Background: Multiple renal arteries (MRA) are often encountered during living-donor kidney transplantation (LDKT), requiring surgeons to pursue complex renovascular reconstructions prior to graft implantation. With improvements in reconstruction and anastomosis techniques, allografts with MRA can be successfully transplanted with similar outcomes to allografts with a single renal artery. Here, we describe in detail various surgical techniques for reconstruction of MRA grafts with the intent of creating a single arterial inflow.Methods: We retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys between March 2008 and July 2021. Recipient and donor characteristics, operative data, type of reconstruction, and recipient outcomes were analyzed. The primary outcomes were the incidence of developing delayed graft function (DGF) and/or a vascular or urological complication within 12 months post-transplant.Results: Seventy-three LDKT recipients of MRA donor allografts were evaluated. Two renal arteries (RA) were encountered in 62 allografts (84.9%) and three RA in 11 allografts (15.1%). Renal artery reconstruction was performed in 95.8% (70/73) of patients. Eighteen different reconstruction techniques of MRA were utilized, the most common being side-to-side anastomosis in allografts with two RA (N = 44) and side-to-side-to-side anastomosis in allografts with three RA (N = 4). Interposition grafting was performed in seven cases (9.6%). A single ostium was created in 69 cases (94.5%), and the median warm ischemia time was 27 (range 20–42) minutes. None of the patients developed DGF or post-operative vascular or urological complications. Median creatinine at 3, 6, and 12 months post-transplant remained stable at 1.1 mg/dl. With a median follow-up of 30.4 months post-transplant, only one graft failure has been observed–death-censored graft survival was 98.6%.Conclusion: Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA show acceptable warm ischemic times, with no increased risk of post-operative vascular or urological complications.  With a widening gap between supply and demand of organs, living-donor kidney transplantation (LDKT) has substantially increased in efforts to expand the donor pool. This has led to a surge in living-donor kidneys (LDK) with anatomical variations, specifically, multiple renal arteries (MRA) , 2. Kidnin situ vascular anastomosis, minimize recipient WIT, and reduce post-operative complications. We evaluated recipient and donor demographics, operative data, early outcomes such as delayed graft function (DGF), development of any post-operative vascular, urological, or other complication within 12 months post-transplant, and graft survival.Although long-term graft and patient survival have been shown to be similar for single and multiple arteries, the impact of the type of arterial reconstruction method for MRA has rarely been investigated and warrants additional study , 13. PerWe retrospectively reviewed the medical records of all LDKT recipients with laparoscopically procured MRA kidneys at our institution between March 2008 and July 2021. This study was approved by the University of Miami Institutional Review Board and follows the ethical principles (as revised in 2013) of the Helsinki Declaration. All patients gave written informed consent prior to enrollment.All donors underwent comprehensive nephrologic evaluation including their medical history, physical examination, renal function assessment, and urinalysis. Evaluation of the donor renal vascular anatomy was performed using computed tomography angiography (CTA). Thus, the presence of multiple vessels was known before surgery. All donors referred to us were considered suitable based on their vasculature. The approach for reconstruction of MRA and the availability of deceased donor vessels for interposition grafting reconstruction were determined before surgery.All recipients began Aspirin 81 mg daily on post-operative day 3 and remained on this regimen indefinitely. To monitor development of vascular and/or urological complications, baseline Doppler Ultrasound (DU) was performed after surgery, and then repeated at 1, 3, and 12 months post-operatively. If there were any vascular or urological concerns, further imaging with magnetic resonance angiography and/or Tc99m MAG-3 renal scintigraphy was performed.Analyzed baseline variables included date of transplant, recipient age, recipient gender, recipient race/ethnicity, recipient BMI, recipient pre-transplant history of diabetes mellitus, kidney retransplant status, donor type, donor kidney location (left or right), number of donor arteries, type of vascular reconstruction, whether or not a single renal artery ostium was used, living donor type (related/unrelated), double-J ureteral stent insertion, JP drain insertion, total operative time, cold ischemia time (CIT), and warm ischemia time (WIT) for single and multiple anastomoses. Recipient outcomes included development of DGF , length of hospital stay, development of a post-operative vascular, urological, or other complication within 12 months posttransplant, and graft loss . Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney disease Epidemiology Collaboration Equation. Percentages of patients having selected baseline characteristics were determined as well as means, standard errors, medians, and ranges of values for baseline continuous variables.A hand-assisted laparoscopic donor nephrectomy was performed in a standard fashion with special attention given to the renal hilum and preservation of the length of the renal vessels . The vesEx-vivo reconstructions were performed during bench surgery according to the case-specific anatomy. Surgical loupes at 3.5x magnification were used for the reconstructions. All the vascular reconstructions were performed with 8–0 Prolene.N = 43), the preferred approach was a single ostium side-to-side anastomosis, which was created by spatulating the two arteries medially and conjoining them into a single lumen (N = 4), where a single renal artery ostium was created by conjoining the arteries in a side-to-side-to-side manner  of similar length (le lumen . This tee manner . If the e manner .N = 4) or lower pole renal artery (LPRA) (N = 3), an end-to-side anastomosis to the main RA was created in a running fashion (N = 1) or short LPRA (N = 1), it was anastomosed end-to-side to one of the branches of the main RA (N = 1)  ( fashion . If ther main RA . In one  (N = 1) .N = 1) (N = 1) (N = 1) (N = 1)  . In one  (N = 1) , 6A. In  (N = 1) . Finally (N = 1) , 6B.N = 4). In three of these cases, there were grafts with two RA, with a short LPRA located too far from the main RA to perform a reconstruction. One of these was a case of 2-year-old pediatric recipient in which the LPRA was anastomosed end-to-side to the external iliac artery, and the main RA was anastomosed end-to-side to the common iliac artery. The two remaining cases had a short LPRA that was 8 cm from the main RA. The short LPRA was anastomosed end-to-end to the recipient inferior epigastric artery, and the main RA was anastomosed end-to-side to the external iliac artery  and creation of a single ostium was not feasible, two separate arterial anastomoses were implanted (c artery . In the c artery .N = 3) or end-to-side (N = 1) to the main RA (N = 1) (N = 1)  was used in four renal grafts two 2 RA; a short UPRA was anastomosed end-to-end to the RIEA, and then anastomosed side-to-side ( main RA . In a gr (N = 1) . A segme (N = 1) . Finally (N = 1) , 6C.Once the reconstructions were complete, grafts were anastomosed end-to-side to the recipient external iliac artery and vein. After reperfusion, an extravesical ureteroneocystostomy was performed .Of note, while diameter sizes of donor arteries were measured pre-operatively by CTA (upper and lower pole arteries measured approximately 2 mm in diameter), the diameter of the ostium of the reconstructed arteries was not measured. However, its diameter was the combined size of the two or three conjoined RA.All recipients received immunosuppressant therapy according to our center’s protocols  with indRecipient and donor baseline demographics and operative data appear in The types of reconstruction are detailed in Recipient outcomes are listed in None of the 73 patients had DGF or developed a postoperative vascular or urological complication. Since the main concern with lower pole artery reconstruction is the risk of developing a postoperative urological complication, it was reassuring that no such complication was observed in any of the patients. Thus, there were no differences in clinical outcomes between those who received an upper pole artery vs. lower pole artery reconstruction.C. difficile colitis/sepsis at 4 days post-transplant (N = 1) and acute respiratory distress syndrome (ARDS) at 6 days post-transplant (N = 1). The patient who developed c. difficile colitis/sepsis died of that infection (with a functioning graft) at 0.8 months post-transplant. The patient who developed ARDS did not experience graft loss.Two patients (2.7%) developed a nonsurgical post-operative complication during the first 30 days (12 months) post-transplant, including C. difficile colitis/sepsis in one patient at 0.8 months post-transplant, and death due to sepsis in one patient at 125.2 months post-transplant), and ruptured aortic aneurysm in one patient (at 5.2 months post-transplant).One patient (1.4%) developed graft failure due to acute T-cell-mediated rejection (TCMR) at 41.8 months post-transplant. Five patients have died with a functioning graft: cardiovascular event in two patients , infection in two patients . Additionally, we prefer to revascularize simultaneously, because sequential revascularization requires added WIT and increases the risk of troublesome bleeding , we report a median WIT of 27 min. In the four cases where vessels were implanted with two arterial anastomoses, the median WIT was 31.5 min. Our median WIT for creating a single inflow orifice is acceptable compared to the reported published literature  was not an option for achieving a single lumen in these specific cases, as it would have required too long of a graft, increasing the risk of complications. Nevertheless, the use of interposition grafting in LDKT has been shown to be a useful standard method for grafts with MRA , 10, 34.When dealing with deceased donor kidney grafts with MRA, we also perform vascular reconstructions with the goal of creating a single arterial orifice in efforts to minimize ischemic insult. We commonly transplant MRA from deceased donors with the use of a Carrel aortic patch. If the renal arteries are located too far apart from the aorta and result in a case of long Carrel patch, we trim the Carrel patch and anastomosis it end-to-end to create a shorter carrel patch , or we pLimitations of our study include the lack of comparison to outcomes for LDKT of single renal arteries. Additionally, sample sizes for certain subgroups of patients were relatively small, limiting our ability to show significant differences between the WIT of single and multiple arterial anastomoses. Another limitation of our study includes the fact that this was an evaluation of consecutively transplanted living donor recipients performed at a single center by a single, highly experienced transplant surgeon. While the chances of achieving such successful anastomoses without post-operative complications being an issue requires a surgeon who is highly experienced in performing such techniques, these techniques can be easily duplicated and incorporated by other transplant surgeons to expand their surgical armamentarium.Complex reconstruction techniques to create a single renal artery ostium for graft implantation anastomosis in allografts with MRA shows good clinical outcomes and acceptable WIT, with no increased post-operative vascular or urological complications. These techniques can be applied by other transplant surgeons when faced with vessel multiplicity to avoid potential complications associated with multiple arterial implantations.


American Journal of Preventive Cardiology (AJPC) marks our 10th issue which we are proud to present to you all. The success of the journal represents the tireless efforts of our associate editors and greater editorial board and the many reviewers which we will be forever grateful to. This month we in particular wish to thank Dr. Koos Admiraal who recently departed Elsevier as our publisher and was instrumental in his efforts to help us launch the AJPC and to provide guidance and help in our application last year to successfully obtain Pub Med and Scopus indexing. Since our first meeting in Summer 2019 at the European Society of Cardiology in Paris to propose the idea of the AJPC, he provided the greatest support to launch and sustain the journal. We now welcome our new Elsevier publisher, Diana Goetz who will help us take the journal into the future!This issue of the How well is the AJPC growing and getting exposure worldwide? We are happy to announce that the number of submissions grew from 108 to 149 from 2020 to 2021. While the great majority of the submissions were from the United States, we also had submissions from China, Finland, France, India, Iran, Japan, Sweden, and the United Arab Emirates. We particularly welcome submissions internationally and continue to encourage those from overseas to contact us if they are interested in being a reviewer and possibly editorial board members for the journal. Moreover, the current (2022) average time from submission to first decision is 4.8 weeks, to acceptance 11.1 weeks, and to first on-line publication 11.5 weeks. Very impressive, in particular, is the growth in usage of the journal – in 2020 there were 49,109 total downloads which increased to 163,330 in 2021. For the first 3 months of this year, there were 57,930 downloads, a 93% increase over the same period last year.Our June issue features a number of key articles of great value to the preventive cardiology community. Two ASPC clinical practice statements are featured in this issue, one on evidence-based nutritional modifications to reduce atherosclerotic cardiovascular disease (ASCVD) risk and another on strategies for ASCVD risk assessment. Following is a commentary on the need for increasing virtual cardiac rehabilitation availability and then state-of-the-art reviews, one being the annual Ten Things to Know about Cardiovascular Risk Factors and the other on evaluation of blood lipids throughout a woman's lifecycle. The issue is rounded out by original research contributions on an update on lipid treatment and goal attainment in US adults, effectiveness of community-based interventions, patient experiences with familial hypercholesterolemia, cascade testing for lipoprotein(a), and on area deprivation index and anticoagulation among atrial fibrillation patients.https://www.aspconline.org/2022congress/. Thank you for your readership and continuing support of our AJPC journal, which continues to grow in impact.Finally, we wish to thank our outgoing ASPC President Peter P. Toth, MD, PhD for his tireless efforts and accomplishments too many to be named here in this short message, taking ASPC to greater heights during the past two years. We also welcome Martha Gulati, MD, MS as our incoming ASPC president who will undoubtedly lead our organization to even greater heights. We hope you will consider attending our upcoming ASPC Congress on CVD Prevention to be held July 29–31, 2022 in Louisville, Kentucky. A great program has been planned and is featured on our website  The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Beat-to-beat blood pressure (BP) is an important cardiovascular output and regulated by neurophysiologic elements over multiple temporal scales. The multiscale dynamics of beat-to-beat BP fluctuation has thus been characterized using “BP complexity” and has been linked to age-related adverse health outcomes. We here aimed to examine the relationship of BP complexity to frailty, and if BP complexity mediates the association between arterial stiffness and frailty. Method: A total of 350 older adults completed assessments for frailty , arterial stiffness , and beat-to-beat finger BP. The complexity of beat-to-beat systolic (SBP) and diastolic (DBP) BP series were measured using multiscale entropy. The relationships between frailty, BP complexity and arterial stiffness were examined using ANOVA and linear regression models. The effects of BP complexity on the association between arterial stiffness and frailty were examined using mediation analyses.Compared to non-frail, pre-frail and frail groups had significantly elevated lower SBP and DBP complexity , and greater arterial stiffness . Greater arterial stiffness was associated with lower BP complexity . SBP and DBP complexity mediated the association between arterial stiffness and frailty (indirect effects>0.28), account for at least 47% of its total effects on frailty .This study demonstrates that BP complexity is associated with frailty in older adults, and mediates the association between arterial stiffness and frailty, suggesting that this metric would serve as a marker to characterize important functions in older adults.


Kidney transplantation is the most promising treatment available for patients with end-stage kidney disease. However, despite the application of immunosuppressive protocols, long-term graft survival remains relatively short, mainly as a result of immunological issues . The SpeVery early events, starting from the kidney graft harvesting, may affect the recipient’s immune response and eventually impact long-term graft survival. Unfortunately, the shortage of available kidney transplants has resulted in the use of non-optimal grafts, which are more susceptible to ischemia–reperfusion injury (IRI)-induced acute tubular necrosis, resulting in the increased frequency of delayed graft function . DelayedBesides the release of damage-associated molecular patterns that activate the recipient’s immune system, IRI also affects the renal endothelium glycocalyx. The glycocalyx consists of proteoglycans, glycoproteins, and glycolipids ; it is aAs noted, perioperative kidney transplant IRI may enhance the recipient’s immune response, consequently resulting in a shorter graft survival time. However, the kidney graft stimulates the immune system of the host continuously. At present, three T cell allorecognition pathways have been identified . In the This Special Issue includes an experimental study by Eleftheriadis et al.  which chDespite the progress in elucidating the mechanisms involved in kidney graft dysfunction by the host immune response, a huge amount of ground still has to be covered to achieve a more accurate and early detection of graft rejection in the clinic. Kidney biopsy is the gold standard for assessing the interaction between the recipient’s immune system and the kidney graft. It discriminates the various types of rejection and determines their severity. Moreover, surveillance kidney biopsies allow the identification of subclinical rejection and early treatment. However, despite advances in the histopathology of kidney transplant classification, reflected by the many revisions of the generally accepted Banff calcification system, there are borderline cases of graft rejection in which clinical decision is difficult . UsuallyIn this Special Issue, Chamoun et al. evaluated rejection-related gene expression in subclinical rejection and biopsies with borderline changes or IFTA. A rejection-associated gene (RAG) score containing 109 genes derived from normal and clinical rejection was employed to classify the study groups. A positive RAG score was observed in 83%, 38%, 17%, 25%, and 5% of subclinical rejections, borderline changes in biopsies for cause, borderline changes in surveillance biopsies, IFTA in biopsies for cause, and IFTA in surveillance biopsies, respectively. Considering outcome as death-censored graft loss, or a glomerular filtration rate decline greater than 30% at 2 years, a positive RAG score was an independent predictor of graft outcome from histological diagnosis (hazard ratio: 3.5). Thus, a positive RAG score can predict graft outcome in surveillance and for cause biopsies with a less severe phenotype than clinical rejection.In conclusion, the articles of the present Special Issue indicate that, with the assistance of constantly evolving modern technology and medicine, there are great opportunities for prolonging kidney graft time and patient survival. In the near future, measures for ameliorating IRI at the perioperative period, better understanding the alloimmune response, and the use of advanced technology for the early and accurate diagnosis of graft rejection are expected to extend graft survival.


To investigate the influence of different pretreatment methods, attachment materials and artificial aging on shear bond strength (SBS) between monolithic zirconia and metal brackets. Zirconia substrates were pretreated with silica coated alumina (CoJet) and (1) clearfill ceramic primer plus (CF), (2) RelyX ceramic primer (RXP), (3) Futurabond U (FU). The brackets were bonded with (1) Transbond XT Adhesive (TB), (2) BrackFix Adhesive (BF), (3) bracepaste adhesive (BP). SBS was tested after 24 h, 500 thermal cycles, 90 d at 37 °C with a universal testing machine. SBS values reached from 8.3 to 16.9 MPa. The Weibull moduli ranged between 0.37 (RXP combined with BP after 90 d) and 7.42 (CF combined with TB after 24 h). The pretreatment with FU after 90 d, independent of the attachment material, and RXP with BF resulted in the lowest SBS values 8.3–9.9 MPa, the combination of RXP or CF with TB showed the highest (13.2–16.9 MPa) independent of aging. After FU pretreatment the proportion of ARI 1 and 0 was higher, of ARI 3 lower as after CF and RXP pretreatment. All tested combinations showed sufficiently high SBS values for clinical use. Pretreatment with FU presented the lowest values after 90 days. According to the literature shear bond strength (SBS) values between enamel and bracket of 5–10 MPa are recommended3. In orthodontic adult treatment the bonding of brackets to prosthetically restored teeth can be challenging. There is always the risk of damaging the restoration, but on the other hand accidental bracket loss during the treatment implies a further pretreatment of the restoration, increasing the risk of fractures, but also prolongs treatment time4. Nowadays, metal-free restorations are increasingly used, and they are becoming more and more popular due to their good biocompatibility and esthetics7. Due to the improved esthetics of zirconia, especially 4Y-TZP and 5Y-TZP ceramics, monolithic restorations are used more frequently8. Therefore, apart from a reliable bonding strategy to silicate ceramics, the orthodontist also needs a proven workflow for bonding to monolithic zirconia surfaces. Zirconia, in contrast to silicate ceramics, exhibits poor wettability. Since zirconia has no glass components, the wettability and at the same time the surface roughness cannot be influenced by etching with hydrofluoric acid—as known from silicate ceramics9. For restorative purposes, an air-abrasion using alumina powder (50 µm grain size) and a low pressure of 0.1 MPa or alternatively using silica coated alumina powder are described to create a suitable surface for adhesive bonding systems to zirconia and veneering materials12. In addition, the use of an acidic phosphate-containing monomer (e.g. MDP monomer) as a bonding agent is recommended11. To date, no gold standard or clinical recommendation exists for conditioning monolithic zirconia restorations when temporary brackets or attachments need to be bonded as part of fixed orthodontic treatment. Although different pretreatment methods have been investigated, most studies focus on the pretreatment methods and include only one attachment material16. Different attachment materials might also have an influence on the bonding strength between bracket and zirconia surface. The only studies that investigate different attachment materials used bonding materials that are frequently used for prosthetic purposes19 and not in orthodontic daily routine. Furthermore, the influence of water storage as additional aging regimen has not been considered by any other study. The aim of the in vitro study was therefore to compare the shear bond strength of a metal bracket and monolithic zirconia after air-abrasion using silica coated alumina (CoJet) and application of different adhesive systems using various orthodontic attachment materials and different aging regimens. The following hypotheses were assumed: (1) different pretreatment methods, (2) the use of different light curing attachments materials, (3) different artificial aging methods do not influence SBS values of metal brackets bonded to monolithic zirconia.For orthodontic treatment with fixed appliances brackets are usually bonded to the enamel surface, using the etch and rinse technique and phosphoric acidThe specimens with a minimum size of 5 × 5 × 3 mm were cut out of zirconia blanks  and sintered in the sintering furnace  according to the manufacturer's instructions. Then, zirconia substrates were embedded in acrylic resin  and polished up to P1200  for 20 s with an automatic polishing device  under permanent water cooling. After ultrasonically cleaning  for 60 s in distilled water, the 405 specimens were allocated to one of the 27 test groups (n = 15 per group).2, Ortholux luminous curing light, 3 M, Monrovia, USA). After bonding, the specimens were directly stored in distilled water and underwent one of the three aging regimens  as shown in Fig. All specimens were photographed with a microscope at 10× magnification  to search for possible cracks and afterwards cleaned prior to bonding with a polishing brush  and pumice/water mixture (40:50 g) at a speed of 3000 rounds per minute moving from left to right as well as up and down for 3 s. The specimens were cleaned with water and air-abraded using silica coated alumina  for 2 s at 90°, 10 mm distance, 2 bars. After rinsing off the specimens underwent different pretreatments according to the manufacturer’s recommendation  and the metal brackets were bonded to the zirconia substrate with different attachment materials  as detailed presented in Fig. Shear bond strength testing was carried out at room temperature 23 °C) and all specimens were wetly stored at room temperature for 1 h prior to testing. The specimens were dried carefully with air and placed in the universal testing machine  in a special test apparatus  on the zirconia, 1 = less than 50% remaining on the zirconia, 2 = more than 50% remaining on the zirconia, 3 = 100% AM remaining on the zirconia.Afterwards, all specimens were photographed with a microscope at 10× magnification  to evaluate the adhesive remnant index (ARI) and look for possible cracks. ARI was determined according top values. The distribution of ARI was checked for significant differences using Chi2 tests. p values of p < 0.05 were considered as statistically significant. Weibull module was determined using the maximum likelihood estimation method and 95% confidence interval to be able to predict failure probability21.For statistical analyses IBM SPSS Statistics 25  was used. A global univariate ANOVA test with partial eta-squared Not applicable, because this article does not contain any studies with animal or human subjects.p < 0.001) and attachment material (p < 0.001), rather than by aging regimens (p = 0.025).The median of the SBS values ranged between 8.3 and 16.9 MPa Table . SBS valp = 0.047, after TC p = 0.040) and CF . After 90 days water storage, RXP presented higher SBS values compared to FU (p < 0.001) and CF (p = 0.025). With respect to the attachment material BF, FU showed after 90 days water storage lower values than RXP (p = 0.030) and CF (p = 0.002). Within BP and after 90 days water stored, lower SBS for FU than for CF (p = 0.027) was measured.Within the attachment material TB, FU showed lower initial SBS as well as after thermal cycling than RXP  and after thermal cycling higher values than BP (p = 0.006). With respect to RXP, TB showed higher bond strength compared to BF, regardless on the aging regimen (p < 0.001–p = 0.043).Within the pretreatment method CF, TB showed higher initial SBS than BF (p = 0.014). Attachment material BF in combination with FU and RXP, 90 days storing in water resulted in lower values than tested initial  or after thermal cycling .Within TB combined with CF, after 90 days water storage lower SBS than after thermal cycling (The lowest Weibull modulus was observed for BP combined with RXP after 90 days water storage Table . TB comb2 < 0.001). In the TB group an ARI of 2 was predominantly observed after pretreatment with CF and RXP . After the pretreatment with FU an ARI of 1 was more frequently determined (51.1%). In the BF, as well as the BP group an ARI of 2 was the most frequent after pretreatment with RXP, CF and FU . After FU pretreatment in all three groups the proportion of an ARI 1 and 0 was higher, of an ARI 3 lower as after CF and RXP pretreatment , as the phosphate group can react chemically with the zirconia23. Lee et al. reported clinically sufficient SBS values between ceramic brackets and monolithic zirconia after air-abrading with Al3O2 and pretreatment with different zirconia adhesives but also a universal adhesive containing 10-MDP. In contrast, the pretreatment with a metal primer, not containing 10-MDP, resulted in insufficient SBS values24. In the present study, three different types of pretreatment methods were used: CF containing the classical MDP monomer but also a silane. The application of CF showed reliable SBS values which is in accordance with other studies25. As further pretreatment a classical silane RXP was investigated. The idea was to have a method that would result in reliable SBS values for all types of ceramics. Resulting from a previous study the combination of CoJet and RXP was shown to be effective for bonding brackets to different types of silicate ceramics26. The present findings indicate also consistent adhesion using this combination when brackets are bonded to zirconia substrates and is in accordance with the findings of other studies27 although they used a ceramic instead of a metal bracket. A different study also found sufficiently high SBS values using the combination of CoJet and RXP, although the SBS values were lower and very close to the lower limit of the recommended values28. In general, the literature is very controversial as some studies found that air-abrasion and silane application results in sufficient SBS29 and others reported contrary findings30.The first hypothesis “different pretreatment methods do not influence the SBS” was rejected. Within the TB group the application of FU resulted in lower SBS values initially and after 500 TC. After 90 days the combination of RXP and TB showed higher SBS values as FU or CF with TB. In the BF and BP group SBS values after FU pretreatment were lower compared to BF/RXP and BP/CF after 90 days. For restorative purposes the general recommendation in the literature to obtain a reliable adhesion to zirconia includes surface air-abrading with either alumina powder or silica coating (CoJet)23. Therefore, further investigations are necessary here. Although other studies apply the corresponding adhesive (bonder) of the attachment material as an additional step of pretreatment31, the present and previous results29, indicate that this extra step seems to be mandatory.The third pretreatment was a universal adhesive (FU). Especially after 90 d of wet storage FU showed in comparison to the other methods lower SBS values. In a prosthetic investigation the combination of air-abrasion followed by CF pretreatment and Panavia F2.0 resulted in comparable tensile bond strength values as followed by FU combined with DuoCem after 5000 thermal cycles18. Nevertheless, in a clinical setting it is of interest to the orthodontist to have a reliable attachment material that can be generally used to bond to enamel but also to artificial surfaces such as ceramic. Neither Panavia F2.0, nor RelyX U200 were developed for orthodontic purposes and are due to their lower viscosity compared to TB, BF or BP not the first choice for direct bracket placement. There is one other study that compared SBS values of TB and BF but in a different context as brackets were bonded to bovine enamel, but they also found similar SBS values between metal brackets and either TB or BF32. In accordance with this study, Cetik et al. found the combination of CF and BF to be a suitable pretreatment for zirconia substrate to bond metal brackets16. Nevertheless, they found almost double as high SBS values compared to our results. This could be caused by the fact that they treated the zirconia surface with Al3O2 and applied an additional layer of BrackFix primer or due to the differences in the study setting since they used a crosshead speed of 0.5 instead of 1.0 mm/min. To the best knowledge of the authors there is no other study using bracepaste as attachment material for bracket bonding. Although there were some differences considering SBS values, all attachment materials showed sufficiently high SBS values for clinical use.The second hypothesis  was also rejected as the combination of CF/TB showed higher SBS values than CF/BF after 24 h and CF/BP after 500 TC. Within the RXP group the application of TB resulted in higher SBS as BF. In general TB is the most frequently used attachment material in orthodontic SBS studies. There is only very little data on other attachment materials. The combination of alumina powder air-abrasion, CF and Panavia F2.0 showed higher SBS values as in the present study, whereas the use of RelyX U200 instead of Panavia F2.0 was comparable to TB33. In the present study, thermal cycling did not have an influence on SBS. As recommended by the DIN 13990:2017-04 specimens underwent 500 thermal cycles34. In contrast to prosthetic restorations brackets need to bond to the teeth only for a limited time period of approximately 2 years35, but on the other hand there must be a reliable adhesion throughout the whole multibracket treatment to avoid prolonged treatment times36 and undesired tooth movement if teeth are not fixed to the wire. Therefore, including aging regimens into orthodontic SBS testing seems to be of major importance, although this aspect still not considered in many orthodontic SBS studies38. Despite of thermal cycling, SBS was tested after 90 days of wet storage at 37 °C. Although wet environment can have an influence on SBS values as is can cause a degradation of fillers and weaken the attachment material or hydrolysis33, this kind of aging regimen was only considered in two further orthodontic SBS studies39. Within the FU groups SBS values were lower for all the different attachment materials after 90 days of wet storage and the combination of FU/BF and FU/BP showed the lowest median SBS values within the study, but values were still in the range of the required 5–10 MPa3.The third hypothesis  again was rejected. The pretreatment with CF and application of TB showed lower SBS values after 90 days than after 500 TC. 90 days of storage also reduced SBS of BF/FU and BF/RXP compared to the initial values. In the present study SBS values were tested 24 h after bonding and additionally after two different aging regimens. Thermal cycling is supposed to test the resistance of the adhesion against temperature fluctuations that may cause mechanical stress, volumetric changes or microleakage at the bonding area25. The approach of the present investigation was a to find a clinical pretreatment method that could be used for all type of ceramics. When silicate ceramics are pretreated with alumina powder there is a higher risk to cause fractures and cracks within the ceramic as with silica coating (CoJet) due to the geometry of the particles10. Therefore, the CoJet system was used for pretreatment in accordance with a previous study26.In other studies, zirconia was pretreated using alumina powder resulting in reliable SBS valuesWith respect to Weibull modulus, the combinations with the adhesive systems containing MDP-monomers showed trends to higher values than a silane. A high Weibull module indicates good bond strength reliability. However, since orthodontic adhesions usually do not have to withstand longer than 2 years, this is a factor that can possibly be neglected. However, further investigations are necessary here.40, the results of in-vitro ARI should be interpreted with great caution as their clinical relevance seems to be very limited.In all three attachment material groups the distribution of the ARI was different when FU was applied in comparison to CF and RXP as there was a higher percentage of ARI 1 and 0. In the other groups an ARI of 2 was predominant. Many authors interpret an ARI of 2 or 3 as favorable as the risk of implementing cracks into the ceramic is reduced when the fracture occurs in the interface between bracket and attachment material. On the other hand, all the attachment material needs to be removed from the ceramic surface with a drilling device, which again can be a risk for damaging the restoration. Regardless of this consideration the results of the ARI do not reflect clinical reality. The force that is applied to debond a metal bracket in a clinical setting is very different from the force in the standardized testing device. In-vitro the force is only applied in one direction  from occlusal to gingival. Clinically the brackets or wings are usually squeezed with a special debonding plier, straight cutter or similar. As even the use of different pliers results in significant differences in terms of ARI distribution43. Nonetheless, the shear bond strength set-up in the orthodontic research, especially when brackets are bonded for testing, is closer to clinical conditions, but is also less complex and less expensive. However, there is a strong need to follow standardized protocols in term of study setting insofar as possible and include aging regimens as standard procedure to create a reliable tool for comparative measurements as a basis for further clinical research.The results of in-vitro SBS studies always need to be interpreted with caution and are very often criticized. In terms of the method, micro-tensile bond strength tests seem to be favorable compared to shear bond strength as they reduce for example the stress concentrationAll investigated pretreatment methods and attachment materials showed sufficiently high SBS values.After 90 days of wet storage the pretreatment with FU presented lower SBS values.The previously investigated method (CoJet/CF) for bonding to silicate ceramics, can also be used for bonding to zirconia.Within the limitations of the study the following conclusions can be derived:


Correction: Pediatric Surgery International (2023) 39:27 10.1007/s00383-022-05289-7In the original publication, the unit of measurement for serum PTX3 in tables 3, 4, 5 was incorrect. In the original version it was pg/mL, and the correct unit is ng/mL.


The negative role of lipids in rice starch digestion is well-known; however, the effect of individual native lipids on starch digestibility has not been studied. In this study, native rice lipids, such as triacylglycerols (TAGs), diacylglycerols (DAGs), phosphatidylcholines (PCs) and lysophospholipids (LPLs), were analyzed using liquid chromatography–mass spectrometry (LC-MS) and correlated with in vitro rice starch digestibility. Most of the tested lipids exhibited a negative correlation with the in vitro starch digestibility with the correlations being more pronounced for LPLs. Removal of lipids from rice flour increased the in vitro starch digestibility. Conversely, a lipid extract addition to rice flour reduced the starch digestibility. Addition of 1% pure lysophosphatidylcholine (LPC)16:0, TAG54:6, DAG36:4 or PC36:2 individually to rice flour reduced starch digestibility by different extents in the order of LPC16:0 > TAG54:6 > PC36:2 > DAG36:4. LPC16:0 was the most abundant lipid among all the assessed lipids in the white rice (milled rice), and addition of 1% LPC 16:0 to rice flour reduced glucose release following three hours of in vitro starch digestion by 7.4%. There may be a scope to breed rice with a lipid composition to reach a desired starch digestibility or simply through addition of certain lipids before cooking the rice. Rice starch is a major source of dietary calories, and rice starch digestibility has a great impact on global health and nutrition . Rice stLipids are the second major non-starch component in rice grain after protein and are more concentrated in brown rice (~3% of dry weight) than milled rice (~1% of dry weight) ,8. Rice Addition of non-rice lipids to rice decreases starch digestibility . TraditiLipids may decrease starch digestibility by the formation of a lipid–starch complex ,14, whicAlthough lipids are known to modulate starch digestibility, the effects of individual lipid classes native to the rice grain on rice starch digestibility have not been compared. Ethanol, a polar organic solvent, can remove starch granule surface lipids such as phospholipids, and Hu et al. removed lipids from rice starch with ethanol and found increased in vitro starch digestibility . PetroleIn total, 25 milled rice  samples were used in this study . The ricAll organic solvents were of high-performance-liquid-chromatography (HPLC) grade. Ammonium formate was purchased from Aldrich Chemical Company Inc. Trichloroacetic acid was purchased from Merck, Darmstadt, Germany, and trifluoroacetic from Sigma-Aldrich Co., St. Louis, MO, USA. Lipid standards , triacylAll rice samples were ground to flour using a ball mill  by grinding six times at 30 rps for 30 s, as modified from Liu et al. . Particlg  for 10 min. The supernatant was discarded and the residual rice defatted by repeating the procedure once. Defatted rice flours were dried under low pressure.Rice samples (20 mg) were defatted by heating with 5 mL of 85% ethanol at 60 °C for 30 min . After c2 and 3.0 g of KI in 1 L of water, 5 mM I2 solution) was added for staining and then mixed ..R2 = 0.5The negative correlation between AAC and starch digestibility was only significant at 180 min for the purchased commercial rice samples (Gas chromatography (GC) and thin-layer chromatography (TLC) have been widely used for the analysis of fatty acid composition and characterization of lipids in rice grain ,40. LipiLiquid chromatography–mass spectrometry (LC-MS) and liquid chromatography– tandem mass spectrometry (LC-MS/MS) can identify and quantify individual plant lipids directly after solvent extraction ,42. LC-MEight TAGs, four DAGs and four PCs from WSB extracts of rice flours were analyzed by the two optimized LC-MS methods. However, as the elution times of lipids overlapped, the lipids were separated into two groups and quantified . It shouTAGs were the major non-starch and starch surface lipid  C,D. Totan-propanol solution allows more LPLs to be extracted [Although WSB can extract lysophospholipid (LPLs), heating the rice flour to 100 °C in 25% water and 75% xtracted ,44. Fivextracted . LPL wasxtracted .The association between individual native lipid content and in vitro rice starch digestibility could not been seen when all the rice samples used in this study were considered together. This could be due to the similar digestibility among all rice samples and low contents of lipids in milled rice. The fact is that there were so many differences in the major components, starch and protein, between the rice samples, which could also affect rice flour digestibility ,30. The r ≤ −0.42; p > 0.05) were observed between TAGs and glucose concentration at 60 min   in the rice samples acquired from Bangladesh (R11–R25) except for TAG 50:2 and TAG 52:2 (r = −0.51 and −0.50)  . There wR04–R10) . The negd −0.50) .p < 0.01) in the rice samples acquired from Bangladesh (R11–R25), but there were no correlations in the purchased commercial rice samples . Individual PC content had weak negative correlations with glucose concentration at 60 and 120 min of in vitro starch digestion in the purchased commercial rice samples  but no correlation with glucose concentration at 180 min digestion  with shorter fatty acid chains in rice samples from Bangladesh  and DAGs  with longer fatty acid chains had negative correlations with glucose concentration after 180 min of digestion to a larger extent than TAG 50:2, TAG 52:2, TAG 52:3 and DAG 34:2 . There was no significant (p > 0.01) difference in AUCs at 120 and 180 min of digestion among R + WSB, R + PPL and fresh control rice flour (R) , DAG 36:4 (R + DAG), PC 36:2 (R + PC) and LPC 16:0 (R + LPC) to rice flour decreased in vitro rice starch digestibility B,C. The lour (R) .p > 0.05). Addition of 1% LPC 16:0 to rice flour reduced glucose release following three hours of in vitro starch digestion by 7.4%  between AAC and total LPL content (R2 = 0.62 in low-AAC and R2 = 0.34 in intermediate- and high-AAC rice) were observed between the AAC and LPL content (R2 = 0.42) and lipid-bound amylose (R2 = 0.22) had weak positive correlations with LPL content in rice samples  (There was no correlation between lipid-bound amylose (or the amylose–lipid complex) and glucose concentration during in vitro rice starch digestion (−0.02 ≤  ≤ 0.24) . Starch– ≤ 0.24) .The current study demonstrated for the first time the negative impact of individual native rice lipids on in vitro rice starch digestibility. Most of the tested TAGs, DAGs, PCs and LPLs were negatively associated with in vitro rice starch digestion either in the early or late stage of digestion. However, the association study was not conclusive, possibly due to the large effects of other rice grain components . Genetically modified rice with differences only in rice lipids should be used in the future to understand the effects of rice lipids on rice starch digestion.Removal of lipids from rice flour increased in vitro starch digestibility while addition of extracted lipids to rice flour reduced starch digestion. Unlike in previous studies, the added and removed lipids were the same lipids in milled rice. Addition of triacylglycerol (TAG 54:6), diacylglycerol (DAG 36:4), phosphatidylcholine (PC 36:2) and lysophosphatidylcholine (LPC 16:0) reduced starch digestibility, and the effects were more pronounced with addition of LPC 16:0 and TAG 54:6. This study suggests lipids of rice grains can affect the rice starch digestibility, and modifying the lipid content and composition in rice by breeding may assist in achieving desirable rice starch digestibility.


The restorations were milled and cemented onto zirconia implants. After simulated chewing for 1.2 Mio cycles, the fracture load was measured and fractures were analyzed. Results: No fractures of ICFDPs or along the implants were detected after simulated aging. The mean fracture load values were significantly higher for a connector size of 9 mm2 (951 N) compared with 12 mm2 (638 N). For the zirconia material with a higher biaxial flexural strength, the fracture load values were increased from 751 to 838 N, but more implant fractures occurred. The position within the zirconia disk did not influence the fracture load. Conclusions: A connector size of 9 mm2 and a zirconia material with a lower strength should be considered when designing ICFDPS on zirconia implants to reduce the risk of fractures along the intraosseous implant portion.Background: The objective was to determine the optimal connector size and position within zirconia disks for implant-supported cantilever fixed dental prostheses (ICFDP). Methods: Two-unit ICFDPs ( Cantilever fixed dental prosthesis (FDP) retained at one dental implant are frequently indicated for edentulous spaces with two missing teeth or in free-end situations, due to limited space for two implants, soft or hard tissue deficiencies requiring complex surgical procedures, or financial reasons. The 5-year survival rate of implant-supported cantilever FDPs (ICFDP) varies between 89.9 and 92.7%, with implant fracture being the most common reason for failure . TechnicMetal–ceramic or zirconia (zirconium dioxide) are currently the materials of choice for ICFDPs . ZirconiDental implants made of titanium or titanium-zirconium alloy are currently the most prevalent, with reported survival rates above 90% after 10 to 15 years ,12,13. OThe objective of this study was to determine the optimal connector size and position within different zirconia disks for ICFDPs on zirconia implants in the premolar region in vitro, over 5 years of simulated function. The null-hypotheses were that (1) varying connector size does not affect fracture load values, and fracture load is neither influenced by (2) the biaxial flexural strength of the restorative zirconia material, nor (3) by the position of the restoration in the dentin or enamel layer of the zirconia disk.The replacement of a mesial premolar with an ICFDP on a zirconia implant was simulated in vitro. ICFDPs were manufactured to test the effect of connector size, zirconia material and position within the zirconia disk. Artificial aging replicating 5 years of function was performed with a chewing simulator. Afterwards, fracture load testing was conducted, and fractures were analyzed.Sixty zirconia implants  of diameter 4.1 mm and length 12 mm were embedded in an epoxy resin  that has a similar elastic modulus to human bone while keeping a 3 mm distance from the nominal bone level of the implant, according to ISO standard 14801:2016.2 or 12 mm2 . The designs were saved in a StereoLithography (STL) format and transferred to a lab software . Two different zirconia materials were tested; a 3Y-TZP with a translucent 5Y-PSZ enamel layer  and a multilayered 4Y-PSZ material . The ICFDPs were nested in the zirconia blanks in the lab software, either in the top-most position  or bottom  position (FDPs for an implant in the premolar region (tooth 35) with a mesial cantilever (tooth 34) were designed with an oval shaped connector size of either 9 mmposition . After mThe intaglio surface of the ICFDPs were then air-abraded with alumina particles of 50 µm, cleaned in an ultrasonic bath  with 70% ethanol for 4 min and dried with oil-free air. After drying, a ceramic primer  containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) was applied on the abutment surface of the zirconia implants and the intaglio surface of the ICFDPs using a microbrush . ICFDPs were subsequently cemented with an adhesive resin composite cement  and placed in a custom-made device applying a load of 2 N for 10 min on each specimen. Excess cement was immediately removed with foam pellets and light-curing of the margins was performed for 60 s . Specimens were placed in 37 °C water for 24 h directly after cementation.All specimens were subjected to a custom-built chewing simulator for 1.2 Mio cycles with a frequency of 1.5 Hz and a load of 49 N to simulate aging by 5 years ,18. SimuSpecimens were subjected to fracture load testing directly after chewing simulation and inspection. Using a universal testing machine , load was applied for all specimens on the occlusal surface of the cantilever in an axial direction c with a Fractured specimens were examined using a 3D scanning laser microscope  and a light microscope . Fractures were classified as Type 1: failure within the ICFDP, or Type 2: failure of the implant. The fracture origin was analyzed with scanning electron microscopy  at 15 kV for selected fractures using secondary electron (SE) and backscattered electron (BSE) modes.To test the influence of the position within the zirconia blanks of the specimens, biaxial flexural strength of the two zirconia materials (ZP and ZM) was measured. Disks with a diameter of 12.5 mm and a height of 1.8 mm were designed , and nested in either the top enamel layer (E), the middle (M), or the dentin layer at the bottom (D) of the respective zirconia blank (ZP or ZM). Twelve disks were produced for each of the six groups and sintered according to the recommendations of the manufacturer . Load-to-fracture of the specimens was obtained according to ISO standard 6872:2015 with the specimen’s surface pointing towards the enamel layer placed downwards on the three supporting balls. A universal testing machine  with a crosshead speed of 1 mm/min was used and biaxial flexural strength was calculated. Afterwards, two specimens per group were selected and thermally edged for 1 h at 1250 °C  to visualize the grain structure. Specimens were gold-sputtered and images of the surfaces facing towards the enamel layer were obtained with SEM . Elemental composition  of the surfaces was obtained using energy-dispersive X-ray spectroscopy .Sample size for fracture load testing was chosen based on the outcome of a previous study  considerp < 0.001) and zirconia material (p = 0.02), but not the position within the zirconia disk (p = 0.797). The fracture load values with material ZP were significantly higher  than for ZM (751 ± 167 N). Implant fractures (Type 2) occurred in 83% of the ZP specimens and 29% of the ZM specimens. The fracture load values were significantly higher with 9 mm2 connectors (951 ± 145 N) than with 12 mm2 connectors . Furthermore, fewer implant fractures occurred with 9 mm2 connectors  than with 12 mm2 connectors . While implant fractures were not observed in ZM-E-9 and ZM-D-9 specimens, 50% of the specimens that underwent loading of the cantilever had fractures of the implant. The position within the disk had no significant effect (p = 0.145).Loading the cantilever during the chewing simulation (specimens ZM-E-9* and ZM-D-9*) significantly decreased the mean fracture load (446 ± 81 N) compared with equivalent samples ZM-E-9 and ZM-D-9 (871 ± 105 N) loaded on the implant crown  occurred mainly at the level of the embedding material, 3 mm below the nominal bone level. A typical compression curl was visible on the failure site of all fractured implants c. Three p < 0.001) and the position within the disk (p < 0.001). The mean values and standard deviations are presented in p < 0.001). Positioning of the specimens within the enamel layer E of the disk resulted in significantly lower biaxial flexural strength values compared with group M (p < 0.001) and D (p < 0.001), while no significant difference was found between group M and D (p = 1.0). The calculated Weibull characteristic strength was as follows: ZP  and ZM . The Weibull characteristic strength was overall around 5% higher than the mean biaxial flexural strength.Biaxial flexural strength values were significantly affected by the zirconia material  material displayed a higher biaxial flexural strength with higher fracture load values compared with the 4Y-PSZ (ZM) material. The positioning of the ICFDP within the zirconia disks did not, however, significantly affect the fracture load values, and the third null-hypothesis was confirmed.The objective of this study was to determine the optimal connector size, restorative material, and position within the zirconia disk for ICFDP of either 4Y-PSZ or 3Y-TZP/5Y-PSZ on zirconia implants in the premolar region in vitro over 5 years of simulated function. It was found that the highest fracture load values (870 N) for an ICFDP with the lowest risk for implant fractures after simulated aging can be expected with a 9 mm2 connectors, the stress build-up with load peaks arose at the pivot point where the implant was embedded, as no buffering was possible within the stiff connector during fracture load application on the cantilever. In most cases, fractures within the ICFDPs started from the implant crown margin and progressed towards the connector. This is the area where the highest compressive strength accumulated. For zirconia single crowns on titanium implants it has been observed that restorations with thin walls at crown margins were especially prone to such contact fractures [Surprisingly, the larger connector size of the FDPs decreased the fracture load of the samples significantly and increased the risk of implant fractures. A possible explanation is that in ICFDPs with 12 mmractures . In the 2 for ZP and 16 mm2 for ZM. Although 9 and 12 mm2 were planned within the software, the actual connector size may have been slightly increased as a result of the machine’s calculated milling path and limited access of the drills to narrow spaces in the connector area.For three-unit FDPs, manufacturers recommend connector sizes of 9 mm1c), which subsequently leads to failure of the implants [The overall fracture load values of the ICFDPs with the 3Y-TZP/5Y-PSZ material (ZP) were significantly higher (838 MPa vs. 751 MPa with the 4Y-PSZ (ZM) material); however, implant fractures occurred with most of the ZP specimens (83% vs. 29% of ZM specimens). Hence, to avoid implant fractures with the consequence of challenging implant removal surgery, a restorative material for the ICFDP with a lower strength should be chosen. Cantilever restorations on zirconia implants are currently not approved by the implant manufacturers. For titanium implants, cantilever restorations are a common treatment option with 5-year-survival rates of between 89.9% and 92.7%. However, implant fractures are reported as the main cause for failure . For cliimplants .In the present study, the positioning of the ICFDPs within zirconia disks did not affect the fracture load significantly for either zirconia materials, while the biaxial flexural strength of the specimens in the translucent enamel layer was lower than in the middle or dentin layer. For ZP, the manufacturer discloses a lower biaxial flexural strength of 650 MPa in the top 3 mm of the 5Y-PSZ enamel layer compared with the 3Y-TZP dentin layer (1200 MPa) that is attributed to the higher yttria content and consequently higher cubic phase of the enamel layer. These specifications are consistent with the SEM and EDX findings of the present study; however, the biaxial flexural strength of the dentin layer was lower (976 MPa) in the present study. The manufacturer characterizes ZM as 4Y-PSZ material with a biaxial flexural strength of 650 MPa in the enamel and 850 MPa in the dentin layer. The obtained biaxial flexural strength reported here was slightly lower (585/844 MPa). The SEM analysis revealed the presence of grains > 1 µm that occur with the cubic phase in the enamel layer. EDX analysis showed that the yttria content within all layers was higher  than the information given by the manufacturer . It is possible, however, that thermal etching of the samples may have enhanced the presence of yttria on the surfaces as crystal phase transformations can occur at the applied temperature of 1250 °C .A previous study confirmed lower flexural strength of multicolored zirconia disks for the translucent enamel layer, while even lower values were found within the transition layer . ManufacIn the present study, all implants survived the chewing simulation which is reported to simulate a clinical function of 5 years ,18. PrevDespite the in vitro character of the study, relevant and surprising information was obtained on how the material and design of the ICFDP affect the fracture load, as these parameters are not legitimate to be simulated in a clinical trial. A finite element analysis would provide further information on critical loads and predict fracture initiation areas. As zirconia implants are also available as two-piece systems, these may be tested in further studies.2 than for a 12 mm2 connector.Higher fracture load values are obtained for cantilever restorations with a 9 mmFracture load values are significantly higher for ICFDPs made of 3Y-TZP/5Y-PSZ than for 4Y-PSZ disks, while implant fractures are also increased with high-strength zirconia restorations.The position of the ICFDP within the enamel or dentin layer of the zirconia disk does not affect fracture load values significantly.For cantilever FDPs of zirconia with varying connector size, zirconia material and position within the disk cemented on one-piece zirconia implants, it can be concluded that:


Dear readers,In 2005, the Editorial Board, consisting of Prof. Sílvio Caldas Neto, Prof. Regina H. Garcia Martins and myself, João F. de Mello Jr., took over the honorable work of coordinating the Brazilian Journal of Otorhinolaryngology, the year it had just been accepted to the MEDLINE database.Despite its hugeness, the job to be done was very enlightening. Throughout these years we registered a growing number of submissions month-in-month-out, clearly showing the growing interest in publishing in our journal. In these five years, we had more than 1,500 papers submitted for assessment. Unfortunately, because of the need for more strictness concerning the quality of the publications, not all of them reached the necessary relevance to be published.The Brazilian Journal of Otorhinolaryngology has always been seen as the pearl of our Association, and thus it received special treatment, which required much dedication from all of us. Our goals were established right at the onset of our administration, and the most important of those was to become part of the ISI (Institute for Scientific Information), which would allow JCR  to calculate our journal's impact factor, placing it at a higher level when compared to the current journal classification by CAPES (Higher Level Personnel Enhancement Coordination). This goal was reached in August, 2010, with the much awaited application. We are waiting for their response, and should it be approved, the publications in our journal will have a higher weight in graduate program reports from all educational institutions.In the beginning of our administration, there was an average of 466 monthly downloads of our pages. Such figures increased with time, and by September, 2010, we were having 1030 downloads of .exe files and/or PDFs.During this time we pumped up the excellence of our journal as the most important Brazilian publication in the field of otorhinolaryngology. Our success reached international acknowledgement, and we now receive countless paper submissions from different regions of the world. We also strove to further strengthen our foundations, so as to climb higher. These have brought us immense satisfaction; nonetheless, renewal is fundamental to continue growing and to reach new heights.The hard work of the associate editors and our colleagues from the body of revisers was crucial to maintain the scientific standard of our journal, and to these colleagues we extend our most special gratitude. We must also thank our secretary, Fernanda and the GN1 Group, with whom we kept continuous, and almost daily, contact, and they were always willing to accept our ideas and help us in everything we needed. With this important partnership, our journal became modern and pleasant to read. We grew together, and most importantly, as a team.And finally, we would like to thank all of those who helped us these past years, especially the Presidents of our Association (ABORL-CCF) Richard Voegels and Ricardo Bento, for their full support and autonomy concerning the decisions associated with the Editorial Board. As we stand down from the board, we are quite certain we are yielding the floor to serious and competent colleagues, to whom we will not let down should they need our help. You can count on us.Editorial Board


However, the classification strategy and homology group of tet(X)-positive Acinetobacter spp. plasmids remain largely unknown. In this study, we classified them by genome-based replicon typing, followed by analyses of structural characteristics, transferability and in vivo effect. A total of 34 plasmids distributed in at least nine Acinetobacter species were collected, including three tet(X3)-positive plasmids and one tet(X6)-positive plasmid from our genome sequencing results. Among them, there were 28 plasmids carrying Rep_3 superfamily replicase genes and classified into six homology groups, consisting of GR31 (82.1%), GR26 (3.6%), GR41 (3.6%), GR59 (3.6%), and novel groups GR60 (3.6%) and GR61 (3.6%). Our tet(X3)-positive plasmids pYH16040-1, pYH16056-1, and pYH12068-1 belonged to the dominant GR31 group, whereas the tet(X6)-positive plasmid pYH12068-2 was unclassified. Structurally, all tet(X)-positive GR31 plasmids shared similar plasmid replication (repB), stability (parA and parB) and accessory modules [tet(X) and sul2], and 97.6% of plasmid-mediated tet(X) genes in Acinetobacter species were adjacent to ISCR2. Conjugation and susceptibility testing revealed pYH16040-1, pYH16056-1, and pYH12068-2, carrying plasmid transfer modules, were able to mediate the mobilization of multiple antibiotic resistance. Under the treatment of tigecycline, the mortality rate of Galleria mellonella infected by pYH16040-1-mediated tet(X3)-positive Acinetobacter spp. isolate significantly increased when compared with its plasmid-cured strain (p < 0.0001). The spread of such plasmids is of great clinical concern, more effects are needed and will facilitate the future analysis of tet(X)-positive Acinetobacter spp. plasmids.The rapid dissemination of plasmid-mediated  Acinetobacter species is a heterogeneous group of opportunistic pathogens and easily acquires antibiotic resistance genes (ARGs) (tet(X) genes have been reported in at least 10 different Acinetobacter species, including Acinetobacter baumannii, Acinetobacter gandensis, Acinetobacter piscicola, Acinetobacter schindleri, Acinetobacter johnsonii, Acinetobacter indicus, Acinetobacter towneri, Acinetobacter lwoffii, Acinetobacter pseudolwoffii, and Acinetobacter variabilis (tet(X3) and tet(X6) genes were detected with carbapenem resistance gene blaNDM–1 in A. baumannii, A. indicus, A. schindleri, and A. lwoffii isolates, posing a serious public health threat  Gram-negative and Gram-positive pathogens . Howevers (ARGs) . To dateriabilis . Worrisoh threat .Acinetobacter spp. genome and plays an important role in the horizontal transmission of ARGs, such as blaNDM–1 and blaOXA–23 , a series of plasmid classification schemes were developed based on replication initiator protein, mobilization protein and plasmid size (tet(X)-positive Acinetobacter spp. plasmids since the first mobile plasmid-mediated tet(X3) gene in 2019, and their homology groups remained to be analyzed (tet(X)-carrying Acinetobacter spp. plasmids by genome-based replicon typing, followed by analyses of structural characteristics, transferability, and in vivo effect.The plasmid is a self-replicating component of laOXA–23 . With thmid size . As the mid size . Howeveranalyzed . Herein,tet(X)-positive Acinetobacter spp. strains in China (tet(X3)-positive Acinetobacter spp. YH16040 and tet(X3)- and tet(X6)-positive Acinetobacter spp. YH12068 from pig; tet(X3)-positive Acinetobacter spp. YH16056 from soil; tet(X3)-positive A. pseudolwoffii YH18001 from human; tet(X4)-positive A. indicus Q22-2, Q85-2, and Q278-1 from migratory bird. In addition, a newly isolated tet(X6)-positive A. baumannii YC103 by CHROMagar™ Acinetobacter plates  containing tigecycline (2 μg/mL) from duck in 2019 was also analyzed (tet(X)-harboring Acinetobacter spp. plasmids deposited at the NCBI database were collected by tblastn -positive Acinetobacter spp. isolates were sequenced by Oxford Nanopore , respectively. Combining the clean data with our previous Illumina HiSeq data , genome assembly was performed by Unicycler version 0.4.1 and corrected by Pilon version 1.12 (Genomic DNA of eight Seq data  as well ion 1.12 .tet(X)-harboring plasmids were annotated by Rapid Annotation using Subsystem Technology (RAST) version 2.0 -positive structures was conducted by Easyfig version 2.2.5 (All sion 2.0 . Plasmidsion 2.0 . Plasmidsion 2.0 . A maximsion 2.0 . Plasmidme group . Similaron 2.2.5 .tet(X)-mediated tigecycline resistance was evaluated by filter mating with rifampin-resistant Acinetobacter baylyi ADP1 and A. baumannii ATCC 19606 (tet(X) detection and PCR-based fingerprinting (Transferability of plasmid-borne CC 19606 . The putprinting . In paraprinting .tet(X3)-harboring GR31 plasmid pYH16040-1 was cured of Acinetobacter spp. YH16040 using sodium dodecyl sulfate (SDS) with adjustment (tet(X3) gene .The justment . An overX3) gene  and repl1 whereas eravacycline was uninterpreted with no breakpoint. Escherichia coli ATCC 25922 served as a quality control strain.Minimum inhibitory concentrations (MICs) of all strains were determined by broth microdilution and interpreted according to the Clinical and Laboratory Standards Institute guideline M100-Ed28 . The tesG. mellonella  were randomly grouped (16 per group), and then infected with GR31 plasmid-mediated tet(X3)-positive Acinetobacter spp. YH16040 or its plasmid-cured strain YH16040C  via the last left proleg. After incubation at 35°C for 2 h, the infected larvae were treated with tigecycline (2 μg/g) or phosphate-buffered saline (PBS) by injection into the last right proleg. Finally, the larvae were observed for survival rates per 24 h in the next 4 days. All in vivo experiments were performed in triplicate.As previously described , the heatet(X)-positive Acinetobacter spp. isolates successfully revealed four tet(X)-carrying plasmids. These included tet(X3)-positive plasmids pYH16040-1 (GenBank accession number: CP094542) from Acinetobacter spp. YH16040, pYH16056-1 (CP094546) from Acinetobacter spp. YH16056, and pYH12068-1 (CP094556) as well as a tet(X6)-positive plasmid pYH12068-2 (CP094557) from Acinetobacter spp. YH12068 (tet(X6)-positive chromosome cYC103 (CP054560) from A. baumannii YC103 was also obtained (tet(X)-positive strains A. pseudolwoffii YH18001, A. indicus Q278-1, A. indicus Q85-2, and A. indicus Q22-2 (tet(X)-harboring plasmids or chromosomes despite repeated attempts. By querying Nanopore raw data of A. pseudolwoffii YH18001 , A. indicus Q278-1 , A. indicus Q85-2 , and A. indicus Q22-2 , a repeated structure consisting of multiple copies of tet(X) genes was detected, respectively, which may lead to the failure of complete sequence assemblies.WGS analyses of eight  YH12068 . Meanwhiobtained . For theus Q22-2 , we failtet(X)-positive Acinetobacter spp. plasmids deposited at the NCBI database has been growing  subtypes located on plasmids (tet(X3) , tet(X5) , and tet(X6) , of which tet(X3) usually coexisted with tet(X6) . Besides tet(X) genes, large amounts of plasmid-mediated genes conferring resistance to tetracyclines, aminoglycosides, β-lactams, phenicols, sulfonamides, macrolides, lincosamides, and rifamycins were present (tet(X)-positive plasmids ranging from 42,489 to 332,451 bp were widely distributed in A. indicus , A. baumannii , A. towneri , A. schindleri , A. variabilis , A. pseudolwoffii , A. piscicola , Acinetobacter junii , Acinetobacter pittii , and unidentified Acinetobacter spp. strains -positive MDR Acinetobacter spp. plasmids.Since the first report in 2019 , the num n = 34; , includiplasmids , namely  present . Worrisotet(X)-positive Acinetobacter spp. plasmids carried replicase genes and all of them belonged to a Rep_3 superfamily (pfam01051). Therefore, plasmid classification was conducted based on nucleotide sequence alignment with already classified replicase genes (tet(X)-positive Rep_3 superfamily plasmids, a total of six homology groups were successfully identified, such as the dominant GR31 , GR26 , GR41 , and GR59 -positive plasmids pYH16040-1 (CP094542), pYH16056-1 (CP094546), and pYH12068-1 (CP094556) fell within the same group GR31, which has been sporadically detected with tet(X) genes in A. baumannii, A. indicus, A. schindleri, A. towneri, and other Acinetobacter spp. strains (tet(X6)-positive plasmid pYH12068-2 (CP094557) was unclassified due to the lack of replicase genes. In contrast, the replicase genes of tet(X3)- and tet(X6)-carrying plasmids pXMC5X702-tetX-145k (CP084302) and pYH12207-2 (CP048661) have < 75% nucleotide identities with existing homology groups GR1-GR59, and therefore were defined as novel groups GR60  and GR61 , respectively (tet(X)-positive Acinetobacter spp. plasmids.Replicon conserved domain analyses showed that 82.4% (28/34) of se genes . Among t strains . Howeverectively . We provAcinetobacter spp. isolates . In essence, the GR31 plasmids have been detected in 13 validly named Acinetobacter species, including A. baumannii , A. lwoffii , A. indicus , A. towneri , A. schindleri , and others  genes especially in the genera Acinetobacter.In order to evaluate the host range of plasmids belonging to GR26, GR31, GR41, GR59, GR60, and GR61, we conducted a blastn search against the NCBI database and confirmed they were mainly distributed in d others . The plaplasmids . Particuplasmids , but thetet(X)-carrying GR31 plasmids available in the NCBI database. A total of 23 plasmids belonging to GR31 were analyzed and they exhibited GC contents ranging from 39.1 to 46.1%. According to our WGS results, pYH16040-1 was 87,435 bp and harbored 94 putative open reading frames (ORFs), whereas pYH16056-1 was 98,709 bp consisting of 107 ORFs and pYH12068-1 was 100,866 bp consisting of 115 ORFs. Although they originated from different sources, pYH16056-1 and pYH12068-1 showed an average 76.5% nucleotide coverage and 99.8% nucleotide identity to pYH16040-1, with the encoding sequence insertion, deletion and rearrangement  and the accessory modules (tet(X)-positive GR31 plasmids owned a repB gene involved in plasmid replication, and parA and parB genes responsible for plasmid stability. However, only 21.7% (5/23) of them harbored plasmid transfer modules, including conjugal transfer (n = 3) and mobilization genes (n = 2). For accessory modules, they mainly consisted of ARGs  and heavy-metal resistance gene clusters .Predominantly, we compared the complete plasmid sequences of pYH16040-1, pYH16056-1, and pYH12068-1 with angement . Moreoveangement . Archety modules . Our restet(X) genes in Acinetobacter species, including tet(X3) (n = 28), tet(X6) (n = 12), and tet(X5) (n = 2), were further analyzed  and ISAba14 (n = 3). Similarly, the truncation by IS26 was found on GR60 (n = 2) and GR61 (n = 2) plasmids, one of which was also upstream truncated by ISAcsp12. Except the GR26 plasmid carrying a complete ISCR2-mediated transposition unit (n = 1), GR41 and GR59 plasmids were detected with truncation by IS3 (n = 1) and IS1006 (n = 1), respectively. In addition, our WGS results of A. pseudolwoffii YH18001 (JALHBG010000013), A. indicus Q278-1 (JALHBF010000002), A. indicus Q85-2 (JALHBE010000004), and A. indicus Q22-2 (JALHBD010000003) revealed the incomplete tet(X)-carrying structures were also related to ISCR2 (tet(X) variants and ISCR2 as well as truncation by other insertion sequences indicated the frequent recombination events.Genetic environments of all plasmid-mediated analyzed . The res process . For GR3to ISCR2 . The clotet(X3) genes were successfully transferred from Acinetobacter spp. YH16040  and YH16056  to the recipient A. baylyi ADP1 , but failed to A. baumannii ATCC 19606. In Acinetobacter spp. YH12068, the tet(X3)-carrying GR31 plasmid pYH12068-1 (CP094556) couldn’t be transferred, which may be explained by the lack of entire conjugative transfer regions (tet(X6)-positive unclassified plasmid pYH12068-2 (CP094557) carrying plasmid transfer modules was transferred from Acinetobacter spp. YH12068 to A. baylyi ADP1 with a similar efficiency mentioned above. MICs of all transconjugants against tetracyclines increased by at least 32-fold when compared with A. baylyi ADP1, including tetracycline (≥64 μg/mL), tigecycline (≥4 μg/mL), the newly FDA-approved eravacycline (≥2 μg/mL) and omadacycline  gene (CP040912) was also able to be transferred from human-derived A. baumannii to A. baumannii 5AB via electro-transformation, whereas the GR31 plasmid co-harboring tet(X3) and tet(X6) genes (CP044451) was from environmental A. indicus to A. baylyi ADP1 by natural transformation. The transferability of tet(X) genes between Acinetobacter species of human, animal and environment origins reminded us to consider the “One Health” approach to prevent mobile tigecycline resistance.Conjugation experiments showed the GR31 plasmid-mediated  regions . Meanwhitet(X3)-mediated tigecycline resistance from Acinetobacter spp. YH16040, YH16056, and YH12068 to A. baylyi ADP1, as well as florfenicol resistance (128 μg/mL) from Acinetobacter spp. YH16040 and YH12068 and gentamicin resistance (16 μg/mL) from Acinetobacter spp. YH16056, which was consistent with the result of plasmid-mediated ARG mining (tet(X)-mediated tigecycline resistance and blaNDM–1-mediated carbapenem resistance between Acinetobacter species (tet(X) genes, as previously described for resistance determinants mcr-1 and blaIMP–1  was transferred with G mining . Recentl species . With thblaIMP–1 .tet(X3) gene, a plasmid-cured strain YH16040C [tet(X3)-negative] was obtained by serially passaging of tet(X3)-positive Acinetobacter spp. YH16040. For tigecycline, a significant decrease in MIC was detected (1 μg/mL) when compared with the parental isolate YH16040 , eravacycline (0.06 μg/mL), omadacycline (0.125 μg/mL), florfenicol (8 μg/mL) and sulfamethoxazole-trimethoprim (20 μg/mL) also exhibited at least 16-fold decrease. The result further confirmed the elimination of GR31 plasmid pYH16040-1 (CP094542) that co-harbored resistance genes tet(X3), floR and sul2  gene was evaluated using a G. mellonella model. 96 h later of tigecycline treatment (2 μg/g), the larval mortality rate of Acinetobacter spp. YH16040C significantly decreased to 37.5% while Acinetobacter spp. YH16040 was 87.5%  gene compromised the clinical effectiveness of tigecycline. Notably, the infection by Acinetobacter spp. YH16040 and Acinetobacter spp. YH16040C under the treatment of PBS resulted in a greater larval mortality rate (100%) than PBS only (12.5%) after 48 h (p < 0.0001), whereas no significant difference was observed between Acinetobacter spp. YH16040 and Acinetobacter spp. YH16040C -positive Enterobacteriaceae bacteria have also been constructed, and therefore G. mellonella was available for in vivo functional analyses of plasmid-mediated tet(X) genes.Subsequently, the tet(X)-carrying MDR plasmids in Acinetobacter species. Our results classified the tet(X)-positive Acinetobacter spp. plasmids of Rep_3 superfamily into six homology groups, including two newly assigned GR60 and GR61. To the best of our knowledge, this study first revealed a dominant GR31 plasmid mediating the horizontal transfer of tigecycline resistance gene tet(X) across different Acinetobacter species and contributed to the failure of tigecycline treatment in vivo. Accordingly, more efforts are needed to monitor and prevent the plasmid-mediated tet(X)-positive Acinetobacter spp. strains.Taken together, the data presented in this study highlighted the diverse distribution of The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/J-LH, Y-HL, and JS designed the study. CC, P-YH, C-YC, and QH performed the experiments. CC and P-YH analyzed the data. CC wrote the draft of the manuscript. All authors reviewed, revised, and approved the final report.


Maranta arundinacea), kuzu (Pueraria montana var lobata), Sassafras tree  leaves, sugarcane, acorn, and animal-derived gelatin have been reviewed. Hydrocolloid processing, utilization, physicochemical activities, composition, and health benefits have been described. The food industry generates waste such as plant parts, fibers, residue, scales, bones, fins, feathers, or skin, which are often discarded back into the environment, polluting it or into landfills, where they provide no use and generate transport and storage costs. Food industry waste frequently contains useful compounds, which can yield additional income if acquired, thus decreasing the environmental pollution. Despite conventional manufacturing, the aforementioned hydrocolloids can be recycled as byproducts, which not only minimizes waste, lowers transportation and storage expenses, and boosts revenue, but also enables the production of novel, functional, and healthy food additives for the food industry worldwide.Hydrocolloids are naturally occurring polysaccharides or proteins, which are used to gelatinize, modify texture, and thicken food products, and are also utilized in edible films and drug capsule production. Moreover, several hydrocolloids are known to have a positive impact on human health, including prebiotics rich in bioactive compounds. In this paper, plant-derived hydrocolloids from arrowroot ( Approximately 38% of waste comes from food processing  specificdustries . Torres-dustries . Howeverdustries ,5. The adustries .Starches are renewable polysaccharides that naturally form in most plants, serving a nutritional backup purpose. These biopolymers may be found in plants’ rhizomes, branches, fruits, seeds, and tubers. Starch’s two separate components are amylose and amylopectin . Both coGelatin is a protein primarily obtained from the animal industry byproducts—pig skin, bovine and porcine cartilage, bones, and hides during partial hydrolysis of collagen. Collagen is the most common structural protein in animals’ bodies, making up about 30% of all proteins. Animal species majorly influence gelatin properties and tissue types. They are obtained from ,15. TherThis work focuses on the novel utilization of plant and animal food industry byproducts. The byproducts’ physicochemical characteristics, health-promoting benefits, and use as hydrocolloids have been discussed. It is important to establish how many valuable compounds are present in the seemingly useless waste. This way, such ingredients can be identified and extracted or obtained, providing additional income, reducing storage and transportation costs, and mitigating harmful impacts on the environment. The information gathered in this work aims to clarify the topic of novel hydrocolloids from byproducts and show their use in food technology.(Maranta arundinacea), also known as sago banban, sago rare, sago andrawa, sagu, Patat, arut, jelarut, irut, larut, labia walanta, or hudasula [polvoron or pancake topped with grated, young coconut flesh-saludsod. The direct consumption of arrowroot rhizome by humans is unclear, because of its very fibrous texture [Arrowroot hudasula , is a nahudasula , Indoneshudasula , or trophudasula . The phyhudasula . Arrowrohudasula . Its flohudasula . The plahudasula . Its pro texture . Arrowro texture  and is s texture . Three s texture . Arrowro texture ; however texture . Arrowro texture . ConsideThe plant’s rhizome starch composition is presented in The likely reason for the differences in the starch composition is the plant’s age. Extraction of amylaceous fractions carried out on 12- and 14-month plants indicated an increase in amylose content from 17.9 to 20.0%, respectively. Moreover, starch granule size increased with the plant’s development. On the other hand, the values of viscosity  decreased as the plant got older . A largeThe granules’ size is 7–16 μm. Arrowroot starch exhibits a high purity of over 99% . HoweverArrowroot starch exhibits significant thickening, stabilizing , and she−1), its impact on arrowroot starch is insignificant, limiting some gel and paste behavior modifications [Despite various advantages, native arrowroot starch has some industrial limitations. Due to significant viscosity and discord with some hydrophobic polymers, it has finite solubility and unsatisfactory processability. Due to the immensely low phosphorus content  and Malesia . The most popular kuzu variety is Pueraria montana var lobata [Kuzu, also known as kudzu, kudzuvine, kudsu, wa yaka, aka, nepalem, Japanese arrowroot, kudzu comun (Spanish), vigne japonaise (French) and kopoubohne (German)  is a bulr lobata . Easternr lobata . Kuzu str lobata . Howeverr lobata . This plr lobata ,54. Kuzur lobata . Kuzu ror lobata ,57,58 frr lobata  and a mir lobata , eicosanr lobata , diacetor lobata .2H5OH).A common method of isolating kuzu starch is the standard precipitation method, shown in The kuzu starch composition has been presented in Studies indicate that kuzu has C-type starch ,68,69. Hw/v) affects gel structure. 0.1% concentration makes the gel resemble homogeneous, stubby, and curved strands, while 2%—thick masses and entangled aggregates. Storing gels at 4 °C for a week caused the gels to be retrograde, creating an opalescent surface and, at a concentration of 2%, fibrous clusters [Kuzu starch exhibits a high lightness value (L*) of 93.34, which makes it a desirable product ,75. Granclusters . To estaclusters . Native clusters . Inapproclusters . Most moclusters . Howeverclusters . To prevclusters . Compareclusters ,69. Kuzuclusters . Kuzu stclusters . As kuzuclusters . Regardiclusters .w/w). Xanthan gum tends to adsorb on the starch granules, providing a defense against digestive enzymes [Raw kuzu starch shows moderate in vitro digestibility. After 120 min of exposure to digestive enzymes, many eyelets were noticed on the surface of kuzu starch granules. Kuzu starch exhibits a rapidly digestible starch (RDS) content of 5.66%, slowly digestible starch (SDS)—of 25.88%, and 68.46% of resistant starch (RS). Such properties suggest that kuzu starch might be used as a functional ingredient for lowering the glycemic index in food. However, after gelatinization, RS lowered to 11.38% because of heat-damaging crystalline regions, making starch chains easier for amylase to interact with ,92. The  enzymes .Natural extracts present in kuzu flour limit the increase in crystallinity and recrystallization of starch . There iMost isoflavones are destroyed while starch is extracted from the roots. Thus, another isolation method is advised .Native kuzu starch has some industrial limitations, such as low solubility or low stability; thus, some structural modifications might be needed . Kuzu stSassafras albidum is a deciduous tree species native to North America. The tree’s root was used in folk medicine and as a spice in soft drinks such as root beer but was prohibited in 1960 because of an unsafe amount of carcinogenic alkaloid safrole . In the present day, safrole-free extracts are allowed to be used as flavorings. Many other alkaloids were found in the roots, but none in the leaves [e leaves .Sassafras albidum) leaves; however, Parekh [Filé powder is a spice and a thickening agent made of young, dried, and ground Sassafras tree , agriculture mulch, mushroom subsoil, and ethanol via simultaneous saccharification-cum-fermentation by enzymatic or acid hydrolysis [Bagasse is a fibrous waste generated after sugarcane is crushed during sugar production. Fresh bagasse has a high moisture content of about 50% and is later dried to a composition of 45% cellulose, 28% pentosans, 20% lignin, 5% sugar, 1% minerals, and 2% ash , however005 cc/g . Due to drolysis . Bagassedrolysis . Due to drolysis . Anotherdrolysis . Furtherdrolysis . This isdrolysis , sugarcadrolysis .Aspergillus niger, a producer of citric acid, baker’s and food yeast, monosodium glutamate, and substitute for coffee, molasses is implicitly utilized in the food industry. Molasses can be used as a compound of fodder, which benefits the microflora of ruminants’ stomachs and helps them digest fibrous feed such as straw. Moreover, fodder enriched with molasses inhibits the development of bronchial disease. It is also used to obtain itaconic acid—a plasticizer and a chemical intermediate; acetone and butanol; dextran—a blood plasma expander and a toothpaste, paint, glue, iron-dextran complex (a medicine for anemia), sulfate dextran (anticoagulant) ingredient; ephedrine—a cough syrup ingredient; biocides; Nitromiel—an explosive; potassium salts; denaturants; activated carbon; asphalt; cement; drawing lubricants; dehydrating agent in mineral clarifying processes; sealing agents [Another byproduct of the sugarcane industry is black strap molasses—a thick liquid of significant viscosity. Molasses is rich in sugar, which further crystallization is not profitable and is not usually meant for direct human consumption due to its chemical composition and unappealing, dark color. About 23–28 L of molasses is generated for every ton of crushed sugarcane. Molasses consists of 45–55% fermentable sugars—30–35% sucrose, 10–25% glucose and fructose, 2–3% non-sugar compounds, water, and minerals. Molasses is used as an ethyl alcohol production substrate during yeast fermentation, then ethyl alcohol is utilized in other chemicals’ production, e.g., ethyl benzene, ethylene oxide, propionic acid, mono chloroacetic acid, their salts, Acetic acid, Beta picoline (3-Methyl Pyridine), Styrene, or Dibutyl phthalate. Ethanol is also used as a fuel oxygenator with 5% concentration—5–20% as a blend with gasoline (Gasohol), or F-95% as fuel extender/replacement. During yeast fermentation for alcohol, carbon dioxide is produced as well, which can be utilized as a cooling agent or to carbonate beverages. As a component of the subsoil for g agents .2O5, MgO, Fe, and Mn. Press mud is rich in phosphorus, and thus is used as a fertilizer, increasing yield of sugarcane. The mixture of molasses and press mud is utilized as a fertilizer and is useful in animal feed production. Press mud is also used to produce n-triacontanol—a plant growth regulator; policosanol—higher aliphatic alcohol; cement; distemper paints; foaming agents; activated carbon; filter aids; proteins; carnauba wax replacement [Press mud cake (or press mud) is a leftover residue produced during the filtration of sugarcane juice. It consists of 50–70% moisture, 5–14% crude was and fat, 15–30% fiber, 5–15% sugar, 5–15% crude protein, and a notable deal of Si, Ca, Placement .During the processing of sugarcane, a significant amount of foliage is generated. Furthermore, almost all of the leftover sugarcane green tips are converted into cattle feed, which is an inexpensive and wholesome source of feed. Dried leaves are used as a fertilizer or may be ground and utilized as a filler in plastics and linoleum production .Quercus (oak trees), belonging to the family Fagaceae. The genus Quercus grows in the USA, temperate Europe, Asia, and subtropical Africa [w/v). Acorn protein reduces the viscosity of o/w emulsions [Q. infectoria spp. boissieri, because it contains the most protein (8.44%) among other acorn taxa. Acorn protein extraction was presented in “Acorn” is a common name for the fruit of plants of the genus l Africa ,124,125.l Africa . Nowadayl Africa . These fl Africa . Acorns l Africa ,130. Acol Africa , typicall Africa . Utilizal Africa ,132. Acomulsions  SuggesteGelatin is made by breaking cross-linkages between the polypeptide chains and bonds in the parent protein collagen, obtaining a heterogeneous mixture. Even further treatment of enzymes yields gelatin hydrolysates, which show pro-health benefits ,135,136 Despite its wide range of applications, gelatin concerns some consumers because of religious (haram or not kosher food) and health (possibility of prion disease in bovine gelatin) reasons. To overcome those issues and make use of meat and fish byproducts, it is suggested to produce gelatin from poultry skins, feet, heads, and bones and process waste of the fishery industry ,142,143.The process of acid and alkali gelatin extraction from fishery byproducts has been shown in Bifidobacterium and Lactobacillus in the large intestine without stimulating the harmful bacteria such as Clostridium perfringens. As a result, humans absorb microelements including Ca, Mg, and Fe more readily and are less likely to develop diseases such as large intestine cancer and disorders brought on by excessive cholesterol levels. Presently, in the large intestine, the prebiotics ferment, producing short-chain fatty acids, which can limit the development of pathogens [It is important to note the health advantages of arrowroot starch. It is characterized by high digestibility and high content of dietary fibers; contains raffinose, lactulose, stachyose, and fructooligosaccharides which might serve the purpose of prebiotics , meaningathogens . As a reathogens . This seathogens . The rhiathogens  phosphorathogens . Arrowroathogens  most likathogens . This leathogens . Its shoathogens . Arrowroathogens . Anotherathogens . Foods wathogens . Althougathogens . Arrowroathogens .Kuzu is known for its use in diabetes effects mitigation due to the significant content of isoflavonoids, especially puerarin, known for its ability to restore glucose balance. . PueraniSassafras leaves contain many essential oils, including geranial, neral, limonene, caryophyllene, α-pinene, (Z)-3-hexenol, linalool, the caryophyllene oxide . In trad2O2) treatment. Dietary fibers from both bagasse and sugarcane used in the food industry demonstrated significant nutritional value. However, H2O2 treatment promoted oxidation and free radical occurrence thus, being threatening for some human food macromolecules. In terms of chapatti-style bread and pasta noodles, an inclusion of no more than 8% of these fibers has been deemed agreeable [Sugarcane bagasse and sugarcane tops show promising pro-health benefits if processed, to dietary fiber using alkaline (NaOH or Hgreeable . The maigreeable ; hyperglgreeable ; diabesigreeable . DietaryAcorn protein may provide some health-promoting benefits. Acorn proteins consist, among others, of legumin, legumin precursors, which show antioxidant activities, and arterial pressure regulating properties, by inhibiting I-converting enzyme ; 2-Cys pIt is possible to obtain fish and aquatic animal gelatin hydrolysates using various proteolytic enzymes. Gelatin hydrolysates and gelatin-derived peptides show health-promoting properties , shown iMany food industries focus on manufacturing products, which are allegedly the most profitable and easiest to produce, discarding the byproducts into landfills or directly to the environment polluting it. This causes additional transportation and storage costs. Moreover, pollution poses a threat to wild animals and humans as well. Fortunately, production waste has a lot to offer to manufacturers, since it is most often loaded with useful materials, functional substances, and health-promoting compounds. Byproducts such as poultry feet, beaks, feathers, skin or fish scales, fins, heads, and bones are typically discarded or processed into fodder. However, such a common ingredient might be used in a novel way to produce safe gelatin and a substrate for gelatin hydrolysates that are beneficial for health. Many plants are cultivated for their medical application. After processing, leftovers are discarded. These byproducts frequently contain valuable, functional compounds such as foaming agents, surfactants, gelling and thickening agents, cryoprotectants, or syneresis inhibitors. Moreover, the byproducts often pose medical applications too. They may exhibit antioxidative, nutritional, anti-cancer, diabetes regulating, or prebiotic activity. It is worth considering the economic strategy used by sugarcane manufacturers, who not only produce sugar but also utilize the waste to generate fuel for their units, fodder for locals, and fertilizer for their plants. Such technology may be introduced to more food processing industries such as starch, meat, grain, or plant-derived bio-compounds industries. Doing so can reduce the cost of production, transit, and storage, therefore, providing consumers with lower prices without losses for the manufacturers.