The Coulomb energies, determined by the wire length, drive the MTB into two types of ground states with distinct respective out-of-phase and in-phase charge orders. The two ground states can be reversibly converted through a metastable zero-energy state with in situ voltage pulses, which tune the electron filling of the MTB via a polaronic process, substantiated by first-principles calculations. Our Hubbard model calculation with an exact diagonalization method reveals the ground states as correlated insulators from an on-site U-originated Coulomb interaction, dubbed the Hubbard-type Coulomb blockade effect. Our study lays a foundation for understanding and tailoring correlated physics in complex systems.Correlated states have emerged in low-dimensional systems owing to enhanced Coulomb interactions. Elucidating these states requires atomic-scale characterization and delicate control capabilities. Herein, spectroscopic imaging-scanning tunneling microscopy was employed to investigate the correlated states residing in 1D electrons of the monolayer and bilayer MoSe 2 ultrathin films, which can be delicately controlled in-situ at atomic scale.A new mysterious correlated state, dubbed Hubbard-type Coulomb blockade effect, is uncovered in metallic wires embedded in MoSe In reduced dimensions, the screening effect is suppressed, resulting in enhanced Coulomb interactions. Owing to their structural simplicity, low-dimensional systems provide model platforms for studying correlated physics . In partActual 1D systems are subject to quantum fluctuations that profoundly influence correlated states . Inter-cin situ response of electron filling. Conventional methods of carrier doping inevitably introduce disorders into the system. In low-dimensional systems, electric gating acts as another means of tuning electron filling. Recent achievements in such phase transitions between Mott-like insulators, superconductors and topological orders have been realized in twisted magic-angle graphene superlattices [In correlated phases, the electron-filling adjustment is not only decisive for pinning down the nature of the ground states, but also engages with Coulomb interactions for tuning phase transitions. It is desirable to investigate the evolution of the correlated phases with the lattices . Howeverin situ manipulation using spectroscopic imaging-scanning tunneling microscopy (SI-STM) at 4 K. MTBs are driven into two types of correlated insulating states arising from the dubbed Hubbard-type Coulomb blockade (CB) effect. The two ground states can be switched controllably with voltage pulses, which tune the electron filling of the MTB. Our study clarifies the nature of the correlated ground states and demonstrates the feasibility of local control.In this study, we characterize the correlated states in 1D MTB wires and demonstrate their 2 films on the graphene-covered SiC substrate. Their crystal structure   Fig. . Similar.07 Fig. . The gapPG) Fig. .These observations suggest that the low-energy states and the QWSs are implicitly related and are thereafter treated as discrete levels by scrutinizing their node numbers. In Type-1 MTBs, the node number differs by one for adjacent levels Fig. . In TypeFE  and gE2 = ΔEQWS + u2 for tunneling into the second lowest unoccupied level  Fig. . In contgap Fig. . Such moU = 0 case, exhibiting discrete QWSs with different numbers of nodes. Owing to the finite-size effect, the gap between different QWSs varies, and that relevant to Fig. U = 8.0t) is turned on for even-filled (eight electrons) and odd-filled (seven electrons) systems, respectively. When the system is even-filled  in the classical CB effect, where the capacitance C is proportional to the wire length. Thus, its dictation on the correlated insulating state can be considered a Hubbard-type CB effect. The on-site U suggests TLL behavior in the MTB [As expressed in Equation , the ele the MTB ,23, as o2 MTB, which is beyond the scope of clarifying the controversies over its ground state. Such an effect, in contrast to the classical CB effect due to the static Coulomb repulsion energy of electrons, features a quantum many-body effect due to the strong interactions between electrons. Our strategy of in situ electron-filling adjustment allows the addressing and manipulation of individual nano-objects with atomic-scale precision, which may foster the study of correlation physics.In conclusion, we discovered a Hubbard-type CB effect, which could establish an alternative platform for emulating the Hubbard model in artificial quantum systems, as recently demonstrated with bosons  or fermi2 films were grown on graphene-covered SiC(0001) substrates or HOPG substrates with molecular beam epitaxy by co-depositing high-purity Se (purity 99.999%) and Mo (purity 99.95%) atoms with a flux ratio of ∼10:1. The substrate temperature was maintained at ∼530 K during the growth, with subsequent annealing at 870 K for 10 mins. The detailed preparation procedures for the graphene substrate are described in [ex situ and further degassed in a vacuum chamber at ∼1170 K for 0.5–2 h before MoSe2 growth.The experiments were conducted using custom-made Unisoku cryogenic STM  at 4 K. ab initio simulation package (VASP) [DFT calculations were performed using the Vienna e (VASP)  with thee (VASP)  and projnwac210_Supplemental_FileClick here for additional data file.


This study examined the associations of grandparent–grandchild relational closeness and conflict with grandchildren’s socioemotional and behavioral problems, including emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. We analyzed primary cross-sectional survey data collected from custodial grandparents in the United States using logistic regression models. The results indicated that grandparent–grandchild relational closeness was significantly associated with lower odds of custodial grandchildren having emotional symptoms, conduct problems, peer problems, and abnormal prosocial behaviors, whereas grandparent–grandchild relational conflict was significantly associated with higher odds of emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. Implications for increasing grandparent–grandchild relational closeness and decreasing relational conflicts among grandparent-headed families are discussed, which might improve grandchildren’s socioemotional and behavioral well-being. In the United States, nearly six million children live with their grandparents for various reasons, such as child maltreatment, parental substance abuse, domestic violence, incarceration, and military deployment ,2. Due tIn 2018, the Supporting Grandparents Raising Grandchildren Act was passed by the U.S. Congress and called for establishing a federal advisory council to make recommendations that would help grandparents meet the needs of children in their care and maintain their own emotional well-being and mental and physical health. As such, grandparents raising grandchildren has become even more common; thus, further understanding of the well-being of custodial grandchildren is needed.An estimated 21% to 33% of grandchildren raised by grandparents  experience socioemotional or behavioral problems . These cGiven the significant impact of child socioemotional and behavioral problems on child development, it is important to unpack the risk and protective factors associated with custodial grandchildren’s socioemotional and behavioral outcomes. A recent systematic review summarized various factors at both the grandchild and grandparent levels associated with custodial grandchildren’s socioemotional and behavioral well-being . At the More factors were found at the grandparent level that contributed to custodial grandchildren’s socioemotional and behavioral outcomes. As custodial grandchildren’s primary caregivers, grandparents significantly contribute to grandchildren’s well-being. For instance, custodial grandparents’ education, household income, marital stress, coping resources, and family function can affect grandchildren’s behaviors ,23. FurtAlthough some factors associated with grandchildren’s socioemotional and behavioral well-being are known, very limited research has examined the role of the grandparent–grandchild relationship in determining custodial grandchildren’s socioemotional and behavioral problems. Thus, this study seeks to examine the association between the grandparent–grandchild relationship and grandchildren’s socioemotional and behavioral problems, including emotional problems, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors. The results of this study provide important implications with a focus on improving the relationship between grandparents and grandchildren, which may help decrease custodial grandchildren’s socioemotional and behavioral problems.Attachment theory provides a theoretical foundation for understanding the impact of family relationships, particularly the relationship between grandparents and grandchildren, on custodial grandchildren’s socioemotional and behavioral problems. Attachment is developed in the first few years of childhood, and children may have more than one attachment figure, like parents or grandparents . The keyIn the context of grandparenting, grandchildren who are separated from their biological parents have their attachment bonds with their biological parents disrupted. Separating from biological parents may be related to adverse outcomes for children, including mental health problems . HoweverRelationships are patterns of interactions, expectations, beliefs, and effects organized at an abstract level that captures observable behaviors . RelatioGrandparents’ perceptions of their relationships with their grandchildren can serve as an indicator of the quality of the relationship. Due to prior traumatic stress and disrupted attachment with primary caregivers, custodial grandchildren usually have a high level of socioemotional and behavioral problems . CustodiWhen grandchildren are placed in grandparent-headed households, having a close grandparent–grandchild relationship is essential and may be a therapeutic means for improving and correcting grandchildren’s socioemotional and behavioral problems and preventing the development of future adverse outcomes . AlthougAlthough there is a limited amount of research on the effect of grandparent–grandchild relationships on grandchildren’s socioemotional and behavioral outcomes, existing rich literature on child outcomes as a result of the child–parent relationship  Grandparent–grandchild relational closeness is associated with custodial grandchildren’s lower odds of emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors; and (2) Grandparent–grandchild relational conflict is associated with custodial grandchildren’s higher odds of emotional symptoms, conduct problems, hyperactivity, peer problems, and abnormal prosocial behaviors.n = 71) and a sample from Qualtrics Panels across the United States except for South Carolina (n = 216). We recruited grandparents raising grandchildren in South Carolina via various community partners, including state agencies , local nonprofit organizations serving kinship families, the local foster parent association, schools, and churches, from May 2021 to February 2022. The survey link was shared with our partners via flyers and email to be used in listservs or online newsletters. We also provided some hard copies of the survey to partners. Most survey data in South Carolina were collected electronically, but a handful of surveys were returned in hard copies. In addition to data collected from South Carolina, we recruited other grandparents raising grandchildren across the United States except for South Carolina via Qualtrics Panels from January to February 2022. Qualtrics Panels is an online survey panel that includes millions of U.S. residents who regularly take online surveys , p = 0.001) was associated with higher odds that their grandchild experienced emotional symptoms. Grandchildren of other races and ethnicities, compared to their White counterparts, were more likely to have conduct problems . Female grandchildren were less likely to have conduct problems  and hyperactivity  compared to male grandchildren. Furthermore, compared to grandfathers, grandmothers were more likely to report custodial grandchildren’s conduct problems  and hyperactivity . Older grandparents were more likely to report hyperactivity  than younger grandparents. Grandchildren’s disability status was associated with higher odds of hyperactivity  and peer problems .Regarding other predictors, grandparent depression , while children from South Carolina had lower odds of abnormal prosocial behaviors  than their counterparts recruited via Qualtrics Panels.In addition, this study found that grandchildren from South Carolina had higher odds of having hyperactivity , which might have influenced the accuracy of their assessments. Moreover, the validity of the grandparent–grandchild relational closeness and conflict scales were not examined in the present study. The reliability of the SDQ peer problems subscale was relatively low (0.65). Last, the study was cross-sectional; therefore, causal linkages between grandparent–grandchildren relationships and grandchildren’s socioemotional and behavioral problems could not be determined.These limitations point out some directions for future research. First, researchers should use a more rigorous sampling strategy to recruit grandparents when feasible. Second, future studies could consider using multiple informants  to collect data when feasible, reducing the risk of reporting bias. In particular, incorporating grandchildren’s perspectives to understand their relationships with grandparents would be important. Third, a longitudinal study would lead to a better understanding of the association between the grandparent–grandchild relationship and grandchildren’s socioemotional and behavioral problems over time. In addition, future research can be enhanced by exploring more patterns of grandparent–grandchild relationships and their associations with grandchildren’s socioemotional and behavioral outcomes. For instance, future research can examine factors that lead to negative family relationships between grandparents and grandchildren and their relationships with biological parents. It would be interesting to examine the factors moderating the relationship, such as child age and timing of custodial grandparent household formation. Lastly, future research could examine the construct validity of the grandparent–grandchild relational closeness and conflict scales.Our study has several important implications for practitioners serving grandparents raising grandchildren. First, our results emphasize the importance of improving the relationship between grandparents and grandchildren, which may help decrease custodial grandchildren’s socioemotional and behavioral problems. Due to the potentially severe consequences of deteriorating family relationships on both grandparents and grandchildren, social workers, family counselors, educators, and other professionals in the community who work with grandparent-headed families need to understand the complexities of these familial relationships. In addition to a thorough and shared understanding of the relationships between grandparents and grandchildren, social workers and other professionals who aim to improve grandchildren’s socioemotional and behavioral problems may pay attention to the relational closeness and conflicts between grandparents and grandchildren. To improve the relational closeness between grandparents and grandchildren, providing relationship-focused interventions could be an option. Practitioners and intervention researchers could consider implementing existing evidence-based interventions with grandparent-headed families. For example, it might be beneficial to implement child–parent relationship therapy (CPRT) among grandparent-headed families. CPRT, adapted from Guerney’s filial therapy , is inteSocial workers, school counselors, and teachers should also advocate for more school-based and health care-based screenings for emotional and behavioral problems among custodial grandchildren who are experiencing family conflict to serve as a preventive measure . School The current study examined the associations of grandparent–grandchild relational closeness and conflict with custodial grandchildren’s socioemotional and behavioral problems. The findings show that relational closeness was associated with the lower odds of emotional symptoms, conduct problems, peer problems, and abnormal prosocial behaviors, whereas relational conflict was linked to the higher odds of emotional symptoms, conduct problems, peer problems, and hyperactivity among grandchildren. These findings provide implications for social workers to improve relational closeness and decrease relational conflict between grandparents and grandchildren, which may decrease custodial grandchildren’s socioemotional and behavioral problems.


Soft tissue adhesion and sealing around dental and maxillofacial implants, related prosthetic components, and crowns are a clinical imperative to prevent adverse outcomes of periodontitis and periimplantitis. Zirconia is often used to fabricate implant components and crowns. Here, we hypothesized that UV treatment of zirconia would induce unique behaviors in fibroblasts that favor the establishment of a soft tissue seal. Human oral fibroblasts were cultured on zirconia specimens to confluency before placing a second zirconia specimen (either untreated or treated with one minute of 172 nm vacuum UV (VUV) light) next to the first specimen separated by a gap of 150 µm. After seven days of culture, fibroblasts only transmigrated onto VUV-treated zirconia, forming a 2.36 mm volume zone and 5.30 mm leading edge. Cells migrating on VUV-treated zirconia were enlarged, with robust formation of multidirectional cytoplastic projections, even on day seven. Fibroblasts were also cultured on horizontally placed and 45° and 60° tilted zirconia specimens, with the latter configurations compromising initial attachment and proliferation. However, VUV treatment of zirconia mitigated the negative impact of tilting, with higher tilt angles increasing the difference in cellular behavior between control and VUV-treated specimens. Fibroblast size, perimeter, and diameter on day seven were greater than on day one exclusively on VUV-treated zirconia. VUV treatment reduced surface elemental carbon and induced superhydrophilicity, confirming the removal of the hydrocarbon pellicle. Similar effects of VUV treatment were observed on glazed zirconia specimens with silica surfaces. One-minute VUV photofunctionalization of zirconia and silica therefore promotes human oral fibroblast attachment and proliferation, especially under challenging culture conditions, and induces specimen-to-specimen transmigration and sustainable photofunctionalization for at least seven days. Zirconia is widely used in modern dental and maxillofacial prosthetics, including but not limited to dental implants, crowns, inlays, tissue bars, and implant abutments (connecting an implant and crown) ,23,24,25The ultraviolent (UV)-light-mediated photofunctionalization of titanium has revolutionized our understanding of bone–titanium integration, or osseointegration ,48,49,50Next-generation UV photofunctionalization, or vacuum UV (VUV) photofunctionalization ,89, may The objective of this study was to examine the effect of VUV light treatment of zirconia on the behavior and function of human oral fibroblasts. To create a biological seal, oral/gingival fibroblasts must interact with the three-dimensional contours of zirconia surfaces and, if possible, also extend and migrate over the zirconia surfaces. Therefore, here, we examined the potential of VUV-treated zirconia to induce distinct fibroblast behaviors in vitro, especially under challenging culture conditions, mimicking the complexity of the oral environment. For clinical correlation, we also examined glazed zirconia surfaces, a technique widely used for zirconia crowns and other dental restorations, in addition to regular milled zirconia surfaces.Zirconia specimens in rectangular plate form  were milled from a zirconia disk  and sintered at 1530 °C for 120 min. Glazed specimens were prepared by coating zirconia specimens with silica glass paste  followed by heating at 830 °C. All specimens were prepared by World Lab USA .2; DIO Implant, Busan, Korea) for 1 min. Surface morphology was examined via scanning electron microscopy . In addition, the following roughness parameters were quantified via atomic force microscopy : average roughness (Ra), peak-to-valley roughness (Rz), skewness (Rsk), kutosis (Rku), and mean width of profile elements (Rsm). The hydrophilicity/hydrophobicity of zirconia surfaces with and without VUV treatment was evaluated by measuring the contact angle of 3 µL ddH2O, as previously optimized [UV treatment was performed at room temperature using a vacuum UV (VUV) light  were cultured, as reported elsewhere ,95,96, iThe number of fibroblasts attaching to zirconia specimens during the first day of culture was determined by counting the cells in fluorescence microscopy images. The cells were fixed in 10% formalin, permeabilized with 0.5% TritonX-100, blocked with 1% BSA, and then stained with rhodamine–phalloidin  for actin filaments. Cell proliferation was evaluated by measuring cell density on days 2 and 4 using the water-soluble tetrazolium salt (WST-1)-based colorimetric assay, as reported elsewhere ,79,97. IThe spreading behavior of fibroblasts seeded onto zirconia specimens was examined via fluorescence microscopy. On day 1, the cells were fixed and stained using the method above and evaluated for cell area, perimeter, and Feret’s diameter using ImageJ .To assess the transmigration, stained cells on the second specimen were evaluated via fluorescence microscopy on day 7. To capture the largest area, the lowest magnification images (×40) were taken and compiled to cover the entire depth of a specimen (6 mm). The images were obtained along the center line of the rectangular specimen, beginning at the middle of the 14 mm long side of the rectangle. Fibroblast migration was measured in two different ways: volume zone (the extension of confluent area formed by migrated cells) and leading edge (a cluster of cells at the leading edge of migration).Fibroblast collagen production was measured on day 4 via picrosirius red staining , as reported elsewhere ,96. PrioOn day 4 of culture, the specimens were collected. Total RNA was extracted using TRIzol reagent , and the RNA was purified using the Direct-zol RNA MiniPrep kit  according to the manufacturers’ protocols and established methods ,100,101.t-tests; p-values < 0.05 were considered statistically significant.All cell culture assays were performed in triplicate (n = 3), except for cytomorphometry, which was conducted on twenty cells (n = 20). Quantitative surface analysis was conducted on six random areas of zirconia specimens (n = 6). Surface chemical assessment via XPS and contact angle measurements were undertaken on three different specimens (n = 3). Differences between the control and VUV-treated groups were assessed with The SEM images revealed rough submicron nodules all over the surface of the milled zirconia specimens A. There X-ray photoelectron spectroscopy (XPS) was next used to detect the elements present on zirconia specimens, i.e., oxygen, carbon, zirconium, and yttrium D. There To further examine any VUV treatment-induced changes in surface topography, three-dimensional imaging and quantitative roughness analysis were performed via AFM. Three-dimensional color maps confirmed that the control and VUV-treated zirconia specimens had similar surface topographies A. ContouWe next examined how human oral fibroblasts react to milled zirconia specimens with or without VUV treatment. The cells were seeded on zirconia specimens placed horizontally in 12-well cell culture dish wells. Significantly more (~40%) cells attached to VUV-treated zirconia during the first day of culture than to untreated zirconia A.To evaluate the rate of cell proliferation, cell density was measured on days 2 and 4 of culture B,C. TherThe spreading behavior was different on treated and untreated surfaces, with cells spreading on larger VUV-treated surfaces with robust cytoplasmic projections, as shown via fluorescence microscopy and cytomorphometric analysis of cell area, Ferret diameter, and perimeter G.We next created challenging conditions for cell growth to mimic the clinical environment. Zirconia specimens were placed obliquely in the wells of culture dishes at 45° and 60° A and celWe next determined the potential of fibroblasts to migrate across zirconia specimens. First, we cultured fibroblasts to confluency on milled zirconia. Then, the specimen with attached cells was transferred to a new culture well with a second, brand-new specimen placed alongside A, expectA cluster of fibroblasts migrated to the control zirconia surface, with the reach of migration being limited to the contact area of the new specimen  reduction in cell density on 60° specimens. More importantly, compared with the relatively small differences seen between the control and VUV-treated groups in the regular culture setting (0°), obliquely placed specimens amplified the differences and a greater benefit was observed with VUV photofunctionalization on more tilted specimens; indeed, on day 4, the compromised cell density on 45° specimens was fully restored via VUV. Fibroblasts encounter various spatial factors that modify the interaction with biomaterials, and crowns, dental implants, implant abutments, and related components are never flat and horizontal. Given this clinical reality, the accentuated effect of VUV photofunctionalization under challenging conditions was even more clinically significant.Zirconia specimens were treated using VUV light for 1 min in this study based on the recent verification studies of VUV light ,89. The The full range of applications that could benefit from VUV photofunctionalization of zirconia now deserve further consideration. Zirconia is extensively used in modern dentistry as crowns and other restorations as well as implant abutments. Unlike dental implants supplied in a sterile package, those devices are made and finished by hand by dentists and dental technicians and then again, at the chairside, further adjusted and polished, inadvertently contaminating the surfaces with various chemicals, especially carbon-containing molecules. One-minute VUV photofunctionalization as a decarbonizing procedure and biological activator would be of significant clinical benefit, and we saw no evidence of potential adverse events such as discoloration and surface damage.This study tested the ability of VUV-treated zirconia to induce unique behaviors in human oral fibroblasts, namely specimen-to-specimen transmigration. Specimen-to-specimen transmigration across a significant distance was exclusively seen with VUV-treated zirconia specimens after seven days of culture, and the process was characterized by enlarged cells with robust cytoplasmic projections at the leading edge. This observation was corroborated by a significant reduction in surface carbon on VUV-treated zirconia and a highly increased attachment and proliferation of fibroblasts on VUV-treated zirconia specimens in the regular cell culture setting. These results provide the first evidence of a sustainable effect of VUV photofunctionalization for at least seven days.


This was strengthened by a significant benefit observed for HMP in both the sensitivity analyses: an adjusted OR of 0.45  in the multivariable analysis and DGF-rate of 8.7% vs. 17.4% (p = 0.024) after ID-matching. The 5-year graft survival rate was >90% in both groups, with no benefit using HMP . Our results suggest that HMP may be effective in decreasing DGF-rates, however, without any significant benefit in graft survival.Hypothermic machine perfusion (HMP) has been shown to reduce delayed graft function (DGF)-rates in kidneys from expanded criteria donors (ECD) and may increase graft survival compared with static cold storage (SCS). This single-center, retrospective observational study aimed to evaluate this effect. The primary endpoint was the DGF-rate, defined as the use of dialysis in the first postoperative week, excluding the first 24 h. The main secondary endpoint was graft survival at 5 years. Recipients of ECD-kidneys between 2013 and 2021 with ≤2 grafts were included (n = 438). The SCS-kidneys were marginal-matched by propensity score to the HMP-group for donor age, cold ischemia time, and graft number. Multivariable adjusted analysis for confounders in the unmatched cohort and caliper-based ID-matching constituted sensitivity analyses. HMP showed a trend to lower DGF-rate in the marginal-matched comparison (9.2% vs. 16.1%,  The persistent shortage of donor kidneys has led to increased utility of kidneys from expanded criteria donors (ECD). Despite an elevated risk of delayed graft function (DGF) and a 70% increased risk of graft failure compared to recipients of standard criteria donor (SCD) kidneys ,2, recipDuring SCS and HMP alike the kidneys sustain cold ischemic injury, and increased cold ischemia time (CIT) is an established risk factor for developing DGF and decreased graft survival . TherefoDeath-censored graft survival rates in Sweden are reportedly on the higher end, consistently > 90% at 5 years for kidneys from deceased donors ,15. HMP This matched retrospective single-center study included patients who received ECD kidney transplants at SU between 2013 and 2021. ECD was defined as a brain-dead donor aged ≥ 60 years or ≥50 years with at least two risk factors: history of hypertension, cerebrovascular cause of death, and final serum or plasma creatinine ≥ 132 µmol/L . The KDP®  was used for machine perfusion with the manufacturer’s standard settings. The preservation solutions were Kidney Perfusion Solution (KPS-1) or Beltzer MPS for HMP, and Static Preservation Solution (SPS-1) for SCS. The decision to use HMP or SCS was based on the fulfillment of ECD criteria and logistical factors. Kidneys from ECD were preserved using HMP. There were routinely two exceptions where ECD kidneys received SCS instead of HMP; kidneys imported from other transplant centers not using HMP or simultaneous heart donation from long-distance centers. However, owing to anatomical variations, time constraints, and logistical challenges, we expected a relatively low adherence to these routines and a significant use of SCS even for ECD kidneys.The grafts were thoroughly flushed during allocation using the Institut Georges Lopez-1 (IGL-1) solution. LifePortThe standard induction therapy before transplantation consisted of basiliximab and methylprednisolone. Standard maintenance immunosuppression post-transplantation is comprised of triple therapy with steroids, mycophenolic acid, and calcineurin inhibitors.The primary endpoint was the DGF-rate; DGF was defined as the need for dialysis in the first postoperative week, excluding the first 24 h . The secThe following important predictors were presumed to differ between the two groups at baseline and constituted the basis for matching: donor age, cold ischemia time (CIT), and the number of previous grafts. To compare the two groups, three methods were used: the best marginal distribution matched group as the primary analysis, multivariable logistic regression adjusted for multiple confounders in the entire (unmatched) cohort as the first sensitivity analysis, and the best caliper-based ID matched group as the second sensitivity analysis. Unadjusted analyses of all the subjects constituted complementary analyses. For further information about each matching method and the parameters used, please refer to the Matching Methods section in Unadjusted comparisons were performed using Fisher’s exact test for dichotomous variables, Fisher’s non-parametric permutation test for continuous variables, and the Chi-square test for non-ordered categorical variables. Patient survival data were calculated using the Kaplan–Meier survival analysis method, log-rank test, and Cox proportional hazard regression. To correctly adjust for death as a competing event to graft loss in graft survival analysis, we used the cumulative incidence function, Gray’s test and Cox proportional hazards regression model ,23. Graf® v9.4 . All significance tests were two-sided and were conducted at a 5% significance level.Continuous variables are presented as mean, standard deviation (SD), median, and range. Categorical variables were presented as numbers and percentages. All analyses were performed using SASThe study was approved by the Swedish Ethical Review Authority (D.nr. 2022-02644-01).A total of 381 kidneys from ECD donors were transplanted between 2014 and 2021, excluding recipients of ≥2 grafts. A significant number of SCS controls was lost after our first round of matching regardless of the matching method; the best-matched SCS control group included only 136 participants. Therefore, SCS kidneys from 2013 were included to increase the pool, resulting in a final total study population of 438, of which 243 were SCS and 195 were HMP kidneys , Table 2The best ID-matching for the sensitivity analysis was caliper-matching with a caliper width of 8 years for donor age, 1.5 h for CIT, and exact matching for graft number, resulting in 172 subjects from each group .p = 0.0002) and CIT , which were included as matching parameters, as well as KDPI , terminal serum/plasma creatinine  and terminal eGFR  (p = 0.052). Duration of dialysis, frequencies of comorbidities and kidney disease, and immunological profiles were comparable between the groups, having an SMD < 0.2. After marginal-matching every recipient variable achieved an SMD < 0.2, ensuring comparability between the groups on the collected variables, and there were no significant differences between them (p = 0.056).The donor groups were similar in terms of baseline characteristics, except for donor age  . The difeen them . This waeen them , althougp = 0.063).Our primary marginal-matched analysis revealed a small trend for a lower DGF-rate of 9.2% in the HMP group versus 16.1% in the SCS group ; howeverp = 0.012) , modeled for the risk of the DGF and adjusted for donor and recipient age, CIT, graft number, donor terminal creatinine and eGFR, revealed that HMP reduced the odds of DGF by 55%  . In the There was no significant difference in median DGF-duration (8 vs. 9 days) nor in primary non-function rates (0.5% vs. 1.1%). Mean DGF-duration was longer in the SCS-group, sensitivity analyses included, due to an outliner whose graft started functioning after 330 days.Survival analyses were performed using the marginal-matched cohort. There was no significant difference in cumulative incidence of graft loss  or patiep = 0.51) or patient survival .The Cox proportional hazards model revealed no statistically significant hazard reduction with HMP compared to SCS for graft survival . However, logistics regression adjusted for donor age as a continuous variable revealed a 46.8% risk reduction for DGF with HMP . Graft survival analysis did not show a statistically significant difference in cumulative incidence of graft loss in either age group, although a small but statistically non-significant decreased incidence of graft loss in the long-term was observed for SCS for donors aged <70 years and for HMP for donors aged ≥70 years  and donor age ≥ 70 years (n = 167). Analysis using logistic regression and classifying donor age as a dichotomous variable (<70 and ≥70 years) to show how age influences the efficacy of preventing DGF between HMP and SCS revealed an OR of 0.43 (95% CI: 0.19–0.97) for donors < 70 years and 0.80 (95% CI: 0.28–2.24) for ≥70 years. Interaction between these age groups and HMP’s prevention of DGF was not statistically significant , it suggested a trend for DGF-rate reduction when using HMP. This result was strengthened by the significant benefit observed in both sensitivity analyses, suggesting that HMP may be effective in reducing DGF-rates even when the overall DGF-rate is low. With that said, it is not evident that HMP makes sense from an economic standpoint, due to the already low DGF-rates, and therefore, relatively small effect size. A follow-up study including more participants could bring more clarity. Also, cost-effectiveness and harm-benefit analyses would be of interest to further navigate the future use of HMP in ECD kidney transplantation at our center.HMP has consistently yielded better short-term results than SCS in ECD kidney transplantation, but the magnitude varies widely depending on the transplant center. However, this short-term benefit does not seem to unanimously translate into better graft function in the long term; in fact, most evidence suggests that it does not . There ap = 0.012) using logistic regression adjusted for confounders in the entire cohort, as well as the logistic regression adjusted for donor age in the marginal-matched cohort  is comparable to the adjusted OR of 0.46 reported by Treckmann et al. in their RCT in 2011 [The trend found with HMP on DGF-rate in our study is similar to those found in studies from other centers ,10,24. T in 2011  and the  in 2011 . This co in 2011 . The reaThis study was not designed and did not reveal the reason for the relatively low incidence of DGF in our groups. The definition of DGF may have had an impact. DGF is mostly defined as the need for dialysis in the first week post-transplantation. Dialysis within the first 24 h post-transplantation was excluded according to the DGF definition used in our study. It is probable that using the more common definition would result in higher DGF-rates and better comparisons with other studies. In a single-center UK-based study investigating the effect of different DGF-definitions on the outcomes, DGF-rates using our definition reached 32.4%, compared to 40.0% when using the more traditional definition in a DBD cohort . TherefoOur marginal-matching procedure yielded an SCS group that was 2.5 years older (mean) and had 1 h longer CIT (mean and median) than the unmatched cohort. Matching also resulted in a more comparable KDPI between the groups, which was favorable in our graft survival analyses. Donor age and CIT are important risk factors for DGF, and we assumed increasing these would increase the DGF-rates . Surprisp = 0.36) or better effect in any age group, although there was an indication of a better effect for donors aged <70 years (OR 0.43) than for those aged ≥70 (OR 0.80). However, because of the relatively few cases of DGF and participants in these groups, these analyses have low power. This is also true in the survival analyses  in both the SCS and HMP groups, and there was no apparent survival benefit using HMP . The mosThe reason for the good outcomes observed in Sweden is relatively unknown. Donor-related factors do not seem to explain it, indeed the KDPI was relatively high. It is therefore likely that several other factors, such as recipient-related factors, universal and equitable health coverage, organ allocation system, access to transplantation and immunosuppressive medications, good follow-up regimens as well as national health quality registries in Sweden that provide a unique opportunity to monitor quality and results may contribute. Unfortunately, this is mere speculation; to our knowledge, no studies have been conducted comparing these processes to other countries.The post-transplantation graft function was similar between the groups. There was a trend, although very modest, of initially better graft function in the HMP group, although it only reached significance at 1 month . This coThis study had a few limitations. The most obvious is the retrospective and non-randomized nature of the study, and although we performed a matching of good quality, the results can never reach the strength of an RCT. There are also several potential biases. As previously discussed, our DGF-definition, excluding recipients receiving dialysis the first 24 h post-transplantation may complicate comparisons to other studies. The sample size was also small to confidently reveal long-term differences between the groups, especially in the stratified analyses. The inclusion of SCS-kidneys in 2013 may have induced a time-period bias, although this is expected to be limited. The selection of the preservation method was not randomized, and although every ECD-kidney should receive HMP, this was not the case in 186 kidneys between 2014 and 2021. Whether this was due to logistical, donor, or recipient factors, there is potential for selection bias, although we tried to mitigate this to some extent in our matching procedures. Matching may cause clustering or dispersion of confounding factors not included in the matching model; however, we did not find any obvious disproportions of important variables due to matching and the robustness of the matching was also evaluated using our sensitivity analyses, suggesting adequate matching parameters. The results of this study are from a single center in Sweden and cannot be generalized to other populations.The strengths of the study include an extensive and well-characterized cohort, with a low number of dropouts, and the use of the matching procedure that generated comparable groups of important risk factors for both DGF and graft survival, thus strengthening the results. The inclusion of more baseline characteristics in a multivariable analysis including all the participants was also performed to gauge their effect on the endpoints and support the results. We also used the cumulative incidence function for a more correct and accurate graft survival analysis . This beIn this study, we sought to investigate the efficacy of HMP in ECD kidney transplantation at our center. There was an overall relatively low rate of DGF. HMP showed a trend to lower DGF-rate in the marginal-matched comparison, which was strengthened by the significant benefit found in the sensitivity analyses, suggesting a possible short-term benefit of kidney function using HMP. No long-term benefits were observed for graft survival or kidney function.


Pan American Journal of Public Health draws readers’ attention to an error in the following article, pointed out by the authors:The In page 4,


A coronally advanced flap combined with a subepithelial connective tissue graft is considered the gold standard for achieving root coverage on exposed root surfaces. Nevertheless, challenges arise when this technique is applied to multiple teeth and when the palatal soft tissue is very thin. Several surgical modifications have been reported to simultaneously achieve both single or multiple root coverage and widening of the keratinized gingiva. In this context, there have been no reported cases utilizing the submerged technique with partially de-epithelialized free gingival grafts. We intend to introduce a submerged technique involving partially de-epithelialized free gingival grafts for the modification of soft tissue phenotypes in the maxillary anterior region. Free gingival grafts are the most efficient procedure to increase the width of keratinized tissue and have been performed to cover denuded root surfaces ,2. HowevFor root coverage, subepithelial connective tissue grafts are recommended over free gingival grafts. Coronally positioned flaps using a subepithelial connective tissue graft are the most predictable approach for covering denuded root surfaces . NonetheDe-epithelialized free gingival grafts have been used to increase the width of keratinized tissue or cover denuded root surfaces ,10,11. TIn the present study, we introduce a submerged technique for partially de-epithelialized free gingival grafts to increase keratinized gingiva and root coverage for multiple teeth in the maxillary anterior region in patients with very thin palatal soft tissue.The patient, a 33-year-old male smoker, visited the Department of Periodontology, Kyung Hee Medical Center for treatment of cervical erosion in the maxillary anterior region in June 1988. Cervical erosion was observed in the upper six anterior teeth. The phenotype of the gingiva was thin. The thickness of the palatal mucosa was very thin (less than 2.0 mm). The quantity of subepithelial connective tissue grafting was not sufficient to cover the upper six anterior teeth. The submerged technique of a partially de-epithelialized free gingival graft was chosen to cover the denuded root surfaces.A schematic diagram of a partially de-epithelialization with about 1.0 mm thick free gingival graft is shown in All cervical portions of the maxillary anterior teeth were eroded and soft textured a,b. TherAfter local anesthesia with 2% lidocaine , a split-thickness flap with two vertical incisions was reflected. Horizontal incisions were created to pass through the line angle between the cemento-enamel junction and the interdental papilla. In addition, de-epithelialization of the interdental papilla was performed to coronally position the flap. The excess resin fillings were slightly smoothed using an ultra-fine finishing bur and root planing procedures were performed. Root surface biomodification was not performed.TM, GC Inc., Alsip, IL, USA).A free gingival graft was harvested from the ipsilateral palate. In the present case, the thickness of the palatal soft tissue was less than 2.0 mm. The thickness of a donor graft harvested through the conventional method of a free gingival graft procedure was approximately 1.0 mm. The donor site was sutured with 5-0 black silk for hemostasis and covered with a periodontal pack  suture material (The partially de-epithelialized free gingival graft of about 1.0 mm in thickness was stabilized with 5-0 Vicrylmaterial c. The dematerial d. After Two months after surgery, complete root coverage and increased width of keratinized tissue was observed in the maxillary six anterior teeth e,f. ThinThe panoramic radiograph at 10 years after surgery revealed slight interdental bone loss in the maxillary anterior teeth a. MinimaThe thin gingival phenotype has a high risk of long-term esthetic complications and is also associated with crestal bone loss . As in tSeveral surgical procedures including a laterally sliding flap, a coronally advanced flap, and its combinations with barrier membranes or subepithelial connective tissue grafts have been proposed to treat gingival recession of a single tooth . In caseNonetheless, the coronally advanced flap with a subepithelial connective tissue graft has exhibited the most optimal clinical outcome ,16. HoweConventionally, the subepithelial connective tissue graft was harvested using a trap-door approach, a scalpel with parallel blades , or a siIn the conventional free gingival graft procedure, the mucosal flap is apically positioned or removed to prepare the recipient bed. However, in the present procedure using a partially de-epithelialized free gingival graft, a thin mucosal flap is placed over the partially de-epithelialized free gingival graft without being removed. In the early healing stages after surgery, the mucosal flap can provide blood supply to the underlying partially de-epithelialized free gingival graft. The thickness of the partially de-epithelialized free gingival graft is approximately 0.5 mm to 1 mm, consisting of epithelium and several portions of the lamina propria. It is theorized that the presence of the overlying flap, which allows for plasmatic circulation and additional vascularization, could have supported the retention of the thin graft. It is hypothesized that the double blood supply may contribute to the viability of a partially de-epithelialized free gingival graft on the exposed root surface. Furthermore, the overlying mucosal flap could serve as protection for a partially de-epithelialized free gingival graft against external stimuli during the initial stage of the healing process.In the present procedure, it is important to ensure that the de-epithelialized aspect does not come into contact with the root surface, but instead remains in contact with the overlying mucosal flap. Contact between the outer epithelial surface and the root surface could hinder tissue attachment, potentially leading to the development of pockets or epithelial cysts ,28,29. IIt is reported that approximately 31–45% of the graft width tends to shrink within the first 3 months post-surgery, with minimal subsequent alterations thereafter . While tWe report a rare case with a 34-year follow-up of a partially de-epithelialized free gingival graft performed on the multiple maxillary anterior teeth. This is an intermediate procedure between a free gingival graft and a subepithelial connective tissue graft. This procedure has the dual characteristics of a free gingival graft to increase the width of keratinized mucosa, and a subepithelial connective tissue graft for root coverage.One disadvantage of this technique is that postoperative color mismatching is caused by the exposure of the epithelium of the underlying graft. However, the color mismatching of a partially de-epithelialized free gingival graft on multiple teeth is less obvious than that of a single tooth.This case report has several limitations. First, clinical photos and panoramic radiographs were of poor quality as they were from 34 years prior. Second, several recordings for maintenance or clinical photos including donor site might have been missed, although most of the patient’s data and surgical procedures were well documented as a case note with clinical photos and radiographs. Third, the case is limited by the small number of cases and must be supported by further investigation into the effects of residual epithelium.Within the limitations of the present case report, the submerged technique using partially de-epithelialized FGG exhibited an ability to increase the width of the keratinized tissue and enable effective root coverage on multiple teeth even when the thickness of the palatal mucosa is inadequate.


Vibrio cholerae O139 emerged in the early 1990s and spread rapidly to 11 Asian countries before receding for unclear reasons. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) component of lipopolysaccharide (LPS). V. cholerae O139 also expresses the OSP-capsule. We, therefore, assessed antibody responses targeting V. cholerae O139 OSP, LPS, capsule, and vibriocidal responses in patients in Bangladesh with cholera caused by V. cholerae O139. We compared these responses to those of age-gender-blood group-matched recipients of the bivalent oral cholera vaccine (OCV O1/O139). We found prominent OSP, LPS, and vibriocidal responses in patients, with a high correlation between these responses. OSP responses primarily targeted the terminal tetrasaccharide of OSP. Vaccinees developed OSP, LPS, and vibriocidal antibody responses, but of significantly lower magnitude and responder frequency (RF) than matched patients. We separately analyzed responses in pediatric vaccinees born after V. cholerae O139 had receded in Bangladesh. We found that OSP responses were boosted in children who had previously received a single dose of bivalent OCV 3 yr previously but not in vaccinated immunologically naïve children. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 despite the presence of capsules, that vaccination with bivalent OCV is poorly immunogenic in the short term in immunologically naïve individuals, but that OSP-specific immune responses can be primed by previous exposure, although whether such responses can protect against O139 cholera is uncertain.Cholera caused by Vibrio cholerae serogroups O1 or O139. Protection against cholera is serogroup-specific, which is defined by the O-specific polysaccharide (OSP) of V. cholerae LPS. Yet, little is known about immunity to O139 OSP. In this study, we assessed immune responses targeting OSP in patients from an endemic region with cholera caused by V. cholerae O139. We compared these responses to those of the age-gender-blood group-matched recipients of the bivalent oral cholera vaccine. Our results suggest that OSP-specific responses occur during cholera caused by V. cholerae O139 and that the OSP responses primarily target the terminal tetrasaccharide of OSP. Our results further suggest that vaccination with the bivalent vaccine is poorly immunogenic in the short term for inducing O139-specific OSP responses in immunologically naïve individuals, but OSP-specific immune responses can be primed by previous exposure or vaccination.Cholera is a severe dehydrating illness in humans caused by  Vibrio cholerae: O1 and O139 -D-perosamines  oral killed cholera vaccine (OCV) currently included in the global stockpile of cholera vaccine and used in cholera control programs. Here, we characterize O139 OSP-specific antibody responses in individual patients with cholera caused by V. cholerae O139 during an outbreak in 2002 in Bangladesh and compare these responses to those induced by OCV in the age-gender-blood group matched participants in a vaccine study in Bangladesh in 2017.Epidemic cholera has been associated with two serogroups of  reasons –5. Altngladesh –8, Indngladesh , indicatngladesh –14. Althe same , the OSPosamines , while tosamines –20. Fuccharide , 18–21unogenic . Despitelerae O1 , little V. cholerae O139 isolated from stool and had moderate to severe dehydration from diarrhea. In addition, this study included samples from 23 cholera vaccinees from an OCV clinical trial conducted in Mirpur, Dhaka in 2017, who were matched to patients by age, sex, and blood group (O versus non-O)  . All vacs non-O) , 27. Thes non-O) . The demV. cholerae O139 and use of all samples for this current analysis were approved by the Institutional Review Boards of icddr,b and the Massachusetts General Hospital. Venous blood was drawn from patients 2 days after hospitalization and clinical stabilization and then on days 7 and 21; venous blood was drawn from vaccinees on days 0, 14, and 28. Vaccinees in the 2017 cohort received bivalent (O1/O139) vaccine on days 0 and 14. All blood samples were collected and separated to obtain serum or plasma, which were subsequently stored at −80°C until further use in immunological assays.All samples were collected following written informed consent and/or assent, including permission for subsequent analysis. The 2014 vaccine study was approved by the Institutional Review Board of icddr,b, and the 2017 vaccine study was approved by the Institutional Review Boards of both icddr,b and the International Vaccine Institute (IVI). The collection and analysis of clinical samples from patients with V. cholerae O139 strain CIRS245, synthetic terminal tetrasaccharide, and OSP and its terminal tetrasaccharide fragment conjugated to bovine serum albumin  were generated as previously described  extraction of wet biomass of CIRS245 with 1:1 phenol (90%)—water (v/v) at 68°C for 30 min. The extract was dialyzed against tap water for 24 h followed by deionized water for 2–4 h using a MWCO 12,000 membrane . Separation of capsule was achieved by ultracentrifugation of retentate . Supernatant containing capsule and nucleic acids was freeze-dried, then suspended in 50 mM Tris-HCl (pH 7.5) with 1 mM CaCl2 and 2 mM MgCl2  and incubated with 50 µg DNase from bovine pancreas  along with 50 µg RNase A from bovine pancreas  overnight at 37°C, followed by 100 µg Proteinase K from Tritirachium album  for 4 h at 37°C. Enzymes were inactivated by heating at 80°C for 1 h, and the material was dialyzed through a MWCO 3500 membrane . The capsule was further purified by repeated (three times) ultrafiltration using 100,000 MWCO Amicon Ultra 4 mL filters  followed by size exclusion chromatography on a Bio-Gel P30 column  eluted with water. The first eluting double peak detected in the refractive index chromatogram corresponding to the capsule was concentrated and freeze-dried. Absence of nucleic acids and proteins was verified spectrophotometrically using Shimadzu UVmini-1240 UV-VIS spectrophotometer by measuring absorbance at 256 nm and 280 nm, respectively. In order to remove residual traces of LPS detected on SDS-PAGE using Bio-Rad Mini-PROTEAN Cell system, an extra step of ultracentrifugation was performed as described above.LPS and OSP-core from escribed , 22. CapV. cholerae O139 were assessed using ELISA as previously described  in 0.1 M sodium citrate buffer (pH 4.5) and 0.012% hydrogen peroxide. Optical density was measured at 450 nm for 5 min at 14 s intervals, and the rate of change in optical density was expressed as milli-absorbance units per minute. The mean absorbance value for each sample was normalized to ELISA units by dividing the value for the sample against that of a pooled convalescent-phase sera standard. A responder was defined as any patient or vaccinee who had a ≥1.5-fold increase in ELISA units at the assessed time compared to day 2 or day 0, respectively.Antibody responses in plasma or serum against O-specific polysaccharide, terminal tetrasaccharide, lipopolysaccharide, and capsule of escribed , 29. BriV. cholerae O139 CIRS134B as the target organism .Differences in demographic characteristics between the two groups were tested using the Wilcoxon signed-rank test or the Fischer’s exact test, as appropriate. Differences in immune responses within groups were assessed using the Wilcoxon signed-rank test, while differences between groups were assessed using the Mann–Whitney V. cholerae O139 in patients and vaccinees across all isotypes and across all three time points. In patients, plasma IgA, IgG, and IgM antibodies targeting OSP -α-linked (4-N-3-deoxy-l-glycero-tetronyl)-perosamines, with or without a 2-O-methyl group on the terminal saccharide determining the Ogawa or Inaba serogroup, respectively (V. cholerae O139 is a single hexasaccharide containing N-acetyl-d-quinovosamine (QuiNAc), d-galacturonic acid , N-acetyl-d-glucosamine (GlcNAc), d-galactose , and two colitose (Col) residues. It contains two negatively charged groups: a carboxyl group of d-galacturonic acid and a cyclic phosphate bound to O-4 and O-6 of d-galactose  collected on day 2 and day 7 from patients with cholera caused by V. cholerae O139 in Bangladesh and pooled samples  from Haitian recipients of bivalent OCV . Since we matched to this cohort, our vaccinee samples were, therefore, also largely from adults. The naturally infected samples had been collected in 2002, years before the vaccine study in 2017, since O139 had disappeared as a significant cause of cholera when the bivalent OCV was developed and deployed. As such, the adults included in our vaccine cohort were children when Bangladesh was afflicted by large outbreaks of cholera caused by O139, and our detection of O139-specific immune responses in our vaccinees could possibly represent a boosting response from previous undocumented exposure. To address this possibility, we first analyzed O139-specific OSP responses in Bangladeshi vaccinees based on a baseline vibriocidal titer of 80 or greater (possibly consistent with previous exposure). However, we were unable to discern significant differences in subsequent OSP responses by this cohort analysis, perhaps because of the poor predictive value of the vibriocidal parameter in O139 , 43 and V. cholerae O139 had receded in Bangladesh. In this sub-analysis, we had samples from children who received the standard two doses of bivalent vaccine (day 0 and 14) in 2017 and who had been randomized to receive either a single dose of bivalent OCV or a placebo in 2014. We found no significant induction of immune responses against OSP in immunologically naïve Bangladeshi children (vaccine recipients in 2017 who were born after O139 cholera had receded in Bangladesh and who had received a placebo in the previous single-dose vaccine study in 2014). However, we detected significant responses in children who had received a prior single dose of bivalent (O1/O139) vaccine 3 yr previously. These results are consistent with the poor O139 OSP-specific immunogenicity of initial vaccination with bivalent OCV that we observed in immunologically naïve Haitian vaccinees . Vibriocidal responses during mplement . To maxi9 strain , 24. Altactivity ; specifiin vitro , while IV. cholerae O139 is encapsulated, and the capsule is comprised of a polymer of the V. cholerae O139 OSP hexasaccharide  to V. cholerae O139 antigens via community exposure or vaccination. The degree of protection afforded by such priming is unknown. Indeed, the ability of bivalent OCV to protect against cholera caused by V. cholerae O139 has never been demonstrated, and efficacy can no longer be easily assessed since the incidence of V. cholerae O139 infection is now rare; assessing protection afforded by vaccination would now require use of a human challenge model. Moreover, since O139 has not been of public health importance for many years, new simplified versions of OCV are being developed that do not contain V. cholerae O139 (V. cholerae O139 has receded but should it re-emerge, our data suggest that oral ingestion of killed O139 can prime immune responses. However, it remains unclear whether such priming would protect against virulent V. cholerae O139.In summary, naturally acquired cholera caused by rae O139 . It is u


The Frozenix J graft open stent graft has been available since 2014 in Japan. This stent is widely used for the frozen elephant trunk technique in many institutions, mainly for cases of acute type A aortic dissection and also for cases of a true aneurysm and chronic aortic dissection. We treated a rare case in which the metal wires of the Frozenix J graft were broken and embolized to the periphery half a year after being implanted. et al. in 1996 [1].The surgical method of total arch replacement (TAR) using the frozen elephant trunk (FET) was reported by Kato  He was diagnosed with acute type B aortic dissection, and an 83-mm annuloaortic ectasia with mild aortic valve regurgitation. After 1 month of conservative therapy, we performed a total arch replacement (TAR) with the open stent graft  and a 24-mm four-branched tube graft in addition to the Bentall procedure, using a 26-mm Valsalva graft and a 23-mm mechanical valve . Informed consent was obtained from the patient.et al. reported that a stent fracture occurred in 43 (6%) of 686 endovascular abdominal aortic aneurysmal repair cases during the period; the onset varied from 1 to 48 months [et al. reported corrosion of the nitinol wires of endovascular grafts using electron microscopic inspection in the majority of patients [The Frozenix J graft for the FET consists of a fabric part and a stent part constructed with a single knitted nitinol wire. The Frozenix J graft could firmly adjust to the curve of the aortic arch or a flexion of 180° or more. Furthermore, the stent is located inside the graft to prevent the former from coming into direct contact with the aorta and causing damage to the intima. This device was placed at the appropriate position simply by pulling the stent cover up under circulatory arrest without excessive depression to the stent graft during deployment. There are some reports of complications such as graft kinking and stent-induced new entry. However, stent fractures have not been reported, although more than 8 years have passed since approval from regulatory affairs was obtained. We experienced a rare case in which the broken nitinol pieces embolized to the periphery. In other stent grafts, Jacobs 8 months . Heintz


Bracken fern (Pteridium aquilinum) starch is a non-mainstream, litter-researched starch, thus the starch characteristics remain largely unknown.The structural and physicochemical properties of two bracken starches were systematically investigated, by use of various techniques that routinely applied in starch analysis.The starches had amylose contents of 22.6 and 24.7%, respectively. The starch granules possessed C-type polymorph with D  ranging from 18.6 to 24.5 μm. During gelatinization event, the bracken starches showed lower viscosity than typical for rice starch, and lower gelatinization temperature than typical for cereal starches. After gelatinization event, bracken starches formed much softer and sticky gel than rice and potato starch. The molecular weight and branching degree  of bracken starches were much higher than starches of many other sources. The branch chain length distributions showed that the bracken starches were structurally similar to some rice varieties , as reflected by proportions of A, B1, B2, and B3 chains. Notable differences in some starch traits between the two bracken starches were recorded, e. g. amylose content, gel hardness, gelatinization temperature and traits of structural properties. This study provides useful information on the utilization of bracken starch in both food and non-food industries. Both starch samples were extracted by the suppliers and sold online. J1 was purchased from online shop“Yongxing Lao Jia Tu Te Chan” and J2 was bought from “Xun Wei You Pin Te Chan Dian.”Two bracken starch samples were used in this study. One  was used to observe the morphology of the starch granules, with a voltage of 3.00 k V and a magnification of 1.50 k X.2.3.2-KI (0.2–2%), 100 μL acetic acid (1 mol/L) and 9 mL distilled water in a 15 mL centrifugal tube. This final mixture was kept at room temperature for 10 min before measured by an spectrometer , at a wavelength of 620 nm. A standard curve was made simultaneously by using standard amylose  and amylopectin .Apparent amylose content was measured according to the previously reported method . In brie2.4.A laser diffraction particle size analyzer  was used to determine the particle size distribution of the starch samples, according to the manufacturer’s protocol.2.5.An X-ray diffractometer  was used to reveal the diffraction patterns of starch samples. An X-ray tube Cu-Kα (nickel filter) at 40 kV and 40 mA was used as the X-ray source. The angular range of the diffraction angle (2θ) was 5°-40° with a step interval of 0.02°.2.6.A rapid visco analyzer  equipped with Thermocline for Windows software was used to measure pasting properties. In brief, starch sample  was mixed with 25 mL distilled water in a RVA sample can. The starch solution was heated following a temperature program: held at 50°C for 1 min, heated to 95°C in 3.8 min, and kept at 95°C for 10 min, cooling down to 50°C in 3.8 min and maintained at 50°C for 2 min. The peak time (Ptime), pasting temperature (PT), peak viscosity (PV), hot paste viscosity (HPV), cool paste viscosity (CPV) and the derivative parameters breakdown viscosity (BD = PV − HPV), setback viscosity (SB = CPV− PV), consistency (CS = CPV− HPV) were recorded or calculated.2.7.The starch gel formed after RVA test was sealed in the sample can by Parafilm™ and kept at 4°C for 24 h. Then, a TA-XT2i Texture Analyzer  equipped with Texture Expert software (version 2.1) was used to measure the textural properties. The gel samples were pressed twice by a flat-ended, 5 mm diametered cylindrical probe for 10 mm distance at a speed of 1.0 mm/s. Hardness (HD), adhesiveness (ADH) and cohesiveness (COH) were recorded by the software.2.8.o), peak (Tp), conclusion (Tc) temperatures and enthalpy of gelatinization (ΔHg) were calculated using the Universal Analysis Program, Version 1.9D (TA Instruments).Thermal properties were measured by differential scanning calorimetry . In brief, starch sample  was mixed with 6 μL distilled water in an aluminum sample pan. The sample pan was hermetically sealed and equilibrated at room temperature for at least 2 h, before being heated from 30°C to 110°C at a rate of 10°C/min. An empty sealed pan was used as a reference. Onset  was used to scan starch samples for fourier transform infrared spectra. Starch sample (5 mg) was mixed with 250 mg potassium bromide and pressed into film-coated tablet. The potassium bromide was considered as the background of the tablet. Wavenumbers from 400 to 4,000 cm2.10.The branch chain-length distribution of amylopectin was analyzed by high-performance anion-exchange chromatography (HPAEC) on a CarboPac PA-100 anion-exchange column  using a pulsed amperometric detector . Data were acquired on the ICS5000 , and processed using chromeleon 7.2 CDS .2.11.Starch molecular weight was measured by a gel permeation chromatography-refractive index-multiangle laser light scattering detector (GPC-RI-MALLS). The differential refractive index detector  was equipped with two tandem columns . The data were acquired and processed using ASTRA6.1 software .2.12.1H NMR scanning was performed 32 times, at a Larmor frequency of 500.23 MHz. Data were collected and analyzed with MestReNova. Average DB was calculated with Equation: DB (%) =  / *100, where I-1,6 is the integrated signal at 4.77 ppm and I-1,4 is the integrated signal at 5.12 ppm, respectively.Average degree of branching was determined using a Bruker BioSpin GmbH NMR spectrometer equipped with a tempering unit. Starch sample (10 mg) was mixed with 1 mL of deuterated dimethyl sulfoxide-d6 (DMSO-d6) and fully dissolved at 80°C overnight. The mixture was centrifuged at 12,000 rpm and the supernatant was taken and pipetted into an NMR tube. The 2.13.p < 0.05).All traits were measured in at least duplicate. Data analysis was performed using SPSS 25.0 statistical software program. Significance of differences between the means were calculated by the analysis of independent t-test . The mean values of all parameters of J1 were higher than those of J2. This could be attributed to both genetic and environmental factors.The two bracken starches varied significantly in D , D , D (0.1), D (0.5), and D (0.9) , peak (Tp), conclusion (Tc) and gelatinization enthalpy (∆Hg) were 57.9 and 59.3°C, 63.8 and 63.9°C, 69.4 and 72.5°C, and 15.9 and 16.7 J/g, respectively. The two samples varied significantly (p<0.05) in all thermal parameters except for Tp.DSC profiles of the two bracken starches are shown in o, Tp, and Tc ranging from 59.2 to 76.6°C, 66.7 to 81°C, and 71.8 to 87.8°C, respectively  varied from 72.5 to 75.7°C in seven maize samples  can vary greatly in starch structure .The weight-average molecular weight (Mw), number-average molecular weight (Mn), the degree of the dispersion of the molecular weight distribution (Mw/Mn), and the z-radius of gyration (Rz) of bracken starches were presented in 1 was slightly higher than that of J2, this is in consistent with the variation on Mw, Mn, Mw/Mn, and Rz . The results were presented in 2 had more proportions of short-branch chains (58.9% VS 57.4%) and less amylose chain (14.8 VS 16.5) than J1 (p<0.05). A previous study concluded that higher proportion of amylopectin short chains could lead to higher peak viscosity (PV) and breakdown value (BD), and a softer and stickier texture (HD) of the cooked rice (2) did have higher PV, BD and lower HD values than that of sample with lower proportion of amylopectin short chains (J1).The ratios of the three peaks ranged from 57.4 to 58.9%, 26.1 to 26.4%, 14.8 to 16.5%, respectively, in the two bracken starch samples. Jked rice . This is3.11.The chain length distribution of amylopectin was also analyzed by high-performance anion-exchange chromatography-pulsed amperometric detection (HPAEC-PAD). The results were shown in As shown in 4.The structural and physicochemical properties of two bracken starch samples were systematically investigated in this study. Most of bracken starch granules were near-spherical, ellipsoidal or prolate ellipsoidal, and had a mean area diameter less than 20 μm. XRD analysis revealed that the bracken starches had typical C-type crystalline structure. During gelatinization event, the bracken starches appeared to have lower viscosity than that of most of rice and potato varieties, and lower gelatinization temperature than cereal starch. Compared to rice and potato starches of similar AAC, bracken starches could form much softer and sticky gels. Therefore, bracken starches have obvious differences with main-steam starches in physicochemical properties, which indicates a potential of utilization for developing food and non-food products. The branch chain length distribution showed that the bracken starches were structurally similar to some rice varieties. There were notable differences in various properties between the two bracken starches. However, the genetic diversity and effect of growing environment on the properties of bracken starch remain to be studied through collection of a large number of samples. This study provides fundamental information for application of bracken starches in food and non-food industries.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.KL: conceptualization, resources, supervision, data curation, writing-original draft, and writing-review and editing. TZ: writing-original draft, data curation, methodology, and investigation. HR, WZ, and SH: software. YG: methodology. XL: data curation. HC: writing-review and editing and funding acquisition. All authors contributed to the article and approved the submitted version.The authors would like to thank Shantou Science and Technology Bureau (grant no. STKJ2021024), Guizhou University Natural Science Project (2020-23), Guizhou University Seed Program (2020-26), and The Opening Foundation of National Laboratory of Hazard Factors and Risk Prevention of Agricultural Product Quality and Safety (2021DG700024-KF202209) for financial support.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.


Journal of Functional Morphology and Kinesiology , which was first released in March 2016, saw significant developments in 2022. This journal provides an advanced forum for research studies on functional morphology and kinesiology and the regulatory functions of movement. JFMK meets the growing demand for high-quality, peer-reviewed international journals, offering easy access, high publicity via open access, the Digital Object Identifier (DOI), ORCID, and CrossRef to all researchers. We are indexed in Scopus (Elsevier’s abstract and citation database), PubMed, PMC, DOAJ , Scilit , Google Scholar, World Health Organization Hinari, Food Science and Technology Abstracts (FSTA), IFIS, and Norwegian Register for Scientific Journals, Series and Publishers (NSD). Our full texts are archived in CLOCKSS , e-Helvetica , and J-Gate (Informatics India).The In 2022, JFMK was assessed by SCImago Journal Rank as having a 2.7 CiteScore and reached Q2-quartiles in the following research fields: Anatomy, and Physical Therapy, Sports Therapy and Rehabilitation.In 2023, the CiteScoreTracker result for our journal in Scopus is 3.6, which is higher than in the previous year, which demonstrates the citation growth of our journal. In October 2022, we applied to be indexed in the Web of Science.JFMK is a member of the Committee on Publication Ethics (COPE). To verify the originality of content submitted to our journals, we still use iThenticate to check submissions against previous publications. MDPI works with Publons to provide reviewers with credit for their work and with MDPI Scitations Alert to provide our authors information on new publications in their research field.Journal of Functional Morphology and Kinesiology has continued to grow on functional morphology and kinesiology research dealing with the analysis of structure, function, development, and evolution of cells and tissues of the musculoskeletal system and the whole body. It is my pleasure to confirm the progress recorded in recent years [https://www.mdpi.com/journal/jfmk/stats (accessed on 15 January 2023).The journal publishes articles focusing on molecular, cellular, tissue, system, and the whole-body response to a broad definition of physical activities. Furthermore, the journal provides an advanced forum for the analysis of the structure, function, development, and evolution of the cells and tissues of the musculoskeletal system and associated clinical disorders. We are proud to let you know that, thanks to your continuous support, the nt years ,2,3,4,5,Journal of Functional Morphology and Kinesiology receives more manuscripts than it is able to publish, and the decision as to which papers are accepted or rejected is a difficult one. The decision is based on several factors, including originality, experimental design, scientific quality, data interpretation, clarity, and the quality of the written English, in order to uphold the high standards we have set for our journal.Indeed, the number of published manuscripts has jumped from 98, in the 2021 volume, to 112, in the 2022 volume, and we rejected 35% of the contributions to maintain the high standards of our journal. The In 2022, different Special Issues were activated thanks to the huge support of our editors. They include the following: “Motor Competence, Physical Activity and Health 2022”, edited by Prof. Dr. Vítor P. Lopes and Prof. Dr. Luis Paulo Rodrigues ; “MotivaJournal of Functional Morphology and Kinesiology will be published in full open access in order to provide free access to readers, and to cover the costs of peer review, copyediting, typesetting, long-term archiving, and journal management, an article processing charge (APC) of 1600 CHF (Swiss Francs) will be applied to papers accepted after peer review.All articles published in the In 2022, we added new keywords related to our journal as follows: Exercise and Physical Health; Sports Psychology and Cognitive Functioning; Muscle Structure and Musculoskeletal Disorders; Anatomy and Kinesiology; Adapted Physical Activity for Health Promotion; Rehabilitation and Rheumatology; Sports Medicine, Injury Prevention and Treatment; Strength and Power; Nutrition and Body Composition; Physical Activity and Neurodegeneration; Postural Control and Balance; Resistance Training; Sport Physiology and Performance; Athlete Monitoring and Management; Team Sports and Technology.In 2023, we shall continue our efforts to improve the journal through further growth and increased visibility.Follow up the planned papers from editorial board members;Contact international conferences recommended by the Editor-in-Chief or by editorial board members and try to establish media partnerships with them to make JFMK increasingly well known among scholars;Communicate with editorial board members more frequently and seek their generous and valuable input and expertise for journal development;Post high-quality papers through social media  and increase online readership;Reduce the processing time of each submitted manuscript;Take steps to have publications indexed by the Emerging Sources Citation Index (Web of Science), by EMBASE (Elsevier) and by Web of Science—Clarivate;Improve the Citescore in the SCImago Journal Rank in the kinesiology-related sections such as Anatomy, Histology, Orthopedics and Sports Medicine, Physical Therapy, Sports Therapy, and Rehabilitation;Achieve the First Impact Factor status, as released by Clarivate Analytics;Accomplish, for our authors, the JFMK Best Paper Award and the JFMK Travel Grant Award;Garner, for the sake of journal promotion, support from sponsors for our editors to participate in, and disseminate our journal to, international conferences.In order to achieve this target and lay a strong foundation for publications in 2023, and in our application for indexing, we have made the following plans:Since 2021, MDPI has included the accepting Academic Editor’s name on published articles, where they have accepted that manuscript after full peer review. This supports greater transparency for the readership, demonstrates the care that our Academic Editors take in making decisions, and offers full acknowledgement of the effort put in when making expert judgements about the suitability of a manuscript for publication. We strongly believe that this will also support the rigorous and robust quality of our peer-review process.We hope that you share our enthusiasm for this journal, and we look forward to working with you to make JFMK a leader in its field. Your contributions are vital for the success of this new journal. We look forward to receiving your contributions , and proposals for Special Issues are always welcome.I have personally found this to be quite a challenge, one not helped by the COVID-19 pandemic, but one due in large part to the special position that JFMK is trying to navigate in the highly competitive publishing landscape. I wish you a healthy and prosperous new year and look forward to continuing to expand the reach and impact of the journal with your help next year.I take also this opportunity to warmly thank, for their confidence, the following: our authors, readers, and reviewers, as well as our editorial advisors, eminent scientists in these fields, who, with their experience and important suggestions, guide us in this great enterprise; our excellent editorial board members, whose depth of experience covers a very broad spectrum on different disciplines related to morphology and kinesiology arenas; the managing editor, Ms. Molly Lu, for her huge support, the publishing manager, Dr. Peter Ribar, and the other members of the Editorial office, who day after day, thanks to their valuable contributions, ensure the growth of this journal; and finally, all members of our teams in Basel, Barcelona, Beijing, Belgrade, Romania, Tokyo, and Wuhan, as well as our sponsors.