Starch extracted from pineapple stem waste underwent an environmentally friendly modification process characterized by low-energy consumption. This process resulted in the creation of dialdehyde pineapple stem starch featuring varying aldehyde contents ranging from 10% to 90%. Leveraging these dialdehyde starches, thermosetting plastics were meticulously developed by incorporating glycerol as a plasticizer. Concurrently, unmodified pineapple stem starch was employed as a control to produce thermoplastic material under identical conditions. The objective of streamlining the processing steps was pursued by adopting a direct hot compression molding technique. This enabled the transformation of starch powders into plastic sheets without the need for water-based gelatinization. Consequently, the dialdehyde starch-based thermosetting plastics exhibited exceptional mechanical properties, boasting a modulus within the range of 1862 MPa to 2000 MPa and a strength of 15 MPa to 42 MPa. Notably, their stretchability remained relatively modest, spanning from 0.8% to 2.4%. Comparatively, these properties significantly outperformed the thermoplastic counterpart derived from unmodified starch. Tailoring the mechanical performance of the thermosetting plastics was achieved by manipulating the glycerol content, ranging from 30% to 50%. Phase morphologies of the thermoset starch unveiled a uniformly distributed microstructure without any observable starch particles. This stood in contrast to the heterogeneous structure exhibited by the thermoplastic derived from unmodified starch. X-ray diffraction patterns indicated the absence of a crystalline structure within the thermosets, likely attributed to the establishment of a crosslinked structure. The resultant network formation in the thermosets directly correlated with enhanced water resistance. Remarkably, the thermosetting starch originating from pineapple stem starch demonstrated continued biodegradability following a soil burial test, albeit at a notably slower rate when compared to its thermoplastic counterpart. These findings hold the potential to pave the way for the utilization of starch-based products, thereby replacing non-biodegradable petroleum-based materials and contributing to the creation of more enduring and sustainable commodities. Over the past few decades, growing environmental awareness and conscious living have brought significant attention to the global warming crisis, driven by the detrimental ecological repercussions of environmental pollution resulting from human activities. The United Nations (UN) has placed substantial emphasis on addressing these concerns by introducing the Agenda 2030 for sustainable development goals (SDGs), aiming to provide comprehensive solutions for achieving long-term environmental sustainability. This commitment has led to the emergence of three sustainable economic models collectively known as the Bio-Circular-Green (BCG) economy, which has been globally recognized and adopted across various sectors .Central to the ongoing environmental challenges is the escalating accumulation of commodity plastic waste, a predicament rooted in the predominant utilization of petroleum-based or non-renewable resources for plastic production. This approach is unsustainable, primarily due to the non-biodegradable nature of most plastics. One proposed solution to alleviate this issue revolves around recycling. However, practical hurdles arise when dealing with small-sized, lightweight, and contaminated plastic waste, particularly stemming from single-use plastic products in sectors such as food delivery and personal protective equipment. These challenges often result in the escape of such waste from proper disposal cycles, leading to progressively severe environmental consequences over time ,3.In response to these concerns, the development of biodegradable polymer materials has gained traction, presenting a sustainable and environmentally friendly approach to address the aforementioned issues. Commercially available biodegradable plastics encompass a range of materials, including fully synthetic polybutylene adipate terephthalate (PBAT), partially biobased polybutylene succinate (PBS), fully biobased polylactic acid (PLA), as well as natural polymers like starch, polyhydroxyalkanoates (PHAs), and polyhydroxybutyrate (PHB). Each biodegradable plastic exhibits distinct characteristics, advantages, and specific biodegradability profiles within different natural environments ,5. For eStarch, a versatile biopolymer characterized by its high abundance, low cost, renewability, and biodegradability, has garnered attention as a promising candidate for the development of bio-based plastics across various applications. A number of reviews have explored its potential in this regard ,10,11,12Pineapple stem starch (PSS), a byproduct generated after bromelain extraction from pineapple stems, has attracted considerable attention due to its potential utilization in various avenues ,29,30. OConsequently, our overarching goal is to elevate the range of potential applications for pineapple stem starch (PSS) through the innovation of a novel biodegradable thermosetting plastic utilizing dialdehyde pineapple stem starch (DPSS). The synthesis and detailed investigation of DPSS were undertaken with a specific focus on its physicochemical attributes. Subsequent to DPSS preparation, we proceeded to fabricate thermosetting plastic sheets, employing DPSS as the matrix and glycerol as the plasticizer. Employing a hot compression molding process devoid of water gelatinization, this approach aimed to streamline processing steps. The thorough characterization of the resultant thermoset materials encompassed evaluations of mechanical properties, morphology, crystallinity, water resistance, and biodegradability. This comprehensive understanding holds significant importance, as it may set the stage for the advancement of thermoset plastics derived from plant-based materials as a sustainable alternative to petroleum-based counterparts. By addressing environmental concerns associated with solid plastic waste, this research contributes to the pursuit of a more sustainable future.The pineapple stem waste, an agricultural biomass byproduct resulting from the bromelain extraction process, was sourced from Hong Mao Biochemical Co., Ltd. located in Rayong, Thailand. Initially, the peeled pineapple stem underwent a pulverization process to disrupt the cellular structure. Subsequently, the bromelain liquid was extracted from the crushed stem through a sequence of techniques, including ultrafiltration, centrifugation, and lyophilization ,40. FollDialdehyde pineapple stem starch (DPSS) was synthesized employing a modified version of the approach for dialdehyde yam starch, as outlined by Zhang et al. . In this1 and C2 are the concentrations (mol/L) of sodium hydroxide and sulfuric acid solution, respectively. V1 and V2 are the total volume of sodium hydroxide and the sulfuric acid solution used, respectively. w is the dry weight of the DPSS sample. Each sample was repeated in triplicate and the sample code was defined as DxPSS, where x is the percentage of dialdehyde unit.The aldehyde contents in four types of DPSS prepared by varying periodic acid concentrations were determined with a rapid quantitative alkali consumption method using a titration technique . The driThermosetting plastics were prepared from dialdehyde pineapple stem starch containing 30% aldehyde content (D30PSS) as follows: 100 g of D30PSS was added to a 500-mL beaker, and then various amounts of glycerol were weighed and added as plasticizer, according to the ratios specified in −1 to 400 cm−1 with a 4 cm−1 resolution and 64 scans at room temperature.An FTIR spectrometer equipped with an attenuated total reflectance (ATR) accessory  was used to record the ATR-FTIR spectra of the prepared dialdehyde pineapple stem starch and starch-based plastic materials. The measurement was carried out from 4000 cm1H-NMR spectra of starch samples were acquired using an Ultrashield N.M.R. spectrometer with an operating frequency of 500 MHz . The starch samples were completely dissolved in deuterated dimethyl sulfoxide (DMSO-d6) as a solvent at 120 °C for 3 h and placed in NMR tubes. The chemical shifts were expressed in parts per million (ppm). The solvent peak was 2.5 ppm, and the water peak was 3.35 ppm.The η]) of the starch samples with different aldehyde contents was measured using an Ubbelohde-type viscometer (capillary tube with 0.58-mm diameter) at (25 ± 0.1) °C. The starch samples were completely dissolved in dimethyl sulfoxide (DMSO) at 120 °C for 3 h to prepare the starch solution (0.05 g/dL to 0.1 g/dL). The intrinsic viscosity was determined according to the Huggins Equation (2) and Kraemer Equation (3) and each sample was performed in triplicate to obtain an average value.Hk and Kk are Huggins and Kraemer constants, respectively. ηsp = ηr − 1, ηr = t/t0; t is the efflux time of solution and t0 is the efflux time of solvent.The intrinsic viscosity  with nickel-filtered Cu Kα radiation (λ = 1.5406 Å). The scattered radiation was assessed in the angular range (2θ) of 10–40° with a step scan 15 s/point. The degree of crystallinity of the starch powder samples and starch-based plastics was calculated from the integrated peak area of amorphous and crystalline regions using Equation (4).The tensile properties of starch-based materials were investigated using a universal testing machine  with a 1 kN static load cell capacity according to ASTM D882 . Six speThe hardness of the prepared plastics was evaluated using the durometer method or Shore D hardness according to ASTM D2240  (GT-GS-MThe tensile fractured surface of the samples was observed using a scanning electron microscope (SEM) . Before the observation, the samples were coated with platinum/palladium .The water resistance of the starch-based materials was conducted in terms of the water absorption and solubility by following the procedure reported by Namphonsane et al. .wi. Then, the sample specimen was immersed and gently stirred in distilled water. The absorption ability was measured at  minutes of immersion time. Excess water on the sample surface was removed using blotting paper, and its weight was monitored and defined as wf. Water absorption was determined using Equation (5).Water absorption: A specimen prepared from compression molding was cut to dimensions of 20 mm × 20 mm (length × width) and dried in a hot-air ventilated oven at 80 °C for 24 h. The dried weight before soaking in distilled water was recorded and defined as wfd. Water solubility was calculated using Equation (6).Water solubility: The measurement was assessed following the same conditions as water absorption; however, the test sample was immersed in distilled water over 24 h and after that the sample was dried at 80 °C for 24 h. The weight after drying was determined and defined as The biodegradability assessment of starch-based plastics was conducted using a soil burial test, following a modified protocol previously described by Seligra et al. . Sample t-test method with unequal variances was used to determine the statistically significant differences among the means (p < 0.05).The statistical analysis was performed using analysis of variance (ANOVA) with the Data Analysis tool in the Microsoft Excel 2019 program. The Pineapple stem starch was subjected to chemical modification via oxidative cleavage, employing periodic acid as the oxidizing agent, to yield dialdehyde pineapple stem starch (DPSS). The degree of oxidation, denoted by the aldehyde contents, was quantified in terms of the number of carbonyl groups per 100 glucose units. This measurement serves as an indicator of the extent of oxidation achieved under the specific conditions . Notably−1), C-H stretching (2931 cm−1), C-O bending associated with the OH group (1632 cm−1), CH2 bending deformation (1456 cm−1), C-O-C stretching (1149 cm−1), C-O stretching (1200 cm−1 to 800 cm−1), and the C-O-C of the pyranose ring of glucose  [−1, associated with C=O stretching of the aldehyde functional group [−1 and 1110 cm−1 [The chemical structure of PSS and DPSS was investigated using ATR-FTIR analysis and the results are illustrated in 63 cm−1) ,52. The al group . This foal group . Moreove110 cm−1 . The inc1H-NMR technique as demonstrated in HC1-O-, a), 5.41 ppm , 3.65 ppm , 5.51 ppm , 3.58 ppm , and 3.6 ppm  [HC2=O and HC3=O, respectively [The chemical modification of PSS to obtain dialdehyde starch or DPSS was assured by the C-OH, f) ,56. Afteectively . TherefoThe thermosetting plastic starch was produced using D30PSS with glycerol as the plasticizer. Simultaneously, the thermoplastic plastic starch derived from pristine PSS was prepared under identical conditions to serve as a comparative sample against the modified starch. Consequently, the thermoplastic starch derived from PSS containing 30% of the weight fraction of glycerol (PSS_30Gly) exhibited a heterogeneous microstructural phase, distinguishing between starch granules and the glycerol-plasticized starch phase. In contrast, the thermosetting plastic starch derived from D30PSS containing 30% of the weight fraction of glycerol (D30PSS_30Gly) revealed a homogeneous structure, featuring a rough surface devoid of residual starch particles. This phenomenon can be elucidated through two underlying mechanisms: Firstly, glycerol, functioning as a plasticizer, typically disrupts inter- and intramolecular hydrogen bonds within starch granules to facilitate plasticization . SecondlXRD diffraction patterns of native PSS and DPSS variants with differing aldehyde contents, along with starch-based plastics plasticized with varying glycerol quantities, are presented in Turning attention to the crystalline structure of starch-based plastic sheets derived from PSS and D30PSS, with varying glycerol contents, it is depicted in −1 confirms the utilization of aldehyde groups in the modified starch to form crosslinking linkages during thermosetting plastic formation. The proposed linkage structure of thermosetting plastic derived from dialdehyde pineapple starch is visualized in The tensile modulus of thermosetting plastic produced via hot compression molding ranged from approximately 1862 MPa to 2000 MPa, with tensile strength around 15 MPa to 42 MPa, and strain at break ranging from 0.8% to 2.4%. In contrast, PSS-based thermoplastics, prepared using the same method, displayed a modulus of about 37 MPa to 132 MPa, tensile strength around 3.2 MPa to 3.9 MPa, and elongation capability spanning 9% to 38%. This suggests that the thermosetting plastic generated could form an inter- and intramolecular acetal and hemiacetal crosslinking network during the hot compression molding process for sheet production ,26. Furt3 to 1.50 g/cm3) exhibited higher density values than their thermoplastic counterparts (1.37 g/cm3 to 1.45 g/cm3). Additionally, increasing the amount of glycerol content led to a decrease in the materials’ density. This trend aligns with expectations, as the strong molecular packing facilitated by the covalent network in thermosetting plastics results in higher density compared to thermoplastic materials [The densities of the starch-based plastics were also monitored, as depicted in aterials .The water solubility of all starch-based plastics is depicted in 1H-NMR analyses. The aldehyde groups were found to be randomly distributed along the anhydroglucose backbone of starch. Moreover, the oxidative cleavage modification under acidic conditions led to the breakdown of starch molecular chains, reducing the modified starch’s molecular weight as visualized in a significant decrement in the intrinsic viscosity value by adding an oxidizing agent and a more drastic decrease by increasing the periodic acid concentration (0.5 mol to 1 mol). This result is consistent with previous research, which described an apparent decline in starch molecular weight undergoing an oxidative cleavage modification [The preparation of dialdehyde pineapple stem starch with varying aldehyde contents was successfully demonstrated by adjusting periodic acid concentrations, as confirmed by the chemical structure through ATR-FTIR and fication ,50.By combining the prepared dialdehyde starch with glycerol, the mixture was subjected to high temperature and pressure to create a three-dimensional network material known as thermosetting plastic. The formation of a crosslinked network in the thermosetting starch products was evident from multiple indications. The FTIR signal of the aldehyde group diminished, indicating the formation of linkages. Additionally, there was an increase in hardness and mechanical properties, suggesting the establishment of a stronger network structure. Furthermore, the reduced water absorption and solubility further supported the presence of intermolecular linkages within the material.Notably, the starch-based thermoset plastic prepared from dialdehyde pineapple starch exhibited an impressive mechanical performance with the maximum value of modulus (2004.08 ± 114.82 MPa) and mechanical strength (42.31 ± 1.26 MPa). This can be compared with previous findings on a similar topic reported by Yu et al. , who preAs a result, these prepared thermosetting materials hold promise as viable options for single-use or disposable products, as well as other plastic applications such as film coatings, trays, and containers. While this study has shed light on the network structure, further comprehensive investigations will be required and are planned for future publications.The dialdehyde pineapple stem starch was successfully synthesized using a green approach involving periodic acid as an oxidizing agent, characterized by eco-friendly conditions and minimal energy consumption. The prepared dialdehyde pineapple stem starch with several aldehyde contents % was acquired by varying periodic acid concentrations (0.5 mol to 1.0 mol). Through the method of hot compression molding, thermosetting plastic sheets were successfully manufactured from this modified starch and glycerol, offering a cost-effective and practical fabrication technique. Notably, the mechanical attributes of the thermosetting materials show a higher value of modulus (~2004 MPa) and mechanical strength (~42 MPa) than those of thermoplastic starch prepared from the unmodified pineapple starch, rendering them suitable for a wide array of end-use applications. Furthermore, the thermosetting products derived from dialdehyde pineapple stem starch demonstrated exceptional water resistance and biodegradability, positioning them as viable contenders for diverse packaging solutions. This newfound knowledge holds the potential to foster a circular economy and mitigate carbon emissions, leveraging pineapple stem waste as a substantial renewable resource to yield valuable materials. By combining innovation with sustainability, this research contributes to the broader objective of addressing environmental challenges and promoting the transition towards a more responsible and resource-efficient future.


Journal of Managed Care Pharmacy (JMCP). My journey began as a member of AMCP’s Communications Committee. As a member of the committee, I was asked to lead a task force to develop a peer-reviewed academic resource for pharmacy professionals. I was honored and agreed to the opportunity. I must admit, I was not exactly sure how to proceed but the challenge excited me, and the intricate process ensued for developing a peer-reviewed journal.It has been more than a quarter century since I became involved in the development of the JMCP was launched in the summer of 1995.The initial focus of the journal was 2-fold: (1) the scientific advancement of pharmacy professionals working in the health care industry and (2) pharmaceutical care for patients. The task force began its work, and in a short time, through hard work and dedication, the first issue of I remember the creation of the journal vividly, working with many talented individuals towards the task at hand. The initial task force considered several questions. First, what should the journal look like? This began with designing the cover, the title of the journal, colors, fonts, and cover art. Second, what should the content consist of and how should the content flow throughout the journal? Feature articles, Comparative Research, Spotlights, and various departments were placed throughout the pages.JMCP be developed and overseen? Identifying an editor-in-chief for JMCP was an important next step, and I had the honor of being the founding editor-in-chief from JMCP’s inception until June 1999. I am reminded of this privilege daily, as I sit in my office with a gold framed picture of the first and last editions of JMCP throughout my tenure as editor-in-chief, a gift from AMCP.Another very important question was how will the content of JMCP. As work proceeded on the first issue, another challenge that needed to be addressed was who would write the articles for the first few issues. Because JMCP was new and not well-known, members of the Board of Directors, AMCP, and the Editorial Advisory Board all pitched in, using their writing talents to submit articles. JMCP was launched!Very importantly, an editorial advisory board was created; policies and procedures were written; and a process for peer review was developed. Individuals from various health care sectors and roles were identified for the Editorial Advisory Board and to be peer reviewers. Funding, budget, advertising, and other key decisions were also made as the board worked toward the launch of JMCP and the continued dedication to the success and value that JMCP provides to members of AMCP and the health care community. This is truly a success story and shining star in the history of AMCP.As I close, I would like to thank the many kind and talented individuals who helped create


Frequently, sinus augmentation is required when replacing failing or missing molars in the maxilla due to loss of alveolar bone related to periodontal disease, pneumatization of the sinus or a combination of the two factors. Various materials have been advocated and utilized; these fall into the categories of allograft, xenograft and synthetic materials. This article shall discuss a study of 10 cases with a 2-year follow-up utilizing a novel synthetic graft material used for sinus augmentation either simultaneously with implant placement or in preparation for sinus augmentation and implant placement in the posterior maxilla. The results of the 10 cases in the study found consistent results over the 2-year study period with maintenance of the alveolar height at the maxillary sinus. A lack of complications or failures in the study group demonstrates the technique has useful applications in increasing ridge height to permit implant placement inferior to the sinus floor.  Frequently, sinus augmentation is required when replacing failing or missing molars in the maxilla due to loss of alveolar bone related to periodontal disease, pneumatization of the sinus or a combination of the two factors. Various materials have been advocated and utilized falling into the categories of allograft, xenograft and synthetic materials. Each category has been well documented for the utilization in sinus augmentation procedures in the literature ,2,3. Sev4) and beta tricalcium phosphate (β-TCP). Calcium sulfate has been utilized for over 120 years in graft procedures, creating a stable graft material that sets hard, acting as a cell occlusive barrier preventing soft tissue ingress into the graft during its healing and organization phase. β-TCP has also been used medically for many years as a graft material with several benefits suitable to its use in dental graft treatment. It is osteoconductive as well as osteoinductive while being fully resorbed as it is replaced by host bone [The reported potential issues with allograft and xenograft materials have led to the increased use of synthetic materials in dental grafting treatment including maxillary sinus augmentation. Ideally, selection of a synthetic graft material should use one that is fully resorbable over time, without residual particles remaining when the graft conversion has completed to host bone. Two such materials available are calcium sulfate  rate. The potential of utilizing this combination of synthetic materials instead of bovine xenografts and allografts may decrease disease transmission risk [A combination of calcium sulfate and beta tricalcium phosphate combines the benefits of those two materials versus when utilized individually. The hard setting of the CaSOion risk . 4 with β-TCP enhances the individual properties of those individual graft materials. This produces a stable hardening paste that adapts to the shape of bony defect and is a porous bone substitute that serves as a scaffold for bone regeneration [4 alone [β-TCP is structurally porous material which undergoes resorption over a 9- to 16-month period . The resneration ,31,32,334 and β-TCP has demonstrated very favorable healing outcomes related to improved access of the periosteal blood supply to the graft materials without an intervening membrane that may block it [4 permits neovascular ingrowth, with its improved angiogenesis. Clinically, a self-stabilizing graft material will reduce the need for membranes, resulting in shortened surgical treatment time, lower treatment cost and a more simplified surgical approach. In the absence of a membrane, no impediment to stromal cell-derived factor induction from the periosteum occurs as this results in the presence of mesenchymal cells at the bone healing site, which will allow those cells to differentiate into osteoblasts. Utilization of this composite graft material containing CaSOblock it . The rap® Regeneration, Silsden, UK) is composed of 65% βTCP and 35% CaSO4. Clinically, 50% new bone is observed at 12 weeks replacing the graft material and full resorption usually occurs over the following 6–12 months depending on the volume of graft present. Studies have reported these synthetic grafts not only serve as a three-dimensional scaffold for host bone growth, but also actively promote osteoinduction during bone regeneration [® were occupied by 50.28% new bone, with 12.27% residual grafting material, and 37.45% connective tissue [® graft material provides ease of use without the need for a membrane for guided bone regeneration procedures [EthOss graft material  was placed on all healing sites post-surgery and the patient was given a tube of Blue®m to place themselves periodically over the next few days. The patients were each given post-op antibiotics, Amoxycillin 500 mg for 5 days (3 times daily) and instructed to exercise caution when chewing to avoid the site. Sutures were removed a week later and the site was inspected for healing, and the patient was told to return in 9 weeks. The sites were flapped to expose the crest and EthOss graft material was mixed per the manufacturer’s instructions. The EthOss syringe was filled to a specified level with sterile saline to hydrate the graft particles, then shaken vigorously to ensure complete diffusion of the saline with the graft material. A dry sterile gauze was then applied to the syringe’s nozzle and the plunger depressed to extruded excess saline and form the graft mix. The cover was removed from the syringe which was then transferred to the surgical site and extruded into the area to be grafted. A piece of dry sterile gauze was placed over the graft material and gentle pressure was exerted to compress the graft material and shape it to the defect being filled. The crestal sinus augmentation EthOss graft material was expressed into the osteotomy, followed by superior displacement accomplished with an osseodensification bur. The implant was then placed and if any crestal defect was present, an additional EthOss graft was placed followed by compression with dry sterile gauze. The flap was then repositioned and secured with sutures. BlueAt 10 weeks post-surgery (graft placement), the site was again flapped to demonstrate new host-regenerated bone. Implant impressions were obtained and sent to the lab for fabrication of the planned screw retained restoration. A 54-year-old female patient presented with loss of crowns on the upper left 1st and 2nd maxillary molars that had previous endodontic treatment. Examination noted minimal coronal tooth structure remaining and significant bone loss between the two molars with probing of over 10 mm. A periapical radiograph was obtained and confirmation of the poor condition of the two molars both structurally and periodontally was noted , left. TThe consent form was reviewed with the patient and then signed. Local anesthetic was administered into the buccal vestibule adjacent to the molars to be treated. The two molars were atraumatically extracted, and the sockets were curetted to remove any residual tissue. The EthOss graft material syringe was held vertically and per the manufacturer’s instructions, sterile saline was added to the syringe to wet the graft material. Once the saline had wetted the graft material, the end cap was removed from the syringe and a piece of dry gauze was utilized to remove any excess saline. The syringe was then carried to the intraoral site and expressed into the sockets. The material was gently compressed to shape it to fill the void being grafted with sterile gauze for 3 min at which stage it began to harden, showing resistance to pressure and being firm to touch. The flap margins were then closed to achieve primary closure and secured with 5–0 PGA sutured in an interrupted fashion. A periapical radiograph was obtained to document the socket grafting , middle.The patient returned at 10 weeks post-surgery and a periapical radiograph was obtained to evaluate the graft healing , right. The patient returned at 10 weeks to initiate the restoration of the integrated implant. The implant was exposed, and the cover screw was removed , left. AA radiograph obtained at the 2-year recall demonstrated stability of the graft surrounding the implant . The impA 74-year-old female patient presented with failing maxillary left 1st and 2nd molars. Examination noted grade 2 mobility on both molars. Radiographically significant periodontal bone loss was noted on the molars, and they were deemed non-salvageable , left. TAt 10 weeks post-extraction, the patient presented, and consent forms were reviewed and signed for grafting and implant treatment. Soft tissue had healed, closing the site with keratinized tissue , middle.Local anesthetic was administered, and a full thickness flap of the area was elevated. Utilizing a similar technique as outlined in case 1, the 1st molar site underwent a crestal lift and a 4.5 × 8.5 mm Anyridge  implant was placed . The defThe patient returned at 10-weeks implant and graft placement and the soft tissue over the posterior quadrant was noted to be healed with no inflammation present  left. FoThe patient returned at 10 weeks post-2nd-implant placement and a screw-retained restoration was placed on the 1st molar and a radiograph was obtained , left. IA 57-year-old male patient presented requesting replacement of a missing maxillary left 1st molar. A radiograph was obtained with a marker to evaluate the available crestal height present  left. ThThe consent form was reviewed with the patient and signed. Local anesthetic was administered and a crestal incision was made with a flap at the site to expose the ridges top. EthOss graft material was prepared as previously described and placed into the defect on the crest to level the crest with the mesial bone distal to the premolar , middle.The patient returned at 10 weeks and a radiograph was obtained to evaluate the height of the crest  right. AThe patient returned at 10 weeks and the implant was uncovered. An impression was obtained, and a healing abutment placed on the site. A radiograph was obtained to verify the healing abutment was seated, which demonstrated conversion of the graft material to immature host bone , right. As an example, 3 of the 10 cases are presented in detail to illustrate the technique and the results of the 10 cases in the study. No failures were noted in the 10 cases in the study over the 2-year period. For case 5 and 9, periodontal probing of 3–4 mm was noted on the distal of the implant at follow-up after restoration of the implant. Both instances were treated by reinforced homecare improvement and continued on routine recall prophy scheduling .As in all cases with severe periodontal tooth loss in the posterior maxilla, both the patient and their dentist often attempt to retain the teeth for as long as possible, often utilizing scaling and root planning in an attempt to mitigate the periodontitis present and preserve the tooth. This frequently leads to more severe bone loss around the affected tooth complicating the treatment needed to replace that failing tooth with an implant. Following extraction, typically the site is left to heal for a 4-month period whether socket preservation is performed at the time extraction or not prior to implant placement. When socket preservation is not performed at the time of extraction due to an inability to achieve soft tissue closure of the socket, a delay allows soft tissue to cover the site before socket grafting is performed. Socket preservation limits that ridge resorption as the area heals following extraction. Additionally, sinus pneumatization related to site healing is limited so that crestal height is not further lost. So, regeneration procedures of the extraction socket and ridge are critical for improved long-term success of the case and this allows for reduced sinus augmentation height required for implant placement.A critical question is about what happens histologically to the graft and at what stage during healing. For example, when delayed socket grafting was performed at a site where a large defect was present following extraction , left, aAnalysis of the 10 cases utilizing EthOss graft material in relation to sinus augmentation in conjunction with implant placement to increase crestal bone height that were then tracked for a 2-year follow-up found predictable results . The casThe protocol utilized with the EthOss graft material as outlined in the case examples found that the resorption (replacement) rate of the material at 10–12 weeks was 50% new host bone (immature) and 10% residual graft particles as evidenced by histological analysis . That reThe benefits of regeneration of the ridge with a delayed (4-week) socket graft in severely periodontally affected cases using these next generation synthetic graft materials has demonstrated both vertical and horizontal hard tissue dimensional improvement. This two-stage protocol enables a more predictable outcome and results in a very acceptable result aesthetically and functionally.4 combined with β-TCP showed the highest potential, without potential issues that have been reported with allograft and xenograft materials. This protocol along with the newer tools for internal sinus augmentation as well as the new synthetic particulate graft material, EthOss, appears to be helpful in the restoration of these difficult cases. The protocol resulted in significant hard tissue regeneration and improved implant stability permitting implant loading at 12 weeks post-implant insertion ,41. The


This was attributed to the tightest dispersion interface adhesion and maximum matrix plastic deformation, consistent with the mechanical performance results.Styrene (St) was used as comonomer and glycidyl methacrylate (GMA) as grafting monomer to prepare SEBS-g-(GMA-co-St) graft copolymers via melt grafting. Then, the graft copolymers were employed as a compatibilizer for melt blending polypropylene (PP) and hydrogenated styrene-butadiene-styrene (SEBS) triblock copolymers. The effects of the amount of GMA in the graft copolymers on thermal properties, rheology, crystallization, optical and mechanical properties, and microstructure of the blends were investigated. The results show that GMA and St were successfully grafted onto SEBS. The GMA amount in the graft copolymer significantly influenced the comprehensive properties of PP/SEBS/SEBS-g-(GMA-co-St) blends. The epoxy groups of GMA reacted with PP and SEBS, forming interfacial chemical bonds, thereby enhancing the compatibility between PP and SEBS to varying extents. After introducing SEBS-g-(GMA-co-St) into PP/SEBS blends, crystallinity decreased, crystal size increased while transmittance remained above 91% with rising GMA amount in the graft copolymers, indicating excellent optical properties. Notched impact strength and elongation at break of the blends showed a trend of first increasing and then decreasing with increased amounts of GMA in the graft copolymers. When the amount of GMA in the graft copolymers was 3 wt%, the blends exhibited optimal toughness with notched impact strength and elongation at break of 30,165.82 J/m Polypropylene (PP) is one of the most widely used general-purpose plastics, characterized by its low density, low cost, good heat resistance, and balanced mechanical properties ,4,5,6,7.Previous studies have found ,15,16 thTo improve the compatibility between the elastomer and PP, the elastomer can be functionalized before being melt extruded with PP. The interfacial bonding strength is reinforced through in situ grafting reactions to achieve better toughening effects ,28,29. MThe main structure of MAH consists of anhydride groups and double bonds between two carbon atoms, which can undergo free radical polymerization in the presence of initiators . Recent Based on the above analysis, this paper utilizes dicumyl peroxide (DCP) as the initiator, GMA as the graft monomer, and styrene (St) as the comonomer. The SEBS-g-(GMA-co-St) graft copolymer is prepared by using the free radical melt grafting technique. Subsequently, the prepared graft copolymer is melt-blended with PP and SEBS resin to prepare the PP/SEBS/SEBS-g-(GMA-co-St) blend. The effects of varying the amount of GMA in the graft copolymer on the grafting rate and grafting efficiency were investigated. Furthermore, the impact on the blend’s crystallization ability, thermal properties, rheological properties, optical properties, mechanical properties, and microstructure was explored.3, melt flow rate: 20.0–24.0 g/min, supplied by China Lanzhou Petrochemical Company . Polypropylene (PP), grade: RP340R, density: 0.910 g/cm3, polypropylene content: 30.0–33.0%, supplied by US KOTEN Corporation .Hydrogenated styrene-butadiene block copolymer (SEBS), grade: 1651, density: 0.910 g/cmGlycidyl methacrylate (GMA), analytical grade, supplied by US Dow Chemical Company . Styrene (St), chemically pure, a colorless and transparent liquid with 99% content and 0.909 g/mL density, supplied by Tianjin Damao Chemical Reagent Plant .Dicumyl peroxide (DCP), chemically pure, supplied by Chengdu Best Reagent Co., Ltd. .3, supplied by Changchun Chemical (Jiangsu) Co., Ltd. .Acetone, analytical grade, density: 0.789 g/cmThe SEBS was dried at 60 °C for 12 h in a vacuum oven. Then, DCP was dissolved in a mixture solution of GMA and St. After complete dissolution, it was uniformly mixed with SEBS according to a certain mass ratio. The melting graft reaction was carried out in a torque rheometer, and the resulting product was cooled for 24 h and cut into pellets for later use. The compounding conditions were as follows: temperature of 200 °C, rotational speed of 70 r/min, and time of 5 min. The grafted product was denoted as SEBS-g-(GMA-co-St), and the specific formula is shown in Approximately 2 g of the graft copolymer was weighed and refluxed in 25 mL of xylene for 1 h. Then, at room temperature, the unreacted monomers were removed via filtration using acetone as the solvent with a vacuum filtration apparatus . The purAccurately weigh 0.2 g of the purified graft sample. Reflux the sample in 50 mL of xylene and cool slightly. Transfer the sample to a 15 mL solution of 0.05 mol/L HCl-isopropanol and reflux for 2 h. Use phenolphthalein as an indicator and titrate with 0.05 mol/L NaOH-ethanol standard solution until the endpoint.N is the concentration of NaOH-methanol standard solution in mol/L. V0 is the volume of NaOH-methanol standard solution consumed by pure SEBS during titration in ml. V is the volume of NaOH-methanol standard solution consumed during titration in ml. W is the mass of the added purified sample in g.The grafting degree (GD) of GMA is calculated according to Equation (1):After drying, PP, SEBS, and the SEBS-g-(GMA-co-St) graft copolymers were melt blended in a torque rheometer according to a certain mass ratio . It has been found in studies that when the mass ratio of PP to SEBS is 80/20, the toughness of the blend material is optimal ; therefo−1, with a resolution of 0.5 cm−1, a wavenumber accuracy of 0.01 cm−1, and a scanning rate of 75 scans/s.Fourier Transformation Infrared Spectroscopy (FTIR) Analysis: The purified and dried PP/SEBS/SEBS-g-(GMA-co-St) blends were molded into a film on a plate vulcanizer  and analyzed via FTIR. FTIR spectra were recorded on a NEXUS 470 PC instrument. The infrared tests were performed in the scanning range of 5000~500 cm1H-Nuclear Magnetic Resonance (1H-NMR) Analysis: Accurately weigh approximately 15 mg of the PP/SEBS/SEBS-g-(GMA-co-St) blends. Use Deuterated chloroform (CDCl3) as the solvent and tetramethylsilane (TMS) as the internal standard. The analysis is conducted using a Bruker Ascend 500 III nuclear magnetic resonance (NMR) spectrometer with 128 scans.Dynamic mechanical analysis (DMA): The dynamic mechanical thermal analysis of the sample was tested with a DMA tester . In the tension mode, the temperature was raised from −100 °C to 150 °C at a heating rate of 3 °C/min at a frequency of 1 Hz.Differential scanning calorimetry (DSC) analysis: The crystallization and melting behavior of the samples were characterized using differential scanning calorimetry . Approximately 5 mg of the PP/SEBS/SEBS-g-(GMA-co-St) mixture was loaded into a crucible. The temperature was ramped from 0 °C to 200 °C at a rate of 10 °C/min and held for 5 min to eliminate any thermal history. Then, it was cooled back to 0 °C at the same rate. The airflow rate was set to 2.5 L/min.The crystallinity can be calculated using Equation (2):c is the crystallinity of the sample, φ is the content of SEBS.In the formula, X209 J/g) , and φ iWide-angle X-ray diffraction(WAXD)analysis: WAXD analysis was performed on a Bruker D8 ADVANCE diffractometer at room temperature, using Cu Kα radiation (λ = 1.5406 Å) operating at 40 kV and 40 mA. The sample was measured in the range of 5° to 60° with a scanning rate of 2°/min. Thermogravimetric analysis (TGA): Thermogravimetric analysis  was performed under flowing nitrogen (100 mL/min) at a heating rate of 10 °C/min. Approximately 15 mg of PP/SEBS/SEBS-g-(GMA-co-St) blends were heated from room temperature to 600 °C.Vicat softening temperature testing:The Vicat softening temperature test  was conducted according to the GB/T 1633-2000 standard. A sample block was placed in the test area, and a weight of 1.02 kg was applied as the load. The temperature was increased at a rate of 50 °C/h, and the temperature at which the needle penetrated the sample by 1 mm was recorded.Melt flow rate (MFR) analysis:The MFR was determined via a melt flow rate instrument  at 200 °C with a load of 2.16 kg (test standard was ASTM D1238-2013); MFR was calculated according to Equation (3):m represents the mass of the test specimen in grams, and t represents the cutting time of the extrudate in seconds.In the formula, Rheological property analysis: The rheological measurements of the mixture were conducted using a Dynamic Mechanical Analyzer (DHR-2) from TA Instruments, located in New Castle, DE, USA. The frequency sweep of the PP/SEBS/SEBS-g-(GMA-co-St) mixture was performed under nitrogen gas using a 25 mm parallel plate geometry. The gap distance between the parallel plates was set to 0.8 mm. The thickness of the sheet-like mixture was approximately 1.0 mm. The angular frequency range used in the test was 0.1–100 rad/s, with a shear strain of 0.5%. The temperature is set to 235 °C.Optical property analysis: The PP/SEBS/SEBS-g-(GMA-co-St) mixture was compressed into a thin film of approximately 80 µm thickness using a flat press. The film was then subjected to haze and transmittance testing using a CS-700 haze meter .Mechanical property analysis: According to GB/T1843/1-A, Izod notch impact strength was determined with a GT-7045-MD impact tester , the pendulum used was 2.750 J. The tensile properties were measured according to GB/T1040-1BA using a tensile testing machine  at a crosshead speed of 25 mm/min. The test was performed at room temperature, and the average values of at least five tests were reportedScanning electron microscopy (SEM) analysis: The fractured surface of the PP/SEBS/SEBS-g-(GMA-co-St) mixture was coated with a thin layer of gold using a sputter coater. Then, it was observed using a scanning electron microscope (JSM-5600LV) from JEOL, located in Tokyo, Japan.−1 and 2853 cm−1, which are the absorption peaks of CH aliphatics in the SEBS backbone [−1, which is the absorption peak of the aromatic ring in the SEBS backbone. By comparing the infrared spectra of SEBS and the SEBS-g-(GMA-co-St) graft copolymer, it is evident that the overall trends of the two spectra are roughly the same. The difference is that the graft copolymer containing GMA has a new absorption peak appearing at 1780 cm−1, which is caused by the carbonyl stretching vibration in GMA [−1) does not appear in the spectrum of the graft copolymer, indicating that the GMA monomer has been completely removed during the purification process of the graft copolymer. This evidence supports that a grafting reaction occurred between SEBS and GMA during the melting process, resulting in the SEBS-g-(GMA-co-St) graft copolymer in the extrudate.To verify whether a grafting reaction has occurred between SEBS and GMA, we conducted infrared spectroscopy characterizations on both SEBS and the purified SEBS-g-(GMA-co-St) graft copolymer, with the test results shown in n in GMA . Moreove1H-NMR). The test results are shown in 1H-NMR spectra of both SEBS and SEBS-g-(GMA-co-St), which indicates that these spectra are based on SEBS. By enlarging the regions of 5.1–2.3 ppm and 7.8–7.2 ppm, four signal peaks at 7.73, 7.56, 7.41, and 2.55 ppm appear in the 1H-NMR spectrum of the SEBS-g-(GMA-co-St) graft copolymer, which are generally attributed to the signal peaks of St. Furthermore, five signal peaks appear at 4.39, 3.87, 2.78, 2.67, 1.85, and 1.53 ppm, which are generally attributed to the signal peaks of GMA [To further verify whether a grafting reaction occurred between SEBS and GMA, this study characterized both SEBS and the purified SEBS-g-(GMA-co-St) graft copolymer using nuclear magnetic resonance  and grafting efficiency (GE) are two important indicators to measure the grafting reaction of polymers. In the experiments, the amount of DCP was kept constant, and the effect of the added amount of GMA in the grafted copolymer on the GD and GE of the SEBS-g-(GMA-co-St) grafted copolymer was examined. Specific data can be seen in Q-e Equations (4) and (5) [Q values of two monomers are close, they are more likely to undergo copolymerization. As shown in Q and e values of GMA and St are similar [The ratio of each pair of monomers in a specific copolymer can be determined through  and (5) . When th similar ,59,60., loss modulus (E’’), and damping loss factor (tan δ) of composite materials, including factors such as frequency and temperature . The tesg of SEBS (olefin block), PP, and SEBS (styrene block) [g of SEBS (styrene block) in the tan δ curve and the E’’ curve. This mechanism is believed to originate from the relaxation and turning motion of the amorphous side chains of the PP material. As the GMA molecular chain increases, the internal friction increases, and the rigidity of the styrene segment in the SEBS large molecular chain causes the composite material to relax towards a high temperature [As shown in e block) . As can perature .g is obtained by subtracting the Tg corresponding to PP from the average temperature corresponding to the two relaxation peaks belonging to SEBS. Overall, after introducing SEBS-g-(GMA-co-St) into the PP/SEBS blend, as the amount of GMA added to the system increases, the two gradually converge, indicating that SEBS-g-(GMA-co-St) has a good compatibilizing effect on the PP/SEBS blend. When the GMA addition amount is 1 wt%, the ΔTg of the blend, compared to the PP/SEBS blend without added SEBS-g-(GMA-co-St), decreases by 2.69 °C. Further increasing the GMA amount, the ΔTg of the blend further decreases. When the GMA amount is 3 wt%, the ΔTg of the blend drops to the lowest (7.76 °C), a decrease of 4.29 °C compared to the blend without the introduction of SEBS-g-(GMA-co-St). At this point, the compatibility between PP and SEBS phases is the best, and the introduction of the graft copolymer SEBS-g-(GMA-co-St) enhances the compatibility between the PP and SEBS phases [S phases .m) of the PP/SEBS blend is 149.74 °C. However, with the introduction of the SEBS-g-(GMA-co-St) graft copolymer, the Tm of the PP/SEBS/SEBS-g-(GMA-co-St) blend system shows a general downward trend. This is because the incorporation of the SEBS-g-(GMA-co-St) graft copolymer can reduce the regularity of the system’s chain segments, which in the microscopic view of the melting process means that lower energy is required to demonstrate melting behavior. Thus, a decreasing trend in Tm is displayed in the DSC curves.c) of the PP/SEBS blend was 114.32 °C. However, the Tc of the PP/SEBS/SEBS-g-(GMA-co-St) blend system increases slightly, and with the increasing amount of GMA in the graft copolymer, both the Tc and the degree of crystallinity (Xc) of the blend gradually decrease. The inclusion of the graft copolymer acts as a bridge between PP/SEBS, directly reducing the migration rate of large PP molecular chains and inhibiting the movement and crystallization arrangement of PP chain segments. With the increase in the amount of GMA added in the graft copolymer, more active sites can be introduced into the PP/SEBS blend system. This further enhances the structural hindrance effect between PP and SEBS, thereby slightly reducing the crystallization ability of the blend system [As shown in d system ,72,73.The WAXD of PP/SEBS and PP/SEBS/SEBS-g-(GMA-co-St) blends is shown in D represents the average grain size, K is the Scherrer constant , λ is the wavelength of the X-ray used, β is the full width at half maximum (FWHM) of the diffraction peak, and θ is the Bragg angle.The grain size of the blends can be calculated using the Scherrer equation  as shownBased on the data in 95%) of pure PP/SEBS is 409.23 °C, the maximum decomposition temperature (Tmax) is 451.66 °C, and the temperature at which 95 wt% of the weight loss (T5%) occurs is 471.49 °C. In comparison to pure PP/SEBS, the introduction of the SEBS-g-(GMA-co-St) graft copolymer decreases the T95% of the blend system. When the GMA amount in the SEBS-g-(GMA-co-St) graft copolymer is 3 wt%, the T5% of the PP/SEBS/SEBS-g-(GMA-co-St) blend decreases to 394.89 °C, a reduction of 14.34 °C compared to pure PP/SEBS. The decrease in thermal stability may be due to the increased complexity of the blend system with the introduction of the SEBS-g-(GMA-co-St) graft copolymer, leading to new chemical reactions, such as crosslinking or degradation reactions. These reactions might commence at lower temperatures, thereby reducing the thermal stability of the blend system. The decomposition temperatures of the grafted GMA and St components are generally lower than those of SEBS and PP, which may cause the SEBS-g-(GMA-co-St) graft copolymer to start decomposing earlier than the other two components during the heating process. Further increases in the GMA amount of the graft copolymer do not result in significant changes to the blend system’s T5%, which remains stable at around 395 °C. The introduction of the SEBS-g-(GMA-co-St) graft copolymer also does not have a significant impact on the blend system’s Tmax and T95%, which remain stable at around 450 °C and 470 °C, respectively. Although GMA monomer itself has poor thermal stability, since it is present in low contents in the blend, only as trace grafts, its influence on the overall thermal performance of the blend is limited compared to the main polymers . In addition, with increasing GMA addition amounts in the SEBS-g-(GMA-co-St) graft copolymer, the grafting reaction between the SEBS segments and GMA will gradually become saturated. At this point, the excess GMA no longer participates in the grafting reaction, but exists as free monomers, whose negative impact on the thermal performance of the blend can be neglected.This experiment discusses the effect of the amount of GMA added to the graft copolymer on the haze and transmittance of the PP/SEBS/SEBS-g-(GMA-co-St) blend system, as shown in 2 and 1445.32%, respectively. The underlying reason for these phenomena is that the increase in the GMA amount in the graft copolymer leads to more epoxy groups reacting with the end groups of PP/SEBS, thereby significantly improving the compatibility between the two phases. Consequently, the interfacial area can better transmit and bear stress, thus gradually increasing the impact performance and fracture elongation of the blend. The reaction route is depicted in Generally speaking, enhancing the compatibility between PP and SEBS is beneficial for improving the mechanical properties of the PP/SEBS blend . TherefoTo investigate the variation in fracture morphology of PP/SEBS/SEBS-g-(GMA-co-St) blends with the change in GMA amount in the graft copolymer, SEM was used to observe the impact fracture surface of the blend, as shown in St was incorporated as a comonomer into a melt grafting system of GMA and SEBS, creating graft copolymers of SEBS-g-(GMA-co-St) with varying GMA amounts. Subsequently, the prepared graft copolymers were melt-blended with PP and SEBS, yielding a series of PP/SEBS/SEBS-g-(GMA-co-St) blends. Comprehensive studies were conducted on the thermal, optical, rheological, and mechanical properties, and microscopic morphology of these blends. The main findings are as follows:1H-NMR analyses demonstrate that GMA and St successfully graft onto SEBS to form SEBS-g-(GMA-co-St) graft copolymers. As the amount of GMA in the graft copolymer increases, the degree of GMA grafting gradually increases while the grafting efficiency remains relatively stable.(1) FTIR and g between the PP and SEBS phases is minimized (7.76 °C), indicating optimal blend compatibility.(2) Thermo-rheological and crystallographic analyses show that the G’, G″, and η of the blend consistently increase as the amount of GMA in the graft copolymer increases. The introduction of SEBS-g-(GMA-co-St) graft copolymers reduces the migration rate of large polymer chains, hindering the motion and crystalline arrangement of PP chains, consequently lowering the degree of crystallinity. DMA analysis reveals that when the GMA amount in the SEBS-g-(GMA-co-St) graft copolymer reaches 3 wt%, the ΔT(3) From an optical perspective, as the GMA amount in the graft copolymer increases, the transmittance of the blend remains above 90.9%, while the haze of the blend system undergoes only slight changes. This indicates that the SEBS-g-(GMA-co-St) graft copolymer has a minimal impact on the optical properties of the PP/SEBS/SEBS-g-(GMA-co-St) blend, which still exhibits excellent optical performance.2 and 1445.32%, respectively. At this point, the blend’s fracture mode manifests notable ductile fracture characteristics. Increasing the GMA amount in the graft copolymer beyond this point will induce a certain degree of cross-linking side reactions, deteriorating the performance of SEBS-g-(GMA-co-St), eventually disrupting the blend’s phase morphology and reducing its mechanical properties.(4) In terms of mechanical properties and microscopic morphology, within the examined GMA amount range (1–3 wt%), the notched impact strength and fracture elongation of the blend increase as the GMA amount in the graft copolymer increases. Specifically, when the GMA amount reaches 3 wt%, the blend exhibits the best toughness, with a notched impact strength and fracture elongation reaching 30,165.82 J/m


Compared to DCD, LDLT showed superior patient and graft survival (p < 0.05). Younger male PBC recipients with a high BMI, diabetes, and dialysis history were associated with mortality and graft failure (p < 0.05). Our study showed that LDLT had superior patient survival to DDLT. Predictors of poor post-LT outcomes require further validation studies.Primary biliary cholangitis (PBC) prompts liver transplantation (LT) due to cholestasis, cirrhosis, and liver failure. Despite lower MELD scores, recent studies highlight higher PBC waitlist mortality, intensifying the need for alternative transplantation strategies. Living donor liver transplant (LDLT) has emerged as a solution to the organ shortage. This study compares LDLT and deceased donor liver transplant (DDLT) outcomes in PBC patients via retrospective analysis of the UNOS database (2002–2021). Patient survival, graft failure, and predictors were evaluated through Kaplan–Meier and Cox-proportional analyses. Among 3482 DDLTs and 468 LDLTs, LDLT showed superior patient survival (92.3%, 89.1%, 87.6%, 85.0%, 77.2% vs. 91.5%, 88.3%, 86.3%, 82.2%, 71.0%; respectively;  Primary biliary cholangitis (PBC) is characterized by immune-mediated damage to the intralobular biliary tract, culminating in cholestasis, cirrhosis, and eventual liver failure, necessitating liver transplantation (LT) . PBC staHistorically, in the 1980s, PBC was a prominent indication for LT . Yet, adCurrent LT criteria for PBC rely on a Model for End-Stage Liver Disease–sodium score ≥ 15, total bilirubin ≥ 6 mg/dL, or Mayo risk score ≥ 7.8 ,12. An aLiving donor liver transplant (LDLT) has emerged as a prospective solution to bridge the organ supply–demand gap. Comparing LDLT and deceased donor liver transplant (DDLT) outcomes in PBC patients constitutes a pivotal domain of transplantation research. While DDLT has traditionally prevailed as the standard, LDLT presents numerous advantages, encompassing shortened waiting times, reduced risk of graft dysfunction attributed to diminished cold ischemia time, and the potential for superior graft quality due to meticulous donor selection ,17. HoweA retrospective cohort analysis was conducted on adult patients with PBC who were enlisted in the UNOS Organ Procurement and Transplantation Network (OPTN) database and who subsequently underwent primary LT during the interval spanning from January 2002 to December 2021. We excluded the following patients: those younger than 18 years old, those with prior organ transplantation, a history of multi-organ transplantation, and split/reduced LT. The UNOS, which served as the contractor of the OPTN, supplied the data. Any interpretation and reporting of the data shown in the present study are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US government. Beth Israel Deaconess Medical Center and Rutgers New Jersey Medical School deemed the UNOS database as de-identified and publicly available, hence not requiring institutional review board approval.We included variables at the time of candidate listing for LT. Both recipients and donor variables were included and shown in two groups, one LDLT and one DDLT. We included the following recipients’ characteristics: age in years, gender, race, blood type group, body mass index (BMI), the presence of diabetes, the use of mechanical assistance, the use of dialysis the week before LT, portal vein thrombosis (PVT), a history of prior abdominal surgery, MELD score and albumin levels at the time of LT, time on the waiting list, if given MELD exceptions points for hepatocellular carcinoma (HCC), patient location , and time of transplant on periods . Donor variables were analyzed, including graft type , age in years, gender, race, BMI, the presence of diabetes, cause of death (COD) in case of both DCD and DBD , cold ischemia time (CIT) in hours, sharing region , and donor and recipient body surface area (BSA) matching . BSA was calculated by the formula described by Mosteller [The primary aim of the present study was to analyze the patient’s and graft’s survival after liver transplantation. Patient survival was defined as the length of time from the date of LT until the date of death or last follow-up. Graft survival was defined as the length of time from the date of LT until the date of graft failure, last follow-up, or the need for a re-LT.We summarized categorical variables using frequencies and percentages and conducted a chi-square test as a comparative measure. If categorical variables had missing data, our analysis did not include them. Continuous variables were summarized as means and standard deviations or medians and interquartile ranges (IQRs), utilizing ANOVA or the Kruskal–Wallis test based on the distribution of the variable. The median or mean value was assigned in case of missing values in continuous variables.Survival outcomes were compared utilizing the Kaplan–Meier method. Graft type was compared between LDLT and DDLT. The latter was further stratified into DBD and DCD, and an additional comparison was conducted among LDLT, DBD, and DCD. The log-rank test was employed to assess survival differences across these groups. Stepwise Cox proportional hazard regression models were employed to identify predictors influencing patient and graft survival, adjusted for recipient and donor characteristics. Variables that exhibited statistical significance  or clinical relevance  were incorporated into the final model. Statistical significance was defined using a bivariate level . The statistical analysis was executed using Stata version 17.0 MP .p < 0.001), predominantly White (p < 0.001), and had the blood type O positive (p = 0.004). Additionally, they demonstrated higher levels of serum albumin (p = 0.014) and a longer duration on the waiting list (p < 0.001). In terms of their characteristics, LDLT recipients had lower body mass indices (BMIs) (p < 0.001) and fewer MELD exception score points attributed to hepatocellular carcinoma (HCC) (p < 0.001). Moreover, they exhibited a lower likelihood of having undergone dialysis in the week prior to transplantation (p < 0.001) or previous abdominal surgeries (p = 0.007). For more comprehensive insights into the recipients and donor attributes, please refer to Over a span of 20 years, a total of 3950 LTs were conducted, comprising 3482 DDLTs (3251 DBD and 231 DCD) and 468 LDLTs. When contrasted with recipients of DDLTs, those undergoing LDLTs exhibited significant differences. LDLT recipients were notably younger (p = 0.02) (p = 0.03) and DBD subgroup . Notably, the DBD subgroup exhibited superior patient survival when compared to the DCD subgroup   a. Patien = 0.03) b.p = 0.06) (p = 0.09). In contrast, LDLT cohort demonstrated superior graft survival relative to the DCD subgroup .On unadjusted analysis, no distinction emerged in terms of graft survival between recipients of LDLTs and those who underwent DDLTs at 1-, 2-, 3-, 5-, and 10 years  a. Corresp = 0.03)  b.p < 0.001), male gender (p = 0.003), the presence of diabetes (p = 0.005), higher BMI (p = 0.03), the use of dialysis one week before LT (p < 0.001), the presence of PVT (p = 0.03), and the recipient’s hospital location prior to LT (p = 0.004). Moreover, recipient variables linked with improved survival were the transplantation period spanning from 2010 to 2019 (p = 0.002) and Region 2 (p = 0.001). Similarly, donor factors identified as risk factors for patient survival were both donor age (p = 0.007) and other donor race (p = 0.03)  .p < 0.001), male sex (p = 0.003), the presence of diabetes (p = 0.01), the use of dialysis one week before LT (p < 0.001), and hospital location of the recipient prior LT (p = 0.02). Additionally, recipient variables linked with improved survival were the transplantation period spanning from 2010 to 2019 (p < 0.001) and Region 2 (p = 0.001). Similarly, advanced donor age was associated with a higher risk of graft failure (p < 0.001)  .Numerous studies have demonstrated that PBC patients generally exhibit lower MELD scores, consequently diminishing the pool of available deceased donors during their waitlisted period . DespiteOur study demonstrated mortality and graft failure rates among PBC patients undergoing LT that align consistently with findings from prior research. For instance, a study encompassing patients with chronic liver disease who underwent LT and utilized a UNOS database spanning from 1994 to 2009 reported survival rates of 85%, 80.5%, 78.1%, and 71.9% at 1-, 3-, 5- and 10-year intervals . In anotp = 0.002) [p = 0.123). Another study investigating recipients with autoimmune liver diseases from the European Liver Transplant Registry included 1003 LDLT transplants, where 158 were attributed to PBC patients. In comparing these to DDLT , no significant difference emerged (p = 0.963) [In an unadjusted analysis comparing LDLT to DDLT, we observed that LDLT demonstrated superior patient survival compared to DDLT, while no distinction was evident in graft survival. A previous study, also conducted within the UNOS database, encompassing patients with autoimmune and cholestatic disease from February 2002 to October 2006, demonstrated that among all recipients, the estimated patient survival rates at 1, 3, and 5 years were 95.5%, 93.6%, and 92.5% for LDLT and 90.9%, 86.5%, and 84.9% for DDLT, respectively (= 0.002) . Estimat= 0.963) . A Japan= 0.963) . Our finp < 0.001) but not to DCD (p = 0.21) [Upon stratifying DDLT as DBD and DCD, we found that LDLT exhibited superior patient survival compared to both groups. No difference was observed in graft survival when comparing LDLT to DBD, although LDLT outperformed DCD. It is worth noting that only a limited number of studies have compared DBD and DCD to LDLT in PBC recipients. Ziogas et al. reported superior unadjusted patient survival on LDLT compared to DBD ( = 0.21) . In cont = 0.21) .Our study has revealed that both recipient and donor age serve as risk factors for patient and graft survival in patients with PBC. Comparable results have been documented in prior research regarding recipient age ,24,26,27Furthermore, our analysis revealed that LT conducted within the time frame of 2011 to 2019 exhibited superior patient and graft survival outcomes during the post-transplant period. However, it is essential to acknowledge that these findings are constrained by the potential limitations stemming from the presence of missing or incomplete data spanning the years of 2002 to 2010  and 2020 to 2021 .The strength of our study relies on the utilization of a large sample size, meticulously collected through a rigorous and systematic approach. Additionally, we opted to further stratify DDLT into distinct categories, namely DBD and DCD, a comparison that has only been explored in one other study . HoweverNonetheless, while the utilization of a comprehensive database offers valuable insights, there are inherent limitations. First, there exist underlying baseline recipient and donor characteristics between LDLT and DDLT that might not have been fully captured due to the lack of granular data in the UNOS database. Second, our findings are retrospective in nature. Third, our study lacked the intention to treat and did not consider the dropout rates, which we assumed to be higher in PBC recipients. Fourth, certain pertinent clinical information relevant to PBC outcomes in LT is absent. For instance, details like whether the criteria for listing involved intractable pruritus or severity of liver failure or if patients were placed on second-line medication (such as obeticholic acid) or off-label medications (fibrates) prior to listing remain undisclosed.LDLT showed improved patient survival in comparison to DDLT at 1-, 2-, 3-, 5-, and 10-year intervals. When stratifying DDLT into DCD and DBD, LDLT also showed lower mortality rates. LDLT emerges as an appealing choice for patients with PBC, particularly given the propensity to exhibit fewer symptoms and consequently a reduced likelihood of being captured by the MELD score criteria. Regardless of graft type, poorer post-LT outcomes were observed in younger male PBC recipients with a higher BMI and a history of diabetes and recent dialysis. To further validate these findings, more prospective studies incorporating granular data are warranted.


Sexual dimorphism is challenging to detect among fossils due to a lack of statistical representativeness. The Angeac-Charente Lagerstätte (France) represents a remarkable ‘snapshot’ from a Berriasian (Early Cretaceous) ecosystem and offers a unique opportunity to study intraspecific variation among a herd of at least 61 coeval ornithomimosaurs. Herein, we investigated the hindlimb variation across the best-preserved specimens from the herd through 3D Geometric Morphometrics and Gaussian Mixture Modeling. Our results based on complete and fragmented femora evidenced a dimorphism characterized by variations in the shaft curvature and the distal epiphysis width. Since the same features vary between sexes among modern avian dinosaurs, crocodilians, and more distant amniotes, we attributed this bimodal variation to sexual dimorphism based on the extant phylogenetic bracketing approach. Documenting sexual dimorphism in fossil dinosaurs allows a better characterization and accounting of intraspecific variations, which is particularly relevant to address ongoing taxonomical and ecological questions relative to dinosaur evolution. Asilisaurus. In addition, it has been demonstrated on modern populations that sexual dimorphism could be represented only by very subtle morphological variations, making it even harder to detect in fossils with smaller sample sizes  approach that combines anatomical landmarks and sliding semilandmarks along curves and surfaces on both complete and fragmented femora and tibiae . This meWe highlight a dimorphic variation in femora from the ornithomimosaur herd of Angeac-Charente . This diThe most important morphological variation of complete femora is a medial to lateral curvature of the femur . The proHowever, there is no robust bimodal distribution on proximal epiphyses, as shown by the GMM analyses  along PCThe closest extant relatives of non-avian dinosaurs are known to display sexual dimorphism with more or less visibility: birds display variation in their plumage and skeleton , whereasAlligator mississippiensis using linear and geometric morphometrics  but with reversed proportions between males and females (Anas platyrhynchos) had more laterally curved femora than females and that this sexually dimorphic feature disappeared along ontogeny. However, to our knowledge and aside from A femoral dimorphism of the same nature was demonstrated to be sex-specific among populations of extant tetrapods such as carnivorans and primates. Dimorphism in the femoral obliquity  was observed in humans, for which females had higher angles than males . Moreoveometrics . Handleysaurians . The sam females . FurtherAsilisaurus kongwe, the crocodylian A. mississippiensis and the bird Rhea americana . Therefore, we infer these features to indicate sexual dimorphism in the Angeac-Charente ornithomimosaurs according to the EPB approach. Our findings inform about the intraspecific variation in non-avian theropods and emphasize the need for description of size-independent dimorphism in modern and closely related taxa with a priori knowledge of the sex. In the future, our results should be completed by paleohistological studies to (1) sex each morphotype and (2) identify the extent of ontogenetic variations within our sample. Additionally, we show that the sex-ratio of the Angeac-Charente ornithomimosaur is close to 1:1 and thus, likely Fisherian . It was Several complete and fragmented femora and complete tibiae from the Angeac-Charente ornithomimosaur were discovered between 2010 and 2020 . We remo3D GM is a well-established method for quantifying biological shape variations and has already enabled to identify sexual dimorphism in past studies . We follWe performed a PCA in order to reduce dimensionalities of the variation and isolate different components of shape variation . The qua This important contribution offers a convincing analysis of the challenging topic of sexual dimorphism in dinosaurs. Unlike previously published contributions, which are ambiguous, this paper, based on 61 ornithomimosaur fossils, makes a compelling case for measurable differences between male and female individuals. Of particular note, the use of rigorous statistical approaches, a major strength of this manuscript, sets this study apart from previous attempts to tackle this question. Morphological changes are carefully analysed and put into a broader comparative context: the conclusions of this paper allow for interesting comparisons between non-avian dinosaurs and extant groups . As such, this manuscript will be of interest to a diverse audience, including palaeontologists, zoologists, and evolutionary biologists. public reviews designed to be posted alongside the preprint for the benefit of readers; ii) feedback on the manuscript for the authors, including requests for revisions, shown below. We also include an acceptance summary that explains what the editors found interesting or important about the work.Our editorial process produces two outputs: i) Decision letter after peer review:eLife.Thank you for submitting your article "Femora from an exceptionally large population of coeval ornithomimosaurs yield evidence of sexual dimorphism in extinct theropod dinosaurs" for consideration by Your article has been reviewed by two peer reviewers, and the evaluation has been overseen by Nizar Ibrahim as Reviewing Editor and Christian Rutz as Senior Editor. The following individual involved in the review of your submission has agreed to reveal their identity: Michael Benton (Reviewer #1).The reviewers have discussed their reviews with one another, and the Reviewing Editor has drafted this decision letter to help you prepare a revised submission. Only very minor changes/additions are needed.Essential revisions:1) Please add a short text section outlining the rationale for selecting the skeletal elements used in this study (femora and tibiae).2) Please briefly comment on differences in size (or not) between the two groups.3) Please provide a little more information on taphonomically distorted specimens. Essential revisions:1) Please add a short text section outlining the rationale for selecting the skeletal elements used in this study (femora and tibiae).We addressed this issue and added one sentence near the end of the introduction emphasizing the abundance of hindlimb bones from the Angeac-Charente ornithomimosaur, and the high number of hypotheses of sexual dimorphism formulated on femora (and some on tibiae) among extinct dinosaurs, but also numerous observations from extant archosaurs.2) Please briefly comment on differences in size (or not) between the two groups.We added femoral length measurements on complete femora in Table S3 to further emphasize our point that the dimorphism we observed was not linked to body size variations. In addition, we also clarified the sequence of sentence in the Discussion section about ontogenetic allometry and SSD.3) Please provide a little more information on taphonomically distorted specimens.When including taphonomically distorted complete femora, dimorphism was still observable, but along the second axis instead of the first axis. We have added the original PCA (PC1 and PC2) in supplementary figure  highlighting that taphonomically distorted specimens drove the morphological variation along PC1. We also added a short description in the legend of the PCA explaining why the taphonomically distorted specimens presumably interfered with the biological intraspecific variation.