A definitive screening design was used in order to evaluate the effects of starch, glycerol and montmorillonite (MMT) concentrations, as well as the drying temperature, drying tray type and starch species, on packaging film’s functional properties. Optimization showed that in order to obtain films with the minimum possible thickness, the maximum elongation at break, the maximum tensile strength, as well as reduced water vapor permeability and low opacity, a combination of factors should be used as follows: 5.5% wt starch concentration, 30% wt glycerol concentration on a dry starch basis, 10.5% wt MMT concentration on a dry starch basis, 45 °C drying temperature, chickpea as the starch species and plexiglass as the drying tray type. Based on these results, starch films were prepared, and fresh minced meat was stored in them for 3 days. It was shown that the incorporation of MMT at 10.5% wt on a dry starch basis in the packaging films led to a decreased mesophilic and psychrotrophic bacteria growth factor compared to commercial packaging. When assessed for their biodegradability, the starch films disintegrated after 10 days of thermophilic incubation under simulated composting conditions. Finally, to prove their handling capability during industrial production, the starch films were rewound in a paper cylinder using an industrial-scale rewinding machine. In recent years, a global turn is evident towards the use of non-petroleum-based packaging materials with biodegradable properties made from renewable sources for a variety of applications. The study of finding potential candidates to replace conventional non-biodegradable materials is not new and has proved to be a challenging endeavor because of the unique mechanical and practical advantages that come with the use of petrol-based polymers due to their variety of compositions, which enable the manufacture of end products with great mechanical properties and versatility ,2,3.A variety of strategies has been developed in the context of evolving alternatives to petrol-based polymers for packaging materials during the last decade. Among them, polysaccharides like cellulose derivatives and plant gums have been studied intensively . PolylacStarch, organized into unique starch granule structures, is the main polysaccharide in plants and is composed of linear amylose and highly branched amylopectin . AlthougIn starch granule gelatinization, the transition from a crystalline to an amorphous physical state is basically irreversible. In a time- and condition-dependent process subsequent to the loss of granule crystallinity, water molecules that are bound in the amylose matrix are released, and amylose returns to its crystalline state through a reaction known as retrogradation . RetrogrDue to the physical nature of starch, especially following gelatinization, the materials that are formed either as films or as any other shape are susceptible to degradation, which is caused and enhanced by the materials’ high water vapor permeability  and poor2/g) and high cation-exchange capacity  was 3169.65 Pa.The films’ WVP was determined gravimetrically based on the method proposed by Mali et al. (2002) and the ASTM E96/E96M-05 desiccant method with some modifications ,40. FilmThe films’ optical parameters were determined using a non-contact imaging spectrophotometer  and Color IQC 10 software . The opacity index was estimated by measuring the contrast of a film specimen over a white calibration plate and then over a black calibration plate. A D65 (daylight) CIELab scale was used to determine the color parameters of L* (from black (0) to white (100)), a* (from green (−128) to red (127)) and b* (from blue (−128) to yellow (127)). The white plate color standard  was used as the background for determining the film color.An optimization and desirability function approach was utilized to optimize the multiple responses. It was considered that tensile strength, elongation at break, WVP, thickness and opacity properties are essential to produce packaging films with adequate physical attributes. The film composition that met the conditions of the maximum tensile strength, the maximum elongation at break, the lowest possible thickness, the minimum WVP and the minimum opacity was determined using JMP 17 software by SAS™.The antimicrobial activity of the biodegradable starch films for packaging applications was tested on fresh minced meat against natural microbiota (mesophilic and psychrotrophic bacteria). Biodegradable starch films produced according to the formulation suggested by the optimization method were sterilized with UV light . Minced meat samples (30 g) were placed in packages made of two films sealed with starch glue, and the packages were stored in the refrigerator (4 °C) for 3 days before further analyses. Three treatments were tested, namely, a thermoplastic starch film package (TS), a thermoplastic starch film package with MMT (TS + MMT) and a commercial food package made of LDPE . Two packages (subjects) were assigned to each treatment, and the analyses were performed over 3 consecutive days plus the 0  day. Serial dilutions and the pour plate method were used with plate count agar (PCA), and after incubation at 30 °C for 72 h for the mesophilic bacteria and at 4 °C for 10 days for the psychrotrophic bacteria, the CFU/g was recorded. Tests were performed in duplicate. Results were expressed as the growth factor, i.e., the difference between the log cfu/g of each day and the log cfu/g of day 0. The experiment was conducted twice.A repeated-measures analysis of variance (rANOVA) including a between-subjects effect  and a fixed between-subjects factor (treatments) was applied. This design was selected to evaluate whether and how the different treatment affected every response, whether there was a different performance in the responses over the preservation time and whether a significant interaction developed between treatment and preservation time, i.e., whether at least one treatment affected the responses differently over a period of time as compared to the others. The results are depicted graphically as mean changes with 95% confidence intervals based on the error mean square of rANOVA. Pairwise indicates that values whose intervals do not overlap denote significant difference.The films’ biodegradability was assessed according to the ISO 20200:2015 . BrieflyA sheet of biodegradable starch film (110 cm × 38 cm) that was produced according to the recipe suggested by the optimization method was cut into specific dimensions (90 cm × 30 cm) in order to fit the technical specifications of the rewinding machine . During the rewinding process of the commercial film, the machine was stopped, and the commercial film was cut in order to attach the biodegradable starch film in the middle (between unwinding and rewinding) section. The two films were joined together using a standard double-sided adhesive tape. The rewinding process was continued, and the biodegradable starch film was rewound in a paper core with a 77 mm internal diameter.p < 0.05) effect on the film thickness, and more specifically, an increase in the starch or glycerol content led to an increase in the film thickness from 0.09 mm to 0.16 mm when the starch concentration increased from 4 to 7% wt , biodegradable films of thicknesses between 0.1 and 0.3 were investigated . Parametto 7% wt . The samp < 0.05) effect on the elongation at break values  on the elongation at break values. This is in contrast to the existing literature, which has shown that an increase in the nanoclay concentration resulted in lower elongation at break values. More specifically, the incorporation of MMT presented a remarkably negative impact on the elongation at the break of starch films, and more specifically, the elongation at the break of starch films with 5% wt MMT on a dry starch basis was 3.2% compared with starch films without MMT, for which the elongation at break was 10.7% [However, a difference between the present work and the literature is the impact of MMT incorporation on the film matrix at the elongation at break. Ιt is remarkable that the addition of MMT at concentrations between 1 and 20% wt on a dry starch basis did not show a significant effect  (2), and then to a decrease in the tensile strength. The first trend is in accordance with the available literature, in which an increase in starch content is correlated with increasing tensile strength values—a fact that is explained by the strengthening of the amylose matrix [Parametric analysis data for the tensile strength showed that the starch, glycerol and MMT concentrations and the drying temperature had significant effects ( < 0.05) . Regardi < 0.05) , and thee matrix , which l2 when the MMT concentration was 20% wt. This is in accordance with the literature and the incorporation of nanoclays from different sources or different types that act as fillers in junction zones, strengthening the amylose matrix [Regarding the effect of the glycerol concentration on the tensile strength, a decreasing trend was observed as the glycerol concentration increased, as expected. Glycerol, which acts as a secondary plasticizer, interacts with water, causing a reduction in intramolecular forces and, consequently, a reduction in the tensile strength values and an increase in the elongation at break values ,50. Regae matrix ,9.2) and reaches a maximum at 20% wt . This trend is in accordance with the available literature, particularly the study of Romero-Bastida et al. (2015) and Kochkina et al. (2021), who reported an increase in the tensile strength in starch films, from 6.2 (0% wt MMT on a dry starch basis) to 15.2 N/mm2 (5% wt MMT on a dry starch basis) and 4 (0% wt MMT on a dry starch basis) to 13 N/mm2 (15% wt MMT on a dry starch basis), respectively [As mentioned above, MMT enhances the mechanical properties of polymeric films through the process of intercalation within the amylose network, creating intra- and inter-molecular interactions, and thus enhancing the strength and structure of the resulting films. Still in question is the range of nanoclay concentrations over which this enhancement of mechanical properties is observed, as well as whether this enhancement applies to all mechanical properties. Based on ectively ,53.p < 0.05) by the starch, glycerol and MMT concentration, the starch species and the drying tray type .Barrier properties, particularly the film’s resistance to moisture, is a very important property in materials intended for use in food packaging. Biodegradable films based on natural materials have poor barrier properties in general, because natural materials are hydrophilic . The WVPray type . More spp < 0.05) values for the WVP (−7 and 3.73 × 10−7 (g·Pa−1·h−1·m−1), respectively. Similar results were also observed in the study of Tang et al. (2008), in which MMT incorporation into corn starch films at 9% wt on a dry starch basis led to an one-fold decrease in the WVP compared to the control [2) [The incorporation of MMT into the thermoplastic starch solution for film casting applications was not only intended to solve problems related to the poor tensile properties of starch films, but also to improve the barrier properties, particularly the barrier against water vapor . In the  the WVP . More sp control , and in t al. 200, in whicThe opacity index is an indicator of how transparent a product is. Generally, light transmission properties are very important in the food packaging industry, since they determine how well a consumer can see a product before its purchase, and they thus ultimately influence the acceptance of the product by the consumers. It is favorable for a packaging material to be transparent, and therefore, a biodegradable food packaging material that aims to replace the conventional synthetic plastic packaging should also present good optical properties. As can be seen from Regarding the influence of the glycerol concentration on the opacity index, it can be seen that increasing the glycerol concentration from 20 to 50% wt on a dry starch basis led to a nearly three-fold decrease in the opacity index (or increase in the transparency). This observation was also made in the study of Fu et al. (2021), in which increasing the plasticizer concentration caused a decrease in the opacity index of starch films as well. This was mainly attributed to the better starch gelatinization in the presence of a higher plasticizer concentration, resulting in lower quantities of undissolved starch ghost particles that scatter the light and increase opacity .In the case of the MMT concentration, it can be seen that increasing the MMT concentration from 1 to 10.5% wt on a dry starch basis caused a ~two-fold increase in the opacity index, resulting in less transparent films. This observation is in agreement with the work of Slavutsky et al. (2012) , in whicThe film opacity increased as the drying temperature increased. When the film is dried at lower temperatures, the mobility of MMT particles decreases, inhibiting the aggregation of MMT particles and, therefore, resulting in less opaque films. Regarding the starch type, films prepared from chickpea starch were opaquer than films prepared from rice starch. Taking into consideration that the size of rice starch granules is 2–7 μm , whereasSince starch biodegradable films aim to replace conventional plastic packaging for food products, it is understandable that the film’s color properties are of great importance. The L* value is an indicator of the lightness and clarity of samples. As can be seen from Regarding the MMT concentration’s effect on the L* value, a decreasing trend was observed, which became steeper after ~10% wt MMT concentration on a dry starch basis. More specifically, the L* decreased from 87.2 to 86.5 for MMT concentrations between 1 and 10.5% wt on a dry starch basis, and it decreased from 86.5 to 83.9 for MMT concentrations between 10.5 and 20% wt on a dry starch basis. The same trend was observed in the study by Hong et al. (2022), in which increasing the MMT content in the starch films from 1 to 5% wt on a dry starch basis caused a decrease in the L* value from 95.6 to 88.1. This fact was attributed to the increase in the film’s density due to the large particle size of MMT .The factors influencing the film’s b* value or yellowness are presented in Furthermore, increasing the MMT concentration resulted in an increase in the film’s yellowness. More specifically, an increase in the MMT concentration from 1 to 5% wt on a dry starch basis led to an increase in the b* value from 8.1 to 10.1. This can be attributed to the yellowish color of the MMT powder itself. This increase, however, was much lower than the one reported in the work of Hong et al. (2022) for the same levels of MMT content. In this study, the b* value increased from 10.7 to 29.6 . However2 = 0.78) is:The optimization of the film thickness based on the statistically significant examined functional parameters  was derived using multiple linear regression analysis based on the results. The linear regression equation (R2 = 0.53) obtained from the experimental data is:The optimization of the mechanical properties and, more specifically, the elongation at the break based on the examined functional parameters (glycerol and MMT concentration) was derived using multiple linear regression analysis based on the results. The linear regression equation (R2 = 0.84) for the optimization of the tensile strength based on the examined functional parameters  is:The corresponding linear regression equation (R2 = 0.97) is:The optimization of the WVP was based on the statistically significant examined functional parameters . The linear regression equation (R2 = 0.95) is:The optimization of the film opacity index was based on the statistically significant examined functional parameters . The linear regression equation  (8–20 N/mm2) [−8 g·Pa−1·h−1·m−1) [The aim of the optimization and desirability analysis was to come up with the best combination of factors for obtaining desirable attributes in the final product. In starch-based biodegradable films for food packaging applications, desirability generally includes combining high tensile strength and elongation at break values, which will provide resistance and extensibility, respectively, but also low thickness values for low-cost applications, as well as high moisture barrier properties, and hence low WVP values. Therefore, the best outcome should include the maximization of the tensile strength and the elongation at break values and the minimization of thickness and WVP. The results from the optimization plot  in conju0 N/mm2) , and theh−1·m−1) . Prelimip < 0.05) (p < 0.05) at all sampling days than that of the commercial sample  . More spl sample . Also, tBrochothrix thermosphacta, Carnobacterium spp., Enterobacteriaceae, Lactobacillus spp., Leuconostoc spp., Pseudomonas spp. and Shewanella putrefaciens. These can cause slime production, off-odor and off-flavor production, gas production and the discoloration of meat and meat products [® extended the lag phase of the microbial culture during biodegradation studies [p > 0.05) according to the results of the statistical analysis  evenly on such an extended surface and the lack of appropriate equipment to produce such large quantities of thermoplastic starch dispersion. The latter demanded more vigorous agitation, which resulted in more air bubbles embedded within the film. Upon successfully overcoming these issues with the preparation of a uniform film, a piece with the appropriate dimensions was cut and tested in an industrial application, namely, handling of the film in a rewinding machine. The film was successfully rewound into a paper cylinder . This isThe observations from the present study represent a holistic approach to the preparation of starch biodegradable films and the quantitative and qualitative factors that affect such preparation. The optimization process  will be a useful tool for the industrial-scale design and production of biodegradable starch films according to their intended use. The incorporation of MMT at a level of 10.5% wt on a dry starch basis decreased the mesophilic and, most importantly, the psychrotrophic bacteria growth factor in a perishable food model, proving the antimicrobial activity and the potential of these films to be used as active food packaging materials. The biodegradability assessment showed that these films are a promising candidate for replacing synthetic polymer food packaging. Finally, the industrial-scale application of the films prepared according to the optimization results was demonstrated in terms of handling the film. In this vein, future plans include the evaluation of the lamination capability of biodegradable starch films reinforced with MMT. Since this type of packaging aims to replace conventional plastic packaging, the migration of nanoclays to food materials should be studied, because nanoclays have limited application due to the regulatory framework. However, if the nanoclay to be used is safe for human consumption, then migration should not be an issue of major concern. The cost of the raw materials for the preparation of the films is low, and starch and MMT are abundant in nature. The ability to use rice and legumes that have been rejected from the food industry as unfit for human and animal consumption as a starch source is expected to greatly contribute to the circular economy and sustainability, as well as to resolve issues related to using possible food-grade starch intended for human consumption. Although the results presented in this study are promising for the development of a fully biodegradable packaging material, further research is needed before industrial implantation, particularly regarding the manufacturing line of film production. Casting will not be applicable in this scenario, and other alternatives, such as extrusion and calendering, should be studied. This is a subject of ongoing research in our laboratory.


Aortic stent graft infection is a rare, but potentially lethal, complication of endovascular aortic aneurysm repair. Definitive treatment is complete stent graft explanation with in-line or extra-anatomical reconstruction. However, several factors can render such an operation unsafe, including the patient's overall fitness for surgery and partial incorporation of graft with a resulting robust inflammatory process, especially around the visceral vessels. We present the case of a 74-year-old man with a history of an infected fenestrated stent graft that was managed with partial explantation, wide debridement, and in situ reconstruction using a rifampin-soaked graft and a 360° omental wrap with good results. The use of fenestrated and branched endografts for repair of complex aortic aneurysms continues to gain worldwide acceptance owing to the technique's minimally invasive nature and shorter convalescence compared with open surgical repair.7,,Medical management with antibiotics alone or combined with percutaneous aneurysm sac drainage has been offered with various degrees of success.We present the case of a 74-year-old man with history of FEVAR for a juxtarenal aortic aneurysm. He had presented to an outside institution with constitutional symptoms and found to have an infected stent graft. He underwent partial explantation and reconstruction using a rifampin-soaked Dacron graft with good clinical results and complete resolution of infection found at the 3- and 6-month follow-up examinations and fluorine-18 fluorodeoxyglucose positron emission tomography (PET) scans. The patient provided written informed consent for the report of his case details and imaging studies.A and B). Broad-spectrum antibiotics were started, and he was transferred to our institution for further management. His blood cultures showed no growth. The findings from an extensive infectious and inflammatory workup led by infectious disease and vascular medicine at our institution, including for syphilis and human immunodeficiency virus, and blood cultures were negative. Rheumatologic serology tests, including for antinuclear antibody, antineutrophil cytoplasmic antibodies, complements, cyclic citrullinated peptide, and immunoglobulin G, were all normal.A 74-year-old man with cardiovascular risk factors significant for hypertension, hyperlipidemia, chronic obstructive pulmonary disease, congestive heart failure, ongoing tobacco dependence, and 5.6-cm juxtarenal aortic aneurysm underwent three-vessel FEVAR using a Zenith fenestrated stent graft  with stenting of the superior mesenteric artery and bilateral renal arteries (RAs) in 2015 with good results. He presented to an outside institution 7 years later with complaints of abdominal and back pain, poor appetite, malaise, night sweats, and failure to thrive. The laboratory study results were significant for leukocytosis and hyponatremia. Computed tomography angiography revealed a remodeled aneurysm sac, thickening of the aneurysm wall, and possible periaortic fluid collection that was concerning for aortitis and/or infection , A and BPET revealed increased, noncircumferential, uptake limited to the infrarenal aortic sac tissue suggestive of infection , C-F. SuThe procedure was performed via a midline transperitoneal approach. An attempt was made to perform a left medial visceral rotation.To the best of our knowledge, four cases of FEVAR explantation have been reported in the English literature, making ours the fifth case. Three of these were for infectionC-F and B-F). Our decision was guided by reports from the literature showing no reinfection in patients who had undergone partial stent graft explanation, wide infected tissue debridement, in situ reconstruction, and 360° omentum wrapping.,For our patient, we had planned for complete stent graft explantation. Our plan changed after realizing that the tissue above the RAs appeared uninvolved in the infectious process. Also, compared with the infrarenal device, the suprarenal stent graft was well incorporated, and no pus, abscess, or any SAEF was found. This was consistent with the PET findings C-F and , B-F. OuIt is reasonable to argue that an autogenous or a homograft should have been the conduit of choice. The decision to use a rifampin-soaked Dacron graft was because (1) unlike “early” infections, “late” graft infections without obvious SAEF usually result from less virulent pathogens; (2) no pus or abscess was found during the operation; (3) the cultures were negative; and (4) rifampin-soaked Dacron grafts have been proved effective, even in cases of pseudomonas as long as the infected tissue is debrided and the graft is wrapped 360° in omentum, as was it was for our patient .18 GraftPartial FEVAR explantation with wide debridement of all infected tissue, followed by in situ reconstruction with a rifampin-soaked Dacron graft and 360° omental wrap, appears to be a safe alternative to complete stent graft explantation for patients with no pus or abscess and a well-incorporated graft. Patients should be followed up for life and advised regarding the risk of recurrence.


The study aims to evaluate the wear surface using 3D surface roughness and other material characterization of zirconia fabricated using photopolymerization based Lithography-based Ceramic Manufacturing (LCM).3. Scanning Electron Microscope, 3D–profilometer, X-ray Diffraction, and hardness test characterized the samples before and after wear and Coefficient of friction (COF) was monitored.LCM technology was used to fabricate zirconia specimens of size 10 × 10 × 2mmThe COF was around 0.7 and did not differ much between the horizontally and vertically printed specimens. However, the surface roughness after wear for horizontally printed specimen was 0.567 ± 0.139 μm, while that for vertically printed specimen was 0.379 ± 0.080 μm. The reduced valley depth and the dale void volume were low for the vertically printed zirconia specimen, indicating lesser voids and low fluid retention. In addition, it was observed that the hardness value of the vertically printed sample was better. The scanning electron microscopic images and 3D surface profiles of the zirconia specimens depicted the surface topography and revealed the wear track.The study shows that zirconia fabricated using LCM technology possesses surface roughness of about 0.5 μm with no machining scars that are usually associated with CAD/CAM dentistry and also indicating agreement with clinically acceptable values for minimal surface roughness of dental restorations. Dental restorations using LCM fabricated zirconia redues the requirement of post-processing work flow that is part of CAD/CAM dentistry. Computer-aided design and computer-aided manufacturing (CAD/CAM) technologies and additive manufacturing are now used for zirconia processing , 2. ZircAdditive manufacturing (AM) paves the way for developing the manufacturing technology paradigm. High-strength ceramics were created using light-curing additive manufacturing techniques like Stereolithography (SLA) and Digital Light Processing (DLP) , 7. LighHowever, the adoption of AM technology is limited by a few technological challenges, one of which is the rough surface texture of AM, which is inferior to that present in manufacturing processes employing conventional technology , 15. MatHowever, for applications, a proper understanding of the tribological characteristics of zirconia is a prerequisite. Though several researchers have previously investigated the wear behaviour of CAD/CAM milled zirconia, there are not many reports on the study of tribological properties of additively manufactured structures –27. HencA CeraFab System S65 Medical 3D printer by Lithoz GmbH , was chosen to manufacture 3D-printed ceramic specimens. DLP printing was done from the bottom up using this technology. The machine’s build platform equals 102 × 64 mm² and allows for a maximum print height of 320 mm. A Digital Mirror Device (DMD) projector with a lateral resolution of 1920 × 1080 pixels  was integrated to a polymerization LED light with a wavelength of 465 nm. LithaCon 3Y 210 (3 mol percent Yttria-stabilized Zirconia (3Y-TZP)) slurries from Lithoz GmbH  were used.Specimens have been designed with Deskartes 3Data Expert  as cuboids of dimension 10 × 10 × 2 mm³ (X×Y×Z) and exported as STL-file. There were total five samples are prepared for each group.Two print jobs  have been conducted with the parameters presented in Table For characterization one sample is used from each group. The material characterization was carried out using a Scanning Electron Microscope (SEM) , that employs a high vacuum source operating at 5 kV voltage and 60 µA current intensity to study the zirconia specimens’ surfaces that were subjected to various surface treatment processes. The X-ray diffraction pattern of the zirconia specimens were obtained using XRD . The Cu k-α radiation (wavelength = 0.15406 nm) was used to determine the crystalline phase of the surfaces. The scan was performed with a scanning step of 0.02° in the 2θ range of 10–80° to determine the nature of different phases. The 3D-surface roughness . The wear behaviour of four samples from each group was studied. The antagonist Zirconia ball had a diameter of 6 mm, while the block dimension of the zirconia plate was 10 × 10 × 2 mm³. The wear test parameters were evaluated under a constant applied load of 10 N at a temperature of 37 ± 1°, with 0.5 mm stroke length, for a duration of 1 h at a frequency of 5 Hz. Distilled water (1000 ml) was used to prepare the artificial saliva medium [The investigation of the wear behaviour was conducted on the Y-TZP specimens with a ZrOa medium . The friSEM images with the 3D topography of the vertically printed (V.P) and horizontally printed (H.P) micropores on the zirconia specimens are shown in Fig. The results of the Vickers microhardness test in Fig. During the initial cycles, the coefficient of friction (COF) for both the vertically and horizontally printed specimens was observed to increase, reach a maximum, and then decrease to attain a steady-state regime Fig. . The steCeramic additive manufacturing involves the bonding process, both within and in between layers, is caused by chemical reaction of the organic binder  The bonding depends on light intensity, time period allowed during irradiation as well as the reactivity of the binder formulation of the ceramic suspension. Other factors that affect bonding are the homogeneity of the ceramic particles within and between the layers and the solid loading, indicating green density. These parameters have a role for wear characteristics too.The SEM images in Fig. Surface roughness gives information on wear, lubrication, and component lifespan prediction, among other things. Several standards for evaluating the two-dimensional and three-dimensional surface roughness have been created and are widely used –30. The In the 3D–printing method, the surface texture forms naturally during the process of transfer, wherein exposure to light radiation causes the liquid used in the stereolithography process to harden in a layer by layer manner until the desired shape is achieved. The visible light radiation induces a polymerization process in which the polymerizable components present in the suspension combine together and solidify, thereby allowing them to be cast into a 3D object. The surface texture in this study is called micro-texture, since the peak  and valley  dimensions and the layer heights are much smaller than that observed in subtractive manufacturing. In the present study, when the surface layer was abraded, the surface roughness reduced, with the Sa values for H.P and V.P being 0.567 ± 0.139 μm and 0.379 ± 0.080 μm, respectively. The surfaces became smooth after wear, as seen in Fig. Anna Paradowska-Stolarz et al.  studied The compression and tensile study on the effect 3D printed resin and concluded the resistant tensility test . The autMaterial surface qualities have a significant impact on their tribological properties. Creating a textured surface while improving tribological performance that include achieving reduced coefficient of friction and increased resistance to wear, has been gaining significant attention in recent decades. In the present study, the measurement of the friction coefficient, as in Fig. From Fig. During tribology measurements, high points on the surfaces come into contact during wear or friction. The shape, form, and deformation qualities of the asperities play a role in tribology contact modelling. The Spk (reduced peak height) of H.P and V.P specimens predominately decreased after wear, as seen in Table Limitation of the study is that only zirconia by LCM technology and thickness of layer height was 25 μm is studied. The influence of layer orientation of different thicknesses on the tribological properties of 3D-printed parts made of a different material may be investigated in the future.For organizations aiming to enhance manufacturing efficiency, AM opens up new possibilities and lends itself to several alternatives. AM simplifies the traditional processes greatly and has the potential to become the standard in the coming decade. The investigation of the tribological characteristics of additively manufactured zirconia shows that the volumetric substance loss was negligible in the specimens subjected to occlusal wear by zirconia antagonists. Both the H.P and V.P specimens exhibited a friction coefficient of 0.7. Thus, both materials exhibit better resistance to wear. The results of the present study show similarity to those from the CAD/CAM milling process.Further evaluation revealed that the 3D surface roughness before and after wear ranges between 0.168 and 0.747 μm, much lower compared to subtractive manufacturing of zirconia. The direction of printing influences the material’s properties and hence must be considered when planning a printing strategy. The 3D roughness parameters like reduced valley depth (Svk) and the dale void volume (Vvv) were low for the vertically printed zirconia specimen, indicating lesser voids and low fluid retention that makes the printing process as an alternate chair side manufacturing for dentistry.


This contrasts sharply from the European experience of 46 left lobe LDLTs from 4 centers showing a relatively poor 1-year graft survival of 59.4% due to a high rate of small for size syndrome (SFSS) and hepatic artery thrombosis.2 The key to their excellent outcomes was achieved by the use of venous outflow augmentation and liberal use of splenectomy to modulate portal inflow.We would like to congratulate the authors for publishing this important article on the outcome of utilizing left lobe grafts in their series of living donor liver transplantation (LDLT).3 In contrast, no difference in survival were found between left lobe or right lobe recipient if only 1 risk factor was present. The Kyushu group reported donor age ≥ 48 years, MELD score ≥ 19, and end portal venous pressure ≥ 19 mm Hg as the important factors for the development of SFSS.4 These factors reflect on the poor graft quality from higher donor age, poor clinical status of the recipient and excessive portal flow after reperfusion of the partial graft. To highlight the important of graft selection, the Kyushu group has also devised a scoring system that incorporates factors such as graft size, donor age, MELD score, and the presence of portosystemic shunts, which correlate well with graft survival and can be employed for graft selection.5 Although there is currently no consensus on the selection criteria when comes to choosing left lobe graft, most groups have demonstrated that donor age, and MELD score as crucial deciding factors as mentioned. In fact, the European cohort with poor outcome with left lobe grafts reported MELD score >14 as the most significant factor for the development of SFSS.2 Looking at the Cleveland cohort, it is very clear that this is a highly selected group of donors and recipients when considering for left lobe graft with a donor median age of 36 years , low median MELD score of 12 , and less severe portal hypertension as evident by the low median splenic volume (611 mL for left lobe graft compared with 918 for right lobe graft). Their left lobe graft experience has been accumulated over 8 years from 2013 to 2020 sharing between the 2 centers ranging from 5 to 17 left lobe grafts per year (mean 7 to 8 per year). This likely represents only a fraction of their overall liver transplant activity and further suggests that the recipients chosen for left lobe graft were highly selected.From their series, 61 of 130 (47%) recipients received left lobe graft. Donor/recipient selection likely played a huge role to their highly favorable outcomes. The Kyoto group previously showed that the overall survival was significantly worse when using left lobe graft compared with right lobe graft in recipients who were considered high risk .6 Therefore, it is unclear how much contribution to current reported outcomes were related to patient selection or the use of splenectomy, the use of which has been shown to be a protective for graft dysfunction here. Although the reported morbidities with splenectomy were acceptable in this series, with sicker recipients, the added morbidity of splenectomy may become problematic and could lead to worse outcomes.As regards to the use of inflow modulation such as splenectomy in this series, a group from Tokyo has described in their series of 42 LDLTs using exclusively left lobe graft without the use of any inflow modulation technique with a very good 1-, 3-, and 5-year graft survival rate of 100%, 97%, and 91%, despite 38% of their recipients had graft-to-recipient weight ratio (GRWR) of less than 0.8%.7 This article has also reported the graft outcome when actual size of the graft was smaller than the expected minimum GRWR of 0.6%. While the 5-year graft survival of 88% and only 1 mortality amongst the 9 left lobe recipients is impressive, this is still small numbers, from selected donors and recipients. Until there are more data and replication of this practice in other centers, we feel that the usage of small left lobe grafts remains an option for very few and not a promised land for the many.It has been well established that the grafts are considered small for size when the GRWR is less than 0.8% or the standard liver volume is less than 35%.


Arquivos Brasileiros de Endocrinologia e Metabologia” 1 to “Archives of Endocrinology and Metabolism” (AE&M)2. This modification didn't affect the pertinence of the journal to Brazil  but, using English as the official language, became more available to the scientific word. As a matter of fact, the submission of articles from abroad increased substantially, ranging from 44.8% to 52.3% of total, encompassing about 50 different countries, despite the still bigger participation of Brazilian papers. Among the submissions from abroad, the top ten countries were Turkey, China, Iran, Portugal, India, Argentina, USA, Italy, Mexico and Greece, in decrescent order. The amount of total submissions of manuscripts per year (including Brazil) was 306 in 2015, 337 in 2016 and 320 in 2017 (2018 is still ongoing), with an acceptance rate of about 25% of total submissions.Four years have elapsed since I took the post of Editor-in-Chief and changed the traditional “Arquivos Brasileiros de Endocrinologia e Metabologia” to 1.076 – the first impact factor of AE&M. This achievement could not be attained without the dedicated and competent collaboration of our Associated Editors, as well as the Editorial Board and all the reviewers. I wish to express a heartfully acknowledgement and gratitude to all of them.Concerning the impact factor, the marker of a Journal's relevance, it increased from 0.056 as the last “I was honored by my pairs with an additional four years as Editor-in-Chief of the AE&M. I thank them for their confidence and will do my best to accomplish the task to improve our Journal's relevance in the scientific community.


Archives of Endocrinology and Metabolism – AE&M (formely ABE&M – Arquivos Brasileiros de Endocrinologia e Metabologia) is the official scientific journal of the Brazilian Society of Endocrinology and Metabolism (Sociedade Brasileira de Endocrinologia e Metabologia – SBEM) which is affiliated with the Brazilian Medical Association (Associação Médica Brasileira).The Besides SBEM, the alma mater society, the journal also provides a connection for publications with the following medical organizations and associations of interest in the fields of Endocrinology and Metabolism: Brazilian Diabetes Society (Sociedade Brasileira de Diabetes – SBD) and the Brazilian Association for the Study of Obesity (Associação Brasileira para o Estudo da Obesidade – ABESO).®/MEDLINE® U.S. National Library of Medicine, ISI-Web of Science, SCOPUS, BIREME-LILACS, Excerpta Medica, Chemical Abstracts, Biological Abstracts, Academic Google.This journal is published on a regular basis, with six printed issues per year in addition to online version at AE&M homepage and SciELO. Special issues on seleted topics as well the proceedings of the Brazilian Endocrinology Congresses are also published. It is a peer reviewed journal with a very scientifically respected Editorial Board. AE&M  is indexed on PubMedth anniversary of the foundation of the AE&M. It was with a great joy and surprise that I received a phone call from Marcello Bronstein, the current Editor-in-Chief of the AE&M, asking to write an editorial commenting on some historical facts about the AE&M. I immediately agreed because I do believe that the knowledge of how the Archives have reached this high level of a great scientific journal have developped over the years is important for the continuing progress of the journal.This year we celebrate the 66Journal of Clinical Endocrinology and Metabolism (JCEM) was founded by the Endocrine Society in the United States. Therefore the ABE&M together with the JCEM is one of the oldest medical journal in the field of Endocrinology.We do not know exactly who conceived the idea of launching a Brazilian journal in the field of endocrine glands. Around the nineteen fifties, there was a pletora of basic scientists in the axis Rio de Janeiro-São Paulo working in the area of internal secretion. Eventually the ABE&M was founded in 1951 by this basic scientist group together with another group of distinguished clinical medical doctors. These scientists doctors are considered the pioneers of Endocrinology in Brazil. They were either envolved in basic science or in clinical endocrinology. In the first group, we should mention Thales Martins and Ribeiro do Valle. Endocrinology at that time was commencing to be characterized as a clinical specialty. Among these medical doctors interested in endocrine disease we should cite Emilio Mattar, João Gabriel H. Cordeiro, Luciano Décourt, Arnaldo Sandoval, Luiz Carlos Lobo and many others, specially from Rio de Janeiro. Regarding the foundation of the ABE&M, all of them were represented by Waldemar Berardinelli, a famous endocrinologist from Rio, who is considered the founder and was the first Editor-in-Chief of the journal. Interestigly, the foundation year (1951) of the Archives was also the year that the We do not know exactly what came first, the society (SBEM) or the journal (ABE&M). But certainly, that time was the heyday of the growth of Endocrinology and the turning point for the recognition of Endocrinology as a medical specialty.Founder, Previous Editors and presente EditorWaldemar Berardinelli (Founder Editor) 1951-1955Thales Martins, 1951-1955Clementino Fraga Filho, 1957-1963Luiz Carlos Lobo, 1964-1966Pedro Colletti-Solberg, 1966-1968João Gabriel H. Cordeiro, 1969-1972Armando de Aguiar Pupo, 1978-1982Antonio Roberto Chacra, 1983-1990Rui Monteiro de Barros Maciel, 1991-1994Claudio E. Kater, 1995-2006Edna T. Kimura, 2007-2010Sergio Atala Dib, 2011-2014Marcello D. Bronstein, 2015-presentWe can divide the history of the AE&M in diferente stages accordingly to the tenures of the Editors-in-Chief. The first years are charecterized for publishing mainly the results of original articles related to experimental research. As the clinical specialty of Endocrinology emerged, many clinical articles in the field of physiopathology, diagnosis and treatment of endocrine and metabolic diseases started to increase. For reasons not very well clarified, there was a gap of publications from 1973 to 1977.In 1978, Armando de Aguiar Pupo was indicated as Editor-in-Chief. I remember the great effforts of Armando Pupo to revive the journal, proactively asking us to send manuscripts to be submitted and then published at the Archives. Armando Pupo can be considered the co-founder of this new phase of the ABE&M. We have to be very grateful to Armando Pupo for his dedication in revival the ArchivesConselho Nacional de Pesquisa). I am very grateful to CNPq, specially in the person of Reginaldo Holanda e Albuquerque, a great endocrinogist from Brasilia, who helped us to keep the journal alive. During that time, I had also to deal with the legal formalities of the journal and the connection of the Archives to our Brazilian Society of Endocrinology and Metabolism (SBEM). Another task was to make the Archives known to new subscribers and contributors and stimulate receiving manuscripts for publication.I followed Pupo as the Editor-in-Chief (1983-1990). During those years Brazil was in economic turmoil and recession, with a high rate of inflation. My main objective at that time was raising funds in order to save the Archives and keep the publication of the journal. I wrote a project and I remember sending the Archives project to a great number of organizations, including pharmaceutical companies. Finances were very bad at that time and we received a lot of refusals. Eventually we got a support from the Brazilian Medical Association and the CNPq , who followed Kater, was one of the most proficuous in the history of the Archives. In 2009, Edna Kimura expanded the fascicles number/year from six to nine, a great achiement.The following remarkable facts were also achieved during her period and deserve to be mentioned: eletronic edition on the site, www.abem-sbem.org.br was made publically available extending the visibility of ABE&M, that was electronically visible also in the www.scielo.br. Eletronic Submission in 2008-January. First JCR-Web of Science Impact Factor in 2009. Financial support of CNPq (2007-2010). Edna also gave continuity to the publication of the tematic esdtions.Sergio Atala Dib was the next Editor-in-Chief. Regarding the rules for publication, Sergio Atala Dib during his tenure introduced an important issue against plagiarism. That was a great achievement among others that Dib has contributed for the Archives. After completing his four year period as Editor-in-Chief, he wrote a editorial where he enphasised the importance of this measure: “In order to regulate the publishing procedures in ABE&M after publication, the publishing authorization and the copyright cession term, a tool for the transference of the copyright to ABE&M, was created with the aid of the Juridical Department of the Brazilian Society of Endocrinology and Metabolism. In this era when publications became profuse and sophisticated, there is an increase in the prevalence of plagiarism, including in journals of high impact factor. In order to protect ABE&M from plagiarism, an anti-plagiarism tool was recently acquired, and all manuscripts will be analyzed by it before being published”.Archives of Endocrinology and Metabolism” (AE&M). As he wrote in his first editorial, “the aim was to make Brazil even more visible in the international scientific community. In fact, I expect that, little by little, colleagues in Brazil and abroad give prestige to our journal by submitting high level articles. This will only be possible if AE&M, by raising its impact fator”. The result of that change has been positive and a great number of articles from several countries around the world have been published. Brazilian authors, as well, are now submitting more and more articles to AE&M.The more recent and innovative phase on the history of the Archives started by the time Marcello D. Bronstein was apointed as Editor-in-Chief at the beggining of 2015. Bronstein totally transformed the journal into an international one. The first step was changing the name to “Finally, I would like to congratulate Marcello D. Bronstein for his great achievement as the present Editor-in-Chief of the AE&M and to thank him for inviting and giving me the opportunity of writing this editorial.


Pinus elliottii used as rootstock instead of homologous rootstock, have been proved to accelerate early growth of the scion (Pinus massoniana), for cultivation of large diameter wood. However, the basal diameter of scions in heterologous grafts was significantly smaller than self-graft 10 years later, according to field investigation, which was opposed to cultivation objectives. Although advantage of heterologous grafts has been reported, less is known about the long term effect of heterologous rootstock on scions of P. massoniana. The aim of present study was to investigate the mechanism of the above difference. Toward this aim, the growth traits and physiological characteristics of scions in the two graft groups were studied, and the underlying mechanism was preliminarily explored through transcriptome sequencing technology. Results showed that scions of heterologous grafts had less TSCA compared to self-grafts, while no significant difference of plant height, number of branches and canopy volume between two graft groups. Besides, scion leaves of heterologous grafts displayed higher antioxidant enzyme activity and lower chlorophyll content. And interactions between rootstocks and scions had also changed the mineral element composition of scion leaves. Compared with homologous grafts, scion leaves of heterologous grafts accumulated more K+, Mg2+ and Zn2+, but less Ca2+,which have been proved to be conducive to the growth of stem diameter of P. massoniana. Moreover, a comparative transcriptome analysis of two graft groups showed that DEGs between them were mainly caused by the specificity of rootstock. GO and KEGG analysis found that heterologous rootstock had different gene expression preferences, and the gene expression level between rootstocks and scions were significantly different, such as auxin auxin-related genes and stress responsive genes. That may imply that auxin pathway played an important role not only in grafting healing process, but also in maintaining the growth between scion and stock. Summary of all above results, we concluded that the long term effect of heterologous rootstock on scions may be unsatisfactory with the later rapidly growth of scion, probably due to delayed graft incompatibility between scion and stock of heterologous grafts. This study may remind us that the long-term growth of the scion deserves attention as well as the healing process, which could also provide a basis for delayed graft incompatibility. Many studies have indicated profound influence of rootstocks on scion cultivars. Because the scion-rootstock interaction influences tree physiology, absorption capacity of mineral elements, yield efficiency, maturity and fruit quality10.Grafting is an effective and essential technique used worldwide in the planting industries to increase the yield, enhance biotic and abiotic stress resistance and modify the scion architecturePinus massoniana (Lamd.) is one of the most widely distributed tree species in the genus of Pinus in China, which plays a pivotal role in ecological environment construction and sustainable forestry production11. A great deal of research has been conducted on germplasm resources, genetic determination and selection, and improved varieties breeding12. Meanwhile, multi-generation clonal seed orchards based on homologous graft have been established13. Nevertheless, the slow growth of P. massoniana at early stages seriously hindered its popularization and application. Interspecific hybridization is difficult because of its cross-incompatibility, long cross breeding cycles, and difficult separation of progeny traits14. Graft is one of the most widely useful methods of asexual reproduction, aim to make genetic improvement of germplasm resources so as to improve offspring and improve their performance15. The key to success of grafting is the compatibility between rootstock and scion16. Therefore, the selection of rootstock is extremely important17. As a member of the double vascular subgenus,Pinus elliottii (Engelm.) grows faster and has a better trunk structure than P. massoniana. In addition, its afforestation application areas overlap partially with that of P.massonian18. It was also reported that the 2.5-year-old grafted trees were 60.8% and 197.2% larger of diameter than the homologous graft trees, when P. elliottii were used to graft P. massonian by researchers of Guangxi Academy of Forestry13. Thus, the heterologous graft might be a good idea to ameliorate the characteristics of slow growth of Masson's pine at early growth stage. Although the success of heterologous grafts, we found that scions grafted on P. elliottii were not better than those self-grafted tress, 10 years later after graft, particularly in the trunk cross-sectional area (TSCA). It is very necessary to study the causes of this problem, because large diameter wood is the ultimate goal of commercial foresters depend on basic research.Based on 10 years of heterologous and homologous grafted seedlings, we were able to detect the long term effect of heterologous rootstocks on scion by physiological and biochemical methods, and preliminarily explore the underlying mechanism together with transcriptome sequencing technology. And the results were supposed to have important practical application value and theoretical significance.P. massoniana national fine variety base in Duyun City, Guizhou Province, China, on September 2019. The scions used in the experiment were all from the same clone of Masson's pine. Thrity 10-year-old trees in heterologous grafts P. massoniana (scion)/P. elliottii (stock) and thirty 10-year-old trees in homologous grafts were selected for growth traits measurement. Mature leaves were collected from these trees for physiological measurement. Phloem tissues of 5 cm above and below the graft union of three trees in each grafted groups were collected for RNAseq. And all collected samples were quickly frozen by liquid nitrogen and stored at − 80 °C.This study has complied with relevant institutional, national, and international guidelines and legislation. The collection of materials has been approved by relevant departments. The material were collected from the gene collection area  of 2b, Where a: spread (E-W) + spread (N-S)/2, b: 1/2tree height.For estimating canopy volume, the tree height was measured from the collar region at the base to the longest shoots at top. Diameter at breast height (DBH) and canopy diameter were both measured by measuring scale in N–S and E–W directions. TCSA was measured using the following formula: TCSA = π (d/2)2, where d = average of cross measurement of trunk in N–S and E–W directions. Canopy volume (CV) was calculated according to the equation Canopy volume = 4/3*π*a19. The extinction values of samples were measured by UV Spectrophotometer at 470 nm, 649 nm and 665 nm for pigment concentrations Chlorophyll a (Ca) and Chlorophyll b (Cb) respectively. And the Chlorophyll content calculation formula was below:The leaf chlorophyll content was estimated by 95% ethanol extraction methodLeaves in each tree were randomly collected from all directions, washed with tape water and followed by double distilled water. The leaves were then dried at 105° ± 1 °C in oven for 0.5 h and then at 60 °C to constant weight.20.Phosphorus in leaves was estimated by vando-molybdo-phosphoric yellow color method21.Total K+ contents in leaves were estimated according to Jackson22. For quantification of Ca2+and K+ in leaves, 1.0 g dry weight was digested in diacid (using HNO3 and HClO4 in the ratio of 9:4). K+ were analysed by a micro-processor based flame photometer. And Ca2+, Mg2+, Zn2+, Cu2+and Fe2+contents were determined by atomic absorption spec-trophotometer.Nitrogen content in leaves was determined by using Digestion Block method23. POD activity was measured as the increase in absorbance at 470 nm caused by guaiacol oxidation24. CAT activity was measured as the decline in absorbance at 240 nm caused by a decrease in H2O2 removal25.In each sample, 0.5 g fresh leaf was ground with a pestle in an ice-cold mortar with 4 ml of 50 mM phosphate buffer (pH 7.0). Activations of enzymes were measured in the supernatant of homogenates centrifuged for 20 min at 4 °C at 12,000 rpm. SOD activity was assayed by measuring its ability to inhibit the photochemical reduction of nitro blue tetrazolium26. Soluble sugar were measured according to Laurentin and Edwards27 and following the manufacturer’s directions with absorbance readings at 620 nm and quantified by comparison to glucose standards.Samples were placed in 1.5 mL microfuge tubes and crushed in 100 mM sodium phosphate buffer (pH 7.8) for protein and carbohydrate extraction. At 4 C, samples were centrifuged for 15 min at 16,000 rpm. The supernatants were removed and analyzed. Protein samples were diluted 1:50 and carbohydrate samples were diluted 1:25 in the sodium phosphate buffer before analysis. Protein levels were determined using a BCA assay following the manufacturer’s directions with absorbance readings at 595 nm and quantified by comparison to BCA standardshttps://www.ncbi.nlm.nih.gov/sra/). The accession number is BioProject ID: PRJNA792704.Total RNA was extracted from the above samples using the TRIZOL kit (Invitrogen) and then treated with DNaseI to remove DNA. Before preparation of the RNA libraries, total RNA samples were quantified. 1% agarose gel was used to monitor degradation and contamination of the RNA samples. The mRNA was enriched with magnetic beads of Oligo (dT) beads after the quality test. The fragmentation buffer was added to break the mRNA into short pieces. Using mRNA as template, cDNA was synthesized by reverse transcription using six base random primers. Illuminape library was established after double stranded cDNA purified, terminal repair. After passing quality inspection, Illumina PE library was constructed and 2 × 150 bp cDNA library was sequenced. The raw data generated in this study have been uploaded to Sequence Read Archive (http://hannonlab.cshl.edu/fastx_toolkit/); Seqprep (https://github.com/jstjohn/SeqPrep) was used for quality control on the original sequencing data, the reads with linker, N ratio greater than 0.1% and low-quality sequences were removed to obtain clean reads. Bowtie2 (https://sourceforge.net/projects/bowtie-bio/files/bowtie2/2.3.5.1/) was used to compare the full-length transcriptome of the third generation of P.massoniana obtained for mapping and RSEM for transcription. In this quantity, the obtained read Count value is FPKM to analyze gene expression levels. The gene differential expression analysis of multiple samples (≥ 2) was carried out by DESeq2 (http://bioconductor.org/packages/stats/bioc/DESeq2/) , which was defined as differentially expressed genes (DEGs) according to the screening criteria of|log2.Fold_change|> 1 and q.value < 0.005. Differential expression gene (DEGs) were assigned to gene ontology (GO) enrichment analysis using the GOseq R package, and GO terms with corrected P-values < 0.05 were considered significantly enriched. The statistical enrichment of DEGs inThe quality of the original sequencing data of each sample was evaluated by fastx _ toolkit_0.0.14 (http://www.genome.jp/kegg/) was tested using KOBAS software.KEGG pathways (https://cloud.majorbio.com ) and GraphPad Prism 8 (https://www.graphpad.com/scientific-software/prism/).All data were analyzed with SPSS Statistical Software (Version24.0). Student’s t-test was used to compare means between two graft groups. Data visualization and GSEA analysis were performed using the Majorbio Cloud Platform , polyphenoloxidase (POD), and catalase(CAT) activity and lower malondialdehyde (MDA) content of scion leaves in heterologous grafts were found than those in homologous grafts Fig. , indicatAim to investigate the correlativity between scion growth traits and these physiological and biochemical indexes, a correlation analysis was conducted Fig. . The resRNA-Seq results were summarized in Table To evaluate gene function of these DEGs, DEGs between grafted scions and rootstocks were annotated using GO and GSEA method Fig. A–D. And KEGG pathway enrichment analysis was employed to further understand the main biochemical metabolic and signal transduction pathways between two grafted groups Fig. A,B. Ten Due to the interaction between rootstock and scion, intersection of DEGs between Heterg_r and Heterg_s and DEGs between Homog_r and Homog_s, namely common DEGs caused by heterologous and homologous grafts, were also analyzed by GO Fig.  and KEGGSince auxin plays an important role during grafting reconnection, we wanted to investigate whether this hormone also affected the growth between scion and rootstock at a later stage. Thus, the auxin signal transduction pathway of plant hormones was primarily studied Fig. . It was 29. It is critical to the tree growth that the rootstock-graft interactions are compatible, including the root characteristics30, absorption and translocation of water and nutrients32 and different signals passing through the graft union4. In the present study, we measured the growth and development traits, physiology and biochemistry of P. massoniana scion as well as transcriptomic difference to study the long-term effect of heterologous rootstock on scion growth. Unexpectedly our results showed that the P. elliottii rootstock had no significantly positive effect on the development and physiology of the P. massoniana scion compared to homologous graft 10 years after graft. Although heterologous grafting scion had more content of soluble sugar, soluble protein and higher antioxidant enzymes activity, their TCSA were lower than homologous grafted scion, which was not good for timber forest cultivation.In modern agriculture, grafting is widely used to improve biotic and abiotic stress tolerance, modify plant architecture, induce precocious flowering and rejuvenate old perennial varieties, boost yield, and more32. In heterologous graft groups rootstocks changed the content of mineral elements in leaves, with lower content of K+ and Ca2+ and higher content of Zn2+ and Mg2+compared to homologous graft groups, which was consistent with the previous researches that nutrition efficiency could be influenced by the rootstock34. Difference in leaf nutrient concentration of different rootstocks might be due to alteration of root morphology and hydraulic conductance. Because it have been reported that rootstocks had differential capacity of hydraulic conductance, which was positively correlated with nutrient accumulation34. As for P. massoniana, leaf calcium was positively correlated with thoracic diameter, but leaf zinc was inversely correlated with diameter31, which was consistent with our correlation analysis.Rootstock had a meaningful impact on nutrient absorption and the nutrient uptake efficiency varied with the rootstocks29. Grafting, as a wounding stress, triggers antioxidant defense systems4, resulting a higher level of reactive oxygen species (ROS) or a less efficient detoxification system on incompatible scion/rootstock interfaces35. Initial healing of the graft union does not ensure long-term compatibility, because some stock/scion combinations incompatibility may appear only after several years36. In this article, higher antioxidant enzymes activity, soluble protein were found in heterologous grafting scion leaves, which could indicate that incompatibility may exist between rootstock and scion in P. massoniana/P. elliottii heterologous graft system due to a belated response to the auxin and carbohydrate imbalance38 caused by phloem graft union irregularities. Meanwhile, the study also revealed that rootstock-scion interactions persist throughout the composite plant's lifespan, even if graft compatibility was satisfactory38.More researches showed complex physiological metabolites were affected during graft union formation40. However, much attention had been absorbed on the connection of the graft union. Until recently, little was known about the long-term changes between rootstocks and scions. RNA-Seq was used in this study to identify DEGs in heterologous and homologous grafted tissues. Functional annotation and enrichment analysis of DEGs revealed that the overrepresented genes were involved in physiological metabolism  between scion and rootstock in homologous graft group, while response to water deprivation and abscisic acid between scion and rootstock in heterologous graft group. These transcriptomic results suggested that stress about water existed between scion and rootstock in heterologous grafting group due to delayed graft incompatibility, with the later rapidly growth of scion41. And this could be partly proved by the higher antioxidant enzymes activity, soluble protein and soluble sugar in leaves.It has also been reported that grafting induces differences in the transcriptome profile of grafted parents in plants, such as grapevines43 and regulate the normal function of nutrients and water transportation, resulting in more stem growth. Thus, IAA may also play an important role in maintaining the function of grafted plant, not only at the beginning of graft union reconnection. When compared with Heterg_s and Homog_r, water deprivation and abscisic acid response were both upregulated in Heterg_r. Together with physiological data, we could conclude that P. elliottii as rootstock to graft P. massoniana was more sensitive to water deprivation than P. massoniana. The observed reactions  in scions were mainly due to upregulation of enriched genes between rootstock and scion in Heterologous graft.Then we focused on the auxin-activated signaling pathway in homologous graft. Results showed that AUX1、IAA13、IAA9 genes, bZIP transcription factor were differentially expressed between scion and rootstock in homologous graft group when compared to heterologous graft. All those auxin related genes may contribute to maintain the local auxin concentration above and below the graft portComplex interactions between rootstock and scion have changed mineral element composition and antioxidant enzyme activity in scion as well as transcription changes. Based on the results of compared transcriptome analysis, there may be late incompatibility between rootstock and scion of Heterologous graft. The delayed incompatibility was mainly caused by auxin imbalance between rootstocks and scions and large moisture requirement for rapid growth of scion in later period.


To compare the failure rates and the prevalence of technical complications between full-coverage tooth-supported monolithic zirconia (MZ) and porcelain-veneered zirconia (PVZ) fixed dental prosthesis, based on a systematic literature review.An electronic search was performed in three databases, supplemented by hand searching. Several statistical methods were used.Seventy-four publications reported 6370 restorations , followed up until 152 months. A total of 216 prostheses failed, and survival was statistically significant different between groups. PVZ had higher occurrence of complications than MZ; the difference was especially greater for either minor or major chipping. The difference in prevalence of either minor or major chipping was statistically significant for PVZ prostheses between cementation with glass ionomer and adhesive resin cement (higher), adhesive resin and resin-modified glass ionomer cement , and between RMGIC (higher) and glass ionomer cement. For MZ the difference was significant only for minor chipping between RMGIC (higher) and adhesive resin cement. Abutment teeth to PVZ prostheses more often lost vitality. Decementation was not observed with RMGIC. Air abrasion did not seem to clinically decrease the decementation risk. The 5-year difference in the occurrence of minor or major chipping between MZ and PVZ prostheses was statistically significant, but nor for catastrophic fracture.Tooth-supported PVZ prostheses present higher failure and complication rates than MZ prosthesis. The difference in complications is striking when it comes to chipping.Awareness of the outcome differences between different types of zirconia prostheses is important for clinical practice.The online version contains supplementary material available at 10.1007/s00784-023-05219-4. The development of yttria-stabilized tetragonal zirconia polycrystalline (Y-TZP) for dental purposes has resulted in a range of different products. The main advantages of Y-TZP include exceptional mechanical properties, biocompatibility, and resistance to corrosion , 2. One There are today two main categories of dental prostheses made of Y-TZP: monolithic zirconia (MZ), in which the bulk of the restorations is made of zirconia and external stains are painted in order to better copy the natural colors of teeth, and porcelain-veneered zirconia (PVZ), in which a framework of zirconia is fabricated, upon which veneering porcelain is applied . ProstheQuestions have been raised concerning the effect of cement type on the clinical outcomes, although a recent review failed to find evidence of difference in the complication patterns between adhesive and conventional cementation for zirconia and lithium disilicate tooth-supported crowns .Therefore, the purpose of the present systematic review of the literature was to test the null hypothesis of no difference in the failure rates and the prevalence of technical complications between full-coverage tooth-supported MZ and PVZ fixed dental prosthesis (FDP). The review presented an additional focus on the effect of the type of cement used on the occurrence of complications.This study followed the PRISMA Statement guidelines . RegistrThe focused question was elaborated according to the PICO format : In patients being rehabilitated with dental prosthetic restorations, is there a difference in the failure rate and in the prevalence of technical complications between monolithic zirconia and porcelain-veneered zirconia prostheses?An electronic search without time restrictions was undertaken in October 2021, with a complementary updated search in June 2023, in the following databases: PubMed/Medline, Web of Science, and Science Direct. The following terms were used in the search strategies: (tooth OR teeth OR tooth-supported) AND  AND (monolithic zirconia OR porcelain-veneered zirconia OR porcelain fused to zirconia OR pressed on zirconia ceramics).Due to the initial large number of search entries in Science Direct, the options “research articles” and “review articles” were selected in the filter “Article type.”A manual search of all related prosthodontic and specialist dental and oral journals was performed. The reference list of the identified studies and the relevant reviews on the subject were also checked for possible additional studies. Gray literature was not searched.Eligibility criteria included clinical human studies, either randomized or not, providing information on the clinical outcomes of full-coverage tooth-supported MZ and/or PVZ FDPs. The minimum of follow-up was set to 6 months. Only publications written in English were considered for inclusion.Combined tooth-implant-supported FDP cases were excluded, as well as zirconia copings to be used with removable partial dentures. Inlay-retained FDP cases were excluded, as they do not present the same quality of support as a conventional FDP. Cases of zirconia restorations aimed to be cemented on abutment teeth for partial removable dental prosthesis were excluded, as these are subjected to additional forces on the occlusal rest seat and from retentive clasps. Cases of partial crowns and endocrowns were excluded. Additional exclusion criteria were case reports, technical reports, animal studies, in vitro studies, and reviews papers.Two reviewers independently screened the titles and abstracts of the entries (publications) resulted from the searches conducted in the three databases. The full text of a publication was obtained when this appeared to meet the inclusion criteria, or for when there were insufficient data in the title and abstract to make a clear decision, which was carried out independently by two reviewers. Any disagreements between the reviewers were solved by discussion.The detection of duplicate references from different electronic databases was performed by using the RefWorks Reference Management Software .The Quality Assessment Tool for Case Series Studies of the National Institutes of Health  was used2), with its crystal structure stabilized by the addition of yttrium oxide (Y2O3) or yttria [Yttria-stabilized zirconia is a ceramic material, a white crystalline oxide of zirconium  over the observation period. Survival was defined as the cases in which the prothesis remained in situ, with the occurrence of any complication, while still in function. Prostheses removed or replaced were considered failed prostheses .Biological complications included caries, loss of tooth vitality, periapical infection, mobility, and abutment loss. Technical complications included tooth fracture, loss of retention, framework fracture, and minor and major veneer chipping.Chipping was defined as loss of ceramic substance, being classified as minor  or major  , 12.Catastrophic fracture was defined as a fracture extending through the entire bulk of the restoration, namely, from the external to the inner surface.“Unacceptable color” and “unacceptable anatomical form” of the restorations were considered neither biological nor technical complications, and therefore not considered for the present review.From the studies included in the final analysis, the following data were extracted (when available): year of publication, study design and setting, number of patients, patients’ age, type of material , number of failed and placed prosthesis, jaws receiving the prosthesis (maxilla and/or mandible), type of prosthetic rehabilitation, opposing dentition, presence of smokers or bruxers, and follow-up time. Authors of the included studies were contacted for additional information in case of need for additional data.Descriptive statistics were expressed in means, standard deviations (SD), and percentages; Kolmogorov–Smirnov test was used to evaluate normal distribution and Levene’s test to evaluate homoscedasticity. The comparison of continuous variables between two independent groups was done with Student’s t-test or Mann–Whitney, and Pearson’s chi-squared or Fisher’s exact test for the comparison of categorical variables. Comparison of prostheses survival between different groups was done with the log-rank (Mantel-Cox) test. Information for the period of prosthesis failure extracted from the included studies was used to calculate interval survival rate (ISR), and the cumulative survival rate (CSR) was calculated over the maximal period of follow-up reported, in a life-table survival analysis.The estimated 5-year occurrence proportions of minor and major chipping, as well as of catastrophic fracture were calculated, by assuming constant event rates. The total exposure time of the prostheses of the studies was calculated, and from this the estimated annual rate per 100 prosthesis years and the estimated occurrence after 5 years for each of these 3 outcomes were calculated. The 95% confidence intervals for the survival proportions were calculated using the 95% confidence limits of the event rates. A meta-analysis for each group was conducted using proportions with inverse-variance weights. The value of 0.5 were added to zero frequencies. Groups were then compared using a z-test.p < 0.05. Data were statistically analyzed using the SPSS version 28 software .The degree of statistical significance was considered n = 16), not enough or no clinical outcome data available (n = 4), no separate information on clinical outcomes between tooth- and implant-supported prostheses (n = 3), endocrowns (n = 3), inlay-retained restorations (n = 3), more than one type of restoration material included in the study, but no separate data on the zirconia restorations (n = 1), restorations made of zirconia-reinforced lithium silicate (n = 1), technical complications not investigated (n = 1), restorations in abutment teeth for partial removable dentures (n = 1), 3D-printed zirconia crowns (n = 1), no follow-up (n = 1), not providing clinical information regarding the number of prosthesis, but the number of prosthetic units (n = 1), lab study (n = 1), single-retainer prostheses (n = 1), partial crowns (n = 1), and study of post-cementation occlusion with no follow-up (n = 1). Thus, 74 publications were included in the review [The study selection process is summarized in Fig. e review –86.Fig. The 74 included clinical studies reported 6264 tooth-supported zirconia FDPs, supported by 8200 abutment teeth (pontics were not taken into consideration in this amount). The 3549 patients consisted of 1377 (43.1%) men and 1818 (56.9%) women, with no available information on gender for 354 patients.p < 0.001; Mann–Whitney test). Women were more often than men rehabilitated with PVZ FDPs, the opposite happening with MZ FDPs . Most of the prostheses were single crowns, for both groups (67.7% of PVZ and 94.4% of MZ). Adhesive resin was most commonly used for cementation of the prostheses, and natural teeth were most often observed in the opposing arch occluding to the zirconia prostheses.Table In general, PVZ FDPs had a higher occurrence of complications than MZ FDPs. The difference was, in particular, greater when either minor or major chip-offs were considered. Decementation was more commonly seen in prosthesis cemented with adhesive resin than with glass ionomer, with no occurrences with resin-modified glass ionomer.Table Table Table Table p = 0.935; Mann–Whitney test). There was no clear concentration of failures in any period of the follow-up, either for PVZ or MZ prostheses . As the number of cases entering the longest follow-up intervals was very low for both groups, the survival between the groups was compared after the follow-up was limited to 5 years, which still resulted in a statistically significant difference between the groups . When the data were limited to follow-up up to 5 years, the CSR was 88.7% and 93.3% for PVZ and for MZ prostheses, respectively.A total of 216 prostheses were considered failure, and the mean time from prosthesis cementation to failure was not statistically significant different between the groups , but nor for the occurrence of catastrophic fracture (p = 0.122).The estimated 5-year occurrence of minor chipping, major chipping, and catastrophic fracture for MZ prostheses were 0.076% , 0.080% , and 0.301% , respectively (Table All included studies were classified as “good” (Table p = 0.007). The reason for this difference can be due to the great difference in the occurrence of some complications that led to removal and/or replacement of the prosthesis. A much higher occurrence of porcelain chipping/fracture, framework fracture, and vitality loss were observed among PVZ than among MZ restorations.The aim of the present review was to evaluate and compare the clinical outcomes between full-coverage tooth-supported MZ and PVZ FDPs. The results showed that MZ prostheses present higher survival rates than PVZ prostheses  may be related to the inherent difference in the restoration design between these two types of zirconia restorations, as PVZ restorations present a thinner core of zirconia material than MZ restorations, which in turn influences the thickness of the crown/prosthesis margins . TherefoTeeth supporting PVZ prostheses presented a higher rate of vitality loss than teeth supporting MZ prostheses , which could be related to the fact that veneer restorations are thicker, meaning that more underlying tooth structure needs to be removed , raisingThe rate of decementation was higher when prostheses were cemented with zinc phosphate (5.0%)—only cases of PVZ prostheses were cemented with this type of cement. The zinc phosphate cement should not be recommended due to unfavorable properties such as brittleness and water solubility . When itNo cases of decementation were observed among prostheses cemented with resin-modified glass ionomer, even when the inner surfaces of the prostheses were not air abraded previously to cementation. In general, the rate of decementation for zirconia restorations cemented with either conventional glass ionomer or adhesive resin cements was higher when the inner surface of the prostheses were air abraded before cementation. However, it seems that there is still some controversy whether air abrasion alters the shear bond strength of zirconia ceramic restorations . NeverthThe problem with decementation when adhesive cements are used may be due to the already aforementioned reasons, although in vitro studies showed that resin-modified glass-ionomer cement presented the same level of retentive quality or the same mean removal stress as resin luting agents –111. MorThe present review is not without limitations. First of all, most of the included studies were retrospective reports, which inherently results in flaws, manifested by the gaps in information and incomplete records. The number of technical complications observed is very probably underestimated, since not all studies reported data on all types of complications. Second, several professionals were involved in the treatment of these patients, which could have had some influence on the failure and complications rate. Third, much of the research in the field is limited by small cohort sizes and short follow-up periods, which could have led to an underestimation of the actual clinical outcomes.p = 0.007). The difference in the 5-year occurrence of minor (p < 0.001) and major chipping (p = 0.002) between MZ and PVZ prostheses was statistically significant, the same not happening with catastrophic fracture (p = 0.122). Loss of vitality happens more often with abutment teeth to PVZ prostheses. Decementation was not observed with resin-modified glass ionomer cement. Air abrasion does not seem to clinically decrease the risk of decementation.Tooth-supported PVZ FDPs present a lower survival than MZ FDPs (Supplementary file1 (DOCX 70 KB)Below is the link to the electronic supplementary material.


In this workshop we aim to discuss the ins and outs of publishing in psychiatry with practical guidance from both sides of the couch.The executive editors of the European Journal of Psychiatry  will talk about the experience of starting a journal from scratch with very limited resources and share practical tips with the participants about publishing for ECPs by ECPs.None Declared


Erratum zu:Psychotherapie 202310.1007/s00278-023-00646-wIn diesem Artikel fehlte N. S. Teichmann an der Psychologische Hochschule Berlin, Berlin, Deutschland in der Autorenliste. Die korrekte Autorenliste lautet: S. Gries, N. S. Teichmann, F. M. L. Beck-Hiestermann, B. Strauß, A. Gumz. Der Interessenkonflikt wurde ebenfalls ergänzt: N. S. Teichmann gibt an, dass kein Interessenkonflikt besteht.In diesem Artikel waren außerdem die Adressdaten für den Autor B. Strauß falsch angegeben. Statt ‚Friedrich-Schiller-Universität Jena, Jena, Deutschland‘ hätte sie ‚Universitätsklinikum Jena, Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Jena, Deutschland‘ lauten sollen.Der Originalbeitrag wurde korrigiert.


Ex-vivo normothermic perfusion (EVP) limits ischemic time allowing assessment of graft function. We investigated the outcome of HTx in 80 high-risk recipients transplanted with marginal donor and EVP-preserved grafts, from 2016 to 2021. The recipients median age was 57 years , with chronic renal failure in 61%, impaired liver function in 11% and previous cardiac surgery in 90%; 80% were mechanically supported. Median RADIAL score was 3. Mean graft ischemic time was 118 ± 25 min, “out-of-body” time 420 ± 66 min and median cardiopulmonary bypass (CPB) time 228 min (126–416). In-hospital mortality was 11% and ≥moderate primary graft dysfunction 16%. At univariable analysis, CPB time and high central venous pressure were risk factors for mortality. Actuarial survival at 1 and 3 years was 83% ± 4%, and 72% ± 7%, with a median follow-up of 16 months (range 2–43). Recipient and donor ages, pre-HTx extracorporeal life support and intra-aortic balloon pump were risk factors for late mortality. In conclusion, the use of EVP allows extension of the graft pool by recruitment of marginal donors to successfully perform HTx even in high-risk recipients.Extending selection criteria to face donor organ shortage in heart transplantation (HTx) may increase the risk of mortality.   Orthotopic heart transplantation (HTx) is considered the gold standard treatment for patients with advanced refractory heart failure; however, while the demand is growing, the possibility to perform HTx is still limited by the chronic donor shortage . AlthougCold static storage is the standard preservation technique of the donor graft, but it may not avoid ischemic and reperfusion injuries when preservation time exceeds 4 h [Ex-vivo normothermic perfusion (EVP) is a novel procedure that, maintaining donor grafts in a beating, normothermic condition, limits ischemia-reperfusion injuries, allowing potential recovery of suboptimal organs, also favoring recruitment of longer-distance donors. Moreover, during graft transportation, EVP allows real-time monitoring of graft hemodynamic and metabolic parameters and timely identification of potentially unsuitable hearts [e hearts .The aim of the present study was to investigate the clinical outcomes of HTx in high-risk recipients who were transplanted only with grafts, selected according to extended donor criteria and preserved with EVP.All consecutive high-risk patients who underwent HTx with grafts from marginal donors and preserved with EVP at the University Hospital of Udine and Hannover Medical School, from 2016 to 2021, were retrospectively analyzed. Indication for EVP was the same in the two centers and involved in all cases employment of a marginal graft for a high-risk recipient, as subsequently defined. The study was approved by the Institutional Review Board  and informed consent was waived due to its retrospective nature. The major end-point of the study was the assessment of early and mid-term clinical outcome in terms of survival and major complications after HTx.In the present series EVP was achieved in both participating centers employing the Organ Care System (OCS) . The OCS perfusion technique has been described in detail previously ; brieflyCriteria for recipient selection and donor-recipient matching were based on standard guidelines –12. HTx High-risk recipients were defined as those on pre-HTx dependence from inotropic support, pre-HTx implantation of an intra-aortic balloon pump, those bridged to HTx with extracorporeal life support systems (ECLS) or a ventricular assist device (VAD). For ECLS support a Quadrox-i oxygenator and a Cardiohelp centrifugal pump , were employed. ECLS was used in 26% of patients in one center and in 5% in the other depending on different treatment policies of moderate primary graft dysfunction (PGD). Donors selected according to extended criteria, defined as “marginal,” were considered those ≥55 years of age, with a history of drug abuse, cardiac resuscitation or severe prolonged hypotension (>20 min), coronary artery disease, with at least a >30% stenosis of a major coronary branch, expected graft ischemia time ≥4 h, left ventricular ejection fraction <50%, interventricular septum thickness >14 mm, or body surface area difference between donor and recipient >20%. Hemodynamic support of the donor grafts was generally obtained with infusion of ≤0.1 y/kg/min of norepinephrine.2 or a persistent 50% increase of serum creatinine level. Impaired liver function was considered as at least a twofold increase of bilirubin and/or liver enzymes.Chronic renal failure was defined by a glomerular filtration rate <50 mL/min/mPGD was defined according to the International Society for Heart and Lung Transplantation (ISHLT) consensus statement, considering it relevant when grade ≥ moderate , 19.Acute renal failure was defined following the Risk of renal dysfunction, Injury to the kidney, Failure of kidney function, Loss of kidney function, End-stage kidney disease (RIFLE) criteria . The indInfections were defined as any episode requiring antibiotic, antiviral or antifungal treatment. Acute rejection was diagnosed, scored and treated following the ISHLT guidelines . Grade ≥For prediction of PGD, the RADIAL score has been used which is calculated on six factors with similar influence, four of which are related to the recipient: Right atrial pressure ≥10 mmHg, Age ≥60 years, Diabetes and Inotropic support dependence while two are related to the donor: Age ≥30 years and Length of total graft ischemic time ≥240 min. The presence of each of these factors in an individual patient adds 1 point to the final PGD predictive score [Continuous variables were expressed as mean ± standard deviation or median and range (min-max) according to the data distribution, after performing the Kolmogorov-Smirnov test for normality. Categorical variables were presented as absolute numbers and percentages. Cumulative overall survival was defined as freedom form all-cause mortality and was determined by the Kaplan-Meier method. Binary logistic regression was used to assess factors for PGD ≥ moderate and in-hospital mortality, while Cox-regression model was used for long-term mortality after HTx. De Long’s nonparametric receiver operating characteristic analysis of the area under the curve (AUC) was performed to estimate the accuracy of risk factors that were identified at the univariate analysis and to determine a cut-off value.Analyses were performed with IBM SPSS Statistics 22 for Microsoft Windows .During the study period, out of 88 marginal grafts 80 were employed for HTx in high-risk recipients; 37% were transplanted at the University Hospital of Udine and 71% at the Hannover medical School; 8 (10%) were discarded after being considered unsuitable for HTx through OCS graft assessment because of pathological increase of lactates despite adequate coronary perfusion in most cases; in particular, right ventricle dysfunction, severe aortic valve regurgitation, coronary anomaly and coronary dissection were detected in four grafts.Recipient data are shown in Donor data are summarized in Mean graft ischemic time was 118 ± 25 min, mean EVP time 289 ± 62 min, mean total “out-of-body” time 420 ± 66 min and median cardiopulmonary bypass (CPB) time 228 min (range 126–416 min). Three patients underwent combined heart- kidney transplantation .n = 2) or haemorrhagic shock (n = 2), pancreatitis (n = 2), multi-organ failure (n = 2), and ECLS-related complications (n = 1). Postoperatively, 15 patients (19%) needed de novo ECLS support, because of ≥ moderate PGD in 13 patients (16%), vasoplegia syndrome in 1 and respiratory insufficiency in 1. Moreover, two patients needed veno-venous ECLS for pulmonary complications while an intra-aortic balloon was implanted in three patients. Two patients were assisted with ECLS for <24 h and 8 for <72 h.Post-operative data are shown in Median intensive care unit stay was 6 days ; median mechanical assisted ventilation time was 29 h  with 26% of patients requiring >72 h of ventilation and 18% a tracheostomy. Median hospital stay was 36 days , during which 64% of patients needed dialysis for acute renal failure, 24% had new onset of atrial fibrillation and 11% acute rejection grade ≥2 (combined with antibody-mediated rejection 2 in two cases); 19% needed sternal re-entry for bleeding and 1% had a stroke.p = 0.001) and in-hospital mortality (p = 0.031).At univariable analysis, CPB time resulted a risk factor for both ≥moderate PGD (p = 0.050); PGD ≥ moderate and in-hospital mortality predictions of the CPB time showed AUC of 0.82 and 0.73 with cutoff values of 246 and 272 min, respectively. The predictive role of CVP regarding in-hospital mortality showed an AUC of 0.69, with a cutoff value of 15 mmHg  was also a risk factor for hospital mortality , eight patients died. The causes of late mortality are shown in p = 0.021), pre-HTx ECLS (p = 0.010), donor age (p = 0.031) were reported to be risk-factors for late mortality  is related to a more liberal use of ECLS owing to the greater safety of such systems in the current era. This reflects differences in the centers policy, since one Institution preferred to employ early ECLS for a limited time, generally from <24 to 72 h, in patients with signs predicting the possible onset of even moderate PGD. The rate of PGD in our study was quite acceptable, being 16%, not much higher than what reported in the Expand trial  and by GThis study has certainly some limitations mostly represented by its retrospective nature and those pertaining to any multicenter collaboration. In this specific study only two centers were involved minimizing potential biases in patient selection and treatment; however, some differences in each center policy, especially in postoperative immunosuppressive treatment and follow-up protocols, have emerged, which might have had an impact on patient outcomes but with negligible influence on PGD and perioperative complications. Moreover, the number of patients enrolled in this study was limited due to the specific patient characteristics, both of donor and recipients, thus precluding to select a control group for comparison.Our study, dealing with a very complex setting represented by marginal donors, very high-risk recipients and expected long ischemic time, indicates that EVP appears to be an effective tool in reducing overall donor graft ischemic time and allowing continuous evaluation of graft function and viability during transportation. This should provide adequate grafts for high-risk recipients who would be otherwise excluded from the possibility of a HTx. Nevertheless, based on the gratifying results observed in the present study, we advocate the employment of EVP using OCS technology as a promising and valid tool to further extend the donor pool, to successfully perform HTx even in high-risk settings.