With an increasing treatment time, the degree of substitution (DS) of the malate starch displayed an increasing trend. Scanning electron microscopy (SEM) demonstrated a significant change in the surface structure of the starch granules. X-ray diffractometry (XRD) reflected that the crystal structure of the malate starches was destroyed. The thermogravimetric (TG) curves showed that the maximum heat loss rate of the malate starch was ahead of that of native starch, which caused the decreased degree of crystallinity. These properties of malate starch could allow it to be used for the purpose of starch modification to produce resistant starch and to provide new applications for starch. In this study, corn, potato, and wrinkled pea starches were esterified with malic acid under high temperatures for different lengths of time. The degree of substitution (DS), granule morphology, crystal structure, gelatinization properties, and the digestibility of the malate starch were investigated. Fourier transform infrared spectroscopy (FT–IR) suggested that the malate starch showed a new infrared absorption peak near 1747 cm Starch is an important source of energy for the human diet and an important component of food . It comeEsterified starches have various applications in the field of food processing, such as in thickeners, additives, stabilizers, emulsifiers, flavoring ingredients, and binders for drying foods. There are also nonfood uses, for instance, as fillers, super disintegrants, hot melt adhesives, coatings, etc. . In the 13C CP/MAS NMR spectra, FTIR, etc., and simultaneously investigated the effect of HMT on the properties of esterified starch [Our previous research explored the reaction mechanisms of wrinkled pea starch and malic acid to produce resistant starch as measured through nuclear d starch . Corn, pIn this experiment, corn, potato, and wrinkled pea starches were esterified with malic acid under high temperatures for different lengths of time. The structure, degree of substitution, physicochemical, and in vitro digestibility of malate starch were studied. The preparation of malate starch could achieve the purpose of starch modification to produce resistant starch and provide new applications for starch.Aspergillus niger  were purchased from Sigma-Aldrich Chemical Co. . Glucose oxidase–peroxidase (GOPOD) assay kits were obtained from Megazyme International Ireland Ltd. . All other chemicals and reagents were of analytical grade.Corn starch was purchased from Qinhuangdao Lihua Starch Co., Ltd.  with 0.3% protein, 0.2% ash, 10.9% moisture, 23.2% amylose, and a little fat. Potato starch was produced by Weston Company , and it contained 0.1% protein, 0.3% ash, 15.8% moisture, 21.6% amylose, and a little fat. Wrinkled pea seeds (wild variety) were obtained from the farmers of Gansu Province in China. The wrinkled pea starch had 0.4% protein, 0.1% ash, 10.0% moisture, 30.8% amylose, and a little fat. Malic acid was acquired from Fuchen Chemical Reagent Factory . Pancreatin from porcine pancreas  and amyloglucosidase from The reaction of starch and malic acid was carried out following the method of Klaushofe  with appThe DS of the malate starch was determined by the method of Kweon . The DS Mass fraction of malic acid substituents A:0—the volume of HCl solution consumed by the blank, mL;V1—the volume of HCl solution consumed by the sample, mL;VC—the exact concentration of the standard titration solution of hydrochloric acid, mol/L;4H5O4) = 117);M—the molar content of the 2-hydroxysuccinyl group, g/mol  at 20 KV . a and Ic are the amorphous and crystalline area, respectively, on the X-ray diffractogram.The XRD patterns of starch samples were obtained by an X-ray diffractometer  at 3 kV and 20 mA with 0.1542 nm Cu Kα radiation (Ni filter). The scanning range was 2θ values of 5–35° at a 0.04° step size and with a scanning rate of 4°/min . The rel−1 with a resolution of 4 cm−1 on an FT–IR instrument  The samples were scanned 64 times using the transmission method. Finally, the average value was obtained [The sample and the required KBr were dried in an air oven at 40–50 °C for 4–5 h to avoid the influence of moisture before testing. FT–IR analysis of the malate starches were executed over a wave number range of 4000–400 cmobtained .2 gas flow [The thermal stability of the malate starch sample was performed using a differential thermal analyzer . Starch  was heated in an aluminum oxide pan from 30 to 600 °C with a 10 °C /min heating rate and 40 mL/min Ngas flow . The tem20min and Glucose120min represent the amount of glucose released within 20 and 120 min, respectively and FG represents the glucose content (free glucose) in the sample before hydrolysis.In vitro digestibility of starch was evaluated using the method of Englyst , as modip < 0.05. All the graphs were obtained using Origin 6.1 software.The data reported were the averages of triplicate determinations and the results were represented as the mean values ± SD (standard deviation). Analysis of the data was performed through variance analysis (ANOVA) and significance analysis was done by Duncan’s multiple range tests. Significance analysis was performed using SPSS 21.0. The level of significance was set at Starches with different crystal types were reacted with malic acid for different dry heat times. Reaction time had a great impact on the DS of the malate starch. The DS values of malate starches prepared over different reaction times are shown in The granular morphologies of native starches and malate starches treated for different reaction times are shown in The surface of esterified starch was rougher than that of native starch, which was easier to gather together. The surface of starch granules becoming rough is a common feature of esterified starch. The aggregation of starch granules could be caused by the surface destruction of some starch granules during chemical modification . It has The X-ray diffraction patterns of different crystalline native starches and malate starches treated for different times are shown in −1, which was related to the new ester linkages between carboxyl groups of malic acid and hydroxyl groups of starch [−1 was formed by the stretching vibration of the starch hydroxyl group. The decrease in the broadband peak indicated that the hydroxyl group was gradually replaced by the ester group. The data further confirmed that there was an esterification reaction between starch and malic acid. The new characteristic peaks neighboring 1747 cm−1 signal were weak in the malate starch samples with the 2 h dry heat reaction time level, however, with the extension of the dry heat reaction time, the intensity became stronger. The effect was most significant for malate starch treated for 5 h, which indicated that an appropriate dry heat treatment time could promote the esterification reaction and increase the DS.Infrared spectroscopy is an important method used to observe any changes in the functional groups on the starch molecules. The resulting infrared spectra of the native starches and malate starches are shown in f starch . The bro1/B1/C1) showed an initial peak (first mass loss) at 70–130 °C. The mass was stable until 200 °C and the DTG curves (A2/C2) showed a second peak at 250–300 °C, which indicated prominent mass loss for the corn and wrinkled pea malate starches. The DTG curves (B2) showed a second peak at 300–325 °C for potato malate starch. The main mass loss was caused by the elimination of polyhydroxyl groups, accompanied by depolymerization and decomposition [Thermogravimetric analysis was used to study the thermal stability and composition of materials . When thposition . This alposition  found thThe digestibility properties of the malate starch are presented in −1—the C=O absorption shock peak—reflecting that the starch was esterified with malic acid. With increased dry heat treatment times, the DS of malate starch showed an overall upward trend, and the starch surface structure changed significantly. Depressions, cracks, and crosslinks appeared on the surfaces of starch granules. The esterification of starch destroyed the crystal structure, especially in pea starch. The amorphous properties of malate starch were revealed. The heat loss rates and thermal stability of the malate starches were lower than those of native starch, and its dissolution process became longer. The RS contents in the malate starch samples increased significantly. Therefore, the esterification reaction of starch from different sources and malic acid by the dry heat method can effectively increase the content of resistant starch.The experiment above demonstrated successful esterification reactions of starch and malic acid by the dry method. The esterification reactions of malic acid with different crystalline starches caused significant changes in the structure, morphology, and gelatinization properties of malate starch. The different crystalline malate starches presented obvious characteristic peaks around 1747 cm


Emerging Infectious Diseases (EID) will join the growing ranks of journals published online only. We made the decision to stop publishing on paper with the recognition that our readers increasingly access the journal only online, and not through paper copies. In addition, we think the move offers at least three advantages to the journal and its readers. First, we can use budget dollars saved for other important journal functions, such as editing and production. EID is now recruiting a new assistant editor, who will help speed up the review of submitted manuscripts.Starting with the January 2020 issue, Second, we can “go green.” Printing and mailing paper issues of the journal carry environmental costs. In recent years, we have come to believe that these costs are not outweighed by whatever advantages remain to printed pages.Third, we can place even more emphasis on online-only materials included as supplements or appendices to articles published in the journal. These materials now represent a substantial portion of all the pages that we publish. We think that, in the future, they will become an even more important part of the journal.Readers should rest assured that EID articles will continue to be available online as they have before, along with supplemental materials and appendices. Entire issues of the journal will continue to be available in the PDF format. Readers who have enjoyed browsing a full printed issue of EID can continue to so by using any Web-connected desktop or laptop computer, tablet, or smartphone.https://wwwnc.cdc.gov/eid/subscriptions.We invite all readers to subscribe to our monthly table of contents alerts on the journal’s Web site at D. Peter Drotman, MD, MPHEditor in Chief


Background: Traditional journal clubs have been limited by the geography of participants. Web based modalities and social media platforms are now being used to bridge this barrier. Medical education journal club, given the diversity of its community would lend well to these platforms. To date there is very little published regarding online medical education journal clubs.Objective: To bridge geographical barriers; enhance interdisciplinary and interprofessional discussion and collaboration; and to provide opportunities for continuing medical education and faculty development; a monthly synchronous medical education journal club was created for faculty.Design/Methods: From April 2015 to November 2016, 11 online journal clubs were held for the faculty at Northwell Health and the Barbara and Donald Zucker School of Medicine at Hofstra/Northwell (Zucker SOM). All articles picked were relevant to medical education and participants were from multiple disciplines.Results: 74% of respondent participants agreed that the content covered during the sessions would positively impact personal and/or professional life and 58% of respondents reported that their overall knowledge/skill level changed positively.Conclusions: On-line medical education journal club can provide a valuable opportunity for continuing education and faculty development for both the participant and the presenter. Since their advent in 1875 by Sir William Osler at McGill University [One major drawback of journal clubs is the inability of participants to attend in-person meetings, particularly when they are not in the same location. This isThere is a dearth in the literature regarding interdisciplinary topics in journal clubs, most notably the topic of medical education. Despite the growth of medical education as a science, there are few published reports on journal clubs – in-person or online – dedicated to this topic. Medical education journal clubs can allow participants to keep up to date with current health sciences education literature as well as foster education research.To bridge geographical barriers; enhance interdisciplinary and interprofessional discussion and collaboration; and to provide opportunities for continuing medical education and faculty development; a monthly synchronous medical education journal club was created for the faculty at Northwell Health and the Zucker School of Medicine (SOM). The purStarting from April 2015, synchronous online journal club meetings have been held on a monthly basis with the exception of the summer months  and December. Meetings are scheduled on a weekday and are one-hour in length. AdvertiAll meetings are hosted using the online web conferencing platform, GoToMeeting. The platform tools that are used most often are: the webcam, recording functions, screen sharing, and the chat box. All journal club meetings are recorded and available on the Zucker School of Medicine’s Faculty Development site.Faculty presenters, spanning multiple disciplines are chosen based on interest in teaching medical education topics. Faculty development for the presenter includes guiding the format of the PowerPoint presentation, reviewing and editing the presentation, and moderating the discussions during the interactive portion of the presentation. Formative data is collected via a survey at the end of each meeting.Two medical education articles based on a specific theme are selected for each session by the faculty presenter and the Assistant Vice President of Faculty Development . The preBeginning in January 2016, a medical librarian was added as a regular contributor to the club. The librarian covers the limitations, search methodology and bibliometrics of each article. Bibliometrics is a statistical measure of written publications which provides a general idea of the articles’ impact and influence. Traditional metrics captured by Web of Science and Google Scholar as well as alternative metrics such as social media site mentions, newspaper articles, and government reports captured by Altmetrics are discussed during the MedOnline.The process of setting up a MedOnline requires logistical planning and support. One administrative support person covered the registration process, marketing, dissemination of email reminders, and any other housekeeping items. A technical support person from the Zucker SOM provided assistance on how to use the web conferencing software; acted as the point-person for troubleshooting technology-related issues before, during and after webinars; and records, downloads, and posts webinars. The Vice President for faculty development at the Zucker SOM provides assistance for the PowerPoint presentation, reviewing and editing of the presentation, moderating the discussions during the interactive question(s) portion of the presentation, and acting as a champion for the club on a monthly basis. This project was reviewed and deemed not to be research as it is a continuing professional development program by the IRB at Northwell Health.On average, there were 16 participants per session over the 11 sessions . The parst century[Web based modalities have allowed journal clubs to enter the 21t century. By remoThe first limitation noted was whether the participants thoroughly read the articles before the meeting. Lack of familiarity with the article can affect the depth and quality of the discussion. Second, it is unclear how many participants are actively listening during the meeting. Third, more time is needed for interactive discussion. Some themes require more time than the scheduled one hour. Finally, the survey needs to potentially be revised to ensure that the journal club’s objectives are being met and that the effectiveness of the meetings is being captured properly.In the future, we hope to increase attendance by including other social media channels in the advertising process. We also hope to improve participation using the KeyLIME format of the Royal College of Physicians and Surgeons of Canada with the addition of a discussant alongside the presenter. SimilarThe MedOnline has been well received by participants and faculty presenters. The positive feedback as well as the steadily increasing number of participants and returning participants indicates the club’s success at Northwell Health and the Zucker School of Medicine. The MedOnline provides a valuable opportunity for continuing education and faculty development for both the participant and the presenter.


Although T1rho and T2 map magnetic resonance imaging (MRI) have been perceived as useful diagnostic modalities for cartilage degeneration, no studies have assessed whether these two sequences are useful for monitoring ACL graft maturation after ACL reconstruction. The present study examined whether the two sequences reflect graft function and maturation after ACL reconstruction.Twenty consecutive patients who consented to undergo MRI at 3, 6, and 12 months after double-bundle ACL reconstruction were enrolled. MRI was performed using T1 rho and T2 map sequences in a single session. Temporal changes in T1rho and T2 values of a purely tendinous portion of graft were assessed at each time point. Correlations were analyzed between T1rho or T2 map values and clinical results, including anteroposterior laxity at 2 and 4 years postoperatively, pivot shift test results at 4 years, and graft tension on second-look arthroscopy. Separate analyses were performed for the anteromedial bundle (AMB) and posterolateral bundle (PLB).T1rho sequence was able to visualize the tendinous portions of AMB and PLB more clearly than T2 map sequence even on gray-scale images. Mean T1rho and T2 map values gradually decreased during the first operative year, but the trend was more prominent and consistent for T1rho values than for T2 map values. Correlation analysis revealed that T1rho and T2 map values at 1 year correlated significantly with anteroposterior laxity at 2 and 4 years. This trend was found in both AMB and PLB. Both T1rho and T2 map values failed to exhibit a statistical correlation with arthroscopic findings of graft tension.The present study was the first trial to assess the feasibility of T1rho and T2 map sequences to objectively monitor the course of graft maturation after ACL reconstruction. Both sequences successfully detected purely tendinous portions of graft, and mean values gradually decreased during the first year postoperatively. Both values at 1 year correlated significantly with anteroposterior laxity of the knee joint at 4 years, indicating that the values reflected graft fate. Magnetic resonance imaging (MRI) is a noninvasive imaging modality that has been widely used to examine injuries to the anterior cruciate ligament (ACL). The diagnostic accuracy of MRI for ACL injuries is increasing and has already reached ≥ 90% . HoweverT1rho and T2 map sequences have shown potential in musculoskeletal MRI at 3 T, and have been perceived as particularly useful diagnostic modalities for depicting early cartilage degeneration in osteoarthritic knees –13. AlthAmong 75 patients undergoing anatomic double-bundle ACL reconstruction using semitendinous tendon graft at our institute between January 2011 and January 2012, participants comprised 26 consecutive subjects who consented to participate in this study and undergo MRI at 3, 6, and 12 months postoperatively. All patients provided written informed consent, and an institutional review board approved the study (ID #2011266). Exclusion criteria were multiple ligament injuries (PCL or MCL), simultaneous bilateral ACL injuries, multiple operated knees, or inflammatory joint disease. According to this criterion, 26 patients were initial candidates eligible for analysis, but 6 patients were lost to follow-up, lost halfway, and did not complete three sequential MRIs. Finally, 20 patients were enrolled . Lysholm score was collected 4 years postoperatively. One orthopedic surgeon blinded to clinical scores and MRI findings performed all stability tests. Second-look arthroscopy was performed at the time of hardware extraction, at a mean of 18.9 months  after ACL reconstruction. Grafts were evaluated for tension by probing at 20–90° of knee flexion, then classified into three categories as follows: tension same as normal ACL, taut; tension less than normal, mildly lax; and obvious loss of tension, lax.Assessment with MRI was performed at 3, 6, and 12 months postoperatively. All MR exams were implemented on a 3-T MR scanner  equipped with an 8-channel transmit/receive knee phased array coil. In each sequence of T1rho and T2 map imaging, centers of the bone tunnel outlet for both femur and tibia were plotted on the axial plane, and the plane passing through these 2 points was the slice plane for oblique sagittal imaging. Single or double oblique imaging has been reported to contribute to an accurate diagnosis of ACL injury . CentersMRI data were transferred to a workstation for offline quantification of T1rho and T2 map values. Three intra-articular locations of the graft at which slice planes could be made perpendicular to the long axis of the graft were defined on sagittal images. Those included the midpoint between femoral and tibial tunnel outlets and points 1 cm proximal and 1 cm distal to the midpoint. Segmentation was performed manually on the three slice planes to segregate the purely tendinous portion from surrounding synovial tissue. Regions of interests (ROIs) set on the purely tendinous portion of the graft were measured for relaxation times of T1rho and T2 map sequences, and the mean value of the three slice planes was calculated. Mean values for AMB and PLB were measured separately.All ACL reconstructions were performed arthroscopically by a single surgeon using anatomic double-bundle procedures, as reported previously , 19. Brit test was used to statistically analyze differences among 3-month, 6-month, and 1-year T1rho and T2 map values. Values of p < 0.05 were considered statistically significant.Spearman’s rank order correlation was performed to examine the relationship between T1rho or T2 map values at 1 year and anteroposterior laxity measured at 2 and 4 years postoperatively. Correlations of T1rho or T2 map values with pivot shift test results and graft tension at the time of second-look arthroscopy were also analyzed. The paired Student’s On MRI examination, the T1rho sequence was able to visualize tendinous portions of the AMB and PLB more clearly than the T2 map sequence in gray-scale images, and easily segregated the purely tendinous portion from surrounding synovial tissue Fig. .Fig. 1ReMean anteroposterior laxity increased from 0.7 to 1.6 mm during the observation period of 4 years Table . Second-Correlation analysis revealed that T1rho values of both AMB and PLB at 1 year correlated significantly with anteroposterior laxity at 2 and 4 years Table ; Fig. 4.Many studies have evaluated cartilage and meniscus degeneration and injury quantitatively, using T1rho and T2 map sequences , 22–24. The present study had two important findings. First, color coding images of both T1rho and T2 map sequences successfully visualized the purely tendinous portion of the ACL graft in the axial plane. T1rho and T2 map values of the tendinous portion gradually decreased in the first operative year. Second, both T1rho and T2 values at 1 year correlated well with anteroposterior knee laxity at 2 and 4 years, suggesting that both sequences could be used as surrogate measures of graft function during the postoperative course of ACL reconstruction. If increased graft signals can be assumed to indicate failed or delayed graft maturation in this study, clinical significance of graft signals can be seen for determining an appropriate timing to return to sport activities on an individual basis. Most surgeons to date have allowed patients to return to the original sport activities according to the time from surgery , isokineTo date, difficulty in detecting poorly functioning graft by MRI has been reported. One possible reason is the discordance between MRI findings and physical examination of anteroposterior and rotational stability, when using conventional T1- or T2-weighted fast spin echo or proton density-weighted imaging (PDWI) sequences . To the Hypervascularity of the synovial membrane at 3–6 months may increase mean graft signals in the axial plane, which may obscure signals from the tendinous portion of the graft. This might be the case with the PDWI sequence, which has been perceived as a common sequence for not only cartilage, but also ACL. Although no significant differences were identified, T2 map values of PLB appear to increase from 3 to 6 months postoperatively and decrease thereafter, resembling the temporal pattern of conventional T2, PDWI, and gradient echo T2 sequences reported by previous studies , 30, 31.Some limitations need to be considered when interpreting the present results. First, as the T1rho sequence is reportedly more sensitive than the T2 map sequence for detecting early cartilage degeneration , some diThe present study was the first trial to report the feasibility of T1rho and T2 map sequences in objectively monitoring the course of graft maturation after ACL reconstruction. Both sequences successfully visualized the purely tendinous portion of the ACL graft, and values decreased with increasing graft maturation during 1 year postoperatively. Both T1rho and T2 map values at 1 year correlated significantly with anteroposterior laxity of the knee joint at 4 years, indicating that both sequences are useful to evaluate graft function and possible timing of the return to sport activities.


Eight years have passed since the launch of PhytoKeys  – PensofIn a very short time period after its inception, PhytoKeys became one of the most popular and appreciated Open Access journals in botany. The journal started with only 48 submissions in 2011; by 2017 that number quadrupled to 187 manuscripts submitted annually (Table IPNI)  , 2016. IOver the years PhytoKeys has attracted a diverse range of botanical researchers from all parts of the world, with the highest numbers coming from the United States of America (193), Brazil (93), China (80), United Kingdom (53) and Germany (49). Altogether 939 scientists from 67 countries have published in the journal from its launch until 1 June 2018 CNKI (China)CINIPIEC (China)eLibrary (Russia)ORCID Dryad Data Repository Open Citations Corpus Since 2016 PhytoKeys has been using Altmetric – a technology providing article level metrics which enables authors to track the online shares and discussions of their published articles. Figure PhytoKeys site have received 147,865 views. Four species described in PhytoKeys – the flowering tree named as a new genus Sirdavidiasolannona, the dragon tree Dracaenakaweesakii, the orchid Telipogondiabolicus and the bush tomato from northwestern Australia, Solanumossicruentum made it to the top 10 new species nominated by the State University of New York College of Environmental Science’s International Institute for Species Exploration (IISE) .Pensoft continues to invest in the popularization of PhytoKeys via media campaigns. Some examples of press releases on articles published in the journal that grasped the attention of journalists and received large media coverage are listed in Table Over the eight years of the existence of PhytoKeys, the journal has positioned itself among the world’s leading journals in systematic botany. Started by the editors primarily as a taxonomically-oriented journal, the journal has since extended its scope to enable publications across other botanical disciplines, such as plant ecology, genomics, evolutionary biology, paleontology, bioinformatics, ethnobotany, etc.As the chief editors of PhytoKeys we have worked hard to expand the journal’s editorial board, which has grown significantly and today is comprised of more than 80 experts from various scientific disciplines and geographical areas. The journal has achieved an international reputation by publishing milestone works that will affect all botanists, such as the changes to publication requirements made at the XVIII International Botanical Congress in Melbourne , b, the With its continuous technological innovation and support from subject editors and reviewers, PhytoKeys continues to receive recognition by the international community of plant researchers. This success would not have been possible without our authors, reviewers, subject editors, production staff, readers, and supporters, to which we express our sincerest gratitude and thanks! We cannot wait to see what the 200th issue will look like!


Background and Objectives: All-ceramic prosthesis is widely used in modern dental practice because of its improved physico-mechanical and optical properties. These restorations are exposed to coloring agents from various nutrition and beverages in the oral cavity. Long-term color stability is critical for the success of these restorative materials. The purpose of this in vitro study was to assess the effect of common beverages and mouthwash on the color stability of lithium disilicate (LD), monolithic zirconia (MZ) and bilayer zirconia (BZ) surfaces. Materials and Method: Thirty disc-shaped specimens from each material were fabricated; each group was subdivided (n = 10) according to coffee, green tea and chlorhexidine immersion solutions. The baseline color of ceramic discs was recorded according to the CIE L*a*b* system with a portable spectrophotometer. The second measurement was recorded after 3000 thermocycling and immersion in coloring agents for 7 days. The mean color difference was calculated and data were compared with Kruskal-Wallis and Mann-Whitney post hoc tests (0.05). Results: ΔE values for LD with the immersion of coffee, tea, and Chlorhexidine gluconate (CHG) were 1.78, 2.241 and 1.58, respectively. Corresponding ΔE values for MZ were 5.60, 5.19, and 4.86; marginally higher than the clinically acceptable level of 3.5. Meanwhile, BZ showed better color stability compared to MZ with ΔE values of 4.22, 2.11 and 1.43. Conclusions: Among the ceramics evaluated, LD ceramic was found to be more color stable, while MZ ceramics displayed a higher susceptibility to discoloration. MZ and BZ ceramic colors were significantly altered with coffee immersion, while LD ceramics were more affected by green tea. The demand for aesthetic dental services is on a constant upsurge due to an aesthetic conscious society . AesthetProsthesis must not only have the dimensions, texture and contours of the teeth to be replaced but should also have similar light behavior. Furthermore, the color stability of the restoration is critical for the long-term success of the aesthetic restorations. Although the physicomechanical properties of ceramics have been vastly improved, they are susceptible to discoloration ,10. ExtrLithium disilicate specimens were fabricated by the burning out of a 2 mm thickness, 10 mm diameter pattern inlay in wax. These wax patterns were heat pressed with an IPS Empress, Programat, EP 5000 furnace  at 920 °C. To finish and flatten the specimen surface, 400–1200 grit silicone carbide papers were used. The specimens were cleaned in an ultrasonic cleaner with distilled water for 10 minutes and were coated with a single layer of the neutral shade glaze by firing at 765 °C.Monolithic zirconia discs measuring 10 mm in diameter and 2 mm in thickness were fabricated by scanning  the identical size resin pattern. The pre-sintered zirconia block  was copy milled with computer-aided design and a manufacturing system . Milled discs were polished with sequential use of 400–1200 grit silicon carbide papers under a water jet. The milled discs were sintered by further firing at 1450 °C . The Core specimens for bilayer zirconia discs  were fabricated with yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) by the copy milling of resin pattern following a similar process to that of monolithic zirconia (MZ). One side of the zirconia core was covered with the feldspathic porcelain veneer  with a layering technique following the manufacturer’s instructions. The thickness of the veneering porcelain was kept at 1mm for all the samples and it was confirmed with a digital caliper .n = 10) was calculated from the ΔE values of previous studies [The samples from each ceramic material were randomly divided into three subgroup groups of 10. The sample size for each subgroup  with a portable spectrophotometer . The putty index was made over the disc with a window of 3 mm diameter in the center to standardize the area color measurement. The borders of the window were well-formed with sharp edges. On each occasion, the disc color was measured three times. The average value from 3 repeated color measurements was considered the color of the disc. Three color parameters—‘ L’, ‘a’, ‘b’—were recorded for each ceramic veneer following the CieLab color system. The mean color difference because of immersion of the sample was determined by adopting the formula : ΔE* = . Data were analyzed by Kruskal-Wallis and Mann-Whitney post-hoc comparison at the significance level p value of 0.000. The lower mean rank of 6.10 was recorded by LD and a higher mean rank by MZ (23.40). Immersion in green tea also demonstrated a significant difference between the groups with P-0.007 and H value 10.025. MZ showed a higher rank (22.50). However, BZ recorded the lowest mean rank at 12.50. The results also indicated a significant difference in chlorhexidine groups with an H value of 12.062, p = 0.002. The mean ranks of 23.30, 12.50 and 10.70 were recorded by LD, MZ and BZ, respectively. p = 0.288). Additionally, chlorhexidine immersion also showed a similar trend with a statistically insignificant difference between glass ceramics and BZ with a p value of 0.579.The mean L, a, and b values along with the mean color change (ΔE) for all the tested material after immersion in the discoloring solutions are summarized in The success of dental prostheses depends on their ability to restore function and aesthetics. Precisely matching the color to adjacent teeth along with other aesthetic objectives like position, texture and contour is vital for a good aesthetic outcome. Because of deeper translucency close to the natural tooth, all-ceramic restorations are preferred in the anterior region . The perBased on the results of the present investigation, the null hypothesis of no discoloration of ceramic restoration with beverages and mouthwash was rejected. The surface disintegration of ceramics depends on material composition, fabrication methods, surface treatment and measurement methods ,27 CoffeThe findings of our study indicated that monolithic zirconia was susceptible to higher discoloration from coffee, green tea and CXG. The corresponding ΔE values were 5.602, 5.192, and 4.866, respectively. These results are consistent with those of Kurt et al. , who shoThe BZ with feldspar veneering ceramic showed the lesser discoloration across all the discoloring solution compared to monolithic zirconia. The corresponding ΔE values of coffee, green tea and chlorhexidine were 4.229, 2.11, and 1.438, respectively. The core Y-TZP was reported as being more resistant to LTD than MZ. Previous research has also shown that Core Y-TZP used in BZ prosthesis possesses higher crystal intensity counts compared to monolithic zirconia . The supThe limitation of the present in vitro study includes the fact that the thermocycling was conducted in water, unlike saliva in the oral cavity. The staining solutions not being refreshed during the immersion period and the constant exposure of ceramics over 7 days of immersion could affect the discoloration of the tested ceramics. The complementary effects of brushing, micro-surface roughness and coloring agents in nutrition were not considered in the study. Additionally, the study did not include the effect of UV light on the discoloration process. Further studies are recommended to evaluate the effect of sunlight exposure, salivary proteins and nutritional coloring agent on the color stability of all-ceramic restorations.(1)Discoloration from coffee was more significant in monolithic and bilayer zirconia compared to lithium disilicate ceramic. Green tea affected lithium disilicate more than coffee discoloration.(2)Lithium disilicate ceramic was found to have better color stability compared to monolithic and bilayer zirconia.(3)Monolithic zirconia displayed the least color stability among all the tested discoloring agents.Within the limitations of this in vitro study, the following conclusions were drawn:


Concerns have been raised that the transplants performed in the local context at the time of procedures reported in this article  may haveInternational ethics standards call for transparency in organ donor and transplantation programs and clear informed consent procedures including considerations to ensure that donors are not subject to coercion. It was noted in  that decThe authors requested withdrawal of the article in response to the journal’s queries about the above issues, and the corresponding author raised concerns about the premise of the journal investigation.PLOS ONE Editors retract this article.Owing to insufficient reporting and unresolved concerns around the source of transplanted organs and whether they included organs from prisoners, and in compliance with international ethical standards for organ/tissue donation and transplantation, the


The degree of nano-composite crystallinity was formed by the strong interfacial interaction between the titanium dioxide nanoparticles and the amorphous region of the chain. The decomposition temperature of starch bioplastic was increased by mixing with titanium dioxide nanoparticles. The results gained from SEM showed that better compatible morphologies in composite bioplastic compared to starch bioplastic for its fewer voids, holes, and crack. The functional group O–H, C–H, C=O, and C–O indicate the formation of starch bioplastics and composite bioplastics has already occurred which was confirmed by FTIR spectroscopy. The result is also verified with the available results of other researchers. Therefore, composite bioplastic is a modified elevation of a starch bioplastic with a modified upgrade feature. It can be an alternative to existing conventional plastic, especially packaging applications.Plastic is an amazing material, and wonderful invention, it has changed the world. Plastic is used everywhere and every day across the globe. But despite its varied uses, its disposal has threatened the environment. Biodegradable plastics can meet these needs and can easily be disposed to the environment. This work focuses on the characterization and performance analysis of starch bioplastics and composite bioplastic to reduce the plastic pollution by its various uses. TGA, DSC, SEM, FTIR, and surface roughness analyses were used to characterize, the mechanical properties, thermal properties and the morphology of the starch bioplastics and composite bioplastic. Starch bioplastics were fabricated using starch vinegar and glycerol. Composite bioplastics ware fabricated using starch, vinegar, glycerol and titanium dioxide. The addition of titanium dioxide improved the tensile strength of the bioplastics from 3.55 to 3.95 MPa and decreased elongation from 88% to 62%. According to Differential Scanning Calorimetry (DSC) Test, the melting point (T So, it would be a new addition to research. The main objectives of this research were the preparation and characterization of composite bioplastics using titanium dioxide nanoparticle with corn starch. The analysis was done to identify the area of application of these materials and to evaluate the potentiality. This research database can be useful for designing and manufacturing biodegradable materials.Plastics are used worldwide from drinking cups to various parts of automobiles and motorbikes. They are imperative to the trade market as well as the packaging of materials all over the world. However, they have been an environmental concern because of its prolonged rate of degradation. Starch is a promising candidate for developing sustainable materials are considered which mainly due to its biodegradable properties, low cost and renewability , 2, 3, 422.1Corn starch , glycerol, white vinegar and Titanium dioxide nanoparticles (21nm) ware locally purchased from Dhaka . All other reagents were analytical grade. The following amounts of each ingredient are needed to fabricate the bioplastic  see Tab, 4.Table2.22.3To fabricate the starch bioplastic, 50gm of corn starch was added into a beaker together with 300ml of distilled water. Next, 25gm. glycerol and 30 ml of white vinegar were added into the beaker. Then the beaker is placed on the" Hot-plate-magnetic-stirrer" and the mixture is stirred for 5 min. During heating, stirrer should be turned on. This process occurs quickly, so the mixture must be stirring until thickens. Once the mixture is completely ready, it will have to be stir several times and then the mixture should be poured into aluminum foil or dye. Depending on the thickness of the plastic it requires time may be less or more during drying. Then the plastic will be kept in a cool, dry place. After 10 days, bioplastic in sheet form was obtained as shown in 33.13.1.1DSC analysis coupled with TGA performed in TA-Instrument SDT650. The weight of the specimen was in the range of 10–25mg and the temperature increased by 5 °C per minute starting from 30 °C up to 500 °C.3.1.22 in size, of each bioplastic were fractured after immersion in liquid nitrogen and randomly broken to investigate the surface of the samples. Cryo-fractured samples were mounted on aluminum stubs and fixed on the support using double-sided adhesive tape. Finally, samples were gold palladium coated and observed using an accelerating voltage of 10 kV and a working distance of 10 mm.The microstructural analysis of the bioplastics was carried out using a Scanning Electron Microscope (Hitachi S-4800). Two different samples, 0.5 cm3.1.3The FTIR measures were carried out on a Perkin Elmer Spectrum One spectrometer coupled to an Auto Image light microscope. These analyses were performed on samples of starch bioplastic and composites bioplastics.3.1.4Tensile tests were performed using the CMT-10 Computer Control Electronic Universal Testing Machine. Tensile strength (TS) and elongation were determined from the stress-strain curves, estimated from force-distance data obtained for the different and a strain rate of 2 mm/min at room temperature. All mechanical testing of bioplastics was conditional according to the standard method of ASTM-D638-14. The sample Width of narrow section was 13mm, length of narrow section 57mm, overall length 165mm, thickness 3.5mm and gage length 50mm. There are three specimens ware tested for each sample.3.1.5Surtronic S128 surface roughness tester is used to analyze the surface roughness parameters of starch bioplastic and composite bioplastic.3.1.62 composite bioplastic of dimensions 50 mm × 30 mm × 3 mm were placed in the soil at a depth of 10cm. The soil was placed in the laboratory, and the moisture of the soil was maintained by sprinkling water at regular time intervals. The degradation rate of the soil burial test was calculated from weight loss of the sample over time. The biodegradation weight loss was determined for seven days interval by using the following equation-i is the initial mass and Mf is the final mass of the sample after drying.This analysis was carried out according to the methodology reported by M. Maiti et al. 44.12 granules. This morphology is typical of incompatible blends, resulting in a poor tensile property. A similar finding was offered by Selene Harunsyah et al. The surface microstructure of composites bioplastics was studied with SEM and 3D AFM micrographs with RMS roughness . Analyse2 granules is higher in composite bioplastic than starch bioplastic. The surface roughness starch bioplastic increased and the uniformity decreased by the TiO2 nanoparticles. Fewer voids, holes, and crack shows better compatible morphologies in starch composite bioplastic compared to starch bioplastic.The starch bioplastic presented a uniform and smoother surface than starch composite bioplastic. The presence of the remaining part of the starch particle and non-gelatinized TiO4.2−1 was the OH stretching. A small peak near 1643.22 cm−1 was due to the C=O stretching and a peak at 1740 cm−1 suggested the presence of a carbonyl group in the film. The peak at 2926.31 cm−1 corresponded to the C–H stretching. The bands from 704.27 to 1014.48 cm−1 corresponded to the C–O bond stretching.The FTIR spectra of corn starch bioplastic are shown in −1 is determined to stretching vibrational band of free –OH groups. It indicates an increase in the number of hydrogen bonds between TiO2 and hydroxyl groups of the plastics components. The other probable reason was the electrostatic interactions (O⋯Ti) between –OH groups of starch and Ti2+ atoms. The absorption band of the C–H and C–O–H bending are shown at the wavenumbers 2932.52 and 1152.92 cm−1 respectively, Similarly, Seyed Amir et al. −1, it is confirming the possible electrostatic interaction between the starch chains and titanium dioxide.In the FTIR spectrum of composite bioplastic, the absorption peaks at 3270.17 cm4.3Thermogravimetric analysis (TGA) of starch bioplastic and composite bioplastic decomposition graphs is shown in 2 is fully decomposed at 410 °C.TGA of the bioplastic composite shows two-step degradation. The first step is attributed to the evaporation of moisture contained in the starch-based bioplastic composite and the second stage between 240-410 °C indicate thermal decomposition of composite bioplastic TiO50% (temperature at which 50% of weight loss occurred) are at 250 °C and 310 °C, respectively for yam and potato bioplastics. The overall results of the thermal and physical properties analysis of the bio-plastic can be concluded that the major loss in the weight is 4–70% with titanium dioxide reinforcement and 2–87% without TiO2 within the range of 30 °C–500 °C. The decomposition temperature of composite bioplastic is higher than starch bioplastic. It can be concluded that starch bioplastic increases the decomposition temperature when adding TiO2 nanoparticles as well as indicates that composite bioplastic has greater heat stability compared to starch bioplastic.The decomposition graphs of starch bioplastic and composite bioplastic are shown the 50% of weight loss occurred at 291 °C and 303 °C, respectively for starch bioplastic and composite bioplastics. Nurul et al. 4.4m) and glass transition temperature (Tg) of starch bioplastic and bioplastic composite were studied using DSC as shown in g) which obtained from the results of DSC measurements. The composite bioplastic had a Tg of approximately 66.8 °C which was higher Tg than starch bioplastic (57.2 °C).The thermal properties like melting temperature  indicates the consistency and miscibility of the components with biopolymer. Identifying only one Tg for all the plastic means that all substances contributing to the structure of the bioplastic have been very well spread and consistent with each other. Titanium dioxide nanoparticles were able to form chemical bonds on hydroxyl group sites of the starch chains. These strong bonds can obstruct the motion of the polymer chains and the addition of anti-plasticizers into the starch bioplastic increase the Tg. TiO2 acts as an anti-plasticizer, TiO2 significantly shifted Tg of composite bioplastic to higher temperatures. Similar to Tg, the melting point (Tm) of the composite bioplastic was significantly affected by the presence of TiO2 and its values increased when the bioplastic was reinforced with TiO2. According to Seyed et al. 2 nanoparticles and the amorphous region of the chain.The higher the T4.52 nanoparticles. The reason for this behavior can be anti-plasticization. Similar findings were reported by Seyed Amir et al. 4.6t), maximum peak height (Rp) and maximum valley depth (Rv) of starch bioplastic was found to be 5.50 μm, 1.5 μm, and 2.0 μm, respectively. Average roughness, Maximum height of roughness (Rt), maximum valley depth (Rv) and maximum peak height (Rp) of composite bioplastic were found to be 1.0 μm, 10 μm, 2.0 μm, and 3.5 μm, respectively  and glass transition temperature (Tg) of composite bioplastic showed a tendency to a higher than starch bioplastic, Which can be favorable for the packaging system. TGA indicates that the composite bioplastics have higher heat stability than the starch bioplastics. Soil burial biodegradation test indicates the biodegradability of starch bioplastic is more than composite bioplastic and also both plastics are highly biodegradable. By adding TiO2 to starch bioplastics, its properties have been improved. The preparation of starch bioplastic and composites bioplastic with better thermal, mechanical and chemical properties is a significant achievement. These products can be a appropriate alternative for the existing conventional plastics for its high biodegradable properties with suitable thermal and mechanical properties. Also starch is a renewable resource, cheap and easy to modify. Titanium dioxide nanoparticles have antimicrobial properties and composite bioplastics can be considered suitable for the food and pharmaceutical industry considering the experimental results. It will reduce reliance on petroleum polymers and environmental problems like today will not be intense.In this study, it can be ascertained that starch-based bioplastics and composite bioplastic have been successfully characterizied by various analysis. The composite bioplastic is stronger than starch bioplastic with increased tensile strength and reduced elongation. From FTIR analysis the absorption band of the C–H and C–O–H at 2932 cmMd. Ruhul Amin: Conceived and designed the experiments; Wrote the paper.Asaduzzaman Chowdhur: Contributed reagents, materials, analysis tools or data.Md. Arefin Kowser: Performed the experiments.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.The authors declare no conflict of interest.No additional information is available for this paper.


Vibrio cholerae O1 and O139 organisms  are playing a central role in global cholera control strategies. OCV is currently administered in a 2-dose regimen (day 0 and 14). There is a growing body of evidence that immune responses targeting the O-specific polysaccharide (OSP) of V. cholerae mediate protection against cholera. There are limited data on anti-OSP responses in recipients of Biv-OCV. We assessed serum antibody responses against O1 OSP, as well as antibody secreting cell (ASC) responses  and memory B cell responses in blood of adult recipients of Biv-OCV in Dhaka, Bangladesh.Oral cholera vaccine (OCV) containing killed We enrolled 30 healthy adults in this study and administered two doses of OCV (Shanchol) at days 0 and 14. Blood samples were collected before vaccination (day 0) and 7 days after each vaccination (day 7 and day 21), as well as on day 44. Serum responses were largely IgA with minimal IgG and IgM responses in this population. There was no appreciable boosting following day 14 vaccination. There were significant anti-OSP IgA ASC responses on day 7 following the first vaccination, but none after the second immunization. Anti-OSP IgA memory B cell responses were detectable 30 days after completion of the vaccination series, with no evident induction of IgG memory responses. In this population, anti-Ogawa OSP responses were more prominent than anti-Inaba responses, perhaps reflecting impact of previous exposure. Serum anti-OSP responses returned to baseline within 30 days of completing the vaccine series.Our results call into question the utility of the 2-dose regimen separated by 14 days in adults in cholera endemic areas, and also suggest that Biv-OCV-induced immune responses targeting OSP are largely IgA in this highly endemic cholera area. Studies in children in cholera-endemic areas need to be performed. Protective efficacy that extends for more than a month after vaccination presumably is mediated by direct mucosal immune response which is not assessed in this study. Our results suggest a single dose of OCV in adults in a cholera endemic zone may be sufficient to mediate at least short-term protection. Vibrio cholerae, remains a global public health concern for many developing countries. Immune responses targeting the O-specific polysaccharide (OSP) of V. cholerae are involved in mediating protection against cholera. Evidence suggests that inactivated whole-cell oral cholera vaccine (OCV) that includes killed V. cholerae O1 and O139 organisms provides protection against cholera caused by V. cholerae O1, but the immune correlates of this protection are not fully defined. In this study, we specifically assessed induction of immune responses targeting V. cholerae O1 OSP following vaccination with the OCV in adults in a cholera endemic area, Bangladesh. Our results show that OCV induces serum, mucosal and memory anti-OSP responses, and that these responses are maximal following the first dose of vaccination, without evident boosting with the second dose. This result calls into question the day 0 and day 14 two dose regimen currently used among adults in a cholera-endemic zone.Cholera, which can be a severe watery diarrheal illness caused by the non-invasive bacterium  Vibrio cholerae, remains a leading public health problem for many of the world’s impoverished individuals [V. cholerae have been characterized to date, but in most recent years serogroups O1 has been the cause of epidemic cholera [V. cholerae O1; the prevalent serotype of El Tor V. cholerae O1 often fluctuates between and even during cholera outbreaks, switching between Ogawa and Inaba [O-methyl group in the Inaba type in the terminal carbohydrate of the O-specific polysaccharide (OSP) in the lipopolysaccharide (LPS) moiety [V. cholerae OSP, the primary determinant of LPS antigen specificity, may play a central role in mediating such protection [Cholera, a dehydrating diarrheal illness that is caused by the bacterium ividuals . More th cholera , 3. Base cholera . The cland Inaba . The dif) moiety , 7. Evidotection , 3, 8.V. cholerae O1, as well as V. cholerae serogroup O139 organisms [V. cholerae O1 and also the recombinant cholera toxin B subunit [Among the three World Health Organization (WHO) pre-qualified and commercially available OCVs, our primary focus for this study was on Shanchol , which is an inactivated bi-valent whole cell vaccine containing both biotypes and serotypes of rganisms . Despiterganisms –14 compa subunit . As a reV. cholerae O1 OSP at different time points following vaccination with Shanchol among healthy adult participants in Bangladesh. Memory B cells (MBC) develop following a variety of natural infections and immunizations, and may be a mechanism by which long-term immunity to cholera is mediated [V. cholerae MBC responses. We present here evidence of the development of systemic and mucosal immune responses to OSP, as well as a circulating OSP-specific IgA MBC population after vaccination.In this study, to determine whether vaccination with Shanchol induced significant systemic and mucosal immune responses, we measured vibriocidal antibody responses, antigen specific-plasma antibody responses, and levels of antibody-secreting cell (ASC) responses against mediated . TherefoShanchol is pre-qualified by the WHO and is recommended to be used in populations at risk for outbreaks such as Bangladesh. We obtained approval for this study from the Research Review Committee and Ethical Review Committee of the icddr,b and the Institutional Review Board of the Massachusetts General Hospital. Informed written consent was obtained from all participants prior to enrollment.V. cholerae O1 Ogawa and Inaba O-specific polysaccharide (OSP) were assessed. We also assessed circulating antigen-specific IgA and IgG ASCs at day 7 and day 21 in isolated peripheral blood mononuclear cells (PBMCs). Antigen (OSP)-specific IgA and IgG MBC levels were measured from PBMCs of vaccinees at day 0 and day 44.A total of 30 adult healthy volunteers were enrolled in this study. Participants were administered two doses of Shanchol at a 14-day interval (at day 0 and day 14). Blood specimens were collected from the participants on day 0 (before vaccination), day 7 (7 days after first vaccination), day 21 (7 days after second vaccination), and day 44. At each time point, vibriocidal antibodies and IgA, IgG, and IgM antibodies in plasma to o C until used in immunologic assays. PBMCs were re-suspended at a concentration of 1×107 cells/ml in RPMI-complete medium containing RPMI 1640  and 10% heat-inactivated fetal bovine serum . The cells were then immediately used for the enzyme-linked immunospot (ELISPOT) assay to determine ASC responses, and cells were also cultured for MBC responses as described below.Sodium-heparinized blood was diluted two-fold with phosphate buffered saline . PBMCs and plasma were separated by density gradient centrifugation using Ficoll-Isopaque . Isolated plasma specimens were frozen at– 20V. cholerae O1 Ogawa (X-25049) and V. cholerae O1 Inaba (T-19479) as the target organisms [Vibriocidal antibody responses in plasma at each time point were assessed as previously described using rganisms . The vibV. cholerae O1 Ogawa OSP: BSA (1 μg/ml) or with V. cholerae O1 Inaba OSP: BSA (1 μg/ml) dissolved in bicarbonate buffer (pH 9.6–9.8). OSP Inaba and Ogawa were generated from V. cholerae O1 El Tor PIC018 and PIC158, respectively, as previously described [Plasma IgA, IgG and IgM antibody responses to OSP were assessed at each time point using standardized protocols of enzyme-linked immunosorbent assays (ELISA), as described previously , 12. In escribed , 20.V. cholerae antigen-specific responses, nitrocellulose plates were also coated with 100 μl of the following antigens: V. cholerae O1 Ogawa and Inaba OSP: BSA (10 μg/ml), and, as a negative control, keyhole limpet hemocyanin . To detect IgG and IgA ASCs, alkaline phosphatase-conjugated mouse anti-human IgG  and horseradish peroxidase-conjugated IgA , each diluted 1:500 in sterile filtered PBS-1%-FBS-tween-0.05%, were added to the plates. Following overnight incubation at 4°C, plates were developed with 5-bromo-4-chloro-3-indolylphosphate-nitroblue tetrazolium , and 3-amino-9-ethylcarbazole , respectively. Two individuals using a stereomicroscope independently quantified IgG and IgA ASC numbers based on the different colored spots. We expressed the number of antigen-specific IgG and IgA ASC as the percentage of the total circulating ASC of the same antibody isotype at the same time point.ASC responses were measured by ELISPOT assay as described previously . To meas5 PBMCs/well were placed in cell culture plates  containing culture media including RPMI 1640, 10% FBS, 2 mM L-glutamine, 200 units/ml penicillin, 200 mg/ml streptomycin, and 50 mM beta-mercaptoethanol. For stimulating antigen-independent proliferation and differentiation of MBCs into ASCs, a mixture of three B-cell mitogens containing 6 μg/ml CpG oligonucleotide , a 1/100,000 dilution of crude pokeweed mitogen extract, and a 1/10,000 dilution of fixed Staphylococcus aureus Cowan  was added to all wells except those being used as negative controls, to which only media was added. Culture plates were incubated at 37°C in 5% CO2 for 5–6 days; then the cells were harvested and washed. For the MBC ELISPOT assay, ELISPOT plates were coated as above with anti-human immunoglobulin, OSP or KLH and 20% of the cells from each culture plate well were added for detection of total ASC and 80% were used for detection of antigen-specific ASC. These plates were then incubated for 5 hours at 37°C in 5% CO2, and the plates were washed, and horseradish peroxidase-conjugated goat anti-human IgA or IgG  was added at a dilution of 1:500. Plates were incubated overnight at 4°C. On the following day, plates were developed with 3-amino-9-ethyl carbazole (AEC). ELISPOT counts were expressed as the percentage of antigen-specific MBCs out of the total MBCs of that isotype at the same time point. Appropriate stimulation of PBMC was defined as a 3-fold increase in the number of total MBCs after stimulation compared to un-stimulated cells. The limits of detection for responders for antigen-specific IgA and IgG were defined as 0.004% and 0.001%, respectively, per 5x105 PBMC after 6 days of stimulation [MBC assays were performed using PBMCs on day 0 and day 44 as previously described , 22, 23.mulation , 24. We mulation .2 or Fisher’s Exact test. Data analysis and figure preparation were performed using Graphpad Prism 5.0 .We assessed the differences in the magnitude of responses within a group using Wilcoxon signed-rank t tests. All reported P values were two-tailed, with a cutoff of P ≤ 0.05 considered a threshold for statistical significance. Seroconversions were compared using the χThirty healthy adult individuals were enrolled in this study . Blood sVibriocidal seroconversion was observed at all time points from day 7 onwards, although the highest seroconversion frequency (Ogawa: 71% and Inaba: 79%) was seen at day 7 following the first vaccination. We stratified participants based on their baseline vibriocidal titer and found that those with a baseline (day 0) titer > 80 had a lower seroconversion rate compared to those who had a baseline titer ≤ 80 .We assessed antibody responses to Ogawa and Inaba OSP in plasma. Vaccinees had IgA, IgG and IgM plasma responses to Ogawa OSP that were significantly higher at day 7 and day 21 than the baseline values (P ≤ 0.05) , but theWe detected OSP-specific IgA ASC responses in PBMCs from a subset of participants . IgA ASCWe assessed OSP-specific MBC responses at day 0 and day 44 in vaccinees . We deteThis study for the first time characterizes OSP-specific serum, mucosal and memory B cell responses in adults vaccinated with two doses of an oral cholera vaccine, Shanchol, in Bangladesh where it has been shown that OSP-specific serum and mucosal immune responses, as well as IgA memory B cell responses are maximal following the first dose of vaccination, without evident boosting with the second dose.Cholera has continued to be a significant problem globally, with large scale epidemics in Haiti in 2010 as well as in sub-Saharan Africa , 27. At V. cholerae in this endemic area. However, a second dose of vaccine did not provide any immunological boosting, perhaps suggesting that despite having low baseline vibriocidals, many adults in this endemic area had already been primed by previous exposure and had an anamnestic response after first vaccination, so that additional boosting was not seen after the second vaccination.The serum vibriocidal antibody has previously been the best characterized immunologic correlate of protection against cholera , 42. VibV. cholerae is a non-invasive pathogen and does not enter the body beyond colonization of intestinal mucosal tissue, protective immunity against this pathogen is more likely mediated by antigen-specific immune responses at the mucosal surface rather than by vibriocidal activity in serum [V. cholerae develop prominent serum immune responses to OSP and that these anti-OSP responses, particularly IgM anti-OSP responses, correlate with the serum vibriocidal activity [V. cholerae O1 in U.S. volunteers [Because in serum . We haveactivity . We haveactivity . We havelunteers , though lunteers , 37, 47.Because cholera is a mucosal infection, gut homing IgA antibody-secreting cell (ASC) responses in blood shortly after infection may also play a role in mediating protective immunity when they return to intestinal tissue . PreviouSerum and ASC responses following cholera, however, are short-lived , 24, sugV. cholerae. Whether individuals vaccinated with OCV in a non-endemic area would have similar results is not known. Second, all of our participants were adults and how immune responses measured here would differ in children is unknown. Third, we measured ASCs and MBCs in blood and did not directly assess mucosal immune responses, either mucosal memory B cells or long-lived plasma cells, in these volunteers receiving vaccine. Despite these limitations, this is the first study characterizing OSP-specific immune responses in adults receiving two doses of the OCV-Shanchol in Bangladesh and suggests that vaccination produces IgA OSP-specific circulating and mucosal antibody responses as well as MBC responses. Our results call into question the utility of the current two dose vaccination regimen separated by 14 days and support the observation that a single dose of OCV in adults in highly cholera endemic areas may be sufficient to mediate at least short term protection against cholera. For maintaining the long term protection single dose OCV could be administered every year or two. But further studies with more data need to be done to assess the association between immune responses and protection, particularly in children, because children are the most vulnerable population to cholera where the disease is endemic.Our study has a number of limitations. First, our volunteers were all vaccinated in Bangladesh, a country endemic area for cholera, suggesting many of the vaccinees may have had previous exposure to S1 FigOgawa OSP responses to (A) Immunoglobulin A (IgA), (B) IgG, and (C) IgM and Inaba OSP responses to (D) IgA, (E) IgG, and (F) IgM. Each single dot indicates an individual OSP ELISA unit; horizontal bars represent geometric mean (GM) and error bars indicate 95% confidence intervals. The Wilcoxon signed-rank test was used for analyses of the data. Asterisks indicate a statistically significant difference from baseline level (day 0) (P ≤ 0.05).(TIF)Click here for additional data file.S2 FigOgawa OSP responses to (A) IgA, (B) IgG, and (C) IgM and Inaba OSP responses to (D) IgA, (E) IgG, and (F) IgM. Each single dot indicates an individual OSP ELISA unit; horizontal bars represent geometric mean (GM) and error bars indicate 95% confidence intervals. The Wilcoxon signed-rank test was used for analyses of the data.(TIF)Click here for additional data file.


The aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom.Electronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings.There were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK.Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses’ and doctors’ migration is different.Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants’ integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes.Migration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.The online version of this article (10.1186/s12960-018-0293-9) contains supplementary material, which is available to authorized users. International migration of human resources for health (HRH) affects individuals themselves and has an impact on both the source and destination countries’ health systems by affecting service provision, health policies , 2, workn = 2, 121) in 1993 to 53%  in 2001/2002 and decreased to 30%  in 2016 [n = 11, 106) of new registrants in early 2003 and subsequently decreased to 41%  in 2016 [n = 524) in 2001 to 66%  in 2005 and then decreased to 35% (n = 795) in 2016 [In sharp contrast, NHS England’s 2016) workforce planning, along with other measures, aims to recruit 500 international doctors through an international recruitment campaign to meet the targets of extra 5 000 doctors by 2020  workforc. Data fo 30% n = , 785 in  in 2016 . RetentiThe aim of this systematic review was to examine the migration motives, barriers to and facilitators of integration of international nurses, doctors and dentists to the UK, to inform policies on international recruitment, retention of workforce and identify future workforce planning research gaps. Along with retention of this international workforce in the NHS, their integration, training and support are required to maintain patient safety. Understanding barriers to and facilitators of integration for this mobile workforce will help to inform future research into suitable adaption processes.A review protocol was designed Table  followinThe lack of universally accepted definitions to the search terms was recognised and the variation in their use in the titles resulted in non-identification of relevant papers which was overcome by hand searching the references in key papers. The papers were initially selected by means of their titles. Abstracts of all the selected papers were read by two authors  and 137 papers were shortlisted. An eligibility checklist  . A samplMeta-synthesis of the qualitative data was carried out using framework synthesis which has successfully been used to inform policy and practice in health sciences where a conceptual framework is used to map and analyse the data . FramewoThe framework of Young’s model of macro- , meso- (profession led factors) and micro-level  drivers of migration  was usedThe number of papers screened, assessed for eligibility and included in the review, together with details of exclusions, is presented in the PRISMA flow diagram Fig. . There wA summary of the study methods, type of participants, methodological approach, sample sizes, sampling process, study settings and the country of primary qualification in the 31 papers selected for this review is presented in Table n = 15) out of the 31 studies were scored high and a similar number (n = 14) as moderate, with only two papers scored as low. The second reviewer (DRR) scored 8 out of the 31 papers (25%). Percent agreement between the reviewers was 0.78, with 100% inter-rater agreement with kappa score of 1 for the overall score for each paper. The agreement was high for study design, sampling, data collection, ethical matters and results and the differences arose in evaluating the discussion section which may be due to second rater having more experience in evaluating qualitative papers. Papers were scored lower when the abstracts did not reflect the outcomes and when there was no clarity on the rationale of the chosen research design or methodology or researchers’ philosophical approaches to qualitative research.The quality of the studies was assessed in line with CCAT score resulting in high (≥ 31–40), moderate (21–30) and low (≤ 20) scores. Almost half  , and socThe nurses in the UK reported multi-level discrimination, whilst doctors reported less individual and more institutional discrimination resulting in career stagnation. This may be as a result of nurses being in direct contact with patients for longer periods of time and the struggle to control the work environment in hospitals with established hierarchy based on race and gender, whilst doctors had more control on their work environment . MigrantIt is important that organisations involved in the registration and employment of international HRH, have fair systems in place to recognise HRH international education and training to improve their integration , 55. RetThere have been systematic reviews of international HRH in OECD countries, Australia, Canada and USA but none have focused on qualitative outcomes involving the nurses, doctors and the dentists working in the UK, using formal review criteria for this timeframe. Meta-synthesis of qualitative data using framework synthesis can identify the common recurring themes in a broad context and therefore help policy decisions. This review is limited by the lack of literature on the dental workforce and draws on limited publications in the medical and nursing literature in the UK. It highlights lack of publications, which may be due to publication bias towards workforce research and qualitative research or a lack of research in this area.Systematic reviews on migration of HRH, in the literature, have focused on trends in workforce migration , but notThis review is considered timely as the UK prepares to leave the EU, with implications on recruitment of EU health professionals, whilst the NHS is still reliant on international professionals to meet the workforce deficit. There is a lack of qualitative literature on international doctors’ and dentists’ migration and integration compared with nurses, despite their contributions to the UK workforce. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuates migration into the UK, but the extent to which each of these drivers influence nurses and doctors migration is different.Integration experiences for international nurses and doctors differed as nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared with doctors. A better understanding of the migration motives and integration experiences of different health care professions will help form policies that are bespoke and therefore more effective in recruitment and retention, which in turn will help reduce UK’s reliance on international workforce. Understanding the barriers to and facilitators of integration for each of these professions is also important for migrants, employers and policy makers to develop a personalised health care system that can meet the sustainable development goals of the WHO Global workforce strategy. Further research into the dental workforce is clearly required.Additional file 1:Electronic search sample using PubMed. (DOCX 14 kb)Additional file 2:Eligibility screening checklist. (PDF 408 kb)Additional file 3:Quality scoring summary. (XLSX 34 kb)


Idiopathic full-thickness macular hole is a severe visual impairment disease. Pars plana vitrectomy remains the primary treatment option for idiopathic full-thickness macular holes, and over 90% idiopathic full-thickness macular holes are closed by vitrectomy surgery. However, the full-thickness macular hole may close spontaneously, with a good visual acuity progress. Since recent studies are small-sample studies and case reports, the characteristics for spontaneous closure of idiopathic full-thickness macular holes are not fully understood. Here, we review the articles in PubMed database from 1999 to 2018 and discuss the characteristic and the risk factors, especially OCT structure features, for spontaneous closure of idiopathic full-thickness macular holes. Idiopathic macular hole (IMH) is a kind of disease that seriously affects the visual quality of patients, showing obvious central visual loss and visual deformation. The AAO guidelines suggest that stage 2–4 IMHs have a good prognosis after vitrectomy surgery, which can effectively improve the central vision acuity and reduce metamorphopsia. The closure rate after vitrectomy has been reported to be from 91% to 98% in the last 5 years [A structured literature search in PubMed was performed on October 1, 2018, and a search strategy of “((spontaneous closure) OR (spontaneous closed) OR (spontaneous resolution)) AND (macular hole)” executed in “title and/or abstract” was applied. We also checked all the references of relevant reviews and eligible articles that our search retrieved. Language restrictions were not used. Title and abstract screening of all retrieved articles was performed using prespecified criteria. Studies were included if all following criteria were fulfilled: (1) adults with IMHs and (2) the IMH closed spontaneously during the follow-ups. Criteria for exclusion were as follows: (1) adults with systemic diseases, such as diabetes and hypertension; (2) adults with ophthalmic diseases, glaucoma, high myopia, diabetic retinopathy, etc.; (3) adults with a history of ophthalmology surgery; and (4) surgery and drug intervention performed during the period from the onset of IMHs to closure.We identified and screened a total of 186 articles and found 78 relevant articles. Among these, 30 articles were excluded for non-IMHs. 11 articles were excluded because patients also suffered from other ophthalmic diseases. 8 articles were excluded because the cases were not described in detail. Finally, we included 21 articles, including 58 eyes in 54 patients.μm. The results of this query are shown in In our statistical result, the average age of spontaneous closure of IMHs was 69.0 ± 6.4 (50–81). Complete data on gender were recorded in 38 reports, with 26 females and 12 males. The stages of IMHs were described in 41 eyes, with 21 stage II, 13 stage III, and 7 stage IV IMHs. The course of disease (the time between patients' description of symptoms and visit time) ranged from 5 days to 31 months, with an average of 96.1 ± 178.0 d. The closure time was 100.9 ± 98.3 d on average. Follow-up time ranged from 3 months to 49 months. The average initial BCVA was 0.36 ± 0.20, and the average final BCVA after spontaneous closure of MH was 0.70 ± 0.17. The average diameter of MH was 178.6 ± 77.3 The incidence of spontaneous closure of idiopathic macular holes varies from 4% to 11.5%. Yuzawa et al. retrospected 97 eyes with full-thickness IMH for a period ranging from 2 to 182 months, and 6 eyes (6.2%) showed spontaneous closure within 24 months of the initial examination . A multiSo far, no researches have mentioned that basal characteristics, such as age, gender, and the course of disease, have relationship with spontaneous closure of IMHs. Among these, the age of patients reported by most of the articles was greater than 60, except a 50-year-old case reported by Kelkar et al. . The aveAll cases with a spontaneous closure of IMHs acquired progress in visual acuity. The average initial BCVA was 0.36 ± 0.20, and the average final BCVA after spontaneous closure of MH was 0.70 ± 0.17. This shows that the spontaneous closure of MH may gain a well visual acuity, and the influencing characteristic needs to be explored.μm diameter have more opportunity to close spontaneously [μm in 13 patients, except in one patient who had a 350 μm macular hole [μm and that in 13 IMHs are between 250 μm and 400 μm. It seems that the small diameter of IMHs gives the chance to both edges of the IMHs to combine together. Also, in a case studied by Fernández and Navarro [Many articles mentioned that the spontaneous closure occurred in IMHs with a relatively small diameter. Sugiyama et al. suggested that MHs of less than 250 aneously . Privat lar hole . In our  Navarro , the minIt is widely believed that spontaneous release of the vitreomacular traction (VMT) may account for the closure of IMHs , which iPrevious literature has suggested that some of the edges of macular holes become sharp and stretch out bridge-like structure. This sharp edge was stated by Michalewska et al. , who belFew articles found the epiretinal membrane formation during the spontaneous closure of MH. Smiddy  and PetrIn the meantime, there are some spontaneously closed macular holes with cystic structure . This kiResent studies has focus on the autofluorescence and OCT angiography in macular hole closure. Zhang et al. believed that postoperative area of high AF in macula can be an evaluating indicator for poor macular function recovery . Teng etμm, especially less than 250 μm, may have more chance to close spontaneously. Also, these spontaneously closed macular holes have some distinctive OCT characteristics, such as the relieve of VMT, bridge-like structure, epiretinal membrane, and cystic structure. In our review results, these characteristics give the macular hole tendency to close spontaneously. Although these characteristics may not be irreplaceable and unique risk factors, they give the doctor a consideration to observe for a few months before surgery. Further research is needed to understand the pathophysiology underlying the development of spontaneous closure of idiopathic full-thickness macular holes [In conclusion, there exists a percentage of idiopathic full-thickness macular holes to be spontaneously closed, which occur in about 3 to 4 months after initial examination. The macular hole with the diameter of less than 400 ar holes , 34.