Native starch (NS) from different botanical origins  were hydrophobically modified by octenyl succinic anhydride (OSA), and the octenyl succinic (OS) groups were successfully introduced in the starch molecules which obtained OS-starch  with different levels of modification  and degree of substitution (DS). The structural properties of the OS-starch, such as granule size, crystal, wettability and morphology were studied, and the OS-starch was used as particulate stabilizers to produce oil-in-water (O/W) Pickering emulsions. The emulsion index, droplet size distribution and microstructures of Pickering emulsions produced by different OS-starches were compared. OSA modification had almost no effect on the morphology or crystal structure types of three kinds of NS and OS-starch but markedly increased the contact angle and particle size distribution of OSRS, OSTS and OSOS. Esterification reaction of OSA and starch mainly occurred in amorphous regions of starch, and the OSA significantly improved the emulsifying capacity of OSRS, OSTS and OSOS granules and thus stabilized emulsions formed at higher levels (2.5% and 3.0%) of modification of OS-Starch exhibited better stability; the ability of OS-starch to stabilize Pickering emulsion was 3.0% OSRS > 3.0% OSOS > 3.0% OSTS, respectively. Observation and structural properties analysis of OS-starch granules and Pickering emulsion droplets showed that the number and thickness of the starch granules on the oil-water interface of the emulsion droplets increased with improvement of the OSA modification level, and an aggregation state was formed between the OS-starch granules, which was also enhanced with the OSA modification levels. These were all necessary for the Pickering emulsion stabilized by starch granules to remain in a steady state. Recently, there has been more research on Pickering emulsions stabilized by particulate emulsifier from food raw materials ,2. The POSA belongs to a class of chain-enyl succinic, where the chain-enyl group in the chain-enyl succinic structure can be an alkyl, alkenyl, aromatic alkyl or aryl group, or a lipophilic chain containing 5–18 carbon atoms. Octenyl succinic starch (OS-starch) is a recognized safe emulsifier among biological macromolecular emulsifiers, which has characteristics of being a colorless, odorless, inexpensive, non-allergic and approved food additive and excipient with a degree of modification lower than 3% based on the dry weight of starch, with no limit on application ,10. OS-sAt present, OS-starch is widely used in the food industry, however the use of oat, rice and tapioca starches is unconventional, and the Pickering emulsion prepared by OS-starch has demonstrated its unique advantages and an important role in many fields ,16, but The following are the materials and their vendors: NRS ; NTS ; raw oats ; OSA ; and sunflower seed oil (Jiage Investment (China) Co., Ltd., Shanghai, China). All other chemicals were of analytical grade.m/V) and adjusted to pH10 with an NaOH solution (1.0 mol/L), a 25 °C constant temperature water bath and magnetic stirring for 90 min. After stirring, the fiber was removed by using a 100-mesh sieve filter, and the filtrate was centrifuged at 3000 r/min for 15 min; precipitate was washed to pH7 using HCl solution (0.0025 mol/L) and centrifuged again at 3000 r/min for 15 min; precipitate was washed with distilled water and finally centrifuged at 3000 r/min for 15 min. The precipitate was dried at 35 °C for 36 h, crushed and passed through a 100-mesh sieve to obtain NOS.Extraction of NOS was according to the procedure of Falsafi et al. , with soNative starches  were esterified using OSA according to the procedure of Marefati et al. , with so3), then the precipitate was suspended in 300 mL of deionized water, heated in a boiling water bath with constant stirring for 20 min, and then titrated with 0.1 M NaOH. Phenolphthalein was used as an indicator, and the color of the solution changed from transparent to pink to the end point. The DS was calculated by the following formula:A is the volume (mL) of NaOH required for sample titration, W is the starch weight (g), M is the molarity of NaOH, 162 is the molecular weight of the glucose unit, and 209 is the molecular weight of octenyl succinic group minus the molecular weight of hydrogen.The DS of OS-starch was determined by titration method according to Ruan et al. , with mistarchm and OSAm are the quality (g) of the starch and OSA used in the reaction, respectively.The RE was calculated as follows:The particle size distribution (PSD) of the starch sample was measured using a laser diffraction particle size analyzer . The refractive index of the starch phase was 1.54 and the water phase was 1.33 . The resThe contact angle of starch samples was determined using an OCA 20 , following the method described by Dai et al. . The staw/v). A drop of the liquid was placed on a glass slide, covered with a coverslip, and placed on the objective table. Then, the sample was viewed using objective and eyepiece magnifications of 40× and 10× or 20× and 10×, respectively.The crystal structures of starch samples were observed using a polarized microscope . The starch samples were regulated in a certain proportion to form an emulsion . Each sample was spread directly onto the surface of the stub and dried in an oven at 32 °C for 1 h. Then, all of the samples were coated with gold and examined in the SEM under an acceleration voltage of 5 kV.The morphologies of the starch granules were observed by SEM . The starch samples were suspended in acetone at 1% (w/w) and scanned in the wave number range of 400–4000 cm−1.The changes in chemical structure of starch samples were qualitatively analyzed using FT-IR . Samples were prepared by grinding the finely powdered starch with KBr . The scanning region of the diffraction ranged from 5°to 50°with a target voltage of 40 kV, current of 40 mA and scan speed of 2°/min. The relative crystallinity (RC) of the starch granules was calculated according to the following equation:v/v oil-in-water starch granules stabilized emulsions were prepared. The emulsions were homogenized using a rotor-stator high shear homogenizer  at 22,000 rpm for 60 s, and the starch-based Pickering emulsions were obtained.The starch-based Pickering emulsions were prepared as described by Marefati et al. , with soThe emulsion index (EI) refers to the proportion of the emulsified layer of the emulsion relative to the total volume of the emulsion. The Pickering emulsions obtained from 2.10 were transferred to 25 mL scale tubes, 25 °C standed for 1 d, 7 d and 15 d, and the observed emulsified layer volume was recorded . The EI The droplet size distribution (DSD) of Pickering emulsions was measured using a laser diffraction particle size analyzer . The refractive index of the starch phase was 1.54, the water phase was 1.33 and the oil phase was 1.52. The result was recorded as the median mean particle size d(0.5) and volume-average droplet size d.The microstructure of the starch-based Pickering emulsions was observed using a polarized microscope  and photographed to evaluate the droplet size and distribution state. Each sample was placed on a clean dry microscope slide and covered with a cover slip prior to analysis.p < 0.05) were identified using Tukey procedures.For each batch of samples, all specific experiments were carried out in triplicate (triplicate observations). All data were analyzed using the General Linear Models procedure in the Statistix 8 version 8.1 software package . Analysis of variance was performed to determine the significance of the main results. Significant differences (As shown in the The d(0.5) and d values of three types of OS-starch were significantly improved compared with that of NS after being modified by OSA and increased with the DS value. The increase in d(0.5) and d values indicates that a certain degree of aggregation of the OS-starch granules occurred in the aqueous solution, and a greater DS value reflected a stronger aggregation of the OS-starch granules . Aggrega2, C3, and C6, as well as the circular structure of the glucose molecules. It is observed from −1, 2930 cm−1, 1650 cm−1, 1370 cm−1 and 1020 cm−1. Among them, the larger peaks occurring at 3380 cm−1 were generated by O-H expansion vibration; the peaks occurring at 2930 cm−1 were generated by C-H expansion vibration; the peaks occurring at 1650 cm−1, 1370 cm−1 and 1020 cm−1 were generated by C-O  of the emulsion droplets increased with increasing of OSA modification levels, and the main peak of DSD also shifted toward a larger droplet size with increasing of OSA modification levels. The emulsions prepared from NRS, NTS, and NOS had weaker peaks, representing free starch granules at 0.72–2.6 μm,1.14–3.51 μm and 0.86–2.21 μm. These weaker peaks gradually disappeared with the improvement of starch OSA modification levels, which indicated that the increased level of OSA treatment causes more starch granules to be adsorbed at the emulsion droplet interface or aggregated between starch granules.Comparisons made with different NS and OS-starch showed that the smallest d(0.5) and d of Pickering emulsion droplets were prepared from NRS and OSRS, followed by NOS and OSOS, and the relatively largest d(0.5) and d were prepared from NTS and OSTS. These were related to the particle size of the three types of starch; the small particle size starch having a small interface tension at the oil-water interface and being more easily adsorbed at the oil-water interface after hydrophobic modification, which was the reason for the relatively highest EI value of Pickering emulsion prepared from 3.0% OSRS. Rayner et al.  preparedOSA modified treatment effectively improved the emulsification capacity of NRS, NTS and NOS but did not change the crystal structure type of starch granules. Emulsification ability of OSRS, OSTS and OSOS were affected by the DS value and were related to the size and relative crystallinity of the starch granules. The OS-starch as particle emulsifier stabilized Pickering emulsion depended on starch granules forming a thicker multi-granule layer at the interface of the emulsion droplet, and the starch granules inclined to aggregation each other around the droplet; this trend shifted the particle size distribution of the emulsion droplet to a larger size. Based on the above research results, we plan continue to study the effect of OS-starch based Pickering emulsion on emulsifying and gel properties of myofibrillar protein to provide a reliable theoretical basis for the application of OS-starch as a better food particle emulsifier in meat products.


The CS group showed the highest SBS value (23.42 ± 3.88 MPa). On the other hand, the lowest was found in the MB group, which was not statistically different from the CB group . The MS, MBS, and CBS groups showed no statistical difference compared to each other . SBS is highest when a ceramic bracket with silane is bonded to glazed monolithic zirconia.This study aims to compare shear bond strength (SBS) and mode of failure (MOF) between ceramic and metal orthodontic brackets on glazed monolithic zirconia using non-woven polypropylene fiber adhesive. Sixty glazed and sintered zirconia blocks were divided into six groups and attached with orthodontic brackets as follows: CS, ceramic bracket with silane; CB, ceramic bracket with bonding agent; CBS, ceramic bracket with bonding agent and silane; MS, metal bracket with silane; MB, metal bracket with bonding agent; and MBS, metal bracket with bonding agent and silane. There was a statistically significant difference in mean SBS values ( In the past, conventional ceramics were established to meet the needs of dentists and patients for superior aesthetic and natural-like restorations. Nevertheless, conventional dental ceramic restorations have mechanical limitations, such as low tensile strength, crack dissemination, fragility, fractural strength, marginal accuracy, wear resistance, and difficulty of reparation .1/2) has been demonstrated [In the early 1990s, zirconia was developed for dentistry and was chosen as a substructure to help support more aesthetic materials. Zirconia is the hardest ceramic material used in dentistry and it also displays equal mechanical properties to those of some metals ,3. Zirconstrated . Therefonstrated .In the following years, the attention of researchers was given to the nanostructure modification of zirconia by adding yttrium oxide, called zirconia–yttria ceramics or tetragonal zirconia polycrystals (TZPs) . TZPs weMonolithic zirconia crowns without layering ceramics have become increasingly popular as a result of CAD/CAM technology and increasing zirconia translucency ,8. Most Zirconia has evolved, but it still has significant drawbacks. To make zirconia look more natural, it must be glazed. The dental ceramics glazing procedure was developed to solve the issue. Glazing is formed by burning a thin, transparent silica glass coating on the surface or by firing the substructure up to the proper temperature for a few minutes to obtain a glossy ceramic surface . FurtherThe number of adult orthodontic patients has recently increased. A comparatively higher percentage of people (about 45 percent) in the middle-age group are interested in orthodontic treatment . Women bv/v% in different marketable brands. Recent commercial resin composites in dentistry, a gold standard, contain the following components: resin matrixes, free-radical initiators and inhibitors or stabilizers, dyes (pigments), fillers, and silane coupling agents. The combination of the filler elements increases the mechanical properties and decreases the polymerization shrinkage after curing them [The currently present silane coupling agents in dentistry use tri-alkoxysilane, such as 3–methacryloxyproyltrimethoxysilane (MPS), as the reactive vital ingredient. The concentration of silane can vary between 1–10 ing them . Adding ing them .A non-woven polypropylene fiber orthodontic adhesive was introduced using a novel material manufacturing technology . It was Nowadays, there are several types of orthodontic appliances. Ceramic brackets, lingual brackets, and even clear aligners have been developed to meet the aesthetic needs of adult orthodontic patients. Fixed orthodontic braces with aesthetically pleasing brackets have been reported to be among the most commonly used in adult patients . Due to A systematic review of orthodontic bonding to porcelain in 2013 concluded that etching with 9.6% hydrofluoric acid for 1 min, rinsing for 30 s, air-drying, and then applying a silane coupling agent is the best protocol for bonding to porcelain. Regarding the dangerous effects of hydrofluoric acid etching, another alternative is sandblasting to create physical roughness, followed by silane application .With fixed orthodontic brackets, the bond strength between teeth and appliances should exceed the force that is needed to move teeth successfully. Reynolds and colleagues stated that a maximum value of 5.9–7.9 MPa would be reasonable enough . For non®, Dentsply Sirona™, Charlotte, NC, USA), were milled into 60 small pieces (size 10 × 10 × 3 mm2). All of the small zirconia blocks were sintered and glazed. Sixty glazed and sintered monolithic zirconia blocks were embedded in a polyvinylchloride tube fixed with self-cured acrylic resin. All of the sample surfaces were treated with 9.6% hydrofluoric acid  for 1 min, rinsed for 30 s, and then air-dried [TM ClarityTM Advanced Ceramic Brackets, 3M Victory SeriesTM Bracket System, and 3MTM APCTM Flash-Free Adhesive, 3M ESPE, St. Paul, MN, USA) were used to attach the first and second groups, respectively. In this study, precoated orthodontic adhesive was chosen for both metal and ceramic brackets in order to avoid unequal adhesive thickness. Then, each group was divided into three subgroups based on the bonding techniques: CS: ceramic bracket with silane; CB: ceramic bracket with bonding agent; CBS: ceramic bracket with bonding agent and silane; MS: metal bracket with silane; MB: metal bracket with bonding agent; and MBS: metal bracket with bonding agent and silane . Both precoated metal and ceramic brackets were placed by using 300 g of loading force after surface preparation  was used to cure each distal and mesial part of the bracket for 6 s  was used to evaluate shear bond strength. According to ISO/TS 11405:2015 (E), all samples were stored in distilled water at 37 °C for 24 h prior to the test. The Zirconia surface was parallel to the force applied, and then the vertical load was transferred to the bracket base, fabricating shear force at the bracket–zirconia interfaces. Shear bond strength was recorded at a crosshead speed of 0.75 mm/min. Then, the measured values were divided by the area of the bracket base and transformed into MPa units. Image analysis software  was used to measure the base area of the bracket.A universal testing machine  and was scored based on the amount of remaining adhesive material on the bracket base; scores were expressed as a percentage of the bracket base area. The ARI was performed to categorize the sites and types of bonding failure between the zirconia surface, adhesive, and bracket. The ARI was recorded on a range of 0 to 3; 0 means all adhesive was left on the bracket base; 1 means more than half the amount of the adhesive was left on the bracket base; 2 means less than half the amount of the adhesive was left on the bracket base; and 3 means no adhesive was left on the bracket base, as shown in According to the pilot study, a group of 6 samples was indicated by using G Power software . The sample sizes were raised to 10 specimens per group for error compensation. p ≤ 0.05 was utilized. SPSS statistical software was used to analyze the data, and descriptive statistics were used to examine the specimen characteristics. To ensure data normality, the Kolmogorov–Smirnov test was used. A one-way ANOVA was used to identify whether a significant difference existed between the shear bond strengths of various groups. For the non-homogeneity of variances, the Tamhane test was used to examine differences among multiple groups’ means. To evaluate whether a statistical test proved significant, p < 0.01). The Tamhane for multiple comparison tests, as in The descriptive statistics for the SBS values of all groups are shown in p = 0.00). The CS group showed ARI scores of 1 (70 percent), 2 (10 percent), and 3 (20 percent), showing that a significant amount of adhesive remained on the zirconia surfaces. The ARI scores of the MS, CBS, and MBS groups were mainly 1 and 2 , indicating that a small amount of adhesive remained attached to the zirconia surfaces. However, the ARI scores of the samples in the CB and MB groups were all 0 , which shows that there was no adhesive left on the bracket bases after the brackets broke.In this study, the bonding properties of ceramic and metal brackets were verified. When attached to the glazed monolithic zirconia using precoated, non-woven polypropylene fiber orthodontic adhesive, the SBS values of the CS group (ceramic brackets with silane) were much higher than those of the other groups.According to Reynolds in 1975, the range of 5.8–7.8 MPa was the minimum SBS value required to bear regular orthodontic forces [v/v) of silane concentration granted higher SBS values than that of 3% and 1% (v/v) of silane concentration when bonding composite resin to lithium disilicate glass ceramics [Furthermore, using only a silane coupling agent resulted in higher SBS values compared to a combination of silane and a bonding agent for both metal and ceramic brackets attached to glazed monolithic zirconia. In 2022, Charoenbhakdee et al. demonstrated that 6%  when bonding to polished monolithic zirconia . Imani eOn the other hand, Kwak et al., in 2016, demonstrated that hydrofluoric acid etching provided no significant difference in SBS values compared to the alumina air abrasion surface treatment  on glazed monolithic zirconia attached to metal brackets. Furthermore, using bur roughening for surface preparation on glazed monolithic zirconia exposed the zirconia substructure. Thus, silanization for enhancing SBS values was not recommended for this method . MoreoveThere were two types of failure modes between the two materials. First, cohesive failure arises in the bonding agent, the bracket, or even in the zirconia itself, indicating that the bond within the interfaces was tougher than the material. The second type, adhesive failure, happens at the bracket/adhesive or the zirconia/adhesive interfaces, indicating that the bond strength was even weaker at the interfaces between the adhesive and material . In ordeIn this study, pure adhesive failure at the adhesive/zirconia interface in the CB and MB groups (100 percent ARI score of 0 for both groups) indicated that there was no adhesive left on the zirconia and, therefore, no chance of damaging the zirconia surfaces. Although bracket debonding was an advantage of these bonding techniques (the CB and MB groups), the SBS values fall short of the minimal threshold for moving teeth. The adhesive was unable to adhere to the silica oxide presented in the glazed monolithic zirconia surfaces since there was no silane coupling agent used in the bonding procedure, as shown in The majority of MOFs were mixed and cohesive failures inside the adhesive for the CS, MS, CBS, and MBS groups; none of these failures affected the surfaces of the brackets or zirconia. However, two samples from the CS group had an ARI score of 3, indicating that there was a huge amount of adhesive residue on the zirconia surface overall. A 1994 study found that cohesive failures in ceramic itself would occur at an excessive force of more than 13 MPa. This means that after debonding, the extremely high force of bond strength might harm the restoration surfaces . This coThe highest SBS is achieved when a ceramic bracket with a silane coupling agent is bonded to a glazed monolithic zirconia surface using precoated, non-woven polypropylene fiber orthodontic adhesive. However, silane coupling agents and bonding agents are best used to lessen the possibility of damaging the restoration during debonding and preserve a suitable shear bond strength value. Therefore, it is not recommended to bond to glazed monolithic zirconia using a bonding agent alone.


Mineral-based oils are the market leaders when it comes to their consumption in different types of rotating machines. Recently, a lot of attention has been given to the bio-oils and lubricants due to their better thermophysical, tribological, and environmental characteristics for use in journal bearing and other rotating machines. The superior physical properties of bio-oils have instigated this research in order to evaluate their dynamic characteristics that can cause the harmful dynamic instabilities in rotating machinery. The dynamic characteristics of the fluid film are influenced by temperature, eccentricity ratio, and rotational speed. In this work, the effect of temperature is experimentally measured on the dynamic viscosity of bio-oils and mineral-based oil. The dynamic viscosity measured is then computationally used to estimate the hydrodynamic pressure response of three bio-oils  and SAE40, a mineral-based oil, to check their performance in the rotor bearing system. It is found that at 40 °C, the hydrodynamic pressure for SAE40 is observed to be 2.53, 2.72, and 3.32 times greater than those of rapeseed, palm olein, and soybean oil, respectively, whereas, at 125 °C, the hydrodynamic pressure for SAE40 is observed to be 8% and 4.3% less than those of rapeseed and palm olein, respectively, but 14% greater than that of soybean oil. Hence, the increasing temperature has less effect on the viscosity and hydrodynamic pressure of bio-oils compared to SAE40. Therefore, for high-temperature applications, the bio-oils can be used with further processing. The superior response of bio-oils is also an indication for better dynamic characteristics. L/d = ∞) and the short bearing assumption (∂p/∂z >> ∂p/∂x). In addition, the solution obtained by making the short bearing assumption is much simpler than that from the infinite long bearing assumption [The governing equation of hydrodynamic lubrication, the Reynolds equation, was established in 1886. From the results of Tower and Petroff, Reynolds derived the basic equation of the hydrodynamic theory of lubrication of a journal bearing from the Navier–Stokes equations using many assumptions. The Reynolds equation is a partial differential equation and cannot be solved in its full form without making certain assumptions to simplify the equation and obtain the solution. There are two general simplifications: the infinitely long bearing , finite element method (FEM), and finite volume method (FVM) . The mosThe bio-lubricants are environment friendly, renewable, and biodegradable. This gives them an edge over the conventional mineral-based lubricants, which are toxic to the environment and are also non-biodegradable ,20. FurtxxK, xyK, yyK, yxK) and damping coefficients . The cavitation and journal whirl are used to evaluate the static characteristics, dynamic characteristics, and stability of journal bearings [The journal bearings can be evaluated by the static and dynamic characteristics under different thermal operating conditions . The stabearings . The majbearings . Therefobearings . Similarbearings .Thus, in this paper, the performance of bio-oils  and SAE40 is computationally evaluated in terms of hydrodynamic pressure, in order to determine how the bio-oils behave under different dynamic conditions in fluid film journal bearings. This is novel area of research that has not yet been experimentally and numerically simulated for bio-oils and lubricants. The short bearing assumption is used for analysis purposes. Furthermore, using different eccentricity ratios, the dynamic characteristics are also evaluated.h is the film thickness, p is the pressure developed in the film, and η is the oil film viscosity. Similarly, another important parameter to define a bearing that combines speed and load effects is often termed as the bearing characteristic number or the Sommerfeld number S:η is the viscosity of the lubricant, N is the speed of shaft rotation, D is the diameter of the bearing, L is the bearing length, W is the applied load, R is the shaft radius, and C is the radial clearance.The nonlinear fluid film forces generated by the journal bearing may be derived by considering the solution to the Reynolds equation. The Reynolds equation for laminar, iso-viscous, and iso-thermal flow may be written as :(1)∂∂x{FxFyFrom the above equations, we have two direct or principal stiffness coefficients:Similarly, two direct or principal damping coefficients are also present:The cross-coupled stiffness coefficients can be defined as:yxK relates to a vertical force due to a displacement in the x direction. Thus, the horizontal and vertical directions are coupled. Almost all structures have cross-coupled stiffness terms, but most are symmetric in nature, meaning xyK = yxK. The cross-coupled stiffnesses are detrimental because, instead of damping the whirling motion of the rotor such as the direct damping, these cross-coupled stiffnesses combine to produce a force in the whirl direction, increasing the shaft vibration. When the direct damping is unable to dissipate the energy induced by the cross-coupled stiffness force, the natural frequency  will become unstable, causing the journal to whirl at this frequency [The coefficient requency .In this work, the dimensionless stiffness and damping coefficients are determined for various eccentricity ratios. These coefficients are important in defining the overall dynamic characteristics of the fluid film bearing under different loading conditions.L/d ≤ 0.5. In addition, the load applied on the shaft is in the form of a disk, as shown in In this work, the journal bearing is modeled by taking the following design values. The short bearing assumption is used where Dynamic viscosity is the measure of the shear stress per unit area required before an oil sample begins to deform. Lubricants are characterized by their viscosity as a function of temperature, pressure, and shear rates. However, viscosity is largely influenced by the working temperature of the liquid . The inc−6 is used for all residual terms. The limitations for the Ansys fluent solver are that it uses constant viscosity unless the values are changed by the user.The Navier–Stokes equation, mass and momentum equation, and energy conservation equations are solved in steady-state, taking gravity forces into account. The model is established using ANSYS Fluent. The operating pressure is taken as an absolute 101,325 Pa at the inlet and 0 Pa at the outlet. In this work, the results are obtained by assuming a laminar flow. For the hydrodynamic pressure measurement for bio-oils and SAE40, the viscosity is not kept constant. Instead, the variable viscosity values are used, measured at different temperatures for different types of oils. The bearing shell is modeled as a stationary wall. The journal is modeled as a moving wall with a rotational speed of 3000 rpm. The rotational axis origin is set to the value of eccentricity. The lubricant inlet is modeled as pressure inlets and the lubricant outlet is modeled as pressure outlets. For greater accuracy, a convergence criterion of the order of 10Mesh refinement is carried out in order to obtain the accurate results of various parameters under consideration in ANSYS Fluent. At larger mesh size, the results are generally not accurate. As the mesh size decreases, the results tend to become more accurate, although the computational time also increases.Therefore, based on the dynamic viscosity values at different temperatures, the CFD technique is used for further evaluation of bio-oils and SAE40 for the hydrodynamic pressure distribution.Increasing temperature has an effect on the dynamic viscosity of oils. As the temperature increases, the viscosity decreases. This is further elaborated in The dynamic viscosity of the three types of bio-oils and SAE40 is measured from 27 °C to 25 °C. The experimental measurement of dynamic viscosity is performed using the viscometer. From The eccentricity ratio also affects the stiffness and damping coefficients. The stiffness and damping coefficients play an important role in defining the dynamic response of the system. This is further explained in xyK and yxK are the prime cause of rotordynamic instability. Therefore, it is very important to keep these terms as low as possible. The stiffness values are plotted for different eccentricity ratios. Depending on the condition of eccentricity ratio , the concerned value of ijK can be used. The dimensionless stiffness coefficient ijK can be converted to dimensional stiffness coefficient ijk by the given formula:C is the radial clearance and W is the load on the bearing.In xyC and yxC have the same value. The damping values are plotted for different eccentricity ratios. Depending on the condition of eccentricity ratio , the relevant value of ijC can be used. The dimensionless damping coefficient ijC can be converted to dimensional damping coefficient ijc by the given formula:In fe range . Anotherfe range .Hydrodynamic pressure is measured for bio-oils and SAE40 under different operating conditions of temperature and viscosity using ANSY Fluent. This is further explained in the figures below.From In In Overall, from the CFD results, rapeseed oil and palm olein have shown superior responses in comparison with SAE40, showing a lower decrease in viscosity and giving higher values of hydrodynamic pressure at higher temperatures. These oils can be specifically considered for applications where the steady-state temperature of the journal bearing oil film is above 100 °C.◦The dynamic viscosity drop is much less for bio-oils compared to SAE40. The stable behavior of bio-oils against the increasing temperature makes them suitable for high-temperature applications in journal bearings.◦At 40 °C, the hydrodynamic pressure for SAE40 is observed to be 2.29, 2.39, and 3.01 times greater than those of rapeseed, palm olein, and soybean oil, respectively. Hence, the load-carrying capacity of oil film for SAE40 is also higher as the viscosity is higher compared to bio-oils.◦By contrast, at 125 °C, the hydrodynamic pressure for SAE40 is observed to be 8% and 4.3% less than those of rapeseed and palm olein, respectively, but 14% greater than that of soybean oil. This decrease in hydrodynamic pressure causes the decline in load-carrying capacity of oil film for SAE40 compared to bio-oils.◦Stiffness and damping coefficients are also investigated for different eccentricity ratios. Depending on the operating parameters , the value of eccentricity ratio can be calculated. The eccentricity ratio is important in evaluating the dynamic characteristics (stiffness and damping).Based on the CFD study to measure the hydrodynamic pressure response, bio-oils have shown a superior response. Similarly, from the results, it can be concluded that:This shows how the temperature rise affects the performance of mineral-based lubricants more compared to bio-oils. Similarly, changing the eccentricity ratio also changes the stiffness and damping coefficients, which can have an effect on the dynamic stability of the system. Furthermore, the bio-lubricants used here are unprocessed compared to the mineral-based lubricant SAE40. The treatment of bio-oils according to operating conditions and requirements can also enhance their physical and dynamic properties.


To evaluate the clinical and radiographic assessment of customized fusion-sputtered one-piece zirconia implants.Twenty-eight patients received either fusion sputtered one-piece zirconia implants (n = 14) or one-piece titanium implants (n = 14). All implants were one-piece designs. After 4 months of immediate loading, all implants were restored with a monolithic zirconia crown. All implants were evaluated at baseline, 6 months, 1 year, 2 years, and 5 years. Implant mobility, plaque index, and gingival index evaluations were performed. The measurements of marginal bone level were calculated radiographically.P = .364) between zirconia (3.3 ± 0.7 mm) and titanium (3.5 ± 0.6 mm) implants, after 5 years. There was no statistically significant difference (P = .470) between zirconia (1.77 ± 0.039 mm) and titanium (1.80 ± 0.28 mm) implants regarding marginal bone loss, after 5 years.All implants were well maintained through the evaluation period with a 100% survival rate without any clinical complications. Regarding gingival index, there was no statistically significant difference (One-piece fusion-sputtered zirconia implant represents a reliable treatment modality in replacing a missing tooth in the esthetic zone.The online version contains supplementary material available at 10.1186/s12903-022-02600-9. Every day, more difficult cases are being treated with dental implants, and the success rate is increasing . Since tA number of clinical techniques have been introduced in order to reduce the risk of immediate loading, like accurate patient selection, less preparation of the osteotomy, the use of nonfunctional provisional crowns, and the use of implants with special anatomical designs . IncreasExcellent biocompatibility and a wide range of therapeutic possibilities are provided by titanium implants . FailureFusion-sputtering is a new technology for creating a rough zirconia surface by spraying small zirconia particles over unsintered zirconia with an air–water jet. These particles get structurally bonded with the zirconia surface during sintering, resulting in a layer thickness of 4 to 12 . In a prAfter 4 weeks, the existence of newly produced bone trabeculae in direct contact with all implant surfaces could be seen histologically. There were no gaps, fibrous tissue, or foreign body reaction at the implant-bone interface, indicating active osteoblasts secreting osteoid matrix. After 8 weeks of recovery, there was a further rise in bone apposition on all implant surfaces. Successful osseointegration of zirconia and titanium implants was found across the whole length of all implant surfaces after 12 weeks. At the examined intervals, histomorphometric analysis revealed no significant difference in measured bone density within or outside the implant threads between fusion-sputtered zirconia and titanium implants .Since immediate loading of one-piece implants has become a widely used procedure for the rehabilitation of partially edentulous patients, no reports are available on the impact of fusion sputtering implant surface treatment on the clinical outcome of zirconia implants. Therefore, the aim of this clinical investigation was to evaluate and to compare the safety and efficiency of fusion-sputtered customized one-piece zirconia dental implants in comparison with titanium implants after 5 years of loading. The proposed hypothesis tested in this study was that fusion sputtered zirconia implants would perform similarly compared to one-piece titanium implants.www.sealedenvelope.com). A blocked list was generated and a randomization code was performed. A staff member not involved in the study prepared the envelopes.The study was prospective cohort study, comparing one-piece zirconia implants and one-piece titanium implants, for the replacement of a single-tooth in the maxillary premolar area. Sample size calculation was based on success rate between cases with zirconia and titanium implants retrieved from previous research. Using G*power version 3.0.10 with expected difference of 49%, 2-tailed test, α = 0.05 and 80.0% power. The total sample size was 14 cases at least in each group . For randomization, the patients were sorted by using online software  Patients were instructed to rinse with chlorhexidine . Surgery was done under local anesthesia . The incision was placed at the mid-crest, with releasing incisions if necessary, and a mucoperiosteal flap was raised. Osteotomy preparation started with a pilot hole drill followed by a 2 mm depth drill till the length of 12 mm at 800 rpm. The drilling was done in a straight up and down motion using a low-speed, high-torque handpiece. Subsequently, the osteotomy was enlarged using a 2.5 mm twist drill at 12 mm length followed by a 3.4 mm twist drill till one-third of the implant length.After osteotomy preparation, the customized one-piece zirconia and titanium one-piece implant was selected Table  and seatAccording to classification of Misch et al. , nonfuncFour months later, after soft tissue maturation the provisional was removed. The implant was checked. The abutment portion of the implant was modified and the inter-occlusal space was adjusted if needed. The preparation was done using a high-speed carbide bur  and finished with the high speed tapered diamond . Excessive water cooling was used during abutment modification to protect the implant from overheating. After digital scanning, monolithic zirconia crowns were milled  using a CAD/CAM system . After intra-oral checking, the finished restorations were cemented using self-adhesive resin cement .The baseline for the radiological analyses was implant placement. Radiographs were taken at implant placement, prosthetic insertion (4 months), 6 months, 1 year, 2 years, and 5 years' follow-up. Periapical radiographs were taken without standardization to evaluate marginal bone level at each interval.After radiographic exposure the sensor was scanned with a radiographic dental scanner  then the digital radiograph was imported to a scanora software for measurements. The changes of marginal bone the implant was assessed. The average of bone loss on mesial and distal level around side of the implant was measured and recorded in patient chart. To eliminate the radiographic magnification error, the scale of measurement was adjusted according to the actual length of the implant. Two reference points were established within the implant head  at the chamfer finish line of the abutment portion. A straight line was established between the two reference points represented by black line Fig. . Mesial The baseline for the clinical analyses was prosthetic insertion. The clinical evaluation was done at implant placement, prosthetic insertion (4 months), 6 months, 1 year, 2 years, and 5 years' follow-up. Implant stability, absence of pain, perimplant clinical indices   computer software 2013, version 22.0, Armonk, NY, IBM Corp. Qualitative data were described using numbers and percentages. Quantitative data were described using median (minimum and maximum) for non-parametric data and mean, and standard deviation for parametric data after testing normality using the Shapiro–Wilk test. The significance of the obtained results was judged at the (0.05) level. For qualitative data, the description of the data was done in form of frequency and proportion. Kruskal Wallis and Mann Whitney tests were used to comparing between the two groups. For quantitative data, the description of the data was done in form of means ( ±) SD. General Linear Model measure one-way ANOVA was used to compare one group at different times.All implants were well maintained through the period of evaluation with a 100% survival rate with no signs of pain, swelling, pus discharge, or mobility during the observation period Fig. .Fig. 8ZiRegarding plaque index, zirconia implants resulted in score 0 for 11 implants (78.6%) and score 1 for 3 implants (21.4%), whereas titanium implants scored 0 for 11 implants (78.6%), scored 1 for 2 implants (14.3%) and scored 2 for 1 implant (7.1%). Kruskal Wallis test showed that there was no statistical significant difference as regard to plaque index of one-piece zirconia implant as compared to one-piece titanium implants.P = 1.000).With Gingival index, zirconia implants scored 0 for 11 implants (78.6%) and scored 1 for 3 implants (21.4%), whereas titanium implants scored 0 for 11 implants (78.6%), scored 1 for 2 implants (14.3%) and scored 2 for 1 implant (7.1%). Kruskal Wallis test showed that there was no statistical significant difference as regard to gingival index of one-piece zirconia implant as compared to one-piece titanium implants. Mann Whitney showed that there was no statistical significant difference as regard to plaque index and gingival index at 3 months, 6 months, 12 months and 18 months for one-piece zirconia and titanium implants (P = 0.364) between zirconia implants (3.3 ± 0.7 mm) and titanium implants (3.5 ± 0.6 mm). The mean probing depth values at follow-up intervals are summarized in Table Regarding probing depth after 5 years, there was no statistically significant difference P = 0.64 betweeP = 0.470) between zirconia implants (1.77 ± 0.039 mm) and titanium implants (1.8 ± 0.028 mm), , Figs.  and 11. ), Figs. .Table 4MThe purpose of this study was to assess the clinical and radiographic outcome of customized fusion-Zirconia has proven to be an excellent titanium substitute. The proposed hypothesis for this study was accepted as there was no significant difference between zirconia and titanium implants regarding probing depth and marginal bone loss. Currently, one-piece designs make up the bulk of zirconia implants . QualityWith immediate loading becoming more and more common, the one-piece implant design gives an intriguing alternative. Immediately loaded zirconia single-piece implants had a good success rate in terms of clinical and radiological outcomes, according to Steyer et al. . The oriCustomized root-analog zirconia implants have emerged as a potential substitute for standard implants in order to address issues with stress distribution, aesthetics, and biofilm-induced peri-implantitis . With peSteam autoclaving was used to sterilize the custom-made implants in this investigation. The surface free energy and surface chemistry of zirconia changed after sterilizing procedures, according to Han et al. . The typThe abutment part was adjusted in situ in this investigation. After heating bone to 47–50 °C for one minute, tissue injury can occur , 36. ExcThe amount of heat created during intra-oral abutment preparation under coolant did not cause bone loss or promote osteoclastogenesis at the bone-implant contact, according to Russe et al. . The parFor the purpose of cementation of each crown to its corresponding abutment on the one-piece dental implant, self-adhesive resin cement was used. In contrast to traditional glass-ionomer cement and resin-ionomer cements, it has high compressive strength, low solubility, and resists tensile fatigue. This kind of cement eliminates the need for bonding agents, which speeds up the bonding process and, most critically, reduces the "window of contamination." Due to the presence of phosphate ester group in its makeup, it chemically linked to etched ceramic and zirconia ceramic. According to Rohr et al. , self-adRutkowski et al.  reportedThis study verifies the predicted outcome of immediate loading with a one-piece implant design, with an implant survival rate of 100% after 5 years. No significant differences were found in marginal bone level loss between zirconia and titanium implants. The majority of bone resorption in one-piece implants occurs within the first year of implant placement , 48. ManTo minimize variability from load or bone quality, both zirconia and titanium implants were placed in the same location for each patient. Computer software was used for accurate and reliable analysis of periapical radiographs . A mean One customized implant design was used in this study, further clinical studies are needed to investigate fusion sputtered zirconia implant with various micro- and macro-geometry designs such as length and diameter. Also, it is mandatory to investigate the clinical outcome of fusion sputtered zirconia implant as support for fixed dental prosthesis. Also, clinical studies are needed to study custom made zirconia implant as a root analogue. More researches are needed to study if zirconia implant used as full arch rehabilitation or not. Finally, longer term evaluation periods are required. One drawback of the present study is the placement of only one type of restoration (zirconia) which may transmit all occlusal stresses to the implants and implant-bone interface. Furthermore, non-standardized peri-apical radiographs for the assessment of the changes in the marginal bone around the implants. This has to be regarded as a limitation of the current study.Within the limitations of this clinical study, One-piece fusion-sputtered zirconia implant represents a reliable treatment modality in replacement of a missing tooth in esthetic zone, compared with one-piece titanium implants.Additional file 1. Gingival index score, Plaque index score, Periodontal depth, Marginal bone loss.


We identified 96 KTRs (38.7%) with superior (group 1) and 152 KTRs (61.3%) with inferior graft function (group 2). Donation after cardiac death, female sex, glomerulonephritis as primary disease, and early TCMR were independently associated with inferior graft function. Graft survival was significantly better in group 1 compared to group 2 . Besides group affiliation , multivariable analysis identified DSA development  and donor age  as independent factors. Interestingly, there was no significant difference in patient survival . In ultralong-term survivors, excellent graft function refers to superior graft survival but does not extend ultimate patient survival. DSA-formation should be taken seriously even in the ultralong-term.Kidney transplant recipients (KTRs) with ultralong-term survival represent a growing, yet insufficiently studied patient cohort. In this single-center retrospective study, we analyzed 248 ultralong-term survivors (≥20 years). KTRs were classified into those with superior graft function (defined as eGFR ≥45 ml/min + proteinuria ≤300 mg/day + eGFR-slope ≤ 2 ml/min/1.73 m  Kidney transplantation has become standard procedure in care of patients with end stage kidney disease (ESKD) and by today, is the preferred treatment for most of them . Over thHence there is a growing population of KTRs who have lived with a functioning graft for several decades ,13,14,15(1) What graft function (estimated glomerular filtration rate (eGFR), proteinuria, eGFR decline) do KTRs display 20 years post-transplant?(2) What factors influence graft function 20 years post-transplant?(3) What is the incidence of donor specific antibody (DSA)-formation in ULS?(4) What is the outcome regarding graft and patient survival beyond 20 years post-transplant?(5) What factors influence ultimate graft and patient survival of ULS?To optimize ultralong-term aftercare and to overcome the still important challenge of further improving long-term outcome , it is cThis single-center retrospective study was approved by the local Ethics committee of Zurich, Switzerland (Basec Number: 2019–02082) without informed consent requirement and performed in adherence to the declaration of Helsinki.We considered all adult (age ≥16 years at the date of transplantation) KTRs transplanted at University Hospital Zurich between 1 January 1981 and 31 December 1999. Among a total of 1,180 single-kidney transplantations performed at our institution during this era, we identified 304 KTRs with documented graft survival ≥20 years. 22 KTRs who had denied consent had to be excluded, further 34 KTRs due to insufficient data. This led to a total study cohort of 248 KTRs .visit for each KTR, defined as the closest and most complete visit to the date of transplantation plus 20 years. For all KTRs, median time from transplantation to the 20-year post-transplant visit was 240 months (range 228–248 months). If the 20-year post-transplant visit did not reveal full data, we checked medical records from 19–21 years post-transplant for completion. Cases with insufficient documentation between 19–21 years post-transplant were excluded, as stated above.At our center, follow-up care after the first post-transplant year is generally performed quarterly in our outpatient clinic or, in stable conditions, by local nephrologists, complemented by an annual visit at our center. For data collection, we reviewed medical records from the electronic database of the hospital registry. End of follow-up and data collection was 31 January 2021. To evaluate characteristics 20 years post-transplant, we identified the 20-year post-transplant 2  , Chronic2 ,23. To i2  were cal2 . For 31 . KTRs were excluded from this sub-analysis in case of missing HLA antibody-screening during the observation period  or if the very first screening was performed beyond 21 years post-transplant and DSA-positive, thus the date of DSA-occurrence was indeterminable .All donors and recipients were typed for human leukocyte antigen (HLA)-A, -B and -DR. Since approximately 2009, annual HLA antibody-monitoring using Luminex based assay  became standard procedure in KTR-care at our center. In case of worsening graft function or progression of proteinuria, screening may have been performed more often. If Luminex mix assay was positive and/or clinical suspicion was high, an additional Luminex single antigen bead assay was performed to test for DSA. We classified KTRs with ≥1 DSA-positive Luminex single antigen bead assay up to 21 years post-transplant as DSA-positive, irrespective of the level of mean fluorescence intensity (MFI). KTRs were classified as DSA-negative in case HLA antibody-monitoring  did not show DSA up to 21 years post-transplant or if the very first screening was performed beyond 21 years post-transplant and negative for DSA2/year 15–20 years post-transplant. Subjects in group 1 had to meet all 3 criteria. KTRs who did not pass ≥1 criteria were assigned to group 2. Two cases with missing data on proteinuria that fulfilled the other criteria for group 1 were classified as insufficient data and excluded, consequently. Two cases were categorized according to BSA-indexed CKD-EPI, because of unknown BSA (missing documentation of patient’s height).According to the KDIGO 2012 Clinical Practice Guideline for the risk of CKD progression, KTRs were stratified into two groups based on graft function 20 years post-transplant.  CriteriaWe separately studied patient survival (treating graft loss as a censored event), death-uncensored and death-censored (treating death as a censored event) graft survival, calculated from the date of transplantation to KTR’s death or graft loss , whatever came first. If there was no event, survival dates were censored at the date of last follow-up or end of data collection (31 January 2021).Specific causes of graft loss and results of indication biopsy were evaluated for KTRs with death-censored graft loss in group 1.https://www.PIRCHE-II.org).The HLA-derived mismatched peptide epitopes presented by KTRs HLA-molecules were calculated using the PIRCHE-II algorithm. Presentation of both HLA class I  and HLA class II derived peptides  were calculated for each HLA locus. Detection of HLA antigens was performed by DNA-based HLA-typing technology using blood samples. Either sequence-specific oligonucleotide (SSO) or sequence-specific primer (SSP) technologies were used to generate low-resolution HLA typing results. The imputation of probable allele resolution results needed for the PIRCHE-II calculation was achieved by the use of the imputation algorithm included in the PIRCHE-II calculation. The PIRCHE-II algorithm is available online . Continuous variables are expressed as median (range minimum-maximum) and compared using Mann Whitney-U Test. Categorical data are expressed as number (%) and compared using Chi . No differences were observed for PIRCHE-II scores for HLA-class I  vs. median 23.26 (range: 0.00–76.93) between KTRs developing and not developing DSA (p = 0.116). Group 1 and group 2 did neither significantly differ in amount of DSA-positive KTRs nor in number, category, or maximal MFI of detected DSA . No differences were observed for the total PIRCHE-II scores  and the PIRCHE-II scores per locus between group 1 and group 2 (p > 0.05).Maintenance immunosuppression is shown in Subdivision of the cohort is shown in p = 0.041), female sex , early TCMR , and glomerulonephritis as primary disease . While 17 of 152 KTRs (11.2%) of group 2 developed recurrence of primary disease, only 1 of 96 KTRs (1.0%) of group 1 did (p < 0.001). A minor impact was observed for donor age  and length of pretransplant dialysis .Multivariable Cox regression analysis is shown in Survival analyses are shown in de novo DSA (dnDSA) during the third post-transplant decade. Graft loss resulted from biopsy-proven chronic antibody mediated rejection (ABMR). The other two KTRs both had their first HLA antibody-screening performed during the 28th year post-transplant and were DSA-positive by then . Indication biopsy showed glomerulopathy and low level glomerulitis in one, and glomerulopathy and vasculopathy with signs of de novo IgA nephropathy in the other case. In group 2, 67/152 (44.1%) grafts failed during follow-up: 30/67 (44.8%) due to DWFG, 37/67 (55.2%) due to DC-GF. Death-censored and death-uncensored graft survival was significantly superior in group 1  grafts failed during follow-up: 23/26 (88.5%) due to DWFG, 3/26 (11.5%) due to DC-GF. These latter 3 KTRs were analyzed more closely: 1 KTR was DSA-negative 20 years post-transplant but developed p = 0.003), overall DSA-development , donor age . For patient survival (p < 0.001) and CsA-based immunosuppression  were significantly associated with outcome.Univariable and multivariable Cox regression analysis are shown in survival , only KTULS represent a growing, yet insufficiently studied patient population ,9. To adGroup comparison revealed a significant difference in DCD, early TCMR, recipient gender, and glomerulonephritis as primary disease. For the first, previous studies suggest comparable survival rates for kidneys from DCD.  For the Data on long-term maintenance immunosuppression is extremely limited . In our To target therapeutic interventions and optimize ultralong-term aftercare, we need to improve our understanding of late graft loss ,31, whicIn their comprehensive study of 177 ULS, McCaughan et al. observed that DC-GF after 20 years is uncommon . Our stuDonor age profoundly impacts graft quality  and is aLate DC-GF is profoundly driven by alloimmune mechanisms ,39,51. DHence, DC-GF is predominantly seen in ULS with inferior graft function. However, despite the known link of declining graft function with increased mortality , there wOur results allow us to specify this statement and lead to further clinical implications. Indeed, in case of good, stable graft function up to 20 years post-transplant, risk of ultimate DC-GF is very low, and focus should be on controlling the medical comorbidities . In contOur study has several limitations. First, it is a retrospective and single-center analysis with the intrinsic limitations and potential biases. Secondly, our cohort differs in several aspects from more recently transplanted KTRs. Thirdly, DSA-subanalysis is limited by transplant era and available techniques: it affected time of first and frequency of subsequent screenings, 50 cases with missing or insufficient data had to be excluded, and KTRs were mostly not typed for HLA-DP and -DQ.However, most of these limitations are inevitably associated with the retrospective design of research on ULS and the according necessity of lengthy follow-up . In addiOverall, KTRs with ultralong-term survival ≥20 years do extremely well. Particularly KTRs with stable and high eGFR and low proteinuria likely keep their graft function and ultimately die of medical comorbidities. The risk of graft failure is predominantly seen in KTRs with inferior graft function. This graft function-related risk profile could augment long-term monitoring and treatment.


Purpose: Monitoring the contractility of muscles assists the clinician in understanding how muscle functions as part of the kinetic system. This study investigated the effect of knee joint angles under different resistance on the stiffness of the medial gastrocnemius (MG), lateral gastrocnemius (LG), and soleus (SOL) muscles using the shear wave elastography (SWE) technique.Methods: A total of 22 females were recruited. During isometric plantar flexion, at knee 0-degree (fully extended) and knee 90-degree (flexed 90°), the shear modulus on the MG, LG, and SOL was measured by shear wave elastography at no contraction and two intensities (40% and 80%) of maximal voluntary contraction (MVC). Shear modulus is a mechanical parameter to describe stiffness, and stiffness is a proxy for muscle contractility.Results: There were moderate-to high-positive correlations between the active stiffness of triceps surae muscles and isometric contraction intensity . The active stiffness in MG and LG with extended knees was higher than that with flexed knees (p＜0.001). The active stiffness in SOL with flexed knee was higher than that with extended knee (p＜0.001).Conclusion: Active stiffness can be considered a quantitative indicator generated by the force output of the triceps surae. Different knee joint angles cause three triceps surae muscles to exhibit non-uniform mechanical properties, which may explain part of the mechanism of soft tissue injury during physical exercise. The triceps surae are the important muscles for humans to be able to perform upright movements. Injury, performance, and training of the triceps surae have been a popular issue in current sports and sports science research . After tin vivo.The voluntary contraction of the triceps surae creates the bulk of the plantar flexion torque in the mid–late gait stages . Isometrμ = 3ρ·v2 . Shear modulus is a mechanical parameter to describe stiffness, and stiffness is a proxy for muscle contractility. Our previous study shows that SWE is a reliable method for measuring the triceps surae stiffness  has been widely used to assess the relationship between local muscle stiffness and contractility. The shear modulus and normalized joint torque with isokinetic dynamometry showed a good linear relationship in the rotator cuff muscle . Previoutiffness . To the It can be hypothesized that changing the knee joint angle can alter the active stiffness of three triceps surae muscles, allowing the body to be more economical and accurate in responding to different functional tasks. Thus, the aim of this study was to assess the active stiffness of the MG, LG, and SOL at different knee postures during isometric plantar flexion.All procedures were approved by the Ethics Committee of Guangdong Provincial Hospital of Traditional Chinese Medicine (YE 2020-329-01) and carried out following the guidelines of the Declaration of Helsinki. All recruited subjects were informed of the experimental procedures and the safety of SWE in the present study. Each subject signed an informed consent form.A total of 22 healthy female college students  were recruited. The dominant leg was defined as the leg used more for kicking. Only triceps surae muscles of the right calf were measured. All subjects were identified as right leg–dominant. Because the instrumentation has a small threshold for musculoskeletal patterns that make it difficult to monitor larger muscle stiffness in male subjects, only female subjects were recruited for this study. Inclusion criteria were as follows: all subjects were healthy and able to follow the operator’s instructions. Exclusion criteria were as follows: anybody with a lower limb neuroskeletal muscle injury, such as Achilles tendon injury, heel discomfort, plantar fasciitis, or an anterior cruciate ligament (ACL) injury, and individuals taking corticosteroid medication.All ultrasound examinations were performed by an ultrasound SWE system  with a 50-mm linear array transducer , using the instrument’s default standard musculoskeletal (MSK) settings. Other settings of the SWE mode were as follows: penetration mode with 85% opacity, and the middle part of the muscle thickness was chosen for measurement. The size of the region of interest (ROI) was set to 10 × 10 mm. The Q-box diameter was set to 5 mm. Change from blue (soft) to red (hard) was based on shear modulus. The measurable range was adjusted to 0–300 kPa.A micro FET2 hand-held dynamometer (HHD)  was used to measure force during plantar flexor isometric contraction. The HHD was anchored on the wall as in the previous study , using aIn the 0-degree knee (K0), the trunk was secured by straps on the platform, with the hip and knee joints in full extension; in the 90-degree knee (K90), a wooden block was placed in front of the thigh, with the hip and knee joints at 90°. The trunk and thighs were secured by straps to a wooden block (with loop hooks) to prevent body movement. The regions of the MG, LG, and SOL were identified by the ultrasound B-mode. The MG and LG were at 30%  of calf-length , where the cross-sectional areas of the gastrocnemius are nearly maximum. The length of the LG is measured from the popliteal fossa to the medial malleolus. A tape was used to measure the length, and a black pen was utilized to mark the location of the measurement site ). The SOIn the pilot test, the maximal voluntary contraction (MVC) force of the plantar flexors was measured at neutral ankle position using a HHD . In addiMeasurement of the muscle stiffness at no contraction and two intensities of MVC after 30 min of the pilot test. 1) Without contraction: the degree of the muscle stiffness was measured with a position of the knee extension or knee flexion. To reduce experimental errors, subjects were explicitly asked to keep the lower extremity fully relaxed . 2) IsomA sample size of 4 (22 subjects included) was deemed sufficient to achieve high statistical power. The effect sizes for MVC were determined from our pretest (eight subjects). A effect size of 3.69 was calculated by the sample size calculator G∗Power 3.1.9.2, alongside a power of 95% and a significance level of 0.05. The experience of our previous study has also been taken into account n = 20; .p = 0.05.SPSS 18.0  was used for statistical analysis of all the data. The Shapiro–Wilk test was used to check the normal distribution of all stiffness data. All stiffness data were expressed as mean ± standard deviation. All stiffness values were normally distributed. A 2-way (2 knee positions × 3 contraction intensities) analysis of variance (ANOVA) was performed to evaluate the data to discover if differences exist in muscle stiffness between the extended and flexed knee when comparing various contraction intensities. If there was a knee position × contraction intensity interaction, the main effects were investigated and a Bonferroni correction was applied on the post hoc tests. The plantar flexion force was divided into two stages: the low-load stage (no contraction (0%)–40%) and the high-load stage (40%–80%). The validity of shear modulus was evaluated using general linear model analysis. The slope of the stiffness is the regression coefficient of the general linear equation, which indicates the level of change in stiffness when altering the contraction intensity. Correlation between muscle stiffness and plantar flexion intensity was assessed using Pearson’s correlation analysis. The correlation degree of the correlation coefficient  was set to |r| > 0.8 for high correlation, 0.5 <|r| ≤ 0.8 for moderate correlation, 0.3 <|r| ≤ 0.5 for low correlation, and |r| ≤ 0.3 for no linear correlation. Paired t-tests were applied to verify differences in muscle stiffness between knee extension and flexion. Cohen’s d was used to examine the effect size. The significance level of the statistical data difference was set as p＜0.001); the SOL with a flexed knee was stiffer than that of an extended knee (p＜0.001) (p＜0.001) .p＜0.001). At flexed knees, the slope of the MG, LG, and SOL at the high-load stage increased by 65%, 105%, and 41% compared to that of the low load stage, respectively. But the increase of the MG and LG in extended knees was blunted during the high-load stage, and the slope of the MG and LG at the high-load stage decreased by 27% and 36% compared to that of the low load stage, respectively. There is a knee position × contraction intensity interaction, the main effects are investigated, and a Bonferroni correction is applied on the post hoc tests in The main findings of our study were that 1) he slope of the MG stiffness with an extended knee was larger than that with a flexed knee, and the slope of the SOL stiffness with flexed knees was larger than that with extended knees. 2) The stiffness of the MG and LG with an extended knee was larger than that with a flexed knee. The stiffness of the SOL in a flexed knee was larger than that in an extended knee. 3) There was a moderate-to-high positive linear relationship between the stiffness of muscle and the intensity of isometric plantar flexion.During the high-load stage, the slope of MG stiffness with flexed knees was larger than that with extended knees. The slope of SOL stiffness changes with an extended knee was larger than that with a flexed knee. This was the first trial to compare the active stiffness recruitment of three triceps surae muscles at different knee postures. First, the pennation angle between the fiber and fascia of the MG is ∼60° . AccordiAlthough both the MG and LG have 50% of slow muscle fibers , we alsoWe also compared the relaxed stiffness of the SOL at two knee angles. Contrary to our previous study results in male subjects , the relp < 0.001)  . At an i< 0.001) . These sMicroscopic-level analyses of the active stiffness production indicate that it occurs in an environment of tissues that exhibit spring-like behavior. Muscle myosins are highly efficient motors that adjust the power output according to loads. When the load increases, it elicits a stronger binding between myosin and actin (termed the “cross-bridge”)  and decrWe also considered that a lower coefficient of fitting (R-squared range: 0.32–0.78) appeared at the high-load stage in the current research. Our results agreed with a study by Inami et al. who found that the force–stiffness relationship was not linear . Howeverin vivo. Further studies will investigate other factors that affect stiffness recruitment.SWE provides a quantitative assessment of mechanically driven muscle recruitment in macroscopic conditions. Active stiffness can be regarded as a parameter indicator of muscle contraction capacity for physiotherapy or therapeutic feedback in the fields of sports science and rehabilitative training. SWE provides additional information on voluntary muscle contraction by adding stiffness as another measurable characteristic of current ultrasound imaging techniques. As far as we are concerned, the exact proportion of fibers  and muscin vivo. Second, although we instructed the subjects not to contract auxiliary muscles , we were unable to confirm that this was the case due to the lack of electromyography (EMG) equipment. In the next trial, we will introduce an EMG device to objectively monitor muscle activity. Finally, in our preliminary experiments, muscle stiffness in male subjects with 80% MVC often exceeded the measurement range of the instrument. Therefore, only female individuals were recruited in this study. Finally, the results of this study apply only to healthy young people. In the future, we will progressively conduct studies on injured patients.There were several limitations in the present study. First, the mechanical behavior of the Achilles tendon may also influence the active stiffness of the triceps surae. The stiffness of the Achilles tendon exceeded the threshold of the SWE’s device. We were unable to explore the biomechanical link between the triceps surae and the Achilles tendon In summary, SWE can be used to quantify active stiffness changes in the triceps surae during muscle contraction. Knee joint angles can affect the stiffness recruitment of the MG, LG, and SOL. The MG and LG with extended knees showed higher stiffness at the low-load stage, whereas the SOL with flexed knees exhibited higher stiffness at the high-load stage. Non-uniform stiffness increase in MG, LG, and SOL may explain part of the mechanism of soft tissue injury. Further studies are necessary to evaluate the stiffness recruitment of other muscles in different functional tasks.


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Autism diagnostic observation schedule (2nd ed.). Torrance, CA: Western Psychological Services.Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Publisher information was missing from this reference and has now been added.Journal of Autism and Developmental Disorders, 50(9), 3424–3431. 10.1007/s10803-019-04100-2McGarry, E., Vernon, T., & Baktha, A. (2019). Brief report: A pilot online pivotal response treatment training program for parents of toddlers with autism spectrum disorder. Behavior Analysis in Practice, 13(3), 291–298. 10.1007/s40617-020-00429-8Rodriguez, K. A. (2020). Maintaining treatment integrity in the face of crisis: A treatment selection model for transitioning direct ABA services to Telehealth. Volume number and pages from these articles were missing and have now been added.Journal of Applied Behavior Analysis 54(1), 87–102. 10.1002/jaba.803Pollard, J. S., LeBlanc, L. A., Griffin, C. A., & Baker, J. M. (2021). The effects of transition to technician-delivered telehealth ABA treatment during the COVID-19 crisis: A preliminary analysis. In Autism diagnostic interview, revised. Los Angeles, CA: Western Psychological Services.Rutter, M., Le Couteur, A., & Lord, C. (2003). Publisher information was missing from this reference and has now been added.Verbal behavior. New York: Appleton-Century-Crofts.Skinner, B. F. (1957). Publisher location was missing; reference has now been corrected.Journal of Autism and Developmental Disorders, 45(7), 1951–1966. 10.1007/s10803-014-2351-zWong, C., Odom, S. L., Hume, K., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2014). Evidence-based practices for children, youth, and young adults with Autism Spectrum Disorder. Journal name has been corrected for this paper and volume and page numbers have been added.https://apps.who.int/iris/bitstream/handle/10665/350199/Telehealth-PHC-eng.pdf?sequence=1&isAllowed=yWorld Health Organization. (2021). Leveraging telehealth for efficient delivery of primary health care in the WHO South-East Asia Region. Reference title was incomplete and link obsolete.This erratum is presented to fix these errors.The original article has been corrected.


The mUPO, on the other hand, has also the potential to reduce shrinkage from 33.91 to 21.77% and moisture absorption from 5.93 to 1.73% by increasing the content from 0 phr to 6 phr in starch foam. Furthermore, the mUPO helps the forming of the foam structure as measured by SEM, and the mUPO utilization of waste-based material could be a promising green alternative plasticizer for starch components, especially starch foam applications.A novel waste-based plasticizer derived from modified used palm oil (mUPO) was successfully developed and has been used as a new plasticizer to non-glutinous thermoplastic starch foam to improve their properties. The molecular weight and hydroxyl number of the mUPO was 3150 g/mol and 192.19 mgOH/g, respectively. The effects of mUPO content ranging from 0 to 9 phr were investigated. The results revealed that the optimal mUPO content as an additive was 6 wt%. The addition of mUPO had a direct effect on the mechanical properties and thermal properties. The impact strength increased from 1.30 to 4.55 J/m, while the glass transition temperature ( Polymer-based foams are now widely used in our daily life in applications such as medical engineering, packaging, sound absorption, and insulation due to their light weight, high mechanical properties, portability, and ease of processing and control . Almost There are numerous bio-based starches that have been developed and used to prepare foam material, including potato starch ,6,7,8,9,Maranta arundinacea) starch biopolymers by loading glycerol into the matrix. According to the literature reviews, the addition of plasticizer allows mixing and interacting with the starch, resulting in a significant improvement in starch processability as a thermoplastic and their properties, particularly thermal and mechanical properties. According to the report of Silva et al.  versus θ, in range of the DTG peak, gives a straight line. By the least-square method, the kinetic parameters of thermal degradation can be calculated from the slope of the graph and the intercept of the straight line can also be calculated.The thermal decomposition kinetics of the thermoplastic non-glutinous starch can be used to assess the thermal stability of materials in the step of degradation indicated by TGA and DTG data, ascribed by the activation energy (Eradation ,44,45,46a of the degradation of thermoplastic non-glutinous starch is shown in a of the degradation values for thermoplastic non-glutinous starch with mUPO contents of 0, 3, and 6 phr are 0.88, 1.05, and 7.88 kJ/mol, respectively. This study implies that mUPO can also insert and react with the starch chain, thereby improving the thermal stability of thermoplastic starch foam. According to the findings, the addition of 6 phr of mUPO helps increase thermal resistance by tenfold compared to the pristine formulation.The summary of EBased on the findings, it can be concluded that mUPO has an effect as a plasticizer of thermoplastic non-glutinous starch foam. The increased flexibility of the thermoplastic starch foam was caused by inserting the molecule of mUPO into the starch foam and its reaction with the starch foam as a secondary bond. The addition of a mUPO-based plasticizer increases the chain mobility and free volume of the thermoplastic non-glutinous starch, resulting in a reduction in shrinkage percentage and moisture absorption, as well as improved impact strength and thermal properties. Furthermore, the mUPO aids in the homogeneous spread of foam formation. Accordingly, the possibility of mUPO action on the thermoplastic non-glutinous starch foam is represented in gT dropped to 66.50 °C by adding 6 phr of mUPO in the thermoplastic starch foam. Furthermore, the mUPO could be able to reduce shrinkage to 21.77% and moisture absorption to 1.73%. The morphology study revealed that the mUPO can also reduce the viscosity of the foam. As a consequence, the mUPO derived from waste could be a promising green plasticizer for starch foam applications.In this study, a waste-based polyol derived from mUPO, with a molecular weight of 3150 g/mol and a hydroxyl group of 192.19 mgKOH/g, has been discovered as an effective plasticizer of starch foam. According to the findings, the optimal mUPO content as an additive was 6 wt%. The addition of mUPO had a direct impact on the mechanical properties of the starch foams, increasing their toughness and impact strength by about threefold. It also improves thermal decomposition and broadens the temperature range. The impact strength increased to 4.55 J/m and


The risk of sustaining a graft rupture after anterior cruciate ligament reconstruction (ACLR) is high. Contributing risk factors are, however, still not clearly identified.The aim of this systematic review was to identify and quantify risk factors for graft rupture after ACLR.A systematic review with meta-analysis (PROSPERO CRD42020140129) based on PRISMA guidelines was performed. MEDLINE, CINAHL and EMBASE were searched from inception to September 2021. Prospective and retrospective studies addressing risk factors for graft rupture after ACLR in males/females of all ages were considered. Meta-analyses using a random effect model  were performed. The GRADE tool was used to assess evidence quality.Following full-text screening of 310 relevant papers, 117 were eventually included, incorporating up to 133,000 individuals in each meta-analysis. Higher Tegner activity level (≥ 7 vs < 7) at primary injury , increased tibial slope (degrees) , lower psychological readiness to return to sport (RTS) , early surgery (< 12 vs ≥ 12 months) , RTS (pre-injury level)  and family history of ACL injury  were all associated with increased odds of graft rupture. Higher age , female sex , fewer self-reported knee symptoms pre-reconstruction  and concomitant cartilage injuries  instead decreased the odds. Meta-analysis revealed no association between body mass index, smoking, joint laxity, RTS time, knee kinematics, muscle strength or hop performance and graft rupture.Conspicuous risk factors for graft rupture were mainly sports and hereditary related. Few studies investigated function-related modifiable factors or included sports exposure data.The online version contains supplementary material available at 10.1007/s40279-022-01747-3. Injury to the anterior cruciate ligament (ACL) is common among athletes , 2 and oProminent risk factors for primary ACL injury are female sex, increased joint laxity as well as aberrant neuromuscular and biomechanical movement patterns, such as deficits in neuromuscular control of the trunk and lower extremity and higher ground reaction forces during landing . FurtherThis systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines , 20 and A systematic search was performed from inception to January 2020 (updated in September 2021) in the following databases: MEDLINE (PubMed), CINAHL and EMBASE with search terms incorporating different aspects of secondary ACL injuries and associated risk factors, previously published in full  (Online All studies meeting the following criteria were considered for inclusion: (1) prospective or retrospective studies with any follow-up duration; (2) inclusion of males and/or females of any age with primary ACLR (any graft/surgery technique); (3) assessment of any factor related to demographics/characteristics, injury, timing of surgery, activity/sport, biomechanics, joint geometry/skeletal maturity, function and patient-reported outcomes at baseline; and (4) recording of at least three graft ruptures, defined as clinically verified, MRI verified or self-reported graft rupture or as revision surgery during the study period. Exclusion criteria were (1) animal studies and in vitro studies; (2) case studies, conference abstracts, review papers and editorials; (3) external risk factors, such as weather, equipment, playing surface or possible risk factors related to type of graft and/or surgery technique; and (4) published in a language other than English or a Scandinavian language.All abstracts and full texts were independently screened according to the inclusion/exclusion criteria by two of the authors of this review (AC and ET) using the Covidence software . Any disagreements were resolved by a consensus discussion between AC and ET, and if required with the third author (CH). The following data were extracted from the studies: authors, publication date, country, number of participants, sex, age, activity level, number of graft ruptures, time to graft rupture, graft type, follow-up period (years), assessed risk factor/s and effect measure/s. If there were not sufficient data to perform meta-analysis reported in a study, study authors were contacted with a request for additional information if the study was published within the last 10 years. A meta-analysis was performed if there were two or more studies that included the same risk factor for sustaining a graft rupture.2) into account [Q test and corresponding I2-statistics were used to calculate the between-study effect measure heterogeneity [Comprehensive Meta-Analysis software, version 2.2.064  was used for meta-analysis. The odds ratio (95% CI) for each risk factor for sustaining a graft rupture was chosen as the effect measure. The odds ratio was primarily calculated from the number of events and sample size in each group or from mean (SD) as appropriate. If not reported, the reported unadjusted univariable odds ratio was used if available. A random effect model was used because of expected heterogeneity between studies, regarding sex, age, graft types, physical activity level and time duration of follow-up. All meta-analyses and corresponding forest plots were weighted under the random effect model, taking both within-study variance and between-study variance  (aged ≤ 19 years) and adults (aged > 19 years) were performed if two or more studies investigated the same risk factor for graft rupture.I2 was ≤ 50%, funnel plots with trim and fill were used to evaluate any publication bias [Two of the authors (AC and ET) independently assessed all included studies for risk of bias using the Quality In Prognosis Studies (QUIPS) tool , 26  were performed separately for 42 potential risk factors for graft rupture. Sixteen risk factors were rated as moderate quality, 12 as low and 14 as very low-quality evidence according to GRADE  high activity level with the odds being almost four times higher for those having a Tegner score of ≥ 7 compared with those scoring < 7 at the primary injury ; (2) young age (dichotomous variable), with the odds being 2.6–3.5 times higher for those aged < 18–30 years compared with ≥ 18–30 years, respectively ; (3) increased lateral tibial slope (degrees) ; (4) lower psychological readiness to RTS ; (5) surgery within 12 months compared with surgery ≥ 12 months post-injury ; (6) returning to pre-injury activity level ; and finally, (7) family history of ACL injury  . In addition, higher age (continuous variable) , female sex , better pre-reconstruction score on the Knee injury and Osteoarthritis Outcome Score (KOOS)   and concomitant cartilage injury  decreased the odds of sustaining a graft rupture . The following factors were found not to be associated with future graft rupture: BMI, smoking status, contact versus non-contact injury mechanism, medial tibial slope, general joint laxity, pre-reconstruction KOOS score , timing of surgery (≥ 3 vs < 3 months or ≥ 6 vs < 6 months), number of physical therapy visits, timing of RTS (≥ 6 vs < 6 months), playing soccer compared with other sports, Marx activity score at primary injury, hop performance, quadriceps strength, hamstring strength, knee abduction after RTS, concomitant meniscal or medial collateral ligament injuries or femoral condyle ratio .Sex was the sole variable eligible for meta-analysis for the adults. No difference in the odds of sustaining a graft rupture was observed between males and females if only adults were considered .Of the factors eligible for meta-analysis in the subgroup of C&A, a family history of ACL injury  was associated with a higher odds of future graft rupture, whereas female sex decreased the odds  . On the other hand, the following factors were not associated with the odds of sustaining a future graft rupture in this population: age, BMI, return to pre-injury activity level, growth plate status and concomitant meniscal injury .Sex, family history, RTS and concomitant meniscal tear were the only variables eligible for assessment of publication bias. The funnel plots with trim and fill imputations showed no difference in effect measure, indicating no publication bias for either of the variables as risk factors for graft rupture  .Fifty-eight (50%) studies were rated as low risk of bias, 17 (14%) as moderate and 42 (36%) as high risk of bias . After sensitivity analyses were performed, excluding articles with high risk of bias , a BMI ≥I2 ranged between < 0.001% and 92% for all meta-analyses, indicating low to high heterogeneity between studies [ studies  , family history of ACL injury, surgery performed within 12 months and RTS. Increased lateral tibial slope and lower psychological readiness to RTS were also associated with sustaining a future graft rupture but with very low to low quality evidence. Female sex decreased the odds . On the other hand, factors such as smoking status, joint laxity, timing of RTS, kinematics, knee muscle strength and hop performance were not associated with future graft rupture. Few studies investigated factors related to sensorimotor function and neuromuscular control.A pre-primary injury Tegner score of ≥ 7 compared with a lower activity level was associated with the highest odds (OR 3.91) of sustaining a graft rupture. In addition, and in line with our previous review on risk factors for C-ACL injury , return Extending the result from a recent meta-analysis reporting younger age to be a risk factor for C-ACL injury , youngerIn accordance with research on risk factors for both primary , 212 andPerforming ACLR within 12 months from injury increased the odds of sustaining a graft rupture by 87% compared with delayed surgery (≥ 12 months). In contrast to our previous review where a higher risk of sustaining a C-ACL injury was reported for those who received an ACLR within 3 months  and it iSimilar to our previous review on C-ACL injury , the metn = 3), and that the OR (1.72) was quite similar to the OR (1.91) for the full analysis. Furthermore, young males seemed to undergo ACLR using a physeal-sparing technique due to skeletal immaturity and open growth plates to a higher extent than females, which has been suggested to influence graft rupture rate in young males [In contrast to previous research reporting female sex to be a risk factor for sustaining both a primary ACL injury , 227–230ng males . Neitherng males  nor growng males .2 was associated with higher odds of sustaining a future C-ACL injury, whereas smoking status did not seem to be related to C-ACL injury [2 was associated with decreased odds of sustaining a graft rupture, indicating that any relation between BMI and graft rupture is still to be verified.In a previous systematic review, a BMI < 25 kg/mL injury . IndividL injury . NotwithKnee kinematics, kinetics, knee muscle strength, hop performance and self-reported outcomes, such as knee confidence, have previously been linked to the risk of second ACL injuries (graft ruptures and C-ACL injuries combined) , 50, 233n = 2–4) highlight the lack of studies that include the same measures of sensorimotor function or psychological aspects as potential risk factors for graft rupture. Standardized objective and self-reported measures on function and psychological constructs that are responsive to training/intervention, in contrast to demographic factors that are non-modifiable by nature, should thus be considered in future studies on risk factors for secondary knee injuries. This is a prerequisite to fully understand the role of the neuromuscular and psychological factors in the risk of graft rupture after ACLR.Similar to the findings for primary ACL injury , 240, weACL injuries are most frequent in sports, and re-injury incidence is very high . AccordiIn this systematic review, we included all studies that assessed risk factors for graft rupture without any restrictions related to either participant demographics, sport exposure, graft type or year of publication, which also increases the generalizability of our findings. Other strengths of our review are the very high number of individuals in most of the meta-analyses .n = 4) or females (n = 3) and all other articles included both sexes, we do not believe that this had any major influence on our result. An additional limitation is that we pooled studies including different types of grafts and surgery techniques for ACLR. Since most of the included studies comprised a mixture of different graft types/surgery techniques or did not report graft type at all, we chose to not perform subgroup analysis for graft type. Although assessing graft type and surgery technique as possible risk factors was beyond the scope of this study, research indicates an advantage for autograft versus allograft and patella graft versus hamstring graft in the risk of graft failure [I2 statistics (≥ 75%) [I2 statistics [I2 statistics for these specific studies should be interpreted with caution. The mechanisms contributing to ACL injury and graft rupture are most likely multifactorial and incorporate a combination of both demographic factors, such as family history and age, as well as factors related to neuromuscular control and sensorimotor function [However, there are several limitations. Our review includes studies with different definitions of graft rupture, such as clinically or MRI verified ruptures as well as revision surgery identified from surgical records. It is possible that using only revision surgery as outcome may underestimate the graft rupture rate and consequently influence the result of the meta-analysis, since this approach will not capture those who chose to have non-surgical treatment of their second injury. We also pooled studies on males and females and different age groups, but have performed subgroup analysis to account for possible differences between C&A populations and adults. Since only seven of the 117 included articles reported solely on males  . To accoatistics . Thus, tfunction . Applyinfunction .This systematic review with meta-analysis provides evidence that high activity level, RTS, young age, low psychological readiness to RTS, family history of ACL injury, surgery performed within 12 months, and increased tibial slope are all factors related to increased odds of sustaining a future graft rupture. Females seem, however, to have lower odds of graft rupture compared with males. Studies including modifiable risk factors such as neuromotor control were rare. We recommend that future attention in research should be given to factors such as muscle strength and activation, sensorimotor control and movement quality as well as psychological factors, all of which may be responsive to training/intervention, and thus able to be incorporated into rehabilitation protocols aiming at reducing the risk of further knee injuries after ACL injury and facilitating a safe RTS for ACL-injured individuals.Supplementary file1 (PDF 385 KB)Supplementary file2 (PDF 382 KB)Supplementary file3 (PDF 727 KB)Supplementary file4 (PDF 825 KB)Supplementary file5 (PDF 391 KB)Supplementary file6 (PDF 611 KB)Supplementary file7 (PDF 458 KB)Below is the link to the electronic supplementary material.