In recent years, live video streaming platforms for video games have been gaining popularity. These types of services, which enable anyone to broadcast and consume live content, are revolutionising the current video game landscape. Users approach the emergence of and participation in these platforms driven by a range of motivations. It is essential to characterise the different forms of participation in services such as Twitch to evaluate the phenomenon and reflect on its advantages and disadvantages. To that end, a survey was carried out of 580 young people and adolescents aged between 14 and 24. The aim of this study is thus to explore the uptake of these platforms, as well as identify user groups, distinguish between different motivations, and address the associated benefits and harms. Applying a methodology based on factor analysis and cluster analysis, user profiles were characterised according to their specific features, gaming/viewing hours, self-perception of their skill level as a player, devices used, and type or genre of video game. Four subgroups of gamers/viewers were thus identified: casual, social, hobby, and problematic. The results showed that older users and female users feature more prominently in the first two groups, as do those spending less time on video games and live streaming platforms. Conversely, in the hobby and problematic groups, we observe just the opposite. The existence of profiles at possible risk of addiction underlines how, at a preventive level, there is a need for more in-depth research on these types of services and greater public awareness of the dangers of uncontrolled use. Over the course of human history, if there is one society that has championed the prioritisation of free time as a need Art. 24 ), it is 4 , it isPlaying video games is a common activity among young people and adolescents . There iThe world of video games is currently in the midst of a genuine revolution, ushered in by two relatively recent and interconnected phenomena: the rise of e-sports and the development of activities related to the live streaming of video games. Crowdsourced live streaming services allow anyone to broadcast and consume live content over the internet . NotableThe positive and negative elements associated with video games also apply to live streaming services . The facIn recent years, some promising lines have emerged within the research on live streaming that point to the professional opportunities linked to streaming ,28,29,30The success of video games, due in part to their interactive nature , extendsThe growing importance of this phenomenon is in little doubt. In this respect, Johnson and Woodcock  underlinKnowing the different motivations of different users is essential in order to gain an understanding of their behaviour and to identify distinct profiles. Motivation is one of the aspects that most strongly influences the desire to continue playing . Some ofIndeed, one of the most promising avenues of research into live streaming of video games focuses on the analysis of motivation ,44,47; aThe literature on the utility and benefits of video games reveals enormous potential. Results have been found indicating a connection with enhanced cognitive abilities, improved coordination of senses such as sight or touch, spatial reasoning, capacity for attention and creativity ,51, and This set of benefits extends to live video platforms; however, an approach to such services requires a more in-depth exploration of what they offer. Gros, Wanner, Hackenholt, Zawadzki, and Knautz  point toIn line with this dual utility, the most recent studies on video games and streaming platforms focus on the professional possibilities, where gaming stops being a hobby and becomes an occupation ,33, or oSome adverse effects are related to antinormative behaviour, harassment, or dissemination of offensive or inappropriate content ,54,55.Misgivings about problematic gaming, especially in children, adolescents, and young people, has become a focus of growing concern among parents and caregivers . As BuizIn relation to the internet, as Fineberg et al.  point ouThe methodology used is based on primary data collected through an online survey administered via the Surveymonkey platform.The study population is Spanish video game players and users of video game live streaming services between the ages of 14 and 24. According to the Spanish Association of Video Games, in 2018, around 3.4 million users in Spain were in this age group . A conveThe questionnaire design was based on previous research papers ,44,47,68a.Sociodemographic characteristics.b.Gamer attributes, preferred platforms for gaming/viewing, time spent weekly, and self-perception of skill level.c.Motivations for gaming/viewing content.d.Potential harm.e.Potential benefits.The questionnaire was divided into five blocks:n = 12), in order to correct any phrasing or inconsistencies, as necessary. To obtain a diversity of usage habits, the selection criteria for the survey respondents were not restrictive, that is, all participants who reported having used live streaming services in the previous 6 months were included, giving rise to a high degree of randomness. The survey remained open from September to November 2019. A total of 609 questionnaires were completed, of which 580 were valid. A number of those respondents left some questions unanswered, which is why some of the tables presented do not add up to 580 users.The sociodemographic section included closed-ended questions, with a number of answer choices for the respondents to choose from. Subsequent blocks included questions assessed using a 5-point Likert scale. Before the final survey, a pre-test was performed on a control group .Regarding the motivation variables, drawing on the classification proposed by Sjoblom and Hamari , they weThe potential benefits of live streaming platforms have not yet been established and more research is needed in this regard; nevertheless, some benefits are understood to be based on the unique features of these platforms, such as interactivity  and advaLastly, to determine the potential adverse effects, the scale developed by Andreassen, Billieux, Griffiths, Kuss, Demetrovics, and Mazzoni  was adapOnce the data had been tabulated, a reliability analysis was performed, using Cronbach’s Alpha to evaluate the validity of the responses and the measurement scale. In all cases, the value of this coefficient was greater than 0.8, indicating good internal consistency. Given the number of variables, an exploratory/confirmatory factor analysis was then carried out, using the Varimax orthogonal rotation method. Of the 19 variables initially evaluated, 4 non-significant variables were eliminated: to contact streamers, to watch Twitch/platforms with friends, to be part of the gamer community, to be part of today’s gaming culture, and the remaining ones were reduced down to four factors.On the basis of these factors, an analysis was carried out to identify possible patterns according to which survey respondents could be grouped. User subgroups were determined using non-hierarchical clustering techniques. Thus, cluster analysis was applied to determine whether there are characteristic features that can define their behaviour. The results of the dendrogram and the icicle plot suggested an optimal solution consisting of four clusters. To check the significance of belonging to a particular cluster of individuals, as indicated by the evaluation of the variables, a MANOVA  analysis was used. In addition, since this analysis cannot be used to determine where the significant differences in means exist, Tukey’s post hoc test was applied. The statistical analyses were carried out using IBM SPSS Statistics 25 .Recreational-informative factor: incorporates the motivations linked to utility, connected to the needs they meet. This factor explains 28.9% of the total variance in gaming/viewing on streaming platforms.Escapist-addictive factor: incorporates aspects considered potentially negative in the use of video games and social networks ,60. ThisBM factor (bad manners or bad behaviour): includes potentially negative issues related to the aggressiveness arising in relationships with third parties when interacting on such platforms, such as making or receiving hurtful comments or trolling others, and it explains 12.5% of the variance.Social factor: incorporates issues connected to social networks within these platforms, and accounts for 12.1% of the total variance explained.Exploratory factor analysis (EFA)  was thenIn order to evaluate the validity and reliability of the four dimensions extracted in the EFA, we used confirmatory factor analysis (CFA) with structural equation modelling, applying the unweighted least squares (ULS) estimation method. The factor scores indicated the use of a non-hierarchical clustering method, with the aim of maximising the variance between groups and minimising it within each group. Of all the possible solutions, the one that best met these criteria was chosen and four clusters were established, and the user profiles in the detected groups are shown in Cluster 1 denoted a sporadic-casual audience: the largest group with 256 respondents or 44.1% of the sample, and this group scored the lowest in all the dimensions analysed.Cluster 2, or social audience: composed of 82 respondents (14.1%), it registered high scores in social variables and moderate scores in the recreational-informative dimension.Cluster 3, termed a hobby audience: comprising 205 respondents (35.3%), their motivation stems from aspects such as entertainment, learning strategies, staying up to date on video games, and complementing social networks. They show medium–high values in components related to the escapist-addictive factor, such as playing to forget problems or spending an ever-increasing amount of time gaming.Cluster 4, or potentially problematic audience: composed of 37 users, only 6.4% of the sample; however, this cluster represents the most complete spectrum, registering very high scores in factors associated with bad behaviour in networks and notable escapist-addictive elements, together with high recreational-informative motivation.The tests for differences between means highlighted that belonging to a particular group has a significant relationship with the factors considered , yielding four possible audience profiles:The groups were then characterised according to factors associated with problematic gaming, such as gender, age, device, gaming/viewing time , as wellThe results showed that young women and female adolescents feature more prominently in Clusters 1  and 2 . They have a smaller presence in Cluster 3 (hobby) and only a minimal presence in Cluster 4 (problematic). The male survey respondents are mostly found in Clusters 3 and 4, more closely related to the concept of gaming as a hobby and problematic gaming. Furthermore, Clusters 3 and 4 are made up of the youngest users (under 19 years of age), in contrast to Clusters 1 and 2, which comprise respondents aged between 20 and 24 years old. Weekly hours spent gaming or viewing are also related to the allocation to the different clusters: only 2% of those in Cluster 1 admit to playing more than 15 h a week, whereas this proportion increases to 32.4% in Cluster 4. A similar pattern is observed with viewing. The young people included in Clusters 3 and 4 perceive themselves as having a higher skill level as a player than those belonging to Clusters 1 and 2. Regarding devices, it can be seen that the use of PCs and PlayStations is more widespread in Clusters 3 and 4, while no significant relationships were found for the use of tablet. On the other hand, devices such as Xbox or Nintendo have a negligible presence in the sample. Another noteworthy aspect is that the members of Clusters 3 (27%) and 4 (15.2%) think that their passion for video games can be turned into a profession. Lastly, it is worth noting that action/adventure was the favourite genre in all groups: a preference for potentially more addictive genres appeared in Clusters 3 and 4, with high percentages of MMORPG/FPS/MOBA , which were not seen in Clusters 1 and 2.Regarding the characterisation of the groups, To determine the extent to which the four clusters differ from one another with respect to these three variables, post hoc multiple comparisons tests were used, namely the Brown-Forsythe and Welch’s t tests . In thisThe main objective behind this study was to gain an understanding of the characteristics of young people and adolescents’ entry into live video game streaming services. To that end, their motivations were determined following previous research on motivation and adverse effects related to addictive use ,47,68,69Four clusters were identified through factor analysis followed by clustering. The first contained the most users and registered the lowest scores in all the variables analysed. Denoted the sporadic-casual audience, it fits a profile of users who are newcomers to these platforms and whose main motivation is entertainment and spending time enjoying their favourite hobby without the need to perform . The timFocusing attention on the motivation variables used in the different clusters, the uses and gratifications theory has often been used to gain a better understanding of the emerging phenomenon of video game live streaming ,78,79,80Regarding the variables capturing users’ perceptions, their self-perception of their skill level as a player was particularly notable for the scores registered by the four clusters, with the younger players grouped in Clusters 3 and 4 recording the highest levels. According to White  and HoppThe classification established here is a reflection of some of the existing groupings for types of players ,83,84,85Unlike previous studies such as those by Sjoblom and Hamari  and WangLastly, we believe that this research can help parents, caregivers, and guardians identify certain profiles, offering a better understanding of a phenomenon that is here to stay, and helping to strike the difficult balance between advantages and disadvantages. Generally speaking, except for the problematic profile (a minority), the motivations relating to entertainment and learning new strategies or gaming techniques are those that register the highest scores.


This paper proposes a novel method for sports video scene classification with the particular intention of video summarization. Creating and publishing a shorter version of the video is more interesting than a full version due to instant entertainment. Generating shorter summaries of the videos is a tedious task that requires significant labor hours and unnecessary machine occupation. Due to the growing demand for video summarization in marketing, advertising agencies, awareness videos, documentaries, and other interest groups, researchers are continuously proposing automation frameworks and novel schemes. Since the scene classification is a fundamental component of video summarization and video analysis, the quality of scene classification is particularly important. This article focuses on various practical implementation gaps over the existing techniques and presents a method to achieve high-quality of scene classification. We consider cricket as a case study and classify five scene categories, i.e., batting, bowling, boundary, crowd and close-up. We employ our model using pre-trained AlexNet Convolutional Neural Network (CNN) for scene classification. The proposed method employs new, fully connected layers in an encoder fashion. We employ data augmentation to achieve a high accuracy of 99.26% over a smaller dataset. We conduct a performance comparison against baseline approaches to prove the superiority of the method as well as state-of-the-art models. We evaluate our performance results on cricket videos and compare various deep-learning models, i.e., Inception V3, Visual Geometry Group , Residual Network (ResNet50), and AlexNet. Our experiments demonstrate that our method with AlexNet CNN produces better results than existing proposals. The rapid growth of devices and widespread internet connectivity and automation has generated data drastically like never before. In addition to textual data, video streaming contents are the main contributor in data generation, which demands a larger space and bandwidths to store and stream. The web pages with video content are more engaging and seem informative than that of only showing the text. Video processing, monitoring, summarizing, and broadcasting are snowballing with the introduction of live broadcast apps and the provision of live streaming on existing major video hosting websites. Therefore, the video processing is gaining the attention of the computer vision and deep-learning researchers. Video content searching, video description, and video summarization are the hot topics of the times. They are high-level tasks in the field of video processing. On the other hand, shot classification, scene classification, shot-boundary detection, and action recognition are the building blocks for those high-level tasks.Sports videos are the most engaging and contributive content and have enormous commercial aspects. Sports video scenes are usually repetitive; because every sport has its predefined camera positions, zooming protocols, and action replay strategies. Sports videos are usually long in duration; therefore, it is not always possible for the offline audience to watch full contents of the recorded video for a specific event. Due to the longer duration of the recorded video and busier life of the audience, researchers are actively working on automatic video summarization, and scene classification is the core component for the sports video summarization. Since sports videos have known rules for video capturing and have a particular scene protocol, a sport-specific scene classifier can produce better results in comparison to generalized scene classifier. Sports video covers all the events, including exciting as well as boring events, and some of the events are less exciting, i.e., breaks, tedious parts of the game, and other activities where a viewer loses interest. It produces the opportunity to publish the videos consisting of only the best parts of the game. Therefore, accurate and high quality of scene classification can help to produce a high-quality video summary.The objective of our proposed method is to present a high-performance method to achieve high-quality summarization. The lower error rate in classification ensures the high reliability of the classification and hence high reliability of the dependent processes that consume scene classification building block. We achieve this objective by introducing a three-step upgrade to the state-of-the-art method proposed by , i.e., pThe sports audience is more interested in meaningful content, and analyzing and summarizing the video content is a substantial labor task. Computers are helping humans more promising than ever before, and particularly with the evolution of machine learning and other methods of artificial intelligence (AI) in almost every domain of the life sciences. Therefore, researchers are proposing novel techniques almost all the time. Since scene classification if a fundamental building block, it requires significant attention to improve the performance over the existing research state-of-the-art level. Previously, several researchers proposed generalized schemes for shot classification, shot-boundary detection, and scene classification; however, generalized proposals are less helpful for a specific domain. Proposing a specialized technique has its significance and achieves superiority over the existing generalized proposals.Many researchers proposed excellent methods recently with significant improvements. Minhas et al.  proposedIn this paper, we propose a model for sports video scene classification with the particular intention of sports video summarization. The proposed method contributes a combination of three techniques over the existing state-of-the-art technique : the proWe compare the model with the existing state-of-the-art models, particularly deep-learning models, e.g., Inception V3, VGGNET16, VGGNET19, ResNet50, and from non-deep-learning models like SVM to present a performance evaluation. We also compare the model with existing models in the field of sports video summarization and scene classification. We focus on scene classification with a primary intention of video summarization using deep-learning methods, and we have selected the sport of cricket as a case study.Our proposed methodology demonstrates a 5% better performance over the existing method proposed by  and supeThe primary audience of the proposed method is the video summarization and video description researcher community. However, classification, in general, can also be employed in several other domains, i.e., medical image analysis ,3, agricThe rest of the paper is organized into the following four sections, Existing approaches presented significant work on sports videos. Mainly shot classification and scene classification methods classify the camera views in the field, i.e., audience, players, and state of the sports field views specialized to each sport. Recent approaches employed various methods and models, including conventional classification models, i.e., Kth Nearest Neighbor (KNN), Support Vector Machines (SVM), as well as deep-learning models, i.e., AlexNet CNN, Recurrent Neural Network (RNN), Long Short-Term Memory (LSTM), Visual Geometry Group Network (VGGNET) and Gated Recurrent Units (GRUs). Approaches involving deep structures ensure an improved accuracy but at the cost of increased computational complexity. The need for a dedicated dataset for large-scale multi-label video classification is being addressed by Abu-El-Haija et al. , with ovRahul et al.  presenteMinhas et al.  proposedThis section provides a detailed methodology of the proposed method. The core of the proposed method is AlexNet CNN, which is pre-trained on ImageNet  weights.In the proposed method, we employed AlexNet CNN deep-learning architecture for scene classification and evaluated using Keras application 2.0 and Tensor Flow backend in Python. Keras provides a variety of deep-learning application layers. We employed Keras layers to construct AlexNet and extended the codebase from the ConvNet library . AlexNetT from the Equation  is convoluted over layer input tensor to obtain feature maps and forwarded to output tensor. We obtain an output feature map Equation  and 2)..T from tT is the output tensor with K denotes the kernel with size S to P. Similarly, r indicates the layer of operation. Output feature map tensor is obtained by applying a convolution process on the input layer X by kernel K such that X and the kernel K with x and y spatial indices. The convolution is represented here with standard notation by symbol ∗. Equation (3) shows the detail expression of convolution in Equation (3)Where The proposed framework consists of five convolutional layers with three split convolutional layers to load balance on multiple GPUs. We have eliminated batch normalization after convolutional layers since we have not observed any accuracy improvements during our experiments. Convolutional Layers’ output was activated using Rectified Linear Unit (ReLU)A fully connected layer cross-connects every neuron from the input tensor to every neuron in the output tensor, with an activation function at the output layer. The fully connected layer flattens the input tensor if the input shape rank is higher than 2. Hence a fully connected layer is a dot product of the input tensor by the applied kernel.Fully connected layers generate probabilities in a wide range; therefore, to reduce the noise level, it is essential to eliminate the weaker predictions. To perform this operation, a dropout process is carried out with a certain threshold of usually 0.5. This less densifies the neurons after removing the value of lesser probabilities. The dropout layer helps to avoid a model overfitting and significantly improves the validation accuracy. A dropout layer reduces the functional size of the process by removing unproductive neuron outputs. It is a regularization technique and filters out complex co-adaptation during the training phase.Rectified Linear Unit (ReLU) is a tensor output activation function and makes the model training process non-linear. During the convolution process output, tensor may contain positive and negative values; therefore, before forwarding the output to the next layer, an activation function is applied. A ReLU function converts the values lower than zero to a zero value, and positive values leave unchanged. This process is called rectification. A non-saturating function Equation .(4)Y model and with the work presented by Minhas et al. The performance demonstrates the robustness of the model. The proposed model achieved a mean accuracy of 99.26%, precision of 99.27%, recall of 99.26%, which computes to 99.26% of F1-score, and an error rate of 0.74%. Results indicated the effectiveness of the proposed model in the domain of sports video summarization. Proposed model evaluations reveal the inter-class similarities and intra-class differences. We compared the performance of the proposed model with state-of-the-art models and existing methods proposed in recent research in sports video shot classification. To compare our model, we selected the most relevant and recent work in the same domain. Minhas et al.  proposedVarious studies proposed models, frameworks, and methodologies in the recent past for shot classification exclusively or part of their scheme, conclusively, deep-learning approaches presented high quality of the classification. Deep learning proved its importance in image classification, and incorporating the pre-trained model and applying augmentation  improvedWe selected the best learning rate to achieve the peak performance of the model. We tested our model on various datasets publicly available on the Kaggle  to make In this paper, we proposed a model for sports video scene classification with the particular intention of sports video summarization. Our findings demonstrated that our proposed model performed best against state-of-the-art models and existing recent research level. We evaluated our proposed model on cricket as a case study and obtained videos from publicly available YouTube source. We labeled the five most frequent scenes from the videos, i.e., batting, bowling, boundary, close-up, and the crowd to evaluate it to be the best fit for video summarization. We compared our proposed model with the existing state-of-the-art models, particularly deep-learning models, e.g., Inception V3, VGGNET16, VGGNET19, ResNet50, and from non-deep-learning models like SVM to present a performance evaluation. We also compared our proposed model with recently proposed models in the field of sports video summarization, and scene classification; the performance results showed a remarkable improvement.Although the proposed methodology is evaluated over sports video data to provide a building block for video summarization; however, it can also be used for medical image analysis, agriculture classification, biological organism classification, self-driving vehicles and various other fields where classification requires respectively higher accuracy and the error rate is a critical constraint. The proposed model produced excellent performance indicators over previously proposed models, which makes it a strong candidate to be a reusable building block. Scene classification can be further extended to research on video description and medical video analysis and event description. Similarly, sports video to text summarization is a hot topic of the times and requires researchers to improve the quality of the task.


We discuss an unusual presentation of Zenker's Diverticulum (ZD). A 76-year-old man presented with a left sided neck mass which was misdiagnosed as a thyroid mass due to the anatomical location and size. The ultrasound and fine needle-aspiration cytology findings were inconclusive, and a CT scan was then considered which reported a large pharyngeal pouch. Our recommendation is to consider an early CT scan in patient's where there is a clinical suspicion or risk factors for the development of pharyngeal pouch specially when the fine-needle aspiration cytology findings are inconclusive. This would reduce the risk of a delayed diagnosis which can prevent potential perforation of the pharyngeal pouch and development of mediastinitis. •Left sided neck mass misdiagnosed as thyroid mass.•Zenker's Diverticulum is formed due to muscular weakness.•Pharyngeal pouch symptoms mimic head and neck cancer presentation.•Barium swallow is a gold standard investigation for pharyngeal pouch.•Pharyngeal pouch can be treated with endoscopic or external surgical approaches. The patZD's are more commonly seen in males than females, and occur more frequently in the elderly population, especially in patient's over the age of 70. The diverticulum typically presents with various symptoms including chest pain, chronic cough due to aspiration, dysphagia, halitosis, regurgitation, and weight loss. As the pharyngeal pouch enlarges patients can become more symptomatic, malnourished, and often suffer from significant weight loss ,3,4.This case describes a distinctive presentation of a left sided neck mass which was mistaken as a thyroid mass in a patient who had prior endoscopic stapling of a pharyngeal pouch. The work has been reported in line with the SCARE criteria .2A 76-year-old man presented with a left sided neck mass, abdominal pain, progressive dysphagia over a few weeks and weight loss. He was referred urgently for investigation of a suspected thyroid malignancy under the two-week cancer referral pathway. He had a known past-medical history of dysphagia, total hip replacement, and nine years previously had endoscopic stapling for a pharyngeal pouch. On clinical examination, a left lateral level three neck mass was identified. The mass was described as approximately 4–5cm in diameter and palpable anterior to the sternocleidomastoid.He was referred for an urgent ultrasound scan, which at the time reported a left sided thyroid nodule. This was described as a solid-cystic nodule, isoechoic with smooth margins and multiple echogenic foci with a comet tail artefact  as well as multiple small foci of calcification. He then underwent a fine needle aspiration cytology (FNAC), the result of which was inconclusive. Based on the ultrasound findings he underwent a CT scan of his neck which showed a large (65 × 53 × 37mm) left sided pharyngeal pouch which was filled with more debris than gas.Given the patient's progressive symptoms, surgical options for treating his pharyngeal pouch were discussed. He subsequently underwent external diverticulectomy. The final histology showed squamous epithelium lining with focal ulceration and patchy chronic inflammation in the subepithelial tissue. Following the procedure his dysphagia improved significantly enabling him to return to a normal diet.This patient had an exceptionally large pharyngeal pouch measuring (65 × 53 × 37mm) radiologically which required external excision.3A clear understanding of the pathogenesis underlying development of a pharyngeal pouch is missing. The most accepted theory is based on a physiological abnormality above the cricopharyngeal muscle at the level of the upper oesophageal sphincter ,4. This This theory is further supported by malfunctioning of the cricopharyngeal muscle, the inability of the sphincter to relax and causing a raised hypopharyngeal (intrabolus) pressure during swallowing. The raised intrabolus pressure can be confirmed using specialized cricopharyngeal pH manometry . The intDue to the proximity of the thyroid gland, ZD can occasionally mimic thyroid nodules and this can be misdiagnosed as a thyroid mass. Some diverticula contain fluid and debris which can project as complex thyroid cyst, haemorrhagic adenoma or even an abscess  and the ZD's are usually diagnosed with a barium swallow or via an endoscopy ,11. BariHowever, mortality rate is slightly higher after external approach 1–2%) which is partially due to increased age and frailty of these patients and partially due to the type of the surgery –2% which. For his4Recurrence of ZD following endoscopic surgery is a known complication and this should be considered as part of the differential diagnosis when investigating a large anterior neck mass. We recommend repeat imaging and considering an early CT scan when there is a suspicion or risk factors to exclude pharyngeal pouch.Not commissioned, externally peer-reviewed.Case report, not a research study.None.Dr. Fatemeh Salimi: Main author, Data collection, analysis.Dr. Jerocin Vishani Loyala: 2nd Author.Dr. Arbaz Perviaz: 3rd Author.Professor Stuart Winter: Principle investigator, Design, data collection, analysis, interpretation, Contributing author.All authors have NO financial, personal nor conflicts of interest to disclose. All authors disclose that NO funding to be declared.1.Name of the registry:2.Unique Identifying number or registration ID:3.Hyperlink to your specific registration (must be publicly accessible and will be checked):Dr. Fatemeh Salimi.Dr Vishani Loyala.


It is crucial to identify factors contributing to malnutrition risk in older persons in order to prevent malnutrition as far as possible.Factors that increased the risk of malnutrition were: increased levels of IL-8, osteoprotegerin (OPG), and Soluble-Receptor-For-TNF-alfa . In comparison with previous studies, in our study there was no significant difference in hsCRP and IL-6 in participants at risk of malnutrition and those who were well-nourished, nevertheless, those at risk of malnutrition had significantly higher IL-8, OPG and sTNFRII concentrations, but higher levels of IL-18.The etiopathogenesis of malnutrition in older persons is complex and our study indicated that chronic inflammation plays a probable role and should be considered in evaluating nutritional status in the geriatric population; however, it also exposes an avenue where further research is needed in order to enhance our understanding and guide comprehensive patient care. Malnutrition is an underestimated, but significant problem among older persons. It is described as a consequence of genetic and environmental factors, lack of physical activity, and co-morbidities. However, a key role of a geriatrician is to further explore the multidimensional complexity of this issue. The aim of this study was to identify the relationship between nutritional status and different factors, particularly focusing on inflammatory biomarkers.Nutritional status was assessed using Mini-Nutritional-Assessment with a score below 24 (out of 30) defined as malnutrition. Different serum biomarkers of inflammation were measured, such as High-Sensitivity-C-Reactive-Protein (hsCRP), Interleukin-6 (IL-6), Interleukin-8 (IL-8), Interleukin-18(IL-18), osteoprotegerin(OPG), and Soluble-Receptor-For-TNF-alfa(sTNFRII). Medical history, mental status  and activities of daily living  were used in the evaluation. The relationship between nutritional status and the factors listed was assessed.The mean age of 76 examined persons  from the outpatient clinic was 71 years. Malnutrition risk was recognized in 29%. The following factors significant in univariate regression were used in stepwise regression analysis: age, sex, mental status , valve disease, number of diseases, IADL. Stepwise regression revealed that the risk of malnutrition was increased by the presence of valve disease, number of diseases, and female sex. Factors that increased the risk of malnutrition were: logsTNFRII , IL-8 , and OPG . Risk of malnutrition was negatively associated with Il-18.Chronic inflammation and immunologic process are likely contributors to the complex etiopathogenesis of malnutrition in older persons. Nutrition plays a pivotal role in life. Although the vast majority of nutrition-focused efforts are dedicated to the epidemic of obesity, on the other end of the spectrum, malnutrition is a significant problem posing increasing concern in our geriatric population. The term “malnutrition” is used to describe a host of nutritional abnormalities. Typically, it refers to protein–energy malnutrition that occurs when metabolic requirements chronically exceed nutritional intake, resulting in a longstanding negative balance of both energy and protein . AccordiSevere malnutrition leads to cachexia, a complex metabolic syndrome associated with underlying illness and inflammation which contributes to increased catabolism and increased muscle protein breakdown. It is characterized by loss of muscle with or without loss of fat mass. The prominent clinical feature of cachexia is weight loss in adults (corrected for fluid retention) or growth failure in children (excluding endocrine disorders) . CachexiIt is recommended that the GLIM consensus criteria should be applied to diagnose malnutrition in persons with sarcopenia, cachexia and frailty so that the priority to undertake appropriate nutrition interventions may be recognized.The important issue is that malnutrition is a risk factor for increased morbidity and decreased quality of life –7. Its pIncreasing evidence from basic biological studies suggests that inflammatory cytokines play a direct role in the development of typical manifestation of aging, such as sarcopenia, anaemia, and cognitive decline. Higher levels of pro-inflammatory cytokines were found in the majority of older people, also in the absence of clinically active diseases  and withNonetheless, there is an evidence of a relationship between malnutrition and inflammation expressed by elevated levels of pro-inflammatory cytokines and these biomarkers were independent risk factors of malnutrition in various disease states, such as renal failure , neoplas. stated that among different factors like serum levels of albumin, transferrin, total cholesterol, vitamin D, and lymphocyte count, low serum albumin levels best predict 1-year mortality in hospitalized older adults, followed by low transferrin serum levels  resulted in OR = 1.27 (95% CI 1.022–1.57); increase of IL-8 by one [pg/ml] resulted in OR = 1.09 (95% CI 1.003–1.18); odds of malnutrition increased more than three-fold per each logsTNFRII (OR = 3.09 95% CI 1.07–8.96). An inverse relationship was observed between IL-18 level and malnutrition risk; per increase of IL-18 by one [pg/ml], odds of malnutrition decreased by 0.5% (95% CI 0.991–0.999).In our study population, the risk of malnutrition was associated with female sex, presence of valve disease, and multiple co-morbidities. Factors that increased the risk of malnutrition were: increased levels of IL-8, OPG, and sTNFRII (log-transformed). The risk of malnutrition was negatively associated with Il-18 level. The obtained results indicate that irrespective of the etiology (inflammaging or related to chronic conditions), inflammation is associated with a greater risk of malnutrition.2 and both groups did not differ significantly in muscle mass.Although chronic diseases may lead to cachexia most of our patients were not malnourished, but at risk of malnutrition. Because of a cross-sectional design of this study, we were not able to assess the potential loss of weight, but even in the group at risk of malnutrition median BMI was over 26 kg/mPrevious studies have demonstrated a relationship between malnutrition and elevated levels of IL-6 and TNFα , 23. It . proposed that inflammation, especially expressed by elevated IL-6 levels, may be a common cause of multiple age-related diseases or a final common pathway by which disease leads to disability and adverse outcomes in older adults [Our study included an expanded panel of inflammatory biomarkers and assessed their association with risk of malnutrition in a population of geriatric counseling patients. Oe et al. also studied a population of older persons, but located in Japan. Their study showed that TNFα was associated with inflammation and insulin resistance in both Japanese older men and women; a prominent association was observed between TNFα and malnutrition status in older women . In anotr adults .In a study of patients with end-stage renal disease, it was suggested that malnutrition was best predicted by hsCRP and IL-6 levels . In our IL-8 is a small protein chemoattractant that recruits neutrophils to sites of inflammation through interaction with at least two types of receptors-A and B . The levAdditionally, Abo-Shousha et al. demonstrated that IL-6 and IL-8 levels were higher in children with protein-energy malnutrition than in properly nourished children . Sugawar. studied patients with sarcopenia, demonstrating that they had higher levels of CRP and erythrocyte sedimentation rate (ESR) than his control group. Chronic inflammation, associated with increased degradation of muscle protein, was determined to be an important risk factor for hip fracture in sarcopenic patients [Yoo et alpatients . In our Further evidence of the relationship of malnutrition with inflammation is the study by Takele et al. who found a significant correlation between low BMI and increased levels of IFN-γ, IL-2, IL-12, IL-4, IL-5, IL-13, IL-10, IL-33, and TNFα; however, not IL-8 or CRP. Their results show that even in the absence of apparent infections, healthy malnourished individuals display dysfunctional immune responses which may cause increased susceptibility to infectious diseases with more severe presentations .As shown above, the presence of chronic diseases can contribute to increase of inflammatory marker levels, but increase of inflammatory cytokines was also observed in malnourished but healthy individuals , 40.. in their systemic review found moderate evidence for no association between having a chronic disease and protein-energy malnutrition. In addition to this, strong evidence for no association was found for, among others, high number of diseases, stroke, heart failure and coronary failure [Moreover, van der Pols-Vijlbrief et al failure .TNFα is among the inflammatory markers frequently used to study processes of aging. It is primary produced by macrophages and plays a role in directing inflammatory reactions in our bodies by stimulating release of proteins, like IL-6 and CRP. TNFα is produced as an adipocytokine in adipose tissue. When adipose tissue expands to a great extent, TNFα contributes to insulin resistance . StudiesThe actions of TNFα are mediated by two distinct TNF receptors, receptors 1 and 2 (TNFRI and TNFRII). Our study used TNFRII level as an inflammatory marker and it was determined to be higher in patients at risk of malnutrition.. observed a significant association between TNFα and malnutrition status in older women [As written above, Oe et aler women . In anoter women . Correiaer women .Another important biomarker is OPG, a member of the TNF receptor super-family, which we found to be associated with increased risk for malnutrition. OPG is secreted by osteoblasts, mesenchymal stem cells, fibroblasts, endothelial cells, and human adipose tissue . It has . postulated that OPG might be an early indicator of all-cause mortality in patients with chronic kidney disease and advanced medial arterial calcification [. found that elevated serum OPG levels may be useful as a prognostic marker of cardiovascular risk in dialyzed patients [The role and significance of OPG seems to be broad and not fully understood. Krzanowski et alfication . Janda epatients . A highepatients , 17. OurIn contrast to the biomarkers mentioned above, IL-18 was associated with decreased risk of malnutrition in our study. IL-18 is an inflammatory cytokine, first identified by Okamura et al. in 1995. It is found in multiple cell types including immune, hematopoietic, chondrocytic, intestinal epithelial cells, astrocytes, and microglial cells. As a member of the IL-1 family, IL-18 acts in synergy with IL-12 to activate murine and human T-cells, thereby signaling induction of inflammation, interferon-gamma production, and cell-mediated immunity .IL-18, together with IL-1β, serves in activation of downstream inflammation signaling in a state of infection and injury , 48. HigIn addition to its role in autoimmune diseases, IL-18 contributes to the process of atherosclerosis and, therefore, by inference to aging. Clearly, reducing IL-18 activities can be viewed as possible therapeutic strategies to slow the aging process . It was Worth mentioning is fact, that one study demonstrated significantly decreased plasma IL-18 levels in patients with anorexia nervosa compared to controls. Plasma IL-18 levels directly correlated with BMI in controls, but not in patients with anorexia nervosa. These results suggest that a decline in plasma IL-18 levels in patients with anorexia nervosa is not only due to malnourishment, but other pathophysiologic changes as well. IL-18 has a role in brain’s reaction to sadness and chronic stress. Therefore, decreased levels of IL-18 may commonly occur in patients with chronic anorexia nervosa .It is difficult to explain the lower IL-18 level in patients with malnutrition risk in comparison to the patients with proper nutrition. It might be a result of a relatively low number of participants. However, as an explanation, we should also take into account an appropriate treatment that causes the stability of the diseases, as evidenced by relatively good muscle mass in patients with heart failure.An article published in November 2019 dedicated the MaNuEL Toolbox  shows how important is the problem of malnutrition is in older people. It was made available to effectively distribute and disseminate the MaNuEL results and recommendations, which will support researchers, healthcare professionals, policy-makers as well as educational institutes to advance their efforts in tackling the increasing problem of protein–energy malnutrition in the older population .However, the authors of The MaNuEL Multicohort Meta-Analysis focused on and stressed the importance of social and physical factors contributing to malnutrition of older people. According to its results unmarried, separated, or divorced participants were more likely to develop malnutrition that married participants, whereas no association was found for widowed participants. Participants with difficulty in walking or difficulty in climbing stairs and those who were hospitalized before baseline and during follow-up had higher odds of incident malnutrition .We are aware of some limitations of this study—first, the observational nature of the study does not allow to determine the causative relationship between malnutrition risk and inflammation process, this should be studied in depth later. The second, the number of patients included in this analysis is small and that limits the statistical power to detect differences between study groups, as well as do not allow for studying many possible confounders that can play role in the association between malnutrition and inflammation. Another important consideration is the lack of participants diagnosed with malnutrition, which may weaken the significance of relationships assessed. In addition to this, the group is heterogeneous and, as previously was written, relatively small, so that might influence the results. Finally, we also took into consideration that the markers are of poor specificity.Despite these limitations, our study points out that there is a relationship between inflammation and risk of malnutrition in patients in stable period of chronic diseases. Besides, it extends a cytokine spectrum connected with unsatisfactory nutritional state.In conclusion, the etiopathogenesis of malnutrition in older persons is complex.Our study indicated that chronic inflammation, irrespective of the reason, plays a probable role and should be considered in evaluating nutritional status in the geriatric population; however, it also exposes an avenue where further research is needed in order to enhance our understanding and guide comprehensive patient care.


Indeed, the use of HBO in inflammatory bowel disease (IBD) has been reported as early as 1989, and an emerging amount of scientific evidence is available.6 In current practice, its application mostly remains at the discretion of the treating physician and the availability of hyperbaric chambers. One of the underlying reasons for this is the quality of the current evidence: a substantial proportion of studies that have been published have a small sample size and a high risk of bias.4 The authors state in their letter that it would be ethically questionable to add a control group to a study because patients with an aggressive condition and limited therapeutic options would be denied a possibility of treatment with HBO. Performing (sham) controlled trials using HBO can indeed be challenging (though not impossible), but high-quality research is necessary precisely to make sure that the treatment is available for those patients that might benefit from it.7Although there is an increase in published studies about the therapy and its effects, HBO is not (yet) an established indication for IBD, neither in Europe nor in the USA.8We would like to thank the authors for their suggestion of performing a subsequent study on metastatic CD and HBO; a multicentre or international approach could indeed result in the required sample size. The HOT-TOPIC trial that the authors refer to has been executed as a first step in expanding the knowledge about HBO for perianal fistulas in CD; its short-term outcomes will be submitted for publication in the near future.


In randomized trials, the term “double-blind”  has no standard or widely accepted definition. Agreement about which groups are blinded is poor, and authors using these terms often do not identify which groups were blinded, despite specific reporting guidelines to the contrary. Nevertheless, many readers assume—incorrectly—that they know which groups are blinded. Thus, the term is ambiguous at best, misleading at worst, and, in either case, interferes with the accurate reporting, interpretation, and evaluation of randomized trials. The problems with the terms have been thoroughly documented in the literature, and many authors have recommended that they be abandoned.We and our co-signers suggest eliminating the use of adjectives that modify “blinding” in randomized trials; a trial would be described as either blinded or unblinded. We also propose that authors report in a standard table which groups or individuals were blinded, what they were blinded to, how blinding was implemented, and whether blinding was maintained. Individuals with dual responsibilities, such as caregiving and data collecting, would also be identified. If blinding was compromised, authors should describe the potential implications of the loss of blinding on interpreting the results.“Double blind” and its derivatives are terms with little to recommend their continued use. Eliminating the use of adjectives that impart a false specificity to the term would reduce misinterpretations, and recommending that authors report who was blinded to what and how in a standard table would require them to be specific about which groups and individuals were blinded. The single biggest problem in communication is the illusion that it has taken place. George Bernard ShawIn reports of randomized trials, the use of the term “double-blind” and its derivatives  is commonly understood to indicate that two groups participating in the trial are kept unaware of which participants are receiving the experimental intervention and which are receiving the control intervention –6.Despite its long and widespread use, however, the term has several problems.Agreement about which groups are blinded in a double-blind trial is poor –16. For Even when using the term in an article, many authors do not identify which groups were blinded or how blinding was implemented , 16, 17.Many readers assume—incorrectly—that they know which groups are blinded in a double-blind trial Table  2–5, 11, 16. UnfThe suggestion to establish explicit definitions for the term , 18 is cbefore participants have been assigned to experimental groups, whereas blinding minimizes surveillance, expectation, and ascertainment bias after group assignment. Many readers are not aware of this difference [In randomized trials, the allocation schedule  has to be kept secret to prevent group assignment from being manipulated. That is, allocation concealment minimizes selection bias fference , 18–20, “A randomised trial can be methodologically sound and not be double blind or, conversely, double blind and not methodologically sound.” . Said anhow treatments are made indistinguishable [which groups are unaware of treatment assignment [Some authors prefer “masking” to “blinding,” although the meaning of either term in a clinical trial may not be readily apparent to nonnative English speakers , 22. Furuishable , 25, 26,signment –6. FinalThe problem with trying to identify in a single term the groups who are blinded in a trial is that the number of pairs is potentially large. The literature identifies 11 groups or individuals who could be blinded: participants, care providers, data collectors and managers, trial managers, pharmacists , laboratAs near as we can tell, despite the above problems and several calls to abandon the term , 16, 28,The terms “fully blinded” or “partially blinded” do appear in the literature, but not as substitutes for substitutes for double-blinding or single-blinding . AlthougWe considered blinding “assignment concealment ” becauseHowever, assignment concealment does not work well as a label. We concluded that “a concealed assignment trial” was unlikely to replace “a blinded trial.” Likewise, its use can be awkward: “group assignment was concealed from participants” was unlikely to replace “participants were blinded to treatment.” Further, as noted above, for better or worse, the mere use of the term “blinding” is widely considered to indicate study quality, and we concluded that authors would be unwilling to give up using this prized and familiar term. Finally, many people believed that “concealment” should be reserved for, or would be confused with, allocation concealment.The term “blinding” is so firmly established that a simple substitute term, even if we could find one, is unlikely to be acceptable. Instead, we propose two changes in reporting trials described as blinded.Our first proposal is to eliminate the use of adjectives that modify “blinded”: single-, double-, triple-, observer-, personnel-, rater-, observer-, fully or partially blinded, or any other qualifier that would make “blinded” seem more specific than it is. A trial would be described as either blinded or unblinded. Using “blinding” as a verb in a sentence would also be helpful. Such use encourages specificity by requiring a noun, usually which groups were blinded: “We blinded caregivers and data assessors” or “caregivers and data assessors were blinded.”We wholeheartedly endorse the near-universal recommendation that authors report whether or not the trial was blinded , 14–16, was or was not blinded, what information they were blinded to, how blinding was implemented, and whether blinding was maintined during the trial. The supplemental part, used when necessary, would present the same data for any other group or individual who was blinded. Individuals with dual responsibilities, such as caregiving and data collecting, would be identified in the same row heading. If blinding was compromised, authors should report the fact in the table and indicate in the text the potential implications that loss of blinding might have for interpreting the results.Accordingly, our second proposal is to have all trials described as blinded include the details in a standard “Who Knew” table Table . This ta“Blinding” as a concept to reduce bias has been used for more than 200 years , and “doThomas A. Lang, MAPrincipal, Tom Lang Communications and Training InternationalAdjunct Instructor, Medical Writing and Editing Program, University of Chicago Professional EducationSenior Editor, West China Hospital/Sichuan Medical School, Chengdu, ChinaDonna F. Stroup, PhD, MScPrincipal, Data for Solutions, Inc.Adjunct Instructor, Medical Writing and Editing Program, University of Chicago Professional EducationCo-signers :Matthias Egger, MD, MSc, FFPH: Professor of Epidemiology and Public Health and former Director, Institute of Social and Preventive Medicine, University of Bern, and President, National Research Council, Swiss National Science Foundation. Former co-editor, International Journal of EpidemiologyForough Farrokhyar, MPhil, PhD: Professor and Research Director, Department of Surgery, Department of Health, Evidence and Impact, McMaster UniversityRobert Fletcher, MD: Professor Emeritus of Population Medicine, Harvard Medical School; founding Co-Editor, Journal of General Internal Medicine; former Co-Editor-in-Chief, Annals of Internal Medicine; founding member, Word Association of Medical Editors (WAME); member, International Advisory Board, The LancetSuzanne W. Fletcher, MD: Professor Emerita of Population Medicine, Harvard Medical School; founding Co-Editor, Journal of General Internal Medicine; former Co-Editor-in-Chief, Annals of Internal Medicine; National Academy of Medicine; former member, American Board of Internal Medicine; founding member, US Preventive Services Task ForceR Brian Haynes, OC, MD, PhD, FRCPC: Professor Emeritus of Clinical Epidemiology and Biostatistics; Professor of Medicine, McMaster University; co-founder, Evidence-Based Medicine movement; founder, Health Information Research Unit; founding Editor, ACP Journal Club; lead developer of the structured abstractAnne Holbrook, MD, PharmD, MSc, FRCPC: Professor, Department of Medicine, and Director, Division of Clinical Pharmacology & Toxicology, McMaster University; leading Canadian drug policy advisor and research lead for evidence-based therapeuticsEileen K Hutton, RM, PhD, DSc (HC): Professor Emerita and former Assistant Dean, Faculty of Health Sciences, and former Director of Midwifery, McMaster University; Professor of Midwifery Science, Vrije University, Amsterdam; and Fellow, Canadian Academy of Health SciencesAlfonso Iorio, MD, PhD, FRCPC: Professor, Department of Health Research Methods, Evidence and Impact; Bayer Chair for Clinical Epidemiology Research and Bleeding Disorders; Chief, Health Information Research Unit and Hamilton-Niagara Hemophilia Program, McMaster UniversityRichard L. Kravitz, MD, MSPH: Professor, Internal Medicine; Former Director, Center for Health Services Research in Primary Care, University of California, Davis; former co-Editor-in-Chief, Journal of General Internal Medicine; Director, UC Center Sacramento, a program providing leadership training in politics and relevant evidence for policymakersJosé Florencio F. Lapeña Jr., MA, MD, FPCS: Professor of Otolaryngology; former Vice-Chancellor, University of the Philippines; Editor-in-Chief, Philippine Journal of Otolaryngology Head and Neck Surgery; Charter President, Philippine Association of Medical Journal Editors; Past President, Asia Pacific Association of Medical Journal Editors (APAME); Secretary and Past Director, World Association of Medical Editors (WAME)Maria del Carmen Ruiz-Alcocer, MD: Senior Medical Editor, Intersistemas Publishers; Former President, Mexican Association of Biomedical Journal Editors (AMERBAC); Past Director, World Association of Medical Editors (WAME); member, European Association of Science Editors (EASE)Roberta Scherer, PhD: Senior Scientist, Clinical Trials and Evidence Synthesis, Johns Hopkins Bloomberg School of Public Health; former Associate Director, USA Cochrane Center; Adjunct Assistant Professor, Epidemiology & Public Health, University of Maryland School of MedicineChristopher H. Schmid, PhD: Professor and Chair of Biostatistics and founding member and former Co-Director of the Center for Evidence Synthesis in Health in the Brown University School of Public Health; founding Co-Editor of Research Synthesis Methods; helped develop Institute of Medicine national standards for systematic reviewsThomas A. Trikalinos, MD: Associate Professor of Health Services, Policy, and Practice; Director, Center for Evidence Synthesis in Health, School of Public Health, Brown UniversityJunmin Zhang, MD, PhD: Professor and Managing Director, Journal of Capital Medical University, Medical Education Management, Journal of Translational Neuroscience, Capital Medical University, Beijing, China


Reticuloendotheliosis virus (REV) is a retrovirus that causes severe immunosuppression in poultry. Animals grow slowly under conditions of oxidative stress. In addition, long-term oxidative stress can impair immune function, as well as accelerate aging and death. This study aimed to elucidate the pathogenesis of REV from the perspective of changes in oxidative-antioxidative function following REV infection.4.62/0.1 mL TCID50. Thymus was collected on day 1, 3, 7, 14, 21, 28, 35, and 49 for histopathology and assessed the status of oxidative stress.A total of 80 one-day-old specific pathogen free (SPF) chickens were randomly divided into a control group (Group C) and an REV-infected group (Group I). The chickens in Group I received intraperitoneal injections of REV with 102O2 and MDA in the thymus increased, the levels of TAC, SOD, CAT, and GPx1 decreased, and there was a reduction in CAT and Gpx1 mRNA expression compared with the control group. The thymus index was also significantly reduced. Morphological analysis showed that REV infection caused an increase in the thymic reticular endothelial cells, inflammatory cell infiltration, mitochondrial swelling, and nuclear damage.In chickens infected with REV, the levels of HThese results indicate that an increase in oxidative stress enhanced lipid peroxidation, markedly decreased antioxidant function, caused thymus atrophy, and immunosuppression in REV-infected chickens. Reticuloendotheliosis (RE) constitutes a group of pathological syndromes caused by reticuloendotheliosis hyperplasia virus, including runting syndrome, chronic tumors of lymphoid and other tissues, acute reticulocytoma, and severe immunosuppression. Reticuloendotheliosis virus (REV) is a C-type avian retrovirus , 2. The Under normal physiological conditions, the body’s oxidation-antioxidant system is in a dynamic equilibrium, and oxidative stress occurs when the antioxidant system is overwhelmed by the oxidation system , 10. Oxi2O2. RNS includes NO, NO2, and peroxynitrite [The oxidation system primarily includes reactive oxygen species (ROS) and reactive nitrogen species (RNS). ROS and RNS are by-products of the body’s metabolism that contain an unpaired electron. Moreover, ROS and RNS represent an important component of the pathogen resistance mechanism and may act as an intracellular and intercellular signaling molecules; however, excessively high levels may also lead to oxidative stress . ROS priynitrite .Antioxidant systems include enzymes and non-enzymatic antioxidants . Antioxi2O2, MDA, CAT, and GPx1, as well as CAT and GPx1 mRNA expression in the thymus of one-day-old SPF chickens after an REV infection. Pathological sections and ultrastructural changes of the thymus were observed to further clarify the pathogenesis of REV infection and morphological changes resulting from oxidative stress and pathological processes, to facilitate the prevention and treatment of RE.Currently, there are few existing studies that have investigated the changes in the oxidation-antioxidant system of poultry following an REV infection. This study examined the dynamic changes in the level of TAC, SOD activity, HThe chickens in Group I showed obvious reduction in growth, The body weight growth rate was lower than that of the control chickens, and showed typical clinical symptoms . In addition, lesions in the thymus exhibited volumetric reduction and petechial hemorrhages Fig. .2O2 activity, and MDA of the chickens in both the infected and control groups. After the chickens were infected with REV, the thymus TAC , 28 (P < 0.01), 35 (P < 0.01) and 49 (P < 0.01) days post-REV infection. Compared with the control group, the SOD activity , 21 (P < 0.05), and 28 (P < 0.05) post REV-infection. Moreover, the level of MDA . The H2O2 content . Compared with the control group, the level of CAT , 21 (P < 0.01), and 28 (P < 0.05). The level of GPx1 post-infection.We first sought to study the oxidative-antioxidant capacity of the thymus in chickens infected with REV. We used commercial kits to detect the level of TAC, SOD, HP < 0.05) and 28 (P < 0.05). From day 1 to 49 post-REV infection, the level of GPx1 expression  and 35 (P < 0.05).In REV-infected SPF chickens, the level of CAT Fig. a expression Fig. b in the P < 0.05) and 35 (P < 0.05).In SPF chickens infected with REV, the Thymus/BW index Fig.  was loweThe histomorphology and ultrastructural changes of the thymus are presented in Fig. . CompareSeveral studies demonstrated that ROS activated the immune system to eliminate the infection and played a positive regulatory role in viral infections , 24. Sim2O2 is an important ROS that can be scavenged by catalase or peroxidase, and can also react with free Fe2+ to produce ·OH to initiate lipid peroxidation, destroy the cell membrane structure, accelerate protein decomposition and results in nucleic acid damage [2O2 in the thymus on day 35 in REV-infected chickens was significantly higher than that of the control chickens. Our research shows that the level of biomarkers of oxidative stress increase in REV-infected chickens. In our previous study, REV infection caused thymic lymphocyte apoptosis, inhibited T cell proliferation, and enhanced the immunosuppressive effect [Under conditions of oxidative stress, ROS and RNS promote the accumulation of lipid peroxidation in polyunsaturated fatty acids in oxidized biofilms, and produce lipid peroxides  . MDA cand damage , 30. In e effect . Moreovee effect . Accordi2•− in the body to produce both H2O and H2O2 [2O2 can break the structure and function of the cell membrane, react with purines and pyrimidines, and result in nucleic acid damage [2O2 in the body, and excess -OOH can be reduced to -OH under the action of GPx1. The main function of GPx1 is to remove lipid peroxides; however, in organs or tissues with low H2O2 production or CAT content, it can replace CAT to remove H2O2. GPx1 can scavenge lipid peroxides to reduce damage to the body and play a positive role in oxidative defense reactions [2O2 from the body [2O2) compared to the control group. In addition, we also evaluated TAC and found that the level of TAC in the thymus was significantly decreased in the infected group. This finding indicated that the antioxidant capacity of the thymus decreases during the REV infection, and excess ROS cannot be effectively neutralized by the antioxidant enzymes, which leads to oxidative stress.Under normal conditions, SOD can catalyze the disproportionation of Oand H2O2 . H2O2 cad damage . Viral id damage . CAT caneactions . CAT andthe body . TherefoOxidative stress is related to viral pathogenesis. ROS production is caused by inflammatory cell activation  during the course of disease progression and is considered to be an important defense against the host virus. However, excessive ROS can have an adverse effect on the body . In avia2O2 and superoxide in the thymus was increased, the TAC and SOD activity decreased, and the Thymus/BW index was reduced. These changes exceeded the body’s ability to scavenge antioxidant substances, resulting in oxidative stress in the body. In the future, we aim to study the effects of REV on other physiological mechanisms in the thymus from the perspective of endoplasmic reticulum stress and apoptosis based on the results of oxidation and antioxidant research.Following REV infection in one-day-old SPF chickens, the content of MDA and H50 was 104.62/0.1 mL as determined by cell breeding.All of the chickens used for experiments were one-day-old SPF chickens obtained from Harbin Veterinary Research Institute (HVRI), Chinese Academy of Agricultural Sciences (CAAS), China. The REV-T strain (CVCC No. CACCAV107) was purchased from China Veterinary Culture Collection Center (CVCC). The virus TCIDA total of 80 one-day-old SPF chickens were randomly divided into a control group (Group C) and an REV-infected group (Group I). Group I were intraperitoneally administered with 100 µL of viral suspension at day 1. Group C were intraperitoneally administered 100 µL sterile physiological saline. The two groups of chickens were housed in isolators with similar environments, and the chickens were given free access to feed and water. Each group further consist of 8 cages (5 chickens/cage). In order to reduce the artificial error and ensure the repeatability of the experiments, we decided to set the sample size for each test index to 5 chickens, as described previously , 42. Dur2O2 activity, and MDA in the thymus was determined using commercially available detection kits . The level of CAT and GPx1 was measured by an ELISA, according to the manufacturer’s instructions .The prepared 10% tissue homogenate was removed from − 80 °C. The level of TAC, SOD, HThe total RNA in the thymus was extracted by using Trizol reagent . The quality of RNA was assessed using a NanoDrop2 000 spectrophotometer (Thermo Fisher Scientific) through the ratio of absorbance at 260 nm and 280 nm. cDNA was obtained by reverse transcription of the RNA using the M-MLV Reverse Transcriptase kit (Invitrogen) according to the manufacturer’s instructions.−ΔΔCt method.Determination of CAT and GPx1 mRNA in the thymus by real time PCR. The CAT, GPx1, and β-actin primers were designed using Primer5.0 software. CAT: forward primer 5’- ATGTCCGTTTCAGGAGATGTGCAGC-3’, reverse primer 5’- CCAGCAGTGCCTGAATACG − 3’; GPx1: forward primer 5’- ATGACCAACCCGCAGTACATCATCT-3’, reverse primer 5’- GCAGTTTGATGGTCTCGAAGTGGC-3’; β-actin forward primer 5’- CGGGACGGATGAGAAGAA − 3’, reverse primer 5’- TCGGCGCTCCAGATGTAC − 3’. Amplification of the target gene using the LightCycler2.0 real-time PCR System . The real-time PCR reaction procedure was 95 °C for 2 min, 45 cycles of 95℃ for 20 s, 59℃ for 20 s, and 72℃ for 10 s. To ensure the repeatability of the amplified samples, all samples were analyzed in triplicate. β-actin was used as a reliable normalization gene, and the expression of the samples were evaluated in relation to this housekeeping gene. The level of CAT and GPx1 mRNA expression were analyzed in accordance with the 2Weight of the chickens and thymus at the time of sampling for calculating the thymus index. The thymus index was calculated based on the weight of the thymus (g)/chicken weight(kg).Thymus tissues were fixed in 4% formalin. The samples were dehydrated with ethanol and embedded in paraffin. Each sample was cut into 5-µm sections with a microtome and placed on a glass slide, and stained with hematoxylin and eosin (H&E). The pathological changes of the thymus were observed by three pathologists unaware of the experimental conditions under both light microscope  and electron microscope .P < 0.05 was considered as statistically significant.The data were analyzed with SPSS 17.0 software, and the differences were compared between the groups were analyzed using a one-way ANOVA followed by a Tukey’s post-hoc test. All data were expressed as the mean ± SD.


Arteriovenous malformation (AVM) is defined as a disease that causes blood flow abnormality due to anastomoses of the arteries and veins. AVM can occur in any gastrointestinal tract, but pancreatic AVM (P‐AVM) is very rare. Previous reports demonstrated that contrast‐enhanced CT (CECT) typically showed abnormal vascular network in pancreas. We present a 58‐year old man with a history of acute pancreatitis. He was referred to our hospital for examination of pancreatic mass. CECT showed a round‐shaped hypervascular lesion with a diameter of 8 mm in the head of the pancreas. Selective angiography showed vascular network and early visualization of superior mesenteric vein. We finally diagnosed this case as P‐AVM. He underwent duodenum preserving pancreatic head resection. Histological findings confirmed the preoperative diagnosis of P‐AVM. An asymptomatic 58‐year old man with a history of acute pancreatitis was referred to our hospital for examination of a round‐shaped hypervascular lesion with a diameter of 8 mm in the head of the pancreas. Selective angiography showed vascular network in the pancreatic head and super‐selective injections from pancreaticoduodenal artery revealed early visualization of superior mesenteric vein. Pancreatic arteriovenoous malformation typically showed multiple discrete intrapancreatic vessels, and few cases were reported as hypervascular tumorous lesion. Selective angiography showed a vascular network in the pancreatic head, and super‐selective injections from the pancreaticoduodenal artery revealed early visualization of superior mesenteric vein . He underwent duodenum‐preserving pancreatic head resection because we could not exclude the relationship between P‐AVM and a past history of pancreatitis. Histological findings revealed the anastomosis of abnormal arteries and veins, which confirmed the preoperative diagnosis of P‐AVM Fig. c,d.P‐AVM is defined as a disease that causes blood flow abnormality due to anastomoses of the arterial and portal systems in the pancreas.


In nature, microorganisms never live alone but rather build interconnected communities, able to perform complex biochemical tasks that are essential to the function of most of earth’s ecosystems. By comparison, the microorganisms we rely on as chassis for synthetic biology lead relatively simple, isolated lives. However, mimicking the natural complexity of microbiomes can help synthetic biologists realize more advanced functionalities; e.g. as shown for the efficient biosynthesis of oxygenated taxanes (precursors of the antitumor agent paclitaxel) in a two-species ecosystem .Recently, microbial ecologists demonstrated that it is possible to evolve coexistence between two important synthetic biology chassis in just 100 days, opening the possibility to rapidly assemble synthetic ecosystems by directed evolution .Several challenges stand in the way of designing synthetic ecosystems . AssuminISME Journal that stable cocultures of Escherichia coli and Saccharomyces cerevisiae can be established within 1000 generations (100 days) of directed co-evolution in simple microtiter-plate cocultures. Both species compete for the same resources, and E. coli grows faster than S. cerevisiae. Theory predicts that under such strong competition E. coli would drive S. cerevisiae extinct. While this happened in 58 out of their 60 replicate cultures, two cultures still contained both species after an initial 420 generations. The authors then further directed the evolution of coexistence by coculturing the coexisting isolates for another 580 generations in 30 replicates. Eventually four cultures developed stable coexistence at a fixed ratio. Impressively, coculture-evolved S. cerevisiae isolates were able to re-establish this ratio even when inoculated at low cell numbers into a culture of their co-evolved E. coli partner. Ancestral S. cerevisiae was not able to do that, showing that the acquired evolutionary changes were necessary and sufficient to coexist with E. coli. The E. coli partner in return had acquired mutations that enabled it to better access media resources either provided by or not used by its coevolved S. cerevisiae partner, showing the start of evolved dependence or occupation of non-competitive niches.Recent findings from the field of microbial ecology could provide a powerful alternative to the coexistence challenge. Researchers from Michael McDonald’s laboratory report in Nature’s For synthetic biology, these results are important as they indicate that evolution of co-existence and the beginnings of interconnected behaviour happens in a surprisingly short timeframe (∼3.5 months). This opens the door to a number of applications that were previously limited by the coexistence challenges.S. cerevisiae, engineered to produce the chemical of interest.For example, the area of agricultural waste valorization where cellulosic material is biosynthetically converted into valuable chemicals would profit from evolved coexistence between cellulolytic bacteria or fungi that extracellularly degrade cellulose into glucose—than acting as the shared resource—and genetically tractable workhorses like There are several important next steps that studies bridging synthetic biology and microbial ecology should take to explore this area further: Is the directed evolution of coexistence scalable to multiple species and other species-pairs? How resilient are evolved cocultures to environmental perturbations and the addition of engineered functionalities? Finally, can we extract genetic rules for coexistence in order to rationally engineer ecosystems in the future?Conflict of interest statement. None declared.


Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference.A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates.p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores  and PG-SGA . Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC.Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07)  with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC. Older adults living in long-term care (LTC) facilities are nutritionally vulnerable –3. Poor Calf circumference (CC) is a simple tool that can be used as a surrogate indicator of muscle mass and as some have suggested, sarcopenia , 9. A CCWithout careful menu planning and the use of standardized recipes and portion sizes, diet quality of menus can be poor . ModifieThis cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces: Alberta, Manitoba, New Brunswick and Ontario and conducted between October 2014 and March 2016. The main study questions regarding determinants of food intake and prevalence of inadequate intake were used to determine the sample size. In brief, a convenience sample of homes was recruited in each province to promote diversity . Home eligibility criteria included: being in operation for at least six months; and having a minimum of 50 residents who met the resident eligibility criteria. One to four units in each home were randomly selected for recruitment of participants; if the home had a dementia care unit, this was included.n = 160) and for the entire study (n = 640) was based on the analyses planned for the main study (multi-level regression modeling) , zinc) and a mean adequacy ratio (MAR), which was the average of the seventeen NARs. NARs were calculated as the proportion consumed relative to the corresponding sex and age-specific. Recommended Dietary Allowance for each nutrient; a maximum of 1.0 indicated that the recommendation was met/exceeded  was associated with a greater risk of low CC in the simple model. Only magnesium was significantly associated with low CC  in the fully adjusted model; odds of low CC were reduced when the NAR for magnesium was higher.Diet parameters and their association with nutrition risk (MNA-SF), malnutrition (PG-SGA) and low CC adjusted for home, unit, age and sex (simple model) are presented in Table This study examined diet quality of LTC residents using the MAR method and its association with malnutrition and low CC. Comparable to other studies conducted in LTC, approximately half of residents were malnourished or at risk of malnutrition according to the PG-SGA and MNA-SF –3. The pDiet quality as assessed by MAR and several NARs was associated with lower risk of malnutrition when adjusting for ONS, MTD and eating assistance, confirming the importance of a nutrient dense diet in LTC facilities. As well, this association confirms that MNA-SF and PG-SGA, although focused on protein/energy malnutrition, also reflect micronutrient intake. However, no significant association was observed between MAR score and low CC and only the NAR for magnesium was significant in the fully adjusted model for low CC; protein in g/kg body weight was of borderline significance. This suggests that factors , other than micronutrients and diet quality may be more influential on low muscle mass.Previous studies have found a positive association between mealtime assistance on energy intake of residents with dementia , 37. YetAs expected, results show that higher energy intake was associated with higher MNA-SF score, indicating less risk of malnutrition and with lower odds of malnutrition and low CC. One study also found that residents with malnutrition or at risk thereof had lower energy intake . LikewisMean NAR score for the total sample was low for five of the 17 micronutrients: vitamin D, vitamin E, folate, calcium, and magnesium, which corresponds to previous findings that show inadequate intakes from food/beverages for these nutrients in LTC , 5, 40. Limitations to this work include the purposive sampling of homes, which likely do not represent all homes in Canada; therefore, generalization of the findings is cautioned. Random selection of homes was not feasible, but diversity was attained by recruiting homes with key characteristics such as culture, size, non/for profit, etc. By randomly selecting units and participants, selection bias was reduced; comparison of participants to the eligible pool in the home demonstrated that participants were representative of their home . Data frThis analysis demonstrates that when attempting to prevent or mitigate malnutrition, attention to micronutrient intake, in addition to energy and protein, is needed. In the past, Canada’s Food Guide has been used to plan menus, potentially leading to inadequate micronutrient content . The new


The program also facilitates collaborations by using a portable specification for loading and processing data and retrieving data files from online sources. Two examples are shown in which the software is used to explore experimental datasets with extracellular nerve or muscle recordings and simultaneous video of behavior. The configuration specification for controlling how data are located, loaded, processed, and plotted is also summarized. Algorithms for spike detection and burst detection are demonstrated. This new program could be used in many applications in which behavior and signals need to be analyzed together.A software tool for synchronization of video with signals would be of broad general use to behavioral neuroscientists. A new program, called  A new tool, called http://www.mathworks.com/solutions/neuroscience), there are few free and open-source software tools with the capability to synchronize video and neural signals. Although there are many open source neuroscience tools and libraries for analysis of neural signals alone , they often have steep learning curves and require that users program their own scripts. Especially appealing would be an open source application that facilitated the review of electrophysiology data with synchronized video, was simple to install on any computer, easy for non-experts to use, and powerful enough for experienced data scientists to use in their data pipelines.In behavioral neuroscience, to interpret data after it is collected, it is essential that behavioral video be synchronized with electrophysiology. Although some commercial data acquisition systems may provide this functionality using proprietary hardware, software, and data formats .neurotic functions as a standalone application and also as a library with classes and functions that may be used in scripts or Jupyter notebooks. With neurotic’s API, users can read configuration files, load data, and apply processing steps as in the GUI. The resulting data objects are represented using Neo’s object model  magnesium chloride and immersed in an ice bath. An incision was made in the side of the head, and hook electrodes were attached using Kwik-Sil biocompatible silicone adhesive (World Precision Instruments) to nerves and muscles of the animal’s feeding apparatus: the I2 protractor muscle, the radular nerve (RN), and buccal nerve 2 (BN2) and buccal nerve 3 (BN3). The incision was then sutured closed, and animals were allowed to recover for 1–3 d.Multichannel differential hook electrodes made from fine stainless steel wires  were implanted in adult Animals were presented with food in the form of seaweed strips . While animals fed, signals from the hook electrodes were amplified and filtered , digitized , and recorded at 5000 Hz using AxoGraph X (AxoGraph Scientific) in continuous acquisition mode and saved in the AxoGraph file format, which is readable by Neo. In some trials, double-sided tape was placed between two seaweed strips to create an unbreakable strip, and this was attached to a force transducer  oriented over the animal to measure downward pulling force during swallowing. Force was also amplified, low-pass filtered, digitized by a strain gauge conditioner , and recorded using AxoGraph X.neurotic.Simultaneously, video of the behavior was captured at 30 frames per second using a webcam (Logitech HD Pro Webcam C920) and Logitech Webcam Software. Video was saved as MP4 files with H.264 video encoding. A digital counter  was programmed to increment at 10 Hz when the recording software was started; the counter was visible in the video recording at the start and end of the experiment, and pulses to the counter were recorded in AxoGraph X. This allowed the difference in timing between the start of video acquisition and the subsequent start of signal acquisition to be determined after the experiment, ensuring that the video and signal data could be synchronized by The methods for assessing human balance performance and control strategies while walking on a narrow beam are described. The participant consented to the protocol approved by the Georgia Tech and Emory Institutional Review Boards.The participant attempted to walk as far as possible across a narrow beam with left arm free and right arm held across the chest. The participant was instructed to stop if she uncrossed her right arm or stepped off the beam. No explicit instructions were given regarding stepping pattern or walking speed.Video data, EMG signals from arm muscles, and kinematics of the body were recorded using a ten-camera motion capture system (Vicon). EMGs were obtained at 1200 Hz from surface electrodes placed over the following arm muscles: biceps, triceps, and wrist flexors and extensors. The 3-D locations of retro-reflective markers placed at the center of the clavicles and both heels were collected at 120 Hz, along with time-synched video data (Vicon Bonita) collected at 40 Hz in AVI format and later converted to MP4 files.neurotic for reviewing behavioral video and synchronizing it with neural signals greatly reduces analysis time. Previously, alignment of video and neural signals, which were recorded and reviewed in separate programs with independent time bases, required that times of interest for every comparison had to be located separately in each program.Using neurotic solves the data stream alignment problem for old and new datasets. Moving through the video and finding the corresponding signal is done automatically in a unified interface, allowing for continuous playback and skipping to different parts of the experiment, making review easier, faster, and less prone to error.neurotic, initial analysis of effects of mechanical load on feeding in Aplysia was simplified. Swallow durations were greater in the presence of load, and motor pattern changes could be quickly surveyed during multiple responses. For example, one swallowing response under conditions of low load  can readily contribute to its further development. In general, open source projects depend on an enthusiastic community of developers, and if neurotic attracts such a community, it will continue to develop. The source code is stored on GitHub, which provides valuable collaboration tools such as issue tracking, pull request management, conversations, and task delegation. The open source model allows anyone to suggest improvements, submit bug fixes, or contribute new features; the community of maintainers seeks consensus on whether to accept contributions or request alterations; finally, changes are accepted only after passing a review process and automated testing. The complete history of the code can be found on GitHub, and prior releases of the software will remain available on distribution platforms like PyPI and Anaconda Cloud, so older versions of the software should always remain accessible.Open source projects like this thrive on contributions from volunteer developers. Because neurotic are few, and those proprietary alternatives may require expensive investments in software licenses and specific hardware. Maintaining proprietary systems depends on the continued financial viability of the company that makes them; old versions may stop working, and new hardware may be needed to upgrade software. For open source programs, maintainability again depends on the community. In some important ways, open source is superior for reproducibility and transparency, because the code is available for inspection, users suggest and often implement improvements to the code, and bugs are usually found and fixed quickly. Although proprietary systems often provide expensive “plug-ins” that can be added to the original software, open source projects excel at extensibility, because users can readily add functionality, or even specialize the program further for their own applications. The major investment for an open source project is the time that needs to be devoted to the project, whereas the major investment associated with proprietary software and hardware solutions is the money that needs to be invested into the hardware and software.There are trade-offs scientists should consider when choosing to use either free, open source software for their research or proprietary, closed source software. Commercial solutions that provide video synchronization capabilities similar to neurotic. More signal processing options could be provided, such as customizable or even arbitrary multistage analysis procedures. Sound could be added to video playback. More advanced spike sorting techniques could be integrated . The py