Background/Purpose: Resistance exercise (RE) is known to improve cardiovascular health, but the role of RE variables on arterial stiffness is inconclusive. In this systematic review and meta-analysis, we investigated the influence of RE and its intensities on arterial stiffness measured as pulse wave velocity (PWV) in young and middle-aged adults.Methods: Web of Science, PubMed/MEDLINE, Scopus, EMBASE, Cochrane Library, ScienceDirect, CINAHL, Wiley Online Library, and Google Scholar were searched for relevant studies. RE trials that reported PWV data, and compared with respective controls were included. The Cochrane Collaboration tool was used to assess the risk of bias.Results: Data were synthesized from a total of 20 studies, involving 981 participants from control (n = 462) and exercise (n = 519) trials. The test for overall effect (pooled outcome) showed RE intervention had no effect on arterial stiffness , but risk of heterogeneity (I2) was 64%. Meta-regression results revealed a significant correlation (P = 0.042) between RE intensity and PWV changes. Consequently, the trials were subgrouped into high-intensity and low-to-moderate-intensity to identify the effective RE intensity. Subgroup analysis showed that low-to-moderate-intensity significantly decreased PWV , while high-intensity had no effect . When trials separated into young and middle-aged, low-to-moderate-intensity notably decreased PWV in young  and middle-aged adults , whereas high-intensity had no effect in both age groups.Conclusions: Our findings demonstrated that RE intensity is the key variable in improving arterial stiffness. Low-to-moderate-intensity can prescribe as an effective non-pharmacological strategy to treat cardiovascular complications in young and middle-aged adults. Arterial stiffness, measured from pulse wave velocity (PWV) is an independent risk factor for the development of cardiovascular disease (CVD). Increased arterial stiffness is closely associated with increased risk of morbidity and mortality in older populations and also in patients with chronic diseases  –4. ArterFor decades, physical exercise, either resistance or aerobic, has been prescribed as a non-pharmacological intervention to promote overall health and to treat cardiovascular complications . StudiesHowever, the influence of RE on arterial stiffness or changes in PWV is still controversial. Some studies reported that RE training can improve the arterial stiffness in young healthy subjects , 18 and High heterogeneity signifies the involvement of variables related to exercise protocol and/or patients' characteristics. In 2020, Ceciliato et al., who reported high heterogeneity without altering the PWVs, recommended further studies to identify the responsible variable of RE intervention . TypicalWe used major electronic databases, including Web of Science, PubMed/MEDLINE, Google Scholar, EMBASE, Cochrane Library, ScienceDirect, CINAHL, Scopus, and Wiley Online Library for article search. The articles search was conducted until April 2021 using the main keywords: “resistance” or “strength” and “arterial stiffness.” In addition, “exercise” or “training” or “physical activity” should be in the title and abstract. The keywords “exercise,” “training,” or “physical activity” were independently used with “resistance” or “strength” and “arterial stiffness” and all searches were performed separately. In the search process, a filtering function of the databases was applied to filter the preliminary search results using “article,” “randomized controlled trial,” and “journals” options wherever applicable.The two authors (Y.Z. and Y.J.Z.) conducted the article search and selection independently. The author W.B.Y. provided additional review and insight. M.K. discussed and confirmed the disagreements on inclusion or exclusion of trials into the study. Initially, the titles and abstracts of searched articles were screened for relevance, and then the full text of the specified articles was obtained and carefully reviewed for the inclusion criteria. The following criteria were used to include the trials in this systematic review and meta-analysis: (1) studies were randomized controlled trials (RCTs) published in English; (2) resistance training is the only intervention in the trials, and is not combined with other interventions; (3) the control trial did not participate in any exercise, and maintained daily behavior or was sedentary; (4) participants were adults aged ≥18 years; (5) the duration of resistance exercise was 4 weeks or more; and (6) the outcome assessment was “arterial stiffness” measured as carotid-femoral PWV (cfPWV) or brachial-ankle PWV (baPWV), which is typically used to assess the central and whole-body arterial stiffness, respectively. We excluded studies according to these criteria: (1) non-randomized controlled trials or without control group; (2) combined with other interventions ; (3) if participants were children or adolescents; (4) acute intervention study; (5) study did not report cfPWV or baPWV data; and (6) articles with repeated results, non-English, poor quality, or insufficient information about RE.The specific details of the selection process, inclusion, and exclusion of articles for this study are presented in The data from 20 eligible articles , including basic information , characteristics of participants (sex and age), resistance exercise protocols , and clinical outcomes (cfPWV and baPWV) were extracted and presented in The risk of bias for the included articles was determined according to the Cochrane Collaboration tool . Two of The intensity of RE performed by individuals in each trial was converted and presented as 1-RM percentages , 44. BasAs a gold standard approach for assessing the arterial stiffness, the outcome values of cfPWV  and baPWV  were included in the meta-analysis.p > 0.05). The random effect model was used, if heterogeneity was found significant (p < 0.05). We used STATA version 12  for the analyses of sensitivity, publication bias, and meta-regression. The changes in pulse wave velocity after exercise were found to be correlated with the intensity variable , and not with other variables . Hence, trials were categorized into two subgroups, high-intensity  and low-to-moderate-intensity  to identify the effective intensity of RE . The main statistical procedures were heterogeneity analysis, computation, and verification of combined effect size. The fixed effect model was used for meta-analysis, if no significant difference was found in heterogeneity analysis , we performed another subgroup analysis to examine the association between age and RE intensities on the outcomes (cfPWV and baPWV). According to the participants' age, trials were subgrouped into young (<40 years) and middle-aged (≥40 years) , and theogeneity .We identified a total of 962 articles from the electronic databases, Web of Science, PubMed/MEDLINE, Scopus, ScienceDirect, EMBASE, Cochrane Library, CINAHL, Google Scholar, and Wiley Online Library. After screening the titles and abstracts, 813 articles were excluded, and the remaining 149 were selected for the full-text assessment. Of these, 129 articles were further excluded with reasons explained in n = 20) were intercontinental, published between 2005 and 2020. A majority of the articles (n = 9) were conducted in Japan (n = 7)  , 33, 39  (n = 7) , Brazil  (n = 7) , England (n = 7) , and New (n = 7) . Of thesThe Cochrane Collaboration method was employed to assess the risk of bias for the included trials, and the detailed statement was presented in t = 2.52; p = 0.018; 95% CI: 0.46, 4.46) showed a publication bias . This trial reported significantly increased baPWV  with upper limb resistance training.The sensitivity analyses results showed that no trial had a significant impact on the total effect size. However, the funnel plot and Egger linear regression test (Egger's test) , 17 trials reported cfPWV data and 13 reported baPWV data. We combined the effect size of two outcomes (cfPWV and baPWV) under the random effects model, and used SMD to determine the effect size of RE intervention on arterial stiffness. The pooled results showed that RE intervention had no effect on PWV in adults . The overall effect of RE on arterial stiffness was not statistically significant (P = 0.42), but heterogeneity was moderate , while frequency , duration , sets , and repetition  were not correlated with the changes of PWV  and low-to-moderate-intensity . Consequently, we determined the effectiveness of two different RE intensities on reduction of arterial stiffness in adults.P = 0.26), which indicates high-intensity RE was unable to improve the arterial stiffness (P < 0.0001) with no risk of heterogeneity (I2 = 0%). From the subgroup analysis, we further noticed that there is a significant difference (P = 0.01) in the effect size of RE on arterial stiffness (SMD changes) between high- and low-to-moderate intensity trials   .P = 0.49, P = 0.0003) with no risk of heterogeneity (I2 = 0%). These findings indicate that RE improved arterial stiffness in middle-aged adults, but not in young individuals.We next hypothesized that the beneficial effects of RE on arterial stiffness could be influenced by the “age” of the individuals. To explore this phenomenon, we categorized the trials into young  and middle-age or old groups  . RegardlP = 0.14), and trials indicated considerable risk of heterogeneity (I2 = 77%). In contrast, low-to-moderate-intensity  resulted in a significant (P = 0.03) reduction of PWV in young adults  with low risk of heterogeneity (I2 = 4%). Furthermore, the test for subgroup difference between low-to-moderate-intensity and high-intensity was significantly different . These results witnessed that only low-to-moderate-intensity improved the arterial stiffness in young individuals  had no effect on PWV changes  (P = 0.0007) with SMD of −0.32, 95% CI is −0.51 to −0.14, and low risk of heterogeneity (I2 = 0%). Subgroup analysis showed no significant difference (P = 0.85) between high- and low-to-moderate intensity trials  . Notewory trials . Taken tTo the best of our knowledge, this is the first systematic review and meta-analysis to demonstrate the influential role of RE intensities on arterial stiffness in young and middle-aged adults. Arterial stiffness is a growing global-health burden associated with increased risk of cardiovascular events, hypertension, dementia, and mortality. However, reversing arterial stiffness or decreasing PWV (m/s) could prevent the incidence of such diseases , 6, 8. HI2) that is 40% in Evans' study (I2 = 64%) reported in our analysis suggests the possible involvement of exercise variables on PWV changes. Through meta-regression analysis, we found exercise intensity is associated with reduction of PWV rather than exercise frequency, duration, sets, and repetitions. To be particular, low-to-moderate-intensity had a greater beneficial effect in improving the arterial stiffness, while high-intensity was ineffective to do so.It is well-documented that arterial stiffness determined by increased PWV is associated with age and systolic blood pressure, and is an independent risk factor for CVD and mortality , 8, 51. s' study   significantly decreased PWV in middle-aged adults, but not in young individuals. However, when trials were subgrouped based on the intensity, only low-to-moderate-intensity improved arterial stiffness in young and middle-aged adults, while high-intensity had no effect in both age groups. These findings opened for debate why high-intensity RE is not beneficial to improve arterial stiffness in individuals separated into similar age groups. Relatively with a lesser number of trials , MiyachiThe detailed mechanism for the diverse effect of RE on arterial stiffness has yet to be fully elucidated. We postulated that internal factors, including muscle tone, sympathetic nerve activity, blood pressure, blood circulation, and endothelial function could influence the arterial stiffness following exercise intervention. Okamoto and team demonstrated that upper- but not lower-limb high-intensity RE increased arterial stiffness (baPWV) in young adults. This was accompanied by an increased plasma norepinephrine concentration, which reflects sympathetic nervous system activity. The activation of the sympathetic system may acutely affect the arterial distensibility through complex interactions between large arterial smooth muscle tone and distending blood pressure . The cenDecreased central blood pressure and peripheral PWV (not cfPWV) in pre-hypertensive patients after whole-body resistance training  are associated with improved endothelial function and vasoactive substances . It is fIn our analyses, we mixed the trials that investigated the effect of RE in healthy individuals as well as patients. Although our results showed that low-to-moderate intensity RE is beneficial in improving the arterial stiffness in young and middle-aged adults, the beneficial effects of RE intensity in specific population, like hypertensive or diabetic patients, remains uncertain. The small sample size in the included trials (not many) might be a limitation for those studies. Very small sample size can undermine the internal and external validity of the study, and it is hard to determine whether the changes in outcome measures are true or statistically different. Further analyses with large-scale sample size are required to confirm negative or neutral effects of high-intensity RE on the arterial stiffness of an aged population with or without the existence of chronic diseases.The evidence from our systematic review, meta-analysis, and meta-regression analysis confirmed that RE intensity is the key variable to promote arterial stiffness. Precisely, low-to-moderate-intensity RE is effective in improving arterial stiffness in young and middle-aged adults. In contrast, high-intensity RE is ineffective in decreasing the PWV. Therefore, practicing high-intensity RE should be cautious in particular age groups/patients due to the unfavorable effects on arterial stiffness. Practicing of low-to-moderate-intensity RE is beneficial to promote arterial stiffness that may aid to reduce the risk for cardiovascular diseases.The original contributions presented in the study are included in the article/YZ, Y-JZ, and MK designed the study, performed article search and screening, reviewed the full-text articles, and extracted the data. YZ and Y-JZ performed statistical analyses and drafted the manuscript. WY provided additional suggestions and assisted in interpretation of data. YZ and MK revised and finalized the manuscript. All authors have read and approved the submission.This study was supported by the grant from the National Social Science Foundation of China (Grant Number 17BTY008), China.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.


The journal retracts the article “Beneficial Role of HO-1-SIRT1 Axis in Attenuating Angiotensin II-Induced Adipocyte Dysfunction” [Following publication, concerns were brought to the attention of the publisher regarding the figures. The microscopy image for one of the experimental groups in Figure 4A was duplicated, appearing in Figure 1A of another published paper . The autInternational Journal of Molecular Sciences Editorial Office has taken the decision to retract the paper. The editor-in-chief approved this retraction.The The authors agree with the retraction.


A-type to the A-type and the relative crystallinity reduced with increasing moisture levels of HMT. Results of ANN-modified water caltrop starch were mostly similar to those of the native one. Moreover, water caltrop starch modified with HMT20 and dual modification contained a pronouncedly higher resistant starch content. These results suggested that HMT, ANN, and dual modification effectively modified the functional properties of water caltrop starch.The influence of hydrothermal treatments on the structural properties and digestibility of water caltrop starch was investigated. Scanning electron microscopy (SEM) showed some small dents on the surface of starch granules for samples treated with heat moisture treatment (HMT), but not for samples treated with annealing (ANN) which generally showed smoother surfaces. The gelatinization temperature of starch was generally increased by hydrothermal treatments, accompanied by a trend of decreasing breakdown viscosity. These results implied the improvement of thermal and shearing stability, particularly for HMT in comparison to ANN. After being cooked, the native and ANN-modified water caltrop starch granules were essentially burst or destroyed. On the other hand, the margin of starch granules modified by HMT and dual hydrothermal treatments remained clear with some channels inside the starch granules. X-ray diffraction revealed that the crystalline pattern of water caltrop starch changed from the C Trapa Taiwanensis Nakai) is an aquatic plant belonging to the genus of Trapa. It contains various nutrients such as dietary fiber, amino acids, and starch, and has been consumed as traditional food in China and India for years due to the diverse nutritional benefits [Water caltrop  content and digestibility . HoweverWater caltrop was composed of 0.58% crude lipid, 12.85% crude protein, 1.02% crude fiber, 3.81% ash, and 81.74% nitrogen-free extract (N.F.E.) on a dry basis (d.b.). With the isolation and purification procedure applied, the water caltrop starch obtained was composed of 0.07% crude lipid, 0.59% crude protein, 0.07% ash, and 99.28% nitrogen-free extract (N.F.E.) on a dry basis (d.b.). The high N.F.E. content (above 99%) of the water caltrop starch prepared in this study indicated the fairly high purity of the starch.p < 0.05) because of the rearrangement of the starch structure that enfeebled the gelatinization and limited the swelling of starch granules. However, it also implied that hydrothermal modification could reduce the effect of shearing force under high temperatures [p < 0.05) indicated that modified starch showed less tendency to retrograde [p < 0.05), and the viscosity decreased gradually with the increased moisture level during HMT (p < 0.05), which was possibly due to the shorter chain length of amylopectin and lower swelling power in HMT samples [The viscosity profiles during the pasting of water caltrop starch are shown in eratures ,25. In atrograde . Moreove samples .p < 0.05), indicating better heat stability, and it became more difficult to gelatinize. This result was in accordance with Ali, et al. [p < 0.05). In addition, ANN + HMT20 showed better heat stability than HMT20 + ANN. The previous study of corn starch modified with the combination of ANN and HMT also showed a lower viscosity than a single modification [, et al.  who had , et al. ,28. Bothp < 0.05). Moreover, there were some light-colored channels inside the starch granules, which also led to an increment of crystal heterogeneity. Some studies about canna, corn, and potato starch also report similar results [After pasting in RVA, the appearance of starch paste stained with iodine solution was further examined . It was  results ,30,31. TA-type allomorph, characterized by the presence of small intensity peaks at 2θ of 5.6° , 11° and 20°, strong peaks at 15° and 23° and double peaks at 17° and 18° . Moreover, the relative crystallinity of the ANN-modified sample showed no significant differences compared to native water caltrop starch. The previous study on potato starch also shows similar results [The results of the X-ray diffraction pattern and relative crystallinity of native and hydrothermally modified water caltrop starch are demonstrated in  results . Though  results .A-type to A-type due to HMT modification. The altered crystalline pattern by HMT was also observed in a study by Li et al. [However, for hydrothermally modified samples involved with HMT , the peak at 2θ of 5.6° disappeared, implying the crystalline type of HMT-modified starch transformed from Ci et al.  who poini et al. . For duai et al. .p < 0.05). This could be explained by the altered crystalline pattern into A-type crystallinity which was composed of shorter A-chains (DP 6–12), mainly located in the crystalline area, and was more likely to be digested by enzymes and so reduced the content of resistant starch [The digestibility of starch is affected by the source, particle size, amylose/amylopectin ratio, crystalline pattern, and amylose–lipid complex . Accordit starch . A previt starch ,38. Thert starch ,40. Howep > 0.05), but slightly decreased the SDS and very-SDS, and increased the RDS significantly (p < 0.05). Moreover, for dual hydrothermally modified samples, the RDS increased and SDS decreased slightly, but very-SDS decreased and RS increased pronouncedly (p < 0.05). This was possibly due to the fact that the combination of HMT20 and ANN produced more ordered structures between starches that increased the relative crystallinity and enhanced the resistance to the enzymes.As compared with native water caltrop starch, ANN had less impact on the resistant starch content (p > 0.05). ANN had no significant difference compared to native starch, and the trend was consistent with the results of wheat, corn, and potato starch modified by ANN [As shown in d by ANN .p < 0.05). Onyango, et al. [The squeezing and shearing forces caused by grinding during the processing would produce damaged starch. Starch granules were more likely to absorb water and be affected by enzymes, and in bread processing, an appropriate amount of damaged starch assists the fermentation of bread . HMT inc, et al.  found siANN increased the content of damaged starch, and HMT20 + ANN also had a higher damaged starch content than HMT20. It was because the high moisture content of ANN led to an irreversible swell of starch granules, resulting in the leaching out of amylose and facilitated the entry of enzymes for hydrolysis . On the Trapa taiwanensis Nakai) harvested in Taiwan were purchased from Xiaying district of Tainan, Taiwan. The resistant starch assay kit, amylose assay kit, and damage starch assay kit were purchased from Megazyme . All chemicals and solvents, including sodium hydroxide  and 95% ethanol  were of analytical grade.Fully matured water caltrops (w/v) sodium hydroxide solution. The mixture was placed at 4 °C for 12 h, and the brown supernatant was discarded. The wet starch was then mixed with ten times the amount of distilled water by weight to wash out impurities. This washing process was repeated several times until the supernatant was neutral (pH = 7), followed by hot-air drying at 40 °C until the moisture content was less than 10% (d.b.), then starch was ground, sieved through a 100-mesh sieve, and stored at room temperature.Water caltrop starch was essentially isolated by using the method of Sun . BrieflyThe proximate compositions of water caltrop flour and starch were determined according to AOAC methods . The nitThe previous method was essentially applied . BrieflyThe previous method was essentially applied . The moiDual hydrothermal modification of water caltrop starch was performed by applying HMT20 and ANN treatment in different sequences. For the HMT20 + ANN sample, water caltrop starch was subjected to HMT20 treatment . The observation was performed with a scanning electron microscope  under a 3.0 kV accelerating voltage.The pasting properties of native and hydrothermally modified water caltrop starch were evaluated by using the method of  with a r2/KI). The observation with a light microscope  was recorded by a digital camera  at a 400× magnification.The morphology of starch granules after being gelatinized by RVA was observed by staining aliquots of samples on the glass slides with iodine solution . The scanning angle 2θ was applied and scanned from 3° to 50° under a voltage of 45 kV and a current of 40 mA with a scan step of 0.02°. PeakFit software  was utilized for calculating the relative crystallinity with the following equation,c is the relative crystallinity (%) of the samples; Ic: the integration of diffraction intensity at the crystalline part; Ia: the integration of diffraction intensity at the amorphous part.Native and hydrothermally modified water caltrop starch samples were equilibrated in a glass desiccator filled with saturated sodium chloride solution (RH = 75%) for one week, in order to stabilize the starch granule structure . Measuretime is the glucose content released at the time, and TS is the total starch content of the samples.In vitro digestibility of native and hydrothermally modified water caltrop starch samples were determined by the Megazyme resistant starch kit  according to the previous method with modifications ,50. The Amylose and damage starch content of native and hydrothermally modified water caltrop starch were determined by using the Megazyme amylose kit (K-AMYL) and damage starch kit (K-SDAM) according to the respective analysis procedures provided by the manufacturer.n = 3). The post-hoc analysis of Duncan’s multiple range test was applied at a confidence interval of 95% (p < 0.05).Analysis of variance was performed using SPSS 19  and the data were expressed as mean ± standard deviation  contained a pronouncedly higher resistant starch content and showed great potential in regulating blood sugar. These hydrothermally modified water caltrop starches can be further explored as functional ingredients to be added to daily foods or other starch products for better nutrition or improved thermal/shear stability in food processing. Nevertheless, the in vitro digestibility may not completely reflect the exact digestion in vivo, and more research is needed to have a better understanding of the mechanism in vivo.After being treated by HMT, slightly dented or damaged regions on the surface of water caltrop starch granules were noticed, though the geometry of starch granules essentially remained intact. The high energy provided by HMT may disrupt the α-1,6 glycosidic bonds, resulting in an increased amylose content and lowered relative crystallinity. Moreover, HMT may promote molecular rearrangement, leading to modifying the crystalline type of water caltrop starch from C


Case Reports in Transplantation has retracted the article titled “Successful Treatment of Refractory Wart with a Topical Activated Vitamin D in a Renal Transplant Recipient” [Journal of Dermatology [cipient” , becausematology . It was matology  appears matology , despiteThe authors were contacted for clarification, but they did not respond. The article is therefore retracted from the journal with the agreement of the Editorial Board due to concerns regarding the reliability of the data.


Gastroesophageal varices (GOV) are a life-threatening complication in chronic liver disease. A method for non-invasively predicting GOV is crucial for management. This study aimed to determine whether a vein-viewing application can detect abdominal wall varices (AWV) and elucidate the relationship between AWV and GOV.One-hundred patients with chronic liver diseases were prospectively enrolled. All the patients underwent esophagogastroduodenoscopy within three months of the enrollment. Unmanipulated images (UI) and vein-weighted images (VWI) were taken for assessing AWV by a vein-viewing application on iPhone. Two doctors independently evaluated both image types. We defined the grading of both UI and AWV as grade 0 (non-detectable), grade 1 (slightly detectable), and grade 2 (distinct).The causes of liver diseases among the 71 men and 29 women  included Hepatitis B (n = 19), Hepatitis C (n = 21), alcoholism (n = 33), primary biliary cholangitis (n = 3), autoimmune hepatitis (n = 4) and others (n = 20). GOV was indicated in 60 patients, and half of them had not been treated previously (non-treated). VWI could significantly visualize AWV than UI . The presence of cirrhosis  and GOV  were significantly higher in the VWI-AWV grade 2 group. Multivariate analysis demonstrated that VWI-AWV grade 2 was an independent factor related to the presence of non-treated GOV .The vein-viewing application non-invasively detected AWV related to the presence of cirrhosis and GOV, and VWI-AWV grade 2 was an independent factor related to the presence of non-treated GOV. In this study, liver cirrhosis was lower in patients ≥ 71 years old . Therefore, age was negatively related to GOV , rS =  −0.092 p = 0.363, Dr.N; rS =  −0.029 p = 0.777) or BMI  and VWI grading by both doctors. Total bilirubin showed a weak positive correlation with VWI grading by both doctors  .Several parameters, such as hemoglobin, total bilirubin, and BMI, can affect VWI grading. However, there were no correlations observed between hemoglobin . Moreover, most of the patients with alcoholism had cirrhosis (87.9%).The image-based method for the prediction of GOV has been validated. Further development will enhance the usefulness of this approach in future medical diagnostics. Smartphones and mobile devices have rapidly become part of everyday life around the world. In the current situation with COVID-19 the role of on-line medical services is increasingly important. The vein-viewing application on the iPhone was not originally developed for medical purposes; however, we have established that it is useful in detecting AWV in cirrhotic patients in a medical context.In this study, VWI-AWV grade 2 was related to the presence of cirrhosis, high Child–Pugh score, the presence of ascites, the presence of GOV, the presence of PHG, and low platelet count. A weak positive correlation between total bilirubin and VWI grading can also be associated with liver dysfunction. Furthermore, multivariate analysis demonstrated that VWI-AWV grade 2 was an independent factor related to non-treated GOV. GOV treatment would alter the hemodynamics, including AWV. Our approach is therefore more meaningful for diagnosing naïve than treated patients. Intriguingly, eight patients (22.9%) who were identified as grade 2 had no AWV when assessed by UI. Five patients with GOV (three were untreated) were included in the eight patients. The interrater reliability was lower in VWI-AWV grade 0–1, indicating that identifying a slight AWV was difficult. However, the identification of grade 2 AWV was significantly higher by VWI in both doctors, and the reliability of VWI-AWV grade 2 was satisfactory.Among twenty-two VWI-AWV grade 2 patients who had no history of GOV treatment, six patients did not have any GOV. In this group, four patients (67%) had cirrhosis. VWI-AWV grade 2 may therefore have the potential to identify not only GOV but also cirrhosis. However, the other two patients had no cirrhosis and GOV; this would be an entirely false positive. Novel technology is warranted for the improvement of the vein-viewing application to minimize this outcome.The role of artificial intelligence is also rapidly growing in the medical field, such as pathology, EGD, mammography, brain diseases, and COVID-19 diagnosis –28. DeepThis study has several limitations. The cohort studied represented a small group of patients on which EGD could be performed. Selection bias was therefore inevitable. However, based on the promising results of this pilot study, a large-scale cohort study will be conducted for validation. Presently, there are no available objective data on detectability differences for skin color. One user from Zimbabwe commented on the App Store review that the app was helpful to patients with dark skin. Although it may work for different skin colors, verification is warranted.In summary, the vein-viewing application could non-invasively detect AWV related to the presence of cirrhosis and GOV. VWI-AWV grade 2 was an independent factor related to the presence of non-treated GOV. This result suggests a future direction of medicine using consumer mobile devices as medical devices. The camera lens will be like the eyes on "Baymax," a prototype healthcare-providing robot on Disney animation.


This paper proposes a cylindrical grip type of tactile device that is effectively integrated to a surgical robot console so that a surgeon can easily touch and feel the same stiffness as the operating organs. This is possible since the yield stress (or stiffness) of magnetic-responsive materials can be tuned or controlled by the magnetic field intensity. The proposed tactile device consists of two main parts: a magnetorheological elastomer (MRE) layer and a magnetorheological fluid (MRF) core. The grip shape of the device to be positioned on the handle part of the master of the surgical robot is configured and its operating principle is discussed. Then, a couple of equations to calculate the stiffness from the gripping force and the field-dependent yield stress of MRF are derived and integrated using the finite element analysis (FEA) model. After simulating the stiffness of the proposed tactile device as a function of the magnetic field intensity (or current), the stiffnesses of various human organs, including the liver and heart, are calculated from known data of an elastic modulus. It is demonstrated from comparative data between calculated stiffness from human tissues and simulated stiffness from FEA that the proposed tactile device can generate sufficient stiffness with a low current level to recognize various human organs which are significantly required in the surgical robot system. Surgical robots were commercialized about 20 years ago, and robotic surgery has achieved remarkable development for nearly 10 years by accumulating data and technological developments. Robotic surgery and laparoscopic surgery are known as surgeries with less burden on patients since it enables operations with minimal invasiveness to be performed ,4,5. In Various simulations exist to increase surgeons’ operation accuracy and help them become familiar with it. Recently, various subtask devices have been developed that provide a virtual environment for surgeons to practice before performing robotic surgery . The mosIt is known that the vibration feedback system utilizing piezoelectric material is also a good option for use as a tactile device. As per several references, various human tissues and organs have the characteristics of viscoelastic materials. Therefore, in order to transfer more realistic information regarding the viscoelastic properties to surgeons, a tactile device which has similar or the same properties as human tissues and organs should be utilized to achieve high surgical quality and safety. However, it is very difficult to implement viscoelastic properties via the vibration feedback system due to the viscous effect that yields a time delay. Thus, it is not suitable for application to the tactile device associated with the console part of the surgical robot. Other systems include piezoelectric technology . This isMost of the previous papers focused on designing and manufacturing a single object, and no specific application plan was presented ,43. In tIt is known that there are two types of grips for surgical robots: the pinch grip type and the power grip type. The power grip type  is also From the free-body diagram shown in x-axis, the absolute value of the force that the fingers and palm are pressing on both sides is taken, and the added value is displayed when the cylinder is held. The figure below shows the free body diagram of the force applied to the cylinder in the x-axis direction. When the hand applies the force to this cylinder to hold it, the force received by each part will be applied as shown in the figure below, and the formula can be expressed as follows: In this equation, It is remarked here that the stiffness of MRTGC due to gripping or the yield stress can be obtained through structural analysis using the finite element method (FEM) associated with a 3-D model. This is carried out in In general, a magnetorheological (MR) material refers to a material whose properties change depending on the presence or absence of a magnetic field. Among several MR materials, MRF is the most popular for research and commercialization since it has several salient benefits: a fast response time, reversible behavior, high yield stress, and excellent control performance. MRF is a magnetorheological substance containing fine iron particles in a base silicone oil . The proThe MRF used for the calculation of the stiffness of MRTGC is MRF-132DG, which is suitable for mimicking human tissues with low yield stress. It is seen from MRE is also one of the magnetorheological materials whose stiffness changes due to the interaction of CIP (Carbonyl Iron Particle) particles distributed between the rubber-like matrix according to the strength of the magnetic field. The strength of the magnetic field controls the stiffness of the MRE. However, to feel the change in the stiffness of MRE, effective results can only be seen when it is placed under high-frequency vibration. In this tactile design, MRE is used to help the formation of the chain-like structures by wrapping both MRF and polyurethane foam. Thus, the contribution of MRE to the stiffness change of MRTGC is small and hence neglected. H. Therefore, according to the current input, the effective area can be calculated. More specifically, the effective area value for each magnetic field strength is calculated by integrating the value obtained by adding the H value of each node. H value.It is clear that the y-axis in the analysis). The normal force generated in the MRPF when the grip is applied is shown in In order to determine the field-dependent stiffness, the structural analysis of MRTGC is undertaken, utilizing the finite element method (FEM). The Ansys Workbench program  is used for the simulation. To input each human source into the engineering data, all tissues are assumed to be incompressible. Therefore, when entering the elastic modulus, all Poisson ratios are fixed at 0.49. Since the 3D model is not a complex structure, the mesh is created as an automesh as a coarse type. The number of created nodes is 15,479, and the number of elements is 2385. The model used in this work is shown in Now, material data of various human organs are required to calculate the stiffness and compare with the simulated data from FEA of the designed MRTGC. Therefore, the structural analysis is carried out using the same method as before using the elastic modulus of major human organs. The elastic modulus is calculated using the cylindrical grip model shown in In this paper, a new tactile device that can be applied to the controller of a surgical robot was proposed, and its field-dependent stiffness was simulated using the finite element analysis (FEA). A cylindrical type of tactile device utilizing magnetorheological materials MRTGC was devised and designed so that a surgeon can easily grip the device during an operation. The main components of this device consist of MRF absorbed into polyurethane foam with magnetic cores and MRE as cover to provide smooth magnetic circuit formation and prevent the leakage of MRF. The magnetic intensity of the conceptually designed device was calculated based on the effective method using magnetic analysis via the Ansys Maxwell program . In this analysis, a simplified 3D model was used considering external gripping force. Then, the field-dependent stiffness of MRTGC was simulated using the material data of MRF: the relationship between the yield stress and the magnetic field intensity. As for the comparative group, the repulsive forces of various human organs were also calculated with the data of the elastic modulus using the same FE model and process. Then, a comparison of the stiffness between the simulated values from the proposed MRTGC and calculated values of human organs was made. It was shown that the stiffness of MRTGC can include most human organs. More specifically, MRTGC can generate stiffness from 0.3564 N to 1.4244 N by applying a current from 0.05 A to 0.35 A. This range includes both stromal tissues with the lowest stiffness (0.4990 N) and cartilage with the highest stiffness (1.2248 N).It is finally remarked that in order to actually implement the proposed tactile device in surgical robotic systems, some issues need to be explored in the future. These issues include an optimal design to adapt it to an existing console of a surgical robot by focusing on the geometry minimization and joint connection between the console and the surgeon’s gripping hand, an experimental validation of the data accuracy and repeatability as a function of time by focusing on the effect of the magnetic field intensity and surgical motion movement, an establishment of a feedback loop for the stiffness communication between the proposed device and the organs to be operated on by focusing on the surgeon’s training process, an integration with the existing joystick haptic system of a surgical robot by focusing on the surgeon’s feeling from the operating organs and the stiffness felt from the proposed device, and an extension of the proposed device which can generate both the stiffness (force) and the torque, which frequently occurs during robot surgery by focusing on the configuration modification of the cylindrical type.


Waxy and starch synthase II a (SSIIa) genes to divide high amylose (256 g/kg to 284 g/kg) varieties into three haplotypes to examine their effects on RS, RVA parameters, and 14 cooked rice texture properties. RVA characteristics were influenced by both genes with peak and hotpaste viscosity differentiating the three haplotypes. Setback from hotpaste viscosity was the only RVA parameter correlated with RS content across three haplotypes (r = −0.76 to −0.93). Cooked rice texture attributes were impacted more by Waxy than by SSIIa with initial starch coating, roughness, and intact particles differentiating the three haplotypes. Pairwise correlation (r = 0.46) and PCA analyses suggested that roughness was the only texture attribute associated with RS content; while protein content influenced roughness (r = 0.49) and stickiness between grains (r = 0.45). In conclusion, variation exists among genetic haplotypes with high RS for sensory traits that will appeal to diverse consumers across the globe with limited concern for negatively affecting grain processing quality.Human diets containing greater resistant starch (RS) are associated with superior glycemic control. Although high amylose rice has higher RS (29 g/kg to 44 g/kg) than lower amylose content varieties, sensory and processing properties associated with RS have not been evaluated. This study used variants of  Dietary fiber consumption is recommended to decrease the risk of developing chronic diseases such as obesity, diabetes, cardiovascular disease, and some cancers . Cereal Resistant starch (RS) is a type of dietary fiber in cereal grains that resists digestion in the small intestine and has higher fermentability in the gut than other dietary fibers, such as the non-starch polysaccharides from cell wall material . RS suppFaecalibacterium prausnitzii and reduced the number of Escherichia coli and Pseudomonas spp. in pigs [F. prausnitzii produces butyrate, a short chain fatty acid, which is the major energy source for colonocytes, modulates immune and inflammatory responses and enhances the barrier function of the intestinal epithelium [There are five types of RS (RS I-V). RS I, physically embedded, i.e., in a protein matrix or thick cell-wall; RS II, raw granules or un-gelatinized starch; RS III, retrograded starch; RS IV, chemically or enzymatically modified starch; and RS V, lipid-starch complexes ,8. Diffe in pigs . F. prauithelium ,10.The crystalline structures of RS III are primarily formed from retrograded amylose; therefore, RS in cooked rice is positively correlated with apparent amylose content (AAC) of rice ,11,12,13Amylose content, which is positively associated with the firmness of cooked rice, is one of the major quality traits that determines consumers’ preference globally. High amylose varieties are popular in some regions, i.e., South and Southeast Asia, West Africa, and South America ,18. HoweWaxy intron 1 and exon 6 [Waxy and SSIIa. The Waxy 10 SNP is associated with a specific RVA profile related to properties preferred by the food processing industry and it is also associated with gel consistency, an assay predicting hardness of the cooked rice [SSIIa is a key gene regulating gelatinization temperature (GelT) of rice; however, knowledge of its effect on viscosity and texture properties is lacking [Waxy and SSIIa) on RS and functional and sensory properties within the high amylose genetic background has not been well investigated.Most studies regarding the genes associated with functional and sensory properties utilize rice across a wide range of amylose contents (0–30%). However, there is additional variation for functional and sensory properties of rice within the same amylose class. High amylose rice can be categorized using the single nucleotide polymorphisms (SNPs) of d exon 6 ,23. Withked rice ,25,26,27 lacking ,29. The Waxy, SSIIa and two other loci reportedly regulate RS content in rice [Since a near 2-fold difference in RS content was reported among high amylose varieties, there is opportunity to breed rice cultivars with enhanced nutritional properties associated with RS ,13. Waxy in rice ,12. The  in rice . These s in rice . We hypoGlobally, there is increasing incidence of Type II diabetes, obesity, heart disease, and cancer. Several studies showed that rice consumption from regions that prefer low amylose rice were linked to increasing risk of developing Type II diabetes (in review article ). Thus, Waxy and SSIIa SNPs on RS content of rice in the high amylose class and the associated influence on the RVA viscosity profile and texture properties of cooked rice. It was concluded that natural genetic variation exits that can be used through breeding to increase RS content within high amylose haplotypes with minimum impact on processing quality and cooked rice texture.The objectives of this study were to determine the combined effects of Waxy exon 10 and TT/GC dinucleotide polymorphism (DNP) of SSIIa exon 8 [Waxy exon 10 distinguishes between rice varieties having strong (T) versus weak (C) RVA viscosity curves [SSIIa discriminates low (TT) and intermediate/high (GC) GelT of rice [Ten high amylose varieties were selected for this study along with one intermediate amylose variety, Wells, and one low amylose variety, Hidalgo (HDLG). These high amylose varieties were classified into three haplotypes-T-TT, T-GC and C-GC based on the T/C single nucleotide polymorphism (SNP) of a exon 8 ,30. Variy curves . The TT/ of rice . These 12 rice varieties were grown in 2016 at Stuttgart, AR and Rayne, LA using non-replicated plots and common cultural management practices for these locations. Rough rice samples were hand harvested at approximately 20% moisture and dried to 12%. Whole milled kernels (head rice) were obtained from milling 100 g aliquots of rough rice using a laboratory rice mill model PAZ-1 DTA . A total of 2000 g of whole milled kernels from each location were sub-sampled for descriptive sensory analysis. A portion of the whole milled kernels were ground to flour and then passed through a 0.5 mm screen using a Cyclone Sample Mill  for grain quality analyses. All physicochemical and sensory analyses for each sample were determined in duplicate (12 varieties × 2 locations × 2 replicates).Apparent amylose content (AAC) of the milled rice flour was determined using the iodine spectrophotometric method of AACC 61-03  (1999). Briefly, the rice solution (samples or standard) was prepared to 1 mg/mL by sequentially adding 100 mg flour, 1 mL of 95% ethanol and 9 mL of 1N NaOH into a 100 mL volumetric flask to dissolve the starch for 24 h. This was followed by adding deionized water to 100 mL. The iodine color reaction was then performed by adding sequentially: 0.5 mL of rice flour solution, 5 mL water, 0.1 mL 1N acetic acid, 0.2 mL iodine solution (0.2% iodine in 2.0% KI) and then 4.2 mL of water. After mixing, the color developed was read at 620 nm. The AAC was determined against a standard curve of four calibrated rice standards as described previously reported . The AACThe protein content in milled rice flour was determined using a CHNS/O Elemental Analyzer . The rice flour was first de-fatted with petroleum ether using a Soxtex 2050 auto extraction unit  as described in Bett-Garber et al. . BrieflyThe flour pasting properties were determined using a Rapid Visco Analyser (RVA)  following the AACC 61-02 method (1999). A 3 g sample of flour was weighed and added to a canister containing 25 g of deionized water and then mixed with a paddle. The flour/water mixture was subjected to a heat-hold-cool temperature cycle and the pasting properties of the curve were determined. The time (min:s)/temperature cycle is as follows: 0:00–1:00/50 °C, 1:00–4:45/50 °C–95 °C linearly (heating cycle), 4:45–7:15/95 °C (holding cycle), 7:15–11:06/95 °C–50 °C linearly (cooling cycle), and 11:06–12:30/50 °C. The paste viscosity parameters for the RVA curve were peak viscosity (PV), hotpaste viscosity (HPV), coolpaste viscosity (CPV), breakdown (BD), setback from PV (SBfPV = CPV − PV), and setback from HPV (SBfHPV = CPV − HPV). PV is the maximum viscosity recorded during the heating and holding cycles. HPV is the minimum viscosity after PV. CPV is the viscosity achieved at the end of the test. BD is PV − HPV.The thermal properties of milled rice were determined using a differential scanning calorimeter . A sample of 8 mg of rice flour (defatted with petroleum ether) was weighed into an aluminum pan and 16 mg of deionized water was added. The pan was hermetically sealed and equilibrated at room temperature for 1h before being heated at a rate of 5 °C/min from 30 to 100 °C. The reference was a sealed empty pan. The peak temperature  representing the GelT and the enthalpy of gelatinization  were calculated using the associated software .w/w) rice to water ratios. Both rice varieties that were cooked at 1:1.8 rice to water ratio were fully hydrated and remained intact, unlike those cooked at 1:2 ratio. Thus, the 1:1.8 (w/w) rice to water ratio was used for this study.Two of the high amylose rice varieties with differing viscosity profiles (SJ and DXBL) that were harvested in AR were subjected to preliminary cooking and sensory tests using both 1:2 and 1:1.8 (A portion of milled rice (600 g) was rinsed and strained three times, placed in the rice cooker insert, and then water was added to reach the final weight of 1680 g of rice plus water. The rice samples were cooked in a rice cooker  at a temperature of 100 °C, until automatically stopped, indicating all water had been absorbed.Thirteen panelists who were previously trained in the principles and concepts of descriptive sensory analysis participated in the study ,31,32. Tv/v ethanol. The RS in the pellet was dissolved in 2 M KOH, neutralized with acetate buffer and hydrolyzed to glucose with amyloglucosidase. After adding glucose oxidase/peroxidase reagent to the samples the absorbance of each solution was determined using a spectrophotometer at 510 nm. The glucose concentration was then converted to RS.The concentration of resistant starch (RS% dw) in the cooked rice was determined based on the AOAC Method 2,002,02  using a Resistant Starch Assay kit from Megazyme  and expressed as % resistant starch/cooked rice (dry wt basis) as described in Chen et al. . Brieflyp value forward variable selection (p < 0.05), was performed to determine the variables of RVA curves and texture attributes that were best in discriminating the three Waxy-SSIIa haplotypes. All statistical analyses were conducted using JMP software . Tukey–Kramer HSD was used for mean comparisons between all traits. The relationship of grain quality traits with RVA parameters and with sensory attributes were analyzed using pairwise correlation coefficient and Principle Component Analysis (PCA). Discriminant analysis, using stepwise covariance analysis and The means and ranges of AAC, RS, protein, Tp and ∆H of the three high amylose haplotypes , T-TT, TThe highest RS found in our study was higher than the highest one reported in Bao et al.  , either when all high amylose varieties were included or when varieties were grouped based on Waxy exon 10 SNPs. RS was correlated with SBfHPV across all high amylose varieties (r = −0.46) as well as with rice varieties of Waxy exon 10 T− and C-SNP types .Bivariate correlation analyses of grain quality traits and RVA parameters were conducted, either including all high amylose varieties, or grouping varieties based on T/C SNPs of  exon 10 . RS was Thermal property of rice appeared to affect the RVA curve. When all high amylose varieties were included, Tp was negatively correlated with all RVA parameters except BD and SBfHPV. For varieties with the T-TT and T-GC haplotypes, Tp was negatively correlated with HPV and positively correlated with BD. For varieties of C-GC haplotype, Tp was negatively correlated with BD and positively correlated with FV, SBfHPV and SBfPV, and ∆H was positively correlated with HPV, FV and SBfPV.Waxy and SSIIa, while those in PC2 were those that were primarily associated with RS, not with the Waxy and SSIIa. The variance of SBfHPV was distributed between PC1 and PC2.PCA analysis of grain quality traits and RVA parameters of high amylose varieties is presented in Fourteen texture attributes of the cooked rice were evaluated in four chewing phases . The meaThe low amylose variety, Hidalgo, had most of the attributes different from the high amylose haplotypes with only one, three and two attributes that were not significantly different from T-TT, T-GC and C-GC haplotypes, respectively . Moist ww/w) in [The comparison of the current study results with other references for textural properties of cooked rice was not possible because the rice-to-water ratios differ across studies. This ratio affects cooked rice texture . The ricw/w) in ,33 for tr = 0.47 and 0.49, respectively, both at p < 0.05) and Tp was negatively correlated with Rough . Protein was also positively correlated with StickGn . Tp was also positively correlated with Starch, StickLp and negatively with residuals . Pairwise correlation among texture attributes of high amylose varieties showed that some attributes were highly correlated with others, specifically, Starch, CohevM, IntactP, Hard, and Cohev.Pairwise correlation of grain quality traits with the texture attributes is presented in Waxy exon 10 SNP in that C-GC varieties are clustered on the positive scale of PC1 and T-TT and T-CC varieties are clustered on the negative scale of PC1, while PC2 divided varieties having higher and lower RS. StickGn and Rough were two texture attributes that had higher loading for PC2 compared to PC1.PCA analysis of grain quality traits and texture attributes of high amylose varieties are presented in p < 0.0001) and PV plus HPV (both had p < 0.0001), that were best in discriminating between the three high amylose haplotypes , IntactP (p < 0.01), and Rough (p < 0.05) variables were associated with the three haplotypes except two samples, one is a T-TT from LA being grouped to T-GC and the other one is a T-GC from AR being grouped to T-TT . On the other hand, Parween et al. [r = 0.42). Growing environment, genotype selection and cooking method all might affect the RS content. As reported in [H2 = 0.4) from three replications of growth in the wet seasons. In Chen et al. [In the present study, the three high AAC haplotypes studied had the same functional SNPs for intron 1 (G) and exon 6 (A) in eviously . RS was eviously . Bao et eviously  includedn et al.  reportedorted in  the herin et al.  the highSSIIa is related to the enzyme activity of SSIIa and that the GC allele has higher enzyme activity, while the TT allele has zero to low activity. Thus, rice varieties with the GC DNP have longer exterior B chains and higher Tp [SSIIa gene. On the other hand, other reports that utilized rice varieties across a wide range of amylose contents found that RS was associated with SSIIa along with Waxy and other starch synthesis related genes [R2: ADP-glucose pyrophosphorylase small subunit 1, isoamylase 1, Waxy, and SSIIa, while Parween et al. [SSIIa gene.Haplotype T-TT had lower Tp than T-GC and C-GC, which agrees with previous reports that the functional DNP of igher Tp ,29. Our igher Tp . Both sted genes ,12. Bao ed genes  identifiWaxy exon 10 SNP and SSIIa exon 8 DNP were associated with RVA viscosity profiles. Varieties having the Waxy exon 10 T SNP had higher values for PV, HPV, CPV and SBfHPV compared to those with the C SNP. This agrees with the study of Traore et al. [SSIIa, previous reports using genotypes across the low, intermediate and high amylose classes, found that SSIIa was a minor player in controlling RVA traits, while Waxy had a major effect on these functional properties [SSIIa plays a critical role in controlling RVA traits by affecting HPV and BD. Plus, linear discriminant analysis identified that the RVA profiles of the three high amylose haplotypes could be best represented by just two variables, PV and HPV.Both the e et al.  where itoperties ,36. ThisHPV and BD are the viscosity parameters that determine the mechanical shear strength of starch granules at a holding temperature of 95 °C and they are associated with swelling and rigidity of starch granules, protein and amylose contents, and amylopectin structures . In the Waxy exon 10 allele according to score and loading. Therefore, high amylose varieties with increased RS may have processing quality similar to their lower RS counterparts. Further study of the parboil processing quality of these varieties would be needed to confirm this. The T-GC haplotype is preferred by the U.S. rice processing industry because kernels maintain their integrity after parboiling and canning and there is less soluble amylose loss compared to the C-GC haplotype ,24. SoluSBfHPV measures the amount of retrograded starch molecules created during the cooling phase of an RVA analysis . RS is aWaxy exon 10 into two sub-groups, Tp differed in correlations with other RVA parameters. For those having the T SNP, Tp was negatively correlated with HPV and positively correlated with BD and that was due to having varieties of both the TT and GC DNP of SSIIa in this sub-group. For the varieties with the C-GC haplotype, Tp was negatively correlated with BD and positively with FV, SBfHPV and SBfPV. In addition to the double helical structure of exterior chains of amylopectin, other starch structures, i.e., the medium chains of amylopectin and amylose as well as the amylopectin internal structure, were reported to be associated with GelT and pasting properties of high amylose rice varieties [Other starch characteristics may also explain some of the variation in the RVA curve for the high amylose varieties. By dividing the high amylose varieties by the T/C SNP of arieties ,40.Waxy exon 10 were recently confirmed by Tran et al. [SSIIa and Waxy on 14 texture attributes of cooked rice. Most of the sensory attributes of cooked rice between T-TT and T-GC were similar except that T-TT had lower Slick and StickGn and higher Rough than T-GC, all in chewing phase I. On the other hand, five attributes were significantly different between T-GC and C-GC across all chewing phases. This suggests that the sensory attributes in these high amylose varieties were impacted more by the soluble/insoluble amylose fractions than by amylopectin structures. However, pairwise analysis showed some attributes were highly correlated. Using linear discriminant analysis we identified three texture attributes  that best differentiate the three Waxy and SSIIa haplotypes with 90% accuracy. Rice with intermediate amylose is preferred by many consumers in the U.S., Europe and in some parts of China, South America and south Asia [High amylose rice varieties that differ in cooked rice hardness have been identified by rice breeding programs using the gel consistency and RVA methods ,25. The n et al. ,41. Thisuth Asia . The higWaxy exon 10 SNPs, those with C on positive scale of PC1, those with Ton negative scale of PC1; thus, suggesting that higher loading traits of grain quality and sensory attributes in PC1 were more likely linked to differences in the Waxy exon 10. The score plot of PC2 divided high RS and low RS varieties, thus suggesting higher loading traits in PC2 might be related to RS plus protein, AAC, Rough and StickGn. Pairwise analysis further confirmed that for cooked rice texture, Rough was impacted by RS, and protein was correlated with Rough and StickGn.Within the high amylose class, >2 folds difference in RS content have been reported ,13. ThusWaxy and SSIIa haplotypes, have different textural attributes that may be suitable for different consumer markets in various parts of the world. Positive correlations of protein with roughness were reported by Champagne et al. ,43. The The evidence indicates that high amylose varieties would be suitable for use in food products designed to have a lower impact on blood glucose levels. This is the first demonstration of native rice with high resistant starch that has sensory properties suitable for use as cooked rice, as opposed to previous reports that have created high resistant levels using biotechnology tools . Waxy and SSIIa of high amylose varieties and the key pasting parameters and texture attributes were identified. RS content had little association with paste viscosity indicating that there would be no expected effect on processing quality that is important to the parboiling industry which prefers high amylose rice. The amount of RS was significantly related to one texture attribute, Rough, out of the 14 studied. However, among high amylose rice haplotypes with elevated RS levels variation exists in sensory properties that can likely meet the divergent expectations for consumer acceptance in various rice consuming regions of the world. Rice with higher RS offers the rice industry an opportunity to capture a new market of consumers that desire foods with a low glycemic index. In conclusion, high amylose rice varieties with >1.6-fold variation in RS were studied to better understand the effects of genetics and RS on sensory and RVA pasting properties. Three haplotypes were studied that combined functional genetic variants of


Vicia faba L.) is a pulse with high protein concentration. In this study, prepared faba bean (FB) flours were added to wheat based baked crackers. Wheat cracker recipes were modified by substituting forty percent wheat flour with flours from whole faba bean, starch enriched flour (starch 60%), protein concentrate (protein 60%) or protein isolate (protein 90%). Baked crackers were ground into meal and analyzed for their macronutrient composition, starch characteristics and in vitro starch hydrolysis. Faba bean supplemented crackers had lower (p ≤ 0.001) total starch concentrations, but proportionally higher protein (16.8–43%), dietary fiber (6.7–12.1%), fat (4.8–7.1%) and resistant starch (3.2–6%) (p ≤ 0.001) than wheat crackers . The increased amylose, amylopectin B1- chain and fat concentration from faba bean flour and starch flour supplementation in cracker recipe contributed to increased resistant starch. Flours from whole faba bean, starch or protein fractions improved the nutritional properties and functional value of the wheat-based crackers. The analytical analysis describing protein, starch composition and structure and in vitro enzymatic hydrolysis advance understanding of factors that account for the in vivo benefits of faba bean flours added to crackers in human physiological functions as also previously shown for pasta. The findings can be used to guide development of improve nutritional quality of similar wheat-based food products.The nutritional quality of common wheat-based foods can be improved by adding flours from whole pulses or their carbohydrate and protein constituents. Faba bean ( The market demand for snacks is steadily increasing due to busy lifestyles and hectic schedules that necessitate consumers supplant traditional meals with healthy snack options. A recent survey published by Mondelez International showed consumers prefer snack foods that are high in protein and dietary fiber, but low in fat, salt, cholesterol, sugar and calories  for 10 min and supernatant was discarded. Protein and crude fat deposited on top of crude starch was scraped off using a spatula. The crude starch pellet was purified using 80% (w/v) cesium chloride density centrifugation followed by water, sodium dodecyl sulphate wash buffer and acetone washes as described earlier  showed positive correlation with RS in raw starch samples but showed no correlation in the cooked pasta . Pasta iCrackers are ready to eat. As a result, the benefits provided by faba bean flour supplementation are practical as there is no secondary influence of consumer cooking time or secondary processing. However, the health benefits that may be achieved will depend on the composition of the faba bean flour. Faba bean protein supplemented crackers (FB-protein concentrate supplemented cracker and FB-protein isolate supplemented cracker) with similar starch digestibility profile as the wheat cracker control also offer significantly higher protein concentration and quality and TDF to the consumer. Whereas faba bean flour and starch concentrate containing crackers provide a reduced digestibility profile. Both formulations can be used for post-prandial glucose management and weight management. Increased dietary fiber in FB-supplemented crackers can be useful to target fiber gap in Canadian population . These cFaba bean whole, starch concentrate, protein isolate or concentrate flours use at 40% supplementation in wheat cracker formulations have the potential to add health benefits to consumer snacks. They differentially altered starch composition and amylopectin structure, in vitro enzymatic hydrolysis of wheat crackers. Changes in starch composition (amylose %) and structure (amylopectin chain-length distribution) combined with higher dietary fiber and fat decreased the overall starch digestibility of the crackers. The amylopectin B1- chain and fat concentration in faba bean supplemented crackers contributed towards RS, while amylopectin A- chain proportion in absence of faba bean carbohydrate fraction in crackers resulted in an increase in HI and RDS and, hence, overall digestibility. Amylose in FB-supplemented crackers contributed towards RS while dietary fiber influenced SDS. The protein concentrate, and isolate flour increased both protein quantity and quality of the wheat crackers. Therefore, faba bean supplemented crackers can be formulated using specific constituents such as protein and/or starch to improve their nutritional quality and human physiological functions to meet the end-user specifications.


We also expect the compliant device to exhibit lower PWV compared to a rigid stent-graft. Depending on the aortic tissue stiffness, the compliant stent-graft could raise or lower PWV compared to no stent. Mean pressure in the compliant case is likely to be slightly higher than the other two cases because the compliant stent-graft’s narrower lumen increases flow resistance. Although mean pressure will be higher, peak pressure should be lower than in the standard stent-graft because the added compliance decreases overall pressure swing between systole and diastole. DISCUSSION/SIGNIFICANCE OF IMPACT: Lower PWV in the compliant stent-graft over the standard stent-graft will indicate its potential to therapeutically lower aortic stiffness in patients needing aortic stenting. Positive outcomes from this study will be a step toward the eventual translation of a compliant stent-graft to clinical use.OBJECTIVES/GOALS: High aortic stiffness is associated with increased cardiovascular morbidity and mortality. The purpose of this work is to demonstrate the potential of our compliant stent-graft design to therapeutically increase aortic compliance over a standard aortic stent-graft. METHODS/STUDY POPULATION: The aorta from a human cadaver will be excised and placed into a pulse duplicator circuit. The stiffness of the system will be estimated using the pulse wave velocity (PWV), which will be calculated using the time delay between pressure measurements at proximal and distal locations in the system. Baseline measurements with the unstented aorta will be compared to two cases: (1) with a standard stent-graft placed, and (2) with our compliant stent-graft prototype in the descending thoracic aorta. PWV is calculated as the distance between the pressure sensors divided by the time delay. Faster PWV is associated with a stiffer vessel, or lower aortic compliance. RESULTS/ANTICIPATED RESULTS: Prior work


Introduction: Early graft dysfunction (EAD) complicates liver transplantation (LT). The aim of this analysis was to discriminate between the weight of each variable as for its predictive value toward patient and graft survival.Methods: We reviewed all LT performed at the Medical University of Innsbruck between 2007 and 2018. EAD was recorded when one of the following criteria was present: (i) aspartate aminotransferase (AST) levels >2,000 IU/L within the first 7 days, (ii) bilirubin levels ≥10mg/dL or (iii) international normalized ratio (INR) ≥1.6 on postoperative day 7.Results: Of 616 LT, 30.7% developed EAD. Patient survival did not differ significantly , graft survival was significantly higher in non-EAD patients . Bilirubin and INR on postoperative day 7 were identified as strong mortality predictors , in contrast to AST . Similar results were achieved for graft loss estimation. A comparison with the Model for Early Allograft Function (MEAF) and the Liver Graft Assessment Following Transplantation (L-GrAFT) score identified a superior discrimination potential but lower specificity.Conclusion: Contrarily to AST, bilirubin and INR have strong predictive capacity for patient and graft survival. This fits well with the understanding, that bile duct injury and deprivation of synthetic function rather than hepatocyte injury are key factors in LT. Liver transplantation (LT) is the treatment of choice for patients with liver failure and select cancer –4. BecauTo evaluate post-operative organ quality and function, liver function parameters, histology, as well as less invasive procedures were established . PrimaryWe herein aspire to discriminate the individual effect of each variable on the clinical short and long-term outcome in LT. Furthermore, we aim for the identification of potential risk factors for EAD in a European transplant center.This study was conducted in compliance with the Declaration of Helsinki and with local and national regulations. The study protocol was approved by the Internal Medical Review Board (protocol-number EK 1077/2018). The reporting of this study conforms with the STROBE guidelines . AdditioThe following donor data were collected: donation after brain or cardiocirculatory death (DBD/DCD), age, sex, donor risk index (DRI), body mass index (BMI), blood type, cause of death, length of intensive care unit stay, vasopressor use, steatosis in time-zero biopsy, allocation, arterial anatomy, serum parameters. Surgical procedure data included cold ischemia time (CIT), anastomosis time, simultaneous transplantation of more organs, preservation solution, anhepatic phase, duration of surgery, arterial lactate and surgical experience. Recipient data comprised age, sex, BMI, blood type, indication for LT, hepatitis C virus (HCV) status, biological MELD score, Child Pugh Score and Surgical Risk Score at LT. Following post-operative factors for clinical outcomes and complications were achieved: length of hospital stay, Clavien Dindo post-operative complication rate, transplant-related reoperations, vascular and biliary complications, graft and patient survival. Transplant-related reoperations were classified as re-interventions within 30 days of the first surgery, including surgeries for intra-abdominal bleeding or fluid collection and treatment of vascular or biliary complications. Length of hospital stay was defined as the time from LT to hospital discharge. Vascular complications included hepatic artery thrombosis, stenosis, or dissection, portal vein stenosis, portal or supra-hepatic venous thrombosis. Biliary complications included bile duct leakage, anastomotic and non-anastomotic strictures.P-value. Comparative analysis of clinical outcomes of patients in the EAD and non-EAD group was conducted using the Chi-square and Fisher's Exact Test for categorical variables and Mann-Whitney-U-Wilcoxon Test for continuous variables. Mann-Whitney-Wilcoxon tests are approximated by using the t or F distributions. Patient and graft survival were evaluated at different time points: 1, 3, 5 years. Graft survival was calculated from the transplant date until the date of re-transplantation or death (whichever came first). The discriminant ability of individual components of EAD definition was assessed by developing a Cox proportional hazard model using the Wald test with backwards stepwise selection. Results were expressed as Hazard Ratio (HR 95%CI) and P-value. All information outside the periods of interest was censored for the date of the end of the study period or for the date of the last correspondence. Patient and graft survival rates were compared using the Kaplan–Meier method. The log-rank test was applied for comparative analysis of EAD and non-EAD groups. For descriptive analysis and survival curves, two tailed P-values <0.05 after adjustments for confounding were considered significant throughout the analysis. Discrimination  was assessed by computing the area under the receiver operator characteristic curve (AUROC) and its 95% confidence intervals. The AUROC and the differences in AUROCs were estimated across the bootstrapped imputed datasets and averaged. The 95% confidence intervals (CI) for the point estimates were computed using the percentile method. Sensitivity analyses were performed using complete cases where not a single data point was missing and the results compared to the imputed analyses. Statistical analyses were performed using R statistical software  (Data were presented as proportions (%), means ± standard deviation (SD) or medians as appropriate. Factors associated with EAD were investigated using logistic regression analysis. Results were expressed as estimated odds ratio (OR), 95% confidence interval (CI) and Austria) .P = 0.092) respectively. Allograft survival rates in the non-EAD group vs. the EAD group at 1, 3, and 5 years were 89/83/79% vs. 81/72/67%, respectively  developed EAD. This rate varied between 12 and 21% in the early years (2007–2009), while in the following years (2010–2018) a trend toward higher rates (between 32 and 40%) was observed. The 1-, 3-, and 5-year patient survival rates were 91/86/83% vs. 86/78/76% in patients without EAD vs. those with EAD , AST did not serve to display a significant discrimination , while AST did not reach significant effect  suggesting a categorized discrimination potential of individual variables in EAD status. Similar results were achieved for graft loss estimation  and the MEAF score , respectively. Concerning patient survival, the MEAF score showed a superior discrimination potential compared to the binary EAD definition . Both scores revealed a low specificity for patient and graft survival indicating a limited capacity in correctly classifying outcomes in this cohort , Child C Score , surgery duration  CIT , donor risk index (DRI)  and donor BMI > 25  were identified as independent recipient-, surgery- and donor-related risk factors . However, analyzing this subgroup descriptively, some relevant common aspects stand out: the re-transplantation rate was 18 and 29% of the recipients were classified as surgically high risk. The donor data revealed that 59% had a mild steatosis and that the cause of death was a cardiovascular event in 88%. Compared to patients without EAD-BILIRUBIN/INR, the 1-, 3-, and 5-year patient survival rate was very low . Allograft survival rates in the non-EAD group and the EAD-BILIRUBIN plus EAD-INR group at 1, 3, and 5 years were 89% vs. 61%, 83% vs. 48% and 79% vs. 0%, respectively . Re-operation rate was 76% and amount of biliary complications in the first 30 days reached 41%.Since our assessment indicated, that the clinical implication of EAD is most significant when the criteria bilirubin and INR are driving the condition, a logistic regression was performed for the EAD cohort under the modification to exclude EAD-AST patients. Despite the comparable statistical effect size, the determination of the mathematical significance is limited due to the resulting small EAD group .In line with other analyses , 25, the2 and EAD. Recipient sex is weakly associated with transplant outcomes. Sex may be indirectly related to graft size and liver mass since the trend relates to male recipient with BMI > 25 kg/m2 displaying a higher rate of EAD. Since graft steatosis also correlates with EAD, we hypothesize that increased hepatocyte loss in larger steatotic livers is a contributing factor to this finding. Future analyses might consider to adjust for donor and recipient liver mass to accurately identify EAD .The DRI introduced by Feng et al., is based on selected donor characteristics and permits quantitative graft dysfunction risk assessment , 31. TheThe strength of the analysis is the relatively large and well documented cohort, the overall uniform practice within our department regarding standardized surgical techniques, medical treatment and postoperative management. However, the retrospective study design should be considered as limitation. Future multi-center studies are warranted to confirm our results.In summary, this single center study provides new insights into the utility of EAD as end-point in LT. Our findings demonstrated a diverse impact of the single parameters contributing to the EAD definition, indicating different clinical conditions and possibly requiring different interventions. While EAD was associated with inferior graft survival, only bilirubin and INR weighted in on this correlation. Individual discrimination of each variable provides more precise information than current categorical classifications. This analysis displayed a comparable patient survival, probably related to the attenuation of the currently cited risk factors for EAD during the last decades. Eventually, the redefinition of EAD as an early endpoint with predictive value for patient and graft survival is necessary to enable further advancement in LT . Pre-exiThe original contributions presented in the study are included in the article/The studies involving human participants were reviewed and approved by the Innsbruck Medical University Internal Medical Review Board (Protocol Number EK 1077/2018). The patients/participants provided their written informed consent to participate in this study.MF, WP, and SS: conceptualization and validation. MF, AWo, AW, HE, and WP: data curation. MF, AWo, WP, and SS: formal analysis. MF and SS: investigation, project administration, resources, writing—original draft. MF, AWo, and WP: methodology. MF and WP: software. SS: supervision. WP, HE, RO, CM, MM, BC, TR, AWe, RS, HZ, HT, DÖ, and SS: visualization. MF, WP, HE, RO, CM, MM, BC, TR, AWe, RS, HZ, HT, DÖ, and SS: writing—review and editing. All authors contributed to the article and approved the submitted version.This work was supported by Dr. Gabriel Salzner Stiftung.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. 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Pediatric Rheumatology (PROJ) by PReS in 2011 helped us maintain an Open Access journal in the last 10 years free for anyone to read in any part of the world. Any physician or clinician or parent with access to a computer and a search engine can read PROJ without having to pay for access to print journals. We cannot measure the effect of an open access journal for our subspecialty but we think it has been positive. Our Impact Factor has risen to a decent 2.5–2.6 level over the past 10 years and likely reflects much PR interest and support. But some change is coming now in how to pay for our article processing charges (APC), particularly as the number of papers financially supported by PReS has been decreasing every year.We wish to thank the Pediatric Rheumatology European Society (PReS) for its ongoing sponsorship of our journal. PReS has supported our young journal in so many ways. It has agreed with our objective of aiding in the development of the small but rapidly expanding field of international pediatric rheumatology (PR). As far as having its own journal, our subspecialty, the field of PR, had several potential directions to go in the 2000’s and even now. Our journal, backed by the support of 80% of the pediatric rheumatologists who replied to a survey in 2002, chose to be an Open Access journal. The sponsorship of Each author may apply for a discount from BioMed Central/Springer. Written proof from a business manager or administrator that the authors have no access to funds for the APC will allow a full discount for the APC in many cases. Authors whose institution is a member of BioMed Central may get a large discount. As always, authors from countries with limited resources may receive a substantial or full discount. Manuscripts from national, international and global PR organizations with funding challenges will also be eligible for major discounts. Some pediatric rheumatologists have grants that will help with journal costs. Many institutions and governments, especially in Europe and the United Kingdom, support publishing in Open Access journals and pay the APC.So it is time in 2021 for PROJ to leave the nest of PReS and fly on its own financially. It is a developmental step and an inevitable one. It was planned in the beginning of PReS sponsorship that change was eventually coming. So we will do everything we can as Editors to provide help for APC funding for every author who needs it. Please refer to the journal’s website for information on the support available and how to get in touch if you have any questions.


Aside from being known for its excellent mechanical properties and aesthetic effect, zirconia has recently attracted attention as a new dental implant material. Many studies have focused on hydroxyapatite (HA) coating for obtaining improved biocompatibility, however the coating stability was reduced by a byproduct produced during the high-temperature sintering process. In this study, to overcome this problem, we simply coated the zirconia surface with a sol–gel-derived hydroxyapatite (HA) layer and then sintered it at a varied temperature (<1000 °C). The surface showed a nanoporous structure, and there was no crystalline phase other than HA and zirconia when the sintering temperature was 800 °C. The adhesion strength of the HA layer (>40 MPa) was also appropriate as a dental implant application. In addition, in vitro cell experiments using a preosteoblast cell line revealed that the HA-coated zirconia surface acts as a preferable surface for cell attachment and proliferation than bare zirconia surface. In vivo animal experiments also demonstrated that the osteoconductivity of zirconia were dramatically enhanced by HA coating, which was comparable to that of Ti implant. These results suggest that the sol–gel-based HA-coated zirconia has a great potential for use as a dental implant material. The past decades have seen constant demands for dental and bone-related implants according to the aging society , 2. TitaZirconia is bioinert ceramics which does not react with living tissues and causes immune reactions. Particularly, an yttria-stabilized zirconia demonstrates excellent fracture resistance and flexural strength. Due to its superior mechanical properties, zirconia has been used as ball head for total hip replacements –10. In aThe surface properties of zirconia are generally modified by coating it with osseointegrated materials, such as hydroxyapatite (HA). HA has been widely used for dental and orthopedic applications because of the similarity of their chemical compositions to the mineral phase of a bone. The effect of HA coating on bone regeneration have been proven by numerous in vitro and in vivo studies , 17. OneHerein, a thin and stable HA layer was formed on a zirconia substrate using the sol–gel technique to improve its osseointegration. A sol–gel derived HA was coated on a zirconia substrate through the dip-coating method and then sintered with various sintering temperatures which is lower than that used in other studies (400–1000 °C). The microstructure and phases of the coating layer were examined by scanning electron microscopy (SEM) and X-ray diffraction (XRD), respectively. The bioactivity of the HA-coated zirconia was evaluated by an in vitro test using preosteoblast cells. Furthermore, an in vivo test using a rabbit femoral defect model was performed to assess the osteoconductivity of the HA-coated zirconia dental implant.3; and the zirconia plate was then sintered at 1500 °C for 2 h at a heating rate of 5 °C/min. A screw-type zirconia substrate was also prepared by machining the zirconia block to screw shape with 2-mm diameter and 10-mm length to evaluate the osteoconductivity under the in vivo condition.A plate-type zirconia substrate was used to optimize the coating conditions and evaluate the in vitro cellular behaviors. A zirconia block was produced by the following process: first, zirconia stabilized by 3 mol% of yttria powder  was compressed at 20 MPa, followed by the application of cold isostatic press at a pressure of 200–300 MPa and pre-sintering at 1100 °C; next, the block was cut into a plate shape with dimensions of 10 × 10 × 1 mm3)2 · 4H2O, Sigma-Aldrich, USA) was dissolved in 25 ml ethanol. These solutions were mixed together at room temperature for 3 days and aged at 37 °C for 1 day with continuous stirring to make the HA sol. The theoretical concentration of the final HA sol is 0.05 M when it is assumed that all reactants have completely reacted. The synthesis of the HA sol was confirmed by observing the crystallized nanoparticles through transmission electron microscope   of triethylphosphite  was added to a mixed solution of 23.92 ml ethanol  and 1.08 ml deionized water. Second, 0.0251 mol (4.1102 g) of calcium nitrate tetrahydrate (Ca(NOSA) Fig. .HA was coated on the zirconia plate and screw using the dip-coating technique. The dip-coating rate was 0.25 mm/s and performed thrice. The sol was dried for 5 min in the oven at 37 °C between each dipping step. The HA-coated zirconia plate was oven-dried at 70 °C overnight and sintered at 400 °C, 600 °C, 800 °C, and 1000 °C for 1 h at a heating rate of 5 °C/min after the coating was completed. The specimens generated under these conditions were designated as HA400, HA600, HA800, and HA1000, respectively. For the zirconia screw for using in vivo study, excessive sol was trapped between the screw threads, which might cause an unwanted thick coating layer; thus, spinning was performed at 150 rpm for 15 s using a spin coater after every dip-coating. Subsequently, the HA-coated zirconia screw was heat-treated at 800 °C for 1 h at a heating rate of 5 °C/min.The surface microstructure of the HA-coated zirconia was analyzed using a field emission scanning electron microscope . Prior to the FE-SEM observation, a thin platinum layer was deposited  to prevent electron charging. The focused ion beam  technique was used to analyze the coating layer thickness. The crystal phase of the HA-coated zirconia was investigated by XRD . Wide 2θ angle range of 20°–60° and narrow 2θ angle range of 31°–37° was obtained at a scan rate of 1 °/min because of its small intensity. The binding energy of composing elements of HA-coated zirconia was measured by X-ray photoelectron spectroscope .The mechanical stability of the coating layer was measured using the pull-out method. Epoxy precoated aluminum studs were placed on the coating surface and cured at 150 °C for 30 min. The stud was pulled from the attached surface at a rate of 1 mm/min using a universal testing machine . In order to evaluate the stability of the coating layer in the screw-shaped specimen, the HA-coated screw-shaped specimen was removed after implantation by applying a torque of 0.4 N·m to the synthetic bone, and the surface of the implanted part and the unplaced part was observed through SEM.4 and 2 × 104 cells/ml for the cell attachment and proliferation assays, respectively. The cells were then incubated in a humidified incubator at 37 °C with 5% CO2. The alpha-minimum essential medium  containing 10% fetal bovine serum  and 1% penicillin–streptomycin  was used as the culturing medium for all tests.The initial cell attachment and proliferation were evaluated using preosteoblast cell lines . All specimens were sterilized with 70% ethanol solution and UV radiation prior to cell seeding. The pre-incubated preosteoblast cell lines were seeded on each sample at densities of 3 × 10® 555 phalloidin, Invitrogen, USA), and 4′,6-diamidino-2-phenylindole  and then observed using lasers with wavelengths of 540 and 350 nm, respectively.The initial cell adhesion was observed using a confocal laser scanning microscope  24 h after cell seeding. After fixing the attached cells with 4% paraformaldehyde solution, the cytoplasm and nuclei of the cells were stained with fluorescent phalloidin  method. A 10% reagent  in culture medium was added to the cells on the specimens and incubated at 37 °C for 2 h after 3 and 5 days of culturing. The supernatant absorbance was measured by a microplate reader  at 490 nm.An animal test was conducted using a rabbit femoral defect model. This animal test was approved by Genoss’s Institutional Animal Care and Use Committee. Twelve-week-old male New Zealand white rabbits with an average weight of 2.5–3 kg were anesthetized with 0.1 ml of 2% Xylazine HCl  and 0.2 ml Tiletamine HCl , and Lidocaine . A cylindrical defect with a radius of 0.9 mm was created on each leg. Zirconia and HA-coated zirconia screws and Ti screw, which are positive control, were then implanted to these defects by applying an insertion torque of 20 Ncm. A postoperative antibiotic, gentamicin , was intramuscularly administered at 0.1 mg/kg for 3 days after surgery.The rabbits were sacrificed four weeks after the surgery; further, the specimens were extracted from the surrounding tissues. For a histological observation, all the extracted specimens were immediately fixed with 10% formalin then embedded in resin . The resin blocks containing the specimen and the tissues were sliced to a thickness of 40 μm. The slides were then stained using Goldner’s trichrome method and observed using an optical microscope . The osteoconductivity was evaluated in terms of the bone-to-implant contact (BIC) and new bone area ratios. The BIC ratio was calculated by dividing the length of the screw surface that bonded with the bone by the whole length of the screw surface. In addition, the new bone area ratio was defined as the area of the newly generated bone relative to the area inside the threads at the top part of the screw.p value below 0.05 was considered significant in all cases.Statistical Package for the Social Sciences  was used to perform the statistical analysis. All data were expressed as mean ± standard deviation. The normality of the variables was verified using the Shapiro–Wilk test. The statistical analysis was performed by a one-way analysis of variance with Tukey post-hoc comparison. A Figure The crystalline phases of the HA layers with different sintering temperatures were investigated by XRD Fig. . The widFigure The effects of HA coating on the biological properties of zirconia were evaluated in terms of the initial cell attachment and proliferation. For comparison in the in vitro test, cell behavior was also evaluated on the Ti substrate, which has been most widely used in the dental implant field. The CLSM images depicted the cell morphology on the Ti, bare, and HA-coated zirconia (HA800) (Fig. Figure Animal experiments were performed to confirm the effect of the HA coating on the in vivo osteoconductivity of the zirconia-based implant and Ti implant for comparison purposes. Figure The BIC and BA ratios were investigated Fig.  to quantZirconia is mechanically and chemically stable ceramic biomaterials. Zirconia also has tooth like color so that it is used as an abutment, but its bioinertness has limited the application as a fixture. HA coating is one of the simplest ways to enhance the osteoconductivity of zirconia for dental implants. Mechanical stability of coating layer is also important for implant materials because initial micromovement of implant is key factor for the implant success , 26. In The morphological change in HA coating layer with different sintering temperature could be explained by the mobility of ions. As the sintering temperature increases, the mobility of ions also increases. The higher mobility led to a faster reaction between the HA particles. For HA600, adjacent HA particles began to merge together and make granular structures on the zirconia surface. The porous structure of HA800 might be caused by the atomic diffusivity being not high enough to make the dense surface. Likewise, most of the HA1000 specimen surface was covered with the flat and dense HA layer having a large grain size owing to its high atomic diffusivity. In addition, the pores were found in the HA layer inside and in the HA layer surface, suggesting that they would have an interconnected structure. The micro-roughness of the implant surface is known to be highly correlated with the bone integration of the materials . Based oAnalysis of the crystallinity of HA coated zirconia revealed more information. The absence of any peaks in XRD observations means that the HA layer does not crystallize at sintering temperature conditions as low as 400 °C. Amorphous HA has a very high dissolution rate; hence, sintering at 400 °C would not be appropriate for the coating purpose to improve the osteointegration of dental implants . CalciumThese results suggest that the HA coating layer should be heat-treated at a temperature between 400 °C and 1000 °C to obtain the crystalline HA phase without any by-products.The mechanical stability of the coating layer is a very important factor for the success of the implantation. The coating layer is not effective anymore if it is peeled off during the surgery. In addition, delaminated debris could induce unwanted bone regeneration . Weak boThe improved osteoconductivity of HA-coated zirconia was examined by in vitro cell test and in vivo animal study. The biocompatibility of Ti was also evaluated as a positive control because it is most widely used as dental implant . The preHerein, sol–gel derived HA was successfully coated on the zirconia surface using a simple dip-coating technique to improve its osseointegration. The surface morphology and the crystalline phase of the HA layer were varied with the sintering temperature. A nanoporous HA layer was uniformly formed on the zirconia substrate when the sintering temperature was 800 °C. The average thickness and pore size of the HA layer were ~400 nm and ~50 nm, respectively. In addition, there was no cracks on the coating layer, and it was not easily detached under 40 MPa of stress. The HA-coated zirconia exhibited a significantly enhanced osteoconductivity. The MC3T3-E1 preosteoblast cells more actively attached and proliferated on the HA-coated zirconia compared with the bare zirconia surface. The HA-coated zirconia dental implant sample demonstrated a remarkably improved in vivo osteoconductivity similar to that of the Ti implant. Collectively, these results suggest that a low-temperature sintered sol–gel-derived HA coating would increase the potential of zirconia in dental applications.Supplementary Materials