a directing influence on viewers’ psyche and conduct. It will have an extremely harmful effect on society if short video makers solely desire to achieve commercial advantages through their short videos and overlook social benefits. Therefore, the EC effect of short video platforms can be used to target anomalous groups quickly  for positive interventions in the early stages of short video distribution.Third, as a new type of social media, short video platforms inevitably have some fake news or misinformation. In order to control the adverse effects brought by such information, the EC effect can be used to apply different intervention strategies to users with different sentiments. At the same time, platform managers can appropriately use the preferences of different topic EC members for personalized information recommendation services, aiming to avoid information vacuums and prevent cognitive deficiencies and narrow biases.The short video platforms are distinguished by content-based interactions that heavily rely on uniquely personalised videos selected by the feed algorithm of the platforms. In socio-technical systems, algorithms are typically imperceptible mechanisms that have the power to change how we interact with one another and even push users into a polarized EC. This study systematically explored the EC effect in disseminating short videos on different topics  on three platforms: Douyin, TikTok and Bilibili. The study confirmed a significant EC effect in the commenting behavior of Douyin and Bilibili, but TikTok did not perform significantly. By comparing the performance of the echo chamber effect on the different platforms and topics, we conclude that the pattern of information dissemination within the EC is similar and independent of platforms and topics. Moreover, EC members commonly display themselves in order to catch the attention of their peers and that cultural differences can hinder the growth of ECs.Although the above results were obtained in this study, there are still some limitations. First, the data collection period is limited to 30 days to control the effect of time variables. In future studies, we will consider the relationship between the dissemination of information and ECs for longer periods. Second, the main users of Douyin and Bilibili are concentrated in Asia, and the selected topic events also attract more attention and discussion from Asian users. Therefore, we cannot risk making generalizations about ECs on short video platforms. Third, unfortunately, since some short video platforms do not publicly release information on video retweets and favorite users, we limit our current study to the dimension of comment networks. Previous studies have found that retweet networks have a stronger EC effect than comment networks. As data permissions allow, future work will include extensively exploring the impacts of user interaction behaviors on EC effects, for example, subscription behavior of users, across a broader range of short video platforms and topic events. Finally, the data used in this study are in multiple national languages (predominantly Chinese), and future studies will try to explore the laws of the existence of EC effect in multimodal language in order to draw general generalized conclusions, which will be very meaningful research.


Still-life painters, especially of the so-called Golden Age (17th century) in the Netherlands, are famous for their masterful techniques of rendering reality. Their amazing abilities to depict different material properties of fruits and flowers are stunning. But how important are these careful arrangements of different objects for the perception of an individual item? Is the perceived color saturation of a single fruit influenced by its surrounding context? We selected fruits in still-life paintings as stimuli to investigate whether and how perceived saturations of fruits were affected by their original contexts. In our study, we focused especially on effects of five context properties: complementary colors, chromatic and luminance contrast, object overlap, and surround variance. Six fruit varieties depicted in high-quality digital reproductions of 48 classic and eight varieties in 64 more recent, modern still-life paintings were selected. In a single trial, eight images of fruits of the same variety appeared on a neutral gray background; half were single fruit cutouts, and the other half were the same fruits embedded in their circular contexts. Fifteen participants ranked all eight images according to perceived color saturations of the fruits. Saturation ratings showed a high agreement of 77%. Surrounding contexts led to an increase in perceived saturation of central fruits. This effect was mainly driven by object overlap, the presence of the central fruit type also in the context, and surround variance. Chroma contrast between fruits and contexts decreased saturation significantly. No significant context effects were found for complementary colors or luminance contrast. Our results show that in paintings, many of the cues that are usually experimentally isolated occur in interesting combinations and lead to an increase in perceived saturation that makes fruit objects more appealing and convincing. In each single trial, eight fruit stimuli belonging to the same fruit category and time period were presented in a 2 × 4 arrangement on a neutral gray background. Half of the fruits were presented without and the other half with their context on a neutral gray background. The size of the four stimuli in each of the two rows was scaled to cover most of the horizontal dimension of the screen see . Fruit sSD: 10.8, range: 21–53 years) participated. Ten participants were psychology students of Giessen University, and others were friends or family members. All participants were naive to the purpose of the experiment. They were either reimbursed or got course credit for their participation. Before the start of the experiment, the color vision of all participants was tested with the 24-plate edition of the Ishihara test for color deficiencies  that was controlled by a Dell Precision T1700 Computer . The effective monitor size was 1920 × 1200 pixels (71.42 × 44.64 dva). The monitor color primaries were R = , G = , and B = ; D65 was set as the white point, and gamma was 2.2. Stimulus presentation was controlled using the Psychotoolbox  and MATLParticipants were asked to sequentially “pick the fruit that appears the most saturated.” We told them to pick the object that appeared most “intensely colored” and otherwise followed the procedures established in mean rank position for each stimulus and computed the average rank difference between two conditions: fruit stimuli presented as cutouts without context on the gray background and fruit stimuli surrounded by their original contexts. Additionally, we determined the probability of each stimulus to be ranked as more saturated than the others (probability to be more saturated). We expressed the measure of the probability of each fruit to be perceived as more saturated when presented with its context compared to its probability when presented as a cutout as the odds ratio.We extracted the The eight fruit stimuli presented in each single trial were ranked in order of the participant's selection of perceived saturation from 1 (highest) to 8 (lowest). First, the rank value was inverted so that higher numbers corresponded to stronger perceived saturation. Then rank positions of each stimulus were averaged across trials, yielding an average rank for each of the 112 fruit stimuli per participant.We subtracted the average rank of each fruit without context from the average rank of the same fruit presented with context.We estimated the probability of each fruit to be perceived as more saturated than the other fruits shown in each trial. To do so, we converted for each trial rankings into paired comparisons, separately for each fruit stimulus with and without context. For each trial, four fruits were shown as cutouts and four fruits together with their contexts. For each group of four, and for each of the six pairs they yield, we determined based on the average ranking which fruit of each pair was perceived as more saturated. From the paired comparisons, we computed the probability of each fruit to be perceived as more saturated than others as the proportion of the pairs in which that fruit was ranked higher in the pair over all pairs in which the fruit was presented.sp being the probability of being ranked higher than any other painting when presented with surround and nsp without surround. The odds ratio measures how much more likely a fruit is ranked higher than others when presented with the surround as compared to when presented without. If the odds ratio equals 1, chances are the same . If smaller than 1, the surround causes the stimuli to be ranked lower; if bigger than one, it leads to a percept of higher saturation. The odds ratios were first calculated for each observer separately and then averaged across observers.We computed the odds ratio as follows:For each stimulus, we investigated five color and luminance statistics to clarify their contributions to the appearance of saturation to each central fruit when surrounded by its context. Examples of cutouts with extreme values on these five statistics are shown in With this measure, we aimed to capture chromatic induction  caused bWe measured the contrast between the average chroma of the surrounding context and the average chroma of the central fruit as the ratio of the difference between the mean chroma of the fruit and the mean chroma of the context to the mean of these two. This measure was meant to capture how much induction effects can actually influence the color of the central fruit, since the higher the chroma of the fruit color, the less this color is subject to induction e.g., . Also, iWe expressed the luminance (or brightness) contrast between the central fruits and their surrounding contexts as the ratio of the difference between the mean L* of each fruit and the mean L* of its context to the mean of these two. This measure could potentially contribute to explain an effect of the context on saturation because perceived saturation could be reduced within a dark environment , and colThis is a measure of color and brightness variance within the context, computed as the sum of the variances along the three dimensions of the CIELAB color space. It may affect the perceived saturation of the fruits in the center because perceived saturation is reduced in environments with a high color variance . Figure We used this measure to capture cases in which a fruit was surrounded by similar fruit objects of similar hues. In still-life paintings compositions, presentations of several fruits of the same kind in close proximity like a bowl of peaches or a basket of apples are quite common. We segmented the surrounding contexts to isolate fruits with a similar hue as the central fruit. Then we computed the object overlap by determining the proportion of pixels of the surrounding context occupied by such fruits. This measure could be relevant for perceived saturation, as color perception can be influenced by grouping phenomena . Figure There are major differences between still-life paintings of the two time periods concerning not only the style but also the pigments used for the paints. Modern paint colors are based on pigments including cadmium, chrome, iron and cuprous oxide, molybdates, and various synthetic inorganic or organic components and fillers to increase their strength. The use of modern paint colors results in an increase of chroma, as can be seen in All our participants were able to rank the different fruit stimuli according to their perceived color saturation. Due to the randomized presentation of the fruits, not every participant was presented with all 112 fruits. Internal observer consistency for the 15 participants was calculated by determining the proportion of cases in which a participant's pairwise comparison for a fruit with and without context matched the response of the other participants. The consistency proportion was then averaged across all participants. Across all fruits, the internal observer consistency was 77%. When presented within their original contexts, most fruit stimuli had higher chances to be ranked as more saturated compared to their presentations as fruit cutouts. In t-tests against the null hypothesis  revealed significant positive context effects for perceived color saturation of fruit stimuli taken from classic (t(47) = 5.6296, p < 0.05) and modern still-life paintings (t(63) = 4.6362, p < 0.05). To investigate context effects on the perceived color saturation of the central fruit, we computed the odds ratio for each stimulus (see Methods). If the odds ratio equals 1, chances for rankings of perceived saturation are the same for fruits presented with or without context; if it is smaller than 1, saturation is ranked lower with context; and if it is bigger than 1, saturation is ranked higher with context. The chroma contrast, surround variance, and object overlap had a strong impact on perceived color saturation. Neither the proportion of complementary colors nor luminance contrast changed the perceived color saturation of the central fruit significantly.In our analysis of context effects on perceived saturation of our fruit stimuli, we found that the contribution of the five chosen factors differed in an interesting and unexpected way that allowed a new explanation of context effects. Overall, it turned out that In the following section, we will first show linear regressions of the individual five predictors on the measured odds ratios and subsequently present a multiple regression analysis. Since every painting is a unique stimulus and differs in many aspects from all the others, general explanations of context effects may not always hold for each stimulus. To allow better comparisons and to account for the diversity of our stimuli, few selected stimuli are shown as small circular patches in scatterplots for the effects of the five context factors and the multiple regression model.r = −0.52, p = 0.001, for classic and r = −0.343, p = 0.006, for the modern stimuli. This indicates that context effects are reduced when the chroma of the fruit color increases and the chroma of the context decreases. There was a substantially higher (t(110) = 3.14, p < 0.005) chroma contrast in the modern paintings (62%) than in the classic paintings (34.8%). Still, the regression lines for both periods showed nearly complete overlap, and The scatterplot of According to this result, colorful contexts increase the saturation of central colors with low chroma. This is at odds with predictions based on previous literature . At least(110) = 2.31, p < 0.005) luminance contrast in our stimuli of classic paintings (27.3%) than in stimuli of modern paintings (9.5%).In r = 0.237, p = 0.11) or of the modern paintings . Here we noticed that there was a substantially higher (t(110) = 2.95, p < 0.005) proportion of complementary color in the modern paintings (31.5%) than in the classic paintings (15.5%). Only few stimuli had higher amounts of complementary colors in their contexts and high odds ratios, and these stimuli seem to be the ones with particularly low chroma contrast  but not for the classic ones . This result indicates that a high surround variance in the context increases perceived saturation of the central object, and it differs from the finding of t(110) = 5.81, p < 0.0001) surround variance in the modern paintings  than in the classic paintings (754).The regression analysis revealed a significant positive relationship between surround variance of the context and odds ratio for fruits of modern paintings  and the modern  paintings. The regression lines lie on top of each other; therefore, we only plot the common regression line for all paintings. In our sample (see t(110) = 0.05, p > 0.5) in object overlap between classic and modern paintings with an overall average of 22.5%, but in modern paintings, similar fruits were often grouped much closer together. Therefore, similarities, in both color and shape, of the central fruit and surrounding context seem to be a good and well-known artistic strategy to enhance the percept of color saturation of central objects.The relationship between object overlap of the central of fruit and its context and the odds ratio turns out to be also positive and significant for both stimuli selected from classic and modern paintings, as revealed by the regression analysis see . Increasmple see , severalF = 1.684, p = 0.068); therefore, we opted to not include interaction terms. A collinearity analysis revealed that the correlations between predictors were limited. The variance inflation factor computed for each predictor ranged between [1.05 1.24]. As a rule of thumb, values < 10 . The strongest contributions came from chroma contrast, object overlap, and surround variance, as was already shown in the individual regressions above. The images with the highest odds ratios were therefore characterized by negative chroma contrast, large surround variance, and large object overlap.In Still-life paintings are highly complex stimuli that allow studying the contribution of a variety of factors to perceived saturation of color. We extracted fruit stimuli and their original contexts from digitized images of still-life paintings from two different time periods (17th−18th and 19th–21st centuries) to investigate whether the presence of the original context surrounding a single fruit influenced its perceived color saturation. The high agreement of the saturation ratings demonstrated that participants could judge perceived color saturations of the fruit stimuli consistently. Compared to the same fruits shown as cutouts on a gray background, the presence of the original context increased the perceived saturation of the central fruit significantly. Regression analysis for the specific contribution of five different image statistics revealed that three factors exert a significant influence on perceived saturation of the color of the central fruit. Interestingly, the effects of these five image statistics were nearly identical for paintings from both periods, even though their values differed considerably between the time periods. Significant positive effects of high degrees of object overlap of context and central fruit on perceived color saturation were found for the selection of fruit stimuli of both time periods. This is also true but weaker for surround variance, while chroma contrast had a significant negative effect on saturation. For complementary colors, mainly present in the contexts of modern still-life paintings and for luminance contrasts, hardly any context effects on perceived color saturation of the central fruit were found. The increase in saturation resulting from the presence of similar objects in the context is a novel observation that might explain why in still-life paintings, arrangements of the same or similar fruits in close proximity like a basket or bowl of apples, grapes, lemons, or peaches are quite common.For our stimuli, we used a database of high-quality digital images of classic still-life paintings depicting typical arrangements of fruits, food, and valuable household items like glasses, plates, silverware, and carafes. The main criteria for our selection of digital images of still-life paintings was that single fruits should not be covered by other items so that it was possible to cut out whole fruits. Intact fruit shapes were important for the comparison of perceived saturation of fruits presented as cutouts with that of fruits embedded in their original contexts. The comparison of the still-life paintings of the two time periods revealed that the context increased the perceived saturation for most stimuli. Complementary colors in the context were mainly present in the selection of our contemporary paintings and rare in classic still-life paintings. Effects of complementary colors are known  and usedA large object overlap does go along with a larger area covered by the same or similar colors as in the center, and the resulting increase in size could potentially explain the increase in perceived saturation, if colors of similar fruits in close proximity are processed as a whole. It is known that larger stimuli appear brighter . FurtherSo far, our experiment provides evidence that object overlap and surround variance in the context explain parts of positive context effects of perceived color saturation of the surrounded object. However, potentially other factors relevant have not been considered in our analyses so far. Different aspects of the color distributions may affect perception of saturation  . AssuminLuminance contrasts between contexts and fruits seemed to have both positive and negative effects on saturation. It is known that perceived saturation of a patch can be reduced by a dark environment  and thatOne of the most unexpected findings of our study was a negative effect of chroma contrast on context effects. Stimuli with low central chroma and high surround chroma exhibit large odd ratios. While the low central chroma leads to a low ranking of the isolated fruit, results of previous experiments with simple stimuli  would suOur regression analysis is only able to suggest candidate predictors, whereas proper assessment of their individual contributions for the percept of saturation of color would need image manipulations designed to single them out . In geneWhy would painters strive to make the fruits appear more saturated? Still-life paintings depicted the lifestyle of the wealthy middle class by presenting expensive tableware like glasses, plates, and luxurious food items and flower decoration. For painters, it was probably very important to create and paint very appealing and convincing still-life arrangements, especially of quite valuable items. This required presenting the different materials like glasses, silverware, and cloths as convincing as possible and to paint also the food items and flowers as fresh and desirable to increase their value. Although it is still unclear how judgments of saturation are achieved , for theWith stimuli taken from classic and contemporary still-life paintings, we investigated whether the surrounding contexts modify perceived color saturation of central fruits compared to isolated fruit cutouts and which of five different color and luminance statistics of the stimuli modifies perceived saturation in a significant way. We found that the original surrounding context has a positive effect on perceived color saturation of the central object in most cases. Hue similarity between central fruit and context has a significant positive effect on perceived saturation, while the induction effect of chroma decreases with a decrease of the surrounding chroma. Neither the proportion of complementary colors in the context, which were rare in classic still-life paintings, nor luminance contrast changed the perception of color saturation of the central fruit. In our data set, object overlap is typically produced by close arrangements of similar fruits. The effect of object overlap can potentially be explained, at least in part, by the effect of size on perceived saturation, assuming that groups of similar fruits are grouped and processed together. These results suggest that similar objects in the context, possibly due to a similarity not only in hue but also in spatial frequency , let obj


Malnutrition in hospitalized patients is becoming a priority during the patient care process due to its implications for worsening health outcomes. It can be the result of numerous social factors beyond clinical ones. This study aimed to evaluate the link between these various risk factors considered social determinants of health, food security levels, and malnutrition and to identify potential predictors.A cross-sectional observational study was conducted on a random sample of adult patients in five different hospitals in Lebanon. Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients were interviewed to collect social and economic characteristics and were categorized into four criteria: (1) area of residence (urbanization level), (2) level of education, (3) employment status, and (4) source of health coverage. The food security level was screened by a validated two-question tool, adapted from the US Department of Agriculture Household Food Security Survey, targeting both quantity and quality.In a random sample of 343 patients, the prevalence of malnutrition according to the GLIM criteria was 35.6%. Patients with low levels of food security, mainly low quality of food, had higher odds of being malnourished (OR = 2.93). Unemployed or retired patients and those who have only completed only elementary school had higher odds of being diagnosed with malnutrition as compared to those who were employed or had university degrees, respectively . Employment status, education level, and type of health coverage were identified as predictors of malnutrition in the multiple regression model. Household location  was not associated with malnutrition.The social determinants of health identified in our study, mainly the level of education and income level, in addition to food security, were identified as predictors of malnutrition in hospitalized patients. These findings should guide healthcare professionals and national policies to adopt a broader perspective in targeting malnutrition by including social determinants in their nutrition care. Malnutrition in hospitalized patients has been associated with an increasing rate of complications and worsening outcomes . MalnutrHowever, malnutrition in hospitals may also arise from a combination of factors that extend beyond clinical factors, as observed in community settings , 9. An aFood security, another significant social determinant, has also an impact on both the quantity and quality of food intake affecting, as a result, the nutritional status of the hospitalized patient . DecreasThe social determinants of health along with food security are taken into consideration as part of the Right to Health, which dictates their availability and equitable accessibility . The RigLebanon is a small country in the Middle East Region that is divided into five main districts with an estimated population of 6,847,712 and 144 hospitals comprising 11,742 beds , 21. StuPatients were enrolled as a part of a cross-sectional, observational, and multicenter study intended to assess the national prevalence of malnutrition from May to October 2021. They signed an informed consent form after being introduced to the aim and process of the study. A total of five hospitals, one hospital from each of the five districts of Lebanon, were selected by convenience sampling. All adult patients, men and women aged 18 years and above, admitted to the different wards of the hospitals during the period of data collection were recruited within 48 h of admission. Patients with dementia or other cognitive impairment were also included, and the caregivers were approached to sign the consent form and fill the part of the questionnaire. Exclusion criteria included the following wards: gynecology, intensive care unit, psychiatry, and short stay of <48 h because of the inability of conducting questionnaires.The patient's basic characteristics, including age, gender, marital status, and admission diagnosis, were recorded. The World Health Organization and Office of Disease Prevention and Health Promotion identify various indicators as integral to social determinants of health impacting directly health outcomes in their Healthy Report 2030 , 23. FouThe level of food insecurity was screened using a simplified tool based on two questions adapted from the 2000 United States Department of Agriculture Report on Food Security Measurement Project . It was enough of the kinds of food we want to eatenough but not always the kinds of food we wantsometimes not enough to eatoften not enough to eat.The second question was “Which of these statements best describes the quality of food eaten in the household in the last 12 months?” The response categories were determined based on the patient's description of the number of food groups they consume as follows :very goodgoodaveragepoor.The Global Leadership Initiative on Malnutrition (GLIM) was used to diagnose malnutrition and its severity in hospitalized patients . It is ap-value of < 0.2 at the bivariate level. All reported p-values were evaluated at a significance level of 5%.Statistical analysis was performed using STATA v17.1. Descriptive analysis was used to summarize the study variables and to check for out-of-range values. Continuous variables were described using mean and standard deviations, while frequencies and percentages were used to represent categorical variables. Shapiro–Wilk was used to assess data normality. The median and interquartile range (IQR) were used to describe the non-parametric variables. A series of simple logistic regressions were conducted at the bivariate level to identify potential predictors of malnutrition. A multiple logistic regression model was run thereafter to assess the independent associations between malnutrition status and patients' social determinants and food security level. Variables were selected for inclusion in the model based on a A total of 343 participants were enrolled in this study from May to October 2021. Demographics and social characteristics are presented in n = 122) were identified as malnourished, 21.28% (n = 73) had a moderate level of malnutrition, and 14.29% (n = 49) were classified as being severely malnourished. An equal proportion (50%) of malnourished patients were distributed in male and female populations. Among the 122 patients identified as malnourished, the most dominant phenotypic criterion was “weight loss” accounting for 76.7% followed by low muscle mass (57.5%) and low BMI (31.2%). Decreased food intake was the most common etiologic criterion identified (88%) followed by inflammatory status (60.7%).Using the GLIM diagnostic criteria, a total of 35.57% of patients  described their household food to be “enough but not always the kinds of food we want” as shown in p < 0.001) compared to those of younger age. Gender and marital status were not significantly associated. As for the four indicators identified as social determinants, unemployed or retired patients (p < .001) and those who had completed basic schooling (p = 0.004) or no schooling at all (p = 0.047) had higher odds of being malnourished as compared to those employed or had university degrees, respectively. Household location  and type of health coverage were not significantly associated with being malnourished.p = 0.032). There was no association between malnutrition and the reported description of food quantity in the second question (p = 0.4234) as shown in Patients who described in the first question the quality of the food eaten to be “poor” compared to “very good” have higher odds of being malnourished (p < 0.001) and unemployed/retired (p < 0.001) had higher odds of being diagnosed with malnutrition compared to their counterparts. As for food security, patients who described the quality of the food eaten to be “poor” compared to “very good” in the first question had higher odds of being malnourished (p = 0.066), but the results were borderline significant. However, patients who had private insurance as medical coverage means had lower odds of being diagnosed with malnutrition (p = 0.033). The Hosmer and Lemeshow goodness-of-fit test indicates that our model fits the data well with p-values of 0.7247.Age, work status, district, and type of health coverage were found to be independent predictors of malnutrition diagnosis as shown in The nutritional status of hospitalized patients in this study was assessed and diagnosed using the GLIM criteria. It is a newly proposed diagnostic tool based on a global set of criteria that take into consideration different characteristics of malnutrition, including weight loss, muscle mass, and food intake . It is cThis proposed explanation further supports our hypothesis that malnutrition in hospitalized patients is influenced not only by well-known medical and clinical conditions but also by social and economic factors. As a matter of fact, a financial crisis will affect the ability to purchase enough food of good quality affecting in return the nutritional status of the patients . In our Food security is recognized as a component of the social determinants of health that include education, economic stability, and access to healthcare . These f2) has decreased the differences in the level of urbanization between the cities and rural areas, and therefore, a discrepancy could not be identified.Another predictor of malnutrition in our study was the type of health coverage. Patients who had been insured in private insurance had significantly lower odds of being malnourished as compared with patients with no health coverage or relying on social security funds and non-governmental aid. Private insurance in Lebanon is prohibitively expensive and typically only obtained by individuals from higher socioeconomic groups reflecting a correlation between income level and risk of malnutrition. This correlation has also been demonstrated when studying the nutritional status of children and older adults in the community , 39. TheThe association that we have demonstrated between social determinants and food security should alarm healthcare professionals to broaden their perspective when identifying malnutrition in hospitalized patients. When conducting nutritional assessments, including the GLIM criteria or any validated tool, it is advisable to incorporate a social dimension and identify any factors that increase the risk of malnutrition, such as food insecurity, low income, or low literacy levels , 40. WheThis study has several strengths. First, it has a heterogeneous population because it included patients from five hospitals across different areas and admitted to various wards. Second, the identification of malnutrition was not done by a screening process but was determined through a systematic nutritional assessment using the new GLIM criteria. Third, it was the first study to our knowledge to investigate the association of social determinants with malnutrition measured in hospitalized patients and to identify potential predictors. This study also has some limitations. First, social and economic indicators were collected from the patients and their caregivers through a questionnaire and they had some reservations while answering the questions. Second, a direct question on income level could not be collected due to the severe devaluation of the national currency and the inadequacy of any relevant categorization. Third, food security was only addressed at a screening level using a two-item questionnaire as hospitalized patients were less responsive to surveys of longer duration.To conclude, our study found a malnutrition prevalence rate of 35.57% in hospitalized patients in Lebanon. We also identified social determinants of health, including education level, income level, employment status, and health coverage, as factors associated with malnutrition, along with food security. These determinants were also recognized as predictors of malnutrition in hospitalized patients. Our findings suggest that healthcare professionals should consider adopting a broader perspective in targeting malnutrition in their patients. Their approach should aim to address the underlying causes of malnutrition beyond clinical factors by incorporating social determinants into their nutritional care assessments. National authorities should also prioritize addressing the social determinants of health in their policy agenda to improve malnutrition at the clinical level.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Institutional Review Board of the American University of Beirut. The patients/participants provided their written informed consent to participate in this study.EK, KO, NH, and N-BK: conceptualization and methodology. KO: data collection and writing—original draft preparation. KO and JA: formal analysis. EK, NH, and N-BK: writing—review and editing. EK: supervision. KO and NH: funding acquisition. All authors contributed to the article and approved the submitted version.


Prompt diagnosis of malnutrition and appropriate interventions can substantially improve the prognosis of patients with cancer; however, it is difficult to unify the tools for screening malnutrition risk. 3D imaging technology has been emerging as an approach to assisting in the diagnosis of diseases, and we designed this study to explore its application value in identifying the malnutrition phenotype and evaluating nutrition status.Hospitalized patients treating with maintenance chemotherapy for advanced malignant tumor of digestive system were recruited from the Department of Oncology, whose NRS 2002 score > 3. Physical examination and body composition data of patients at risk for malnutrition were analyzed by physicians trained to complete a subjective global assessment. The facial depression index was recognized using the Antera 3D® system, temporal and periorbital depression indexes were acquired using the companion software Antera Pro. This software captures quantitative data of depression volume, affected area, and maximum depth of temporal and periorbital concave areas.r = −0.293, p = 0.033) and calf circumference . The volume and affected area of periorbital depression were significantly negatively correlated with fat mass index  and percent body fat . The volume and affected area of temporal depression in patients with muscle loss phenotype  were significantly higher than those in patients without muscle loss. Moreover, patients with fat mass loss phenotype (low fat mass index) showed a significant increase in the volume and affected area of periorbital depression.A total of 53 inpatients with malnutrition-related indicators were included. The volume of temporal depression was significantly negatively correlated with upper arm circumference (The facial temporal region, and periorbital depression indicators extracted by 3D image recognition technology were significantly associated with the phenotype of malnutrition-related muscle and fat loss and showed a trend of grade changes in the population of different subjective global assessment nutritional classifications. MalnutrIn the past few decades, screening for malnutrition including a comprehensive assessment of the patients’ weight changes, food intake, and functional levels has mainly been performed through subjective assessments by clinicians and nutritionists . Due to The psoas index, quantified by CT imaging of the third lumbar spine (L3), has been recognized as an important indicator of muscle loss, and is significantly associated with morbidity and long-term prognosis in patients with cancer . A comprIn a recent study, temporal muscle thickness (TMT) assessed using 3D imaging technology was used as a quantitative muscle biomarker for predicting progression-free survival and overall survival in patients with primary diffuse large B-cell lymphoma of the central nervous system (PCNSL) . This st3D facial image recognition has demonstrated its clinical application in the analysis of typical facial features of acromegaly , differeTo explore the application value of 3D facial image recognition technology in assisting the diagnosis of malnutrition, we piloted a 3D facial image recognition method for hospitalized patients with cancer. We aimed to verify its applicability in determining the phenotype related to malnutrition, using measures such as the reduction in muscle and fat mass, and thus provided a methodological reference for simplifying the clinical diagnosis of malnutrition.2.2.1.Hospitalized patients treating with maintenance chemotherapy for advanced malignant tumor of digestive system were recruited from the Department of Oncology, Peking Union Medical College Hospital. The inclusion criteria were: (1) Han race, (2) age > 18 years, (3) nutritional risk screening (NRS 2002) score > 3, and (4) voluntary participation and cooperation for facial image collection. The exclusion criteria were: (1) artificial changes in the face ; (2) special diseases with facial changes ; (3) administration of high-dose glucocorticoids leading to facial changes; (4) edema of the face or limbs; and (5) other situations deemed for exclusion by the researchers. This study was approved by the Ethics Committee of the Peking Union Medical College Hospital (Number: JS-2768), and all participants provided written informed consent.2.2.Prior to the start of the trial, two physicians were uniformly trained in the content and standard procedures of nutritional assessments, and any doubts and inconsistencies were discussed and resolved. Physicians were trained to complete NRS 2002 and subjective global assessment (SGA) nutritional assessment by applying structured questionnaires within 24 h of patient admission and conducting a standardized physical examination, which included measurement of height, weight, upper arm circumference, calf circumference, handgrip strength (HGS), and body composition analysis.NRS 2002 and SGAs were performed in accordance with the guidelines of the American Society for Parenteral and Enteral Nutrition and were derived from the patient’s medical history and physical examination. The medical history included weight, appetite changes, gastrointestinal symptoms, mobility, and disease-related nutritional requirements over the past 2 weeks. Physical examination included subcutaneous fat (triceps and chest), muscle mass (including the quadriceps and deltoid), and edema levels. Based on the above assessments, patients were classified into grades A, B, and C, with grades B and C considered to have mild-to-moderate and severe malnutrition, respectively.2). The upper arm circumference (AC) and calf circumference (CC) were measured using a non-elastic tape, with a minimum reading of 0.1 cm. With the patient in a sitting position, the circumference of the relaxed non-dominant arm at the midpoint of the line connecting the acromion and olecranon was measured. Additionally, with the patient sitting on the side of the bed, the relaxed calf was measured on a plane perpendicular to the long axis of the calf to obtain the maximum circumferential value. HGS was measured using an electronic handgrip dynamometer with the patient standing comfortably, repeated three times with the lateral hand; the maximum value was used for the analysis.Weight (kg) and height (cm) were measured in light indoor clothing without shoes. Body mass index (BMI) was calculated as weight (kg) divided by height (m) squared . Fat-free mass (FFM), fat mass (FAT), visceral fat mass (VFA), and percent body fat (PBF) were measured using a portable body composition meter (InBody S10); the fat-free mass index (FFMI) and fat mass index (FMI) were calculated as FFM and FAT (kg) divided by height (m), respectively.2.3.Facial depression index recognition was performed using the Antera 3D® system within 24 h of patient admission, using a camera for acquisition and analysis of skin images, with an area of 56 mm × 56 mm. The camera utilizes light-emitting diodes (LEDs) of different wavelengths to illuminate the skin from different directions and then performs computer-assisted 3D skin surface reconstruction based on spatial and spectral analysis of the acquired image data . The recDepression index of temporal (between the outer edge of the orbit and the hairline) and periorbital  were acquired using the camera companion software Antera Pro  . This so2.4.2 in men and <15 kg/m2 in women. Malnutrition phenotypes associated with reduced fat mass were FMI with cut-off value of <7.7 kg/m2 in men and <5 kg/m2 in women  cutoffs were <27 cm in men and <25 cm in women . and calin women .2.5.t-test and Mann–Whitney U-test were used to compare the differences of depression between different groups of malnutrition phenotypes. Categorical variables were described as frequencies and percentages, and comparisons between groups were performed using the chi-square and Fisher test. Spearman correlation analysis was used to test the association between depression index and malnutrition phenotype. All tests were two-sided, and statistical significance was set at p < 0.05.Previous studies have shown that the incidence of malnutrition in hospitalized patients with cancer in China was approximately 38.9% ; the typ3.3.1.Data of 53 inpatients with malnutrition indicators were successfully collected in this pilot study. According to the SGA assessment, 30 patients had no risk of malnutrition (SGA A), 15 had mild-to-moderate malnutrition (SGA B), and 8 had severe malnutrition (SGA C). The distribution of clinical characteristics and malnutrition-related phenotypes among groups are presented in 3.2.3, SGA B: 75.59 ± 31.72 mm3, SGA C: 99.66 ± 38.34 mm3, p = 0.068) and surface area  of depression showed a significant grading trend among dystrophic groups; the more severe the degree of malnutrition, the larger the volume or surface area of depression. No significant differences were found among the groups with respect to the maximum depth of depression , followed by the SGA B group , while SGA C patients showed the largest depression . No obvious trends were found in the volume or maximum depth of periorbital depression among the groups  and CC . A larger upper AC or CC implies higher muscle mass and was found to be related to smaller volume of temporal depressions, while the phenotypes related to muscle mass, including HGS and FFMI, also exhibited a negative correlation with measures of temporal depression; however, the result was not statistically significant  and PBF . Both FMI and PBF are indicators of body fat content, and patients with more body fat exhibited smaller volume and surface area of periorbital depression. Moreover, FAT and VFM showed a negative correlation with the indices of periorbital depression; however, the difference was not statistically significant  were significantly higher than those in patients without muscle loss. Patients with the fat mass loss phenotype (low FMI) also showed a significant increase in the volume and surface area of periorbital depression. The maximum depth of temporal and periorbital depression showed consistent trends between the groups; however, it was not statistically significant .4.Our study has provided further evidence to support the association between face-specific depression indicators and dystrophic phenotypes. In particular, the degree of temporal depression was inversely correlated with the level of body muscle mass, and the degree of periorbital depression was negatively correlated with the level of subcutaneous fat mass. These findings were consistent with the results of nutritional physical examinations and suggest the application value of 3D image recognition of facial features in the diagnosis of malnutrition.In our study, malnutrition-related phenotypes (anthropometric measures of muscle and fat mass) showed significant differences among patients with or without malnutrition; however, HGS, an indicator of muscle function, did not vary among groups. This indicates that although patients with cancer are at risk of muscle loss because of the inflammatory burden of tumor, they can still maintain a certain degree of muscle quality with active treatment and functional training , and thuIn the nutrition-focused physical assessment (NFPA) proposed by the American Academy of Nutrition and Dietetics and ASPEN , the amoMoreover, the NFPA guidelines use the periorbital fat pad as an important phenotypic indicator to evaluate the level of subcutaneous fat. Our study confirmed the consistency between the degree of periorbital depression and change in body fat mass, However, the thickness of the periorbital fat pad was also affected by age , sex 3030, diseaComputer-assisted image recognition technology has been widely used in many diseases, including cardiovascular diseases , digestiOur study also has some limitations. First, being a pilot study, the sample size was small; however, distribution of malnutrition among the included patients was consistent with the prevalence of malnutrition in hospitalized patients with cancer found in previous surveys, indicating that the study population was still representative to some extent. Second, we did not use the gold standard DXA, CT, and MRI for muscle mass measurement but instead used portable BIA, which reduced the accuracy of body composition measurement. However, BIA is more widely used in clinical settings, and the cost is relatively low, which is conducive to the promotion and verification of tests in a large population. Finally, the 3D image analysis method used in this study is relatively simple, and the accuracy and quantity of extracted data from facial features are limited, which may be the reason why we found that the correlation between facial depressions and malnutrition phenotype is relatively low (0.2–0.4). In a later study with an enlarged amount of facial image data, more image recognition and machine learning technologies will be introduced to improve the accuracy of facial recognition and malnutrition diagnosis, and to further verify the effectiveness of 3D facial image in the diagnosis of malnutrition.5.The facial temporal region and periorbital depression indicators extracted by 3D image recognition technology were significantly associated with the phenotype of malnutrition-related muscle loss and fat loss and showed a trend of grade changes in the population of different SGA nutritional classifications. 3D facial image recognition technology is expected to become an important clinical auxiliary tool for extracting phenotypic indicators of malnutrition in the population and for early warning of malnutrition risk.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Ethics Committee of the Peking Union Medical College Hospital (Number: JS-2768). The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual (s) for the publication of any potentially identifiable images or data included in this article.XL and WC equally contributed to the conception and design of the research. XW and MH contributed to the acquisition of the data. YL and NY contributed to the interpretation of the data. MC analyzed the data and drafted the manuscript. All authors critically revised the manuscript, agree to be fully accountable for ensuring the integrity and accuracy of the work, and have read and approved this statement.This work was supported by the Grants from National Natural Science Foundation of China (grant number: 72074222).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This study aimed to investigate the safety and efficacy of three-dimensional (3D) surgical video systems for proliferative diabetic retinopathy (PDR).This retrospective clinical case study included 30 patients (30 eyes) with PDR. Patients were divided into two groups: one underwent surgery using a 3D surgical video system , while the other underwent traditional microscope surgery . Safety and efficacy were assessed through predetermined surgical parameters, including surgical duration, intraoperative membrane removal rate, and occurrences during intraoperative and postoperative phases.p = 0.051). Furthermore, the mean membrane removal time was significantly shorter in the 3D group at 2.53 ± 1.52 mins, as compared to 3.23 ± 1.76 mins in the traditional group (p = 0.042). Importantly, the membrane removal rate also displayed a significant difference, with the 3D group at 0.55 ± 0.07 and the traditional group at 0.41 ± 0.11 (p = 0.018). However, no notable differences were observed between the two groups in terms of intraoperative and postoperative incidences.Our study revealed noteworthy differences in various aspects between the 3D surgical video system group and the traditional microscope surgery group. Specifically, the mean surgical time was 30.25 ± 14.43 mins in the 3D surgical video system group, while it was 38.56 ± 18.71 mins in the traditional microscope surgery group (The safety and efficacy obtained using the 3D surgical video system in PDR surgery were comparable to those obtained in traditional microscopic surgery. Proliferative diabetic retinopathy (PDR), a severe threat to vision, affects ~6.96% of patients with diabetes globally, making it the leading cause of blindness in the working-age population –3. PDR iIn recent years, three-dimensional (3D) display technology has undergone rapid advancements and has been extensively applied in ophthalmic surgeries requiring high precision and stability. Three-dimensional (3D) surgical video systems are equipped with advanced components, such as a 3D, 4K ultra-high-definition organic light-emitting diode (OLED) 55-inch display screens and high dynamic range (HDR) cameras. These features provide ophthalmic surgeons with a high-definition stereoscopic surgical view and precise spatial orientation. Compared with traditional surgery performed under a microscope, 3D surgical video systems offer significant advantages, such as increased depth of field, higher resolution, reduced retinal phototoxicity, ergonomic design, and support for teaching and instruction. Domestic and international studies have demonstrated the widespread application of 3D surgical video systems in surgeries, such as cataract surgery, macular hole surgery, epiretinal membrane surgery, and macular pucker surgery –14. HoweBased on the aforementioned background, our center conducted a retrospective study to evaluate the safety and efficacy of the 3D surgical video system in PDR surgeries, as compared to the traditional microscope method.This is a retrospective, controlled study.This study was approved by the Ethics Committee of Tianjin Medical University Eye Hospital . All patients were informed of the study's purpose and provided signed consent in accordance with the principles of the Declaration of Helsinki. This single-center retrospective case study aimed to analyze the clinical data of 30 patients (30 eyes) diagnosed with PDR, who underwent minimally invasive vitrectomy at Tianjin Medical University Eye Hospital in Tianjin, China, between April and October 2022.The inclusion criteria were patients diagnosed with PDR who required surgical treatment owing to the presence of vitreous/retinal hemorrhage and/or tractional retinal detachment confirmed by fundus imaging or ocular B-scan.The exclusion criteria were as follows: (1) corneal opacities or corneal opacities that affected visual evaluation; (2) other vitreoretinal or ocular congenital diseases involving the iris, choroid, or optic nerve; (3) vitreous hemorrhage, retinal detachment, or other conditions unrelated to diabetic retinopathy requiring vitrectomy surgery; (4) previous vitreoretinal surgery; and (5) difficulties in follow-up or inability to complete follow-up.Participants in this study were categorized into two distinct groups based on the observation equipment utilized during the surgical procedure. The first group, referred to as the “3D Surgical Video Group,” comprised patients who underwent surgery with the assistance of the 3D surgical video system. The second group, designated as the “Traditional Microscope Group,” consisted of patients who underwent surgery using the traditional microscope system.Preoperative best-corrected visual acuity (BCVA), intraocular pressure (IOP), slit-lamp examination, indirect ophthalmoscopy, and ocular B-scan results were recorded using an electronic medical record system. The BCVA was measured using the international standard visual acuity chart and converted to the logarithm of the minimum angle of resolution (logMAR). The results were manually converted to 2.3 or 2.0 logMAR. Noncontact tonometry was performed to measure IOP in postoperative follow-up examinations involving several aspects, including postoperative BCVA and IOP. The examination also aimed to detect instances of IOP, vitreous hemorrhage, or retinal detachment after surgery.All surgeries were performed by a single experienced vitreoretinal surgeon. It is noteworthy that the surgeon performing the procedures in the “3D Surgical Video Group” had extensive prior experience with 3D surgical video systems, having successfully completed hundreds of surgeries using this technology before the study's commencement. This surgeon's familiarity with the nuances of the 3D system may have impacted certain aspects of the surgeries and potentially influenced the outcomes evaluated. A traditional microscope system  was used in the “Traditional Microscope Group,” while a 3D surgical video system was used in the 3D group . The 3D display screen was placed ~1.2–1.8 m in front of the surgeon, and the surgeon, assistant, and observers were required to wear 3D polarized glasses . In bothWe collected data on several parameters during surgical interventions for PDR to assess surgical efficiency and patient outcomes. These measures included the following:The duration of the entire surgical procedure was recorded in minutes, from the establishment of the three-port sclerotomy to the removal of the trocar cannulas and closure of the surgical incisions. This information was obtained from video recordings of the surgeries.The time taken to completely remove the proliferative membranes was recorded in minutes. This measurement began with the initial use of a vitreous cutter or intraocular forceps to cut, grasp, and separate the membranes and concluded when all the membranes were completely excised. These timings were derived from surgical videos.* the disk area covered by the membranes)divided by [the peeling time (min)] , to delineate the optic disk and membrane areas. By measuring the membrane area as a multiple (X) of the optic disk area, the membrane removal efficiency was calculated as (X e (min)] .Intraoperative complications such as iatrogenic retinal tears, inadvertent retinal or vascular injury due to intraocular instrument manipulation, and lens damage caused by instruments were documented by reviewing the surgical videos.We conducted a subjective satisfaction survey of participants who used the 3D surgical video system, including surgeons, surgical assistants, circulating nurses, and observers. All members of the surgical team completed a satisfaction questionnaire on the 3D surgical video system. The questionnaire focused on comparing and rating aspects such as resolution, stereoscopic effect, field of view, ergonomics, and comfort between the 3D video system and the traditional microscope. The ratings were provided on a scale of 1–5, where 1 = strongly disagree, 2 = disagree, 3 = no significant difference, 4 = agree, and 5 = strongly agree.p < 0.05 was considered statistically significant.Statistical analysis was conducted using IBM SPSS Statistics for Windows, version 23.0 . Continuous variables such as BCVA, IOP, surgical time, proliferative membrane removal time, proliferative membrane removal rate, normality, and homogeneity of variance were assessed. Differences between the two groups were compared by conducting t-tests or non-parametric tests (Mann–Whitney U test). Categorical variables such as gender, presence of intraoperative complications, and postoperative follow-up rate were compared by conducting chi-squared or Fisher's exact tests. Age is presented as the mean ± standard deviation, while other continuous variables are presented as the means ± standard error. A significance level of The present study included 30 patients. While the distribution of operated eyes differed between the two groups, these differences were not clinically significant. Preoperatively, there were no statistically significant differences in age, BCVA, or IOP between the two groups.P > 0.05).Regarding the PDR classification, the 3D video surgery group included 10 cases of combined vitreous hemorrhage and four cases of combined tractional retinal detachment. The traditional microscope group included 11 cases of combined vitreous hemorrhage and five cases of combined tractional retinal detachment . At 1 and 3 months, the follow-up rates were 92.8% for the 3D video surgery group and 87.5% for the traditional microscope group (p = 0.552) .Our comparative analysis of vitreoretinal surgery using a 3D surgical video system and the traditional microscope in patients with PDR focused on four key quantitative indicators: total surgical time, membrane removal time, membrane removal rate, and intraoperative complications.p = 0.051). Although the difference in the total surgical time between the two groups was not statistically significant, we observed a slight trend toward a shorter surgical time in the 3D surgical video system group, suggesting that the system may have certain advantages in terms of operational efficiency.The average total surgical times for the 3D surgical video system and the traditional microscope groups were 30.25 ± 14.43 and 38.56 ± 18.71 mins, respectively . Therefore, the use of the 3D surgical video system allowed faster membrane removal, thereby saving surgical time.The average membrane removal rate was 0.55 ± 0.07 in the 3D surgical video system group and 0.41 ± 0.11 in the traditional microscope group. Further statistical analysis confirmed that the membrane removal rate in the 3D surgical video system group was significantly higher than that in the traditional microscope group. Therefore, the use of a 3D surgical video system enabled more effective removal of proliferative membranes, thereby enhancing surgical precision and efficiency.Regarding intraoperative complications, we compared the occurrence of iatrogenic retinal breaks, retinal hemorrhage, and lens injury between the 3D surgical video system and traditional microscope groups. The results showed no iatrogenic retinal breaks in the 3D surgical video system group, while there was one case recorded in the traditional microscope group. There were three and five cases of retinal hemorrhage in the 3D surgical video system and traditional microscope groups, respectively. None of the groups reported lens injury. The complications did not differ significantly between the two groups. Thus, the use of the 3D surgical video system did not increase the risk of intraoperative complications and demonstrated excellent safety when compared with the traditional microscope .Evaluation of the improvements in postoperative visual acuity revealed significant improvements in visual acuity after surgery in both the 3D surgical video system and traditional microscope groups. Specifically, at 1 week, 1 month, and 3 months postoperatively, the BCVA values in the 3D surgical video system group were 0.45 ± 0.32, 0.29 ± 0.36, and 0.27 ± 0.31, respectively, and 0.47 ± 0.29, 0.33 ± 0.27, and 0.29 ± 0.36, respectively, in the traditional microscope group. Although the differences between the two groups were not statistically significant, these data demonstrated the success of the surgery and a favorable trend in postoperative recovery.We observed changes in IOP during the postoperative follow-up period. Notably, we observed no statistically significant differences in the changes in IOP between the groups. This indicated that the use of the 3D surgical video system did not affect postoperative IOP control and exhibited stable and reliable performance in postoperative IOP management when compared with the traditional microscope.p > 0.05). Moreover, no cases of retinal detachment were observed within the 3-month postoperative follow-up period in the 3D surgical video system group  technology for automatic delineation and measurement of the proliferative membrane area would allow more accurate and meaningful calculations of membrane removal efficiency. The precision of area calculations in the peripheral retina is a challenge due to various factors, including image distortion, variable magnification, and potential inaccuracies in capturing fine details. While our methodology was designed to address these challenges to the best extent possible, it is important to recognize that there may be inherent limitations in accurately quantifying peripheral retinal areas. Future studies could explore advanced imaging techniques to enhance the precision of peripheral retinal area measurements.Furthermore, in the questionnaire survey, the participants expressed a positive evaluation bias toward image resolution, depth perception, field of view, and educational demonstration of the 3D surgical video system. They stated that wearing 3D polarized glasses provided simultaneous, synchronous, and stereoscopic surgical images, allowing a better understanding of the intraocular anatomy and surgical steps for both surgical participants and beginners. However, with increasing surgery duration and number of surgeries, little subjective difference was observed between the 3D surgical video system and the traditional microscope in terms of proficiency, ergonomics, and image latency. Nevertheless, the paradigm-shifting seated and upright viewing posture of the 3D video system eliminated the need for surgeons to bend their heads for prolonged periods, thereby reducing the burden on the surgeons' necks and shoulders and alleviating fatigue and discomfort during surgery.In conclusion, this study's results confirmed that the 3D surgical video system enabled clearer visualization of pathological tissues and differentiation between proliferative membranes and normal retinal tissues during minimally invasive PDR vitrectomy. This allowed surgeons to perform membrane peeling with greater precision and speed, effectively relieving the traction caused by the proliferative membrane and vitreous in the retina. This effect reduced mechanical traction injury caused by repeated membrane peeling and improved the visual prognosis in some patients. The 3D surgical video system also demonstrated safety and effectiveness in PDR surgery, leading to more precise, stable, efficient, and safe PDR surgical treatment. However, this study had a limited sample size and a short follow-up duration; therefore, further research with a larger sample size is needed to investigate the application effects of the 3D surgical video system in minimally invasive PDR surgery.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving humans were approved by the Ethics Committee of Tianjin Medical University Eye Hospital . The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation was not required from the participants or the participants' legal guardians/next of kin in accordance with the national legislation and institutional requirements.BH, XZ, DZ, and WL conceived and designed the study, conducted the experiments, analyzed the data, and wrote the manuscript. HH and ZN assisted in the study design, provided guidance throughout the research process, and contributed to the writing and editing of the manuscript. HG contributed to the data analysis and interpretation of the results, and critically reviewed the manuscript. ZW conducted the literature review, performed statistical analyses, and assisted in manuscript preparation. XL provided technical support and assistance in the data collection and analysis. All authors have read and approved the final version of the manuscript and agree to be accountable for all aspects of the study.