Brazilian Journal of Otorhinolaryngology (Braz J Otorhinolaryngol), considered the main Brazilian scientific journal in the field of Otorhinolaryngology, has just been indexed in Thomson Reuters - Journal Citation Reports, in July of this year. Now, “our” publication is the first Latin-American journal to achieve this much desired goal in the field of Otorhinolaryngology.The This is a reason for much satisfaction and pride, because it is not only an acknowledgement of our journal's scientific quality, but being indexed will make it more visible and accessible to the world community of otorhinolaryngologists, physicians of all other specialties, and other healthcare professionals.Thomson Reuters - Journal Citation Reports was coordinated by João Ferreira de Mello Jr.,MD; Sílvio Caldas Neto, MD; and Regina Martins, MD. The current editorial board continued in this pursue during the first semester of this year, accomplishing this first and important step in the internationalization of the journal of the “Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial” .Such achievement has been the result of an effort which started in previous administrations, and the application to the The growing number of high-quality papers submitted, the rigorous review and selection of the best papers, the dedication of the editorial board, and the constant support of the ABORL-CCF have made this goal a reality. We would like to thank our Brazilian and international colleagues in the field of Otorhinolaryngology and from other healthcare fields who have contributed with papers and/or with the process of selecting them.Braz J Otorhinolaryngol, progressively strengthening its Impact Factor.The responsibility of the current and future editorial boards increases with this achievement, because now we will face the challenge of maintaining the high level of the publications and the increased number of citations of the papers published in the We know that, in order to maintain this quality and to attract the submission and publication of good papers, we must continue to improve the efficiency and speed of the editorial process, facilitating the work of authors and revisers.Braz J Otorhinolaryngol invite and stimulate authors to submit scientific papers, and we pledge to continue to work so that Brazilian and international specialists dealing with the various topics related to Otorhinolaryngology and Neck-Facial Surgery may continue to receive up-to-date, relevant and reliable information originating from well-managed and ethical studies, which can also contribute to their daily clinical practice.The editors of the Sincerely,


Four products  were prepared from 5 common varieties of Yam and evaluated for Digestible Starch (DS) and Resistant Starch (RS). Based on results, two products-pounded yam and Amala-were processed from three of the most popular varieties. Analysis of Rapidly Digestible Starch (RDS), Slowly Digestible Starch (SDS), and estimated in vitro GI (eGI) were then carried out in this stage. Glycemic Index (GI) of these products consumed by apparently healthy young adults were also determined. Variety Amula had highest DS in Amala (19.1/100 g) and pounded Yam (20.4/100 g) while variety Alumaco had highest RS in all the products (2.9–3.3/100 g). When compared with RS in its raw tuber, RS of Alumaco generally increased after processing. Variety Alumaco had lowest RDS in Amala (0.6/100 g) and pounded yam (0.3/100 g) while eGI was lowest in Alumaco made into Amala (53) and pounded yam (48). Assessment of GI resulted in high GI for all products across each variety. Irrespective of variety, processing Yam into Amala released RDS fraction faster when compared with pounded yam. Generally, even though the products are considered as having high GI, Amala raised eGI and GI faster than Pounded yam. Variety-Alumaco particularly showed favorable properties applicable to dietary management of diabetes. Exploring more processing methods and genetic diversity is recommended.Consumption of high Glycemic Index (GI) foods is a risk factor for increasing prevalence of diabetes mellitus (DM). The extent of variation in starch digestibility and GI of Yam varieties and products is not yet fully understood. This study was therefore designed to evaluate  While published studies have established the possible intra-varietal differences in GI and starch digestibility  were analyzed for rapidly and slowly digestible starch fractions, estimated glycemic index (eGI), and glycemic index (GI).Meccakusa, TDr02665, Alumaco, Oju Iyawo, Amula) were grown under rain-fed conditions with no fertilizer or herbicides added.A literature and database search of yam varieties cultivated in Nigeria was carried out which was shortlisted to 5 most popular varieties in consultation with the Yam Breeding Unit of the International Institute of Tropical Agriculture (IITA) Ibadan, Nigeria . The varThe peeled and washed samples were reduced into small sizes of about 12 cm diameter and boiled in water at 100°C for 20–30 min .Washed yam slices were boiled in distilled water and pounded with a mortar and pestle until a constant dough was obtained .Yam tubers were peeled and sliced. Washed yam slices were deep fried in vegetable oil at constant heat of 180°C for 5 min. Small quantity of water was added at intervals so the sample could uniformly cook and also to reduce the evaporation of the frying oil .elubo), and cooked into a thick dough  which used hexane as the extracting solvent. Dietary fiber was determined gravimetrically after subtraction of digested fat and protein content as described in .Slowly digestible starch .in vitro starch digestion. The hydrolysis index (HI) was then derived by dividing the Area Under Curve (AUC) of each starch hydrolysis by the AUC of the reference food (white bread). The HI represented the rate of starch digestion and the eGI indicated the digestibility of the starch in relation to the digestibility of starch in the reference material. The pGI was then calculated using the equation presented and applied by previous studies  were recruited and screened before being admitted to the procedure. The portion used for testing was 50 g of available carbohydrate both of the reference food item (glucose) and the food products. The experimental portions served were deduced from the values of digestible carbohydrates. Glycemic responses of each participant were obtained from capillary blood and used in calculating the incremental area under the glucose response curve (IAUC) after which GI was obtained by calculating the percentage area under the curve of the reference material (glucose) in comparison with the test food. The GI categorization of foods was based on low (<55), medium (56–69), high (>70).The methods described in literature  were appp-value set at α0.05. Mean, standard deviation, coefficient of variation and analysis of variance tests (one-way and two-way repeated measures) were applied on the study's results. Duncan's test was applied to separate mean of values. For all inferential statistics, significance was set at p < 0.05. Ethical guidelines including informed consent before blood collection were followed as prescribed by the University College Hospital/University of Ibadan ethical review committee where the study's ethical clearance was registered with approval number UI/EC/17/0407 (approved 28/11/2017).Data obtained from the study was entered into spreadsheets before descriptive and inferential statistical procedures were applied to present the study's results with Amala are presented in Meccakusa, and Amula, respectively. The coefficient of variation was highest in the ash contents of the products at 69.43% and lowest in moisture contents (5.09%). The average moisture content of pounded yam was 72.15/100 g while the carbohydrate content ranged from 19.41/100 g in Oju-iyawo to 24.12/100 g in TDr/02665. The total dietary fiber ranged from 2.53/100 g in Meccakusa to 4.46 g in Alumaco and the coefficient of variation was lowest in moisture content (2.62%). The mean moisture content of fried yam was 41.89 ± 7.32/100 g and the coefficient of variation was highest in the ash content of the products at 63.72%. The lowest ash content was found in Amula which had 0.88/100 g while TDr/02665 had 4.84/100 g which was the highest of all. Amala from selected Yam varieties had the highest mean moisture content of 77.12 ± 2.02/100 g when compared with other products. The carbohydrate contents ranged from 14.77 g in Oju-iyawo to 21.58/100 g in TDr/02665 while the total dietary fiber was from 2.69/100 g in Alumaco to 4.05/100 g in Amula.The nutrient composition of Boiled, fried, pounded yam and Dioscorea cayenensis). Worthy of note in line with the study's objective to probe carbohydrate properties is the differences found with dietary fiber composition which is scarce. There is sufficient evidence that dietary fiber has potentials to provide short and long-term functionality to the gastrointestinal tract  while the lowest was found in Oju-iyawo (11.38/100 g). A comparison between digestible starch in raw tubers and processed boiled yam shows that the highest percentage increase in digestibility is shown in Meccakusa (95.50%) while the lowest was in TDr 02665 which showed a 90.10% increase compared with the raw tubers. The variety with the highest content of digestible starch and digestibility when processed into pounded yam was Amula (20.42/100 g) with digestibility of 96.28% while the lowest was found in Alumaco (13.89/100 g) at 92.15%. When the raw tubers were processed into fried yam, digestible starch was highest in TDr 02665 (18.17 g) and was lowest in Oju-iyawo (11.33/100 g). The highest percentage increase in digestibility results for Amala was shown in Amula (96.02%) and Oju-iyawo (96.02%) while the lowest was in TDr 02665 which showed a 91.34% increase compared with raw tubers. In boiled yam, the variety with the highest content of resistant starch per 100 g after processing was Meccakusa (3.24/100 g) while the lowest was 2.19/100 g in Alumaco and TDr 02665 which contained 2.03/100 g.Alumaco which showed a 25.46% increase compared to the resistant starch in their respective raw tubers. The variety with the highest content of resistant starch per 100 g after processing into pounded yam was Alumaco (2.96 g) while the lowest was 2.36/100 g in TDr 02665. After processing into fried yam, the highest depletion in resistant starch was in TDr 02665 (30.03%) while the highest increase was in Alumaco which showed a 29.13% increase compared to the resistant starch content in its raw tubers. As for depletions or increment in resistant starch content after processing into Amala, Meccakusa (10.83%) was depleted the most while the highest increase was in Alumaco which showed a 27.95% increase compared to the resistant starch in raw tubers.The highest depletion in resistant starch in pounded yam occurred in TDr 02665 (24.60%) while the highest increase was in Dioscorea alata tubers using different methods. A test of between-subjects effect of DS as influenced by yam variety and product (Table 3) also revealed no statistical difference while there was an observed significance for RS. The importance of the resulting fractions (digestible and resistant) to the rate of carbohydrate digestion has been reviewed  compared to boiling or roasting . Oju-iyawo had a slightly higher RDS (0.36/100 g) in comparison with the other two varieties considered. The values of both RDS and SDS fractions were similarly lowest in Alumaco at 0.34/100 g and 13.55/100 g, respectively. In Amala, Amula had the highest slowly digestible starch fraction (17.84/100 g). Oju-iyawo had the highest rapidly digestible starch (1.38/100 g) in comparison with the other two varieties. Despite the similarities in rapid and slowly digestible starches of pounded yam and Amala, when the Yam was processed into Amala, it released RDS fraction faster when compared to pounded yam. This is explainable due to the impact of processing which is obvious by the steps required to obtain Amala in which boiling, drying, blending to flour and then cooking to dough will disrupt starch structure more when compared with preparing pounded yam. The method of processing pounded yam which involves a pounding effort that increases cohesiveness in the texture of the final product could also be responsible for its resistance to starch hydrolysis. In a study of Chinese yam (Dioscorea opposita), a similar inhibitory character was attributed to starch-protein interaction in the food matrix  seems to be an attribute of yam species due to an increased degree of α-amylase and α-glucosidase inhibition action when its flours are processed into dough  in pounded Yam. The results of the in-vivo assessments presented in this study were similar to a compilation of GI literature values which confirms Yam in most of its different food forms and varieties will result in high GI after consumption  as a basis, the arieties . Beyond nded yam  was not to dough . All thesumption , 15, 30.sumption , 15. In in vitro analysis than results gotten from the in vivo test. The main varietal distinction was observed in Alumaco which resulted in the lowest rapidly digestible starch across the two products. Real life applications of these findings will include dietary management of diabetic patients and also an advantage over the use of GI which can hardly be used to distinguish between varieties in this manner. Another observable trend in the results is that the higher/lower the content of rapidly digestible material in the food, the more glucose is released into the blood which translated into a higher/lower eGI. This suggests that there are stronger associations between the glycemic parameters  with eGI and GI compared to proximate parameters such as fat, ash and protein. This assertion was also suggested by Arvidsson-Lenner et al.  compared with the glycemic index (GI). In summary, this study provides evidence about factors such as variety and most importantly the effect of processing on starch fractions which are main determinants that affect GI and in-vitro starch digestibility properties of products from White Yam. Considering the diversity of varieties that exists and other products of white yam that are commonly consumed (and were not considered in this study), exploring more genetic diversity and processing methods is recommended for further studies.This study evaluated the differences in nutrient compositions, starch digestibility properties and GI of common staples made from Yam varieties across three stages of experiments. Overall, there were differences based on processing and variety across each stage of the experiments. Even though each product was different in composition, varietal differences were marginal in the first stages of food compositional analysis. A further evaluation of the digestible and resistant fractions of starch in stage two revealed further differences in varieties after processing. Particularly, variety The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by University College Hospital University of Ibadan Ethical Review Committee. The patients/participants provided their written informed consent to participate in this study.Study design and conceptualization and writing—original draft paper: TE, RS, and BM-D. Methodology: TE and BM-D. Data analysis: TE. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


In thisications . Pu et aex vivo right posterior sectionectomy cases in both pediatric and adult liver transplant recipients. Despite the advantages of ex vivo right posterior sectionectomy, as described by Pu et al., it must be admitted that this surgical procedure still carries increased risks of surgical complications, especially in patients with decompensated cirrhosis with a high MELD score  combined with graft weight (GW)/right anteroposterior (RAP) as a new “LFSS predictor,” in which both GRWR > 2.5% and GW/RAP > 100 g/cm indicated the need for reduction of the right liver graft. However, this new “LFSS predictor” has its intrinsic limitation, which only considers the graft weight and the depth of the lower right hemithorax of the recipient, but not the morphological parameters of the graft, especially the RAP vertical distance and the longest horizontal distance . The morLD score . Based oLD score . NeverthLD score . RecentlLD score . Thus, mCollectively, combining the volumetric and morphological parameters of the donor liver with the anthropometrics of the recipient may be more beneficial in determining the individualized strategies to prevent the occurrence of LFSS in adult liver transplant recipients when facing donor-recipient mismatching.


Background: SMEs have made a major contribution to the national economy, but Pandemic covid-19 made the decline of SMEs which directly affected the economy in Indonesia. The purpose of this research focus to explore the innovation of business models the novelty of the research model in the business model of innovation research models is to include the variable self-efficacy. This research emphasizes self-efficacy and Islamic financial literacy as independent variables, business model innovation as an intermediate model and business performance variables as dependent variables, with the focus of research on SMEs.Methods: This quantitative study uses partial least square structural equation modeling (PLS-SEM) and a questionnaire survey to analyze the 40 Street Vendors which is categorized as SMEs around Unisba. In the initial stages, the Questionnaire was tested with the Validity and Reliability test. In the PLS-SEM analysis, the validity of the indicators / items forming latent variables is based on the significance value of t arithmetic obtained from the loading factor value divided by the standard error. After being collected, the data is then processed and analyzed. The analytical method used in this study is the simultaneous equation model, namely Partial Least Square (PLS). The statistical tool used to test the hypothesis is Smart PLS.Results: The results showed that self-efficacy and Islamic financial literacy through business model innovation, had a positive effect on SMEs business performance simultaneously or partially.  Conclusion: So that by having good self-efficacy and good Islamic financial literacy plus an appropriate business innovation model, it will improve the business performance of SMEs. Small Medium Enterprises (SMEs) play a very important role in economic growth, in both developing and developed countries. In developing countries the perspective of employment opportunities and sources of income for the poor, income distribution and poverty reduction and rural economic development .The Ministry of Cooperatives and Small and Medium Enterprises (KemenkopUKM) shows that in 2018 there were 64,194,057 SMEs in Indonesia  . The devBased on this phenomenon, SMEs are facing rapid changes resulting in the current business model is no longer sustainable. The driving force for changes in the SMEs industry - self-efficacy and Sharia financial literacy - is increasing because these facts are interrelated . Self-efThe Covid-19 pandemic phenomenon causes the problem of decreasing assets, SMEs market share in Indonesia . This phThe issue of MSMEs never stops to be studied. This has become a joint PR for MSME activists, especially since almost a year has been hit by the COVID-19 pandemic, MSMEs are getting worse, as well as row stall traders around the Unisba campus. The trading system is too conventional so that when the Unisba campus is carried out an online lecture system, there is no buying and selling process anymore. There are 40 traders around Unisba, they sell various kinds of food and drinks. Meanwhile, based on interviews with street vendors via telephone, they are currently selling at home, it’s just not clear what income they get because only a few neighbors are buyers.This research emphasizes self-efficacy, Islamic financial literacy as independent variables, business model innovation as an intermediate model and performance variables as dependent variables, with a focus of research at the SMEs level in Indonesia, so that the aspects of concern are dominant aspects affecting business model innovation and SMEs performance. This study assumes two main variables that influence or become determinants of the innovation of the SMEs business model. So the purpose of this research is whether it influences or determines the innovation of the SMEs business model.The variables in this study are self-efficacy (SE), Islamic financial literacy, business model innovation.So that the research examines self-efficacy, Islamic financial literacy, its influence on the performance of SMEs by moderating business model innovation. Several previous studies related to the relationship of the variables studied contained contradictions or differences in research results, so that it became a research gap that could be studied further from the limitations of previous research.In addition to self-efficacy, SMEs face certain difficulties, due to the limited financial literacy of their owners. According to Lusardi and Mitchell  financiaAccording to  Islamic The relationship between socio-economic concerns and business success is not something that happens automatically. A business case for sustainability must be created . The conTheoretical considerations show that various approaches to integrate aspects of sustainability into the business model and also its expansion must be present and that this must be directly related to the extent to which environmental and social aspects have been embedded in the performance of companies that underlie the business model. In general, it seems clear that because environmental and social issues gain relevance in strategy, modifications to the broader business model must be made; both, regarding the modification of existing models and the development of new sketches of existing business models.Two considerations that explain why business performance and business models are closely related. First, if companies implement strategies aimed at business cases that are sustainable, for example  businessThe results show that companies that are trying to improve their sustainability performance must change their business models. Changes in business models can be incremental or radical can turn into determinants (ie limit or support) to successfully create one or many business cases for sustainability  and a questionnaire survey to analyze 40 SMEs especially row stalls that are managed by 3IKB (women association of Unisba) around Unisba. The research location was determined purposively, from January to April 2021.The sampling technique used is saturated sampling, that is, all of the population is used as a sample, namely 40 SMEs at the location of the Unisba Row stall managed by 3IKB. The primary data used are measurement and data collection directly by researchers with questionnaires. Filling out the questionnaire was carried out by filling in directly by the research subject.Instruments which is developed by Bandura  was usedIn the initial stages, the Questionnaire was tested with the Validity and Reliability test. In the PLS-SEM analysis, the validity of the indicators/items forming latent variables is based on the significance value of t arithmetic obtained from the loading factor value divided by the standard error. Validity and reliability tests were conducted to measure the validity and reliability of the variables proposed by the researchers. Overall, the validity test determines whether the external loading of each indicator exceeds 0.4 , while the reliability test determines whether the value exceeds Cronbach's alpha 0,6, which shows acceptable reliability.Evaluation of external models is done by examining two elements, namely: convergent validity and discriminant validity. In general, convergent validity is determined by examining the loading factor and extracted average variance (AVE), while discriminant validity is measured by examining cross-loading values. In this study, all factor loading meets the standard value of 0.4, while all AVE values exceed 0.5, thus indicating that convergent validity is achieved. Based on the inspection of cross-load values, the discriminant validity also increases. The model is evaluated according to R-square for endogenous latent variables and path coefficient values, the results of which are shown inAccording toAfter being collected, whereas instrument of financial. The analytical method used in this study is the simultaneous equation model, namely Partial Least Square (PLS). This method is also the development of path analysis. The statistical tool used to test the hypothesis is SmartPLS.The process of processing statistical data with PLS is done by 2 approaches, namely (i) estimation of the measurement model and (ii) structural model estimation. In the measurement model test, the conformity test with indicators included Chi-Square, Root mean square residual (RMR), Roor Mean Square Error of Approxation (RMSEA), Adjusted good of fit index (AGFI), and so on. In structural model tests, the influence of exogenous latent variables to endogenous latent variables that are direct and indirect can be determined, as well as determining the direct and indirect effects of path analysis. The direct effect shows the direct effect of a variable on other variables. Indirect effects indicate the indirect effect of a variable on other variables through other variables. Total effect is the sum of direct effects and indirect effects.This study focuses on the influence of self-efficacy (X1) and financial literacy sharia (X 2) at Innovation Business Model (Y) on the Performance of Business (Z) on SMEs in Unisba row stall Indomesia are analyzed based on research data using Analysis of Structural Equation Modeling (SEM) Smart PLS software tools.After evaluating the outer and inner models, a bootstrap is carried out to determine the impact of each variable on the performance of SMEs. SE, and Islamic financial literacy on SMEs performance is shown inAccording toOverall, the majority of respondents indicated that SE increased their confidence in running their business. According to , high SEWith regard to social cognitive theory  found thBased on the modeling of the least square’s structural equation (PLS-SEM) in this study, Islamic financial literacy has a positive impact on the performance of SMEs. This is in line with his research  financiapositively influencing the performance of SMES businesses in Indonesiasimultaneously or partially.Meanwhile, the results of the study found that the influence given the variable self-efficacy (X1), Islamic financial liters (X2) on Business Model Innovation (Y) was 89.9 % and the influence of other variables not included in this study was 10.1 %. While the influence given by the Business Model Innovation Variable (Y) on Business Performance (Z) is 75.7 % and the effect of other variables not included in this study is 24.3%. then the hypothesis is accepted, namely self-efficacy and Islamic financial literacy through business model innovation,et al.  to successfully create one or many business cases for sustainability (regarding the intensity of modification and innovation of different business models .This research was approved by the Ethics Licensing Committee of the Universitas Islam Bandung (Protocol number: 660/B.04/Bak-k/XII/2020) after consultation, a letter of approval was given by the researcher to all respondents. Written approval to participate from the Unisba 3IKB Management (Unisba Large Family Mothers Association) was obtained in accordance with document 097/3IKB-K/XII/2020. Written consent to participate was obtained from respondents through the Traders Stall Row. Respondents have given their consent without coercion from anyone. The informed consent was given before the research was conducted by providing a consent form to become a respondent. Respondents who are willing, then they must sign the consent form. Furthermore, to protect the rights and privacy of respondents, all forms of data obtained will be kept confidential.This quantitative study examines the effects of self-efficacy and Islamic financial literacy through business model innovation on the performance of SMEs around the Unisba campus. Based on questionnaire surveys and related analysis, self efficacy has a positive effect on the performance of SMEs, because it motivates owners to evaluate their business-related activities. Similarly, Islamic financial literacy has a positive effect on the performance of SMEs. Islamic financial literacy will improve or influence the performance of their business. It's just that the owner of SMEs still lacks an adequate level of Islamic financial knowledge. Product innovation also has a positive effect on SMES performance. So that the novelty of SMES products will make business continuity continue in any condition and situation, especially in pandemic covid-19.The implication of this finding is that in general the Resource Base View is an important thing in competitive strategies that come from internal organizational sources, especially human resources, so SMEs must improve their SE as best as possible, while integrating their Islamic financial literacy into SMEs to improve overall performance. In addition, MSMEs should ideally implement Islamic financial literacy initiatives, which will not increase the confidence of MSME owners in running their business, but will also improve the performance of their SMEs in achieving long-term competitive advantage.Further research could include refining Islamic financial literacy resources and data. Limitations of the study include the variety of characteristics of respondents, the sample size is still limited.https://doi.org/10.6084/m9.figshare.17082419 .Data are available under the terms of the This is very interesting research examining the roles of self-efficacy and sharia financial literacy on SMEs performance. However, a minor revision is required to improve the quality of the paper. 1. Some abbreviations used in the article was not written in full. Example: MSME, UNISBA should be written in full when it first appears in text before using abbreviations. 2. Please replace the keyword "literacy Islamic finance" to "sharia financial literacy" and "The performance of SMEs" to "SMEs performance". 3. In the methodology section, the author should first discuss the research design  then followed by the type of analysis . 4. This article must be submitted for proofreading.Is the work clearly and accurately presented and does it cite the current literature?YesIf applicable, is the statistical analysis and its interpretation appropriate?YesAre all the source data underlying the results available to ensure full reproducibility?YesIs the study design appropriate and is the work technically sound?YesAre the conclusions drawn adequately supported by the results?YesAre sufficient details of methods and analysis provided to allow replication by others?PartlyReviewer Expertise:Economics; Econometrics; Data analyticsI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. She paper has been improved significantly. So, I recommend for publication.Is the work clearly and accurately presented and does it cite the current literature?PartlyIf applicable, is the statistical analysis and its interpretation appropriate?PartlyAre all the source data underlying the results available to ensure full reproducibility?PartlyIs the study design appropriate and is the work technically sound?PartlyAre the conclusions drawn adequately supported by the results?PartlyAre sufficient details of methods and analysis provided to allow replication by others?PartlyReviewer Expertise:business management and accountingI confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Thank you very much. The research gap is not clearly stated.The justification for choosing the mediating variable of business model is needed.The sample size is too small for the study of SMEs.The reasons for choosing street vendors in Bandung is not clearly described.Introduction:The use of RBV is not specifically explained, what is its relevance for the current study.No hypotheses are developed for this study. Literature Review:Sample size equals to population (40) vendors (SMEs) is insufficient for SMEs study.How to deal with common method variance (CMV) is absent in this study. Method:The interpretation of statistical attributes need correction .Discussions need elaborations, especially the relevance of the findings (using 40 samples) to the wider audience.It is difficult to discuss the findings without the development of hypotheses. Results and Discussions: The implications of this study needs further elaboration, to SMEs and their stakeholders (in both discussion and conclusion).A thorough proofreading of the manuscript is recommended. Language:Is the work clearly and accurately presented and does it cite the current literature?PartlyIf applicable, is the statistical analysis and its interpretation appropriate?PartlyAre all the source data underlying the results available to ensure full reproducibility?PartlyIs the study design appropriate and is the work technically sound?PartlyAre the conclusions drawn adequately supported by the results?PartlyAre sufficient details of methods and analysis provided to allow replication by others?PartlyReviewer Expertise:business management and accountingI confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Thanks for the feedback and review.


As isothermal, enzyme-free signal amplification strategies, hybridization chain reaction (HCR) and catalytic hairpin assembly (CHA) possess the advantages such as high amplification efficiency, excellent biocompatibility, mild reactions, and easy operation. Therefore, they have been widely applied in DNA-based biosensors for detecting small molecules, nucleic acids, and proteins. In this review, we summarize the recent progress of DNA-based sensors employing typical and advanced HCR and CHA strategies, including branched HCR or CHA, localized HCR or CHA, and cascaded reactions. In addition, the bottlenecks of implementing HCR and CHA in biosensing applications are discussed, such as high background signals, lower amplification efficiency than enzyme-assisted techniques, slow kinetics, poor stability, and internalization of DNA probes in cellular applications. Moreover, the development of aptamers has expanded the scope of analytes to include metal ions, small molecules, proteins, and living cells  involves hierarchical reactions of HCR, producing branched DNA polymers and higher levels of amplification efficiency. For example, Wang’ group  developeThe kinetics of typical HCR is limited since the working principle is based on random collision of hairpins. To accelerate the reaction, localized HCR (LHCR) was developed based on the spatial-confinement effect. The reaction time could be reduced by anchoring the reactants to DNA nanostructures in order to reach higher local concentration of hairpins. For instance, in-situ bipedal HCR and produced FRET signals. In addition, In addition to the strategies mentioned above, other HCR technologies have been developed. A recent study by via digoxin/biotin recognition. The detection limit was calculated to be 2000 copies/mL. These studies demonstrate the potential of CHA for clinical diagnosis.The CHA was firstly introduced by Yin’s group , in whicin-situ imaging of miRNA. In another study, in-situ growth of DNA nanostructures by introducing palindromic sequences to bCHA hairpins. According to Branched CHA (bCHA) usually employ three or more hairpin probes to form three-way or four-way junctions upon the initiator. Due to the higher energy barriers, bCHA had a much lower background signal than traditional CHA, providing higher detection sensitivity. Localized CHA (LCHA) takes advantage of the spatial-confinement effect by limiting CHA hairpins in a compact area, leading to higher amplification efficiency and reaction rate. Similar to LHCR, the hairpins could be fixed on 1D, 2D, or 3D DNA nanostructures to realize LCHA, such as DNA origami , Y-shapeFor the development of biosensors with higher sensitivity, multiple amplification strategies could be cascaded, whereby the product of the upstream reaction acts as a trigger for the downstream reaction. In this section, we will discuss recent advances in biosensors based on cascade reactions involving HCR and CHA.Cascaded CHA could achieve exponential signal growth by interconnecting multiple CHA circuits. For example, The cascaded integration of CHA and HCR is expected to provide higher amplification efficiency than single amplification. As shown in The last decade has seen a rapid development in HCR and CHA for the biosensing applications. Based on their features of being isothermal and enzyme-free, these techniques have been employed for the detection of metal ions, small molecules, proteins, cells, tissues and living animals.Despite significant progress, the applications of isothermal and enzyme-free amplification still face several challenges. 1) To improve detection accuracy, the problem of background leakage must be resolved. During the spontaneous breathing process of DNA duplexes, non-specific reactions between hairpins of HCR or CHA may occur in the absence of the initiator, leading to a high background signal. To minimize background signals, more effort should be directed toward rationally designing the sequence in order to avoid unexpected reactions. 2) In terms of sensitivity, traditional HCR or CHA showed limited amplification efficacy compared to enzyme-assisted amplification. To increase sensitivity, the development of cascaded amplification strategies would be beneficial . 3) The In spite of the challenges, continuous attention has been paid to the development of isothermal, enzyme-free amplification techniques. It is believed that more advanced amplification strategies based on HCR and CHA will be emerging, and more targets will be detected with the aid of aptamers or antibodies, and more signal transduction methods  may be integrated to develop multifunctional sensors. Eventually, these efforts will result in more useful tools for bioanalysis, clinical diagnosis, and environmental monitoring.


Tumor treating fields (TTFields) is an anti-cancer technology increasingly used for the treatment of glioblastoma. Recently, cranial burr holes have been used experimentally to enhance the intensity (dose) of TTFields in the underlying tumor region. In the present study, we used computational finite element methods to systematically characterize the impact of the burr hole position and the TTFields transducer array layout on the TTFields distribution calculated in a realistic human head model. We investigated a multitude of burr hole positions and layouts to illustrate the basic principles of optimal treatment planning. The goal of the paper was to provide simple rules of thumb for physicians to use when planning the TTFields in combination with skull remodeling surgery. Our study suggests a number of key findings, namely that (1) burr holes should be placed directly above the region of interest, (2) field enhancement occurs mainly underneath the holes, (3) the ipsilateral array should directly overlap the holes and the contralateral array should be placed directly opposite, (4) arrays in a pair should be placed at far distance and not close to each other to avoid current shunting, and finally (5) rotation arrays around their central normal axis can be done without diminishing the enhancing effect of the burr holes. Minor deviations and adjustments (<3 cm) of arrays reduces the enhancement to some extent although the procedure is still effective in these settings. In conclusion, our study provides simple guiding principles for implementation of dose-enhanced TTFields in combination with burr-holes. Future studies are required to validate our findings in additional models at the patient specific level. Currently, an ongoing Scandinavian multinational phase 2 trial (NCT0422399) aims to investigate the efficacy of the intervention in a randomized comparative setting with 84 patients  therapy is an anti-cancer technology that induces low-intensity fields locoregionally to inhibit tumor growth. The technology is increasingly being used to treat a multitude of solid cancers . The head model was initially created from a dataset of a healthy participant, which was then adapted to emulate a trial patient's pathology based on their post-operative MRI and CT of the head. More specifically, we created the computational head model using the example dataset “Ernie” in the SimNIBS software package as a proof-of-concept demonstration. The “Ernie” dataset corresponds to a young and healthy subject, including a high-resolution T1 and a T2 weighted image. Details on the “Ernie” dataset can be found in the documentation from the SimNIBS toolbox (“Ernie”).Step 1: An automated tissue segmentation was performed on the T1 and T2 weighted images of the “Ernie” dataset. The initial segmentation includes the following eight tissue compartments: white matter, gray matter, CSF, scalp, skull, muscle, blood, and eyeballs.Step 2: The segmented image was visually inspected, and the configurations of the virtual tumor resection cavity, the residual tumor, and the burrholes were set manually based on the trial patient's post-operative MRI and CT of the head and were as follows:A Virtual Sphere-Shaped Tumor Resection Cavity With a 2.5 cm Diameter in the “Ernie” Head Model .A Cylinder-Shaped Funnel on the top of the Tumor Resection Cavity Mimics the Surgical Entry to the Tumor. The Funnel Track Has a 0.8 cm Diameter.A Sphere-Shaped Tumor Remnant of a 2.5 cm Diameter Underneath the Tumor Resection Cavity.Virtual SR-Surgery Was Applied to the Head Model. The SR Surgery Entailed Placing five Burrholes of 1.5 cm Diameter on the Skull With one Central Burr Hole Surrounded by four Evenly Distributed Burr Holes. Each Burr Hole Was Assigned CSF Conductive Value (1.654 S/m). We Investigated five Different Positions of Burrholes as Described in Section Placement of TTField Transducer Arrays.Step 3: The head models were created using the segmented voxel image with virtual tumor cavity, residual tumor, and with or without burrholes. Then the voxel segmentations with/without burr holes were converted to tetrahedral head meshes using the SimNIBS toolbox. The final head mesh with each burr hole configuration consisted of a total number of ≈4,750,000 tetrahedral elements, assigned to more than 11 types, including while matter, gray matter, CSF, scalp, skull, muscle, blood, eyeballs, tumor resection cavity, residual tumor, and burrholes.Step 4: The electrode arrays were placed on the skin surface for each head model as described in Section Electric Field Calculation and Evaluations. Conductivity values were assigned to the different compartments, consisting of skin (0.25 S/m), sponge bone (0.025 S/m), compact bone (0.008 S/m), CSF (1.654 S/m), gray matter (GM) (0.276 S/m), white matter (WM) (0.126 S/m), residual tumor 0.24 S/m) and necrotic tissue (1.0 S/m)  Rotation of the array pair in 15 degree intervals around the central cranio-caudal z-axis . We hypo2) Rotation of the ipsilateral array around the normal to the skin surface at the center of the array located above the resection cavity . The conZ-axis toward the vertex of the head (3) Translation of the array pairs along the central the head . We expeElectric field calculations were performed using a development version of SimNIBS v4 at the Danish Research Center for Magnetic Resonance (DRCMR) and Technical University of Denmark (DTU)  approach provided in the SimNIBS toolbox to analyze the uncertainty of the electric field intensities in the brain due to uncertain knowledge of the ohmic conductivity of the tissue in the burrhole. The employed UQ approach is a regression-based generalized polynomial chaos method (gPC)  was observed when the burr-holes were located directly above the tumor with overlapping edge transducers of the array . This was expected, given the more pronounced overlap between holes and transducers. Furthermore, the residual tumor was located in the posterior aspect of the resection cavity and therefore in close proximity to the burr holes. In the peritumoral region, all SR-configurations with holes close to the tumor bed were comparable in efficacy.To illustrate the effect of varying the array position relative to the burr hole configuration we included axial views of the topographical field distribution in the plane of the tumor and resection cavity for different combinations . The figThe corresponding absolute median and peak field intensities are shown in Rotation around the head resulted in modest (~20 V/m) variation in the median field intensities in the tumor and peritumoral region, when no burr holes were present (absolute field range 90–120 V/m). However, the array layout had a significant impact on the observed peak fields in the peritumoral region, which ranged from 200 to 330 V/m. For all array positions, the median field intensities were relatively uniform around 80–100 V/m in WM and GM. Maximum median field intensities in the tumor occurred for layouts between 60 and 105 degrees when transducers were located close to the tumor.As a general trend, all configurations of burr holes in the vicinity of the tumor region  to 0% at the maximum translation, When moving the arrays toward the vertex of the head, the field intensity progressively dropped in all tissues of the head, due to increased shunting of current through the skin between the electrodes . At the The results indicate that the standard deviation does not exceed ~20 V/m, which is about 10% of the mean electric field strength in the region of interest. We therefore conclude that the effect of the uncertainty in the conductivity of the burr holes is small in our analysis of the TTFields dosimetry.Recently, cranial burr holes have been shown to greatly increase the intensity of TTFields in underlying brain tissue. The concept is currently being tested in a randomized clinical phase 2 trial against recurrent glioblastoma. In this paper, we examined the influence of various configurations of burr holes in combination with a multitude of clinically relevant array layouts. Our aim was to provide clinicians with simple guidelines to be used when positioning the burr holes and transducer arrays in order to achieve maximum dose enhancement in the region of interest.Our findings demonstrate the feasibility of a relatively simple set of guidelines to help surgeons plan and conduct SR-surgery and subsequent TTFields array planning. With these guidelines, significant field enhancement can be achieved in the underlying tumor, while absolute optimization would require extensive computation. It is evident that minor deviations and adjustments (<3 cm) of both burr holes configurations and layouts will still be able to induce a significant enhancement, leaving some margin of flexibility for the treating physician. Based on our findings, we suggest the following key principles to be followed when implementing SR-surgery with TTFields:1) Field enhancement will occur mainly underneath the burr holes.2) Burr holes should be placed in close proximity to the tumor or resection cavity, where a high field dose is desired. Slight displacement (up to 3 cm at least) will likely still produce enhancement although less.3) Field enhancement will be most pronounced when array transducers directly overlap the burr holes. Ideally, ipsilateral transducers from both array pairs should overlap the holes. Correct array layout is highly important to maximize the benefit of the burr holes, while it is less important when no burr holes are present. Significant enhancement can be achieved with a wide range of array layouts as long as overlap or close proximity with the burr holes is maintained. Strongest fields occur underneath the array edges as previously  The contralateral array in a pair, should be placed far away from the ipsilateral array to avoid current shunting through the skin. Ideally, the two arrays in a pair should be placed on either side of the head rather than close to the top of the head to allow the current to pass through the head. Placement of arrays directly next to each other, completely diminishes the intracranial anti-tumor field.5) Rotation of an array around its normal axis is less significant, when the position of the contralateral array is maintained. In the standard situation without holes this does not change the field distribution. When burr holes are present it is important that the principle of overlap between the holes and the arrays is respected.6) The uncertainty quantification analysis quantifies the changes in the electric field intensity with respect to the conductivity variation in the burr holes. The results show that the effect of the uncertainty in the conductivity of the burr holes is minor in the simulation.The results and conclusions in our study were based on a single computational head model created from a healthy person's MRI. Although this limits the generalizability of the conclusions in terms of absolute values, we believe the described principles are general in nature and apply widely to GBM models. However, it is important to bear in mind that factors such as tumor configuration, position, shape, size will greatly affect the regional conductivity and anatomy of the model and hence the resulting field distribution  craniotome track created during surgery nor the cranial fixation clamp device, which is made from titanium. Arguably, both aspects could greatly affect the E-field as they would likely contribute to current shunting through these corridors and thereby increase the underlying fields intensity. However, given the complexity of modeling these variable aspects, we believe this topic is beyond the scope of this paper and rather merits a separate in-depth investigation.Future studies based on personalized patient models would be required to validate the numerical accuracy of our findings. These studies should use post-operative MRIs from patients undergoing SR-surgery and subsequent TTFields, such as in the OptimalTTF-2 trial . The patients/participants provided their written informed consent to participate in this study.Model creation and data analysis was conducted by FC supervised by AT. The manuscript draft was led by AK and FC, with contributions from NM, and the final manuscript was edited and approved by all. Figures were created mainly by FC with contributions from NM and adapted by AK. The study outline was planned by AK and AT. All authors contributed to the article and approved the submitted version.Funding has been received from the Danish Cancer Society by 1.700.00 DKK (Grant No. R322-A17630), Independent Research Fund Denmark by 1.392.683 DKK (Grant No. 9039-00307B), and Aarhus University, Department of Clinical Medicine by 550.00 DKK. This study has also received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No. 731827 (STIPED). Furthermore, this study was supported by the Lundbeck foundation (Grant No. R313-2019-622) and the NIH (Grant No. 1RF1MH117428-01A1). The results and conclusions in this article present the authors' own views and do not reflect those of the EU Commission.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.


In this study, we present a successful endovascular therapy using a small-diameter stent graft for a 73-year-old man who developed asymptomatic pseudoaneurysm of the brachiocephalic artery. An 8F sheath was placed in the brachial artery, and a stiff guidewire was advanced to the descending aorta. The stent graft was delivered to the brachiocephalic artery via the brachial approach. After the initial dilatation, the stent graft was post-dilated to maximum diameter. Final digital subtraction angiography confirmed no endoleak. We believed that endovascular for a brachiocephalic pseudoaneurysm using a small-diameter stent graft might be a minimally invasive and simple method useful in clinical practice. Cases of isolated brachiocephalic aneurysms are known to be rare; in fact, there is yet no established strategy for their treatment. There have been reports of artificial graft replacement and surgeon-modified stent graft treatments. Artificial graft replacement has been identified as a more invasive technique. However, implanting a surgeon-modified stent graft or iliac extension is also a complicated procedure, as the approach involves the subclavian artery or right common carotid artery while the operation is performed under general anesthesia.In this study, we present a case of brachiocephalic aneurysm, which we treated with VBX stent graft  via a brachial artery approach under local anesthesia. Here, we describe this successful and minimally invasive procedure. Written informed consent was obtained from the patient for the publication of this report. Because this off-label use of the procedure was quasi-urgent, it was reviewed by an ethics committee after the procedure.A 73-year-old man was referred to our hospital with a chief complaint of diverticular bleeding. The bleeding itself healed, and conservative treatment was planned. A contrast-enhanced computed tomography (CT) scan performed to detect the source of the bleeding has incidentally revealed a brachiocephalic aneurysm. The shape of the aneurysm was noted to be saccular, and much of the interior was thrombosed. There was an area where contrast medium leaked into the aneurysm during the arterial phase, and it was determined to be a pseudoaneurysm  and a 4F pigtail catheter were advanced from the right femoral sheath to the ascending aorta. A 0.035 inch Radifocus Guidewire and a 5F pigtail catheter with markers were advanced from the right upper arm sheath to the abdominal aorta. The Radifocus Guidewire was replaced with a 0.035 inch Amplatz Extra-Stiff Guidewire . The pigtail catheter with markers was returned to the brachiocephalic artery, and treatment length was measured to be 25 mm via digital subtraction angiography (DSA)  is too small for the brachiocephalic artery, while the EXCLUDER iliac extension  is too large for the brachial artery. The VBX balloon-expandable stent with a maximum diameter of 16 mm can bridge the gap between the two, and we believe that it is the largest device that can access the brachial artery. One thing to keep in mind is the VBX stent graft has been shortened; therefore, it is technically difficult to deploy it in an implantation position that anticipates this shortening. Shortening occurs evenly from both ends. The VBX should be deployed around the area to be covered and then expanded to the maximum diameter. Meanwhile, Hu et al. reported using the kissing VIABAHN stent technique for brachiocephalic pseudoaneurysm. The short term results of these reports were deemed to be satisfactory. VBX implantation for the brachiocephalic artery was thought to be effective for injury cases and pseudoaneurysms with a clear leak point, as in this case. However, in cases where the neck length is shortened, such as in fusiform aneurysms, treatment may be difficult.Second, leakage is controlled well in the short term. The VBX stent graft has a maximum extension of φ 16 mm, which can accommodate a wider range of arterial diameters that the φ 13 mm of the VIABAHN. Faraj et al. reported a bailout technique using φ 7 mm VBX  for iatrogenic brachiocephalic injury.This method has two limitations. First, it cannot be used for brachiocephalic arteries >16 mm in diameter. In addition, the deployment position must have a diameter of at most 11 mm because initial dilatation of VBX stent graft is 11 mm. When the VBX is not applicable, the Endurant Iliac Extension  that has a diameter of 20 mm is trimmed to an appropriate length and thereafter implanted. However, it cannot be approached by puncture through the brachial artery. Second, the number of cases was small, and the long-term outcome of the treatment is yet to be known. Thus, it is necessary to accumulate cases and follow them for an extended period of time. CT follow-up should be performed at 3, 6, and 12 months postoperatively and continued at least annually thereafter.Isolated brachiocephalic aneurysm is known to be rare disease, and its standard treatment is yet to be established. Here, we describe the successful use of endovascular therapy in a patient with a pseudoaneurysm of the brachiocephalic artery using a VBX stent graft. With the anatomical conditions satisfied, the method described in our case report might be the most minimally invasive and simple method that could be implemented in clinical practice.


International Journal of Environmental Research and Public Health (IJERPH) has increased its publications of scientific papers related to exercise; a search of Pubmed (on 22 June 2022) using IJERPH and exercise as keywords showed 1788 entries for 2021 compared to 80 entries in 2016 [The  in 2016  being th in 2016 , and ref in 2016  is to de


The observed results indicate that the size of starch granules was enlarged by fertilization and the size was the largest under CF in both hybrids. The amylose content was unaffected by CF and reduced by SF in both hybrids. In comparison to no fertilizer (0F), the peak 1/peak 2 ratio was decreased by CF in both hybrids, whereas the ratio under SF was unaffected in JY877 and decreased in SY30. The amylopectin average chain-length was reduced by fertilization and the reduction was higher under CF in JY877. The relative crystallinity was increased by CF in both hybrids and the value under SF was unaffected in SY30 and increased in JY877. The peak, trough, and final viscosities of starch were increased by fertilization in both hybrids. The starch thermal characteristics in response to fertilization modes were dependent on hybrids. The retrogradation enthalpy and percentage were increased by CF in both hybrids, whereas those two parameters under SF were increased in SY30 and decreased in JY877. In conclusion, starch with similar granule size, higher peak 1/peak 2 ratio, and lower relative crystallinity was obtained under SF than under CF for both hybrids. Longer amylopectin chain-length was observed in JY877, which induced lower pasting viscosities in SY30 and lower retrogradation characteristics in JY877. Improving the quality with desired functions of natural starch through agronomic practice will meet the increasing need of people for natural, functional foods. A one-off application of slow-release fertilizer is a simple and efficient practice in maize production, though its influence on the starch quality is scarce. In the present study, the structural and functional properties of the starch of normal maize under two fertilization modes (one-off application of slow-release fertilizer at the sowing time (SF), and three applications of conventional fertilizer at the sowing time, and topdressing at the jointing and flowering stages (CF)) under the same fertilization level (N/P Among different starch resources, maize is the most important and dominates about 80% of the global market share . In the With the development of the science and technology of agronomy, the use of fertilization transfers to simultaneously improve grain yield and quality, and the use of slow-release fertilizer (SF) as an efficient and environment friendly fertilizer have been widely adopted in maize and other cereal crops production. The N release of the SF agrees with the crop nutrient requirement, allowing for the coordination of vegetative and reproductive growth, a reduction in nutrient loss, an improvement in N utilization efficiency and a reduction in topdressing labor costs . In the A one-time application of SF is a low labor-cost practice in modern agriculture, and grain quality has received more attention as living standards have improved. However, questions regarding the effects of split applications of traditional compound fertilizers and urea and one-off application of SF on the quality of normal maize starch remain unanswered. In this study, the physicochemical properties of starch under two fertilization modes  of two normal maize hybrids are compared. The experiment was conducted in Jiangxinsha farm , Nantong, Jiangsu, China, in 2018. The soil (0–20 cm) nutrient content before sowing was as follows: 11.83 g/kg organic matter, 1.11 g/kg total N, 81.36 mg/kg available N, 6.31 mg/kg available P, and 61.49 mg/kg available K. Pests, diseases, and weeds were controlled by managers. Cumulative temperature, rainfall, and sunlight during plant growth were 2925.8 °C, 290.2 mm, and 670.6 h, respectively. Two normal maize hybrids widely planted in Jiangsu, namely Jiangyu877 (JY877) and Suyu30 (SY30), were used as the materials. Seeds were sown on 1 April with a density of 75,000 plants/ha, and both hybrids were harvested on 6 August. A field trial was performed with a randomized complete block design with three replications. All plots were 45.0 m long and 3.6 m wide with row spacing of 0.4 and 0.8 m.2O5 and K2O were 405, 135 and 135 kg/ha, respectively, for both CF and SF [2O5/K2O = 27%/9%/9%)  was applied at the rate of 405 kg/ha N (P2O5 and K2O were 135 kg/ha) at the sowing time as basal fertilizer. CF was applied at the rate of 135 kg/ha N, with P2O5 and K2O forming a conventional compound fertilizer (N/P2O5/K2O = 15%/15%/15%) that was used as a basal fertilizer at the sowing time, an N rate of 225 and 45 kg/ha was used for conventional urea (N = 46%) at the jointing and flowering stages as topdressing fertilizer. The fertilization modes included no fertilizer (0F), one-off application of slow-release fertilizer at the sowing time (SF), and three applications of conventional fertilizer at the sowing time, jointing stage and flowering stage (CF). The fertilization rates of N, PF and SF . SF .Grains (100 g) were steeped in 500 mL of distilled water containing 1 g/L NaHSOd method . The graThe distribution of SGS was analyzed using a laser diffraction particle size analyzer . Instrument accuracy was verified with Malvern standard glass particles. The disperse phase was absolute ethyl alcohol. Size distribution was expressed in terms of the volume of equivalent spheres, and the granule size was defined as the volume weighted mean . w/v), acetate buffer , and isoamylase  were added to the starch dispersion, and the mixture was incubated in a water bath at 37 °C for 24 h. The hydroxyl groups of the debranched glucans were reduced by treatment with 0.5% (w/v) of sodium borohydride under alkaline conditions for 20 h. The preparation of about 600 µL was dried in vacuo at room temperature and allowed to dissolve in 20 µL of 1 m NaOH for 60 min. Then, the solution was diluted with 580 µL of distilled water. Starch (5 mg) was dissolved in 5 mL distilled deionized water in a boiling water bath for 60 min. Sodium azide solution  in accordance with a previously published protocol ,35. 3 at a flow rate of 0.8 mL/min. The column oven temperature was controlled at 80 °C. Standard dextrans of known molecular weights  were used for column calibration.The starch was debranched with isoamylase  dissolved in 50 mM sodium acetate, and its molecular weight distribution was analyzed following a method described previously using a PL-GPC 220 high-temperature chromatograph  with three columns  and a differential refractive index detector ,37. The θ) ranged from 3° to 40° at a step size of 0.04° with a count time of 0.6 s. Before measurements, the specimens were stored in a moist chamber where a saturated solution of NaCl maintained a constant humidity (relative humidity = 75%) for 1 week. RC (%) was calculated as the percentage ratio of the sum of the total crystalline peak areas to that of total diffractogram  using MDI Jade 6 software.The X-ray diffraction patterns of starch were obtained using an X-ray diffractometer  operated at 200 mA and 40 kV. The scanning region of the diffraction angle  were evaluated using a rapid viscosity analyzer  in accordance with a previously described method [The pasting properties of starch  in accordance with a previously described method [To), peak gelatinization temperature (Tp), conclusion temperature (Tc), and gelatinization enthalpy (ΔHgel). After the thermal analysis was conducted, the samples were stored at 4 °C for 7 days for retrogradation investigations. Retrogradation enthalpy (ΔHret) was automatically evaluated, and retrogradation percentage (%R) was calculated as %R = 100 × ΔHret/ΔHgel.The thermal characteristics of the starch were determined using a differential scanning calorimeter  with the least significant difference test at the 0.05 probability level using Data Processing System 7.05 .The size distribution of starch granules of all the samples presents dual peaks. In comparison to 0F, the SGS was enlarged by fertilization (CF and SF) in both hybrids . MeanwhiThe isoamylase debranched starch presented trimodal peaks for all the samples , with peThe average ACL of isoamylase-debranched amylopectin was decreased by the fertilization and the influence of this was more significant in JY877 . For JY8The XRD pattern of both hybrids under all the treatments presents a typical “A”-type pattern . The RC Ptemp) and SB in SY30 were unaffected by fertilization, those two values in JY877 were unaffected by CF, and the Ptemp was decreased whereas the SB was increased by SF (Pasting temperature (ed by SF . For JY8Hgel in JY877 was unaffected by CF and reduced by SF, whereas in SY30 it was decreased by fertilization in a similar way for both CF and SF. For JY877, To and Tp were increased by fertilization and the increases were similar between both CF and SF (Tc was unaffected by SF and reduced by CF. For SY30, Tp and Tc were unaffected and decreased by fertilization, To was increased by CF and decreased by SF. In Tartary buckwheat starch, the gelatinization temperatures were decreased by low N rate but increased by moderate and high N rates, ΔHgel was increased by N application [Hgel and gelatinization temperatures of common buckwheat were increased by N fertilization [Hgel was discrepant between the cultivars [Hgel and gelatinization temperatures of cultivars with normal and low amylose contents were unaffected by N fertilization [Hgel was increased and gelatinization temperatures were decreased under the higher ratio of N fertilization at the panicle initiation stage [Hgel was increased and gelatinization temperatures were decreased [Hgel and gelatinization temperatures were decreased by a low N rate and increased by an excessive N rate [The ΔF and SF . Tc was lication ,10; wherultivars . Anotherlization . Under ton stage . With a ecreased . In ‘supe N rate . Hret in SY30 was increased by fertilization, whereas in JY877 it was increased by CF and decreased by SF. The %R was increased by CF in both hybrids, whereas with SF it was decreased in JY877 and increased in SY30. The higher ΔHret and %R under CF may be due to how the starch has a larger SGS, higher RC, and lower peak 1/peak 2 ratio and ACL. A study on rice has observed that ΔHret and %R were lower in SF than in CF under the same fertilization level [Hret and %R were decreased by a low N rate and increased by an excessive N rate [Hret and %R of rice starch was gradually decreased with increased N rates [Hret and %R of cultivars with normal or low amylose contents were increased by N fertilization [Hret and %R. In the present study, the Δon level . In ‘supe N rate . Another N rates . A studylization , but undlization  while lalization  induced To, Tp, ΔHret and %R in both hybrids. Larger SGS, lower amylose content and ACL, and higher PV, TV, and FV were obtained under SF in both hybrids, whereas the responses of other parameters were different between the two hybrids. In comparison to CF, the similar SGS, lower amylose content and RC, and higher peak 1/peak 2 ratio were obtained under SF in both hybrids, but ACL, and pasting and thermal properties were dependent on the hybrids. Between the two hybrids, JY877 has higher ΔHgel, lower pasting viscosities and %R than those of SY30 with fertilization, which may be due to how JY877 has lower amylose content, SGS and ACL and higher RC. The results offer the option to choose the optimal maize hybrid and fertilization mode based on different food utilizations. The starch physicochemical properties of normal maize were affected by fertilization modes. In comparison to 0F, larger SGS, higher RC, lower peak 1/peak 2 ratio and ACL were obtained under CF, which results in higher PV, TV, BD,


Dear Readers,JOR Spine received its first impact factor (IF)‐3.7 in 2022! While only one part of what distinguishes the JOR Spine, this underscores the outstanding content and mission of the journal. Now that we have achieved this first milestone, we turn our attention to continuing our goal of becoming the top journal within the spine basic and translational research field.As noted in the last issue, we were overjoyed that the https://www.ors.org/event/2022-ors-psrs/) where we will provide an update on the remaining milestones for JOR Spine and our plans to build on this momentum.The continued strength and growth of the Journal depend on many factors, most important of which is you, our readers and contributors. The editorial team, in consultation with the Advisory Review Board, are working hard to program new content that further enriches the Journal and expands its reach and impact. We also look forward to seeing many of you and getting your feedback (and celebrating) at this year's International Philadelphia Spine Research Symposium  for this Award!We would also like to bring to your attention the open call for the 2023 As we move forward, in a new world of in‐person interactions, we look forward to seeing and working with all of you to build on the momentum of JOR Spine, and to make it the go‐to resource for the international spine research community.See you all soon!Rob, Dai, and Mauro.


Background and Objectives: Our study aimed to cluster dual kidney transplant recipients using an unsupervised machine learning approach to characterize donors and recipients better and to compare the survival outcomes across these various clusters. Materials and Methods: We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 2821 dual kidney transplant recipients from 2010 to 2019 in the OPTN/UNOS database. We determined the important characteristics of each assigned cluster and compared the post-transplant outcomes between clusters. Results: Two clinically distinct clusters were identified by consensus cluster analysis. Cluster 1 patients was characterized by younger patients (mean recipient age 49 ± 13 years) who received dual kidney transplant from pediatric (mean donor age 3 ± 8 years) non-expanded criteria deceased donor (100% non-ECD). In contrast, Cluster 2 patients were characterized by older patients (mean recipient age 63 ± 9 years) who received dual kidney transplant from adult (mean donor age 59 ± 11 years) donor with high kidney donor profile index (KDPI) score (59% had KDPI ≥ 85). Cluster 1 had higher patient survival , and lower acute rejection (4.2% vs. 6.1% within 1 year), when compared to cluster 2. Death-censored graft survival was comparable between two groups . Conclusions: In summary, DKT in the United States remains uncommon. Two clusters, based on specific recipient and donor characteristics, were identified through an unsupervised machine learning approach. Despite varying differences in donor and recipient age between the two clusters, death-censored graft survival was excellent and comparable. Broader utilization of DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage. Kidney transplantation is widely acknowledged as the most effective modality of renal replacement therapy for patients with end-stage kidney disease (ESKD). It not only increases expected patient survival as compared to chronic dialysis but also improves the quality of life ,2,3. HowDKT is a strategy used in kidney transplantation to augment nephron mass in higher-risk transplant kidneys ,9. DKT iMachine learning is a subfield of artificial intelligence that has been applied to assist clinicians in making better clinical decisions in various areas of the medical field ,42,43. GWe screened renal transplant patients the OPTN/UNOS database (2010 to 2019) to identify adult DKT patients in the United States. We excluded patients who received simultaneous kidney transplants with other organs. The study was approved by the Ethics Board of the Mayo Clinic (IRB ID: 21-007698).We abstracted the comprehensive list of recipient-, donor-, and transplant-related characteristics, as shown in ML was utilized via an unsupervised consensus clustering analysis to categorize clinical phenotypes of DKT recipients . To prevPost-transplant outcomes included (1) patient death, and (2) 1- and 5-year death-censored allograft loss, and (3) acute allograft rejection within 1 year post-transplant. Patients were censored for death at the last follow-up date reported to the OPTN/UNOS database, thus death-censored graft failure was defined as the need for dialysis or kidney retransplantation.t-test for continuous data and Chi-squared test for categorical data. The key characteristics of clusters were identified by applying the standardized mean difference between each cluster and the overall cohort with the pre-specified cut-off of >0.3. We demonstrated the risk of death-censored graft failure and patient death after kidney retransplant using Kaplan–Meier plot. We calculated the hazard ratio (HR) for death-censored graft loss, and mortality using Cox proportional hazard analysis. Because the date of rejection was not reported in the OPTN/UNOS database, we calculated the odds ratio (OR) for 1-year rejection using logistic regression analysis. We did not adjust the association of the assigned clusters with post-transplant outcomes for clinical characteristics because clinically distinct clusters were purposefully generated from the consensus clustering approach. R, version 4.0.3 ; ConsensusClusterPlus package (version 1.46.0) and the MICE command in R were used for consensus clustering analysis and for multivariable imputation by chained equation, respectively [After we categorized adult DKT patients by the consensus clustering algorithm, the characteristics and outcomes among the assigned clusters were compared. The difference in clinical characteristics was tested by utilizing Student’s ectively .From 2010 to 2019, there were total 158,367 kidney transplant recipients in the U.S. Of these, 2821 (1.8%) underwent DKT. Consensus clustering analysis was applied into these 2821 DKT recipients. The CDF plot demonstrated the consensus distributions for each cluster A. The deThere were 1875 (66%) patients in Cluster 1, and 946 (34%) patients in Cluster 2. DKT, the transplantation of two kidneys from the same donor into a single recipient, has been utilized as an alternative approach to expand the available donor pool ,11. ManyIn this study, we use an unsupervised machine learning consensus clustering approach to categorize DKT into two different clusters based on recipient and donor characteristics in the OPTN/UNOS database. Cluster 1 patients, which accounted for nearly 70% of all DKT, were younger patients who received DKT from pediatric non-ECD donors. In contrast, cluster 2 patients were characterized by older patients who received DKT from adult donors with higher KDPI scores.Cluster 2 patients received higher KDPI kidneys and had higher incidence of delayed graft function, and thus higher acute rejection was observed in cluster 2 recipients when compared to cluster 1 patients. While it is perhaps not unexpected that patient survival was better in cluster 1 given that patients in cluster 1 were significantly younger and less likely to be diabetic as compared to those in cluster 2, death-censored graft survival was; however, comparable between the two clusters. Early graft losses due to technical complications likely account for decreased graft survival in pediatric DKT recipients along with increased probability of seeing recurrent primary disease within the allograft . By compThere are some limitations in this study. Due to the registry nature of this cohort, there is lack of detail specific to exact causes for graft loss and death as well as specific detail related to donor-recipient pairing and center-specific criteria for DKT utilization. Additionally, lack of difference in death-censored graft loss between the 2 clusters can be explained by differences in recipient and donor characteristics, which are not necessarily novel. Although these clusters clinically different, and the application of machine learning is novel, there are limitations in how these data will enhance current clinical decision-making. Future studies applying supervised machine learning with prediction models based upon this initial data will be of greater utility in assessing predictors of survival for DKT.To the best of our knowledge, this is the first machine learning approach specifically targeted at DKT. Two DKT clusters were identified using machine learning clustering methods without human intervention. The outcomes of our clustering approach, based on machine learning, support existing studies demonstrating the importance of donor-recipient pairing in DKT outcomes which also highlights opportunities to improve the kidney allocation system in the United States. There are likely existing opportunities to further expand DKT utilization within the transplant community, particularly for high KDPI kidneys. The application of ML consensus clustering approach in this study provides a novel understanding of unique phenotypes of DKT recipients in order to advance allocation systems to expand the donor pool. Given excellent outcomes among both clusters, DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage.In summary, DKT in the United States remains uncommon. Two clusters, based on specific recipient and donor characteristics, were identified through an unsupervised machine learning approach. Despite varying differences in donor and recipient age between the two clusters, death-censored graft survival was excellent and comparable. Broader utilization of DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage.


Grandparent-headed families in South Korea have been growing prominent in the country’s cultural landscape. Approximately 153,000 Korean grandparent-headed households existed in 2015; this number is expected to double by 2035. This qualitative study explored Korean custodial grandparents’ experiences of raising grandchildren and the cultural significance of multigenerational caregiving in Korea. Using a phenomenological approach, semistructured interviews with 22 custodial grandparents were conducted. Significant functions of patrilineality and stigma surrounding divorce for Korean grandparent-headed families were found. Considering the complicated cultural factors, social/family service programs must pay attention to the unique needs of grandparent-headed families and consider the circumstances related to grandparents’ positions in the family . Korean government programs and policies could better help marginalized grandparent-headed families with an empowerment approach to help marginalized grandparent-headed families gain positive attitudes toward their caregiving situation.


Migration is increasingly viewed as a high-priority policy issue among politicians, intergovernmental organizations, NGOs, and civil society throughout the world. Its implications for the private sector, for economic prosperity, and for the cross-border activities of firms are undeniable and likely to grow in importance. Yet, despite its relevance to International Business, treatment of migration in the mainstream International Business literature has been limited. In this contribution, we set out key aspects of migration that are germane to International Business. Specifically, we suggest recent migratory shifts are transforming important elements of the context in which multinational enterprises operate, with significant implications for their international human resource management practices, for firms’ entry modes and market selection approaches, and for the manner in which international strategies are formulated and implemented. We offer a research agenda to motivate International Business scholars to study global migration in more depth and to reevaluate the generalizability of aspects of their theories in light of developments in global migration. Our contribution is threefold. First, we call attention to the relevance and significance of global migration for IB scholarship by delineating the characteristics  and implications of migration for the contemporary context in which MNEs operate. Among the features we identify here are the multiplicity of countries of origin and the increased educational levels of immigrants in developed economies, the fluctuations in labor supply in emerging market economies, and the economic, political, and sociocultural impacts of migration on migrants’ sending and receiving countries. Second, we identify three key ways in which global migration affects existing IB research, namely: the changing nature of location and firm-specific advantages in light of access to human capital; the implications of migration for firms’ entry modes and market selection approaches; and how migration impacts firms’ organizational culture and approach to strategy. Third, we suggest a route forward for IB research on important questions at the intersection of global migration, IB, and society, questions of particular relevance to policy and practice, as well as specifically to MNEs.2 To be clear, the objective of our paper is not to offer a wide-ranging literature review of IB and migration, nor a detailed treatise on their intellectual progression over time. Rather, we suggest that, while global migration is a distinct phenomenon with an “own identity”  changing patterns of global migration; (2) transformation of the international business context; and (3) implications of global migration for the activities, strategies, and decision-making processes of MNEs.We use the International Organization for Migration (IOM) and the United Nations Department of Economic and Social Affairs definition of an international migrant as someone who moves away from their country of usual residence across an international border, temporarily or permanently, and for whatever reason. Most of the descriptive statistics we use rely on this definition, which combines all the different categories of very diverse migrants that have relationships to businesses. Such relationships are vested in the fact that firms benefit not only from migrants’ labor and skills but also from the innovations that they produce, the networks that they leverage, and the consumption in which they engage  declining emigration from Europe coupled with increasing immigration to Europe, (2) increasing emigration from Asia and Latin America, (3) the rise of new global migration magnets, and (4) many developing countries entering a migration transition  the changing nature of location and firm-specific advantages in light of access to human capital; (2) the implications of migration for firms’ entry modes and market selection approaches; and (3) the impact of human capital flows on firms’ organizational culture, and approach to strategy.In this section, we also provide suggestions on how to extend existing IB theoretical perspectives by incorporating different insights from migration studies. Migration research is a multidisciplinary field that dates back to Ravenstein . An in-dMigration research is generally considered to be informed by two main paradigms, namely ‘functionalist’ and ‘historical–structural’ perspectives. Adopting a functionalist perspective largely treats migration as a positive development which contributes to greater equality between and within societies de Haas, . Both puWhile both the ‘functionalist’ and ‘historical–structural’ paradigms offer explanatory power in providing a certain understanding of the nature of migration, they have been critiqued on the basis that they do not treat the issue of human agency and its role in migration  and microprocesses . However, what has not been addressed is the relationship between migration and the firm de Haas, , and it An underlying assumption in IB research has been that location assets are location-bound Dunning, , and in In many developed countries, businesses face labor market shortages and are lobbying governments to allow them to bring in qualified foreign employees. Large global firms regularly make the case that foreign employees they want to hire are essential for the growth of the firm and its future. In this context, companies play a crucial role in the selection and employment of migrants. Yet, their actions and involvement have not been widely recognized in the multidisciplinary literature on migration  mobility policies and practices of MNEs. First, migrants are characterized by diversity , have pursued different migration channels resulting in variations in their legal status, and have different educational attainments  links  migration and the internationalization development path; (2) how the migration-trade nexus can incorporate insights from transnationalism; and (3) constructing and deconstructing migration and the migration–export relationship.In terms of antecedents or predictors of FDI activities for firms, the foreign operations/migration link may be different for firms from migrant-sending (predominantly emerging market) countries. Gao et al.  studied Nearly 70% of international migrants live in high-income countries. The two Asian countries, India and China, had the biggest absolute numbers of migrants residing abroad IOM, . Taking In summary, MNEs are embedded in social systems that are inevitably influenced by migration  has historically assumed headquarters’ employees are representative of their home countries, implying that national culture influences them and the organizations that employ them in a generalizable way, thereby allowing for relatively simple cross-country comparisons. Empirical research into the common understanding that national cultural differences reflect deep differences in values and norms, and thus may cause serious culture clashes in cross-border M&As , as well as widely featured books on migration . Building on this body of evidence, we then moved on to review work within the IB field on migration. We identified and reviewed 41 articles published in the Journal of International Business Studies, International Journal of Business Policy, Journal of World Business, International Business Review, International Journal of Management Reviews, and Management International Review. We also analyzed selected reports from the World Bank, International Organization for Migration (IOM), International Labor Organization (ILO), Institute for Human Rights and Business, and the Responsible Business Alliance. In addition, we drew upon overview and review articles by Barnard, Deeds, Mudambi, and Vaaler (To this end, we reviewed articles published in leading migration-specific academic journals (e.g., d Vaaler , Hajro ed Vaaler , and Hajd Vaaler  on migra


It is controversial whether donor-recipient sex mismatch is a risk factor associated with corneal graft failure. The purpose of this study was to investigate the effect of sex mismatch on corneal graft failure in high-risk and non-high-risk patients.  A retrospective study.  The medical charts of patients who underwent corneal transplantations by one surgeon between 2012 and 2017 were reviewed. Patients were defined as high-risk for failure if they had glaucoma, ocular surface disease, or corneal vascularization. Graft failure rates were compared using the Kaplan–Meier survival curves between sex matched and mismatched subjects and between male-to-female grafting and other patients. p=0.645, log-rank) and in male donor to female recipient transplantations and in the other transplantations . Analysis of fifty-one eyes of 51 high-risk graft recipients  showed that graft failure rates were significantly higher in the sex mismatched than sex matched recipients  and in male donor to female recipient transplantations than in the other transplantations .  One hundred and thirteen patients with a minimum follow-up of 18 months were included. In 62 non-high-risk patients, graft failure rates were similar between the sex mismatched and the sex matched recipients ( Sex matching for every patient bares logistic difficulties; however, in patients who are at high-risk for graft failure, it may be a simple way to improve outcomes and better utilize corneal grafts. The cornea is an immune-privileged site due to various factors, including the absence of blood and lymphatic vessels, blood-eye barrier, and immunomodulatory factors. Thus, any cornea deemed appropriate for transplantation can be transplanted into any recipient, regardless of the recipient's age, sex, and HLA type . HoweverMale-to-female (M⟶F) corneal grafts have been reported to have a lower graft survival rate compared to matched corneal transplants . This fiIn low-risk patients undergoing Descemet's stripping endothelial keratoplasty (DSEK) or Descemet membrane endothelial keratoplasty (DMEK), where the risk for failure is low, sex mismatching was not associated with graft survival . A recenHigh-risk keratoplasty is associated with low success rates due to a high incidence of immune-mediated graft rejection  and may A retrospective chart review of all patients of age ≥18 years who underwent primary corneal transplantation at the E. Wolfson Medical Center, Sackler Faculty of Medicine, Tel Aviv University, between 2012 and 2017 was carried out. DMEK was performed at our institute starting in 2017. The steep learning curve associated with this procedure may bias the results. Thus, DMEK cases done in 2017 were not reviewed.Primary graft failures (nonclearing grafts within 2 weeks of transplantation) were excluded as they represent complexities with donor tissues unrelated to donor-recipient matching . Deep anA single surgeon (HA) performed all surgeries. Postoperative visits were scheduled for day 1; weeks 1, 2, and 4; and months 3 and 6, and then every 6 months. Topical antibiotics t.i.d. and corticosteroid drops (dexamethasone 0.1%) t.i.d. were applied after PK and DSEK. Antibiotics were stopped after one week and corticosteroid drops were tapered down, usually to b.i.d. after one month and once daily after an additional 3 months. After that, a less potent corticosteroid (fluorometholone 0.1%) was used once daily. In high-risk patients, usually a more potent corticosteroid (dexamethasone 0.1%) is used once daily.Graft failure was defined according to the cornea preservation time study as the occurrence of a corneal graft that was initially clear and subsequently became cloudy, preventing recovery of useful vision and requiring additional corneal transplantation . FailureFailure-free graft survival was defined as the period from keratoplasty to the postoperative meeting in which the patient was diagnosed with failure. The study was approved by the Institutional Review Board of the E. Wolfson Medical Center and complied with the principles outlined in the Declaration of Helsinki.t-test and nonparametric variables with the Mann–Whitney U test. Categorical data was analyzed with Pearson's chi-square test or Fisher's exact test when values in any of the cells of a contingency table were below five. The donor-recipient relationship was divided according to sex matched status. The sex matched group included male to male (M⟶M) and female to female (F⟶F) donations, while the sex mismatched group included male to female (M⟶F) and female to male (F⟶M) donations. For survival, the Kaplan-Meier analysis with log-rank (Mantel–Cox) was applied. IBM SPSS Statistics 27  was used for statistical analysis. Unless otherwise specified, values represent the mean ± standard deviation.The clinical parameter distribution for normality was analyzed by the Shapiro–Wilk test. For two-group comparisons, parametric variables were analyzed with the Student's One hundred and thirteen eyes of 113 patients with a mean follow-up time of 3.2 ± 1.3 years were included.p=0.645). No difference was observed in graft failure among the male donor to female recipient transplantations when compared to other transplantations (p=0.496).In the 62 non-high-risk patients, the mean donor and recipient ages were 63.0 ± 9.1 and 75.1 ± 9.7 years, respectively. Male-to-female sex distribution was 47 : 15 (76 : 24%) and 18 : 44 (29 : 71%), among donors and recipients, respectively. There were 23 (37.1%) cases of sex-matched transplantations. Over a mean follow-up time of 3.2 ± 1.3 years, 6 (9.7%) cases of graft failure were documented. No difference was observed in graft failure among the sex mismatched when compared to sex matched recipients  and 25 : 26 (49 : 51%) among donors and recipients, respectively.DSEK was performed in 26 (51%) cases and penetrating keratoplasty (PK) in 25 (49%) cases. There were 33 (65%) cases of sex-matched transplantations. Over a mean follow-up time of 3.0 ± 1.4 years, 11 (21.6%) cases of graft failure were documented.There were no differences in the baseline characteristics between the sex match and mismatch groups . Baselinp=0.022; p=0.002; The graft failure rate was significantly higher among the sex-mismatched when compared to sex matched recipients p=0.022; . The grap=0.034, A comparison of baseline characteristics between non-high-risk and high-risk patients is shown in In this study, we found that in high-risk patients having comorbidities of glaucoma, ocular surface disease, or corneal vascularization, sex mismatching was associated with an increased risk for graft failure after a mean of three years of follow-up. This was emphasized especially in the male-to-female corneal transplantations. Thus, according to our study, women with high-risk characteristics for corneal graft failure, facing corneal transplantation, could benefit from female donors.Currently, corneal transplantation guidelines do not support corneal matching due to the extensive immune privilege of the cornea . The immp=0.02). Hopkinson et al. [In 2006, Böhringer et al,  were then et al.  reportedn et al.  showed tn et al. . A recenn et al. . An updan et al. . In a ren et al. .Regarding the effect of sex mismatching on corneal graft outcomes in high-risk patients, data is sparse. Hopkinson et al. have reported that in high-risk patients, sex mismatching results in a higher graft failure rate, although this is less pronounced than in low-risk conditions . A recen4+ T cells) that recognize H-Y minor histocompatibility antigens, which include intracellular proteins encoded by the Y chromosome of a male donor. Following H-Y antigen recognition, H-Y antibodies were observed to develop in mismatched transplantations in other organs (kidneys and hematopoietic cells) [Donor-recipient sex matching may be more significant on corneal graft outcomes in PK than in posterior lamellar keratoplasty. This could be explained in several ways. First, the thinner posterior lamellar graft has a lower antigen load; therefore, it is less immunogenic than the full-thickness graft . Second,c cells) . These ac cells) . In addiLimitations of our study include its retrospective design and the lack of HLA genetic matching data. The H-Y antigen is not present in all males, but only in those with HLA-A1. The genetic frequency of the HLA-A1 allele is population dependent and is present in 20% of the general population in the UK, 18% of the general population in Australia, and only 15% of the Jewish population in Israel . In addiIn high-risk patients, donor matching, and predominantly female-to-female donor matching, may lead to a lower corneal graft failure rate. Sex matching for every patient bares logistic difficulties; however, it may be a simple way to improve outcomes and better utilize corneal grafts in high-risk patients. We suggest that in high-risk patients where corneal graft failure is more likely, sex matching could be suggested to improve outcomes.