The United European Gastroenterology (UEG) is a community of over 50,000 professionals dedicated to advancing the prevention and care of digestive diseases in Europe by providing education and supporting research. The journal, launched in 2013, is a cornerstone of UEG. At the time of its inception, the journal has formulated its mission as an international forum for research in gastroenterology, publishing original articles that investigate basic, translational, and clinical studies of interest to gastroenterologists and researchers in related fields. It aimed to position itself in the top 15% of gastroenterology and hepatology journals, providing authoritative, high‐quality, open access (since 2021) platform. In this editorial, we will provide a critical appraisal of the journal's success and challenges to date whilst trying to achieve these goals. We hope to offer a comprehensive picture of the UEG journal's impact and influence within the field of gastroenterology.The success of a journal partly comes down to the willingness of the authors to publish their high‐quality research. This willingness often depends on the impact factor, as a measure of citation rate, but also the commitment to the journal, the experience of the authors during the submission process , and the expected visibility of the article. The UEG journal aims to attract top talent and cutting‐edge research in the field of gastroenterology by providing a supportive and high‐quality publishing experience for authors, whilst maintaining rigor and quality and providing timely and constructive feedback to authors. The countries that submitted the most articles in 2022 were China, Germany, Italy, the Netherlands, and the United Kingdom. We foster a dynamic research community, hoping to increase our diversity and global reach.In 2022, the UEG journal saw a significant increase in the number of submissions, with a 32.2% rise compared to the previous year Figure . This stThe journal also made progress in reducing the time from submission to acceptance, with a median of 43 days in 2022, down from 54 days in 2021, excluding editorials or invitations that were generally accepted before peer review. Striking was the response rate of reviewers. The journal sent out 1343 review invitations in 2022, with 696 accepted and 618 completed reviews within a median of 12 days. This high response rate may be due to the participation of young researchers on the editorial board that shows a strong willingness to review, as well as the overall involvement in UEG of other researchers and the possibility of claiming their review of Publons.After the acceptance of the paper, publications follow quickly. In 2022, the average number of days from receipt at Wiley to Early View for United European Gastroenterology Journal was 19 (median 14), as compared to the Medical Sciences average of 27 (median 18) and the Wiley average of 26 (median 18). This demonstrates the journal's commitment to publishing research in a timely manner, which is an important factor for both authors and readers.Moreover, Wiley recently launched a Wiley AI Editing Pilot program, which may be a welcome addition for authors with English as their second language, as it provides additional support during the submission and reviewing process. In short, this program will edit manuscripts with an intelligent, AI‐driven tool to ensure that the manuscript is free of any major grammatical or syntactical errors before submission to UEG Journal.One objective measure of a journal's impact is the number of views, as this indicates the extent to which its research is being accessed and utilized by the wider community. Based on data from 2022, eight out of ten most viewed articles in the UEG journal were guidelines with 5000–15,000 views each.The increase in the number of views may be attributable to its strong emphasis on social media. UEG Journal Twitter  account managed to generate significant engagement and has now reached 9000 followers (as per March 2023). UEG journal's impact is not limited to its immediate readership but extends through its online presence as well. The journal is hosted on the Wiley Online Library platform, which provides global open access to its articles and research not limited to traditional academic circles. By providing accessible, high‐quality research that is relevant to a broad range of stakeholders, the UEG journal can continue to expand its impact within the field of gastroenterology and beyond.Twitter mentions have been the second most impactful altimetric for the UEG journal (11%), with Google Search driving the most traffic (17.4%). Each article published in the UEG Journal has undergone extensive search engine optimization (SEO) by the editorial team aiming to make its content more discoverable online. This percentage may implicate that this SEO has been effective.The UEG journal continues to show strong performance in terms of citation impact, with a CiteScore (Scopus) of 7.9 and a Journal Citation Indicator (Clarivate) of 0.9. Additionally, the Journal Impact Factor (Clarivate) for 2021 was 6.866 (5‐year IF 5.424).The UEG Journal is on a mission to provide an authoritative, high‐quality, international, and trusted platform for all research in gastroenterology. Overall, metrics demonstrate that the journal continues to grow in popularity and impact, even in a highly competitive field, having reached its goal of positioning itself in the top 15% of gastroenterology and hepatology journals. The UEG journal is successfully reaching and engaging its target audience through a combination of effective SEO and increasing social media outreach. With future investments in online and digital media, we aim to reach an even wider audience.The role of guidelines within the UEG Journal is increasing. Based on the current metrics, these are viewed and appreciated. The UEG quality of care committee has played an important role in this by stimulating the generation of high‐quality guidelines and publication in the UEG Journal. The UEG editorial board, in collaboration with the quality‐of‐care committee, aims to further increase the quality of guidelines by formulating criteria and extensive peer review by reviewers who have undergone training in the guideline formulation. This renewed focus on the quality of guidelines may further cement the UEG Journal reputation as a valuable resource for gastroenterologists and other medical professionals in the field of digestive diseases.Looking ahead, the UEG Journal is well‐positioned for continued growth and success. The journal's upward trajectoryAll authors are members of the United European Gastroenterology Journal's editorial board.


We sought to determine whether it was also safe in adult patients with diminished left ventricular function.All patients with preoperative left ventricular ejection fraction ≤ 40% undergoing isolated coronary artery bypass grafting between 1/1/2019 and 7/10/2022 were retrospectively analyzed. Off-pump and beating heart cases were excluded. Patients were divided by surgeon preference between conventional cardioplegia (CCP) and DN. Baseline and intraoperative characteristics and short-term postoperative outcomes were compared.p = 0.939). Other than a significant decrease in bypass time for DN  there were no intergroup differences in urgency, number of grafts, ischemic time or incidence of blood transfusion. Postoperative outcomes between CCP and DN were similar including incidence of atrial fibrillation , intensive care length of stay , total length of stay  and 30-day mortality .Six surgeons performed 829 isolated coronary artery bypass operations during the study. Two-hundred seventy-two met study criteria. Three surgeons used exclusively CCP for the duration of the study, two used exclusively DN and one switched from CCP to DN mid-way through. Group totals were: CCP n = 181 and DN n = 91. There were no significant differences in baseline characteristics including mean left ventricular ejection fraction (CCP 32.5 ± 7.4% vs. DN 33.4 ± 7.29%, Compared to conventional cardioplegia, del Nido cardioplegia provides equivalent short-term outcomes in patients with low left ventricular ejection fraction undergoing isolated coronary artery bypass grafting. Critical to all cardiac operations involving a period of ischemic arrest, meticulous myocardial protection is of amplified importance in patients with diminished left ventricular function to facilitate uneventful separation from cardiopulmonary bypass without the need for multiple high-dose inotropes or new mechanical support . The maiConventional cardioplegia relies on delivery of hyperkalemia to prevent repolarization of cardiac myocytes resulting in a period of depolarized arrest. Hyperkalemia is appealing because it allows for a rapid arrest and a reliable recovery, but it is associated with intracellular sodium and calcium accumulation during the period of arrest . It alsoDeveloped by Pedro del Nido and colleagues at the University of Pittsburgh in the early 1990s for the immature myocardium and modified since, del Nido cardioplegia has expanded to adult populations. Del Nido cardioplegia differs from conventional cardioplegia in several ways: it counteracts the negative effects of hyperkalemia by reducing the potassium concentration and adding the sodium channel blocker Lidocaine which increases the refractory period of the cardiac myocyte  and prolWhile del Nido cardioplegia has been shown to be safe during isolated coronary artery bypass grafting in patients with normal left ventricular function –9, its uAfter obtaining Institutional Review Board approval the adult cardiac surgery database of Loma Linda University Medical Center was retrospectively reviewed from January 1, 2019 to July 15, 2022. All patients that underwent isolated coronary artery bypass grafting (CABG) were identified and those with a preoperative left ventricular ejection fraction of 40% or less were included in the study. Patients who underwent off-pump or beating heart CABGs were excluded, the remainder were retrospectively divided between those who received modified del Nido cardioplegia and those who received conventional cardioplegia  which allows for delivery of oxygenated blood from the oxygenator to the heart after addition of additives which differed depending on which cardioplegia strategy  was employed. The type of cardioplegia, conventional vs. del Nido was based on the surgeon’s preference. Our del Nido formulation differs from the classical del Nido composition  was used. All the continuous univariate analyses were completed using a 2-sample During the study period 829 isolated CABGs were performed by six surgeons. Of these, 272 (32.8%) met inclusion criteria. Of the 272 low left ventricular ejection fraction patients undergoing isolated CABG, 181 were in the conventional cardioplegia group and 91 in the del Nido group. Three of the surgeons used exclusively conventional cardioplegia for the duration of the study period, two surgeons used exclusively del Nido cardioplegia for the duration of the study period and one surgeon switched mid-way through from using exclusively conventional to exclusively del Nido. In no operation did the surgeon convert myocardial protection strategy either from del Nido to conventional cardioplegia or the other way around.Baseline characteristics are shown in Table There were no significant differences between groups. Mean preoperative left ventricular ejection fraction for the conventional cardioplegia group was 32.5 ± 7.4% and for the del Nido group it was 33.4 ± 7.29%.Operative characteristics are shown in Table p = 0.845). The cardiopulmonary bypass time was significantly shorter for the del Nido group: 113.20 ± 37.2 min vs. 122.43 ± 34.3 min, p = 0.043) but the ischemic times and weaning times (difference between cross-clamp and bypass times) were not significantly different.There were no differences in the urgency of the cases. The number of grafts performed did not differ , postoperative length of stay , intensive care unit length of stay  or 30-day mortality .There were no differences between the two groups for postoperative new-onset atrial fibrillation  while statistically significant was likely not clinically significant. Compared to other studies –9 our byThere is growing body of literature that del Nido cardioplegia is safe to use in the adult population, even in higher risk cases such as in patients after acute myocardial infarction, older patients and those with elevated Society for Thoracic Surgery risk scores , 14, to


Perceived financial well-being (FWB) is an important aspect of life that can affect one’s attitude toward future experiences and happiness. However, the relationship between FWB, anticipatory experiences, and happiness, and the brain’s functional architecture underlying this relationship remain unknown. Here, we combined an experience sampling method, multilevel modeling, and functional neuroimaging to identify the neural correlates of FWB and their associations with real-world anticipatory experiences and everyday happiness. Behaviorally, we found that individuals with greater FWB felt more positive and more interested when they expected positive events to occur, which in turn resulted in increased everyday happiness. Furthermore, the level of FWB was significantly associated with the strength of functional connectivity (FC) between the nucleus accumbens (NAc) and ventromedial prefrontal cortex (vmPFC) and the local coherence within the vmPFC. The frontostriatal FC and local coherence within the vmPFC were further predictive of everyday happiness via the anticipatory response involving interestedness during positive expectations. Our findings suggest that individual differences in FWB could be reflected in the functional architecture of brain’s reward system that may contribute to shaping positive anticipatory experiences and happiness in daily life. A possible mediator that links FWB and happiness may be positive anticipatory experiences. When expecting a positive event, an individual who perceives her financial situation as stable and secure would be likely to experience more positive emotional and motivational states and to fully savor upcoming positive events, compared to an individual who worries about her financial situation. Such differences in positive anticipatory experiences would ultimately influence a person’s overall well-being. In the present study, we examine how perceived FWB is associated with real-world positive anticipatory experiences and everyday happiness and how the brain’s functional architecture supports this relationship.Perceptions of one’s financial situation  are an important aspect of individuals’ lives that can have a broad impact on happiness7. The effect of perceived FWB on overall well-being is comparable to the combined effect of other important life domains such as physical health, personal relationships, and job satisfaction8. Despite growing evidence of the relationship between FWB and happiness, the specific mechanisms through which FWB influences happiness remain unexplored. With a novel approach that combines an experience sampling method (ESM) and resting-state functional magnetic resonance imaging (rs-fMRI), we systematically examined how FWB influences real-life emotional and motivational states and everyday happiness. We propose positive anticipatory experiences as a possible psychological mechanism linking FWB to happiness.Recent evidence shows that perceived FWB explains substantial variance in happiness10. This can allow them to plan and prepare for upcoming positive events with a greater sense of control and empowerment in their ability to pursue their interests and make choices, without being constrained by financial concerns. Also, without financial stress, they may have more flexibility to explore a broader range of options and choose activities that truly resonate with their interests and preferences. This expanded array of opportunities can help them experience more positive emotional and motivational states  when expecting desirable future events. Further, given that positive expectations and positive affect are key to happiness13, the relationship between perceived FWB and happiness may be mediated by positive anticipatory experiences. Considering the suggested dyadic correlations between FWB, positive anticipatory experiences, and happiness, we aim to triangulate how the relationship between FWB and happiness is mediated by positive anticipatory experiences. We specifically focused on positive experiences in this study, based on literature that suggests relatively greater variability in responses to negative FWB due to individual differences in psychological factors including adaptive coping strategies, self-efficacy, and perceived control16. Thus, we did not assume any specific relationships between FWB and negative anticipatory experiences, and instead included negative expectations in our analyses for exploratory purposes.Individuals with higher perceived FWB expect to have more resources and options, show greater flexibility in their decision-making, and experience reduced financial stress18, and financial stress manifests itself through mental symptoms of depression and anxiety19. It is therefore possible that perceptions of one’s financial situation may be associated with the functional neural patterns reflecting individual differences in the psychological states. Perceptions of sufficient financial resources and the concomitant positive affect can help individuals to pursue and engage in rewarding experiences. Experiences of such enjoyable events may be associated with better communications between or within reward-related regions. Such functional connectivity (FC) can also help better integrate reward values of financial outcomes with positive affect. Moreover, a positive sense of one’s financial situation is rewarding in and of itself.Importantly, we adopted rs-fMRI to further investigate the functional neural architecture supporting this relationship, which has yet to be explored. Our neuroimaging approach is grounded in literature suggesting that FWB can be tightly linked to psychological states independently of external influences. For example, poverty induces stress and negative affect, which, in turn, limit cognitive ability24. Of particular relevance, elevated activities in the ventral striatum and mPFC were observed in response to monetary rewards or gains28. The ventral part of the mPFC (vmPFC) plays a critical role in representing subjective value29 and generating affective meaning31. Given that perceptions of one’s financial situation are closely linked to appraisal or representation of the subjective value of financial rewards followed by positive affect, it is possible that perceived FWB would be associated with the FC strength between or within the NAc and vmPFC. Furthermore, vmPFC is known to be involved in representing possible future episodes and signaling affective value of the imagined episodes34. Therefore, we expected that the FC strength involving the vmPFC would also subserve anticipatory affective experiences when expecting positive events, which may influence one’s happiness.A large body of neuroimaging research has shown that the ventral striatum, particularly the nucleus accumbens (NAc), the medial prefrontal cortex (mPFC), and broader dopaminergic brain structures mediate reward-related processes across different domains35. For seven consecutive days, participants were asked to report their real-world experiences five times a day, including the presence of positive or negative expectations, current affective states, and experienced happiness  and eudaimonic  aspects of happiness, as well as stress based on its significant role in one’s well-being40. The scores of each happiness item were averaged across the 35 timepoints to quantify each individual’s experienced happiness as an aggregated outcome of momentary experiences, while avoiding biases and inaccuracies of retrospective global evaluations42.To test our ideas empirically, we leverage ESMsee Fig. . We measi) the sense of one’s own economic affluence or scarcity , ii) feelings of stress or worry about one’s current financial conditions , and iii) expectations of their future financial security . The use of these separate measures was based on the literature highlighting that each dimension has unique antecedents and consequences8. Further, we investigated the neural correlates of perceived FWB and examined whether they also support anticipatory affective experiences and momentary happiness using rs-fMRI. Prior work suggests that rs-FC  is stable within individuals and can reliably and consistently capture individuals’ mental states44. Two weeks before the ESM survey, participants reported their perceived FWB and socioeconomic status, and completed the rs-fMRI scanning.Perceived FWB measures included With the ESM data, we first aimed to identify the associations among FWB, positive anticipatory experiences, and momentary happiness. Then, we performed a mediation analysis to test whether the relationship between FWB and everyday happiness is mediated by the positive anticipatory experiences. We expected that greater FWB would predict greater positive anticipatory experiences, which, in turn, would contribute to greater everyday happiness. We then employed seed-based FC and voxel-wise local FC analyses to explore whether FWB is associated with (i) the strength of FC between the NAc and the vmPFC and (ii) local coherence within those reward-related regions. Finally, we explored whether and how FCs associated with FWB are also correlated with the positive anticipatory experiences and everyday happiness.B = 0.004, t = 1.020, p = 0.311; CMS: B =  − 0.009, t =  − 1.540, p = 0.127; FFS: B = 0.009, t = 1.223, p = 0.225; Table B =  − 0.013, t =  − 3.474, p = 0.001; see Table Prior to addressing relationships between FWB and anticipatory responses when expecting upcoming events, we first examined whether FWB measures would be associated with the rates of positive or negative expectations. Any measures of FWB were not associated with the rate of positive expectations  and interestedness  or negative expectations  = 0.003, 95% CI [0.0007 0.0103], Fig. B = 0.006, SE = 0.004, 95% CI [0.0002 0.0152], Fig. B =  − 0.006, SE = 0.004, 95% CI [− 0.017 − 0.0006], Fig. B =  − 0.011, SE = 0.007, 95% CI [− 0.027 − 0.0007], Fig. Next, we tested our hypothesis that the relationship between FWB and everyday happiness would be mediated by anticipatory responses during positive expectations. The mediation analyses revealed significant indirect effects that FWB influenced happiness via positive anticipatory responses. Specifically, the positive association between MA and the composite score of happiness was mediated by the anticipatory responses in valence and interestedness  p < 0.001; FC between the left NAc seed and vmPFC: x =  − 6, y = 38, z =  − 18, t = 3.69, SVC FWE p = 0.016; Fig. x =  − 4, y = 40, z =  − 14, t =  − 6.05, SVC FWE p < 0.001; FC between the left NAc seed and vmPFC: x =  − 4, y = 38, z =  − 14, t =  − 4.79, SVC FWE p = 0.001; Fig. After confirming the significant indirect effects of our mediation models, we conducted seed-based FC analyses to identify functional neural networks associated with FWB. Focusing on the neural networks involved in reward processing, we examined whether the FC between the NAc and the vmPFC would be correlated with FWB Fig. , using tx =  − 4, y = 38, z =  − 22, t = 3.96; SVC FWE p = 0.025; Fig. x =  − 6, y = 38, z =  − 20, t =  − 4.37; SVC FWE p = 0.003; Fig. We further performed a local coherence analysis  with the two regions of interest involved in reward processing . We found that MA was positively correlated with the local FC within the vmPFC , significantly predicted everyday happiness via anticipatory responses  during positive expectations. Regarding the neural correlates, the frontostriatal FC—namely the connectivity between the NAc and the vmPFC—and the local coherence within the vmPFC were associated with MA and CMS. The frontostriatal FCs and the local coherence within the vmPFC were predictive of everyday happiness via the anticipatory response in interestedness. These findings suggest that individuals’ perceived FWB is reflected to the neural networks involved in reward processing, which may play an important role in shaping moment-to-moment positive anticipatory experiences and everyday happiness.45 and found similar patterns of the multiple regression and mediation results  and financial stress  and everyday happiness was mediated by positive anticipatory responses in emotional valence and interestedness during positive expectations. Financial affluence can provide resources that allow individuals to pursue or engage in various positive activities that promote positive feelings and interest, which could contribute to everyday happiness. Conversely, financial stress or poverty can generate negative emotions49. Also, the rate of negative future events that participants reported in the present study was relatively lower than that of positive ones  was not characterized by similar FC patterns. This may be because MA and CMS are associated more with immediate and tangible aspects of financial states, which can give rise to increased affective responses . By contrast, FFS is more cognitively based and captures relatively abstract and less certain aspects of FWB, and thus has less direct influence in individuals’ current affective states involving their financial situation.34, our finding indicates that the FCs of the vmPFC associated with FWB can contribute to representing upcoming positive events and generating anticipatory feelings of interest. Feelings of interest may act as a form of intrinsic motivation, as they lead to goal-directed behavior and increased effort to achieve desired outcomes38, and thus could have been reliably captured in the reward-related regions. On the other hand, emotional valence measured in the present study may reflect a general state of feeling good and include a wide range of emotions55. Thus, the neural correlates linked to feeling good during positive expectations may be more complex and involve other regions beyond the reward and motivation systems.Finally, the FCs associated with the FWB measures predicted everyday happiness via the anticipatory response in interestedness  during positive expectations. Given that the vmPFC is involved in episodic future thinking and processing the episode’s affective value56. However, our study was based on a priori hypotheses, unlike the brain-wide association studies that require very large sample sizes. Recent studies have successfully examined the relationships between neuroimaging and real-world data with a small to moderate sample sizes58. Nevertheless, future studies with larger samples would enhance the reproducibility and generalizability of our findings.The present study has limitations that should be addressed in future research. First, our data is correlational, and therefore, alternative models with different directions of influences are also possible. To seek for a psychological mechanism mediating the relationship between FWB and happiness, we designed our measurements to reflect anticipatory responses as more transient and context-dependent mechanisms and experienced happiness as an aggregated outcome of daily experiences. However, there is also a possibility that FWB increases overall happiness, which, in turn, may influence anticipatory responses. Future studies using a more stable measure of happiness, such as a questionnaire involving global retrospective evaluation of life would elucidate more fine-grained relationships among these variables. Second, the items measuring affective states and happiness may be inherently correlated because of temporal proximity and conceptual overlap. However, our operational definitions and quantifications of anticipatory responses and experienced happiness offer clear distinction between the two variables involving these items, which focused on the relationships between FWB, positive anticipatory responses, and happiness, and the underlying neural architectures. Yet, exploring common and distinct effects of positive expectations on affective states and happiness as well as more detailed relationships between the measurements could be an interesting area for future research. Third, our sample size for FC analyses was relatively small, considering a recent work highlighting the significance of very large samples for reproducible brain-behavior relationshipsTaken together, our integrative approach provides novel, ecologically valid evidence on the neural correlates of perceived FWB and their contributions to real-world anticipatory affective experiences and everyday happiness. The functional neural architecture of the ventral fronto-striatal network, which is known to be involved in reward-related processing, seems to interact with the perception of one’s financial situation. Such perception can contribute to one’s everyday happiness via shaping positive anticipatory experiences. Future research including different demographic groups with a larger sample size and the use of both subjective and objective measures of FWB would offer a more complete view of the relationship between FWB and happiness.59) assuming a moderate effect size (f2 = 0.15) with 80% power at an alpha level of 0.05 for linear multiple regression resulted in a desired sample size of 55. All 87 participants’ behavioral data and 56 participants’ rs-fMRI data  were available in this study, as the remaining 31 participants were scanned with different protocols for another study. Among the 56 participants with the rs-fMRI data, two were excluded due to excessive head motion (≥ 2.5 mm) or signal deviation . All the participants provided written informed consent prior to their participation and were paid KRW 50,000 (approx. USD50) for their participation. All experimental protocols and methods in this study were approved by the Institutional Review Board at Seoul National University and performed in accordance with the relevant guidelines and regulations.Eighty-seven healthy adults  were recruited from a community website of Seoul National University. No participants reported any lifetime history of neurological or psychiatric illnesses or current severe depressive or anxious symptoms. A priori power analysis . During the fMRI scanning, participants were instructed to keep their eyes open and maintain the fixation.Brain images were acquired with a Siemens 3 T Trio MRI scanner  using a 32-channel head coil. Small head pads were placed on both sides of the head to minimize participants’ head motion during the scanning. High-resolution, T1-weighted whole-brain anatomical scans were obtained, consisting of a magnetization-prepared rapid gradient echo sequence [repetition time (TR) = 2300 ms, echo time (TE) = 2.36 ms, field of view (FOV) = 256 × 256 mm, flip angle (FA) = 960). Participants indicated their agreement with eight statements  on a scale ranging from 1 (strongly disagree) to 5 (strongly agree). Second, using the Perceived Financial Well-being Scale (PFWS8), we measured participants’ current money management stress (CMS), which encompasses feelings of stress or worry about one’s current financial conditions and being unable to efficiently control finances. Third, from the PFWS, we also assessed participants’ expectations of their future financial security (FFS) reflecting perceptions of becoming financially secure and meeting future financial goals. Participants indicated their agreement with five statements of CMS  and five statements of FFS  on a scale ranging from 1  to 5 (describes me completely). We also measured participants’ subjective socioeconomic status (SES61) as a control variable to examine the specific role of FWB in our analyses.We assessed different aspects of perceived FWB using the following scales. First, the sense of one’s own economic affluence or scarcity was measured with the material affluence (MA) subscale from the Material Affluence Time Affluence Scale  whether they expected a positive or negative event and (ii) whether a positive or negative event had occurred between the previous survey and the current survey. All items about affective states and happiness were rated on an 11-point Likert scale from 0 to 10. The affective states were measured by asking participants about their (i) emotional valence: how good or bad do you feel at the moment?  (ii) interestedness: how interested or bored do you feel at the moment?  and (iii) activeness: how active or passive do you feel at the moment? . To assess participants’ multidimensional aspects of happiness, we asked them the following four questions: (i) how satisfied are you with your life at the moment?  (ii) how happy do you feel at the moment?  (iii) how meaningful do you feel your life is at the moment?  and (iv) how stressed out are you at the moment? .62. In the models, each participant’s current affective states were entered as dependent variables and were predicted by the presence of each type of event that was coded as a dummy variable , respectively.We quantified the degree to which participants’ affective states are influenced by anticipating upcoming positive or negative events  and by experiencing positive or negative past events, respectively with linear mixed-effects models using the lme4 package in R (version 4.0.4)The multilevel models are specified as follows:Level 1 model :Level 2 model :i and j indicate measurements at level 1 and level 2, respectively, and the parameters j’s current affective state  was influenced by the presence of each type of event . j’s affective state when each event was absent), which was included as a covariate in all relevant analyses to rule out the effect of individuals’ baseline affect. Both The subscripts Then, each participant’s everyday happiness was computed by using principal component analysis (PCA) to create a single index representing the multidimensional aspects of everyday happiness . The PCA identified one component accounting for a total expected variance of 84.508%, and we used it as a composite score of everyday happiness. This composite score of experienced happiness served as the main dependent variable as it reflects an aggregated outcome of momentary experiences encompassing diverse aspects of life domains. In contrast, we designated the value of mentclass2pt{minimi) between FWB and anticipatory responses, ii) between FWB and everyday happiness, and iii) between anticipatory responses and everyday happiness. For exploratory purposes, we also examined whether FWB predicted the rates of upcoming positive or negative events . Then, we conducted a mediation analysis using the PROCESS macro for SPSS63 with 5000 bootstrap samples to test our hypothesis that FWB would influence everyday happiness via the anticipatory responses during positive expectations. In all the analyses, age, sex, subjective SES, and the intercepts of affective states (if applicable) were controlled as covariates.To examine the associations between the FWB, anticipatory responses in response to the anticipation of positive or negative events, and everyday happiness, we first conducted multiple linear regression analyses using IBM SPSS (version 25). Specifically, we tested the relationships 64, implemented in SPM12 (www.fil.ion.ucl.ac.uk/spm). Functional images were spatially realigned and unwarped to correct for between-scan motion and were slice-time corrected relative to the first slice. These images were then resampled to 2 mm isotopic voxels to the MNI space, after which they were segmented into white matter (WM), gray matter (GM), and cerebrospinal fluid (CSF) masks. The spatially normalized images were smoothed with an isotopic Gaussian kernel of 8 mm full width at half-maximum. To reduce the influence of potential outlier scans, they were detected using ART-based scrubbing tools. To remove the effects of head motion and physiological and other spurious sources of noise, the following nuisance parameters were estimated and included as regressors in the general linear model: 24 motion parameters consisting of six motion parameters, their mean-centered squares, their derivatives, and squared derivative, head motion scrubbing regressors, and five principal components extracted from both the WM and CSF masks using the CompCor method65. Finally, a temporal band-pass filter of 0.01 – 0.1 Hz was applied to the time series.Preprocessing of brain images was performed using the CONN toolbox (version 20http://www.fmrib.ox.ac.uk/fsl/). From the individuals’ FC maps, we calculated connectivity strength using Pearson’s correlation coefficients between the timeseries of the seed region and those of all other voxels in the rest of the brain, which were then normalized by Fisher’s z transformation. To determine the regions showing a significant relationship of the bilateral NAc with FWB variables , multiple regression analyses were performed separately, while controlling for age, sex, and subjective SES. We defined a priori anatomical search volume, including the vmPFC created from the Harvard–Oxford Atlas , based on accumulated evidence demonstrating that the frontostriatal network including the NAc and the vmPFC is a core of the brain’s reward system29. To correct for multiple comparison, we ran small volume correction family-wise error (SVC FWE) p < 0.05 within the ROI  with initial voxel level threshold of p < 0.001.To identify significant associations between FWB and FC of the NAc seed region, we first generated seed-based FC maps per participant. The bilateral NAc seeds were defined from the Harvard–Oxford Atlas distributed with FSL , and everyday happiness as the outcome variable.Supplementary Information.


In the atrial fibrillation (AF) population, worsened quality of life (QOL) has been reported even before complications occur. Symptom-based questionnaires can be used to evaluate AF treatment. The Atrial Fibrillation Severity Scale (AFSS) was first developed in Canada in English, which is not the main language in Indonesia. This study aims to test the reliability and validity of the Indonesian version of the Atrial Fibrillation Severity Scale (AFSS).Translation of the AFSS from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire, and a test-retest reliability study was done in a 7-14-day interval.An Indonesian version of AFSS was achieved and deemed acceptable by a panel of researchers. This version is reliable and valid, with Cronbach’s α of 0.819, Intraclass Correlation Coefficient (ICC) ranging from 0.803 to 0.975, and total score correlation ranging from 0.333 to 0.895. Pearson’s analysis of AFSS and SF-36 revealed that the total AF burden domain was poorly correlated with role limitations due to emotional problems  and pain . The symptom severity domain was poorly correlated with physical functioning , role limitations due to emotional problems , pain , and total SF-36 score . Total AFSS score was moderately correlated with role limitations due to emotional problems  and pain . The total AFSS score was poorly correlated with the European Heart Rhythm Association (EHRA) score .The Indonesian version of AFSS has good internal and external validity with good reliability.The online version contains supplementary material available at 10.1186/s12872-023-03240-9. Atrial Fibrillation (AF) the most common sustained supraventricular arrhythmia . The EurThe effect of AF on daily life has been well-established by several previous studies. AF patients have higher risk for stroke and heart failure , 5. EvenThe main aims of AF management are to reduce symptoms and prevent AF complications, with the hope of maintaining or even improving QOL . Treatme≥ 18 years with a high degree of fluency in the Indonesian language. The exclusion criteria of this study were history of hospitalization due to acute or severe chronic conditions within the previous month, history of cardiac surgery within the previous month, physical handicaps, or mental or psychiatric disorders.This study aims to test the reliability and validity of the Indonesian version of AFSS. This cross-sectional study was conducted in March - April 2022. The subjects were AF patients aged General characteristics such as gender, age, highest education level attained, and marital status were taken from medical records, while European Heart Rhythm Association (EHRA) score and duration of diagnosis were obtained during history-taking. Subjects’ ejection fraction (EF) were measured within the previous 3 months by echocardiography examination.Participants were encouraged to independently fill the AFSS and Indonesian version of the SF-36 (gold standard) questionnaires . A seconThe translation process was conducted in two phases after obtaining permission from the original authors. For the first phase, forward translation from English to Indonesian was done by two translators, one medical and one non-medical. Both were certified and experienced as translators and interpreters. After translating the AFSS independently from each other, they discussed and combined their translations into the Indonesian Synthesis Translation. This version underwent a backward translation (Indonesian to English) by two native English speakers, who both had nearly ten years of experience in interpreting and translating English to Indonesian and vice versa. Both backward translations were then compared to the original version of AFSS, as seen in Supplementary 1. Any cultural adaptations and differences were reviewed by the research team before the pre-final questionnaire was distributed to participants. This version of the questionnaire was first pretested on 30 participants, then edited based on patient feedback, forming the final version of the questionnaire, which was then used for the second phase of testing.The AFSS is a disease-specific questionnaire to assess AF severity and note the symptom changes over time. It consists of 19 questions, divided into 3 parts. Part A consists of 8 questions concerning general characteristics, as well as AF frequency and severity. Part B consists of 4 questions concerning the history of cardioversion, hospitalization, emergency room visits, and specialist appointments due to symptomatic AF in the previous year. Part C consists of 7 questions concerning AF severity in the previous 4 weeks. Scores range from 0 to 5, with higher scores indicating worse symptoms [The data recorded were analyzed using SPSS Statistics 26.0 software and are presented in tables. General characteristics are presented as frequency and percentage. Kolmogorov-Smirnov test was used to assess data normality (n > 50). Normally distributed data (p > 0.05) were evaluated with Pearson’s test and non-normally distributed data (p < 0.05) were evaluated with Spearman’s test. AFSS score was first converted to a 0-100 scale and reversed as needed to balance the scores between questions.Test-retest reliability analysis resulted in Cronbach’s α and Intraclass Correlation Coefficient (ICC) between the first test and the retest. For test validity, Cronbach’s α values were interpreted as low (< 0.6), acceptable (0.6–0.8), or very good internal consistency (> 0.8) . ICC valWe also analyzed the AFSS domains, SF-36, and clinical parameters. The degrees of correlation were classified as very low (r:0.01–0.2), low (r:0.21–0.4), moderate (r:0.41–0.6), strong (r:0.61–0.8), or very strong (r:0.81–0.99) .Sixty participants were recruited for the second phase of testing the final version of the AFSS. Subjects’ general and clinical characteristics are shown in Table ≥ 50%, with a mean of 56.8%. Heart failure was reported in 75% of participants. More than half of participants had valvular disorders (53.3%), while 78.3% had tricuspid regurgitation, and 75% had mitral disorders . The AFSS retest took a shorter time to fill than the initial test. A descriptive analysis of general characteristics is shown in Supplementary 2.Most subjects had EF The power (1-β) analysis in our study was performed using G*Power software. The test used was in the T test family, correlation: point biserial model as the statistical test and post hoc as the type of power analysis. After calculation, almost all of the significant values had a power of at least 80% in all variables, which is acceptable for medical research.Our Indonesian version of AFSS was acceptable, as shown by Cronbach’s α > 0.6 and ICC score (r > 0.330). Cronbach’s α of the Indonesian version of AFSS was 0.819, which was considered to be excellent internal consistency. Cronbach’s α domain values were as follows: total AF burden domain 0.651, health care utilization domain 0.713, and symptom severity domain 0.778.The ICC reflects the correlation between the test and retest. The ICC domain scores were as follows: total AF burden domain 0.956, health care utilization domain 0.961, and symptom severity domain 0.948, all indicating excellent reliability. In our study, the ICC values ranged from 0.803 to 0.975, which indicated good or excellent reliability. Our version of AFSS also had good reliability (p < 0.01), with total score correlation ranging from 0.333 to 0.895. The reliability and validation analyses are shown in Table The total AF burden domain was poorly correlated with health care utilization , moderately correlated with symptom severity , and well correlated with total AFSS score . The health care utilization domain was weakly correlated with symptom severity  and moderately correlated with total AFSS score . The symptom severity domain was very well correlated with total AFSS score .In comparison to SF-36, the total AF burden domain was poorly correlated with role limitations due to emotional problems , poorly correlated with fatigue , and poorly correlated with pain . The health care utilization domain was poorly correlated with role limitations due to emotional problems . The symptom severity domain was poorly correlated with physical functioning , role limitations due to physical health , role limitations due to emotional problems , social functioning , pain , general health , and total SF-36 score . Total AFSS score was moderately correlated with role limitations due to emotional problems , moderately correlated with pain , poorly correlated with general health , and poorly correlated with total SF-36 score , as shown in Table In our study, total AF burden, health care utilization, symptom severity, and total AFSS score were not correlated with EF. In addition, total AF burden, health care utilization, and symptom severity domain were not correlated with EHRA. However, the total AFSS score was poorly correlated with the EHRA score , as shown in Table Jones et al. reported that AF patients had lower QOL compared to the general population and those with other cardiovascular diseases. AF symptoms such as tachycardia, shortness of breath, chest pain, sleeping difficulties, and psychological distress contribute to worse QOL in AF patients . The QOLThe Indonesian version of AFSS revealed good internal consistency, based on the high Cronbach’s α value (0.819) and ICC score (0.963). This AFSS version was also found to be valid, as all total correlations scored > 0.330. The overall score of AFSS and SF-36 showed a poorly negative correlation , meaning that higher AFSS score (highly symptomatic) was correlated with lower SF-36 score (worse QOL). The SF-36 total score also showed a poorly negative correlation with the symptom severity domain , which means that higher symptom severity score (more severe AF symptoms) was correlated with lower SF-36 score (worse QOL). The total score of the Indonesian version of AFSS showed strong correlations (r > 0.60) with SF-36, as also seen in the Turkish version of AFSS. However, the lack of strong correlations among the domains of the two tools is evidence that they could be used to complement each other in patient HRQOL evaluations .The ICC for the various domains ranged from 0.803 to 0.975, which were considered to have good or excellent reliability. This finding indicates that in the 7-14-day interval between testing, there were no major changes in the symptoms of AF patients. Lindberg et al. stated that AF is a chronic lifelong condition which requires regular medical control . Heidt eAlthough AF is not considered to be immediately life-threatening, it is a chronic condition that significantly decreases QOL in patients. Dorian et al. reported that worse symptom severity significantly affected the physical and emotional components of QOL, general well-being, and health care utilization . This reBodily pain had a poor correlation with total AF burden , symptom severity , and moderately correlation with total AFSS score  in this study. A similar result was reported by Eren et al., who noted that bodily pain was poorly correlated with global well-being  and total AF burden , and moderately correlated with symptoms domain  in AFSS . HoweverPhysical limitations in AF are related to level of fatigue, shortness of breath, and underlying causes of AF . Atrial Physiological distress in AF has long been established. Anxiety (35%) and depression 20%) was found in patients with permanent AF. This distress is related to long-term medication use and side effects, fear of worsening symptoms, symptoms emerging during activity, and interventions planned to control symptoms % was fou.In our study, total AF burden  and symptom severity domain  had a poor correlation with role limitations due to emotional problems. Approximately 50% of participants reported fear of arrhythmia exacerbation during daily activities, which leads to role limitations due to anxiety. However, none of the AFSS domains were significantly correlated with emotional well-being in SF-36. This finding was similar to a Turkish study, which reported that global well-being , total AF burden , and symptom severity domain  were correlated with role limitations due to emotional problems .Sharma reported that good questionnaires should be able to be administered within 30 min and questionnaires with more than 30 questions should be done on divided occasions to keep participants’ full attention. Longer questionnaires have been correlated with more missing data and non-responsive participants . In our The Indonesian version of AFSS has good internal and external validity and good reliability to evaluate AF severity. This scale can be used to compare symptom development before and after therapy. Higher total AF burden, symptom severity, and AFSS total score are correlated with limitation of daily activities due to emotional problems, while symptom severity itself is strongly correlated with physical functioning of patients with AF.Below is the link to the electronic supplementary material.Supplementary Material 1: Questionnaire Translation Process and AFSS Descriptive Analysis


The anatomy of the spring ligament complex, as well as its pathology, is not well known in daily clinical practice. The purpose of this study was to evaluate the shear-wave elastography properties of the spring ligament and the posterior tibial tendon in healthy adults, and to assess the reliability and reproducibility of these measurements.Shear-wave elastography was used to evaluate both ankles in 20 healthy patients  resting on a hinge support with their ankles in neutral, valgus 20° and varus 30° positions. The stiffness of the spring ligament and posterior tibial tendon was assessed by measuring the speed of shear wave propagation through each structure.p = 0.01), but not for the posterior tibial tendon (p = 0.71). The physiologic weightbearing hindfoot attitude had no impact on the stiffness of the posterior tibial tendon or the spring ligament, regardless of the analysis position. Intra- and inter-observer agreements were all excellent for spring ligament stiffness, regardless of ankle position, and were good or excellent for posterior tibial tendon.Posterior tibial tendon and spring ligament reach a maximum estimated stiffness in valgus 20° position . Flat feet were associated with greater spring ligament stiffness in the 20° valgus position (This study describes a protocol to assess the stiffness of tibialis posterior and the spring ligament by shear-wave elastography, which is reliable, reproducible, and defines a corridor of normality. Further studies should be conducted to define the role of elastography for diagnosis/ evaluation of pathology, follow-up, or surgical strategies. The spring ligament inserts between the sustentaculum tali and the navicular, and is composed of 3 bundles: the superomedial calcaneonavicular ligament, the longitudinal inferoplantar calcaneonavicular ligament, and the oblique medioplantar calcaneonavicular ligament (or third ligament) , 19, 20.The reference examination for studying the spring ligament is MRI . An alteShear-waves elastography (SWE) is a non-invasive ultrasound technique that studies quantitatively the mechanical properties of tissues by shear wave speed propagation . It is uTo date, there are no tools for quantitatively assessing the biomechanical properties of these independent structures in vivo. No elastographic data currently exists to describe these ligamentous and tendinous structures. Thus, normal SWE values for these structures, is representative of the different morphotypes of the hindfoot and arch of the foot, do not exist. Nevertheless, the SWE signal may be unstable depending on the anatomical structures analyzed and its interpretation may be influenced by the operator's experience . A reproThe purpose of this study was to evaluate the spring ligament and PTT SWE properties in a cohort of healthy adult volunteers, and to assess the reliability and reproducibility of these measurements. The hypothesis was that SWE is a reliable means of examining the spring ligament, and that it was associated with a decrease in its stiffness in case of flatfoot morphology.This is a prospective study that was conducted at a single centre, and analysed 20 consecutive healthy subjects. The study was approved by Ethical Committee .Subjects were all resident medical officers, or medical students, of the department, and were enrolled in the study between November 2020 and January 2021. A questionnaire was performed to ensure the absence of any past medical history among: fracture, sprain, or ankle surgery. Before participation, all the volunteers were informed of the purpose of the study and consent were obtained. For each subject, both ankles were included: forty ankles in total were analysed. In addition, the following demographic data were recorded: age, sex, height, side of the dominant foot, type of foot arch , and type of hind foot alignment . These last two parameters were obtained using a podoscope: which uses the Chippaux-Smirak index (CSI) to classify the type of plantar arch and the standing tibiocalcaneal angle to classify the type of hind foot alignment .Twenty consecutive subjects , with mean aged 25.2 (range from 22 to 31 years old), were enrolled. The average weight was 61.9 ± 14.6 kg, and height 1.72 ± 0.09 m. Each subject was examined bilaterally, producing a total of 40 ankles for assessment. Twenty-foot arches were normal, 12 flat feet and 8 high arches. The hindfoot axis was neutral in 11 cases, valgus in 21 cases and varus in 8 cases. All subjects were asymptomatic at the time of examination. Those with valgus flatfoot were all flexible, presenting a type 1 CSI, with a moderate hindfoot valgus ranging from 7° to 12°.An Aixplorer ultrasound scanner , with a 20.2 mm 8 MHz linear probe was used. The probe was applied to the medial ankle surface anterior and inferior to the medial malleolus in front of the head of the talus. The probe was first positioned in the axis of PTT, then moved downward until the PTT was sliding on the superomedial bundle on the same image. The superomedial bundle was the only part of the spring ligament analyzed in this study because it is the main biomechanical active bundle , and becPatients were positioned standing on an articulated platelet . The examination was performed with full weight bearing with ankle in neutral position, valgus 20° and varus 30° Fig. . Two ort2) was calculated by the machine, where ρ is the soft tissue mass density. Each acquisition was in a 15 s video clip, from which the most stable signal image was frozen. Then, the operator defined a round region of interest (ROI) with a fixed two millimeters diameter for PTT and three millimeters diameter for spring ligament positioned in the middle of each ligament. The mean shear modulus (Shear modulus (µ = ρ·SWSth-95th percentile] for each ligament. The determination of the sample size indicates that 38 samples are required to have a 90% chance of correctly rejecting the null hypothesis of r = 0 at the 0.05 significance level assuming a linear correlation of 0.5 (moderate correlation) between spring ligament and posterior tibial tendon. Statistical analysis was performed using the R Language and Environment for Statistical Computing version 3.6.3 .The Wilcoxon-Mann Whitney for unpaired data were used to analyze the association between the different variables. The Krsukall-Wallis H-test for independent groups was used to compare the samples' median values, and a Dunn’s multiple comparison test was then performed. The alpha risk was set to 0.05. The intra-class correlation coefficient (ICC) was used to evaluate the intra-rater and inter-rater agreements in SWS stiffness measurements. The Bland–Altman method was used to visualize means in measurements between raters versus corresponding differences in measurements between raters and to compute the 95% limits of agreements between raters. An ICC value below 0.4 was considered as a poor agreement, between 0.4 and 0.75 as good agreement, and above 0.75 as excellent agreement . A SWS nIntra- and inter-observer agreements were all excellent for spring ligament stiffness, regardless of ankle position. Intra- and inter-observer agreements were good or excellent for PTT stiffness evaluation depending positions. All inter- and intra-class correlations are summarized in Table p = 0.37) and for the spring ligament (p = 0.50). The variation of stiffness evaluated by SWS according to the ankle position is shown in Fig. The median stiffness of PTT and spring ligament varies according to ankle position: PTT and spring ligament reach their maximum stiffness in valgus 20° position (7.43 m/s (range from 5.71 to 9.03); 5.73 m/s (range from 3.98 to 8.57), respectively). There were no differences in SWS measured in neutral and varus 30° position for PTT  and with male gender (p = 0.03). The impact of demographics on spring ligament complex stiffness is reported in Table No demographic data  had an impact on spring ligament stiffness as assessed by SWE. PTT SWS decreased with age (p = 0.01), but had no impact on PTT. Hindfoot type had no impact on variation in PTT and spring ligament stiffness. The impact of foot morphological data on ligament complex stiffness is presented in Table Flat-foot morphology was associated with a significant increase in spring ligament stiffness in the 20° valgus position . There was no correlation in stiffness between the two structures in other positions (Table Finally, there was a statistical correlation in the stiffness of the spring ligament and the PTT in varus 30° (The main results of this study are that the SWE is reliable and reproducible to analyze the stiffness of the superomedial calcaneonavicular ligament spring ligament and posterior tibial tendon. Moreover, it confirms the mechanical action of the spring ligament in the ankle valgus position.This study only focused on the main ligament of the spring ligament: the superomedial calcaneonavicular ligament. It is the widest and thickest of the three ligaments , 20. LocVarious radiological or anatomical studies have examined the impact of certain demographic criteria on the morphology of the spring ligament. No correlation was found between the thickness of the superomedial ligament and the PTT, nor with age  or BMI . By MRI,The reference imaging to assess the spring ligament complex is MRI , becauseThe surgical management remains debated and several techniques of spring ligament reconstruction have been described as alternatives to triple arthrodesis. There is great variability in repair or reconstruction techniques , 8, 25. This study has limitations. First of all, it is a preliminary study on a limited number of healthy subjects, which limits its short-term significance. Additionally, this study analysed only the most superficial bundle of the spring ligament: the superomedial calcaneonavicular ligament. This was chosen as the superomedial bundle is the biomechanically active part of the spring ligament. It has been shown that the analysis of other bundles is more difficult, and not very accessible in current practice . DespiteThe spring ligament, the main stabilizer of the medial arch of the foot, has an important dynamic function. This study describes a protocol to assess its stiffness by SWE, which is reliable, reproducible, and defines a corridor of normality. Flat-foot morphology was associated with a significant increase in spring ligament stiffness in valgus position, but had no impact on PTT. Further studies could be conducted to define its role in diagnosis, follow-up or surgical reconstruction strategies.


S. epidermidis. Later, a quantitative analysis was conducted by means of microcalorimetry and sonication with plating. Additionally, a qualitative analysis was conducted by means of electron microscopy. Results: No significant differences were found between the bacterial growth profiles of the 4×Ht graft and the BPTB graft in microcalorimetry and colony counting. In the samples analyzed with electron microscopy, no specific biofilm growth pattern was identified upon comparing the BPTB graft to the 4×Ht graft. Conclusions: There were no significant differences found at either the quantitative or qualitative level when comparing bacterial growth in the BPTB graft to that in the 4×Ht graft. Therefore, the presence of sutures in the 4×Ht graft cannot be established as a predisposing factor for increased biofilm growth in this in vitro study.Background: The objective of the present study was to evaluate the formation of biofilms in bone patellar tendon bone grafts (BPTB grafts), and to compare it to the formation of biofilm formation in quadrupled hamstring anterior cruciate ligament grafts (4×Ht graft). Methods: A descriptive in vitro study was conducted. One 4×Ht graft and one BPTB graft were prepared. They were then contaminated with a strain of  Although infections after anterior cruciate ligament reconstruction (r-ACL) are not as common as other implant-associated infections, the magnitude of this complication is equally important, since inappropriate treatment could compromise joint function and return to sports activities ,2.For this reason, various studies have focused on the study of this pathology in recent years. Most of those studies concluded that aggressive arthroscopic debridement in combination with specific antibiotic therapy should be the treatment of choice for this complication ,3,4. SevOther studies have focused on the origin of these infections ,11. Somep = 0.001) [There are data published by several authors in which higher rates of infection in r-ACL were observed when quadruplicate hamstring grafts (4×Ht grafts) were used compared to surgeries performed with patellar tendon grafts (BPTB grafts) ,12,13. D= 0.001) . TherefoOne of them is that sutures used in 4×Ht grafts surgeries may harbor bacteria, and that this may be a risk factor for the development of an infection . It has All this leads one to think that a greater bacterial load is introduced into the body in 4×Ht graft surgeries, reaching the MID more frequently. This may be the reason for the higher rate of infections in r-ACL surgeries performed with 4×Ht grafts, as they require sutures. Those sutures may behave similarly to a foreign body that facilitates the growth of the biofilm. With the same contaminating bacterial inoculum, biofilm formation would be more elevated in 4×Ht grafts than that produced in BPTB grafts, in which sutures are not used. This would allow for the introduction of a greater bacterial load in the subject, raising the risk of infection ,21,22. TA similar observation was noted in the classic studies of Elek et al. that were performed in 1956. In those studies, they observed that a wound contaminated with the same quantity of bacteria is more likely to develop an infection if there are sutures on it ,30.The objective of the present study was to evaluate this hypothesis by comparing biofilm formation in BPTB grafts vs. 4×Ht grafts, with both contaminated with the same bacterial inoculum in vitro.The hypothesis was that biofilm growth will be greater in 4×Ht grafts than in BPTB grafts due to the greater formation of biofilm around the sutures.A descriptive in vitro study was conducted. For the production of grafts, a 4×Ht graft and a BPTB graft were prepared from sterilized and frozen cadaveric donor samples.The grafts were provided by Banc de Sang i Teixits (BST) . They were prepared by an orthopedic surgeon with specific training and experience in conducting this type of graft. The production of these grafts was performed in a manner analogous to the one used during the usual surgical procedures, in a sterile environment. In the case of the 4×Ht graft, a high-resistance suture of the same type as those used in normal practice was used .For the BPTB graft, a remodeling of the bony parts to achieve a 10mm diameter was performed as in daily clinical practice.Both of the grafts were divided into 8 representative fragments of each type of graft.We considered a representative fragment as one that contains the representative elements of the complete graft. In the case of the BPTB graft, eight 5 mm × 5 mm × 1 mm fragments of the patellar tendon were produced using a surgical scalpel. The decision was taken to use these dimensions as they were the maximum dimensions that can be used in the analysis processes to be conducted later. In the case of the 4×Ht graft, a representative fragment was considered to be one that contained a hamstring tendon fragment and a suture fragment. These fragments were made with the same dimensions and followed the technique as those previously described.This study was approved by the Parc de Salut Mar Drug Research Ethics Committee with CEIC clinical research project number no. 2018/8269/I on 29 May 2019.5 CFU/mL by Staphylococcus epidermidis (ATCC 35984). They were incubated at 37 °C for 24 h. This bacterium was used, as it is one of the most frequent causes of infection in the context of r-ACL [In 5 fragments from each sample, the formation of the artificial biofilm was brought on. To form the bacterial biofilm, the samples were placed in 2 mL of heart-brain infusion broth culture medium  contaminated at 1 × 10of r-ACL . Moreoveof r-ACL ,32 . Measurements were conducted through the full vital cycle of the pathogen (48 h). It is the same as the one described by Butini et al. [In 2 contaminated fragments and 1 negative control of each type of graft, the heat produced by the i et al. .2  for 1 min. Then, they were sonicated again for an additional 30 s. Next, 100 µL of the sonication product was seeded in Tryptic Soy Agar (TSA) . After 24 h of incubation at 37 °C, the counting of colony-forming units (CFU/mL) was carried out in accordance with the previously described technique [Sonication and seeding analysis was conducted on 2 contaminated fragments and 1 negative control of each type of graft. Each of these was placed in a solution of 1 mL 0.9% NaCl, vortexed for 30 s, and sonicated at an intensity of 40 kHz and 0.1 W cmechnique .Accepting an alpha risk of 0.05 and a beta risk of less than 0.2 in a bilateral contrast, 2 subjects in the first group and 2 in the second group were required to detect a difference equal to or greater than 5 units. The common standard deviation was assumed to be 1.5. A loss to follow-up rate was estimated at 0%.Finally, a qualitative analysis was performed by means of scanning electron microscopy  to determine the biofilm growth areas in the samples. The pictures taken with this technique were analyzed by a trained technician who was blinded for the aim of our study and had been asked to look for differences in biofilm wroth profiles in the different samples and compare them. This was done in accordance with the previously described technique  with a pt-test was used to assess the CFU counting. A p value under 0.05 was considered statistically significant.The statistical analyzes were performed using the SigmaPlot software package  and Prism for the graphics . Continuous variables are presented as means  and ranges. The unpaired Using the isothermal microcalorimetry method, we observed bacterial growth in the contaminated fragments from both the 4×Ht and BPTB grafts. They showed the same growth dynamics of the one typical of this bacterial population. In the beginning, the microcalorimetry curves showed exponential growth rates until they reached a population peak (200 µW) at approximately 8 h after contamination. Then, after a short or non-existent stationary phase, a rapid decline in the bacterial population was detected. Later, there was a phase of senescence or death characteristic of this type of bacterial population , with no7 ± 0.345 × 107 CFU/mL, and 4.6 × 107 ± 1.455 × 107 CFU/mL respectively, p = 0.6667) (p ≥ 0.05). Seeding of the fluid extracted by sonication of the uncontaminated BPTB and 4×Ht grafts fragments (negative controls) did not produce any colony growth.The number of colony-forming units per milliliter (CFU/mL) of the fluid extracted by sonication of the contaminated BPTB and 4×Ht grafts fragments was then determined. The means of the CFU/mL of the different groups were calculated, analyzed, and compared  . No signIn the electron microscopy analysis, no specific or differential biofilm growth patterns were detected by our technician upon comparing the contaminated BPTB graft fragment to the corresponding 4×Ht graft fragment. There was a homogeneous growth pattern observed regardless of the surface on which the biofilm grew. Of note, an increase in colonization was not observed in the suture areas , and no The initial hypothesis of this study equating the BPTB and 4×Ht grafts in their potential for biofilm growth under the contamination of a same bacterial inoculum in vitro has been refuted.The structural differences between the two graft types do not have any effect on the production of biofilm during r-ACL surgery, at least outside of the body. Therefore, differences in the infection rates in r-ACL surgeries with BPTB and 4×Ht grafts cannot be justified in this way.Electron microscopy analysis revealed a homogeneous biofilm growth pattern. These findings rule out the sutures present in 4×Ht grafts being a better surface for biofilm growth than the tendon itself a. This sThe fact that grafts, by their very nature, are not a predisposing factor for biofilm growth leads us to think that there must be some differences surrounding their processing that changes and conditions the differences in infection rates. Therefore, our study encourages future studies for the development of prophylactic strategies not to focus on the structure or composition of 4×Ht grafts, but in other factors such as the ones discussed below. One possible reason is that there are differences in the contamination of grafts. It is well known that contamination during a surgical procedures is time-dependent . The proS. epidermidis was used for contamination and biofilm formation. It would be interesting to perform the same analysis with other types of Gram-positive staphylococci that are frequently associated with this pathology. However, it is unlikely that differences would be found due to their similarity to S. epidermidis. On the other hand, we believe that repeating the analysis with pathogens of other strains including anaerobes would be of little relevance due to their low prevalence in r-ACL infections.This study has some limitations that should be mentioned. Only Another limitation is the concern around this study being an in vitro study. This does not make for exploring the host–pathogen interaction. However, for the moment, this is the best evidence we can provide relative to this topic for bioethical reasons, as the factors mentioned above cannot be explored experimentally in vivo.Another factor that was beyond our control in this study were the host characteristics . Then again, we know that the infection rate differs according to the type of graft used in studies with a large cohort in which the patients are heterogeneous ,12,13. TWe have found that the amount of biofilm formed on the BPTB and 4×Ht grafts by the same bacterial inoculum is comparable in vitro. Therefore, the 4×Ht graft is not intrinsically a predisposing factor for biofilm growth due to its structure and composition when contaminated outside of the body.


Clinical Neuroradiology. It is a great honor for me to take over this responsibility with the beginning of 2023. First of all, my thanks and respect go to László Solymosi under whom the journal Clinical Neuroradiology has evolved from a German language journal with little visibility to an internationally renowned journal in neuroradiology. I had the honor to contribute to this development as a Co-editor from the very beginning of his responsibility as Editor-in-Chief. There are no good reasons to substantially change the overall scope and strategy of the journal. The main focus will remain and be sharpened in the field of interventional neuroradiology, diagnostic neuroradiology, and new evolutions, e.g. artificial intelligence and new diagnostic and interventional developments.As of 31 December 2022 Prof. Dr. László Solymosi has resigned as the Editor-in-Chief of Clinical Neuroradiology. I guarantee a fast and transparent review process and rapid online publication of accepted papers. Likewise, this is substantially dependent on a rapid review by the respective reviewers, who I would explicitly like to thank for their past and future commitment to the journal.The attractiveness of a scientific journal fundamentally relies on the quality of the published papers. Therefore, my sincere request as new Editor-in-Chief is to submit high-quality scientific work to Clinical Neuroradiology as a leading journal in diagnostic and interventional neuroradiology.I am very much looking forward to my work as the Editor-in-Chief with the goal to further establish


Proso millet has been proposed as an effective anti-diabetic food thanks to the combined action of polyphenols and starch. This study aimed to characterize the chemical composition of twenty-five accessions, in order to enhance this cereal as an alternative to available starch for food applications or to propose new food ingredients with health benefits. Proso millet contained a high percentage of starch, reaching values of 58.51%. The amylose content showed high variability, with values ranging from 1.36 to 42.70%, and significantly higher values were recorded for the white accessions than for the colored ones. High-resistant starch content (13.41–26.07%) was also found. The HPLC-MS analysis showed the same phenolic pattern in all the samples. Cinnamic acids are the most abundant compounds and significant differences in their total content were found (0.69 to 1.35 mg/g DW), while flavonoids were only detected in trace amounts. Statistical results showed significantly higher antiradical activity in the colored accessions than in the white ones. Panicum miliaceum L.), included among the four major millets, will be a sustainable and environmentally friendly starch substitute for the manufacturing of resistant starch , where A0 and A30 were the absorbance of DPPH, respectively, at time 0 and after 30 min from the addition of the extract.The antiradical activity was evaluated by using the stable radical DPPH  test, as described in Ieri et al. . In detat-test, applying the Welch correction to the degrees of freedom if the two groups have unequal variances [Each measurement experiment was performed in triplicate and results were expressed as mean ± standard deviation. Firstly, samples were grouped in order to investigate differences between white and colored millet species, considering the agronomic characteristics, the nutritional and phenolic profiles and the antiradical activity. In particular, to determine whether the means of the two groups of millet species differed we conducted an independent sample ariances . Due to the small sample set, we intentionally did not perform a multiple comparison correction. As is well known, this class of corrections has been introduced in the literature to reduce the chance of false discovery in case of multiple comparisons. It is almost certain that the introduction of a multiple comparison correction would lead to the acceptance of the null hypothesis in all the tests performed since those techniques are almost always conservative. But we have to argue that when sample sets are small, tests are not very powerful and the risk of false acceptance of the null hypothesis is very high. The introduction of any conservative technique with the aim of reducing the chance of false discovery will lead to an increase in the probability of a false negative (type II error).Therefore, a Hierarchical Cluster Analysis (HCA) was conducted on all parameters. To inspect the existence of millet varieties with similar properties. HCA is a multivariate statistical method (frequently used in data mining) that allows verifying the existence of natural groupings inside a set of available observations . Groups are formed iteratively, by successively joining or splitting groups of observations. We follow the agglomerative strategy in which each observation starts in its own single group, and groups are successively paired until forming the largest possible one identified by the whole set of available observations. Observation closeness was calculated on the basis of the Euclidean distance, and the Ward hierarchical agglomerative method was used as grouping criteria in order to obtain the minimum variance between the observations that comprise each group.Prior to this chemometric approach, the variables were scaled (transformed with zero mean and unit variance) to standardize the statistical importance of all the measured features. All the statistical analyses were conducted using R (version 4.2.1).This study aimed to deepen the knowledge about proso millet, by conducting a chemical characterization of a world collection of twenty-five accessions. Due to its nutritional qualities, proso millet proves to be an important food crop. Indeed, this cereal contains a high percentage of starch, reaching values of 58.51 g/100 g in our accessions. The amylose content showed high diversity among the varieties and the majority of samples were high amylose content type (non-waxy type), particularly interesting since its link to the hypoglycemic properties and the inverse relationship between amylose content and glycemic index. Proso millets showed high-resistant starch content, ranging from 13.41 to 26.07 g/100 g, higher as compared to wheat flour values reported in the literature. The starch digestibility of proso millet also depends on the variety; digestible starch varied from 20.49 to 38.46 g/100 g in our accessions.Concerning the phenolic profile, the HPLC-MS analysis showed the presence of the same phenolic pattern in all the samples, while the phenolic content widely varies. Significant differences in total cinnamic acid content were found, ranging from 0.69 to 1.35 mg/g; flavonoids were only detected in trace amounts. DPPH radical scavenging capacity varied from a minimum of 36% up to a maximum of 79%, and the statistical results highlighted a correlation between antiradical activity and the color of grains; particularly, colored accessions showed significantly higher antiradical activity compared to white ones. Similarly, statistical analysis showed that the white varieties contained a higher amylose content and lower amylopectin content than the colored ones. As far as we know, this is the first time that this result has been reported for millet grains. The wide variation in the chemical composition observed in our samples should be valuable in guiding the selection of suitable germplasms for breeding programs and food or non-food millet product development. Furthermore, due to the promising functional properties of proso millet starch responsible for the eating quality and cooking parameters of millet, this study could be useful to propose proso millet as an alternative to commercially available starch for food applications.


Assessment of the clinical performance of a porcine dentin-derived particulate bone graft material for bone regeneration after tooth extraction with implant placement at 4 months, in comparison to a commercially available porcine bone-derived graft.This study was a randomized, parallel-group, semi-double-blinded clinical trial evaluating the clinical safety, tolerability, and performance of Ivory Dentin Graft™ in comparison with a commercial bone-derived material in alveolar ridge preservation following tooth extraction . Extraction sites were grafted with test or comparator material and a titanium implant placed at 4 months after taking a graft site biopsy. Primary endpoints were the extent of new bone growth and bone-graft integration at 4 months.p = 0.0084, N = 20 vs 16), better bone-graft integration scores , and higher mean radiodensity of the bone  at the graft site compared to the bone-derived material. The mean implant insertion torque force was similar for the dentin and bone materials (34.75 Ncm vs 34.06 Ncm). Titanium implant placement was successful in 95% of patients with the dentin graft material compared to 81.25% for the bone graft. Both materials had similar clinical safety and tolerability as determined by adverse events and local site reactions. Physician-assessed ease of grafting and ease of implant placement on a 10-point scale showed no statistical differences .The dentin graft material had statistically significantly more new bone formation (60.75% vs 42.81%, A porcine dentin-derived bone graft material has clinical safety, tolerability, and performance for implant placement at 4 months after tooth extraction at least as good as a commercial bone-derived material.The availability of porcine dentin-derived bone graft material allows wider use of dentin-derived material which has so far only been available in the form of autologous dentin from the patient’s own teeth. The use of osseointegrated dental implants has become a standard for the prosthetic rehabilitation of fully and partially edentulous patients, providing excellent long-term functional and esthetic outcomes –5. WhereThis publication describes the results of a prospective, randomized, semi-blinded comparative trial of a novel bone substitute material, Ivory Dentin Graft™ (referred to as “Dentin”) in terms of the primary outcomes of the amount of new bone formation (percent area of woven bone) and the degree of direct contact between the graft and bone  at the graft site at 4 months after grafting. A number of other clinically relevant outcomes were also assessed as secondary endpoints. Ivory Dentin Graft™ is a novel xenogeneic origin, osteoconductive, osteoinductive, and slowly bioresorbable bone graft material for the repair or augmentation of bone defects in dental procedures Table . The matThe study was powered to demonstrate the non-inferiority of Ivory Dentin Graft™ to the comparator in terms of the amount of new bone formation and the integration of the graft material with the host bone in the core biopsy taken just prior to implant placement at 4 months. It is intended to follow up on the implant success over the longer term, but this publication focuses on the events up to and including implant placement as this includes the most critical events for assessing bone graft material properties.The study is a randomized, parallel-group, semi-double-blinded clinical trial to evaluate the safety and effectiveness of Ivory Dentin Graft™  in comparison with the active comparator OsteoBiol Gen-Os®  in adult subjects requiring alveolar ridge preservation following mandibular pre-molar or molar tooth extraction. A comparison with a commercially available active comparator was done because this study was performed to support marketing authorization which requires a demonstration of non-inferiority to existing treatments and provides a higher hurdle than a negative control group comparison. An additional negative control group was considered beyond the scope of the study particularly due to ethical considerations and problems with ensuring a comparable patient group. The study was sponsored by Ivory Graft Ltd., Tel Aviv, Israel, and performed at a single clinical center, the Assaf Harofeh Medical Center, Rishon Lezion, Israel, under the supervision of the principal investigator Dr. Doron Haim. The study conforms to the CONSORT and Cochrane guidelines.The protocol was in accordance with the Helsinki Declaration and the Fortaleza revisions, ICH E6 (R2), and ISO 14155:2011 and was approved by the Institutional Review Board for Clinical Research at Asaf Harofeh Medical Center  and the Israeli Ministry of Health . Written informed consents were obtained from all participants after provision of a detailed explanation of the protocol and the benefits or risks of participation. The study was registered at ClinicalTrials.gov on May 12th, 2017 (Identifier NCT03150472), prior to the enrolment of the first subject.This study was semi-double-blinded. Only the study staff member performing the grafting procedure, the study coordinator, and the study CRO were unblinded to the type of graft applied. The study assessors were located externally from the medical center, independent, and kept blinded to the subject allocations.Grafting procedures were conducted following mandibular pre-molar or molar tooth extraction. The sockets were required to have 4 walls with an alveolar ridge height of not less than 10 mm from the gingival margin to the mandibular nerve canal and a width of not less than 5 mm from buccal to lingual cortical plates. After ensuring compliance with the entry criteria, eligible patients were planned to be randomly assigned by the study site at a ratio of 1:1 to dentin or bone graft groups using Castor’s electronic data capture (EDC) web software and baseline examinations performed  and the degree of direct contact between the graft and bone  at the graft site at 4 months after grafting. All study endpoints are summarized in Table Bone graft site quality was also assessed by the insertion torque during implant placement. Dental implant insertion torque has been shown to be correlated with bone density and is one of the most important factors for successful implant placement in a post-grafting site , 32. BonA further efficacy endpoint was the success of the dental implant placement procedure. A successful implant placement event was defined as an event not requiring the addition of graft material during implant placement or postponement of the implant placement due to re-grafting.Efficacy was also examined by measuring the changes in alveolar ridge dimensions at the graft site. Alveolar bone height at mesial and distal root surface and alveolar bone width was measured on posterior to anterior (PA) radiographs by cone beam computer tomography (CBCT scan) prior to bone grafting and just prior to implant placement at 4 months to accurately measure the changes of the alveolar ridge dimensions during the short-term period. CBCT is considered the best method to evaluate the changes in the alveolar ridges and ridge morphology, following tooth extraction and grafting, as well as for pre-implant surgical design and implant diameter selection. CBCT is considered more accurate than computer tomography (CT) and safer, as the patients are exposed to lower levels of radiation.The ease of the graft placement procedure and the implant placement  was also recorded.Safety parameters were also systematically collected including adverse events (AEs), unscheduled visits, and local tolerability Table . All AEsFor calculation of the sample size, the null hypothesis was that Ivory Dentin Graft™ and Gen-Os® are not equivalent (Gen-Os® is better than Ivory Dentin Graft™), and the alternative hypothesis was that Ivory Dentin Graft is not inferior to Gen-Os® in respect of the study endpoint new bone formation. The statistical calculation based on demonstrating non-inferiority assumed a difference of up to 30% in the area of woven bone between the treatments to be equivalent with a standard deviation of 32%.In a sample of 15 subjects per group, a difference of up to 30% in the mean woven bone between the treatment groups is considered equivalent with a 5% significance level and 80% statistical power.Assuming a dropout rate of ~ 30% required 41 subjects to be recruited and grafted with either the dentin graft or the active comparator bone graft, to ensure a final sample size of 30 study completers (15 per group).N = 2) or to the investigator’s decision of anticipated non-compliance (N = 1). Two subjects from the bone group discontinued, one due to graft failure and the other due to consent withdrawal.The first subject was enrolled on December 12th, 2017, and the last subject completed visit 5 on January 14th, 2020. Out of 57 subjects screened, a total of 41 subjects were randomized to the treatment groups . Furthermore, the majority (85%) of dentin group biopsies were rated as having good bone–graft integration compared to less than half (40%) of the bone group biopsies (Table p = 0.0066). These assessments were made by independent blinded assessors. The histology showed close contact of the dentin graft particles with abundant new host bone growth  in alveolar bone core biopsies from the dentin group was higher than for the bone group  for the dentin group (981.5 HU) compared to the bone group (727.7 HU)  Table . ExampleThe mean torque force for implant placement at the graft site was similar for dentin 34.75 Ncm) and bone (34.06 Ncm)  were recorded during the follow-up period. There were also no severe AEs, severe adverse reactions, or suspected unexpected serious adverse reactions (SUSARs). Overall, there were 28 adverse events in 16 subjects, with similar occurrence in both groups. Graft-associated events such as graft failure and graft complications occurred at a similar frequency in both groups, classified as mild for dentin and moderate for bone. There was also no difference in adverse events associated with local site reactions  most of which were mild and transient.p = 0.2355 and 0.1118, respectively, Mann–Whitney test). This suggests that the physician experience with Ivory Dentin Graft is not inferior than the experience with a similar device in the market, Gen-Os®.The physician assessment of the usability of dentin versus bone, as measured by a 10-point scale, in terms of either ease of grafting  or ease of dental implant placement  revealed no statistically significant differences  was considered appropriate because it is a porcine bone-derived graft material with retained organic matrix that has been shown to be effective in a number of clinical studies , 53 and In keeping with the expected early graft stability, the histological assessment of the graft site and implantation were performed 4 months after grafting, which is comparatively early. The study was statistically powered to examine non-inferiority to the reference material in terms of the histological condition of the graft site in terms of the area of the host woven bone and also the extent of direct contacts between the host bone and the graft particles. Additional relevant parameters were also examined. The subjects included in the study were typical for those seen in clinical practice with the main exclusion criteria consisting of conditions that would be contraindications for bone grafting. A consistent grafting procedure was used for all study subjects which included the use of a collagen membrane (Janson® fleece) to hold the graft material in place and exclude soft tissue infiltration. A semi-blinded procedure was used where the person performing the procedure was unblinded in order to use the material appropriately, but the clinical and histological assessors were unaware of the material used.The clinical study comparing Ivory Dentin Graft™ with Osteobiol Gen-Os® (Tecnoss) fulfilled the primary outcome of demonstrating that Ivory Dentin Graft™ is not inferior to the comparator in terms of the quantity and quality of regenerated bone at the graft site at 4 months after grafting. In fact, the mean percentage of new bone formation for Ivory Dentin Graft™ of 60.75% was considerably higher than that of the comparator which had just 42.81% of new bone. Comparison with other studies , 28, 38 Consistent with the excellent new bone growth for Ivory Dentin Graft™, the graft sites had a significantly higher radiodensity than the comparator (981.5 HU vs. 727.7 HU). This difference did not, however, translate into a difference in mean insertion torque which was similar for Ivory Dentin Graft™ and the comparator (34.75 Ncm vs. 34.06 Ncm). The higher radiodensity probably reflects the higher density of the dentin-derived graft material. It has been shown that in this intermediate range of bone densities and insertion torques, there is no statistical correlation between the parameters , and so p = 0.5881 and width change p = 0.61).Sufficient ridge width and height have been considered one of the key requirements to ensure the longevity and function of implant-supported prosthesis . Since tThese data are in line with data presented in other clinical investigations assessing dimensional alterations of the alveolar ridge at 4 months following bone grafting. The mean vertical loss at 4 months following tooth extraction and grafting with porcine ) and bovine xenografts ) ranged between 0.5 and 1.45 mm , 54, andAlthough the bone remodeling process continues for months after the grafting procedure, these short-term efficacy data indicate that Ivory Dentin Graft™ is not inferior to Gen-Os® in providing adequate bone volume to support implant placement. Furthermore, as the dentin particles are resorbed slowly by sterile external replacement resorption, the stability is expected to be maintained throughout the resorption process.Consistent with the excellent data for Ivory Dentin Graft™ concerning the graft site, the implant placement success was 95% compared to 81.25% for the comparator. This indicates that most implants did not require any additional intervention during implant placement or delaying of implant placement due to graft failure. Physician assessment of the usability of the products using a 10-point satisfaction scale indicated that the materials are similarly easy to use.Safety aspects were actively monitored throughout the study. There were no serious AEs, and also no severe adverse events, severe adverse reactions, or suspected unexpected serious adverse reactions for either product. Importantly, there was no difference in the incidences of probably and possibly product-related AEs.Most AEs were of the type already described for such oral surgical procedures, were mild to moderate, and resolved without consequences. Overall, the safety of Ivory Dentin Graft™ was excellent, with an AE and tolerability profile similar to that of the comparator and as would be expected for this type of therapy.This clinical investigation therefore confirmed that Ivory Dentin Graft™ is efficacious and safe in providing an adequate site for implant placement at 4 months after tooth extraction and is non-inferior to the commercially used product Gen-Os® in terms of new bone growth and graft-host integration at the grafting site. Ivory Dentin Graft™ provided adequate alveolar ridge preservation which allowed stable implant placement and at the graft site had a higher proportion of new bone growth and integration of the graft with the new bone than Gen-Os®. These properties are consistent with the unique aspect of Ivory Dentin Graft™ being based on tooth dentin with a retained protein component. The high proportion of new bone growth at the time of implantation combined with the structural strength of the dentin and intimate bone-graft contact provides for rapid and stable integration of the implant that, however, needs confirmation at later time points. This early follow-up clinical data thus suggests that Ivory Dentin Graft™ is suitable to extend the use of dentin-based bone graft material beyond that of autologous procedures.This study was designed to provide a sensitive comparison of the properties of a novel dentin-derived graft material with an already established bone-derived material under standardized conditions. The enrolment criteria thus excluded patients with comorbidities that may have independently influenced the outcome. These criteria are, however, generally contraindications for implant placement. Only mandibular tooth extraction sites were grafted, and therefore, the outcomes need to be adjusted for other graft locations and situations. The comparator material has, however, been extensively tested in other procedures including sinus lifting, and the principles of host bone ingrowth and formation of a stable site are expected to be similarly transferable for the dentin material. For the histological assessment, only one timepoint could be assessed which is at the time of implant placement at 4 months. Good graft site stability was demonstrated. Subsequent long-term clinical follow-up is required to confirm that this translates into long-term implant stability.