The media play a critical role in informing the public about the COVID-19 pandemic. Throughout the pandemic, international travel has been a highly contested subject at both the international and national levels. We examined Canadian media reporting on international travel restrictions during the pandemic, how these restrictions aligned with the International Health Regulations (IHR 2005), and how the narrative around international travel evolved over time.We analysed articles from Canada’s top three national newspapers by circulation – The Globe and Mail, The National Post and The Toronto Star - published between Jan 1, 2020 - May 31, 2020. Our search yielded a total of 378 articles across the three newspapers. After removing duplicates and screening the remaining articles, we included a total of 62 articles for the analysis. We conducted a qualitative media content analysis by using an inductive coding approach.Three major themes were identified within the articles. These included: 1) The role of scientific and expert evidence in implementing travel restrictions; 2) Federal legislation, regulation and enforcement of international travel measures; and 3) Compliance with World Health Organization (WHO) guidelines in travel restriction policy- and decision-making. The federal government relied primarily on scientific evidence for implementing international travel restrictions and fully exercised its powers under the Quarantine Act to enforce travel regulations and comply with the IHR 2005. The government embraced a rules-based international order by following WHO recommendations on international travel, contributing to a delay in border closure and travel restrictions until mid-March.The media focussed significantly on international travel-related issues during the early phase of the pandemic. The dominant media narrative surrounded the need for earlier travel restrictions against international travel. On January 30, 2020, the World Health Organization (WHO) declared the novel coronavirus COVID-19) outbreak a Public Health Emergency of International Concern (PHEIC) e are not closing the border to any further steps, but we will make those decisions based on what science tells us” – Prime Minister Justin Trudeau [“ Trudeau .Despite measures taken to restrict international travel as early as January, the media criticized the Canadian response as inadequate and slow. The federal government justified their decisions not to implement harsher border restrictions by citing scientific evidence:I think Canadians think that we can stop this at the border, but what we see is a global pandemic meaning that border measures actually are highly ineffective and in some cases can create harm” – Health Minister Patty Hajdu [“ty Hajdu .Similarly, articles cited Taiwan, South Korea, and Singapore as examples of countries that had demonstrated adequate preparedness and response; these were regions that quickly implemented widespread thermal testing and travel restrictions , 23. By Despite the federal government’s stance, articles described actions implemented at the provincial level that did not align with federal action, including mass testing, screening of international travellers, stricter enforcement of quarantine orders, and recommendations for the use of masks , 28–30. Quarantine Act, 2005, which permits the screening of travellers entering Canada. Under the emergency order, any person entering Canada was required to self-isolate for 14 days regardless of whether or not they had symptoms of COVID-19 [On March 25, 2020, the federal government announced an emergency order under the COVID-19 . HoweverCOVID-19 , 30. In COVID-19 . By earlFurther federal regulation was enacted on April 14, 2020 when regulatory amendments under the Contraventions Act came into force. These changes provided increased flexibility for law enforcement agencies to issue fines to individuals in violation of the Quarantine Act . These aSome articles also criticized the federal government for adopting a preferential approach to the United States (US) when closing the borders to other countries . DespiteWhen it came to enforcing travel measures, the role of the CBSA – the federal law enforcement agency responsible for border control, immigration, and customs services in Canada – was closely scrutinized by the media. Despite the CBSA reporting that its officers were well-trained to identify visible signs of illness and to ask screening questions about possible symptoms, CBSA was criticized for inadequate screening measures and a lack of transparency regarding screening for travel history and passenger nationality . The medwe are a signatory to the International Health Regulations and we’ll be called to account if we do anything different” [. This rationale was used to explain a reluctance to close national borders. This stance was often in conflict with the perspectives of provincial premiers, some of whom argued that the federal government’s delays were contributing to the spread of COVID-19 [In the early days of the pandemic, much of the media attention in Canada focused on the WHO’s handling of the pandemic , 40. In fferent” . This raCOVID-19  and resureasonable steps to reduce risk should not await scientific certainty” [Our media analysis indicates that, despite having a comprehensive plan for meeting the IHR requirements regarding PHEICs at points of entry , Canada’rtainty” , 43.Specific media criticisms suggested that earlier action by the federal government may have reduced the number of COVID-19 cases imported into Canada . FurtherThe media play an essential role in the science and policy interface by communicating scientific information to the public and policymakers . One polOur media analysis of three Canadian newspapers suggests that in the early days of the pandemic, much of the media attention remain focused on restricting the international travel and quarantine measures for international travellers. Media studies conducted elsewhere reported similar findings , 11, 47.Our media analysis of three newspapers did not find the same narrative framing used in the case of the Australian media but found some similarities to the narratives presented around Sweden’s pandemic response. Specifically, similarities were noted in Canada’s difficulties containing the pandemic, and Canadian trust in the federal government’s response, while differences were found in Canada’s consideration of expert advice and compliance with WHO’s recommendations for restrictions against international travel. In Canada, both the federal and provincial governments implemented unprecedented public health measures, including international travel restrictions. The studies conducted in Canada found that, through appropriate and best data visualisation strategies, public health experts and governments were able to successfully convince citizens that the public health measures being taken were necessary . The medMultiple modelling studies conducted around the effectiveness of international travel restrictions for the influenza pandemic and other outbreaks determined that international travel restrictions were of limited benefit in slowing the global spread of pathogens –59. MoreThe effectiveness of international travel restrictions such as border closures is not always definitive, but evidence suggests that that the shutdown of international airports and border closures prevented spillover across countries in the early phase of the pandemic , 63 whilThis study is limited to news articles published between January 1st and May 31st, 2020. The majority of articles captured were published in March and April. The data were limited to newspaper articles from three newspapers and may not be representative of Canadian media as a whole. As only newspapers were used from the database and the article formats were limited to news articles, interviews, editorials, and commentaries, excluding speeches, essays, letters to the editor, government documents, we may have missed information outside of our inclusion criteria. Moreover, the term “coronavirus” was more commonly used than “COVID-19” in those months and non-inclusion of this search term may have eliminated some key information. Furthermore, restricting articles to those published in English language may also serve as a limitation.As early as January, Canada implemented border screening measures for international travellers, before closing the borders in March. However, our media analysis of Canada’s international travel measures for the COVID-19 pandemic suggests that these measures were viewed as inadequate and occurred too late. By the time Canada imposed travel restrictions in late March, more than 4 million people had already entered the country. Media reporting suggested that the time for Ottawa to act broadly and in the national interest was in January or February, when strong actions in areas of clear federal responsibility could have had greater impact. The media narrative about the pandemic public health measures that were taken should be considered in discussions of national pandemic preparedness and response, as the pandemic is far from over in Canada and elsewhere.


Journal of Mother and Child, I am pleased to welcome all our Readers and Authors with the first issue of our Journal.On behalf of myself and the Editorial Board of the Journal..At the same time, I would like to inform you about the important changes that have taken place recently at our Journal, and it is now called the Journal of Mother and Child (JMC). We will still retain the original Polish title, i.e. Medycyna Wieku Rozwojowego, in order to maintain an editorial continuity. Later this year, we also intend to archive the previous issues and make them available online on the new platform.As you may have noticed, this year, we have changed the name of our JMC will be published by a new publisher – Sciendo (De Gruyter Group), and soon, it will be available in an electronic version only, with only a few printed copies produced mainly for libraries. Authors will receive their papers online in a portable document format (pdf) form.From 2020, the JMC Editorial Board by inviting experts from respective fields to serve as Section Editors and International Editorial Scientific Board members. I would like to take this opportunity to thank all those fantastic people who have accepted the invitation and will be supporting us on our exciting journey.In order to cover all relevant medical disciplines, I have taken a decision to expand the JMC/Medycyna Wieku Rozwojowego has been published for more than 20 years as a quarterly journal and is now indexed in MEDLINE/PubMed, Scopus, Index Copernicus, EBSCO, BioMedLib, Research Gate, MNiSW and Polish Medical Bibliography. Our current target is to have the JMC indexed in other international indexing databases and catalogues, such as Web of Science.As you may know, the Journal's scope is based on a holistic approach towards a patient, including all medical aspects as well as other important life areas, such as nutrition, psychology and social or ethical issues. Most importantly, we focus on a patient through all stages of the human life cycle, from the early years, i.e. the prenatal and perinatal periods, through the developmental period, until adolescence and adulthood . Moreover, the Journal of Mother and Child should be a platform for presenting the results from all areas of research studies that aim to improve human health, reflecting the connection between clinical knowledge and basic science, called translational medicine. I believe that such a broad approach makes us unique among existing medical journals.All the above-mentioned changes and efforts are aimed at improving the quality of the journal's content while continuing its general concept and scope. The Journal not only articles related to common diseases and disorders, which are important from an epidemiological viewpoint, but also those describing rare conditions. Rare diseases require special attention for several reasons and have become an increasingly important topic in medical literature. Following this direction, the second issue this year will be dedicated exclusively to the category of rare inherited metabolic diseases and will be published as a Special Issue with invited papers from well-known experts of metabolic medicine. I believe that such an approach will make our Journal attractive to Authors, Reviewers and Readers.My ambition as an Editor-in-Chief will be to include in the Journal of Mother and Child, including your ideas for Special Issues.Last but not the least, I would like to encourage both experienced and young researchers to submit their interesting original manuscripts, reviews and case reports to the


The aim of the investigation was to study the factors influencing the radial stiffness of the thoracic aorta stent-grafts with the stent elements made of nitinol tubes by laser cutting and thermal shape setting.The work used stent elements made by different technologies by two different manufacturers from a nitinol tube with a wall thickness of 0.5 mm (E1) and 0.4 mm (E2), with a final diameter of 20 mm. Height of cells E1 — 15 mm, E2 — 12.5 mm. The stents were manually attached to a tubular woven non-crimped base  with a 6/0 suture, resulting in either single or continuous stitches. In the RLU124 radial force tester , each of the four stent-grafts, as well as their individual stent elements, were compressed by 10 mm from the initial diameter. The dependence of the radial forces on deformation under loading and unloading was graphically presented. The temperature and enthalpy of phase transitions of nitinols into the austenite (Af) and martensitic (Mf) phases were studied using differential scanning calorimetry . All indicators were compared with the characteristics of two commercial models — Cronus (China) and E-vita Open Plus (Germany).Four prototypes of SibHybrid stent-grafts were tested; those differed in their stent elements, distances between them, and the type of sutures (single or continuous). The stent elements of the models studied differed in the values of Af, Mf, and the enthalpy of phase transitions of nitinols. The hardest stent was the E2 prototype. The fixation of stent elements to the woven fabric in the graft increased the radial force by 4.0–5.5 times. During compression by 50 and 20% of the original diameter, the SibHybrid models developed radial force 4.5–6.0 times greater compared with the E-vita Оpen Plus model. The radial force values of SibHybrid models were almost the same as for the Cronus and models at 20% compression. Using continuous twining round suturing increased the radial force by about 10 N; accordingly, SibHybrid E2 had the highest radial force because it was fixed by a continuous suture. The density of the stent elements fixed on the fabric did not affect the radial force of the stent-graft as a whole.In the manufacture of stent elements from nitinol tubes, the main factor determining the radial stiffness is the technology of nitinol shape setting. With the standard technology of thermal shape setting, radial force can be changed by varying the height of the structure cell element and the cross-sectional area of the cell bars, as well as the suturing technique. Thoracic aortic stent-grafts are, as a rule, synthetic vascular prostheses with stent elements made of nitinol and attached to the graft. They are widely used at present for endovascular correction of acute and chronic aortic dissections and also as hybrid prostheses. Hybrid aorta surgery is a relatively new trend developing after 2003 when Haverich et al. published a paper  describiIn the world market, there is a wide variety of stent-grafts designed for endovascular implantation, while hybrid prostheses are represented by only four models. These are two international products: E-vita Оpen Plus  and Thoraflex Hybrid , and two national ones: Cronus  and J Graft Open . All four of them differ in their design and method of fixing the stent elements. The tubular part of these stent-grafts is made of special fabrics based on polyester  fibers, which differ in the weaving technique .One of the most important characteristics of stent-grafts is their radial stiffness (RS), i.e. the force they apply to the wall of the true lumen of the dissected aorta. In case of insufficient RS, the stent-graft will not be held tightly in the implantation zone, which can result in its displacement and endoleaks. With an excessive RS, its distal part can break the aortic wall tissue that separates the true and false lumina, causing dislocation of the distal end of the stent-graft into a false lumen –6. The lDespite the fact that the hybrid prosthesis is the top trend in thoracic aorta surgery and stimulates designing of novel stent-grafts –9, the qAll stents used for commercial stent-grafts are made of wire, despite the fact that the vast majority of coronary and peripheral stents (not only nitinol ones) are made of tubular elements by laser cutting and subsequent molding. This method makes it possible to obtain more reliable products, since in their manufacture, unlike the wire-made ones, there is no need to connect the edges, which is the most weak link in the design of the structure.The aim of this work was to study the factors influencing the radial stiffness of four prototypes of thoracic aortic grafts containing stents made from nitinol tubes by laser cutting and thermal shape setting, in comparison with the characteristics of two commercial stent-grafts Cronus and E-vita Оpen Plus.CSS — 0.104 mm2) are connected by a sleeve  has an internal diameter of 42 mm. The diameter of the E-vita Оpen Plus stent is also larger than the stent-graft diameter by 3 mm and reaches 22 mm. Therefore, these stents are fixed to the graft in a stress-strain state.In the manufacture of the four original prototypes, which received the working name SibHybrid (SH), we used non-crimped woven vascular prostheses with a diameter of 20 mm  and stent elements E1 and E2, manufactured by two different (domestic and foreign) manufacturers according to our technical specifications and our drawings . Both tyThe stent elements were manually fixed to the fabric base from the outer surface using single sutures or continuous sutures from Premicron 6/0 .The characteristics of the four SH prototype stent-grafts are presented in The radial forces of the stent-grafts were studied using a radial force tester RLU124  ; in the Together with the final stent-graft, we tested individual stent elements E1, E2, and the elements of both commercial models. Since the Cronus was compressed to 18 mm , its stent element was also compressed to 18 mm.The testing procedure was carried out at temperatures of 24–26°С and 37°С in 3–4 repeats at each temperature. Measurements of radial forces under load–unload modes was performed using an ESM301L universal testing machine . The results were exported to Microsoft Excel, and each point was recalculated according to the formulas recommended by the RLU124 manufacturer:TRF is the radial forces developed by the test object, F are the forces as measured by the tester;where D is the change in the diameter of the tested object, and Δx is the movement as measured by the measuring device.where ΔThe data obtained from all measurements were used to plot the force-strain graphs.onsetT) and the end (endsetT) of the nitinol transition from the martensitic (Mf) to austenitic (Af) state were determined (H) was calculated automatically by the device based on the peak area and sample mass. After that, the test object was cooled again, and the end temperature of the transition from the austenitic to martensitic state was recorded.The temperature of phase transitions of nitinol from stent elements was studied using a DSC-3 differential scanning calorimeter . For this, three straight 5 mm long segments were cut out from the stent elements of all stent-grafts. Each sample was cooled to –30°C and then heated to +70°C at a rate of 10°C/min. Based on the final point of the endothermal peak in the heating curve, the temperatures of the start . Results were expressed as mean ± standard deviation (M±σ). The normal distribution in each group was verified using the Shapiro–Wilk test. Since the data distribution corresponded to the normal one, the significance of the differences was calculated by the Student’s t-test, considering the differences statistically significant at p<0.05.The results of these experiments were One of the important parameters that determine the stent stiffness is the material itself, i.e. nitinol, and the way it had been thermally treated. These factors have an impact on the temperature of phase transition from the martensitic to austenitic state of nitinol, and can also modify the enthalpy of this transition. The temperatures where the nitinols E1, E2, and E-vita Оpen Plus begin and complete their transition into the austenite phase are shown in In this experimentation, we encountered unexpected effects when testing the Cronus model nitinol: in the range of temperatures commonly used to test medical nitinols, we found no phase transition peaks. Therefore, we extended the temperature range and scanned from –150°С to +450°С; then we detect a peak in the range from –120°С to –140°С.When testing the RS of individual stent elements, the following patterns were revealed :oC.In all tested groups, the load–unload curves did not depend (or depended only a little) on the temperature at which the procedure was carried out. This effect is not surprising since even at 24–26°C, stents E1, E2, and E-vita Оpen Plus are already in the austenitic state and their mechanical properties should not be fundamentally changed when the temperature rises to 37CSS of the cell bar in E1 is 25% higher than that in E2. At 50% compression (up to 21 mm), the Cronus stent element develops a force of 14 N and the E-vita Open Plus — about 6 N.E2 stents are known for the highest RS (about 17 N) when compressed by 50% of the initial diameter (i.e. by 10 mm). For E1, this RS value is about 10 N, despite the fact that the After attaching the stent elements to the fabric, the radial force increases sharply : at the Quite unexpected was the fact that for the SibHybrid models, the density of stent elements fixed on the fabric had almost no effect on the RS of the stent-graft as a whole . Thus, tThe effect of the fixation technique on the RS of stent-grafts is shown in Obviously, the main role in the RS differences between various grafts is played by the stent elements ). Samples SH3 and SH2, having the same diameter, fixed to the same woven base with the similar sutures at equal intervals between the elements, still have different stiffness values: at the end point of compression, it is almost 140 N for SH3 that contained the stiffest E2 vs 73 N for SH2, containing E1 stents.The clinical aspect of stent-graft “over-stiffness” is different from the bioengineering consideration. For the latter, excessive stiffness is associated with the mechanical incompatibility of the implants with the pathologically altered aortic wall. Surgeons, however, tend to attribute d-SINE to individual variability in the conical shape of the aorta, which, in fact, is the normal anatomical difference in diameters between the proximal and distal parts of the aorta . Indeed,Based on our results, an analogue of clinical oversizing can be proposed. This is expressed as compression of the stent-graft by 20% of the initial diameter, i.e. 4 mm for E-vita Оpen Plus and other models of the SibHybrid line, and 5.6 mm — for the Cronus models. In It is impossible to answer this question while having no information on the mechanical characteristics of the implantation zone, i.e. the walls of the diseased aorta . In the literature, there are few reports on this issue –17; thosIn this study, we have shown how the stiffness of stent-grafts is influenced by the design and material of the stent element, as well as the fixation technique (continuous suturing increases the stiffness by more than 20%). At the same time, the number of stent elements sutured to the fabric (stent density) has practically no effect on the stiffness of the stent-graft. Considering how sharply the RS of the stent-graft increases in comparison with the RS of an individual element, we assume that the characteristics of the fabric itself , as well as the properties of the sealing impregnation, can affect the stiffness of SH products. In this work, we did not aim to study this issue, but it is part of our future research.CSS and a decrease in the height of the structure cells when their shape and number remain unchanged [CSS 0.25 mm2 and a height of 15 mm were used; those were much softer than SH3 and SH4 with cells 12.5 mm high and CSS 0.20 mm2. Although for wire stents, this relationship may be somewhat different, but it can be modified by varying the height and CSS of the structure cells. No doubt, the method of thermal treatment for nitinol affects the stiffness of such stents [With regard to the design of the wire stent, it is known that its stiffness increases with an increase in the cross-sectional area nchanged . Based oh stents . Our E1 It should be noted that when testing grafts of different designs, it is important to test the entire range of similar grafts (of the same standard sizes) for radial compression, without extrapolating the results from one diameter to other. While testing circular stent elements used in Thoraflex Hybrid and Anaconda (Terumo Aortic) models, Senf et al.  showed tIt should be noted that manufacturers of both endovascular and hybrid stent-grafts do not disclose the specifics of their RS measurements, although this characteristic is of key importance for these devices and largely determines the quality of clinical results. We consider this practice to be flawed, as the risks of complications are ultimately borne by surgeons and patients. A typical example is the clinical experience of using the Thoraflex Hybrid prosthesis, the stent-graft of which was originally conceived as “soft”; it was also perceived as soft by surgeons according to tactile sensations. Subsequently, this stent-graft turned out to be more rigid than the E-vita Оpen Plus  and causCSS of a cell bar comparable to CSS of wire nitinol stents. At the same time, the density of the stent elements fixed on the fabric does not affect the stiffness of the stent-graft structure; changes in the suturing technique from single to continuous sutures increase the stiffness by an average of 10 N. Differences in nitinol thermal shaping technologies may cause significant differences in the stiffness of the stent elements; the thermal characteristics of the materials can be partially revealed with differential scanning calorimetry.Thus, the study of the first samples of aortic stent-grafts, the stents of which were made from nitinol tubes by laser cutting and thermal shaping, showed that they had a significantly higher RS at Therefore, varying the tube thickness, cell bar width and height, as well as the type of fixing sutures can be used for achieving optimal RS only after standardization of the thermal treatment method by the manufacturer of the stent elements. In this case, differential scanning calorimetry can serve as a quality control method. However, the question of optimal values of RS itself remains open and requires large-scale studies on mechanical properties of the diseased aorta.The limitations of this work include the lack of data on nitinol processing technologies for SibHybrid prototypes. According to the confidentiality agreement signed by the authors, they are not allowed to disclose information about the manufacturers and manufacturing technologies of stent elements. In addition, the effect of different woven bases and hermetical sealing on the RS of stent-grafts is yet to be studied in our future research.In the manufacture of stent elements of stent-grafts from nitinol tubes, the main factor determining the radial stiffness is the technology of nitinol thermal shaping. With the standardized shaping technology, the stiffness can be controlled by changing the height of the cell and the cross-sectional area of its bars, as well as by suturing technique.


Since 1978, thanks to Deng Xiaoping's open policy, China's story has been a big success: not only in becoming a world economy power, but also for great advancements in science and technology. Such great success has led China from isolation to become an active member of the global village. China benefited not only from capital investments and modern management, but also science and technology from the developed world. In only 40 years, China has made a great leap forward to become a world economic locomotive.Nevertheless, ever since the Industrial Revolution, world developments have led to alarming depletion of resources and irreversible pollution. As far as chemistry is concerned, Chinese chemists are ready to share the international responsibility and to work closely with international colleagues to tackle the global challenges in energy, sustainability, water, materials and health issues. The Chinese Chemical Society (CCS) consecutively led by Prof. Chunli Bai and then by Prof. Jiannian Yao, has initiated several inter-society memoranda of understanding, for example, with the American Chemical Society (ACS), German Chemical Society (GDCh), Royal Society of Chemistry (RSC) of the UK, French Chemical Society (SCF) and more. The CCS is also an active member of the International Union of Pure and Applied Chemistry (IUPAC) and Federation of Asian Chemical Societies. Prof. Qifeng Zhou (former President of Peking University) served as IUPAC President in 2018–2019.As early as 2003, under encouragement from then CCS President Prof. Chunli Bai and CCS Secretary-General Prof. Jiannian Yao, I started to work as a volunteer for the international affairs of CCS. One of my initiatives was to co-found a consortium ‘CS3’  with other major chemical societies supported by the funding agencies of the respective countries. The motivation was to unite the forces of international chemists to propose a roadmap of chemistry solutions to meet the global challenges. So far, we have issued eight white papers covering solar energy, sustainable materials, health issue, element strategy, water, etc. The latest one is ‘Science to enable sustainable plastics’. These white papers have provided guidelines for funding agencies around the world, in addition to making public appreciation of chemistry for sustainability.It should be noted that the pandemic of COVID-19 has largely devastated the world economy and hindered international travel. But the international scientific community had long reached the consensus that only international cooperation can solve the global problems, including the present difficulty. This is the purpose of this special topic of NSR on ‘International Chemistry for a Sustainable Society’, in which the international chemistry leadership shares their opinions as well as practices for international cooperation. We are confident that chemistry can provide solutions to tackle global challenges in energy, resources, pollution, water and many other areas.Conflict of interest statement. None declared.


Pancreas and kidney graft function after 3 months, 1 year, and 5 years were 70.8% and 66.7%, 66.7% and 62.5%, and 45.8% and 54.2%, respectively. Relaparotomy was performed in 13 out of 24 (54.2%) patients. The results of our study show that Re-SPK, after previously performed SPK, is a technical and immunological challenge, associated with a significantly increased mortality and complication rate; therefore, the indication for Re-SPK should be very strict. Careful preoperative diagnosis is indispensable.Simultaneous pancreas and kidney transplantation (SPK) is an accepted treatment for diabetic patients with renal failure, and is associated with increased survival and quality of life for recipients. There are only a few publications on the outcomes of simultaneous pancreas–kidney retransplantation (Re-SPK) after previous SPK and the loss of function of both grafts. A total of 55 patients with type 1 diabetes mellitus underwent pancreas retransplantation at our center between January 1994 and March 2021. Twenty-four of these patients underwent Re-SPK after a previous SPK. All 24 operations were technically feasible. Patient survival rate after 3 months, 1 year, and 5 years was 79.2%, 75%, and 66.7%, respectively. The causes of death were septic arterial hemorrhage ( The first pancreas transplantation was performed at the University of Minnesota in 1966 . InitialSPK is the only therapeutic option in which patients can live without insulin and dialysis, in a normoglycemic metabolic situation. Because of the constant normalization of blood sugar after transplantation, progression of late diabetic complications and arteriosclerotic vascular disease can be slowed down and long-term survival, as well as quality of life, are greatly improved ,5,6,7,8.Acute or chronic graft rejection, graft pancreatitis, graft thrombosis, anastomotic insufficiency and infections, or recurrence of the underlying disease in patients with type 1 diabetes mellitus are the most common causes of acute or chronic graft failure after SPK ,10,11,12Presently, there are numerous publications on isolated pancreas retransplantation ,23,24,25Since 1994, 599 SPK and 55 pancreas retransplantations have been performed at our center. Of these, 30 patients underwent pancreas retransplantation after simultaneous pancreas–kidney transplantation, one underwent pancreas retransplantation after isolated pancreas transplantation, and 24 underwent Re-SPK after previous SPK. In this study, the results obtained after Re-SPK are presented. To the best of our knowledge, this is the largest case series on Re-SPK published to date.This retrospective study included all patients who underwent Re-SPK from a brain-dead organ donor at the Transplantation Center of Bochum, Germany between January 1994 and March 2021. The analysis comprised patients’ files, laboratory values derived from the electronic databank, and the evaluation of EUROTRANSPLANT donor reports. Preoperative cross-match analysis was negative in all cases.The aim of this study is to investigate patients’ survival, as well as pancreas and kidney graft survival following Re-SPK. With regard to patient survival, the 90-day, 1- and 5-year survival rates were calculated.Further objectives were the characteristics of the donors and recipients, perioperative parameters, postoperative complications, length of hospital stay, and occurrence of rejection.Renal graft failure was defined as patient death with a functioning graft, an allograft nephrectomy, or the need for permanent dialysis or retransplantation. Pancreas graft failure was defined as the need for return to exogenous insulin therapy, removal of the pancreas graft, or patient death. Only histologically confirmed rejection was evaluated and classified according to the BANFF classification.All patients underwent quadruple immunosuppression comprising induction and triple maintenance therapy. Prednisolone and antithymocyte globulin were administered as induction immunosuppression in almost all patients. Maintenance therapy consisted of low-dose prednisolone, cyclosporine, and azathioprine, whereas in the modern era prednisolone, mycophenolate acid, and a calcineurin inhibitor (tacrolimus or cyclosporine) were used.®, Cheplapharm Arzneimittel GmbH, Greifswald, Germany) and then orally . In addition, trimethoprim/sulfamethoxazole  was used for Pneumocystis jirovecii prophylaxis and amphotericin B  for antimycotic prophylaxis, for three months each.Depending on the serologic cytomegalovirus (CMV) status, patients received CMV prophylaxis with ganciclovir over three to six months, which was initially administered intravenously . Quantitative variables are expressed as mean ± standard deviation. The differences in quantitative variables between the groups were determined using Student’s The characteristics of the patients are presented in The average time between primary SPK and Re-SPK was 106.5 ± 80.7 months. The mean duration of dialysis between both transplantations was 35.9 ± 31.9 months. Averagely, the initial diagnosis of type 1 diabetes mellitus was 31.7 ± 8.4 years before retransplantation.There were no significant differences between the BMI values, lengths of hospital stay, operation times, and ischemia times of the pancreas and kidney grafts.p < 0.001). Immunization after initial transplantation required the selection of organs that were as immunologically suitable as possible. Therefore, there was a statistically significant better HLA mismatch in Re-SPK than in primary SPK (p = 0.01). As described elsewhere, a highly immunized patient required desensitization therapy with rituximab prior to Re-SPK, followed by repeated plasmapheresis/immunoabsorption sessions and intravenous substitution of immunoglobulin [At the time of retransplantation, 17/24 (70.8%) patients were immunized. There was a statistically significant difference between the mean peak panel reactive antibody (PRA) values and the last measured PRA values at the time of initial transplantation and retransplantation  (p = 0.04), while Thymoglobuline®  was used more frequently in Re-SPK (p < 0.001). Maintenance therapy after initial transplantation consisted of steroids, cyclosporine, and azathioprine . Due to advancement in the pharmacological development of immunosuppressive medication, steroids, mycophenolic acid, and tacrolimus were used more frequently in cases with SPK-retransplantation (p < 0.001).Induction immunosuppressive therapy in primary SPK was predominantly performed with ATG Freseniusp = 0.004), whereas the duration of stay in the intensive care unit was significantly longer in the first SPK group (p = 0.03).The donor data for the first SPK group and Re-SPK group are shown in p = 0.06). In 2007, the perfusion solution for visceral organ harvesting in Germany was changed from the University of Wisconsin solution (UW) to Histidine-Tryptophan-Ketoglutarate solution (HTK); thus, the proportion of HTK-perfused organs was higher in the Re-SPK group (p = 0.005).The acceptance of marginal organ donors in recent years is also evident in the calculation of the pancreas donor risk index (PDRI), which was higher in the historically younger Re-SPK group. However, this difference was not statistically significant (n = 19) at 3 months, 75% (n = 18) at 1 year, and 66.7% (n = 16) at 5 years. The 1-year mortality rate was 25% (n = 6), and five (20.8%) patients died within the first 3 months after retransplantation. Causes of death were hemorrhagic shock due to arterial hemorrhage in three cases, sepsis with multiorgan failure in two cases, and unknown in one patient.The mean follow-up time after Re-SPK was 4.9 ± 4.2 years. Patient survival was 79.2%  had good kidney graft function , and a glomerular filtration rate  of 61.4 ± 22.6 mL/min. Good kidney graft function was found in 15 patients (62.5%) after one year and in 13 patients (54.2%) after 5 years. The reasons for loss of graft function (besides the death of a patient) were the occurrence of postoperative complications and acute or chronic rejection.Rejection occurred in seven patients (29.2%), five of them in the first year. Mild rejections were treated with steroid pulse and severe cellular rejection with thymoglobuline therapy.One patient experienced an acute rejection, with evidence of donor-specific antibodies (DSA). In this case, an intensified therapy with thymoglobuline, eculizumab, and several plasmapheresis was initiated but, even after the completion of therapy, the graft failed to function.Hospital stay of our patients was significantly longer compared to international data. However, in our department we have the possibility to perform part of the postoperative rehabilitation, which leads to a longer hospital stay. The increased length of stay is also explained by those patients with a prolonged recovery phase after postoperative complications. The median inpatient length of stay was 38 days in the first SPK group and 32.5 days in the Re-SPK group. This is comparable to the length of stay in other German transplant centers.Owing to existing previous operations and associated anatomical variants, Re-SPK presents a technical challenge. Furthermore, the construction of arterial vessel anastomoses is complicated by progressive vasosclerosis in the recipient and previous stent implantations. The duration of the operation and ischemic times are listed in The transplantations in the first SPK group were carried out between 1994 and 2008. Since some of these were also performed in other transplant centers, complete data were not always available for all patients.Exocrine drainage of the pancreas graft in primary SPK cases was performed using the bladder drainage technique in eight (33.3%) patients. In the modern era, small bowel drainage (duodenojejunostomy) will become increasingly established as an exocrine drainage technique, which was applied in 10 patients (41.7%). A duodenoduodenostomy was performed in one patient (4.2%).n = 12; right external iliac vein, n = 1; inferior caval vein, n = 2) and portal-venous to the superior mesenteric vein in two patients.Arterial anastomosis was performed to the right common iliac artery using an arterial Y-graft. Venous anastomosis was performed systemically in 15 patients  after the first simultaneous pancreas/kidney transplantation. In the vast majority of cases, the indications were acute bleeding or graft pancreatitis . Loss ofIn most cases, graft nephrectomy or pancreatectomy is justified for infectious, immunological, and anatomical reasons. In this study, graft nephrectomy was performed in 22 (91.7%) of the cases, of which fourteen (58.3%) were performed prior, seven (29.2%) during, and one (4.2%) after retransplantation. The most common indications were chronic rejection and thrombosis with an associated symptomatic graft. In one case, the indication was a postoperative recurrent urinary tract infection.In contrast, 13 patients (54.2%) required graft pancreatectomy; In 11 of them (45.8%), this was performed prior, in one case (4.2%) during, and in one case (4.2%) after retransplantation. The most common reasons were graft rejection, bleeding, and thrombosis. In many cases, the pancreas graft shrinks to such a small size that anatomical space problems do not occur during retransplantation.In the context of retransplantation, arterial and venous anastomoses of the pancreas graft pose a technical challenge. In most cases, the graft artery was anastomosed cranial to the right common iliac artery of the initial graft in 18 patients (75%). In three patients (12.5%), it was necessary to anastomose the pancreas graft aortally due to advanced pAVK or vascular stents inserted in the pelvic arteries. In two patients (8.3%), the right external iliac artery was chosen for anastomosis, and in another (4.2%), the arterial anastomosis was made to the stump of the Y-graft of the initial graft.n = 19; right common iliac vein, n = 2). In three patients (12.5%), the anastomosis was portal-venous to the superior mesenteric vein. Exocrine drainage was performed in all Re-SPK cases as enteric drainage using a duodenojejunostomy in 11 (45.8%) cases and duodenoduodenostomy in 12 (50%) cases. In one patient (4.2%), duodenoileostomy was performed because of anatomical peculiarities.The majority of venous anastomoses were systemic venous (87.5%)  required graft pancreatectomy of the initial graft. In most cases, the pancreatic graft had shrunk to such a small size that no space problems were encountered during retransplantation. Vascular anastomoses of the renal graft were performed on the left pelvic axis in all patients during retransplantation. In four patients (16.7%), the external iliac artery and vein were used, and in twenty (83.3%), the common iliac artery and vein were used. In seven patients (29.2%), the old kidney graft interfered during retransplantation, so simultaneous graft nephrectomy was necessary for creation of space. In many cases, new vascular anastomoses were made cranial to the old graft. Finally, ureteroneocystostomy was performed with an antireflux plastic according to Lich-Gregoire with the application of a ureteral splint analogous to the initial transplantation.Relaparotomy was indicated in 13 patients (54.2%), with the most frequent indications being acute bleeding  and the occurrence of graft pancreatitis . In this patient population, there was no graft thrombosis.In one patient, relaparotomy was indicated because of abdominal pain and suspected dislocation of an inserted suprapubic catheter. One patient had relevant ureteral stenosis, and another a small bowel perforation.Overall, in the postoperative course after 39.2 ± 35.3 days, five patients (20.8%) required graft pancreatectomy due to bleeding complications and severe graft pancreatitis. Two of these patients (8.3%) underwent simultaneous graft nephrectomy due to primary nonfunction and acute rejection with sepsis. One patient developed thrombotic occlusion of the common iliac artery due to advanced peripheral arterial occlusive disease, resulting in critical ischemia with necrosis of the lower limb. In this case, knee disarticulation was necessary.n = 5) and the 3-year mortality rate was 52.9% (n = 9). Causes of death were myocardial infarction (n = 4/25%), sepsis (n = 3/18.75%), cancer (n = 2/12.5%), hypoglycemia (n = 1/6.25%), and unknown (n = 6/37.5%).Regarding mortality rate on the waiting list for Re-SPK, we performed a subgroup analysis. A total of 17 patients were identified on the waiting list for Re-SPK after simultaneous pancreas–kidney transplantation. One patient still remains on the waiting list, whereas 16 patients (94.1%) died during the waiting period. Among these, the 1-year mortality rate was 29.4%  ,5,6,7,8.In the literature, there are several publications on isolated pancreas retransplantation in which very different results are presented with regard to patient and graft survival.Overall, there is a wide variation in the 1-year survival rate of the pancreas graft, which is reported in the literature to be between 32% and 85%. The 5-year survival rate of pancreas grafts varies between 46% and 69%. However, the 1-year patient survival in these collectives was 89–96%, despite poor graft survival ,14,15,16Patients who underwent Re-SPK after previous isolated pancreas transplantation showed an overall higher mortality rate than those in the comparison groups who only had isolated pancreas retransplantation . Conversn = 7) in the postoperative course to avoid further complications [Loss of graft function often results from postoperative complications or rejection. Seal et al., reported lower complication rates, especially in the first three months after pancreas retransplantation, compared to initial transplantation . In contications . In a stications . Humar eications . This isications .Important criteria for appropriate recipient selection for retransplantation are immunological risk, vascular status, and existing comorbidities .Careful donor selection is also considered a decisive criterion. For example, organs from donors with comorbidity, fatty or hardened pancreas grafts, or those with signs of trauma or ischemia should not be used ,22. In aFor patients with Re-SPK after previous SPK, there are only a few publications in the literature with a smaller number of patients ,27,28.n = 7) or graft pancreatectomy (n = 1) was required as a simultaneous procedure during Re-SPK due to space limitations. The removal of the pancreas graft was less often necessary as the graft had shrunk considerably in most. In contrast, elective graft nephrectomy was performed in most cases prior to retransplantation.This form of retransplantation is characterized by technical and immunological challenges. Depending on the intraoperative peculiarities, a great deal of experience on the part of the surgeon is necessary. This applies to both adhesions after corresponding previous operations and creation of anastomoses in a patient with advanced vascular damage. Intraoperatively, new vascular anastomoses are usually created cranial to the initial anastomoses. In some cases, graft nephrectomy (n = 5) in our survey, is lower than that reported by LaMattina et al. [The mean ischemia time of the pancreas graft of about 13 h is comparable to the 14.5 h reported by LaMattina et al. The rate of rejection in the first year, which was 20.8% . Five of these patients (20.8%) died within three months of retransplantation due to complications. The most common complications were graft pancreatitis and hemorrhage with an associated septic course. In contrast, LaMattina et al. reported 100% patient survival at 1 and 3 years.However, contrary to what has been reported in the literature so far, our analysis shows an increased 1-year mortality rate of 25% (n = 16) compared to 78% in the patient collective from LaMattina and coworkers. The 1-year survival rate of the kidney graft in our study is even lower at 62.5% (n = 15) compared to 89% in the study by LaMattina et al. [The 1-year survival rate of the pancreas graft in our collective was 66.7%  and 52.9% (n = 9), respectively. Venstrom et al. also reported that type 1 diabetics with kidney failure have a significantly increased 1-year mortality rate compared to patients awaiting pancreas transplantation alone [Otherwise, patients on the waiting list for Re-SPK after previous SPK also show an increased annual mortality rate. In our study, 1- and 3-year mortality rates on the waiting list were 29.4% , Re-SPK should be discouraged in order to avoid complications and relaparotomies. A kidney transplant alone is then more likely to be recommended for such patients. According to our experience, organs from donors with severe abdominal trauma, hematoma or fatty degeneration of the pancreas, and a PDRI > 1.3 should not be accepted for Re-SPK.In summary, simultaneous pancreas-kidney retransplantation after a previously performed combined pancreas–kidney transplantation is a high-risk procedure, while the risk of dying on the waiting list is even higher.


This study investigates international students’ acculturation attitude preference and the influence factors  on each acculturation attitude  in China. A group of 229 international students within China responded online. Results from cluster analysis based on process model of acculturation revealed that, integration was the most prevalent acculturation attitude of international students in China. Additionally, logistic regressions analysis indicated that duration in China was negatively associated with adoption of separation and marginalization attitude also higher level of English proficiency predicted the preference of marginalization attitude. However, Chinese proficiency was positively associated with integration attitude adoption, host ties were positively and significantly associated with adoption of assimilation and integration attitude, but negatively associated with the usage of marginalization attitude. Lastly, avoidance attachment was found negatively associating with the integration attitude. This study provides valuable insights for international student education policymakers to assist international students in order to adapt to a new environment quickly and effectively. According to the data of Ministry of Education of the People’s Republic of China, there were 492,185 foreign students from 196 countries studying in China in 2018 [Actually, numerous studies have been carried out in different contexts in order to better understand individuals’ acculturation process in a new environment , 6. ThosPast researches have established that acculturation strategies have effect on individuals’ cross-cultural adaptation –13. Jia-A substantial body of research has led to the understanding that the acculturation process was related to individual’s demographic and social characteristics –16. ThusBerry and his associates  proposedBochner, McLeod, and Lin  were theThe contact hypothesis and its extensions  shed somBrennan, Clark, &Shaver  have proAs attachment theory refers to interaction with others in new environment, there is reason to believe association between attachment style and acculturation attitude. Actually, prior research have provided some evidences for the relationship between attachment style and acculturation attitudes. Jacomijn Hofstra  founded Variables such as age, gender, Place of origin, marital status and religious affiliation in the host country are considered related to the acculturation attitude. For instance, girls were more likely to adopt integration strategy than boys in Olga Pisarenko’s study of Russian adolescents in Latvia . While sLanguage is a useful tool for foreigners to communicate and socialize with host people, which is important for broadening social network and resources. Kashima & Loh  found thLength of residence in the host country is widely reported to influence the acculturation attitude. Studies of multicultural students in Canada showed that the longer their length of residence in Canada, the greater mainstream cultural adoption, and the lower heritage cultural maintenance . Szabó ÁIn the present study, we aim to find influence factors of acculturation strategies in international students, which can provide valuable information for education policymakers in China. Based on above the literature review, we hypothesize that some demographic variables, attachment style, social ties in China may influence international students’ acculturation attitude in the host country. To better understand their potential relationships, we formulate the following hypotheses:Hypothesis 1: Duration in China will be positively related to integration and assimilation, and negatively related to separation and marginalization.Hypothesis 2: Language proficiency will be positively related to integration and assimilation, and negatively related to separation and marginalization.Hypothesis 3: Avoidance will be positively related to integration and assimilation, and anxiety positively related to separation and marginalization.Hypothesis 4: Host ties will be positively related to integration and assimilation, and negatively related to separation and marginalization. Co-national ties will be positively related to integration and separation, international ties will be positively related to integration.The survey received approval by Medical ethics committee of Yangtze university and conducted between November 2019 and January 2020. Written consent was obtained from the participants at the beginning of questionnaire and the consent was informed. All the participants were over 18 years old.International students were recruited from Yangtze university in Hubei province of China. Yangtze University was selected by convenient sampling method among the general international students studying in China, as it is one of the famous universities with the largest number of nationalities, including students of Pakistan, Zambia, Ethiopia, Ghana, Indonesia, Canada, France and so on. International students of Yangtze University were selected using stratified sampling method with duration in China and nationality as stratified variables. Trained data collectors approached participants directly with the assistance of the Yangtze University staff and international student leaders. An anonymous electronic questionnaire was used for the data collection. Participants individually complete the survey on their cellphones. Prior to the survey, all participants were informed to answer each statement as honestly as possible, because the survey was being conducted anonymous and strictly confidential manner. Out of the 235 participants approached in this way, 229 (97%) participants from 20 countries completed the survey, consisting of 94(41.0%) Pakistanis,13(5.68%) Nepalese, 1(0.44%)Thai, 9(3.93%)Indonesians, 22(9.61%)Zimbabwean, 16(6.99%) Ghanaians, 18(7.86%) Tanzanians, 2(0.87%) Ugandans, 22(9.61%)Zambians, 1(0.44%)Gabonese, 13(5.68%)Rwandans, 5(2.18%)Ethiopians, 1(0.44%)Chadian, 1(0.44%)South African, 1(0.44%)Papua New Guinea, 2(0.87%)Congolese, 1(0.44%)Namibians, 3(1.31)Canadian, 2(0.87%)French, 2(0.87%)Britisher. This sample composition is fairly representative for international students in China. 123(53.7%) of participants were male, and 106(46.3%) of participants were female, the average age of male and female was 22.12 (SD = 2.20) and 21.25 (SD = 1.39) respectively.χ2 test and One-Way ANOVA test was used to profiled the demographic factors of international students with regard to their acculturation attitudes. Four binary logistic regression analysis were used to find out what specific predictors such as duration in China, language proficiency, attachment style and social support could impact participants’ integration, assimilation, separation, and marginalization attitudes respectively.This study examined international students’ acculturation attitude from the perspective of demographic factors, attachment style and social support. Cluster analysis was conducted to divide acculturation strategies into integration, separation, assimilation and marginalization. Participants’ age, gender, nationality, current marital status, time spent in the China, English language proficiency and Chinese language proficiency were included in the questionnaire. Self-report was used to assess students’ English and Chinese proficiency instead of their scores on TOEFL/ IELTS and HSK. Because we believe spoken proficiency plays a crucial role in the acculturation process. Example of English proficiency “How good do you think your overall English language ability is?” followed by five ordinal choices: 1: very poor,2: poor, 3: moderate, 4: good and 5: very good.The modified Multi-Dimensional Support Scale  was usedThis was assessed by Meifen Wei and Daniel W. Russell’s  ECR ScalThe measure of acculturation strategy in this study was adapted from ‘Adopt and Keep’ scale developed by Swaidan et al. . The scaχ2 = 8.434, P = 0.038), for which female are more preferred to integration than male, nevertheless male are more preferred to marginalization than female. Consider presenting general demographic data too like not only objective oriented ones.Descriptive statistics for the analysis of international students’ acculturation attitude with regard to demographic characteristic were presented . Among t0.05, = 176.821, F0.05, = 244.131, respectively, P<0.05.Firstly, cluster analysis was conducted linking these two acculturation strategies dimensions. In line with previous studies , 39, theA binary logistic regression analysis was used to predict the chance that the international student would adopt separation. The Hosmer and Lemeshow test showed that the full model was valuable, with χ2 = 9.275, df = 8, p>0.05. The overall correct percentage was 76%. The full model explained 14.1% (Nagelkerke’s R2) of variance in the separation attitude of international students, with duration in China as the significant variable. As shown in P>0.05. The overall correct percentage was 86%. The full model explained 14.0% (Nagelkerke’s R2) of variance in the assimilation attitude of international students, with host ties as the significant variable. As shown in A binary logistic regression analysis was used to predict the chance that the international student would adopt assimilation. The Hosmer and Lemeshow test showed that the full model was valuable, with χ2 = 5.017, df = 8,P>0.05. The overall correct percentage was 86%. The full model explained 30.5% (Nagelkerke’s R2) of variance in the integration attitude of international students, with Chinese proficiency, avoidance and host friends as the significant variables. As shown in A binary logistic regression analysis was used to predict the chance that an international student would adopt integration. The Hosmer and Lemeshow test showed that the full model was valuable, with χ2 = 4.668, df = 8, P>0.05. The overall correct percentage was 90.4%. The full model explained 30.6% (Nagelkerke’s R2) of variance in the marginalization attitude of international students, with duration in China, Chinese proficiency, English proficiency and host friends as the significant variables. As shown in A binary logistic regression analysis was used to predict the chance that the international student would adopt marginalization. The Hosmer and Lemeshow test showed that the full model was valuable, with χ2 = 7.349, df = 8, This study sought to illustrate the influence of several predictors such as demographic factors, attachment style, media usage, and social support on the four acculturation strategies, and found out what specific factors could impact integration, assimilation, separation, and marginalization strategies of international students in China. In line with predictions derived from acculturation mode, findings indicated that duration in China, Chinese proficiency, English proficiency, host social ties and avoidance attachment style could predict the acculturation attitude of international students in China.Results revealed that the most prevalent acculturation strategy for the international students in China is integration, which was in accordance with previous researches , 39. TwoConsistent with previous studies , 34, durContrary to previous studies , 35, thiThe current findings provide clear support for the hypothesis that host ties are positively and significantly associate with assimilation and integration attitude, but negatively associate with marginalization attitude. Host-national contact were positively associated with multiculturalism . ThroughAvoidance attachment was found to have a negative association with integration attitude. According to the internal working model which consists of mental representations of oneself, others, and relationships , if the Our study is the first to investigate predictors of acculturation attitude from attachment style and social ties aspect with data collected from an international student in China, which can provide valuable information for education policymakers in China.In spite of its insights into existing acculturation research, several limitations should be noted. Firstly, Although Yangtze University is one of the famous universities with the largest number of nationalities and participants were selected by multistage sampling method to ensure the convenience of sampling and the representativeness of samples at the same time, the sample was selected from only one university, so the conclusion may have some limitations. Despite this limitation, this research is only a pilot study, future studies with large and more heterogeneous samples are required to gain a better understanding of current findings.Secondly, the data collected for this study by cross-sectional study which has an inherent weakness in identifying causality. Previous researches found that acculturation attitudes and social ties change over time, although findings are inconclusive as to how these changes might come about. In the recent research about acculturation attitudes, Juan Serrano-S´anchez and colleague , who folS1 File(PDF)Click here for additional data file.S2 File(PDF)Click here for additional data file.S3 File(SAV)Click here for additional data file.


Resistant starch (RS) content, defined as the starch that remained after 4 h of simulated in vitro enzymatic digestion, was measured for the starch samples. Upon the addition of ascorbic acid, the RS contents increased in both raw and cooked starches. Cooking significantly reduced the RS contents as compared to raw starches, and less increase in RS was observed with the addition of ascorbic acid. The inhibitory effect of ascorbic acid on the digestion of raw starches showed a dose-dependent trend until it reached the maximum extent of inhibition. At the concentrations of 12.5 and 18.75 mg/mL, ascorbic acid exhibited the most potent inhibitory effect on the in vitro starch digestion in raw and cooked conditions, respectively. Overall, our results strongly indicate that ascorbic acid may function as a glycemic modulatory agent beyond other important functions, and its effects persist upon cooking with certain concentrations applied.Ascorbic acid, also known as vitamin C, was previously reported to inhibit the activity of pancreatic α-amylase, the primary digestive enzyme for starch. A major implication of such inhibition is a slowed rate of starch digestion into glucose, which thereby reduces postprandial hyperglycemia. The aim of this study was to explore the inhibitory effects of ascorbic acid at various concentrations on the  As one of the most common chronic diseases worldwide, diabetes mellitus is a major risk factor for cardiovascular diseases and is associated with an increased rate of morbidity and mortality . It is cin vitro digestion assays, therefore raising concern regarding the dose responses and how this may translate to real-life applications.Ascorbic acid, commonly known as vitamin C, is a water-soluble micronutrient essential for the proper functioning of the body. It can be found in many foods, particularly fruits and vegetables such as citrus fruit, broccoli, and spinach. It is required for the formation and maintenance of connective tissues, and serves as a potent antioxidant which protects the body from harmful free radicals . Since iin vitro digestion. The amount of starch that remained undigested after the 4-h period was defined as the resistant starch (RS) content  was kindly provided by Ingredion . Potato starch  and ascorbic acid were purchased from Sigma-Aldrich Inc. . Digestible starch and resistant starch assay kit (K-DSTRS) was obtained from Megazyme . Ethanol was purchased from VWR International .in vitro starch digestion was conducted according to the method by the Megazyme resistant starch assay kit with slight modifications. The enzyme solution, containing pancreatic α-amylase and α-amyloglucosidase , was prepared immediately before use. Cooked starch was prepared by boiling starch in a 100°C water bath for 20 min and allowed to cool to room temperature (20°C) before in vitro digestion. Starch (100 mg) alone and starch mixed with 12.5, 25, 50, or 75 mg of ascorbic acid were weighed into 20 mL round-bottom test tubes. A test tube with no starch and inhibitors was used as the blank. An amount of 3.5 mL of 50 mM sodium maleate buffer was added into each tube, and the reaction suspensions were mixed and placed in a water bath at 37°C for 5 min to equilibrate. Enzyme solution (0.5 mL) was added into each tube at a certain time interval with accurate timing for further sampling. The test tubes were capped and placed into a shaking water bath at 37°C and 170 strokes per min. After incubating for 4 h, 4.0 mL of 95% (v/v) ethanol was added to each tube and was mixed vigorously. The samples were centrifuged  and the supernatant was decanted. The pellet was resuspended in 8 mL of 50% (v/v) ethanol and vigorously mixed. The centrifugation, washing, and decanting steps were then repeated twice, and the remaining pellet was used for the resistant starch measurements.The TM Excel® Calculator.The RS content in starch samples was determined following the resistant starch assay procedure using the digestible starch and resistant starch assay kit (K-DSTRS) , with slp < 0.05 (a > b > c > d).All experiments were conducted in duplicates. Data were analyzed by one-way analysis of variance (one-way ANOVA) followed by Tukey's multiple comparison test using the OriginPro software . The letters a, b, c, and d indicate statistically significant differences, in vitro starch digestion rate was first explored on two starches (HAMS and PS) in their raw form. To better understand its applicability as an inhibitor of starch digestion, four different concentrations  were used to determine the most effective level of ascorbic acid that could retard starch digestion to the greatest extent. As shown in p < 0.05) in response to all tested concentrations except for 3.125 mg/mL. As the concentration of ascorbic acid increased up to 12.5 mg/mL, the RS content continued to increase, showing a dose-dependent effect of ascorbic acid  . Based o2 mg/day . Using t2 mg/day . This agin vitro digestion of raw starches, it is important to verify that such effect is present in forms of starch that would realistically be consumed in human diet, i.e., subjected to cooking. Accordingly, based on the results obtained from raw starches, we further studied the effects of ascorbic acid with concentrations of 3.125 and 12.5 mg/mL on the digestion of cooked HAMS and PS  in the presence of ascorbic acid, whereas that of cooked PS was only increased to 0.63% (p < 0.05). Such modest enhancement could be explained by the destruction in the starch molecular packing order caused by gelatinization, which could not be recovered or altered in any way by the presence of ascorbic acid. This also indicates that ascorbic acid can only act on the digestive enzymes, but not the substrate, to resist enzymatic hydrolysis (Similar to the results observed for raw starches, ascorbic acid with a concentration of 3.125 mg/mL did not present any inhibitory effect on starch digestion, while 12.5 mg/mL of ascorbic acid resulted in significant increases in the RS contents in both HAMS and PS, although the effects were rather modest as compared to those in raw starches. For cooked HAMS, the RS content was increased to 37.39% (drolysis . Therefodrolysis . The stodrolysis . In our in vitro starch digestion, as evidenced by increased contents of RS, was demonstrated in this study. Our results indicated the dose-dependent response of such inhibitory effect, and that the optimal level of ascorbic acid is practical and achievable via daily food or supplement intake and unlikely to result in toxicity in human body. Furthermore, in the tested cooking condition, the RS contents were significantly increased in the presence of ascorbic acid, although to a modest extent. This evidence suggests that ascorbic acid can be broadly applied to realistic starch systems. The inhibitory ability was most potent in the case of raw starch, and the slighter impact on cooked starch is likely the result of gelatinization with a high water content. Thus, future studies illustrating the inhibitory effect of ascorbic acid on starch cooked in relatively drier conditions are warranted to determine the effects of retrogradation on starch digestibility. Given that ascorbic acid has already been established as an essential nutrient, this study supports its further utilization as a promising agent in glycemic modulation.The inhibitory effect of ascorbic acid on simulated The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.AG: investigation, formal analysis, visualization, and writing—original draft. JG: investigation, formal analysis, visualization, and writing—review and editing. LT: conceptualization, formal analysis, and writing—review and editing. LK: conceptualization, supervision, formal analysis, visualization, and writing—review and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Here, we extend the benefits of one-step, multiplexed, quantitative, isothermal, enzyme-free HCR signal amplification to immunohistochemistry, enabling accurate and precise protein relative quantitation with subcellular resolution in an anatomical context. Moreover, we provide a unified framework for simultaneous quantitative protein and RNA imaging with one-step HCR signal amplification performed for all target proteins and RNAs simultaneously.RNA  Summary: Signal amplification based on the mechanism of hybridization chain reaction enables multiplexed, quantitative, high-resolution imaging of protein and RNA targets in highly autofluorescent tissues. CARD is widely used despite three significant drawbacks: multiplexing is cumbersome due to the lack of orthogonal deposition chemistries, necessitating serial amplification for one target after another . To image RNA expression, targets are detected by nucleic acid probes that trigger isothermal enzyme-free chain reactions in which fluorophore-labeled HCR hairpins self-assemble into tethered fluorescent amplification polymers  without modification. On the other hand, for multiplexed experiments, each target must be detected using a primary antibody raised in a different host species to enable subsequent detection by an anti-host secondary antibody probe that triggers an orthogonal spectrally distinct HCR amplifier. Hence, depending on the available antibody probes, one may prefer HCR 1°IHC in one instance and HCR 2°IHC in another.For protein imaging with HCR we pursue two complementary approaches. Using HCR 1°IHC, protein targets are detected using primary antibody probes labeled with one or more HCR initiators C. For muTables S9 and S10 for additional details). The level of performance demonstrated in see section S5.5 in the supplementary information). It is this amplification gain that boosts the signal above autofluorescence to yield a high signal-to-background ratio even in FFPE tissues and whole-mount vertebrate embryos.Using HCR signal amplification, the amplification gain corresponds to the number of fluorophore-labeled hairpins per amplification polymer. Hence, we were curious to measure the mean HCR polymer length in the context of HCR 1°IHC and HCR 2°IHC experiments. We can estimate HCR amplification gain by comparing the signal intensity in HCR experiments using h1 and h2 hairpins together  versus using only hairpin h1 (so that each HCR initiator can bind only one HCR hairpin and polymerization cannot proceed). Across four measurement scenarios , we observed a median polymer length of ≈180 hairpins . Using one initiator-labeled primary antibody probe per channel, we observe high accuracy (linearity with zero intercept) and precision (scatter around the line) for subcellular 2×2 µm voxels within 5 µm FFPE mouse brain sections using epifluorescence microscopy. This redundant detection experiment provides a conservative characterization of quantitative performance as there is the risk that two antibody probes may interfere with each other to some extent when attempting to bind different epitopes on the same target protein. As a further test of quantitative imaging characteristics, we detected a protein target with unlabeled primary antibody probes that are subsequently detected by two batches of secondary antibody probes that trigger different spectrally distinct HCR amplifiers  with subcellular resolution within whole-mount vertebrate embryos . Here, wplifiers A; bottomplifiers B; bottomplifiers C; bottomplifiers .Fig. 4.Tables S9 and S11 for additional details).It is important for biologists, drug developers and pathologists to have the flexibility to image proteins and RNAs simultaneously so as to enable interrogation of both levels of gene expression in the same specimen. Here, we demonstrate that HCR 1°IHC and HCR 2°IHC are both compatible with HCR RNA-ISH, enabling multiplexed quantitative protein and RNA imaging with high signal-to-background. a priori and then used with large libraries of (unmodified) validated primary antibodies, enabling a plug-and-play approach using validated reagents. For simultaneous protein and RNA imaging: during the protein detection stage, M target proteins are detected in parallel; during the RNA detection stage, N target RNAs are detected in parallel; and during the amplification stage, one-step quantitative HCR signal amplification is performed for all M+N protein and RNA targets simultaneously. In 4-plex experiments in FFPE tissue sections, protein and RNA targets are simultaneously imaged with high signal-to-background in all four channels using fluorophores that compete with varying degrees of autofluorescence. For protein imaging using HCR 1°IHC or HCR 2°IHC, we favor protocols with two overnight incubations , each target protein in a multiplexed experiment can be detected with antibodies raised in the same host species, which is often convenient based on available antibody libraries. However, antibody-initiator conjugation must be validated for each new primary antibody probe. Alternatively, using HCR 2°IHC (unlabeled primary antibody probes and initiator-labeled secondary antibody probes), each target protein in a multiplexed experiment must be detected with primary antibodies raised in different host species, thus enabling subsequent binding by initiator-labeled secondary antibodies that react with those different host species. This approach has the benefit that a small library of initiator-labeled secondary antibodies can be validated ubations B and 3B,ubations A and 6A,HCR RNA-ISH provides automatic background suppression throughout the protocol, ensuring that reagents will not generate amplified background even if they bind non-specifically within the sample . During For RNA targets, we have previously shown that multiplexed qHCR imaging enables bi-directional quantitative discovery : read-ouTable S2 for HCR 1°IHC, in Table S3 for HCR 2°IHC and in Table S4 for HCR RNA-ISH. HCR initiators were conjugated to antibody probes using the Antibody-Oligonucleotide All-in-One Conjugation Kit  according to the manufacturer's instructions.Details on the probes, amplifiers and buffers for each experiment are displayed in section S3 in the supplementary information. HCR 2°IHC with/without HCR RNA-ISH was performed using the protocols detailed in section S4 in the supplementary information. These IHC protocols with/without HCR RNA-ISH were developed starting from HCR RNA-ISH protocols  rather than IHC; for notational simplicity, we use the term IHC uniformly in the main text but denote protocols for cultured cells as ICC in the supplementary information. For five-channel imaging of HeLa cells  the above protocols were modified as follows to enable imaging on an upright confocal microscope: cells were grown on a chambered slide with removable chambers ; prior to imaging, the silicone chambers were removed and cells were mounted with ProLong glass antifade mountant with NucBlue  according to the manufacturer's instructions.HCR 1°IHC with/without HCR RNA-ISH was performed using the protocols detailed in rotocols . The optrotocols  and chemrotocols  bleachinDanio rerio strain AB; fixed at 27 hpf). Procedures for the care and use of zebrafish embryos were approved by the Caltech IACUC.Experiments were performed in HeLa cells , FFPE C57BL/6 mouse brain sections , FFPE human breast tissue sections  and whole-mount zebrafish embryos . All epifluorescence images were acquired without THUNDER computational clearing and are displayed with instrument noise subtracted but without background subtraction. See section S2.6 of the supplementary information, including: definition of raw pixel intensities; measurement of signal, background and signal-to-background; measurement of background components and calculation of normalized subcellular voxel intensities for qHCR imaging.Image analysis was performed as detailed in


Both fragile X-associated tremor/ataxia syndrome (FXTAS) and late-onset neuronal intranuclear inclusion disease (NIID) show CGG/GGC trinucleotide repeat expansions. Differentiating these diseases are difficult because of the similarity in their clinical and radiological features. It is unclear that skin biopsy can distinguish NIID from FXTAS. We performed a skin biopsy in an FXTAS case with cognitive dysfunction and peripheral neuropathy without tremor, which was initially suspected to be NIID.Notch 2 N-terminal like C (NOTCH2NLC) gene. We then performed genetic analysis for FXTAS using RP-PCR, which revealed a repeat CGG/GGC expansion in the FMRP translational regulator 1 (FMR1) gene. The number of repeats was 83. We finally diagnosed the patient with FXTAS rather than NIID.The patient underwent neurological assessment and examinations, including laboratory tests, electrophysiologic test, imaging, skin biopsy, and genetic test. A brain MRI showed hyperintensity lesions along the corticomedullary junction on diffusion-weighted imaging (DWI) in addition to middle cerebellar peduncle sign (MCP sign). We suspected NIID from the clinical picture and the radiological findings, and performed a skin biopsy. The skin biopsy specimen showed ubiquitin- and p62-positive intranuclear inclusions, suggesting NIID. However, a genetic analysis for NIID using repeat-primed polymerase chain reaction (RP-PCR) revealed no expansion detected in the For the differential diagnosis of FXTAS and NIID, a skin biopsy alone is insufficient; instead, genetic analysis, is essential. Further investigations in additional cases based on genetic analysis are needed to elucidate the clinical and pathological differences between FXTAS and NIID. FMRP translational regulator 1 (FMR1) gene [Notch 2 N-terminal like C (NOTCH2NLC), was revealed in NIID [Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late-onset inherited degenerative disorder due to a CGG repeat expansion in the premutation range 55–200) in the 5′ untranslated region of the 00 in the in NIID . HoweverWe performed skin biopsy in a patient with FXTAS with cognitive dysfunction and peripheral neuropathy without tremor who was suspected to be NIID at first and was finally diagnosed as FXTAS owing to genetic analysis.123I-iodoamphetamine SPECT showed reduction of blood flow in the bilateral cerebellum hemisphere. Considering the clinical picture which showed cognitive impairment and no tremor, as well as the corticomedullary hyperintensity lesions on DWI, we initially suspected NIID, although FXTAS had to be differentiated. In the diagnostic flow chart of adult onset NIID reported by Sone et al., skin biopsy is recommended as the next step after the electrophysiological, radiological, and biochemical examinations [A patient in his 70s, with a history of type 2 diabetes mellitus and bronchial asthma, presented with progressive gait disturbance and cognitive impairment in 2017. He did not have a family history of neurological disease. On admission, we did not detect any problems from the general physical examination including consciousness and body temperature. He showed general cognitive impairment, yielding a Mini-Mental State Examination score of 13/30. His ocular movements showed saccadic pursuits without nystagmus. Additionally, muscle weakness was observed in the bilateral lower extremities, predominantly on the right side. In the bilateral lower extremities, vibration and proprioceptive sensations were decreased and deep tendon reflexes were absent. He also showed limb ataxia but no tremor. Autonomic dysfunction was not observed. A blood test including hemoglobin A1c, thyroid hormone, and autoantibodies  showed no abnormalities that could explain his symptoms. An examination of cerebrospinal fluid showed a slight increase in protein (59 mg/dL). A nerve conduction study showed reduced compound muscle action potential amplitude and reduced sensory potentials in the upper and lower limb nerves. An EEG showed general theta waves with no epileptic waves. Therefore, we performed brain MRI and observed hyperintensity lesions along the corticomedullary junction on diffusion-weighted imaging (DWI) in addition to middle cerebellar peduncle sign (MCP sign)  for confirmation of diagnosis, using genomic DNA extracted from peripheral blood leukocytes as previously reported [t report . As a reled Fig. A. The nuled Fig. B. TherefBoth FXTAS and NIID show cerebellar ataxia, dementia, and neuropathy. The tremor can be unremarkable in FXTAS as was the case with our patient.Importantly, an MRI of FXTAS usually demonstrates cerebral and cerebellar atrophy, increased T2 signal intensity in the cerebral and cerebellar white matters, and an MCP sign. An MCP sign is a well-known characteristic of FXTAS, which we observed in our patient; however, it has also been reported in patients with NIID . FurtherThe pathological features of FXTAS in autopsy cases include ubiquitin-positive intranuclear inclusions exhibited in neurons and astrocytes throughout the brain and periphery , 8. The Finally, we were able to diagnose FXTAS by genetic analysis. This finding suggests that a skin biopsy alone is insufficient and that, instead, genetic analysis is essential for the differential diagnosis of FXTAS and NIID. Further investigations in additional cases based on genetic analysis are needed to elucidate the clinical and pathological differences between FXTAS and NIID.


Wheat and rice starches, traditionally used to stiffen fabric, become less contaminated and more antiseptic after fermentation for several years, thus enhancing their functional activity. In the present study, analytical techniques using particle size analysis, a gloss meter and a colorimeter were used to measure the physical properties of wheat and rice starches that had been fermented for 5 and 7 years, respectively. Their chemical contents and composition were determined by nutrient measurements and time-of-flight secondary ion mass spectrometry (ToF-SIMS). The ToF-SIMS spectra and ion images showed that fermented starch contained more carbohydrate and less lipid than fresh starch. The surface morphologies of the fermented starch granules and starch-coated textiles were examined by scanning electron microscopy and compared with the surface morphologies of fresh starch granules. The fermented wheat and rice starch granules were smaller and more rounded with a lower level of N-containing compounds (proteins) and exhibited more antiseptic properties than fresh starch granules. The results showed that physical measurements and chemical analysis were simple and complementary techniques for investigating traditional Korean starch materials and textiles. Starch, a granular, organic chemical produced by green plants, is a white, tasteless powder that is insoluble in cold water, alcohol, or other solvents. Starch from several botanical materials is a polymeric carbohydrate containing mainly two types of polysaccharides, amylose and amylopectin ,4,5,6,7.Many research groups have a lot of interest in coating materials and traditional textiles. Xia’s group had investigated Kemao knitted tapestry as well as Zuoqun made by the folk women in the Sudong region and H. Wang, et al. had provided useful information on other traditional textile fabrics and clothing technology ,11,12. SSurface analytical techniques can provide valuable information on the chemical composition of the surfaces, which is highly important for understanding the function of natural products and developing new materials ,20,21,22However, the specific characterization of the surface of fermented starches used traditionally for laundry, adhesives and paper making has not yet been thoroughly studied. There is little information on the physical properties and chemical composition of the fermented starches although they have been used as clothing starch for a long time. The present study aims to characterize the surface of five-year fermented wheat starch and seven-year fermented rice starch and to compare the results with those of fresh wheat and rice starches using SEM and ToF-SIMS. The physical properties, granule size distribution, glossiness, color and antiseptic properties, will also be measured to determine if fermented starches provide any advantages over fresh starches for coating textiles. Thus, we obtained a profound understanding of traditionally fermented starch for several years in Korea.The fresh and 5-year fermented wheat starch, and fresh and 7-year fermented rice starch were provided by Sunja Park, a craftswoman with great knowledge of traditional Korean clothes. The fermented starches had been prepared by milling the rice and wheat into a powder followed by fermentation in water for 5 or 7 years, respectively, using the traditional Korean method.Two kinds of refined (uncoated) and starched textiles were also provided by Sunja Park, ramie and cotton fabrics. These are known as refined fabrics and were starched with glue made by boiling four types of starch. The fabrics were rinsed with starch glues, dried at room temperature to provide four finished products as starched textiles. For the SEM and ToF-SIMS measurements, the starch suspensions were prepared using 20 mg of starch in 1 mL distilled water then 2–5 μL of the starch solution were deposited onto a silicon substrate that had been thoroughly cleaned using methanol.The particle size distributions of the starches were measured using a Zetasizer Nano-ZS ZEN 3600  with a ZeN0040 cuvette at room temperature. The starch was dispersed in a solvent of dimethyl sulfoxide and dimethylformamide at a ratio of 3:1.Glossiness is one of the most important factors for fabrics used in clothes making and varies with the type of fabric used and the extent of starching. The glossiness was measured using a Novo-Gloss Trio Glossmeter  following the ASTM D523 standard.The color of the starched fabrics was measured using a spectrum colorimeter . A colorimeter measures color by illuminating a surface with white light then measuring the reflected light and assigning numerical values for L (brightness), a  and b .Escherichia coli .To compare the antibiotic effects of the fresh and fermented starches, the starch powders were mixed with cell culture media then observed for 24 h with 2SO4 with a catalyst then the starch was added.The nutritional contents of the starches were analyzed using methods recommended by the Korean Food Standards Codex from the Ministry of Food and Drug Safety . The wat−8 Pa. The surface spectra and 2D ion images were measured in the high-current bunched mode with a pulsed 30-keV Bi3+ beam, which impacted the sample surface at an incident angle of 45° to the normal line. The pulsed current on the target was kept at 0.6 pA. A cycle time of 100 μs was used for the ion doses, well below the static SIMS limit of 1013 ions/cm2. Both the positive and negative secondary ions were accelerated from the sample surface by an ion lens operating at 2 kV into a time-of-flight (ToF) mass analyzer. The ToF used a reflector to decrease the energy distribution and line widths and had a total flight length of 2 m. The secondary ion beam was focused on the microchannel plate with a post-acceleration energy of 20 kV. A low-energy electron flood gun was used to compensate for the charge of the starch and textile samples. The mass spectra from the pure starch were collected from an area of 50 × 50 μm2 and used to determine the characteristic ions from the different starch samples. The spectra and 2D ion images were summarized using SurfaceLab 6.8 software . The ToF-SIMS spectra were obtained from different areas of the starch granules by three measurements to confirm the ToF-SIMS characteristic ions and to obtain typical spectra.The positive and negative ion ToF-SIMS analyses were made using a TOF-SIMS 5 system  with a base pressure of 3.0 × 10The starch particles dispersed with water and coated on the Si wafer were observed using Field Emission Scanning Electron Microscopy (FE-SEM) to investigate the morphology and size of the starch particles. The observations were made at a voltage of 5 kV using an Inspect F50 instrument  after the starch granules had been coated with Pt.−1 and 32 scans were collected with a resolution of 4 cm−1.Attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) spectra were obtained using a Nicolet iS20 FT-IR spectrometer  with a deuterated triglycine sulfate detector. The FTIR instrument uses a germanium ATR crystal which gave a shallow penetration depth. A spectrum was recorded over three times to confirm the measurement of each sample within the wavenumber region of 650–4000 cmThe size distributions of the fresh and fermented starch granules were obtained by dynamic light scattering (DLS) analysis as shown in The compositions of the different starch granules were measured . The freIn The ramie and cotton fabrics were coated with fresh and fermented starch (wheat and rice) then their appearance was measured using a glossmeter and colorimeter. The effect on the morphology of the different types of starch granules is shown in Starch used for clothing is a solution prepared by mixing and boiling the starch powder in water into which the ramie and cotton fabrics were immersed. −1 are due to O-H stretching vibration, and the peaks at 2910 and 2855 cm−1 are due to the C-H stretching and the =C-H stretching vibrations. The peak at 1460 cm−1 is due to C-H bending in a side chain and the peaks at 1150 cm−1 and 1030 cm−1 indicate C-O stretching vibration. The spectrum of textiles with wheat and rice starch is shown with a specific peak at 2360 cm−1 due to the N-H stretching, a peak at 1620 cm−1 that is because of C=O stretching. These results, which are expected because starch is the main coating component support the accuracy of the FT-IR technique. However, it was not possible to distinguish fresh starch and fermented starch in textiles using the ATR FT-IR technique.m/z 1–100) showed the intense peaks of CN− (m/z 26.00), CNO− (m/z 41.99), C2H3O2− (m/z 59.01), C3H3O2− (m/z 71.01), C3H3O3− (m/z 87.01) and C4H3O3− (m/z 99.01). In the higher mass range (m/z 100–360), the major peaks of carbohydrate molecules occurred at m/z 179 (C6H11O6−) and m/z 221 (C8H13O7−). Other intense peaks at m/z 255, 279, 311, 325 and 339 can be assigned to lipid molecules as well as carbohydrate fragment ions. The characteristic peaks at m/z 255, 279 and 339 could have arisen from free fatty acids, such as palmitic, linoleic and behenic acids. The peaks at m/z 311 and 325 were indicative of the presence of arachidic acid ion fragments, generated from free fatty acids and/or from glycerides in the starch granules. The ToF-SIMS spectra of the fresh starch granules provided identification of specific ions generated from granule surface carbohydrates, lipids, and contaminants that were consistent with the results of Baldwin’s group [Information on the molecular structure and chemical composition of the top surface of the materials was obtained by the ToF-SIMS technique. The negative ion ToF-SIMS mass spectra of the starch granules were measured. ’s group .m/z 87, 99 and 221 from the carbohydrate molecules of the 5-year fermented wheat starch increased but the characteristic peaks from carbohydrate molecular ions and free fatty acids significantly decreased. 4+, C4H8O2+ and C5H15O4NP+ as well as total ions. The local distribution of the molecular fragments of carbohydrates and fatty acids (lipids) was homogeneous as shown over the images. The more intense peaks of phospholipids and free fatty acids were present in the ion images of cotton textiles coated with fresh starch. The ToF-SIMS images of textile samples coated with fresh wheat starch exhibited more N-containing ions than those coated with fresh rice starch expected from the composition of the fresh wheat starch. The ToF-SIMS image results confirmed that cotton textiles coated with fermented wheat and rice starch had fewer lipid and N-containing components, such as proteins compared with those coated with fresh starch.The textile samples were coated with the four different starch solutions prepared from fresh wheat, 5-year fermented wheat, fresh rice and 7-year fermented rice starches. The negative ion ToF-SIMS spectra were obtained from these four textile samples. The characteristic peaks from the carbohydrate molecules and lipid molecules were easily observed in the ToF-SIMS spectra of the starch-coated textiles. The ToF-SIMS measurements enabled the chemical distribution of the starch component on the cotton fabric to be easily evaluated. The ToF-SIMS imaging experiment was performed on cotton fabric samples coated with fresh and fermented wheat and rice starch. − from proteins and lipids, was observed in textiles coated with fresh wheat starch. The molecular ions of carbohydrates and fatty acids, such as C4H3O3− and C6H11O6− appeared to be located in small aggregates. The ToF-SIMS technique has provided useful information on both the elements, including isotopic distribution and the molecules present on textiles coated with fresh and fermented starch.As shown in Complementary chemical and physical analysis methods have been used to gain a better understanding of the use of traditionally fermented starch granules for coating textiles. Many research groups have studied starch and textiles, however, research about starch fermented for several years is barely found. Wheat and rice starch granules were fermented for 5 and 7 years, respectively, using a traditional process. The fermented starch granules and their coated textiles were examined by physical and structural methods using a gloss meter, colorimeter, particle size analysis and SEM. The fermented starch granules exhibited a smaller particle size and smoother shape than the fresh starch granules and the glossiness and brightness of ramie textiles coated with fermented starch were better than those coated with fresh starch. The SEM images indicated that the rice starch granules had a very characteristic shape before fermentation which became round and small after fermentation. The antiseptic properties of the fermented starches were highly improved compared with those of the fresh starches. The surface technique, ToF-SIMS, allowed the acquisition of useful information on both the fresh and fermented starch granules and the textiles coated with traditionally fermented starch. The important benefits of using ToF-SIMS to characterize starch materials include the minimal sample size, the lack of sample preparation and the identification of the elemental and organic components of the starch materials. Establishing physical and chemical methods using a systematic approach will provide a deeper understanding of traditional techniques and wisdom for treating fabric materials. Thus, establishing physical and chemical methods using a systematic approach provide a deeper understanding of traditionally fermented starches and coated textiles.