Background: Sour cassava starch is used as an alternative to wheat flour in breadmaking. However, its nutritional and technological properties are limited. To remedy this, the use of legumes has proved to be very successful. Thus, the present study aimed to determine the optimal condition for the production of bread made from sour cassava starch, peanut, cowpea and soybean flour. Methods: The I-optimal design was employed to obtain an optimal proportion of the mixture with the variables sour cassava starch, cowpea, soy and peanut flour. The responses evaluated were overall acceptability, specific volume and protein content. Results: It resulted that the incorporation of sour cassava starch positively influenced the volume but negatively influenced the protein content and overall acceptability. While the addition of legumes increased protein content and overall consumer acceptability, the specific volume was reduced. The optimal proportions of sour cassava starch, cowpea, soybean and peanut flour were 64.11%, 18.92%, 0% and 16.96%, respectively. Under this condition, it led to a desirability of 1, specific volume of 1.35, overall acceptability of 6.13, protein content of 9.72%, carbohydrate content of 67.89%, fat content of 9.39%, fiber content of 2.10% and ash content of 1.04%. Conclusions: The findings suggest that cowpea and peanut can be used for the improvement of the technological, nutritional and sensory properties of sour cassava starch bread and thus increase its consumption and application in the food processing industry. Manihot esculenta Crantz, Euphorbiaceae), also known as yuca, manioc, mandioc, mandioca or tapioca, is a vegetatively propagated perennial shrub grown in the lowlands of the tropics for its starchy tubers with thickened roots [Cassava 2SO4), sulfuric acid (H2SO4), distilled water (H2O), boric acid (H3BO3), color indicators (bromocresol green (C21H14Br4O5S) and methyl red (C15H15N3O2)), sodium hydroxide (NaOH), hydrogen chloride (HCL), hexane (C6H14), nitric acid (HNO3), deionized water (H2O), and standards solutions of aluminum (Al), boron (B), barium (Ba), calcium (Ca), cadmium (Cd), chromium (Cr), cobalt (Co), copper (Cu), iron (Fe), potassium (K), lithium (Li), magnesium (Mg), manganese (Mn), molybdenum (Mo), sodium (Na), nickel (Ni), phosphorus (P), silicon (Si) and zinc (Zn). All the chemicals and reagents used in this study were of analytical grade and were purchased from Sigma-Aldrich Pty.Ltd. The plant material consisted of peanut, soybean and cowpea seeds, collected at the local market in Dschang, and cassava tubers, collected at a farmer’s field in Bertoua. Baking ingredients consisted of composite flour, water and salt. The salt (white Diamant), provided by SOCAPURSEL , was purchased at the local supermarket. The chemicals reagents included ammonium sulfate ((NHSociété coopérative simplifiée des transformations de manioc (SCSTM)). Here, the starch was extracted, fermented for 30 days and exposed to light rays for around 24 h. The soybean and cowpea grains were soaked for 12 h and then dried in an oven at 45 °C for about 24 h, ground and sieved (160 µm) Aleem et al. [The cassava starch was wet-extracted in a traditional production unit  using a modified method of Biata et al. [Here, 1 g of each sample was weighed into digestion vessels and mixed with 10 mL of concentrated nitric acid  is used to calculate all variations around the model mean. The predicted R2 (R2 Pred) is adopted to estimate the extent to which the model predicts the value of the response. PRESS  is used to judge the model’s suitability; the smaller it is, the more appropriate the model is. In addition, it must have a correct “lack of fit”. Indeed, the “lack of fit” is correct when its p-value is not significant [There are six indices for assessing model suitability. A nificant   .The determination of protein content was performed using the Kjeldahl method (AACC 46-11) , which i3 according to the benchmark bread, and the protein content was in the range of 1.24–16.56 according to the data obtained from the different trials. A compromise was then made between the different optimal conditions obtained for each response, and an optimal formulation was chosen.Optimization of the different responses was carried out according to the following conditions: the overall acceptability was maximized, the specific volume was targeted to be 2.6 g/cm−1, holding at 90 °C for 5 min, and then cooling down to 50 °C at 6 °C·min−1 with continuous stirring at 960 rpm for 10 s and then at 160 rpm for the rest of the experiment. The visco-amylogram yielded the following seven parameters: peak viscosity, minimum viscosity (MV), breakdown (BD), final viscosity (FV), setback (SB), peak time (PT) and pasting temperature (PTC). The analyses were performed in triplicate and mean values were calculated.The viscous behavior of starch at various fermentation times and varieties was measured using a Rapid Visco Analyzer model RVA-4 Series  as described by Sánchez et al. . A mass pan de quezo or pao de queijo or Yuca bread. It is also very common in Brazil and Latin America where it originates. Since it is in this form that sour cassava starch bread is known and consumed, we took it as our benchmark bread in this study. For this part, we compare the proximate composition, sensory parameters and textures of the two breads.Cheese bread is a traditional Colombian braid made with sour cassava starch and grated cheese known as The proximate composition was conducted according to standard methods as described in These parameters were determined following the protocol explained in Texture profile analysis (TPA) of sourdough bread crumbs was performed using a texture analyzer  equipped with an 80 mm diameter cylindrical probe. TPA was performed by two sequential compressions . The obtained profile was used to calculate hardness, cohesiveness, consistency, elasticity and plasticity using Nexygen software 4.1 . The resulting profile was used to calculate hardness, cohesiveness, elasticity, gumminess, chewiness, stickiness and stiffness using Nexygen software 4.1  following Shobharani et al. . The tesThe mixture trials were generated using Design-Expert version 11.0 software. Excel version 2013 software was used to express the results of the analyses performed in triplicate as means plus or minus standard deviations, and analysis of variance (ANOVA) was used for statistical analysis using SPSS version 23 software.p < 0.05 between the different flours. Also, cowpea flour, soy flour and peanut flour are richer than sour starch in protein, lipids, fiber and minerals. This is because legumes are of higher nutritional quality than cassava starch [p < 0.05 between the different flours. Also, it appears that more than 50% of the initial content of anti-nutrient has been reduced as a result of the various treatments applied [In order to assess the nutritional contribution of legume flour to sour cassava starch, a bromatological analysis was carried out on sour cassava starch, peanut flour, cowpea flour and soy flour. a starch . They ala starch . The cona starch . Table 3 applied . Indeed, applied . Thus, t3 and the protein content from 1.24 to 16.56 g/100 g . Consequently, the concentration of these responses explains much of their variability.Design-Expert 11.0.5.0 was used in this study to perform regressions, graphical analyses and analysis of variance (ANOVA). Linear, two-factor interaction (2FI), quadratic and cubic models were examined and compared to select the best model for the experiment . The lin2 and high adjusted R2 [1) shows that cassava starch (A), peanut flour (B), soybean flour (D) and flour blends  have a positive influence on the overall acceptability, while cowpea flour (C) and flour blends  influence the response negatively.Sensory analysis includes all the sensations that a person may experience when holding or eating food. It is also used to determine the texture of foods . Hedonicusted R2 . ConcernGenerally, the incorporation of legume flour in gluten-free bread results in an improvement of the overall acceptability of the product associated with improved scores for textural characteristics and appearance. In this study, we observed an improvement in the appearance and textural characteristics with the incorporation of legumes from 3.9 to 6.45 and 4.13 to 6.13, respectively, on a 9-point scale. The high protein content of legume flours enables them to improve the texture and the color of the bread , which r2 and high adjusted R2 [2) shows that there is a positive individual effect of starch, cowpea and soybean flour, and a quadratic effect of flour blends (starch–peanut and peanut–cowpea) on bread volume. Also, we observe a negative individual effect of peanut flour and a quadratic negative effect of flour mixtures  on bread volume.Specific volume is an important measure of bakery product performance. It is a measure of volumetric expansion, which is the sum of radial and axial expansions . Specifiusted R2 . The resHigh incorporation of legume flours results in an inhibition of the expansion that originates, on the one hand, from the competition for water molecules between starch and legume flours; on the other hand, we witness a disintegration of the network formed by the starch and protein molecules due to the presence of other molecules or an imbalance of the different components . Indeed,2 and high adjusted R2 [3) shows, on one hand, that there was a positive individual effect of peanut, cowpea and soybean flours and a negative quadratic effect of starch–peanut, starch–soybean, cowpea–soybean and starch–peanut–cowpea flours. On the other hand, there was a negative individual effect of starch and a positive quadratic effect blend flour of starch–cowpea, peanut–cowpea and cowpea–soybean.The results of the analysis of variance show that B, C and D are significant model terms, and the linear model  was founusted R2 . The resLegumes are well known for their high protein content. The results of the analysis show that the protein content of peanut (28.8%), cowpea 26.8/100) and soybean (33.65%) was greater than that of cassava starch, which does not contain any protein. Thus, their incorporation in the formulation increases the bread’s protein content, as demonstrated by Lemos et al. , Cavalca.8/100 anA compromise was made between the different optimal conditions obtained for each response, and this was used to obtain the optimal bread . The conTo understand the effect of incorporating protein sources on the gelatinization and retrogradation process of starch and the relationship of these properties with the quality of our optimal bread, an analysis of RVA parameters was carried out on sour cassava starch, cowpea flour, peanut powder and optimum flour. p ˂ 0.05) for sour cassava starch, cowpea flour, peanut flour and the optimum flour. According to Singh et al. [p ˂ 0.05) in peak time (PT) and pasting temperature (PT °C) between legume flours and optimum flour; meanwhile. there is a significant difference (p ˂ 0.05) between these flours and starch for PT °C. For PV, MV and FV, peanut flour has the highest value, followed by starch and optimum flour, and cowpea flour was the lowest; for BD and SB, cowpea flour had the highest value, followed by optimum flour, and peanut flour had the lowest. Indeed, the increase in pasting temperature may be due to the greater resistance of peanut and cowpea starch to swelling and breakdown. It has been reported that legume starches in general exhibit type C viscosity (restricted swelling) [h et al. , there ih et al. . Concernwelling) . These rwelling) , who indThe optimal bread scored above 5 on a scale of 9 for all sensory attributes, which means that it was acceptable. We noted a slight superiority of the cheese bread compared to the optimal bread for aspect, odor and taste, while the optimal bread had a better score in texture than cheese bread . Indeed,Concerning the textural profile, the optimal bread was superior compared to the cheese bread in terms of hardness (40.5 N), consistency (27.30 N), elasticity (5.55 1/L) and plasticity, while the cheese bread had a better score in cohesion (0.9 N) than the optimal bread . The glo3/g, overall acceptability of 6.13, protein content of 9.72%, carbohydrate content of 67.89%, lipid content of 9.39%, fiber content of 2.10%, ash content of 1.04%, hardness of 40.5 N, cohesion of 0.70 N, consistency of 27.30 N, elasticity of 5.55 1/L, plasticity of 183.64 mj and a decrease in RVA parameters. This finding suggests that cowpea and peanut can be used for the improvement of the technological, nutritional and sensory properties of sour cassava starch bread and thus increase its consumption and application in the food processing industry, especially in developing countries where wheat is not available.This study demonstrates that peanut and cowpea flour positively influence the global acceptability of bread at moderate incorporation rates, while soybean has a negative influence even at low incorporation rates when combined with cowpea and peanut flours. The incorporation of the three legumes has a negative influence on the bread’s specific volume and a positive influence on the protein content. The optimal proportions of sour cassava starch, cowpea, soybean and peanut flour to yield acceptable bread with better nutritional and technological qualities were 64.11%, 18.92%, 0% and 16.96%, respectively. These conditions result in a desirability of 1, specific volume of 1.35 cm


P = 0.005), whereas β-stiffness index was not changed significantly after WWI. BRS gain correlated with β-stiffness index before  and after WWI . ANCOVA revealed that these slopes of linear regression lines remained unchanged after WWI (P = 0.350). These results indicate that a short-term WWI acutely deteriorates cardiac BRS. Individuals with stiffer arteries are relatively more susceptible to WWI because of their poor baseline BRS, which might be one of the causes of bathing-related falling in elderly persons as well as frailty.Warm water immersion (WWI) causes dizziness presumably due to a substantial drop of blood pressure. The aim of this study was to elucidate the effects of short-term WWI on cardiac baroreflex sensitivity (BRS) and the contribution of arterial stiffness to the cardiac BRS. Twelve apparent healthy men (44 ± 12 years) performed the single stand-up test after 5-min sitting in the bathtub without (Control) and with 41 °C warm water at the heart level (WWI). Cardiac BRS gain was evaluated by R–R interval response to the standing-induced drop of systolic blood pressure. In addition, before and 10 min after the single stand-up test, carotid arterial β-stiffness index was evaluated in the supine rest. BRS gain was blunted (2.9 ± 1.6 vs. 1.8 ± 1.1 ms/mmHg,  Passive heat therapy seems to be capable of inducing improvements in vascular health , 17. ThuOrthostatic challenge results in transient reductions of cardiac output and mean arterial pressure (MAP), and hence concomitant decreases in cerebral perfusion pressure and blood flow because blood is displaced from the thorax to the lower body . In thisA more important issue is that previous results may not provide us adequate answer to aforementioned question of underlying mechanism of non-fatal accidents immediately after WWI because of no-real world experimental setting  , 27–29. Generally, blood pressure is well-regulated instantly by sensing fluctuation of blood pressure via baroreceptors located at the aortic arch and carotid arteries , 19. SinThe aims of this study were to elucidate the effects of short-term WWI on cardiac BRS in healthy men, and the contribution of arterial stiffness to the change in cardiac BRS with WWI. The hypotheses of this study were that a short-term warm water bathing deteriorates cardiac BRS, and that individual changes in arterial stiffness with WWI are attributed to the response of cardiac BRS to WWI.2, body fat of 17.3 ± 7.8%, mean ± SD) were studied.To determine the contribution of arterial stiffness to the change in cardiac BRS with WWI, we set inclusion criteria were men aged between 20 and 60 years who were not medicated individuals, having overt cardiovascular diseases as assessed by medical history, and current smokers. Twelve healthy men /[(D1 − D0)/D0], where D1 and D0 are the maximal and minimum diameters, and P1 and P0 are carotid arterial pressure at peak systole and end diastole.HR and brachial blood pressure (BP) were measured with the cardiovascular screening device . Carotid arterial β-stiffness index, an index of arterial stiffness adjusted for distending pressure, was also measured as we previously reported . In brier) > |0.85| was included in the analysis [Arterial pressure waveform was continuously recorded at the left middle finger by Finometer system  during the single stand-up test, and stored on a computer using a data acquisition system  at the 1000 Hz of sampling rate. Throughout the test, subject was asked to keep the left hand at the heart level: on the side-table out of the bathtub during sitting and on the chest during standing. These data were analyzed offline by flexible data analysis software . Cardiac BRS gain was evaluated by the sequence method  and corresponding reduction in RRI). RRI was estimated from the time interval between the systolic foot and the next systolic foot of arterial pressure waveforms. The slope of linear regression line was calculated from the continuous reduction of SBP and corresponding change in RRI (without time-lag) as long as possible (at least more than 3 beats). A correlation coefficient . FiTympanic membrane temperature was measured 30 s before the standing in both conditions by the infrared tympanic thermometer .t test was applied for comparison between two conditions. Simple correlation analysis was performed to determine relations of interests. The slopes of linear regression line between β-stiffness index and BRS gain were compared by interaction between time and β-stiffness index on BRS gain by ANCOVA. All data are reported as mean ± SD. Statistical significance was set a priori at P values less than 0.05.To evaluate reproducibility of BRS measurement, intra-class correlation coefficient (ICC) and 95% limits of agreement were calculated from two measurements of BRS gain at the control condition. Paired Table P = 0.002, Fig. Regarding reproducibility of BRS gain by the single stand-up challenge, ICC was 0.749 P = 0.00, Fig. 2.P = 0.322) or the standing-induced decreases in finger artery MAP  between two conditions (Table P = 0.007), where linear regression coefficients were equivalent between two conditions (P = 0.719). BRS gain was significantly blunted after the bathing  and brachial diastolic BP  were significantly decreased in the 2nd measurement  than those in the 1st measurement , whereas brachial systolic BP  and β-stiffness index  and WWI  conditions. ANCOVA revealed that the slopes of linear regression line between β-stiffness index and BRS gain remained unchanged after WWI (interaction: P = 0.350).As shown in Fig. r = − 0.626, P = 0.028) and after WWI , and the slopes of linear regression line between β-stiffness index and BRS gain remained similar after WWI. These results indicate that a short-term WWI acutely deteriorates cardiac BRS. Individuals with stiffer arteries are relatively more susceptible to WWI because of their poor baseline BRS, which might be one of the causes of bathing-related falling in elderly persons as well as frailty.Main results of this study are as follows: first, cardiac BRS gain was blunted after the 5-min WWI. Second, BRS gain correlated with carotid arterial β-stiffness index before  have been reported frequently in Japan that has a traditional custom to daily warm water immersion (WWI) in the bathtub at the bathing. It is well-known empirically that immediately after WWI feeling dizzy on standing up frequently occurs presumably due to a substantial drop of blood pressure. Because of hydraulic pressure, impacts of aortic, carotid, and cardiopulmonary baroreceptor unloading might be different between supine and standing postures, and thus, response of cardiac BRS to orthostatic challenge with heat stressor would depend on postural setting. Thus, we evaluated cardiac BRS by use of the more practical setting .The maintenance of BP by baroreflex is critical for preserving cerebral perfusion and orthostatic intolerance. Thus, several studies have been performed to investigate the effect of prolonged passive heat stress accompanied by core temperature elevation on baroreflex control of BP. For instance, whole body heating via water-perfused suits did not alter carotid-cardiac baroreflex function evaluated by the maximal gain between arterial pressure and HR , 27, 28,Prolonged heat exposure with core temperature elevation and hypohydration decreases cardiac baroreflex control of HR , 8. ImpoHigh arterial stiffness is associated with lower BRS  since thIn this study, MAP reduced approximately 30 mmHg at the single sit-stand motion from the floor of the bathtub irrespective of conditions. Such instant hypotensive responses were relatively greater than previous studies which used other techniques  , 14, 28.First, because of the experimental setting , we could not determine sensitivity of aortic, carotid, cardiopulmonary baroreceptors, separately. However, it looks more practical and real-world setting. Second, only men participated in this study. It remains unclear whether WWI similarly affects cardiac BRS in women. Women have lower orthostatic tolerance than men , 9, 26, Heat therapy using hot baths and saunas has been utilized with reports of improved quality of life and overall improved well-being in patients with type II diabetes mellitus . It seemBefore and immediately after the 5-min warm water immersion, we compared RRI responses to abrupt drop of SBP induced by the single sit-stand movement in men. The present data indicate that even a short-term warm water immersion deteriorates cardiac BRS and that individuals with stiffer arteries are relatively more susceptible to WWI because of their poor baseline BRS. This might be one of the causes of bathing-related falling in elderly persons as well as frailty. Further studies to determine the impact of prolonged bathing as well as sex difference are needed.


To the Editor—Recent reports in this journal [ journal  and othe journal  assessed journal . Individ journal . All wer journal . Anti-MPAlthough the only detection of anti-MPXV IgG and NAbs cannot exclude previous exposure to other OPXV due to serological cross-reactivity, the simultaneous presence of IgA and/or IgM suggests a recent OPXV infection. Individuals 16, 17, and 18, who showed the widest range of antibody positivity, were antiretroviral therapy–suppressed aviremic people with HIV with a CD4 count >500 cells/μL; 2 of them  reported sexually transmitted infections in the last year. More importantly, the presence of MPXV DNA in the serum of subject 18 confirms recent MPXV infection at the time of the first MVA-BN dose, as viremia is usually described in the first 3 weeks from symptom onset . In conc


Lactobacillus acidophilus 11073) using whey-protein-isolate (WPI)–octenyl-succinic-anhydride-starch (OSA-starch)-complex coacervates and to investigate the effects on probiotic bacterial viability during spray drying, simulated gastrointestinal digestion, thermal treatment and long-term storage. The optimum mixing ratio and pH for the preparation of WPI-OSA-starch-complex coacervates were determined to be 2:1 and 4.0, respectively. The combination of WPI and OSA starch under these conditions produced microcapsules with smoother surfaces and more compact structures than WPI-OSA starch alone, due to the electrostatic attraction between WPI and OSA starch. As a result, WPI-OSA-starch microcapsules showed significantly (p < 0.05) higher viability (95.94 ± 1.64%) after spray drying and significantly (p < 0.05) better protection during simulated gastrointestinal digestion, heating (65 °C/30 min and 75 °C/10 min) and storage (4/25 °C for 12 weeks) than WPI-OSA-starch microcapsules. These results demonstrated that WPI-OSA-starch-complex coacervates have excellent potential as a novel wall material for probiotic microencapsulation.The aim of this study was to microencapsulate probiotic bacteria ( Bifidobacterium, Lactobacillus and others, have been widely used in functional foods, beverages and so on [Probiotics are living microorganisms that can provide a lot of benefits to the health of a host when properly ingested ,2. Many nd so on ,3. Howevnd so on ,5. Micrond so on . Among tnd so on .It is universally acknowledged that the choice of wall materials is of great importance for microencapsulation . For theLactobacillus pentosus in OSA starch microcapsules after spray drying was only about 65%. The weak protective effect of the OSA starch microcapsules could be attributed to the poor solubility and film-forming property of OSA starch, resulting in an uneven film formation at the beginning of the drying process and therefore the shrunken and wrinkled surfaces of the spray-dried microcapsules [Whey-protein isolate (WPI), isolated from cheese-making waste, is an attractive encapsulant as it has been found to be effective in protecting probiotic bacteria during spray drying . Howevercapsules ,20.Lactobacillus acidophilus encapsulation via spray drying. The SGI digestion, thermal resistance and storage properties of microencapsulated and free probiotic bacteria and the physicochemical properties and microstructure of probiotic microcapsules were further investigated.Complex coacervation is one of the most commonly used methods for combining protein with polysaccharide, which occurs as a phase separation of the water solution containing them with opposite electrical charges and the formation of a coacervate layer surrounding the bioactive compound . ProbiotComplex coacervation of charged protein and polysaccharide can be reflected by the change in turbidity of the solution at the macroscopic level. Therefore, turbidity titration has usually been used to investigate the whole process of complex coacervation and to measure the conditions under which the maximum complex coacervates can be formed .As shown in As the complex coacervation of protein and polysaccharide is mainly motivated by electrostatic attraction, their zeta potential could provide important information about the interaction between them, as well as the formation and stability of complex coacervates .As shown in As shown in As shown in Therefore, the conditions for the preparation of WPI-OSA-starch-complex coacervates for probiotic encapsulation were selected as follows: mixing ratio 2:1, pH 4.0, total polymer concentration of 5%.−1, 1539 cm−1 and 1240 cm−1 were related to the amide I (C=O stretching), amide II (N-H bending) and amide III (C-N stretching and N-H deformation) of WPI, respectively [−1 was related to the O-H stretching of hydroxyl groups. The peaks at 1725 and 1572 cm−1 were observed for the stretching vibration of C=O and asymmetric stretching of COO–, respectively [−1 and 1539 cm−1 in the WPI microcapsules to 1650 cm−1 and 1544 cm−1 in the WPI-OSA-starch microcapsules, respectively, similar to the report of Naderi et al. [−1 and 1571 cm−1 disappeared in the WPI-OSA-starch microcapsules, similar to the report of Zhao et al. [−) of OSA starch and the amine groups (-NH3+) of WPI.ectively . For OSAectively . The FTIectively  and Zhani et al.  and Zhano et al. . The aboFluorescence microscopy was used to confirm the presence of probiotic bacteria in the microcapsules. As shown in The microstructure of the spray-dried microcapsules containing probiotics is also shown in Lactobacillus acidophilus in different microcapsules after spray drying is shown in The viability of p < 0.05) higher viability (95.94 ± 1.64%) than either WPI microcapsules or OSA-starch microcapsules, indicating that the combination of WPI and OSA starch would enhance the protective effect for probiotics during the process of spray drying. The high viability of probiotic bacteria in the spray-dried WPI-OSA-starch microcapsules produced here may also be due to the smooth surfaces and the compact structures of the microcapsules [p < 0.05) higher probiotic viability after spray drying was also found in soy-protein-isolate–peach-gum-polysaccharide, soy-protein-isolate–pectin, WPI–Momordica charantia-polysaccharide microcapsules than that in protein/polysaccharide-only microcapsules and free bacteria [WPI-OSA-starch microcapsules exhibited a significantly  higher than that of WPI–shellac microcapsules and WPI microcapsules due to the low drying rate of shellac microcapsules, despite the strong hydrophobicity of shellac [w values were consistent with the water content, and a higher aw (0.247 ± 0.004) was found in the OSA starch microcapsules than in the others.As also shown in  shellac . The aw Lactobacillus acidophilus was 10.12 ± 0.18 log CFU/mL, which decreased dramatically after SGI digestion, with viability of 4.75 ± 0.32 and 2.47 ± 0.19 log CFU/mL after digestion in SGF and SIF, respectively. After microencapsulation, the viability of Lactobacillus acidophilus after SGI digestion was significantly (p < 0.05) improved. Among all the microcapsules, the WPI-OSA-starch microcapsules showed the highest viability (9.16 ± 0.15 log CFU/g) after SGI digestion.As shown in p < 0.05) increased viability of Lactobacillus acidophilus in WPI-OSA-starch microcapsules during SGI digestion could be mainly attributed to the smooth surface and the compact structure of the microcapsules, as well as the relatively high hydrophobicity of OSA starch, which were beneficial in reducing the hygroscopicity, wettability and solubility of the microcapsules and maintaining the integrity of the microcapsules during SGI digestion, thereby preventing the diffusion of hydrogen ions (H+), digestive enzymes, bile salts, etc., into the microcapsules [Lactobacillus acidophilus during SGI digestion after microencapsulation [The significant  higher probiotic viability after SGI digestion was also found in soy-protein-isolate–peach-gum-polysaccharide, soy-protein-isolate–pectin, sodium-caseinate–gum-ghatti and sodium-caseinate–gum-arabic-based microcapsules than that in protein/polysaccharide-only microcapsules and free bacteria [Similarly, significantly  improved. The viability of microencapsulated Lactobacillus acidophilus in WPI-OSA-starch microcapsules was found to be 8.07 ± 0.25 log CFU/g and 8.52 ± 0.19 log CFU/g after thermal treatment of 65 °C/30 min and 75 °C/10 min, respectively, significantly (p < 0.05) higher than that in WPI microcapsules and OSA-starch microcapsules. The reason for this could be mainly attributed to the improved sealing properties of the microcapsules due to their compact structure and smooth surface, which slows down the heat diffusion.The influences of heat treatments on the viability of Similar results were also reported previously—the viability loss of probiotic bacteria in soy-protein-isolate–pectin microcapsules was only 2.55 log CFU/g, which was lower than that in SPI microcapsules (3.1 log CFU/g) after thermal treatment 75 °C/10 min) . However min . HoLactobacillus acidophilus survived after 10 weeks of storage. The storage stability of Lactobacillus acidophilus was significantly (p < 0.05) improved by encapsulation, especially in WPI-OSA-starch microcapsules. Bacterial vitality was maintained at 9.22 ± 0.31 and 6.25 ± 0.36 log CFU/g after 12 weeks of storage at 4 °C and 25 °C, respectively. Thus, it can be concluded that WPI-OSA-starch microcapsules can effectively protect Lactobacillus acidophilus during storage, mainly due to the smoother surface and the more compact structure of the microcapsules, as well as the relatively high hydrophobicity of OSA starch, which retards the diffusion of oxygen, moisture and other substances into the microcapsules during storage [p < 0.05) higher storage stability of probiotics in sodium-caseinate-gum-ghatti, sodium-caseinate–gum-arabic, soy-protein-isolate–peach-gum-polysaccharide and soy-protein-isolate–pectin microcapsules than those in protein/polysaccharide-only microcapsules and free bacteria has also been reported [As shown in  storage . Similarreported .Lactobacillus acidophilus 11073 was obtained from Gaofuji Biological Technology Co., Ltd. . Rice starch (amylose content of 21.54 ± 0.85%) was obtained from Haixi Biological Technology Co., Ltd. . WPI was obtained from Haofa Biological Technology Co., Ltd. . De Man, Rogosa Sharp (MRS) agar and broth were obtained from Aoboxing Biological Technology Co., Ltd. . OSA, pepsin (P7012), pancreatin (P7545), amyloglucosidase (A7095), porcine-bile extract (B8613) and rhodamine B isothiocyanate (RBITC) were obtained from Sigma-Aldrich . Other analytical pure chemical reagents were obtained from Cologne Chemical Co. .OSA starch was synthesised following a previously reported process . Brieflyw/v) was performed by mixing the powder of WPI with aqua destillata and slowly stirring until complete hydration was achieved. The OSA-starch solution  was prepared by mixing the powder of OSA starch with aqua destillata, followed by gelatinisation at 95 °C for 20 min. As the retrogradation usually occurred in gelatinised starch, the fresh OSA starch solution had to be prepared for each experiment and used immediately after preparation.The preparation of WPI solution , using the glass cells with an optical path of 0.5 cm [Turbidity measurements were performed at different ratios  with a pH range of 2.0–6.5 using a UV-vis spectrophotometer  at 600 nm. In order to adapt the microencapsulation and keep the turbidity values in an appropriate range, measurements were made at a relatively high concentration  was determined as a function of pH  using a zetasizer . The pH at which the zeta potential reaches 0 was defined to be the isoelectric point (IEP) .w/v) were determined following the approach described by Carpentier et al. [g, 20 min) and then dehydrated at 105 °C to constant mass. The yield of each complex coacervate was calculated according to Equation (1):In order to study the adaptability of the process in the field of microencapsulation, the yields of WPI-OSA-starch-complex coacervates with different ratios  and different total polymer concentrations  and Wt is the sum of the dry weight of WPI and OSA starch used for the complex coacervation (g).In this equation, WLactobacillus acidophilus was incubated in an MRS culture medium at 37 °C for 24 h to prepare Lactobacillus acidophilus inoculum, which was then transferred to MRS culture medium and incubated for a further 24 h. The bacterial suspension was centrifuged (6000× g/5 min) and the pellet was washed twice and redispersed in sterile normal saline solution to give a final concentration of approximately 1010 CFU/mL.Glycerol-preserved 10 CFU/g materials and stir continuously for 30 min; (3) adjust the pH to the pHopt determined in 3/h.Microcapsules were prepared as follows: (1) prepare WPI, OSA starch and WPI-OSA-starch-mixed solution, the ratio and the total concentration were determined in −1. The spectral data were obtained via 32 scans with a resolution of 1 cm−1.The FTIR spectrum of the different microcapsules containing probiotics was measured using an FTIR spectrometer . Briefly, 2 mg of microcapsule powder and 98 mg of KBr were blended and ground to a fine powder using an agate mortar. The ground powder was then pressed into transparent flakes using a tablet press. The range of the wave number for measurement was set to 400–4000 cmLactobacillus acidophilus were labelled with RBITC according to the approach reported by Peñalva et al. [a et al. . DiffereA scanning electron microscope (SEM)  was used to measure the microstructure of the different microcapsules containing probiotics. After, they were placed on the adhesive carbon discs and coated with a gold layer. Images of each sample were obtained at 10.0 kV accelerating potential and 20,000× magnification.w) of different microcapsules containing probiotics at 25 °C.The water content of the different microcapsules containing probiotics was measured by removing the water at 105 °C to constant mass. The water-activity meter  was used to analyse the water activity (aw:v), kept at 37 °C for 60 min and then vortexed to homo-dispersion. The suspension was then serially diluted and counted via the standard plate count (SPC) method using MRS agar. Incubation of the plates was performed at 37 °C for 2 days.Following the approach reported by Zhao et al. , microcaw/v, pH 2.0) containing pepsin  was prepared and used as the simulated gastric fluid (SGF). The NaCl solution  containing pancreatin  and bile salts  was prepared and used as the simulated intestinal fluid (SIF). For SGI digestion, microcapsules (0.1 g) or free (0.1 mL) probiotic bacteria were added to 9.9 mL SGF and kept at 37 °C for 120 min. At 60 and 120 min, 0.1 mL of SGF was taken from each sample, serially diluted and counted via the SPC method. After simulated gastric digestion, the rest of SGF was moved to the SIF and the probiotic bacteria were counted at 60, 120, 180, 240, 300 and 360 min as previously described.The viability of free and microencapsulated probiotic bacteria after SGI digestion was determined following the approach described by Mao et al. , with soTo measure the thermal stability, microcapsules (1 g) or free (1 mL) probiotic bacteria were mixed with 9 mL sterile normal saline solution, and then incubated in a thermostat water bath (65 °C/30 min or 75 °C/10 min) followed by cooling with ice. The number of viable bacteria after thermal treatment was then determined.To determine the storage stability, microcapsules (1 g) or free (1 mL) probiotic bacteria were preserved in sealed tubes at 4 °C/25 °C for 12 weeks. Each week, 0.1 mL of free bacteria or 0.1 g of microcapsules were taken from each sample and counted as previously described.p < 0.05).Each measurement was performed three times and the data were recorded as the mean ± standard deviation. Statistical differences between samples were analysed using SPSS software, with one-way analysis of variance (ANOVA) and Tukey’s test (Lactobacillus acidophilus. The optimum mixing ratio and pH for the preparation of the WPI-OSA-starch-complex coacervate were found to be 2:1 and 4.0, respectively. The occurrence of an electrostatic interaction between WPI and OSA starch in microcapsules was confirmed via FTIR. The spray-dried WPI-OSA starch microcapsules exhibited more compact structures and smoother surfaces than WPI-OSA starch-only microcapsules. Microencapsulation via the complex coacervation of WPI-OSA starch was found to be effective in improving the viability of Lactobacillus acidophilus during spray drying, SGI digestion, thermal treatment and long-term storage. Taken together, these results demonstrate that WPI-OSA-starch-complex coacervates are promising wall materials for probiotic encapsulation.In this study, complex coacervates of WPI and OSA starch were prepared for microencapsulation of


Background: Delayed graft function (DGF) is a significant challenge in renal transplantation, particularly with deceased donors, necessitating early postoperative dialysis. The prolonged effects of medium- and long-term DGF remain uncertain, marked by contradictory graft survival outcomes. This incongruity might arise from the inherent graft resilience and regenerative capacity during transplantation. This study investigates DGF’s impact on graft survival, focusing on grafts displaying favorable (KDRI < 1) and unfavorable outcomes (KDRI ≥ 1). Methods: In this retrospective cohort study (January 2015–December 2019), we assessed kidney transplants at our center, excluding multiorgan simultaneous cases, primary non-functioning grafts, and surgical complications causing graft loss. Patients were categorized into DGF presence or absence groups. Univariate and multivariate analyses, alongside propensity score matching (PSM), were performed. Results: The study encompassed 322 deceased donor kidneys, with 83 encountering DGF. Grafts with higher KDRI indices (KDRI ≥ 1) and DGF exhibited a notably increased graft loss risk . However, lower-KDRI donor grafts displayed no significant disparities between the DGF and non-DGF groups. Conclusions: Delayed graft function (DGF) development significantly contributes to graft loss in kidney transplants, particularly in grafts with KDRI ≥ 1. Delayed graft function (DGF) is a complication that affects the immediate postoperative period of renal transplantation, primarily in deceased donor transplantation. DGF is defined as the need for dialysis within the first seven days following renal transplantation .The incidence of DGF varies depending on the type of transplanted kidney (standard or expanded criteria) and the type of donation , with incidences ranging from 5% to 55% ,2,3.DGF is influenced by multiple factors relating to both the donor and the recipient ,2. The dHowever, the medium and long-term negative effects of DGF are not well defined, and there are contradictory findings regarding graft survival in individual studies . In contThe lower long-term survival in kidneys with DGF has been associated with the damage caused by ischemia reperfusion, which can lead to cell death, inflammation, and fibrosis ,7. LikewThis controversy regarding the impact of DGF on graft survival and functional outcomes may stem from the reserve and regenerative capacity of grafts at the time of transplantation , which cThe aim of our study is to analyze the role of DGF in graft survival and, subsequently, examine its impact on grafts with differing survival profiles, defined as a KDRI index equal or below 1 for a more favorable profile and a KDRI index higher than 1 for a less favorable profile.We conducted a retrospective cohort study of kidney transplantations performed at our center between 1 January 2015 and 31 December 2019, excluding patients who underwent multiorgan simultaneous transplantation, experienced primary non-functioning grafts, or had surgical complications that resulted in graft loss., which was defined by the need for dialysis within the first 7 days after transplantation.The cohort was divided into two groups based on the developing of DGF , which wThe study protocol adhered to the ethical guidelines of the 1975 Declaration of Helsinki, and it received approval from the local ethics committee (Ref. N298-4365). All patients provided informed consent for kidney transplantation and data registry.Recipient-related variables  , donor-rThe rapid recovery extraction technique was executed following the declaration of death, and involved a midline laparotomy to cannulate the distal abdominal aorta, clamp the supraceliac aorta, and perfuse it with cold preservation solution, with subsequent venting through the inferior vena cava.The normothermic regional perfusion extraction technique involves the percutaneous cannulation of the femoral artery and vein with local anesthesia before the confirmation of the patient’s death. A catheter with occlusion balloons is advanced to the thoracic aorta and inferior vena cava. After initiating life support limitation measures and verifying the patient’s demise, the occlusion balloons are deflated, and blood recirculation and oxygenation within the circuit begin, facilitating subsequent organ extraction.Transplanted patients were administered a triple immunosuppressive regimen consisting of tacrolimus, mycophenolate mofetil, and prednisolone. Induction therapy was initiated with either an anti-interleukin-2 antibody (basiliximab) or rabbit anti-human thymocyte immunoglobulin (thymoglobulin), based on the hyperimmunized status of the patients or when the graft was obtained after circulatory death.The preimplantation graft biopsies were acquired through wedge biopsy, preserved in formaldehyde, embedded in paraffin, and, subsequently, subjected to standard histological staining and analysis following the criteria outlined by Remuzzi et al. .The qualitative variables are described as absolute and relative frequencies, the and quantitative variables as mean and standard deviation (SD) or median and interquartile range (IQR).Chi-squared, the Fisher test, and Kruskal–Wallis tests were performed to compare the distribution of the independent variables. Kaplan–Meier and univariate and multivariate Cox regression was developed to analyze death-censored graft survival.Propensity score matching (PSM) was performed to estimate the average marginal effect of DGF in the subgroup with KDRI ≤ 1 and in the subgroup with KDRI > 1, while accounting for potential confounding variables.A 1:1 optimal match  was perfp < 0.05) was used to denote statistically significant differences.The analyses were performed using SPSS (v.17.0) , and R (v.4.2.2)  was used to perform PSM analysis. A significance level of 5% (p = 0.01). Additionally, a distinct distribution was observed in the prevalence of a prior history of stroke  and the mean dialysis time   .p = 0.01), along with a greater prevalence of diabetes mellitus , higher basal creatinine levels , and a higher Kidney Donor Risk Index (KDRI)  compared to those without DGF. When donors were categorized based on the expanded criteria definition [Regarding the DGF graft donors, a higher proportion of males was observed . However, no significant differences were observed in cold ischemia times across the various groups.The utilization of the rapid recovery extraction technique was significantly higher in the delayed graft function (DGF) group compared to the non-DGF group , comprising nearly 50% of the DGF grafts analyzed. Nevertheless, no significant differences were found between the groups.A preimplantation graft biopsy was performed when available (p < 0.01) and a higher incidence of acute rejections (p = 0.02)  see .p < 0.01) and multivariate, after adjustment for the potential recipient confounding variables , donor variables , and transplant-related factors (number of rejections and type of donation), confirmed that delayed graft function is an independent risk factor for graft survival   .p = 0.917)    .p < 0.01)    .Delayed graft function has been identified as a crucial prognostic factor for graft survival ,6. It isThe key characteristics that theoretically determine the development of delayed graft function (DGF) and its subsequent survival are the recovery capacity of the nephrons and their tolerance to ischemia-reperfusion damage .When comparing the incidence of DGF in our cohort based on the type of donation, we found that it is similar to the reported rates in other studies for deceased donors due to brain death, but approximately 10% lower in the donation-after-circulatory-death groups .These results can be attributed to the fact that, in our cohort, strategies have been implemented to reduce the cold ischemia time compared to that in the study by Kayler et al. , which iAlthough individual studies have not found a direct correlation between the incidence of DGF and graft survival, meta-analyses conducted by Yarlagadda et al.  and Li eIn our series, the development of DGF was identified as a significant risk factor for graft loss  after adjusting for potential confounding variables , reaffirThe theory proposing that the nature of acute damage and its reversibility may vary based on graft characteristics has attracted attention. It is suggested that standard kidneys exhibit reversible ischemic-hypoxic damage, whereas grafts with expanded criteria demonstrate irreversible chronic damage ,17,18.In our study, grafts with a higher KDRI index (KDRI > 1) that experienced DGF showed a significantly increased risk of graft loss . However, among grafts from donors with a lower KDRI, no significant differences were observed between the DGF and non-DGF groups. These findings lend support to the notion of varying graft behavior in the presence of DGF, highlighting differences in their healing capacity.It is crucial to contextualize our findings within the framework of an experienced third-level hospital that employs a meticulously designed recipient–donor matching program.However, it is important to approach the interpretation of all the results presented in this study with caution, as certain limitations need to be acknowledged. Notably, the retrospective nature of the study and the inclusion of patients from routine clinical practice introduce potential biases. Additionally, the relatively limited sample size might impede the broader applicability of our conclusions.Nevertheless, our findings strongly suggest that DGF serves as a risk factor for graft loss within specific subsets of kidneys. This observation further bolsters the theory that the response of grafts to DGF can be modulated by their intrinsic characteristics. This phenomenon may offer insight into the disparate outcomes observed among different graft types and underscores the complexity of the role of DGF in kidney transplant outcomes.It underscores the necessity for continuous research efforts to unveil the underlying mechanisms that govern graft behavior in response to DGF. Additionally, there is a need to develop non-invasive diagnostic techniques and biomarkers to accurately predict the future implications of DGF ,20.These findings hold substantial implications for clinical practice, as the presence of delayed graft function (DGF) results in extended hospitalization and increased transplantation costs. Thus, it is imperative to direct efforts toward strategies that effectively mitigate the long-term consequences of DGF, particularly in cases involving suboptimal grafts (KDRI > 1).The development of delayed graft function (DGF) plays a pivotal role in graft loss among kidney transplant recipients, particularly in grafts with a higher Kidney Donor Risk Index (KDRI > 1).The theory proposing distinct responses to DGF based on graft attributes is further supported by our observations, highlighting the potential for tailored interventions based on graft type.


Immunologic complications following organ, cell, or tissue transplantation still raise significant challenges related to their diagnosis and treatment. In spite of an increased understanding of transplant immunobiology and the availability of effective immunosuppression, acute rejection or graft-versus-host disease (GVHD) still occur in up to 50% of transplant recipients, depending on the graft type ,2. IncreGraft-versus-host disease (GVHD) is a frequent and feared complication following hematopoietic stem cell transplantation (HSCT), and its development depends on multiple risk factors including donor–recipient matching and preconditioning regimens . In theiXenotransplantation (transplantation across species) has long been envisioned as a practical solution to the organ shortage, yet significant immunological and ethical obstacles have hindered its clinical introduction. The logistic and ethical barriers related to the use of primates have prompted interest in the use of pigs, which are anatomically and physiologically similar to humans, as an economically viable and ethically accepted source of organs and tissues. Nonetheless, humans and pigs are incompatible at the level of several carbohydrate antigens on the cell surface, as humans possess natural antibodies against these antigens. Thus, the spectrum of hyperacute rejection has limited the use of porcine-derived grafts to decellularized tissues . In spitHumoral immunity has long been recognized as one of the significant hurdles to solid organ transplantation. The antibody-mediated recognition of various antigens in transplanted organs has been associated with hyperacute or acute antibody-mediated rejection (AMR) and various strategies have been devised to tackle this obstacle. Complement-dependent lymphocytotoxic crossmatch, desensitization protocols through plasmapheresis, immunoabsorption, and B-cell depletion have allowed for an immunologically safer organ allocation or ABO-incompatible organ transplants, essentially abrogating hyperacute rejection and greatly reducing the occurrence of acute antibody-mediated rejection . More reReactivity against leukocyte antigens (HLAs) has been long recognized as a central mechanism during allograft rejection. The pre-transplant crossmatch test between donor cells and recipient sera developed by Terasaki in the mid-1960s has allowed for better organ allocation and reduced immunologic risks after transplantation at a time when immunosuppressive medication was in its infancy. The initial classification of HLAs developed using early cytotoxicity assays has gradually been refined with the help of advancing technologies, and the extensive polymorphism of the original epitopes has now been solved by next-generation sequencing (NGS). These advances have also allowed for the definition of eplets, which are short sequences of amino acids which represent the HLA loci actually targeted by the HLA antibodies, with them being called “functional epitopes” as a result. Eplet-based matching has been suggested as a more precise strategy compared with HLA antigen matching .In parallel, it has been repeatedly demonstrated that the occurrence of antibodies against donor HLAs after transplantation , particularly those against HLA class II, is associated with the development of chronic allograft dysfunction . A recenThe transplanted intestine is constantly exposed to external antigens, and its complex and dynamic microbiome makes intestinal graft immunology unique among transplantable organs. Intestinal grafts elicit a strong immunologic response due to their abundance in epithelial cells and tissue-resident immune cell populations. These circumstances have led numerous investigators to assume that the mechanisms of rejection in the intestine differ from those of other solid organs. In addition, in our review included this Special Issue, Professor Martin Rumbo and I summarized the experimental and clinical evidence of the roles of the direct pathway, the semi-direct pathway, and the indirect pathway of allorecognition in intestinal transplantation . Our rev


Successful ceramic restorations depend on the strong bonding with resin cement and even stress distribution. The aim of this study was to evaluate the impact of adding MDP-containing zirconia primer before self-adhesive resin cements with different functional acidic monomers on fracture resistance of monolithic zirconia crown.Eighty defect-free human maxillary premolars were divided according to the cement type and application of MDP-containing zirconia primer into eight groups (n = 10): Calibra Universal (C), Calibra Universal combined with zirconia primer (CZ), RelyX U200 (R), RelyXU200 combined with zirconia primer (RZ), Panavia SA Cement Plus (P), Panavia SA Cement Plus combined with zirconia primer (PZ), Multilink Speed (M), and Multilink Speed combined with zirconia primer (MZ). After teeth preparation and fabrication of zirconia crowns, each crown was bonded to its corresponding tooth. All specimens were subjected to 10,000 thermocycles between 5 and 55°C, followed by cyclic load (50 N) for 240,000 cycles. Each specimen was subjected to a static axial load until fracture using universal testing machine and the fracture load was recorded. The fracture mode studied and recorded. The fracture load results were analyzed using two-way ANOVA test (α = 0.05).A significant interaction (P = 0.038) of combining MDP-containing zirconia primer and cement type on fracture resistance of monolithic zirconia crown was detected. The mean fracture load values of zirconia crown were significantly influenced by the combined application of the MDP-containing zirconia primer with Calibra Universal (P = 0.01), RelyX U200 (P < 0.001), and Multilink Speed (P = 0.038), while there was no significant difference with Panavia SA Cement Plus (P = 0.660). There was significant difference  between the mean fracture loads of groups with self-adhesive cements . The highest fracture load was recorded with RZ group (2446.90 ± 126.72 N) while the lowest fracture load was recorded with C group (1623.18 ± 149.86 N).The self-adhesive resin cement with different acidic functional monomer affects the fracture resistance of monolithic zirconia crown. Application of MDP-containing primer could improve the fracture resistance of monolithic zirconia crown with most self-adhesive cements. The application of an MDP-containing primer had no impact on the fracture resistance of monolithic translucent zirconia crown bonded by MDP-containing self-adhesive resin cement. The clinical application of zirconia restoration has gained popularity because of its mechanical properties and biocompatibility . HoweverAdhesion between the restoration and tooth is critical for successful clinical performance of indirect restoration –8. UnlikSelf-adhesive resin cements were designed to adhere to tooth structure in one-step protocol without the steps of etching, rinsing as well as priming . Self-adThe fracture strength of a ceramic restoration is influenced by a number of factors such as elastic modulus of the supporting substrate, loading force, and cementation procedures –34. It wWhen selecting a self-adhesive resin cement, the addition of MDP-containing primer to enhance the performance of zirconia crown need to be studied. Thus, the aim of this study was to evaluate the fracture resistance of monolithic translucent zirconia crown bonded by using self-adhesive resin cements with different functional acidic monomers. Also, the effect of combining MDP-containing zirconia primer with the self-adhesive resin cements with different functional acidic monomers on fracture resistance of monolithic translucent zirconia crown was studied. The first null hypothesis was that the type of self-adhesive resin cement would not affect the fracture resistance of monolithic translucent zirconia crown. The second null hypothesis was that the MDP-containing zirconia primer combination with self-adhesive resin cement with different functional acidic monomers would not affect the fracture resistance of monolithic translucent zirconia crown.The materials used in this study are presented in Table According to the cement type and application of ceramic primer, the teeth were randomly divided into eight groups (n = 10): Calibra Universal (C), Calibra Universal combined with zirconia primer (CZ), RelyX U200 (R), RelyXU200 combined with zirconia primer (RZ), Panavia SA Cement Plus (P), Panavia SA Cement Plus combined with zirconia primer (PZ), Multilink Speed (M) and Multilink Speed combined with zirconia primer (MZ). Panavia SA Cement Plus was the only self-adhesive resin cement which contain MDP in its composition.The teeth were marked 2 mm away from the cemento-enamel junction using permanent marker . For simulation of the periodontal ligaments, the root of each tooth was dipped into the molten wax at 2 mm away from the cement-enamel junction and left to be hardened. The root of each tooth was embedded vertically within acrylic resin . Then, the tooth was removed from the acrylic resin blocks leaving an alveolus-like acrylic mold. The roots and the acrylic mold were cleaned carefully by hot water to remove any wax remnant. Then, the root and its acrylic mold were painted with an adhesive  and left to dry for 5 min . A poly The teeth were prepared, using a dental surveyor , with the following parameters: 6-degree taper, 1 mm reduction for the non-functional cusp, 1.5 mm reduction for the functional cusp, and 0.5 mm chamfer finish line  was applied to the crowns and subjected to glaze firing using a porcelain furnace  furnace. The intaglio surface of zirconia crown was air-borne particle abraded using 50 μm alumina particles at 2 bar air pressure for 10 s from a distance of 10 mm [Fabrication of zirconia crowns: Each tooth was scanned using an optical scanner , then the software  created a virtual model from the scanning data. A virtual custom tooth model  of a maxillary first premolar tooth was selected from the software library to be used with minimal modification to meet the standard design. The thicknesses of the designed restorations were checked using the measurement tool and the cut section view. Each design file was submitted to the milling machine  for milling of the crowns from a zirconia block . Then, the milled crowns were sintered  using a sintering furnace  at 1500of 10 mm . After tof 10 mm .2) 20 s per surface for final curing except Panavia SA Cement Plus 10 s per surface as instructed. The specimen was kept isolated for 5 min to allow for the chemical curing. The margin was finished using a finishing stone  and polished using an impregnated diamond polisher . The cemented specimens were kept in distilled water at 37℃ for 24 h.The crown was subjected to tack-curing  according to the manufacturer’s instructions and the excess cement was removed using a scalpel. Then, each surface was completely cured according manufacture instructions with light intensity  with 30 s dwell time in each water bath (5 and 55°C) and 5 s transition time. Using a chewing simulation unit , specimens were subjected to 240,000 cycles (frequency = 1.6 Hz) to simulate a unidirectional vertical force of 50 N . The loaFracture resistance test: all specimens were subjected to load-to-fracture with compressive load using a universal testing machine . The load was applied with a 5 mm stainless steel ball perpendicular to the occlusal surface with a crosshead speed of 0.5 mm/min. The fracture load of each specimen was recorded in Newton (N). The fracture mode of each specimen was examined using a stereomicroscope  at a magnification of x20. Fracture mode was classified into: minimal fracture or crack in the crown (Class I), less than half of the crown lost (Class II), half of the crown lost (Class III), more than half of the crown lost (Class IV), and sever fracture of the crown and/or the tooth (Class V) . ClassesStatistical analysis: data were statistically analyzed using statistical software . The Shapiro-Wilk test was used to confirm the normality of data. The fracture load results were analyzed using two-way ANOVA test was performed to determine the effect of MDP-containing zirconia primer combination with self-adhesive resin cement. Post Hoc Tukey test was used for multiple comparisons. Chi-Square test was applied to compare the fracture modes. Significance of the obtained results was judged at α = 0.05.The combined interaction effect of the zirconia primer and cement type had a significant impact P = 0.038) on the fracture resistance of the zirconia crown, according to the results of the two-way ANOVA test Table . While T8 on the Chi-Square test Table  showed tSEM analysis showed that the main origin of the fracture was detected at the occlusal surface from the main contact loading area. Few specimens had secondary origins near the major ones at the occlusal surface. The hackle lines, which represent the path and direction of crack propagation, were directed in corono-apical direction in all fractured specimens Fig. .The first null hypothesis, that the type of self-adhesive resin cement would not affect the fracture resistance of monolithic zirconia crown, was rejected because the results of the present study revealed that the fracture resistance of monolithic translucent zirconia crown is affected by the type of self-adhesive resin cement. The combined application of the MDP-containing zirconia primer with self-adhesive resin cement with different functional acidic monomers, except Panavia SA Cement Plus, influenced the fracture resistance of monolithic translucent zirconia crown. Therefore, the second null hypothesis that the MDP-containing zirconia primer combined with self-adhesive resin cement would not affect the fracture resistance of monolithic zirconia crown, was partially rejected.Self-adhesive resin cements offer application without the need for additional priming or bonding treatments . HoweverAir-borne particle abrasion with alumina particles was used in the present study to increase the surface roughness, wettability, and surface energy of the zirconia crown , 17. AlsThe specimens were subjected to thermomechanical aging to simulate approximately one year of clinical service . ThermocThe results of the present study revealed inferior fracture resistance with zirconia crowns cemented by Calibra Universal self-adhesive resin cement. These results could be attributed to the high viscosity of PENTA, in Calibra Universal, which may be an issue when the cement paste approaching the surface of zirconia to establish the chemical bonding , 34. HigAddition of MDP-containing primer in combination with the studied self-adhesive resin cements, except Panavia SA Cement Plus, significantly improved the fracture resistance of monolithic zirconia crown. The application of zirconia primer increased the bond strength of self-adhesive resin cement to zirconia because of the synergic effect of the MDP and acidic functional monomers , 19, 28.Fractographic analysis showed that the main origin of the fracture was detected at the occlusal surface from the main contact loading area which has the highest tensile stress level. While hackle lines indicated the path or the direction of crack propagation, which propagated corono-apically in all fractured specimens. Burke’s classification was used to identify and categorize the various fracture modes of fractured specimens . When coIncreased ceramic resistance to debonding could be observed by fracture that occurred at greater stresses . This miAs limitations, only one type of zirconia crown was studied in this study. Further studies of various zirconia formulations are required. Only axial load is applied in the present study, which does not reveal clinically occurring lateral forces. Also, further studies are needed to compare the performance of self-adhesive resin cements with other types of resin cements. Long-term clinical studies are needed to evaluate the clinical outcomes of zirconia crowns bonded using self-adhesive resin cements.Within the limitations of this in-vitro study, it was concluded that;The self-adhesive resin cement with different acidic functional monomer affects the fracture resistance of monolithic zirconia crown.Application of MDP-containing primer could improve the fracture resistance of monolithic zirconia crown with most self-adhesive cements.The application of an MDP-containing primer had no impact on the fracture resistance of monolithic translucent zirconia crown bonded by MDP-containing self-adhesive resin cement.


Philip Alexander, MD, is a native Texan, retired physician, and accomplished musician and artist. After 41 years as an internal medicine physician, Dr. Phil retired from his practice in College Station in 2016. A lifelong musician and former music professor, he often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. He began exploring visual art in 1980, evolving from pencil sketches—including an official White House portrait of President Ronald Reagan—to the computer-generated drawings featured in this journal. His images, which first appeared in this journal in the spring of 2012, are his own original creations.Methodist DeBakey Cardiovascular Journal, submit your creation online at journal.houstonmethodist.org as a “Humanities” entry.If you would like to see your art published in the


Starch is a renewable and multifunctional polysaccharide biopolymer that is widely used both in the food industry and other areas of the economy. However, due to a number of undesirable properties in technological processes, it is subjected to various modifications. They improve its functional properties and enable the starch to be widely used in various industries. A modified starch is a natural starch that has been treated in a way that changes one or more of its initial physical and/or chemical properties. Chemical modification consists of the introduction of functional groups into starch molecules, which result in specific changes in the physicochemical and functional properties of starch preparations. The bases of chemical modifications of starch are oxidation, esterification or etherification reactions. In terms of functionality, modified preparations include cross-linked and stabilized starches. These starches have the status of allowed food additives, and their use is strictly regulated by relevant laws. Large-scale scientific research is aimed at developing new methods of starch modification, and the use of innovative technological solutions allows for an increasingly wider use of such preparations. This paper characterizes chemically modified starches used as food additives, including the requirements for such preparations and the directions of their practical application. Health-promoting aspects of the use of chemically modified starches concerning resistant starch type RS4, encapsulation of bioactive ingredients, starch fat substitutes, and carriers of microelements are also described. The topic of new trends in the use of chemically modified starches, including the production of biodegradable films, edible coatings, and nanomaterials, is also addressed. Progress in food processing and the continuing high demand for convenient and functional foods have resulted in increased use of allowed food additives in food processing. The use of these substances in accordance with current health and legal recommendations enables food producers to achieve the intended technological, quality, economic, and health effects. Due to their useful and functional values, food additives are essential components of many food products. Although they constantly raise health concerns among some consumers due to the increase in public awareness of the role and the legally regulated conditions of use of food additives, they are becoming more and more widely accepted .Allowed additives are substances not consumed separately as food and are not typical food ingredients; allowed additives are intentionally used in the process of production, processing, preparation, packaging, transport, and storage to provide the intended or expected results in a food or in semi-finished products that are components of the food. Allowed additives may be used only when their use is compliant with current legal regulations and technologically justified and does not pose a threat to the health or life of the consumer. The basic legal acts in the European area regulating the use of food additives are Regulation (EC) No. 1333/2008 of the European Parliament and of the Council of 16 December 2008 on food additives . Th. Th22]. Acetylated distarch adipate is produced by cross-linking of starch with adipic acid and stabilizing with acetyl groups derived from acetic anhydride . The conStabilized cross-linked starches also include distarch hydroxypropyl phosphate, which is a starch modified by cross-linking with sodium trimetaphosphate or phosphorus oxychloride and by etherification with propylene oxide. In E 1442 starch, the content of hydroxypropyl groups must not exceed 7.0%, dwb, while the residual phosphates, calculated as phosphorus, must not exceed 0.14%, dwb, in wheat and potato starch and 0.04%, dwb, in other starches  22]. Th. Th22]. Due to the possibility of using very different physical processes or enzymatic reactions and many chemical reactions, the methods of producing dually modified starch preparations are practically unlimited . If one In the literature, the term “triple starch modification” is also used. In triple modification, the first and dual modifications prepare the starch chains, structures, and polymeric components of the starch granules for the penetration of the modifying agents during the third modification. Triple modification can be used for the synthesis of resistant starches, porous starches, and preparations with high adsorption capacities .Resistant starch (RS) is the part of starch and starch derivatives that resists digestion while passing through the gastrointestinal tract ,54. RS pRS4 includes starches substituted or cross-linked with etherifying or esterifying agents. The presence of large substituent groups and/or chemical bonds in chemically modified starch constitutes a steric hindrance for the active centre of the enzyme, which is why such starches are difficult to digest ,54,55,56Many examples of chemically modified starches highly resistant to enzymatic digestion are described in the literature, for example starch citrate or starch malate ,59,60. TProducing low-fat products that are sensory similar to full-fat products is a major challenge for the food industry. Carbohydrates, including native and modified starches, are most often used as fat substitutes . CarbohyMicroencapsulation is the process of enclosing unstable or volatile substances, usually of a lyophilic nature, such as dyes, flavours, or other biologically active substances, in protective coatings . Native Porous starch preparations also have effective encapsulating properties. They are partially hydrolysed starches with a honeycomb microstructure and a well-developed specific surface, which, compared to native starch, results in a significant improvement in adsorption properties . AdditioThe introduction of deficient bioactive ingredients into food products is one of the trends in the production of enriched and functional food. The introduced active ingredient must be evenly distributed in the food matrix, which is a technological challenge. In the case of microelements, an effective technique is the use of a stable and effective carrier in the form of starch, especially chemically modified starch. Śmigielska et al.  showed tNative starches do not have emulsifying properties due to the lack of hydrophobicity and too large particle sizes, which prevent the formation of a cover around the oil globules in the emulsion. For this reason, native starches are rather used as emulsion stabilizers, and their stabilizing effect is mainly due to the ability to increase the viscosity of the continuous phase . IncreasAcetylated starches were also used to produce food emulsions. It was found that the stability of emulsions created using these starches increases with the degree of starch substitution, and additional cross-linking of acetylated starch contributes to the improvement of emulsion stability. The most stable model emulsions were obtained using acetylated distarch adipate. Emulsions prepared with acetylated distarch phosphate also showed similar stability .Starch is one of the most popular plant polysaccharides used in the production of biodegradable films ,63,68,69Edible starch coatings are increasingly used to extend shelf life and maintain quality during storage of some food products ,72. StarFrom both native and chemically modified starches with the status of food additives, starch particles of nanometric sizes and with various spatial structures can be produced. Generally, starch nanostructures are defined as materials with dimensions in the range of up to 100 nm . Starch Starch, as a fully renewable, biodegradable, and functional biopolymer, is widely used in various industries. Due to its multifunctionality, it is particularly appreciated in the food industry, where it is used both in its native form and after various types of modifications aimed at improving its specific functional properties. Commonly used chemically modified starches with the status of food additives must meet specific legal requirements and the highest standards in terms of their safe use. In addition to the use of chemically modified starches in food production as thickening, filling, binding, gelling, emulsifying, and stabilizing agents, the health-promoting aspect of their use is important, including resistant starch type RS4, the ability to encapsulate and act as a carrier of bioactive ingredients, and as a fat replacement. New development directions in the use of chemically modified starches include, among others, obtaining biodegradable films and edible coatings for food, as well as creating nanomaterials.The production and use of starch and its derivatives as biodegradable products based on renewable raw materials has been increasing every year. A special industry that uses modified starches is the food industry, where, in addition to desired functional properties of these starches, appropriate safety of their use is required. The growing demand of the food industry for starch preparations with new desired functional properties forces intensification of research in this area. In addition to searching for safe reagents allowing the preparation of new chemically modified starches, an interesting direction of development is the combination of chemical modification with physical or enzymatic modification and obtaining dually or even triple modified preparations.


Anterior cruciate ligament reconstruction (ACLR) performed via arthroscopy is the primary treatment for anterior cruciate ligament injury. In traditional ACLR, the surgeon must create bone tunnels in both the femur and tibia, which increases the risk of bleeding and pain. The advent of all-inside technology has introduced the concept of bone sockets. However, the femoral socket created by the traditional all-inside technique is not a true femoral socket since the tunnel ends are still connected to achieve suspensory fixation. We are dedicated to achieving a true femoral socket in the all-inside ACLR technique. The AperFix Implant fixation system offers the potential for a genuine femoral socket by securely holding the ligaments in place through compression fixation. In this report, we present an all-inside ACLR using the AperFix Implant fixation system, which allows for a single exit of the femur side tunnel. This technique effectively reduces “windshield wiper” effect, “bungee cord” effect, as well as surgical time and minimizes the risk of bleeding, pain, and local microfractures. Introduction of improved all-inside ACLR using the AperFix fixation system. Because the ACL is closely related to the mechanical structure of the knee joint, reconstructive surgery is the most common treatment for the current rupture of the ACL. The purpose of ACLR is to replace the anterior cruciate ligament with a graft to maintain knee stability. When autologous tendon is used for ACLR, tendon diameter, fixation mode, and bone tunnel morphology are the key factors affecting the effect of ACLR. In conventional ACLR, tendons are commonly fixed by a cortical suspensory fixation button at the anterior cruciate ligament on the femur side and by compression screw suspension at the tibia side.An overview of our improved technique is shown in We reconstructed the anterior cruciate ligament with single autogenous semitendinosus muscle. In contrast to the traditional all-inside technique, where both ends were used for suspensory fixation, in this technical report, the femur side was fixed by the AperFix system , and the tibia was fixed by the traditional all-inside suspension method . First, the tendon of the semitendinosus tendon was removed from the affected knee joint A. The meThen, we made a combination of AperFix implant System, Tendon Graft, and Tibial Loop Complex. The thinner end was first threaded through 1 of the 2 holes of the AperFix implant systemA. EnsureThen we performed knot fixation of tendon graft ring structure. First, one of the sutures at one of the free ends of the semitendinosus graft was threaded through the loop of the tendon graft A. The suFirst, the true femoral socket was prepared. We then proceeded to immobilize the femur side of the complex. After positioning with an offset positioner(6.5 mm), a 2-mm guide needle was drilled, until it approached the cortex , A and BThe AperFix graft suspension device composite structure was implanted into the femoral socket through the anteromedial approach under direct arthroscopic vision. The entire AperFix implant body should be fully inserted into the socket and reach the socket bottom, as far as possible , A-C. ThThe assistant tensioned the traction suture and pulled the graft into the tibial socket under the direct vision of the arthroscopy , A and BACLR is one of the most important knee arthroscopy operation. With the increasing attention to sports, more and more patients suffer from anterior cruciate ligament injury. Patients with ACL injury usually need ACLR because of knee instability. ACLR’s approach is to replace the anterior cruciate ligament with autologous, allogeneic, or artificial tendons to maintain knee stability. In conventional surgery, a bone tunnel is required in order for the tendon to be delivered and secured to the anterior cruciate ligament.


Type 2 diabetes (T2D) diagnoses are predicted to reach 643 million by 2030, increasing incidences of cardiovascular disease and other comorbidities. Rapidly digestible starch elevates postprandial glycemia and impinges glycemic homeostasis, elevating the risk of developing T2D. Starch can escape digestion by endogenous enzymes in the small intestine when protected by intact plant cell walls (resistant starch type 1), when there is a high concentration of amylose (resistant starch type 2) and when the molecule undergoes retrogradation (resistant starch type 3) or chemical modification (resistant starch type 4). Dietary interventions using resistant starch may improve glucose metabolism and insulin sensitivity. However, few studies have explored the differential effects of resistant starch type. This systematic review and meta-analysis aims to compare the effects of the resistant starch from intact plant cell structures (resistant starch type 1) and resistant starch from modified starch molecules (resistant starch types 2–5) on fasting and postprandial glycemia in subjects with T2D and prediabetes.Databases  were systematically searched for randomized controlled trials. Standard mean difference (SMD) with 95% confidence intervals (CI) were determined using random-effects models. Sub-group analyses were conducted between subjects with T2D versus prediabetes and types of resistant starch.n = 982), 31 of which could be included in the meta-analysis. Resistant starch type 1 and type 2 lowered acute postprandial blood glucose [SMD (95% CI) = -0.54 ] and [–0.96 ]. Resistant starch type 2 improved acute postprandial insulin response [–0.71 ]. In chronic studies, resistant starch type 1 and 2 lowered postprandial glucose  and resistant starch type 2 intake improved fasting glucose [–0.39 ] and insulin [–0.40 ].The search identified 36 randomized controlled trials (via discrete mechanisms, as they appear to influence glycemia differently. Further research into resistant starch types 3, 4, and 5 is required to elucidate their effect on glucose metabolism. The addition of resistant starch as a dietary intervention for those with T2D or prediabetes may prevent further deterioration of glycemic control.Resistant starch types 1 and 2 may influence glucose homeostasis  Type 2 diabetes (T2D) is the ninth leading global cause of death and diagnoses are predicted to reach 643 million by 2030 , 2. T2D Resistant starch cannot be digested by endogenous amylases in the small intestine and reaches the distal gut where it can be fermented by the colonic microbiota . ResistaThe industrial or domestic processing of food structures to reduce particle size may increase plant cell wall permeability, lowering resistant starch type 1 content , 12. RedRoseburia, Faecalibacterium, Akkermansia, and Bifidobacteria; bacterial populations which have been negatively correlated with T2D , which may alter the availability of starch in the distal gut. However, current literature appears to support that when the structural integrity of the plant cell is maintained, an improved glycemic response is seen , 34. Furg et al. .There is an urgent need for cost-effective and accessible methods of maintaining euglycemia to reduce the risk of complications for individuals with T2D and prevent further glycemic deterioration in those with prediabetes. This review and meta-analysis aims to compare the effects of the type of resistant starch (type 1 versus 2–5) on glycemia in individuals with impaired glucose regulation and to identify any differential effects between study populations .This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines . The proThe population, intervention, comparator, outcome, and study design (PICOS) criteria were used to guide the search strategy and study selection . In thisThe literature search was conducted across PubMed, SCOPUS, Ovid MEDLINE, Cochrane, and Web of Science databases for any study-related documents published before 5th May 2022. Specific search terms are found in 1.The authors independently reviewed all article titles and abstracts using Covidence systematic review software . The researchers of registered clinical trials were contacted to provide access to the raw data when trials were deemed relevant. Potentially included studies underwent full-text screening by the three reviewers , independently using the inclusion and exclusion criteria found in The risk of bias (ROB) of eligible studies has been independently assessed by three reviewers  using the Revised Cochrane ROB tool. This tool identifies the level of risk of bias during the randomization process, deviations from the intended intervention, missing outcome data, measurement of outcomes, and selection of the reported result. The studies are categorized to have a low, some concerns or high risk of bias. Randomized controlled crossover studies were assessed for ROB arising from period and carryover effects of crossover studies (domain S). In instances where included studies were not crossover trials, this section was left blank.p-value of <0.05. Heterogeneity was quantified with the I2 statistic and p-values of <0.05 were statistically significant. Where possible, subgroup analysis was used to explore differences in effect between different types of resistant starch and between subjects with T2D versus prediabetes. Sensitivity analyses were conducted by omitting studies with a high risk of bias. Publication bias was assessed using funnel plots and the regression test for Funnel plot asymmetry (“Egger’s test”), in JASP .Studies were categorized by study duration and resistant starch type. Data were recorded and organized in an Excel spreadsheet. Mean and standard deviations were calculated if they were not available in the reports. Standard errors of means were converted to standard deviations. If there were multiple intervention groups, means and SDs were pooled according to the Cochrane method . Review n = 89) and the reasons for their exclusion are found in n = 982), 31 of which could be incorporated into the meta-analysis. The five studies were excluded because they did not report standard error or standard deviation  (n = 142)  and postprandial insulin . After conducting sensitivity analyses, acute resistant starch type 1 intake no longer had a significant effect on postprandial insulin response (p ≤ 0.05)  , 45–55, n = 177) . In subgn = 177) . In a men = 142) , 53–55, n = 142) . In subgn = 142) . Interstresponse . Publica ≤ 0.05) , 3.n = 168) (n = 410) (n = 112) (n = 383)  and fasting insulin , but non-significant for other meta-analyses.In a meta-analysis of seven studies n = 168) –62, resin = 168) . In a men = 410) , 63–69, n = 410) . In subgn = 410) . In a men = 112) , 59–61, n = 112) . In a men = 383) , 68, 69, –62, resn = 383) . In subgn = 383) . SensitiOf the studies which could not be included in the meta-analysis, three reported that the addition of resistant starch to the diet did not affect fasting glucose or insulin , 39, 40.n = 95) (n = 40) (p ≤ 0.001)  , 58, 61,n = 95) . In a me(n = 40) , 45, 57 (n = 40) . Sensiti≤ 0.001) .n = 222), (n = 66), (n = 61), (n = 101), (p ≤ 0.05) , , 68, 70, = 222), , HOMA-%Bn = 66), , 68, 71,n = 66), , HOMA-%Sn = 61), , 60, 71,n = 61),  or HbA1c = 101), , 64, 67  = 101), . Sensiti ≤ 0.05) .Two studies reported that the addition of resistant starch 2 to the diet, had no significant effect on HOMA-IR , 38 or HAcute interventions were identified for resistant starch types 1–3. The present study suggests that both resistant starch type 1  and 2 (high-amylose starch) can significantly lower postprandial glucose in individuals with T2D or prediabetes, similar to what is observed in healthy subjects , 33. IntResistant starch type 1 (intact plant cell structure) is found in starchy ingredients with intact kernels , 57, 63 Resistant starch type 2 is often purified and added to baked products , 54, 61 There was substantial interstudy heterogeneity and a likelihood of publication bias in the acute postprandial meta-analyses. As heterogeneity decreased after subgroup analysis, heterogeneity could be partially attributed to differences in metabolic response between those with prediabetes and T2D and types of resistant starch.Chronic interventions were identified for resistant starch types 1, 2, and 4. Periods of supplementation for these interventions spanned 1 day to 1 year. Resistant starch types 1 and 2 significantly lowered postprandial glucose, similar to results seen in acute studies. Resistant starch type 1 lowered postprandial insulin concentrations, whereas resistant starch type 2 did not. Interestingly, postprandial insulin trended toward an increase in resistant starch type 1 interventions whereas resistant starch type 2 appears to have the opposite effect. Resistant starch type 4 did not affect postprandial glycemia. Chronic interventions using resistant starch type 2 lowered fasting glucose and insulin but no effect was seen after chronic consumption of resistant starch type 1 and 4. The lack of significant effect seen could be due to the insufficient duration of resistant starch type 1 interventions and the small sample size for resistant starch type 4 interventions. Notably, the resistant starch type 1 study with the longest intervention (56 days), reported that intact grain structures improved pancreatic β-cell function and glucose-stimulated insulin secretion whilst refined grain structures did not . SubgrouChanges in postprandial glucose response seen for chronic interventions may be due to lowered available carbohydrate content and inhibited starch digestion, as the results were similar to that seen for the acute studies. Increased resistant starch delivery to the distal gut would elevate SCFA yield from gut bacteria fermentation, which may contribute to chronic improvements in postprandial and fasting glycemia , 76. SCFChanges in glucose metabolism and insulin sensitivity can be confounded by weight loss or changes in body composition . Althougvia distinct mechanisms . Lastly, side effects can arise from substantial increases in resistant starch intake. However, as only one study reported side effects, this risk could not be assessed. Gastrointestinal tolerance must be recorded to determine the feasibility of resistant starch as a treatment for improving glycemic response. Larger studies with longer durations which explore the different resistant starch types are recommended.Conclusions from this systematic review and meta-analysis should be drawn with caution. Significant heterogeneity was detected in several meta-analyses. Furthermore, a number of the included studies had a high risk of bias and sensitivity analyses show that once these studies were omitted, one outcome , was no longer significant. Furthermore, publication bias was detected in acute postprandial glucose, GIP and HbA1c meta-analyses.via different mechanisms.In this meta-analysis, the effect of resistant starch within intact plant cell structures and modified starch molecules on glycemia was comparable. There appears to be an argument in favor of dietary interventions using resistant starch types 1 or 2 for individuals with T2D, however, results were less conclusive in those with prediabetes. Chronic resistant starch type 1 and 2 interventions lowered postprandial glucose whereas solely chronic resistant starch type 2 interventions influenced fasting glucose and insulin. The difference in response between resistant starch types could reinforce the notion that resistant starch types exert their effects on glucose homeostasis JP and MC wrote the introduction and conducted the meta-analysis. JP designed the research. JP, MC, and NA screened the articles and conducted the data extraction. All reviewers and GF interpreted the findings and wrote the discussion. All authors read and approved the final manuscript.