Graft failure was associated with a younger patient age. Functional vision was achieved in 53.3% of patients. Conclusions: The management of congenital glaucoma and its corneal complications is a delicate issue that requires great effort. PKP in congenital glaucoma was moderately successful in the present study. To provide functional vision, PKP could be the treatment of choice.Background: Childhood glaucoma is one of the most common causes of corneal opacity in childhood and is associated with various pathological corneal changes, including corneal enlargement, corneal clouding, and edema. Congenital glaucoma (CG) may cause a decrease in vision outcomes due to corneal opacity or clouding, which is often associated with stimulus deprivation amblyopia. Therefore, to create a balance between preventing amblyopia and sustaining corneal clearance, patients with CG can be managed with early penetrating corneal transplantation surgery along with advanced glaucoma management. Aim: To investigate the graft survival rate and factors affecting graft survival in patients with congenital glaucoma who underwent penetrating keratoplasty (PKP). Study Design: Cross-sectional. Materials and Methods: Patients with congenital glaucoma who underwent PKP were retrospectively evaluated. The associations between age, corneal diameter, presence of ocular comorbidities, concurrent ocular surgeries with corneal graft, and visual outcomes were assessed. Results: Among the 30 eyes enrolled in the study, 6 (20%) had aniridia, 6 (20%) had Axenfeld–Rieger syndrome, and 18 (60%) were diagnosed with primary congenital glaucoma. Graft survival rates were 66.6% and 63.33% at 12 and 24 months, respectively. At the end of the follow-up, the overall graft survival rate was 60%. Statistical significance was observed between patient age at the time of surgery and graft failure ( Childhood glaucoma, a developmental anomaly of the anterior segment, is one of the most common causes of corneal opacity in childhood . It is aTo create a balance between preventing amblyopia and sustaining corneal clearance, patients with CG can be managed with early penetrating corneal transplantation surgery along with advanced glaucoma management ,6. The sIn this study, we evaluated a large case series of patients diagnosed with different types of CG who required PKP. We analyzed primary etiologies, anatomic corneal features, additional surgeries, and other factors with respect to their effects on graft survival.In this retrospective study, 28 CG patients diagnosed with primary congenital glaucoma (PCG), aniridia, and Axenfeld–Rieger syndrome who underwent corneal transplantation were enrolled. Thirty eyes that underwent PKP were included in the transplant survival analysis and were the focus of this study. The records from 2000 to 2020 were screened at the Tamçelik Glaucoma Center, Istanbul, Turkey. The study followed the tenets of the Declaration of Helsinki and was approved by the institutional ethics committee (07/10/2020-68125). Subjects, or their legal guardians in applicable cases, signed a consent form before participation.Congenital glaucoma diagnoses were recorded from the charts. The diagnosis was made based on the following ocular findings: elevated IOP (>18 mmHg), buphthalmos, Haab’s striae, corneal stromal edema, and glaucomatous optic disc change, which had been present at birth or after birth. Patients with childhood glaucoma or juvenile onset were excluded. Medical records were screened for age, sex, surgical indications, primary diagnosis, procedure side, associated surgical procedures, preoperative or postoperative glaucoma, preoperative and last-visit vision, graft clarity, time to graft failure, major postoperative complications and rejection episodes, and outcomes. The associations between age, ocular pressure at the time of surgery, corneal diameter, the presence of ocular comorbidities, and concurrent ocular surgeries with corneal graft outcomes were evaluated. Visual outcomes were also assessed.Proper control of IOP was provided for all patients, and only patients with controlled IOP (IOP ≤ 18 mmHg) underwent PKP. In patients with uncontrolled IOP, IOP control was achieved with topical medical treatment IOP or surgical treatment before proceeding with PKP. Surgical treatment options to control IOP prior to PKP included trabeculectomy with or without Mitomycin C or Ahmed glaucoma valve implantation.Corneal graft failure was defined as the presence of corneal central opacity that was no longer compatible with good visual function. Visual function was recorded as the best visual acuity measured during the first and last visits. In children with insufficient verbal or cognitive skills, the ability to fixate on and follow visual targets was measured. Low vision evaluation was classified into light perception, hand movement, and finger count. Light perception was recorded as 0.002 on the decimal scale and 2.70 on the logarithm of the minimum angle of resolution (LogMAR) scale. Hand movement was recorded as 0.0063 on the decimal scale and 2.20 on the LogMAR scale .All surgeries were performed under general anesthesia by an experienced corneal transplant surgeon. Corneas were preserved in Optisol . Trephination was manual, with a difference in diameter between the recipient and donor between 0.50 and 0.75 mm. The transplant was sutured using 16–24 interrupted mononylon 10-0 sutures. Subconjunctival antibiotics and steroids were applied at the end of the procedure, and the occlusion was maintained for 24 h.Topical antibiotics and corticosteroids were administered postoperatively. Sutures were removed between 6 and 8 weeks postoperatively in patients under 2 years of age, between 8 and 12 weeks in patients aged 3–5 years, and up to 1 year postoperatively in patients over 5 years. Optical correction with spectacles and amblyopia treatment was initiated as soon as possible. All loose sutures were removed when observed, and complications were promptly treated.Graft rejection was determined when corneal clarity was irreversibly lost in the absence of other potential causes. When multiple PKPs were performed on a patient, the first surgery was considered for analysis. Regular visits were scheduled in the glaucoma clinic after the surgery. When an optimal exam was not feasible, examinations were performed under general anesthesia. IOP measurements below 18 mmHg, with or without medication, were considered successful IOP management. A clear graft was defined as the absence of corneal edema, which provided a clear view of the underlying anterior segment chamber details. The graft survival time was defined as the period from PKP to the day when the diagnosis of graft failure occurred or was last recorded during postoperative clinical visits. All patients were followed up for at least 12 months after the surgery.p-value was below 0.05 were evaluated as statistically significant results.Statistical analyses were performed using IBM SPSS Statistics software . The Kaplan–Meier and Cox models for survival were used to evaluate the correlation between graft survival time and corneal opacity, diagnosis, age at surgery, and rejection. Survival curves were compared using the Mantel–Cox and Breslow tests. Specifically, for patients with congenital opacity, the effects of age during surgery on graft survival were evaluated. A Cox model was used to simultaneously assess the correlation between graft survival time and corneal opacity, diagnosis, rejection, and age at surgery. Descriptive analyses were presented using means and standard deviations (SDs), as the variables were normally distributed. T-tests were used to compare two independent groups with normal distribution. Pearson’s correlation was used to assess the relationship between the time until rejection and the age at which the PKP was performed. Situations where the In the study, 30 eyes of 28 patients were included: 13 patients (46.42%) were male and 15 (53.57%) were female. Of the sample, six eyes (20%) had aniridia, six (20%) had Axenfeld–Rieger syndrome, and eighteen (60%) were diagnosed with PCG. At the time of PKP, the median age was 84 [138] months . The mean follow-up time was 116.43 ± 72.19 months . The average time to graft failure after initial PKP was 22.25 ± 39.61 months (range 3–120 months). Two patients underwent concomitant lensectomy with PKP, and one developed graft failure 6 months after PKP. This patient was regrafted, and the cornea remained clear during the three-year follow-up period.Graft failure occurred after PKP in 12 of 30 eyes (40%); among these 12 eyes, 5 underwent regrafting, and 3 regrafted corneas had graft failure again. Failures occurred mainly within the first year after PKP (10 of 12 grafts failed within the first year of PKP). Graft survival rates were 66.6% and 63.33% at 12 and 24 months, respectively . At the p = 0.02). Graft failure was associated with a younger patient age (p = 0.49).Statistical significance was observed between patient age at the time of surgery and graft failure (ient age . Howeverp = 0.46).The median corneal diameter at the time of PKP was 13 mm . No statistical relationship was observed between corneal diameter and graft failure . The average glaucoma medication used to control IOP was 1.83 ± 1.14 per eye (range 1–3). The antiglaucomatous medications used for each patient according to the characteristics of the patient and the type of glaucoma included β blockers, α agonists, carbonic anhydrase inhibitors, and prostaglandin analogues.Before PKP, none of the patients had functional vision. After PKP, a visual acuity of 20/400 or better was achieved in 16/40 (53.3%) eyes. In the remaining 14 eyes, vision of light perception or counting fingers could be achieved .p = 0.76).Fourteen eyes (46.66%) underwent Ahmed glaucoma valve (AGV) surgery before PKP. Among the fourteen eyes with AGV, graft failure occurred in six eyes (42.85%). There was no statistical relationship between the presence of AGV and graft failure  with a mean 30-month follow-up . The lowGraft failure was found to be associated with younger age at the time of PKP in our study, which included patients with CG. Various studies have shown inconsistent graft survival rates related to age at transplantation. Some studies have reported that corneal transplantation in younger patients is associated with a higher incidence of graft failure ,14, wherSeveral studies have reported that the presence of glaucoma alone ,17,18,19Previous glaucoma surgeries have been associated with a higher incidence of graft failure ,21. ConsIt is known that concurrent glaucoma surgery with PKP is associated with poor graft survival ,13. In tA smaller recipient corneal diameter has been found to be more related to graft failure in various studies ,13. AlthVisual prognosis after PKP in congenital glaucoma patients was reported to be poor ,22. A prGraft failure occurred mostly within the first year of PKP; the time to graft failure was independent of patient age.The management of CG and its corneal complications is a delicate issue that requires great effort. With PKP, functional vision could be achieved even in patients with only light perception.In conclusion, there are various factors influencing the graft survival following PKP. In our study, we observed that younger age was the major factor affecting graft survival in patients with CG. Larger-scale studies may identify the presence of other factors that affect graft survival.


The improvement of surgical techniques in kidney transplantation aims to reduce the incidence of post-transplant complications, contributing to the reduction of hospital stay, related costs, morbidity and mortality, in addition to improving the quality of life of patients. The choice of the best technique is influenced by several factors and the most common technique for urinary tract reconstruction in transplants is performed with implantation of the ureter of the graft in the caudal position, with the anastomosis performed in the bladder. However, the kidney pole can be inverted and the graft ureter anastomosis can be performed directly on the recipient’s ureter, facilitating venous and ureteral anastomoses and reducing urological complications. The improvement of surgical techniques and the emergence of more effective immunosuppressive drugs have transformed kidney transplantation into a substitutive therapy with a high quality of life and a significant increase in survival. Despite the gradual reduction in operative morbidity, the procedure involves a wide variety of complex and detailed steps both on graft and its recipient, adding relevant surgical complications, especially those related to the urinary tractAs a general rule, the technique usually used consists of retroperitoneal implantation of the graft via an arciform incision in the iliac fossa. Vascular anastomoses are performed in an end-to-side fashion in the external iliac artery and vein,Historically, the Politano-Leadbetter intravesical ureteroneocystostomy anastomosis was used as the primary technique of ureteral reconstruction in renal transplantation. However, it has fallen out of favor due to high complication rates. Extravesical ureteroneocystostomy techniques, which avoid large openings in the bladder and have shorter operative times, have reduced complication rates from 10% to 6.3%, the Lich-Gregoir technique being the most used today. In these two techniques, the graft ureter is implanted in the usual position, that is, with the lower pole in the caudal positionThe operative management of patients, including anesthetic routine, surgical positioning, access, and preparation of the extraperitoneal space to receive the graft are performed in the usual way. In order to use the ultrashort anisoperistaltic end-to-side ureteroureterostomy technique, however, it is necessary to invert the graft, with cranial apposition of the lower renal pole, to bring the structures of the transplanted kidney closer to the homologous structures of the recipient . Following the usual sequence of anastomoses in transplants, venous and arterial anastomoses are performed. The renal artery and vein of the graft are anastomosed with the respective recipient’s external iliac artery and vein, using an atraumatic needle and 6-0 polypropylene thread in continuous suture, including all layers of the vascular wall. After graft perfusion, the ureteral anastomosis is carried out.The graft ureter is positioned cranially and very close to the native ureter, at the level of its intersection with the common iliac artery . This inHeterotopic kidney transplantation commonly involves the location of the implant in a craniocaudal position in the recipient’s iliac fossa and the creation of an extravesical ureteroneocystostomy by the Lich-Gregoir techniqueThe renal inversion strategy, first described in the early 1970s, is not common and its use raises some questions. One of them is whether this position would cause any problems in the graft’s vascularization or if it would make it difficult to drain the urinary tract, since there would be a need to leave a longer ureter in the case of bladder anastomoses. However, this is not what happens: this approach, inverting the renal poles and positioning the inferior renal pole cranially, brings the urinary structures of the transplanted kidney together with the recipient’s, facilitating the performance of the ultra-short ureteral anastomosis.,Although most kidney transplant groups reserve ureteroureterostomy as a salvage technique for kidney transplants with ureteral complications, few articles in the literature observed a lower rate of reoperation with this technique. One of the explanations is that impaired vascularization of the graft’s distal ureter would be responsible for stenosis and necrosis of the ureter’s tip, with urine leakageA major concern for surgeons who do not perform this anastomosis is how to treat potential ureteral complications, as the native ureter is no longer available for further repair. However, the opposite occurs, since the use of the native ureter allows easy endoscopic catheterization and, therefore, easy access to common endourological procedures, such as ureteroscopy, to investigate or treat any urological event. In addition, despite the anti-reflux system performed in the vesical ureteral reimplantation technique, the incidence of vesicoureteral reflux remains significant and increases the risk of recurrent urinary tract infection and pyelonephritis, consequently impairing graft functionWith the end-to-side ureteroureterostomy technique, the bladder catheter is removed on the first postoperative day, there is a lower risk of urinary tract infection, the placement of a double-J catheter is not necessary, and the endo-ureteral manipulation occurs in a physiological way, similar to non-transplanted patients, reducing the failure related to access when the implant is done in the bladder dome. The ease of this technique reduces surgical time, allows reproducibility among surgeons, and preserves the recipient’s anatomy.


Acinetobacter is a gram-negative bacterium that can cause several infections, particularly in hospitalized and immunocompromised patients. Invasive Acinetobacter infection in pediatrics can lead to significant morbidity and mortality. This study aims to investigate Acinetobacter bacteremia clinical characteristics and outcome in pediatric patients.Acinetobacter species from January 2015 to December 2022. Medical charts were reviewed for demographics, clinical data, and outcomes. IRB approval number (2231132).This is a retrospective study conducted in a tertiary-care center in Riyadh, Saudi Arabia, including pediatric patients (0-14 years) with a confirmed blood culture of one of the Acinetobacter bacteremia were identified. The median age was 10.5 [interquartile range (IQR): 2-48] months, and 25 (59.52%) were males. Over half of the episodes were hospital-acquired infections 26 (61.90%). The most reported subspecies were Acinetobacter calcoaceticus–Acinetobacter baumannii complex 34 (81.13%), then Acinetobacter lwoffii 4 (9.52%). Polymicrobial infection was found in 15 patients (35.71%), most commonly Enterococcus faecalis 4 (26.67). The antimicrobial susceptibility showed that all isolates were susceptible to Colistin, and (68%) to Cefepime and Meropenem. Most of the patients were previously hospitalized 32 (76.19%), exposed to antimicrobial therapy 26 (61.90%), and underwent invasive procedures 23 (54.76%) one month prior to the bacteremia episode. The median duration of treatment was 15 days [IQR: 12-21]. Two patients (4.76%) had relapse (while on treatment), and two (4.76%) had recurrent infection. The overall 14-day crude mortality rate was (11.90%). Interestingly, non-survivors were significantly younger than survivors (median age: 2 [IQR: 1-2] vs. 18 [IQR: 3-48] months respectively.Forty-two pediatric patients with Acinetobacter spp. are important emerging nosocomial pathogens. Most of the mortalities were associated with younger age. Previous hospitalization, prior antimicrobial therapy, and invasive procedures were common features for mortality in this study. Further multi-centers studies might be needed to investigate the mortality related risk factors.All Authors: No reported disclosures


LDLT patient survival  and graft survival  at 1, 3, 5, and 10 years were significantly better than DDLT patient survival  and graft survival  (p < 0.001) in the same interval. Variables including donor and recipient age, male recipient gender, MELD score, diabetes mellitus, hepatocellular carcinoma, and cholangiocarcinoma were associated with mortality and graft failure in PSC patients. Interestingly, Asians were more protected than Whites , and cholangiocarcinoma was associated with the highest hazard of mortality  in multivariate analysis. LDLT in PSC patients were associated with greater post-transplant patient and graft survival compared to DDLT patients.Primary sclerosing cholangitis (PSC) is the leading indication of liver transplantation (LT) among autoimmune liver disease patients. There is a scarcity of studies comparing survival outcomes between living-donor liver transplants (LDLT)s and deceased-donor liver transplants (DDLTs) in this population. Using the United Network for Organ Sharing database, we compared 4679 DDLTs and 805 LDLTs. Our outcome of interest was post-LT patient survival and post-LT graft survival. A stepwise multivariate analysis was performed, adjusting for recipient age, gender, diabetes mellitus, ascites, hepatic encephalopathy, cholangiocarcinoma, hepatocellular carcinoma, race, and the model for end-stage liver disease (MELD) score; donor’ age and sex were also included to the analysis. According to univariate and multivariate analysis, LDLT had a patient and graft survival benefit compared to DDLT (HR, 0.77, 95% CI 0.65–0.92;  Primary sclerosing cholangitis (PSC) is an immune-mediated chronic cholestatic liver disease with an incidence of 1.11 per 100,000 persons in the US population and 0.77 per 100,000 persons globally . It has Currently, no immunosuppressive or disease-modifying agents are available to prevent PSC patients from progressing to end-stage liver disease (ESLD) . Liver tLiving-donor liver transplantation (LDLT) is a potential alternative option to bridge the current organ supply–demand mismatch. While it has been performed for the last 20 years, LDLT accounts for only a small minority (3–4%) of adult LTs in the US . The ratWe conducted a comprehensive retrospective cohort study using the UNOS Organ Procurement and Transplantation Network (OPTN) database to identify adult patients with PSC who received liver transplants between 27 February 2002, and 31 December 2019. To ensure the accuracy and specificity of our findings, we excluded pediatric patients (aged below 18 years), individuals with a history of previous transplants, those who received multiorgan transplants, and patients with associated autoimmune liver diseases. The data reported here were supplied by the UNOS as the contractor for the OPTN. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the OPTN or the US government. Given that UNOS is a publicly available deidentified patient-level database, institutional review board approval was not required according to the policies of the UNOS and Beth Israel Deaconess Medical Center.The primary focus of our study was to analyze the survival of patients after liver transplantation. This outcome was defined as the length of time between the date of transplant and the death of the recipient. Additionally, we assessed post-transplant graft survival as our secondary outcome, which was defined as the length of time between the transplant date and either graft failure or the need for a re-LT.Patient characteristics were compared between DDLT and LDLT groups. Recipient and donor characteristics differed and were analyzed separately. A larger number of variables was considered for the recipient subcohort, including age at the time of liver transplantation, gender, self-reported race/ethnicity, body mass index (BMI), blood type, MELD score at the time of transplantation, history of diabetes mellitus (DM), hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), hepatic encephalopathy (HE), ascites, and UNOS regions. Within the donor variables, we considered the age at the time of transplant and gender. PSC was extracted using the codes in the Scientific Registry of Transplant Recipient (SRTR) dictionary.We stratified clinical and demographic characteristics by donor type and presented categorical variables using numbers and percentages. Continuous variables were expressed as mean and standard deviation (SD). We utilized chi-square testing to evaluate associations among categorical variables and T-tests to compare continuous variables. To analyze survival outcomes, we employed Kaplan–Meier methods.To identify significant predictors of survival, we conducted forward stepwise multivariate Cox regression analyses, which were adjusted for both recipient and donor characteristics. We included variables that were statistically significant at the bivariate level  and partial elimination (0.05)) or were known to be clinically relevant, such as recipient age at the time of transplantation, gender, race, diabetes mellitus, and the model for end-stage liver disease (MELD) score at the time of transplantation. Additionally, we considered the donor’s age as a factor in our analysis. The results are presented as hazard ratios (HRs) with 95% confidence intervals (CIs), and statistical significance was defined as α = 0.05. All statistical analyses were conducted using Stata version 17.0 .p < 0.001). Furthermore, the mean MELD score was significantly higher in the DDLT group than in the LDLT group . According to the data, the regions with the highest rates of PSC among DDLT recipients were 3, 10, and 11, while the regions with the highest rates among LDLT recipients were 2, 5, and 7. However, it is important to note that these findings only provide the number and proportion of PSC cases for each group and do not offer an explanation for why these rates differ across regions based on demographics. Our analysis also revealed that DDLT recipients were more likely to have hepatic encephalopathy and ascites than LDLT recipients. Notably, the presence of cholangiocarcinoma was significantly lower in patients in the DDLT group compared to the LDLT group .Our study identified a total of 5484 patients diagnosed with PSC who received an LT between 2002 and 2019. The cohort characteristics are presented in p < 0.001) were significantly better than those for DDLT recipients  (p < 0.001) compared to DDLT recipients .The patient survival rates for LDLT in this study at 1, 3, 5, and 10 years  . Similarp < 0.001). However, certain characteristics, such as older recipient age , older donor age , and male recipient gender , were associated with decreased patient survival. Additionally, diabetes mellitus , ascites , hepatic encephalopathy , hepatocellular carcinoma , and cholangiocarcinoma  were all associated with post-transplant mortality. Furthermore, we found that Hispanic patients had a higher risk of mortality compared to White patients .We conducted univariate Cox regression analysis to examine post-transplant patient and graft survival, the results of which are presented in p < 0.001). Patient characteristics including recipient age , donor age , and male recipient gender  were associated with worse graft survival outcomes. Variables such as diabetes mellitus , ascites , hepatic encephalopathy , hepatocellular carcinoma , and cholangiocarcinoma  had deleterious effects on post-transplant graft survival. Interestingly, Asians had a post-transplant graft survival advantage .Moreover, other results suggest that LDLT is associated with better post-transplant graft survival compared to DDLT  and donor´s age  were found to have adverse effects on patient survival (refer to p < 0.001), hepatocellular carcinoma , and cholangiocarcinoma . Furthermore, compared to Whites, Hispanics had a higher mortality risk , while Asians had a post-transplant graft survival advantage .In stepwise multivariate analyses, the recipient’s age . In addition, the age of the recipient , the age of the donor , and male gender of the recipient  had deleterious effects on graft survival. Additionally, diabetes mellitus , hepatic encephalopathy , hepatocellular carcinoma , and cholangiocarcinoma  were found to have a detrimental effect on graft survival. In particular, cholangiocarcinoma was associated with the highest hazard of mortality in PSC transplant recipients.A stepwise multivariate analysis was also conducted to examine post-transplant graft survival . ResultsA critical aspect of treating PSC is liver transplantation, as it is the only definitive therapy available. However, LT is a limited resource, with nearly 20% of waitlisted patients either dying or being removed due to clinical deterioration each year ,13. DespOur study demonstrates a significant patient and graft survival benefit favoring LDLT compared to DDLT in PSC. Patients who underwent LDLT had a 25% reduced risk of post-transplant mortality and graft failure after conducting a stepwise multivariate analysis than those who underwent DDLT. Factors that were independently associated with post-transplant patient and graft survival were the donor and recipient ages at the time of transplantation, the recipient’s sex, Asian race, MELD score, diabetes, HCC, and CCA before transplantation. This is in contrast with a cohort study conducted by Heinemann et al. in which the European Liver Transplant Registry was used. In this analysis, LDLT patients had an increased risk of death from graft failure compared to DDLT patients after adjusting for recipient age, sex, and the era of LT. Interestingly, in this study, other autoimmune liver diseases were also analyzed; however, associations between adverse graft outcomes and LT type were only seen in PSC recipients .A few aspects are important to consider with respect to the recipient characteristics. Asian race is a protective survival factor, with a post-transplant patient mortality risk and graft survival risk of 42% less than all other races. Kemmer et al. strongly supported the findings of our findings in a study using a 2002–2010 interval of the UNOS database . In the Estimated patient survival and graft survival before and after adjusting for the mentioned variables appear to be superior in those who underwent LDLT compared to DDLT. It is interesting to highlight that although higher MELD scores significantly increase the mortality risk, the impact is relatively minimal and does not seem to have clinical relevance. Moreover, while previous studies using the UNOS database have shown differences in waitlist time between LDLT and DDLT groups ,21,22, oThere are several hypotheses for our findings regarding the potential patient and graft survival benefits of LDLT. One possibility is that the surgical centers performing LDLT are typically higher-volume centers with well-connected resources. Thus, the surgical and subsequent graft outcomes at these centers compared to those that only perform DDLT may be superior. Second, while data were mixed, large database studies have shown that older donor age at the time of liver transplantation is a risk factor for graft failure, which appears to be the case for PSC patients based on our analysis ,24. IncrSeveral theories have been proposed to explain the superior graft survival observed in LDLT patients compared to DDLT patients. One important factor to consider is the Donor Risk Index (DRI), which can vary significantly between LDLT and DDLT donors and may contribute to differences in graft failure risk ,26. AnotThe strengths of our study include its analysis of a large-scale database of transplant candidates over an extended period. Additionally, to the best of our knowledge, few studies have looked specifically at post-transplant patients and graft survival in patients with PSC. There are some limitations to our study. First, there are significant differences in the baseline characteristics between the live-donor and deceased-donor groups. While our model was adjusted for many variables, given that PSC is a progressive disease, there may be some multicollinearity between age and MELD scores, which would lessen the precision of our findings. Second, it should be considered the retrospective nature of our study and the lack of granularity inherent found in this large, nationwide database. Thirdly, the limitation in the data that were available for review creates difficulties in drawing more conclusive arguments.Our study provides compelling evidence that LDLT offers superior patient and graft survival outcomes in patients with PSC compared to DDLT. Specifically, our findings suggest that LDLT is associated with lower mortality risk after adjusting for multiple variables. However, we also found that recipient age, male sex, MELD score, and certain comorbidities can negatively impact LDLT patient survival, while older donors can be associated with higher mortality. Further investigation is needed to explore the effects of other variables on long-term patient and graft survival.


The evaluation of vascular biomarkers can help to identify patients with high cardiovascular risk providing opportunity for early preventive interventions to avoid clinical endpoints like cardiovascular morbidity and mortality. Recently a consensus paper was published on the clinical use of pulse wave velocity (PWV)  suggestiex vivo animal experiments, technical developments in the measurement of aortic stiffness, reference values of wave reflection parameters as measured in humans, acute effects of vasoactive drugs on arterial stiffness metrics, and a meta-analysis of the effects of antihypertensive medications on central hemodynamic characteristics.This Research Topic provides nine articles  that deepen the knowledge in the field. The wide scope of these articles includes the role of circulating biomarkers in vascular ageing, Gopcevic et al. gives an overview of circulating biomarkers related to vascular ageing including oxidative stress-based, inflammation-based, cell matrix-based and epigenetic-based biomarkers, the process of DNA methylation, and the importance of telomere length. This paper is a report from an international scientific collaboration on vascular ageing, called VascAgeNet  for quality assessment to enable real-time feedback on signal quality in future versions of the device. The authors benchmarked these methods using visual scoring as a reference. Both methods were found to be suitable for the automated assessment of the signal quality of acceleration data measured from the skin at the neck and groin.Laser Doppler velocimetry enables contactless measurement of carotid-femoral pulse wave velocity, however, the developed CARDIS device requires now additional quality assessment which hampers its clinical usefulness. Giudici et al., the authors used mechanistic correction of carotid PWV to distinguish acute and chronic effects of blood pressure on local arterial stiffness. They found that when comparing healthy individuals with patients with stage I and II hypertension, after mechanistic blood pressure correction, the difference in carotid PWV between the two groups was reduced by 68% and became statistically non-significant. These results suggest that moderate hypertension in middle-aged subjects has minor impact on common carotid artery stiffness independently of the acute effect of blood pressure. Further clinical investigations are required to evaluate the clinical utility of this method.In the paper of Fortier et al., the authors demonstrated the acute effect of nitroglycerine on the vasculature using an arterial stiffness gradient (the ratio between aortic PWV and muscular PWV). Besides preserved aortic stiffness, nitroglycerine acutely decreases muscular stiffness and wave reflection enabling higher pulsatility to reach the microcirculation. This effect could be harmful in the longer term, especially for high flow/low resistance organs like the kidneys and brain. The arterial stiffness gradient can potentially have stronger prognostic value than aortic  PWV per se, and its changes due to intervention using vasoactive agents (like antihypertensive drugs) could also bear clinical importance.In the article of Zocalo and Bia provide very important age, height, and sex-specific reference intervals for pulse wave analysis/wave separation analysis-derived parameters like augmentation pressure, augmentation index, forward and backward components of aortic blood pressure, reflection magnitude, and reflection index. The age range of the reference population  is between 2 and 84 years. These data form an important step in the future clinical utility of these parameters.Cheng et al. performed an individual data meta-analysis on the effects of older and newer antihypertensive agents on central hemodynamic parameters. They found a more pronounced decrease in central systolic blood pressure, augmentation index, and augmentation pressure with newer antihypertensive agents  compared to older medications . These data support the therapeutic recommendations of current hypertension guidelines (idelines .In summary, this Research Topic provided important results from both basic and clinical science demonstrating all levels of research of this scientific area. We hope that these valuable data will help to implement the knowledge in clinical practice and to improve cardiovascular outcome of patients.


Arabidopsis phytochrome B (AtPHYB) transformants were investigated. Distinct changes in starch micro and macro structures—an increase in proportion of amorphous lamellae and of large-sized and irregular-shaped granules, as well as shifts in thickness of the crystalline lamellae—were detected. The degree of such alterations, more pronounced in AtPHYB-transgenic tubers, increased with the longevity of tuber dormancy. By contrast, the polymorphic crystalline structure (B-type) of starch remained unchanged regardless of dormancy duration. Collectively, our data support the hypothesis that potato starch remains metabolically and structurally labile during the entire tuber life including the dormancy period. The revealed starch remodeling may be considered a process of tuber preadaptation to the upcoming sprouting stage.The main reserve polysaccharide of plants—starch—is undoubtedly important for humans. One of the main sources of starch is the potato tuber, which is able to preserve starch for a long time during the so-called dormancy period. However, accumulated data show that this dormancy is only relative, which raises the question of the possibility of some kind of starch restructuring during dormancy periods. Here, the effect of long-term periods of tuber rest (at 2–4 °C) on main parameters of starches of potato tubers grown in vivo or in vitro were studied. Along with non-transgenic potatoes,  Starch is a main storage polysaccharide of green plants, and it is widespread in nature. This substance is a biopolymer consisting of two polysaccharides (amylose and amylopectin), and their structures and proportions determine physicochemical and functional properties of extracted starches and respective products. Due to their characteristics and natural renewability, starches of various botanical origin are widely used in many industries as thickeners and as stabilizing and gel-forming agents. Of particular interest are starches for food production and medicine ,2.Solanum tuberosum L.) is one of the most important natural producers of starch. Starch is extensively accumulated in growing potato tubers, serving as long-term storage for carbohydrates, and is remobilized at the time of tuber sprouting ..AGPase gUsing this enzyme as an example, we have checked whether dormant potato tubers retain starch-forming potential. Histochemical staining according to  confirmeThus, in dormant tubers stored in the dark at low (2–4 °C) temperature, starch biosynthesis occurs, or at least has an important prerequisite to occur, in parallel with limited but constant starch degradation. Such dynamic equilibrium between synthesis and breakdown was termed ‘starch cycling’ . InitialTherefore, in this connection a question arose: What happens to starch during prolonged storage of dormant tubers? Does this presumable ‘starch cycling’ lead to any kind of starch structure remodeling, or does it simply preserve the original structure without any significant changes?To address this question, we conducted a comprehensive study of the structure and physicochemical properties of starches extracted from dormant tubers after long-term rest under typical storing conditions .Starch granule morphology was analyzed using scanning electron microscopy (SEM). As expected, all studied starches were markedly heterogeneous in granule size . The larAtPHYB-transgenic tubers, concomitantly with the proportion of granules of irregular shape. This finding was in agreement with [After prolonged dormancy of tubers, the visual proportion of large-sized granules increased for starches extracted from both control and ent with  who repoAtPHYB-transgenic than from non-transgenic tubers  A–D as weDioscorea alata), are mainly characterized by hexagonal packaging of amylopectin double chains, corresponding to B-type polymorphic structure [It is well known that starches can adopt distinct polymorphic crystalline structures. In cereal plants, such as wheat and maize, amylopectins are characterized by monoclinic double chain packing, corresponding to A-type polymorphic structure. At the same time, starches from tuber crops, such as potato and yam , which is associated with endothermic, cooperative, irreversible thermodynamic transition known as gelatinization [The thermogram curves of extracted starches are exemplified in nization . Such th0, Tc) (see melt and Hmelt) of investigated starches decreased with increasing of the dormant period. The established fact of the melting temperature decrease for starches during the dormant period is correlated with data in the literature [0 − Tc) of the starch transition increases with an increase in the dormancy period of tubers cultivated both in vivo and in vitro, which indicates the formation of less perfect crystalline structures, which reduces starch crystallinity [AtPHYB-transgenic (Dara 5) potato tubers cultivated in vitro with dormancy over a period of 8 weeks. In general, the width of the melting transition of potato starches increased during storage of both in vivo and in vitro cultured tubers, indicating the formation of less perfect crystalline structures in the starch. It is possible that the amylopectin double helices in starch from potato tubers elongate during storage without increasing their number, which may explain the absence of changes in X-ray diffraction patterns [Melting temperature can be considered as a measure of the starch structure stability ,38. The  Tc) see , trace Dterature . At the allinity ,41. In opatterns .From the above graphics it can be seen that the melting curves for all the studied aqueous dispersions were, on the whole, symmetrical with respect to the maximum melting point. However, with an increase in the resting time of tubers, the melting curves became less symmetrical. This indicates certain structural changes in the starch, which became more pronounced as the resting time of the tubers was extended. Calculation of thermodynamic parameters according to a one-stage model showed  that vanAs a rule, thickness of the crystalline lamellae of starches is calculated from SAXS data . TheAtPHYB plants, the thickness of the crystalline lamellae, on the contrary, increased with the length of time the tubers were at rest  or such crystals for which the role of free surface energy in comparison with volume energy can be neglected, respectively; γi is the relevant surface free energy; ΔH0melt is the experimental enthalpy; and ρcrl and Lcrl are the density and the thickness of the crystalline lamellae, respectively.It was shown that the melting point of semi-crystalline synthetic polymers can be calculated using the Thomson–Gibbs equation ,47:Tmeltiq and enthalpy is of lamellae end faces [Based on Equation (1), one can obtain with Equations (2) and (3) useful information regarding the thermodynamic parameters of crystalline lamellae melting, namely, surface entropy nd faces ,47:qi = It is well known that the melting of a polymer crystal begins with the melting of defects in an amorphous lamella, and, therefore, the surface entropy value of the end faces of the crystalline lamellae is proportional to the number of defects in starch granule crystalline structures ,48. It i0melt and ΔH0melt values were approximated with those relevant to B-type spherulitic crystals, namely, T0melt = 346.8 K and ΔH0melt = 35.5 J g−1, and the value of density (ρcrl) of B-type structures 1.40 g cm−3 [crl, ΔHmelt, and Tmelt were directly evaluated from the experimental DSC traces obtained for the investigated starches , which were kept at rest, some irregular (unordered) structures accumulated.It is likely that ectopic expression of the c tubers ,33, whicDioscorea opposita Thunb (A-type polymorphic structure) [Data were reported that evidence that irregular amorphous sites are most suitable for enzymatic starch hydrolysis ,53. Potaructure) .The amorphous, unordered structures of potato starch melting at low temperature can serve as initial sites of active starch hydrolysis needed for tuber sprouting. This sprouting should proceed during a favorable season, which may last not too long. Therefore, the more primary sites of starch hydrolysis exist in a tuber, the more material and energy are provided for the concerted growth of sprouts. Hence, the starch structure remodeling during the dormancy period described here can have a clear physiological meaning: a preadaptation to the upcoming physiological stage—tuber sprouting—of the tuber life cycle. In other words, this means that during storage, dormant potato tubers gradually transform the starch structure in order to provide the hydrolysis surge required at the upcoming sprouting stage.PHYB gene constitutively expressed in potato may affect starch structure in tubers [phyA and phyB plants) of Arabidopsis showing a metabolic link between photoreceptors and starches [Arabidopsis cannot produce tubers, so the reasonable question arises, by what mechanism may PHYB affect metabolic processes in the tuber, in particular the process of starch formation. This interesting task remains to be addressed. As evidence in favor of such a relationship, we can cite the data from Schittenhelm et al. (2004) [Our pioneering finding that the n tubers  seemed rstarches . Plants . (2004)  who showSolanum tuberosum L.) cv. Dėsirėe, as well as with two AtPHYB-transgenic lines derived from these varieties: Dara 5 and Dara 12 [A. thaliana phytochrome B gene (AtPHYB), under the control of the constitutive 35S CaMV promoter, were kindly provided by Prof. C. Gatz . The authors of the transformants showed that the Dara 12 line expresses the AtPHYB transgene more strongly than the Dara 5 line.The study was carried out with WT (control) potatoes ( Dara 12 . These tPlants were propagated with single-node cuttings and grown in vitro in sterile tubes on agarized MS medium under long-day conditions at a temperature of 22–24 °C. Tuberization was induced by high (5%) sucrose content in the medium. A part of the obtained microtubers (in vitro tubers) was planted in the pots with soil and put under long-day conditions at a temperature of 22–24 °C, giving rise to full-grown plants that formed tubers (in vivo tubers). For this study, dormant tubers and microtubers of the same year were stored in the dark at a temperature of 2–4 °C for various periods (0–25 weeks). Starch was extracted from tubers and microtubers according to the standard procedure  and was Histochemical staining was based on the coupling of oxidation NADH to the reduction of nitroblue tetrazolium (NBT), which resulted in the precipitation of blue tetrazolium salt. In situ staining of AGPase activity was performed as described  with somMorphological changes of the starch granule were investigated using scanning electron microscopy (SEM). Photos of starch granules were obtained with a scanning electron microscope Mira3 LMU  at room temperature in the conditions of high vacuum with accelerating voltage 500 V.Size and morphology of the potato starch granules were measured or estimated using an extended suite of morphometric algorithms under the ‘Altami Studio’ (version 3.4.0) licensed software GUI. Besides the standard granulometric characteristics, a number of dimensionless shape parameters were analyzed and compared. These parameters included elongation factor, calculated as the ratio of equivalent length and width, as well as compactness factor, calculated as the ratio of the area of a figure to the area of its circumscribing circle. Each value represented an average of 100–200 granule measurements.The type of polymorphic crystalline structure of starches was characterized using the method of X-ray diffraction. The starches were studied in an air-dried state at ambient room temperature. XRD patterns were taken in transmission mode using the X-ray diffractometer of a local design described elsewhere (Cu Kα radiation) . RegistrC was calculated as in [θ from 3° to 50°. In this equation, I(2θ) is experimental XRD intensity of a starch sample, bI(2θ) is a baseline intensity assumed to be a straight line passing through experimental intensity points at 2θ = 3° and 2θ = 50°, and aI(2θ) is the intensity of the starch amorphous part determined on the basis of the experimental XRD pattern of amorphous starch.A starch degree of crystallinity ed as in  with the−1 heating rate and 2.5 bar excess pressure. The volume of the investigated sample was 0.5 cm3 in sealed cells. Deionized water (Millipore Direct-Q3) with a resistivity of 18.2 μS·cm−1 at a temperature of 25 °C was used as a reference solution. The heat capacity was calibrated using the Joule–Lenz effect for each run. Corrections for dynamic lag and residence of the samples in calorimetric cell were not obligatory under the conditions used [The melting thermodynamic parameters of 0.3% (DW) starch aqueous dispersions were determined using a high sensitivity differential scanning microcalorimeter DASM-4  in the 20–100 °C temperature range with a 2 K minons used ,62.−1).The average values of the thermodynamic parameters were determined as described elsewhere ,63 usingThe melting process of starches can be considered in the first approximation as quasi-equilibrium ,63,64,65vH) were calculated according to [melt is melting temperature of the crystalline lamellae, K; Cp* is the maximum ordinate of the DSC trace; and ΔCpexp is the difference in the heat capacities of phase native  and molten (amorphous) state.Values of van’t Hoff enthalpy  were calculated according to Equation (7) [The thicknesses of the crystalline lamellae (Ltion (7) :Lcrl = 0lopectin ,66. In the cases of starches possessing asymmetric melting endotherms, the Peak Fit program  was applied to deconvolute the overall melting endotherms and calculate the thermodynamic parameters corresponding to the components separately .Solanum tuberosum v.6.1. Information on the localization of genes on potato chromosomes was obtained from there. This database was also used to retrieve information about gene expression in various organs (http://spuddb.uga.edu/dm_v6_1_download.shtml (accessed on 6 April 2023). Only genes for which there was reason to assume participation in starch biosynthesis and degradation were considered.In our work, we identified most important genes of the currently proven components of potato starch biosynthesis and degradation in agreement with ,68,69. Dp < 0.05 was considered according to Student’s criterion as statistically significant).All essential experiments were repeated at least twice. In the cases where it was possible, statistics were employed see . Data giIt was previously believed that in dormant tubers stored at low-positive temperatures (2–4 °C) starch is mostly inert and that only a very small part of the starch is broken down to mobile carbohydrates (cold sweetening) to satisfy minimal metabolic needs of tuber cells (negligible respiration and glycolysis). Later on, it became clear that starch in dormant tubers not only degrades, but also can be synthesized by using its decay products during a process termed the ‘starch cycle’. In our study, we confirmed the possibility of starch cycling in dormant tubers. In addition, by means of sensitive physicochemical methods we found evidence for remodeling of the starch structure, which likely affects both the structure of amylopectin  as well as the amylose-to-amylopectin ratio (more amorphous components).AtPHYB transformants constitutively expressing the Arabidopsis phytochrome B gene, the starch retained its original polymorphic structure, despite the fact that starch of such tubers usually accumulates a higher proportion of unordered components. The problem of metabolic relationships between ectopically expressed phytochrome and starch structure in tuber cells represents a new prospect for further studies. Taken together, our data led us to the conclusion that during the whole dormancy period of potato tubers, their starch remains metabolically and structurally labile. It is assumed that the accumulated amorphous starch components and alterations in starch granule size and shape have physiological significance as prerequisites for massive starch hydrolysis, which will be required at the upcoming tuber sprouting stage.The argument attesting to the fact that these changes originated in dormant tubers during the storage period was the positive dependence of structural defect accumulation on storage duration, which was observed for tubers grown both in vivo (plants in the soil) and in vitro (axenic plants in tubes). In addition to changes in the starch’s fine structure, global changes in the shape and size of the starch granules during tuber dormancy were uncovered. Such changes, which can be explained by the fusion of, predominantly, small granules, point to the lability of the structure of starches in this period both at the micro and macro levels. Tuber storage at the dormancy stage affects micro and macro starch structures not only in potato (B-type polymorphic structure) but also in Chinese yam (A-type polymorphic structure) as well. However, despite of all these alterations, an important parameter of the starch structure was kept unchanged: that was a species-specific polymorphic structure. Even in


Soft fingertips have distinct intrinsic features that allow robotic hands to offer adjustable and manageable stiffness for grasping. The stability of the grasp is determined by the contact stiffness between the soft fingertip and the object. Within this work, we proposed a line vector representation method based on the Winkler Model and investigated the contact stiffness between soft fingertips and objects to achieve control over the gripping force and fingertip displacement of the gripper without the need for sensors integrated in the fingertip. First, we derived the stiffness matrix of the soft fingertip, analyzed the contact stiffness, and constructed the global stiffness matrix; then, we established the grasp stiffness matrix based on the contact stiffness model, allowing for the analysis and evaluation of the soft fingertip’s manipulating process. Finally, our experiment demonstrated that the variation in object orientation caused by external forces can indicate the contact force status between the fingertip and the object. This contact force status is determined by the contact stiffness. The position error between the theoretical work and tested data was less than 9%, and the angle error was less than 5.58%. The comparison between the theoretical contact stiffness and the experimental results at the interface indicate that the present model for the contact stiffness is appropriate and the theoretical contact stiffness is consistent with the experiment data. Soft robotics has gained significant attention in recent years due to its advantages over traditional rigid robots ,2. Soft tk along tangential direction; one with stiffness nk along normal direction. For a long time, the modeling of contact stiffness in soft robotic hands has been fundamental to object grasping and manipulating; it is impossible or extremely difficult to establish a theoretical model of contact stiffness on the grasp surface between soft fingertips and an object, and the dynamic properties of the grasp system are generally inaccurately predicted. Most soft multiple fingers use an adaptive open-loop control method for grasping [When a soft finger comes into contact with a rigid object, multiple three-dimensional contact elements exert force on the contact surfaces. Researchers have discovered that the contact force and displacement exhibit strong nonlinearity, and the friction coefficient may change with varying contact conditions. Additionally, as the tangential forces in the tangential directions increase, the contact nodes may separate or re-establish contact, leading to a variable contact stiffness. In this paper, we assume that the contact elements are capable of supporting a compressive load in the normal direction and tangential forces in tangential directions. The displacements in the tangential and normal directions are assumed to be independent; the parameters can be equivalent to three independent contact springs: two with stiffness grasping ,7. Whilegrasping ,9, few hgrasping . The resgrasping ,12.One of the most common methods for modeling arbitrary surface contact is to use finite element models ,14 or haTo address this issue, an elastic constraint model for grasping was established under both friction and frictionless conditions ; it presThe contributions of this work are as follows: (1) the force diagram at an individual elastic contact point can be represented as three springs, and the contact stiffness matrix can be established with screw algebra; (2) we developed a representation of soft fingertips at the contact surface to analyze the contact stiffness matrix of soft fingertips; (3) we present a method by which to investigate the influence of the number of contact points on the stiffness coefficient. The relationship between displacement and force space is established via the proposed stiffness matrix. This work aims to identify the displacement of the object by detecting the contact force or to identify the contact force on the contact surface by recognizing the displacement of the object. The experimental results verify the correctness of the theoretical model.The rest of this paper is organized as follows: The contact stiffness model is proposed in When two bodies are brought into contact, the real contact area will usually be smaller than the nominal contact area, but with differ in contact between two soft bodies or between a soft body and a rigid body. We can visualize the contact region as small areas where asperities from one solid are squeezed against asperities from another body. Moreover, we can visualize the contact region where asperities from one soft surface are squeezed against asperities from another body. The real contact area will usually be larger than the nominal contact area. The contact may be represented by an equivalent system with a reduced elastic modulus ectively .Soft contact occurs on the contact surface between the object and fingertip. To facilitate the model, we assume the contact surface contains a group of concentric circles, inspired by human fingerprints, with a large number of equivalent elastic point contacts on these curves. We establish a group of frames on the contact points and represent the stiffness of the fingertip as a set of passive linear springs.nth curve. A soft contact is represented as nine linear springs, expressed as I = 1, 2, 3, j = 1, 2, 3). They are positioned at three uniformly distributed points on the edge of the contour line. The index i represents the number of each equivalent contact point, and the index j represents the number of the linear spring at each contact point.As shown in A possible distribution of contact points is shown in  follows :(1)ri=[aWe define the screw matrix We choose three equivalent contacts on the curve with interval angle of 120°. The elastic coefficients of the nine springs can be represented by gK:The elastic model of soft fingertip contact is established based on the variation in stiffness of the linear springs during contact, with their vectors arranged into the matrix ith linear spring at the ith equivalent contact point. The Cartesian coordinate system is aligned with the direction of The set of stiffness is placed on the diagonal to form a diagonal matrix These three terms along the x-axis can be written as three independent contacts: This method can simplify the other three diagonal elements:n concentric closed curves, and each closed curve has m equivalent contact points. The schematic diagram of soft fingertip contact is shown in m equivalent contact points are located on a closed curve with radius of We assume a contact surface can be expressed as Where x-axis and y-axis direction, respectively.We can express the contact stiffness matrix of the soft fingertip Equation (15) provides the contact stiffness values along with three translational paths and three rotational movements. However, the conventional point contacts with friction provide translational stiffness without rotational stiffness.m and n are listed in 2, the reference [The values of stiffness coefficients under different combinations of eference  providedWe compared our work with the data from reference  to verifn increases, the error will be reduced; when m = 3, n = 3.Obviously, the differences of eference  data areThe model of the soft fingertip and grasped object was constructed using the finite element analysis software Abaqus. The contact type between the fingertip and the object was a soft contact, whereby the fingertip model was simplified as a semicircular sphere, and the object was simplified as a rigid plate.3, Poisson’s ratio of 0.3, Young’s modulus of 210,000 MPa, and C3D8R hexahedral elements. The plate is meshed with 600 units, each element with a length of 1 mm, a width of 1 mm, and a thickness of 0.5 mm. The material of soft fingertip is set as rubber, and the model type is hyper-elastic constitutive, with parameters set as follows: rubber density is 1.1 g/cm3. The finger end was meshed with C3D8RH and C3D6H elements, while the connection type between the soft finger and the object is static general nonlinear. The connection mode was defined as surface-to-surface, and the friction coefficient was set at 0.5, which is typically used for contact between silicone rubber and plastic materials. Additionally, all nodes on the upper surface of the fingertip are fixed in place.To verify the accuracy of the material parameters incorporated in the soft finger constitutive model, a combined simulation and experimental testing of finger material characteristics was carried out. The simulation involved fixing the spherical bottom surface of the fingertip and applying vertical pressure on the object pressed into the fingertip. The relationship between the contact force and pressing distance is illustrated in As can be seen from the comparison diagram depicting the simulation and experimental curves, the finite element curve and experimental curve are essentially consistent when the deformation of the soft finger is less than 3 mm. However, when the deformation of the finger exceeds 3 mm, a deviation between the finite element curve and experimental curve arises. Moreover, the simulated contact pressure is greater than the pressure obtained via theoretical calculation at the same deformation. The difference between the two becomes increasingly larger as the deformation escalates. This outcome arises as the compression exceeds 1/3 of the total thickness, and the Hertzian model fails in agreement with reference . As a reA comparative analysis of the simulation and experimental results was undertaken in order to evaluate the applicability of the proposed theory. The results showed that the theory has a certain range of application; specifically, when the deformation is less than 1/3 of the total thickness, the relationship between the contact force and the deformation of the fingertip can be accurately described. The experimental setup, as shown in In the experimental setup, one soft fingertip is attached to the end of the guide rod, while the other is securely fastened to the vertical plate. The target object is positioned between these two soft fingertips, with two contact points located at the center of the target’s left and right surfaces. To examine the influence of contact force, we selected force values of 20 N, 30 N, and 40 N. We recorded the object’s position as the external force progressively increased by 1 N. During these experiments, we utilized soft fingertips with diameters of 20 mm and 30 mm and elastic moduli of 1 MPa and 0.3 MPa, respectively.The fabrication of the soft fingertip involves the use of a 3D-printed mold, as depicted in We utilize the PD method for controlling the linear motor to precisely generate pulling and thrust forces. In this experiment, our aim is to explore the correlation between applied force and object movement by comparing the theoretical analysis values with the experimental ones, as illustrated in In this particular experiment, a soft fingertip with a diameter of 20 mm and an elastic modulus of 1 MPa was used. The contact force for the experiment was set at 30 N. The experimental setup and process can be observed in 1, P2, and P3 for each image. These pixel coordinates are obtained by detecting the spatial orientation of the target object, as illustrated in In this experiment, fingertips of varying sizes were used along with different contact forces. The modulus of elasticity was set at 1 MPa. The experimental procedure is depicted in y-axis was larger than that of the theoretical value. The most likely reason is a slight shift in the grasping position by the soft fingertips.As shown in In this experiment, the fingertip was analyzed under different elastic moduli, as shown in x, θy, and θz components of the displacement screw exhibit a linear dependence on external force, albeit with experimental error. Note that if an experimental curve matched its theoretical counterpart, the y and θx components were excluded to facilitate comparison. It is apparent that as the contact force decreases, the trend between displacement and the external force becomes steeper, which aligns with both theory and intuition. With the same external force, a smaller grasp force yields a more substantial change in the displacement screw, indicating weaker constraint by the soft fingertips on the object.In this experiment, the grasping forces with varied magnitudes were presented. In θy and θz components of displacement, where the absolute value of the experimental curve slope is slightly lower than that of the theoretical curve at 40 N of contact force. This discrepancy may be attributed to greater fingertip deformation when contact force is higher. Additionally, the incompressibility of materials may cause the axial and tangential stiffness of a fingertip to exceed theoretical predictions.An exception arises in The manipulation of robotic hands with soft fingertips has become increasingly important in recent years, with applications ranging from manufacturing to healthcare. However, the effective control of a multi-fingertip robot is dependent on understanding the nature and modeling of soft fingertips during grasping and manipulation. Soft fingertips are a critical component of robotic hands as they enable the hand to interact with objects in a manner similar to human hands. Understanding the contact mechanics of soft fingertips is necessary in order to design effective robotic hands that can perform a wide range of tasks. The development of effective robotic hand control requires a comprehensive understanding of the contact mechanics of soft fingertips. The proposed contact stiffness model and six-dimensional representation method provide a mathematical model for the contact stiffness of soft fingertips, making it possible to analyze and predict the behavior of soft fingertips during grasping and manipulation. The experimental results have demonstrated the feasibility of the proposed model, providing a foundation for the development of effective robotic hand control with soft fingertips.In this work, we have presented a mathematical formula based on the Winkler Model and a six-dimensional representation method for soft fingertip contact. The proposed model provides a mathematical model for the contact stiffness of soft fingertips, making it possible to analyze and predict the behavior of soft fingertips during grasp and manipulation. The six-dimensional representation method considers the three-dimensional forces and displacements in the x, y, and z directions, as well as the three-dimensional moments and rotations about the x-, y-, and z-axes. This comprehensive approach provides a more accurate representation of the behavior of soft fingertips during grasping and manipulation. To verify the proposed contact stiffness model, we analyzed and calculated several soft fingertip grasping examples. Our research has shown that the soft multi-fingered hand can effectively manipulate the attitude and position of objects by controlling the stiffness of fingertips and adjusting the contact force. By utilizing the contact stiffness matrix of the fingertip and grasp stiffness matrix, it is possible to predict the micro-displacement state when subjected to specific external forces. Experimental results have demonstrated that the position error between theoretical work and tested data was less than 9% along the x, y, and z directions, while the angle error was less than 5.58% about the x-, y-, and z-axes. This coherence between experiments and simulations proves the feasibility of the proposed contact stiffness model for robotic hands with soft fingertips.The limitation of this research is that the experiment was conducted using a flat contact surface rather than a rough plane with varying shapes. This direction can be further explored. The displacement state under different grasping forces and external forces will vary when the shape of the fingertip differs. The state of the object undergoes significant changes with variations in the angles of the contact surface. Research on the unified mathematical expression of contact stiffness for differently shaped fingertips is crucial for the grasping and manipulation of dexterous hands and has great practical value. In our future work, we plan to enhance the experimental device by incorporating precise force measurement sensors and accurate angle measurement sensors. This improvement aims to reduce measurement errors and introduce a contact angle adjustment mechanism between fingers and objects. Ultimately, our goal is to achieve precise control of objects using soft fingers.


The aim of the present study was to analyze a genome database of 837 Acinetobacter spp. isolates, which included 798 non-baumannii Acinetobacter genomes, in order to define the concordance of classification and discriminatory power of 7-gene MLST, 53-gene MLST, and single-nucleotide polymorphism (SNPs) phylogenies.Non-Phylogenies were performed on Pasteur Multilocus Sequence Typing (MLST) or ribosomal Multilocus Sequence Typing (rMLST) concatenated alleles, or SNPs extracted from core genome alignment.Acinetobacter genus, with classification results concordant with the ribosomal MLST scheme. The discriminatory power and genotyping reliability of the Pasteur MLST scheme were assessed in comparison to genome-wide SNP phylogeny on 535 non-baumannii Acinetobacter genomes assigned to Acinetobacter pittii, Acinetobacter nosocomialis, Acinetobacter seifertii, and Acinetobacter lactucae (heterotypic synonym of Acinetobacter dijkshoorniae), which were the most clinically relevant non-baumannii species of the A. baumannii group. The Pasteur MLST and SNP phylogenies were congruent at Robinson-Fould and Matching cluster tests and grouped genomes into four and three clusters in A. pittii, respectively, and one each in A. seifertii. Furthermore, A. lactucae genomes were grouped into one cluster within A. pittii genomes. The SNP phylogeny of A. nosocomialis genomes showed a heterogeneous population and did not correspond to the Pasteur MLST phylogeny, which identified two recombinant clusters. The antimicrobial resistance genes belonging to at least three different antimicrobial classes were identified in 91 isolates assigned to 17 distinct species in the Acinetobacter genus. Moreover, the presence of a class D oxacillinase, which is a naturally occurring enzyme in several Acinetobacter species, was found in 503 isolates assigned to 35 Acinetobacter species.The Pasteur MLST scheme was able to identify and genotype 72 species in the baumannii Acinetobacter isolates coupled with in silico detection of antimicrobial resistance makes it important to study the population structure and epidemiology of Acinetobacter spp. isolates.In conclusion, Pasteur MLST phylogeny of non- Acinetobacter spp. are aerobic, non-fermentative, Gram-negative coccobacilli that are widely distributed in the environment and are responsible for infections in animals and humans . As the identification of Acinetobacter isolates at the species level has been difficult to obtain using standard phenotypic methods  have been increasingly isolated from humans and reported to be responsible for infections -based phylogenies of A. baumannii group genomes, and identify antimicrobial resistance genes in Acinetobacter spp. genomes.The present study aimed to perform phylogenomic analysis of 837 isolates assigned to 72 distinct species in the A. baumannii complete genomes assigned to international clonal lineages ICI, ICII, and ICIII, which corresponded to Pasteur ST1, ST2, and ST3, respectively, and to additional epidemic clonal lineages assigned to Pasteur ST10, ST25, ST32, ST52, ST78, and ST79  were performed using the concatenated alleles of the Pasteur and ribosomal MLST schemes and a reference phylogeny using genome-wide data . The phylogenies of Pasteur MLST, ribosomal MLST, and core SNP alignments were inferred through the GTR-GAMMA model at 100 bootstrap replicates using RAxML v.8  and Matching clusters (M-C) topology-based tests employing TreeCmp . The M-CAcinetobacter genus were classified as MDR if they carried antimicrobial-resistant genes for at least three of the nine classes of antimicrobials considered by The antimicrobial resistance genes were detected using abricateThe clusters of Pasteur sequence types (STs) were determined using the eBURST algorithm as described previously . MinimumAcinetobacter genus, which were identified at genus and species levels using the ribosomal MLST scheme , A. nosocomialis (n = 175), A. seifertii (n = 61), A. baumannii (n = 39), and A. lactucae (n = 14), while 263 genomes were assigned to other 67 species of Acinetobacter genus  genome-wide distance, respectively. The A. nosocomialis genomes assigned to ST782 and to the most frequent ST279 showed 4 and 5 LVs genome-wide distances with respect to CC2 A. baumannii genomes, respectively  showed similar inter- and intra-species distributions of branch lengths and nodes  in A. seifertii genomes, and no clusters in A. nosocomialis genomes  in  genomes . Clustero clades . Intereshylogeny .Acinetobacter species. The ResFinder software identified 188 genes encoding for resistance to 12 antimicrobial categories  genes blaGIM-1, blaIMP-1,-4,-14,-19,-34blaNDM-1,-16, and blaVIM-2,-4 were identified in 12 of 72 species of Acinetobacter genus. Among species, 34 of 282 A. pittii genomes showed at least one MBL gene. The blaNDM-1 was the most frequent MBL gene and was found in A. nosocomialis, A. pittii, A. lactucae, A. junii, A. bereziniae, A. cumulans, A. wuhouensis, A. sichuanensis, A. rongchengensis, A. indicus, and A. variabilis genomes. The blaADC-25 class C β-lactamase was found in the five species belonging to A. baumannii group and A. calcoaceticus genomes, but not in other Acinetobacter spp.  were identified , which are difficult to identify using standard phenotypic  was identified as a distinct species of the Acinetobacter genus  corresponding to Pasteur ST553, which emerged as a dominant clonal lineage in Asia  can be found in the article/AM: Formal analysis, Writing – original draft, Data curation, Investigation, Methodology. JB: Data curation, Formal analysis, Writing – original draft, Software. MI: Software, Methodology, Writing – original draft. MS: Formal analysis, Investigation, Writing – original draft. GS: Methodology, Software, Writing – original draft. KJ: Methodology, Conceptualization, Data curation, Formal analysis, Writing – review & editing. SB: Conceptualization, Formal analysis, Methodology, Writing – review & editing. RZ: Conceptualization, Formal analysis, Funding acquisition, Supervision, Writing – original draft, Writing – review & editing.


The average lost surface area was 0.38 mm2 with titanium abutments and 0.41 mm2 with zirconia abutments. The average lost surface area was 0.41 mm2 with the external hexagon, 0.38 mm2 with the tri-channel, and 0.40 mm2 with the conical connection. In conclusion, the cyclic loads induced implant wear. However, neither the type of abutment (p = 0.700) nor the connection (p = 0.718) influenced the amount of surface area lost. The most commonly used material in dental implants and their abutments is titanium. Zirconia is a more aesthetic alternative to titanium abutments; however, it is much harder. There are concerns that zirconia could damage the surface of the implant over time, especially in less stable connections. The aim was to evaluate the wear of implants with different platforms connected to titanium and zirconia abutments. A total of six implants were evaluated, two of each connection type: external hexagon, tri-channel, and conical connections (n = 2). Half of the implants were connected to zirconia abutments, and the other half to titanium abutments (n = 3). The implants were then cyclically loaded. The implant platforms were evaluated by digital superimposing micro CT files and calculating the area of the loss surface (wear). In all the implants, a statistically significant loss of the surface area ( Dental implants allow the replacement of missing teeth . The mosThe implants are rehabilitated with prosthetic crowns with the abutments being responsible for the connection between the implant and the crown. The most commonly used material to manufacture abutments is grade 5 titanium alloy. In this alloy, other elements such as aluminum and vanadium are added to increase the mechanical strength . HoweverTo overcome these limitations, the first zirconia abutments were introduced in 1997 . FurtherOther solutions have been studied, such as the use of titanium abutment with CrN/NbN coating. This material can influence the peri-implant tissue behavior compared with the traditional machined abutment . Tissue-®, was developed by Niznick in 1983. It is composed of an internal hexagon with a depth of 1.7 mm [The implant–abutment connection is generally described as an external or internal connection according to its geometry . The extf 1.7 mm . Many dif 1.7 mm . Those tf 1.7 mm . The trif 1.7 mm . The morf 1.7 mm . Previous authors have reported greater wear when implants were screwed to zirconia abutments than when they were screwed to titanium abutments ,25,26. HThe purpose of this study was to analyze and measure the wear of grade 4 titanium implants with different platforms connected to grade 5 titanium or zirconia abutments after cyclic loading. The following null hypotheses were tested: (1) the cyclical load does not affect the lost surface area, (2) the abutment material (titanium or zirconia) does not affect the lost surface area, and (3) the connection type  does not affect the lost surface area.A total of six implants were evaluated, two implants of each type of connection: external hexagon , tri-channel , and conical , n = 2. Each implant was inserted in the center of an epoxy resin block  in accordance with the respective manufacture chirurgical protocols with the implant platform 3 mm above the resin level. Half of the implants were connected to zirconia abutments  and the other half were connected to grade 5 titanium abutments , forming 6 different implant–abutment combinations. Both the titanium and zirconia abutments were designed using Zirkonzhan software  and produced with CAD-CAM (Computer-Aided Design—Computer-Aided Manufacturing) techniques . They had a width of 5 mm, a height of 8 mm, and a 30° incisal edge inclination . Each abThe samples were submersed in artificial saliva SAGF  and submFor each implant, two micro CTs (Micrograph Computer Tomograph) were performed, one before abutment placement and load application in order to obtain an unloaded implant image and the second after the application of the load and the removal of the abutment to obtain the image after load application. The equipment  had 130 kV and an acceleration of 300 μA with a voxel size of 7.86 μm. The reading was carried out by rotating 360° around the implant, and images were taken every 0.36°. The data obtained were exported to an STL file (Surface Tessellation Language) from the micro-CT software . The STL files were imported to the Geomagic Control X64 software version 2021.0.3. In this software, the STL file collected prior to cyclic loading for each implant was superimposed onto the STL file of the same implant after cyclic loading with toll best-fit alignment. The pattern of three-dimensional deviations between the two models was represented by a respective color scale. The negative deviations were represented on a scale of blue and purple, corresponding to the wear zones after load application ,30.The digital superimposed files of each implant were longitudinally sectioned along the zone with major alterations. With the 2D  toll, the linear deviations in that zone were measured to obtain the linear wear values. The implant was segmented into multiple geometric components with the toll auto segments (Geomagic ControlX64 software). The lost surface area was calculated from the sum of the components of the zones of the implant–abutment connection before and after cyclic loading. The summed component for each connection and each component name is illustrated in The implant platform at the indexing zones was observed with a scanning electron microscope (SEM)  after cyclic loading with 22× and 1000× amplifications.To measure the repeatability between different readings performed by the micro CT device, an initial reliability test was performed . Two difSince all samples were measured by the same operator, calibration was performed during data collection to determine whether there was consistency in reading the results. To assess the intraobserver variability, the measurements were repeated 4 weeks after the first session. No identifiers were present on the images to minimize bias .Data were statistically analyzed using SPSS Statistics, version 28.0.1 . p > 0.05), non-parametric tests were used due to small sample size. A confidence level of α = 0.05 was assumed for all statistical tests.Although normality was verified with Shapiro–Wilk test (The intraobserver variability was assessed using Wilcoxon tests between the first and second measurement sessions. 2), and the independent variables were the abutment type and the connection type. The values of the surface area before and after the application of loads were compared with the Wilcoxon nonparametric tests. The difference between the initial and final area was also compared according to the type of abutment and connection.The dependent variable was the lost surface area . A difference of 0.0352 mm2 was recorded between the two readings for the same implant. The average difference between readings in session one and session two (after 4 weeks) were 29.41 and 29.40 mm2, respectively. The Wilcoxon test revealed there was no significant difference between measurements performed on the same implants initially and after 4 weeks (p = 0.655). The readings of the platform surface area were 29.1341 mmThe results of the digital superimposition and digital section of the files before and after cyclical loading are presented in The tri-channel connection also showed wear zones with greater extension in the implant that was connected with the titanium abutment. These zones were most evident on the periphery of the horizontal platform in relation to the interior part of the connection  in the surface area of the implant platform. However, the wear was not influenced by the type of abutment (p = 0.700) or the type of connection (p = 0.718).The application of cyclic loads led to a statistically significant reduction  reduction in the platform’s surface area after cyclic loading in all implants. This reduction was subsequently evaluated according to the type of abutment material and the type of connection present. In terms of the type of abutment material used, the average value was higher with zirconia abutments than with titanium abutments. However, these differences were not statistically significant (second null hypothesis cannot be rejected). The fact that the statistical analysis was performed with a reduced number of specimens may have contributed to this result. Further studies should use a bigger sample size.Only a few studies have assessed the wear of implants connected to titanium or zirconia abutments submitted to cyclic loading. These studies showed superior wear with zirconia abutments compared with titanium abutments ,26,41. HQueiroz et al. compared the wear of titanium implants before and after they were cyclically loaded with two different types of abutment: zirconia and a nickel–chromium–titanium alloy. The wear of the external hexagon was analyzed by scanning electron microscopy. The authors found that the zirconia abutments caused more wear on the implants .The divergent results obtained by the different studies can be explained by the distinct methodologies applied . The advantage of using micro CT is that this technique allows 3D  files of the total body of the implant to be obtained, and these can be digitally sectioned to measure the wear of all platforms. In the present study, the specimens were also submerged in artificial saliva throughout the test, while in other published studies that evaluated the wear of implants, cyclic loads were applied in an ambient atmosphere or in a saline solution. It remains unclear how wear is influenced by the presence of artificial saliva. Thus, caution is advised when comparing the results of the present study with those of other studies that evaluated implant wear, as the test environment is not the same and its influence on the results is unknown.Different connections with different areas and geometries have different micromotions at the implant–abutment interface . Low ampThis study aimed to investigate the safety of using zirconia abutments directly screwed to implants with different connections. The results of this study indicate that zirconia abutments, although harder than titanium, do not significantly damage the surface of the implants to which they are connected.Zirconia abutments have aesthetic advantages over titanium abutments, which are gray in color. Titanium abutments require the application of ceramics or adhesion to an aesthetic zirconia crown. Zirconia abutments can also be directly screwed onto the implant, creating a single one-piece abutment . The resThe main limitation of the present study was the cost of the analyses and the implants used. A very accurate micro CT device with high acceleration was selected. This equipment allows clear images and adequate accuracy tests to be obtained; however, the cost of each analysis is high.Other limitations of the study are the long test duration, the high number of cycles used, and the fact that few studies have used digital tools to compare implant wear and the methodologies  employed have been variable ,24,25. TA clinical trial with real oral conditions is also important to deepen the knowledge of this phenomena.The applied model simulated a clinical dental implant system. The digital methodology created allowed us to quantify the wear of dental implants and observe the pattern of wear with different abutment materials and implant connections.The application of cyclic loads at the abutment level induces wear on the different platforms of titanium implants, but no significant differences were observed between the three connections or between the two types of abutment tested.In the external hexagon and tri-channel connections, there was more wear on the periphery of the platform base, while in the conical connection, the wear was evenly distributed throughout the cone.


The interactions among agar, gellan gum, gelatin, and modified waxy corn starch in the formation of mixed gels were examined in five different ratios. Binary hydrocolloid gels were prepared using three ingredients: two hydrocolloids  and water. The textural properties of the hydrocolloid gels were studied by measuring the gel strength, rigidity, breaking force, breaking point, and syneresis as functions of the mixing ratio. The higher syneresis percentage of binary modified waxy corn starch and gum gels than that of mixed gum gels after cold storage was mainly due to the retrogradation of amylopectin. Agar was shown be the most influential with regards to increasing the gel strength, breaking force, and rigidity among the three kinds of gum, while gellan gum was more effective against syneresis than agar and gelatin for storage periods of 7 and 14 days. In the mixed gels, a dramatic increase in the breaking point from 0 to 0.5% was only exhibited for gellan gum. The results provided useful information, including gel strength, rigidity, breaking force, breaking point, and syneresis, for gum and modified corn starch ingredients selected from refrigerated binary gum gels such as pudding for food product development. Hydrocolloids are primarily responsible for the functional properties and the qualities of many processed foods. Processed foods normally contain mixtures of hydrocolloids for starch, imparting structural functions and providing attractive sensations ,2. ReseaPseudomonas elodea with repeating tetrasaccharide  units containing one carboxyl side group [Gellan gum is an anionic deacetylated exocellular polysaccharide produced by microbe de group ,6. The lde group . Gellan de group  noted thGelatin is the main protein gelling agent obtained by the partial hydrolysis of collagen derived from the collagen present in connective tissues, pig or cow skins, and bones ,10; gelaAgar is a cell wall polysaccharide extracted from the algae Gracilariaceae and Gelidiaceae families in water at temperatures above the melting points of their gels. Extraction may be done under acidic, neutral, or basic conditions, the selection being controlled by the type of agarophyte and the qualities required in the gel . Agars aA mixture of multi-component gels provides better control in processed food products than a single component system. The synergistic effect of single-phase mixed solutions of polysaccharides is due to the excluded volume effect of macromolecules . The excStarch is a major storage energy reserved in plants such as rice, maize, potatoes, and wheat. Starch is the most studied natural polymer in an insoluble granular form. Starch consists of two different glucose polymers: primarily branched (amylopectin) and linear (amylose) chains of molecules. Amylopectin is insoluble in hot water, and it is essentially a highly branched glucose molecule in waxy genotype starch. On the other hand, amylose is soluble in hot water, and it is a primarily crystalline linear glucose molecule with a few branches. When starch granules are heated in the presence of water at temperatures higher than 60 °C, the starch granules swell and rupture, accompanied by an increase in viscosity by dissociating double-helix amylopectin hydrogen bonds. It is also known as the gelatinization of starch. Gelatinized starch imparts mouthfeel and body to a food product. Starches can also interact with hydrocolloids . Since hBy binding hydrocolloids with water to diminish the water flow in the matrix space, a resultant resistance to syneresis occurs, as well as a smooth sensation in the mouth ,25. Uponp ≤ 0.05) increases in the breaking force, gel strength, and rigidity of mixed gels. However, the gel strength of mixed gels increased more sharply at lower agar ratios. Gel strength was defined as the force either at the point where the slope of the curve changed suddenly or at the first peak in the force deformation curve. The rigidity of the mixed gels was calculated as the initial slope of the force–deformation curve. The textural properties of gelatin/agar gels at various gum concentrations, as determined by the penetration tests, are summarized in p ≤ 0.05) reduced the syneresis percentage of gelatin–agar gels. Mixed gels with agar concentrations of less than 0.3% had a high syneresis value (>0.55%). Agar gel alone is brittle, and it has high melting and gelling temperatures but low syneresis in the 0.4% and 0.5% ratios. Gelatin gel alone at these ratios is soft, with low melting and gelling temperatures. Gelatin forms elastic, flexible, and soft gels. Neither agar or gelatin alone provide a soft and low syneresis food gel.The effect of agar and gelatin on the syneresis percentage in composite gels is presented in The effect of different ratios of gelatin and gellan gum on the penetration testing of binary gels is recorded in Nevertheless, The gellan gum was shown to be an effective gelling agent for reducing the syneresis of gelatin gels . Gellan The addition of gellan gum was shown to be a most effective gelling agent in the reduction of syneresis and to increase the breaking point in those binary gels stored in a refrigerator for 7 days . p ≤ 0.05) increases in all the parameters of penetration testing of the modified corn starch/gellan gum mixtures  reduced the syneresis percentage of the modified corn starch gels. The data showed that modified waxy corn starch with 0.2% to 0.3% gelatin, gellan gum, and agar could improve water retention during refrigerated temperatures for storage. Modified corn starch–gum gel with 0.1% gum had a high syneresis value after 7 and 14 days of refrigeration (The effect of hydrocolloids on the syneresis percentage in the modified corn starch gels is presented in geration . Althouggeration .w/w). The effect of agar on the mixed gel strength and breaking force showed that, with an increase in the concentration of agar, the gel strength and breaking force increased dramatically. In contrast, gelatin did not significantly improve the syneresis of the mixed gels, and its effects were more inconspicuous than gellan gum in this research. There were indications that the addition of gelatin to the mixed gel systems could increase the breaking point of modified corn starch and the agar gels.The changes in the syneresis percentage of hydrocolloid gel mixed with gum or with modified corn starch are shown in This study demonstrated that agar and gellan gum have good synergistic properties with modified corn starch and that both gums can increase the gel strength, rigidity, and the breaking force of mixed gels. This synergistic interaction was also responsible for the decreasing synersis percentage of the mixed gels. When the mixed gels containing agar were stored in a refrigerator for 7 and 14 days, agar moderately reduced the syneresis percentage and dramatically increased the gel strength and rigidity. Agar increased the breaking force; it had a lower breaking point than other hydrocolloids during penetration testing. The outcome of blending gelatin with other hydrocolloids was positive but less obvious than the textural alternation and syneresis percentage reduction of gellan gum and agar. The reason for the increase in the modified waxy corn starch concentration from 0.1 to 0.4%, with an increased syneresis percentage of the mixed gels after 7 and 14 days of refrigeration, might be due to the reorganization of the amylopectin molecules with more starch and less hydrocolloid added. The syneresis levels of the modified waxy corn starch/gum gel systems were higher than those of the mixed gum gel systems during 14 days of storage in a refrigerator. It showed that the retrogradation of amylopectin from waxy corn starch mainly caused the expulsion of water from the modified waxy corn starch during refrigerated storage. Our results suggest that gellan gum can increase the gel strength, breaking point, and breaking force of mixed gels containing the other hydrocolloids . The gel strength and breaking force of the modified corn starch–gellan and agar gels decreased with the increased modified corn starch concentration (0 to 0.4%). In all of the experiments, an increase ratio of gum caused a decreased rate of syneresis in the modified corn starch mixed gels. The results could be used as a formula adjustment for ready-to-eat binary gel foods. Food processers could use these results to formulate better textural properties and adjust to consumer likes using the intrinsic interactions between hydrocolloids, modified waxy corn starch, and water, leading to a decrease in syneresis. The results obtained from this work could be used to explain more complex emulsified fat globes with model binary food gels such as milk pudding including milk, sugar, cream, and eggs in the future. A small deformation texture testing, dynamic viscoelasticity, and sensory attribute data collection would be helpful for the fundamental comparisons and explanations of these binary hydrocolloid systems in the future.® CH 20, Roquette, France) is a pregelatinized drum dried waxy corn starch (E1422) used as an additive for thickening in dairy, fillings, sauces, and weaning foods. Highly acyl gellan gum , a water-soluble polysaccharide produced by fermentation, pork skin gelatin bloom 200 , which has a hot viscosity of 1700–2300 mPa.s., and agar C powder were provided by Gemfont Corporation . The agar C powder was extracted from seaweeds gracilaria of different origins.Modified corn starch . The required volume of each polymer solution to give different polymer ratios is given in Hydrocolloid mixtures were composed of 1000 g of distilled water and 0.5% Gel strength (g × mm) = breaking force (g) × breaking point (mm)Rigidity (g/mm) = breaking force (g)/breaking point (mm)Penetration testing of the hydrocolloid gels was carried out using a Model TA-XT2 texture analyzer . Six hydrocolloid gel samples from each mixture were subjected to breaking force (B.F.) and breaking point (B.P.) measurements using a spherical plunger (5 mm diameter) with a depression speed of 100 mm/min. Gel strength (G.S.) and rigidity (R.) were calculated using the following equations :Gel strMeasurements were carried out at room temperature (25–27 °C) in duplicate.The method suggested by Charoenrein et al.  was usedp ≤ 0.05) were determined using Duncan’s multiple range test. All of the statistical analyses were performed using the SPSS program, version 12.0 .All results were tested using ANOVA. The differences between the means at a 5% significance level (