A matched-case analysis of donor and recipient variables was developed: 10 HOPE-ECD livers and kidneys (HOPE-L and HOPE-K) were matched 1:3 with livers and kidneys preserved with static cold storage (SCS-L and SCS-K). HOPE and SCS groups resulted with similar basal characteristics, both for recipients and donors. Cumulative liver and kidney graft dysfunction were 10% (HOPE L-K) vs. 31.7%, in SCS group (p = 0.05). Primary non-function was 3.3% for SCS-L vs. 0% for HOPE-L. No primary non-function was reported in HOPE-K and SCS-K. Median peak aspartate aminotransferase within 7-days post-LT was significantly higher in SCS-L when compared to HOPE-L . Graft survival at 1-year post-transplant was 93.3% for SCS-L vs. 100% of HOPE-L and 90% for SCS-K vs. 100% of HOPE-K. Clinical outcomes support our hypothesis of machine perfusion being a safe and effective system to reduce ischemic preservation injuries in KT and in LT.With the aim to explore innovative tools for organ preservation, especially in marginal organs, we hereby describe a clinical trial of  Nevertheless, the number of discarded organs is increasing constantly, primarily as a consequence of the increasing average age of the donor pool1.The gap between patients candidate to liver or kidney transplant and the actual organ availability is a prominent issue for transplant centres worldwide, and has a significant impact for such patients in terms of morbidity and mortality6. However, the use of ECD organs still entails a considerable price to pay: an increase of primary non-function (PNF) or delayed graft function (DGF) in kidney transplant (KT) and early allograft dysfunction (EAD) in liver transplant (LT), and a decrease of long-term survival7 not related to the experience of the transplant centers8. Cold ischemia time (CIT) and warm ischemia time during reperfusion impair ECD grafts – being those highly vulnerable organs – but at the same time do not increase mortality risk, which remains relevant for patients in waiting list9. These evidences lead scientific transplant community to explore new strategies for the preservation of marginal grafts, which appear more vulnerable when treated with standard techniques, such as static cold storage (SCS). Different innovative preservation methods in KT and LT are currently under investigation in animal models, pre-clinical and clinical trials, comparing different strategies, ranging from hypothermic (4–10 °C) to subnormothermic (20–25 °C) – including controlled oxygenated rewarming – and normothermic (35–37 °C) conditions10. Early clinical evidences from the Zurich group support the benefit of hypothermic oxygenated perfusion (HOPE) as confirmed for LT clinically11 and on rat models for KT experimentally12. Conversely, in United Kingdom, normothermic machine perfusion (NMP) for preservation of LT and KT achieved an optimal safety, feasibility and efficacy14. Subnormothermic machine perfusion (SMP) and controlled oxygenated rewarming (COR) were experienced in animal models demonstrating the improvement in renal or liver function and superiority when compared to SCS17, but to present only COR in LT was applied in clinical practice with good results of feasibility and short-term transplant outcomes18.Several data demonstrate how the use of marginal liver and kidney allografts, defined according to the Extended Criteria Donors(ECD), may represent a valid strategy to enlarge the donor pool and to offer more transplant opportunities otherwise unachievable only with Standard Criteria Donors (SCD)19 lead us to confirm the role of dynamic preservation and the need for oxygen provision to restore ATP levels, despite the fact that their clinical marginal features had labeled such organs as un-transplantable. Therefore, based on our previous findings and several positive suggestions above mentioned12, we designed an interventional clinical trial to apply HOPE as preservation technique in liver and kidney transplant procedure. HOPE was performed through a machine perfusion purposely developed for abdominal organs perfusion in our center. Outcomes data were elaborated to determine safety and efficacy of HOPE treatment in extended criteria donors after brain death (ECD-DBD) for LT and KT.Our preliminary experimental study on human discarded kidneys and liver graftsBetween October 2016 and December 2017, N = 20 recipients (N = 10 LT recipients and N = 10 KT recipients) were recruited consecutively and transplanted with ECD-DBD organs preserved from surgical back-table to implantation by HOPE (Table The study population was properly matched with the control group Table  and no sMedian donor age was very extended: 77.5 (60–84) years for HOPE-L group and 71.5 (60–78) yearsfor HOPE-K group compared to 75.5 (53–85) years for SCS-L group and 69.5 (59–79) years for SCS-K group (p = n.s.).Median recipient age was 57.5 (50–68) years for HOPE-L group and 61 (50–66) years for HOPE-K group versus 60.5 (48–68) years for SCS-L group and SCS-K group (p = n.s.).In the L-HOPE group, the median CIT was 7.1 (6.1–9.6) hours: a value time comparable to 7 (5.4–10) of L-SCS group and very low because the perfusion treatment started at the time of the organ back-table and the livers were immediately transplanted.The median CIT for the kidney group was about 14 hours, partly due to the fact that we do not perform KT during the night in our centre. However, this data was still comparable among the HOPE-K and SCS-K groups, 14.5 (10.8–22) hours versus 14 (8–21) hours respectively.Furthermore, L-HOPE and L-SCS groups were matched similarly for MELD score, previous abdominal surgery and portal thrombosis.In the HOPE-K group, one patient receiving double KT was matched with 3 double KT cases in the control group.The median of Karpinsky’s score was 3 for SCS-K group and 4 for HOPE-K group. Type and time of dialyses were also equally distributed between study and control group.The liver histology of the study groups are reported in Supplementary Materials Table Kidney histology are reported in Supplementary Materials Table The perfusion parameters of N = 11 kidneys, N = 9 for single KT and N = 2 for dual KT, and N = 10 livers undergoing HOPE before the implantation are reported in Table The median hepatic portal flow was 107.5 (65–116) mL/min and median perfusate lactate levels was 16.2 (9–27) mg/dL, as reported in Table The median renal flow was 52.5 (24–85) mL/min and median perfusate lactate levels was 11.7 6.3–22.5) mg/dL, as reported in Table –22.5 mg/2 values at T4 in the Table Oxygen level was in line to the reference limits during HOPE as demonstrated by the paOThe mean perfusion time was 2.2 (1–3.5) hours for HOPE-L group and 3.3 (1–6) hours for HOPE-K group. We had only 2 cases of single KT whose perfusion time was lower than 2 hours, while all other cases had a longer perfusion time.Bile or urine production were not assessed during the liver or kidney perfusion treatment, respectively.Microbiological analysis of the perfusate specimens did not evidence any bacterial or fungal growth defined as pathogen contamination and related to the perfusion strategy under study.vs. 31.7% in the control group, p = 0.05. Primary non-function was 0% for both K-groups and 6.6% for SCS-L vs. 0% for HOPE-L, p = 0.086.Variables related to graft dysfunction were showed in Table vs. 344 (166–1032) U/L in L-HOPE group, p = 0.006  U/L in L-SCS group 24–2100 ULiver graft assessment following transplantation (L-GrAFT) risk score decreased significantly in the L-HOPE group, with a L-GrAFT risk score percentage of 18.82 ± 7.10%, compared to 27.03 ± 11.36% in L-SCS group (p = 0.047).Looking at the kidney transplant subset, the study population showed a trend to a better outcome, with only 20% of DGF compared to 40% in the control group. The only two DGF events in the HOPE-K group took place when the perfusion time for single KT was lower than 2 hours; the remaining 8 cases in the HOPE-K group had no DGF events. Comparing K-HOPE patients receiving a graft which underwent perfusion treatment for more than 2 hours to grafts with shorter perfusion time, the rate of DGF was statistically significant . Overall, early post-operative complications according to the Clavien-Dindo classification were comparable among the study groups, without reaching any statistical significance  versus L-SCS group = 3/30 (10%); K-HOPE group = 1/10 (10%) versus K-SCS group = 2/30 (6.6%)]. Likewise, the incidence of acute rejection was similar between study and control groups .Biliary and ureteral strictures were monitored for 1 year of follow-up after transplant, without observing differences in HOPE recipients vs. 12 days SCS) and KT (17 days HOPE vs. 24 days SCS). All grafts and patients in the HOPE groups survived at 1-year post-transplant, with no significative differences when compared to control groups. In the L-SCS group graft survival was 90% due to two PNF events and one case of multiorgan failure secondary to sepsis; moreover, patients’ survival was 90%: one death for infectious complication and two for recurrence of liver disease. In the K-SCS group, graft survival was 93.3% due to two graft failure cases, one due to renal vein thrombosis in single renal transplant and one due to multiorgan failure following bacterial sepsis in dual renal transplant; patient survival was 96.6% due to one event of death for infectious complication  and we monitored eGFR of HOPE-K group at 1int Fig. . Non stast, 3rd and 6th month after liver transplantation), or CIT and time of perfusion (Table In the liver perfusate (HOPE-L), pGST, Albumin and Beta2-microglobulin were detected with increased values at T2 when compared to T0 , or CIT and time of perfusion , nutrient elements including multivitamins, sodium bicarbonate, heparin, antibiotics, prostacyclin, nutrient solution and creatinine. A further positive aspect of HOPE management, is the effectiveness of the strategy proposed despite advanced donor age in liver but also in kidney transplantation, with no graft loss due to non-function or dysfunction reported.In this manuscript, we report only 1-year of clinical outcomes follow-up, including organ function, graft and patient survival; nevertheless the lower L-GrAFT risk score reported in the liver study group may suggest a better graft survival with a prolonged follow-up.31. Long-term outcomes of machine perfusion in renal storage was reported only in the setting of hypothermic machine perfusion without oxygen. However, graft and patient survival were superior in the machine perfusion groups compared to the SCS groups, with the equalization of usage costs achieved at the 16th month post-transplant32. In our opinion, the analyses of the long-term results of this clinical series could be of interest, as well as other similar research studies with higher sample size.Recently, 5-year outcomes in donors after circulatory death (DCD) human livers preserved with HOPE were reported similar to DBD liver grafts and superior to the DCD liver grafts preserved with SCS33.Simplicity, outcome benefits for liver and kidney transplantation and low-costs equipment are the winning points of our HOPE system. The safety of our new machine perfusion system was confirmed by the absence of adverse events and by the observation that liver hypothermic oxygenation could be effective to improve graft function, similarly to other reported series in the setting of normothermic blood perfusionst, 3rd and 6th month of follow up: despite NGAL is largely known as a marker for acute and chronic renal injuries36, this result partially correlates with our previous findings, suggesting the role of NGAL as an immunomodulatory molecule, able to promote immune tolerance through regulatory T cells (Treg)38 therefore favoring better clinical outcomes.We also measured different markers in perfusates at the beginning and the end of perfusion procedure. Regarding KT, NGAL resulted a positive predictive biomarker of renal outcomes at 1et al.39 demonstrated that mitochondrial flavin levels in perfusates during hypothermic oxygenated perfusion might be a marker of better liver graft function. Our preliminary results confirm the relevance of markers in the perfusate and the fact that perfusate analysis is a further tool to predict clinical grafts outcomes. We are currently exploring a new field where further studies involving a larger sample size and a more comprehensive panel of biomarkers are needed, with the aim to detect optimal targetable markers to correlate with graft function or to confirm the results of Zurich center.In LT, significative differences of all perfusate markers were reported when measured at the end of perfusion if compared with the beginning. Recently Dutkosky 41. Moreover, the analysis of the perfusate may help to evaluate organ viability even in hypothermic conditions, and the infusion of therapeutic agents – e.g. nutrition, mesenchymal stromal cells (MSC) and extracellular vesicles releasing by MSC, anti-inflammatory and anti-apoptotic additives – might be a simple implement of the perfusion system in use45.Summarizing, we consider our innovative system as a functional tool to allow marginal grafts transplantability, with the aim to reduce utilization avoidance of grafts which are actually discardedFuture trials exploring this field must confirm not only safety and benefits, but also cost effectiveness, as some perfusion strategies are still associated with exorbitant costs.In conclusion, HOPE for ECD-DBD grafts is safe and effective in reducing preservation injury and in improving graft function and outcomes for kidney and liver transplantation. Future randomized clinical studies with a representative sample size are needed to confirm our results and hypothesis.47. Each patient included in the study group was transplanted with ECD graft, liver or kidney, restored in the pre-implantation phase by HOPE. Patients’ outcomes (HOPE-L and HOPE-K groups) were compared to the ones of matched control groups composed by liver and kidney recipients transplanted from January 2004 to September 2017 in the same transplant center, whose organs were preserved by SCS (SCS-L and SCS-K groups respectively).This national, single-center, prospective interventional arm with a retrospective case-controlled arm, pilot non-randomized clinical study was performed at the General Surgery and Transplant Unit of University of Bologna Sant’Orsola - Malpighi Hospital in accordance to the Helsinki Declaration. Ethical approval was obtained by local committee of University of Bologna Sant’Orsola - Malpighi Hospital in June 2016. The enrolment process of the interventional study arm was planned considering one procedure per month (liver or kidney perfusion before transplantation) following the inclusion criteria in the period from October 2016 to December 2017. The study was meant to evaluate the safety of a new machine perfusion system, and therefore we decided to monitor adverse events after each procedure for the first 30 post-operative days before enrolling other new cases. During the study period we performed 116 LTs, 60 of which met the inclusion criteria and 10 of which were included in the study according to the aforementioned safety protocol. Similarly we recluted 60 KTs, which met the inclusion criteria, and among those 10 were included according to the protocol. The study underwent clinical trial registration . The organ allocation process followed our center algorithmDemographical, clinical, machine perfusion and histological data collection was performed prospectively for the study groups and retrospectively for the control groups.Study cases of HOPE-L and HOPE-K groups were matched 1:3 to control cases of SCS-L and SCS-K groups; the pairing was performed anonymously using different clinical features about each donor and recipient involved.HOPE-L and SCS-L groups were matched for donor and recipient age, CIT, model of end-stage liver disease (MELD) score, previous abdominal surgery and portal thrombosis.HOPE-K and SCS-K groups were matched for donor and recipient age, (CIT), Karpinski’s score, dialyses type  and dialyses time.2, bilirubin >3 mg/dL, aspartate aminotransferase (AST) o alanine aminotransferase (ALT) above three times the upper reference threshold, sodium >165 mmol/l, days on intensive care unit (ICU) > 7, steatosis >40%, CIT > 14 hours49).ECD-DBDs aged over 18 years were considered eligible for study inclusion after acquisition of informed consent by the family. Definition of ECD was applied according to the UNOS criteria for kidney transplant  and for liver transplant  and at lower values for kidney perfusion .2) of 600–750 mmHg. Oxygen is provided to the fluid perfusion through the addition of a membrane oxygenator to the perfusion circuit. Flow, pressure and temperature values were monitored frequently by the organ perfusion team involved and registered on USB memory support. Perfusate gas analysis were accomplished every 15 minutes on effluent perfusate samples to measure paO2, pH, and lactate production.Before HOPE set-up, the inner and outer sterile flow tubes were connected to the medical devices and the priming phase was started. Belzer University of Wisconsin machine perfusion solution was used for priming and organ perfusion steps. At the begin of surgical back-table, portal vein or renal artery were cannulated with special cannulas for organ perfusion of different sizes (8–12 F for kidney and 18–24 F for liver). Each organ was connected to the perfusion device through the attachment of the vascular cannula to the inner perfusion tubes, already assembled to the machine. HOPE was performed at 4 °C, with a portal vein pressure of 5 mmHg or renal artery pressure of 25 mmHg and an oxygen partial pressure  and after HOPE (T1).Hypothermic oxygenated perfusion was performed in two steps: the first one was the flushing of the organ with hypothermic oxygenated solution for a duration of 30–40 minutes, and during the second step the organs were moved in a different box to permit recirculation of the perfusate until implantation.Graft flushing started at the beginning of the back-table phase, thus without increasing the duration of the standard surgical steps. Flushing was performed with hypothermic oxygenated solution and after 30–40 minutes of graft flushing, the organs were moved in the another organ container to permit recirculation of the oxygenated perfusate. The algorithm treatment is reported in Fig. According to the conventional procedures, surgical team performed kidney and liver transplants. Renal transplants were accomplished into iliac fossa anastomosing the artery to the external/common/internal iliac arteries, the vein to the external/common iliac veins and the ureter to the bladder over a single stent. Orthotopic liver transplantation was performed with “piggyback” technique preserving the inferior vena cava; epato-choledocal anastomoses were performed over T-tube.54. According to transplant guidelines, immunosuppressive state of recipients was preserved administering induction therapy for KT, tacrolimus  with or without mycophenolate as either mycophenolatemofetil or mycophenolate sodium steroid dose decreasing. Long-term follow-up was carried out according to the local protocols at 1-, 3-, 6- and -12 post-transplant months, in a single-center without loss of patients at follow-up.Post-transplant medical care during the hospital stay, including antithrombotic and antimicrobial/antifungal prophylaxis, was managed applying the standard protocols55. LGrAFT risk score was calculated on 1–10 post-LT days of AST, bilirubin, platelet counts and maximum INR values56. DGF was defined as the needing of dialyses treatment within the first week after the transplant; the effect on the outcome is expressed as an absolute number outcome57. Other follow-up data under study were: functional lab test values at 1-, 3-, 6- and -12 post-transplant months, incidence of biliary/ureteral fistula, incidence of graft rejection and the number of hospital readmission within 1 year from transplant.Graft survival as time, incidence of PNF and graft function as percentage of Liver Graft Assessment Following Transplantation (L-GrAFT) risk score or incidence of EAD for LT or DGF for KT were the measure tools to establish the HOPE effects on ECD-DBD donation in LT and KT. PNF was defined as organ failure ending to re-transplant for LT or constant dialyses recovery/transplantectomy for KT. EAD was defined if one or more of these lab values appeared: bilirubin>10 mg/dL on post-operative day 7; INR > 1.6 on post-operative day 7; aminotransferase level (ALT or AST) > 2000 IU/mL within the first 7 post-operative dayshttp://www.thermofisher.com and http://www.merckmillipore.com. All samples were measured undiluted and in doublets. The chemo/cytokine standards were assayed in the same manner as patient samples. The data were collected using a xPONENT® software .5 mL of perfusate were collected at the beginning (T0) and at the end (T1) of perfusion from the perfusion fluid in the organ container and centrifuged at 2500 rpm for 15 min to remove cellular debris. The supernatant was transferred to 1-mL Coming cryogenic vials immediately after centrifugation and stored at −80’C for subsequent analysis. Samples were thawed at room temperature prior to use for analyses. The concentrations of early biomarkers of renal injury  and specific markers of liver functions  were measured using Luminex® xMAP® Technology. We created our own multiplex panel by combining multiple simplex kits: Human CustemProcarta Plex-19 plex  and Human High Sensitivity T Cell . The methodological details including assay protocol, standards and sensitivity are available at the manufacturer’s website, The primary end point were the safety in the interventional arm and differences in terms of graft function between the two study groups. Graft function was measured considering the EAD for the liver and the DGF for the kidney. Liver function was also evaluated considering the L-GrAFT risk core and the peak of aspartate aminotransferase within 7-days post-LT.The secondary en points included: graft and patient survival at one-year, post-operative complications according to Clavien-Dindo classification and hospital stay.Continuous data are reported as mean ± SD or median (range) depending on their distribution and compared by means of parametric  or non-parametric (Mann-Whitney U test) analyses. Categorical data are presented as percentage values and compared using a Chi-squared test. Kaplan-Meier estimators were applied to perform the survival analysis. A p value <0.05 was considered as statistically significant.Further details are provided in the Supplementary Material.NO organs/tissues were procured from prisoners. Organs/tissues were procured from various institutions. Ospedale Maggiore – Bologna (BO), Ospedale Maggiore – Parma (PR), Nuovo Ospedale S. Agostino Estense - Baggiovara (MO), S.Maria Nuova - Reggio nell’Emilia (RE), Ospedale M. Bufalini – Cesena (FC), Ospedale Infermi - Rimini (RN), Arcispedale S. Anna – Ferrara (FE), Policlinico- Modena, S. Orsola Malpighi - Bologna (BO), Ospedale Civile- Piacenza (PC), Ospedale Santa Maria della Scaletta - Imola (BO), Ospedale Bellaria - Bologna (BO), Ospedale Santa Maria delle Croci - Ravenna (RA), Ospedale degli Infermi-Faenza (RA), Ospedale Morgagni Pierantoni - Forlì (FC).Protocol IDPIO-700; ClinicalTrials.gov ID: NCT03031067; Date of registration 01/25/2017.Supplementary materials.


I am extremely glad for this first contact with the readership of our Revista Brasileira de Medicina do Trabalho as the new president of the National Association of Occupational Medicine (ANAMT).I would like to congratulate and thank the Editorial Board for having made our journal a high-quality publication. Congratulations to you all, and thank you so much for your work and the results attained until now.We are making some changes in the journal management. Aware of the many challenges we have to overcome, we intend to meet them by raising even more the quality of our journal. Within this context, the occupational physician, Dr. Andrea Franco Amoras Magalhães, MD PhD, was appointed as the new editor-in-chief to meet the requirement for inclusion in Scientific Electronic Library Online (SciELO) and achieve a higher ranking in the Brazilian Agency for Support and Evaluation of Graduate Education (CAPES) database Qualis.In addition, we invited international editors to join the new Editorial Board, as well as occupational physicians affiliated with higher education institutions-all of them committed to high-quality scientific research. Thus we intend to actualize our commitment to extend ANAMT’s reach to all regions in Brazil.Serious scientific production is an indispensable requirement to make occupational medicine stronger in Brazil and abroad. For this purpose we created a special committee to encourage and support occupational physicians interested in publishing their studies as scientific articles to choose our journal.Stay on with the news! A lot more to come soon!


Pinus sp., with 12% moisture (dry basis), classified in 3 and 1 mm sieves and compacted in a pelleting press in the laboratory, according to European standard EN 14961-2. Physical and mechanical properties of the pellets were evaluated and their densitometric profiles obtained from the Faxitron LX-60 X-ray equipment. Corn starch and kraft lignin additives at 4% improved pellet properties , reducing their losses during handling, storage and transport.Pellets are widely used for power generation because they use renewable raw material with easy storage, transport and high energy density. However, the structural fragility, disintegrating during handling, transport and storage, is one of the main problems of pellets, but the addition of binders/additives can minimize this fragility. The objective of this study was to evaluate the properties of wood pellets with the addition of starch (corn and wheat) and kraft lignin in different proportions. Pellets were produced with the addition of starch (wheat and corn) and kraft lignin in the proportions of 1, 2, 3, 4 and 5% in relation to the mass of wood particles of  The fragility of the pellet structure facilitates its disintegration, generating fines  during handling and transport, which is the main problem of this material6. Organic additives such as starch from corn, manioc, pea starch, potato, sweet potato, rice, wheat, or yam as well as kraft lignin, may reduce pellet cracking and disintegration9.Fuel pellets are widely used in Europe as an alternative to firewood, due to their ease of storage and high energy density7. The biomass heating, with a moisture content of 8–12% in the dry basis, alters the pellet particles, denaturing the proteins and increasing their hardness and quality12. In addition to its binding action, starch lubricates the pelletizing matrix and facilitates the flow of the densified raw material during pellet production6.The starch applied with water vapor should be added for the melting and gelatinization of the particles during pellet production15. This material has potential because it is a waste product from the pulp production and can be obtained at affordable prices. Due to its chemical structure, lignin has found a number of applications. It can be used in cement composite fabrication16; as a filler for polymers18; in bio-based composite thin sheet films19; it was evaluated as an active material in II generation glucose biosensor20 and as component of adhesives22.Kraft lignin, a residue from the wood pulping process, may increase the pellet’s mechanical strength and energy properties23, and the bonds between its particles must be smooth to reduce fissures, cracking or disintegration during handling, transport and storage6. The pellet surface should appear, to the naked eye, to be solid and with well-bonded particles without micro-cracks24. A weak cohesion between its particles reduces the mechanical strength and increases pellet cracking2. X-ray micro tomography and X-ray densitometry can analyze the internal structure of the material, enabling a more detailed analysis of different agroforestry products such as pellets and briquettes25.The quality of the raw material affects that of the pellets26. X-ray densitometry has been used to characterize and evaluate the deterioration of the eucalyptus wood due to white rot fungi, and to detect the limits of the heartwood-sapwood, the effect of forest management on the wood properties, the annual production of biomass and the relation with its anatomical structure29. However, this technique is under-used for evaluating the internal density of solid biofuels such as briquettes and pellets31.The wood product quality can be evaluated using non-destructive methods such as the digital X-ray images used in fields such as dentistry, orthopedics, zoology and zootechnologyPinus sp. pellets with the addition of starch (corn and wheat) and kraft lignin in different proportions, as well as to measure their fines and hardness.We intend, therefore, to answer the following questions:How do additions of starch and kraft lignin to pellets affect apparent density?How do effects of starch and kraft lignin supply on pellets properties like fines content and hardness?How do the density apparent vary along the pellets longitudinal axis?The objective of this study was to use the gravimetric method and X-ray densitometry to determine the apparent density and density profiles of 32.The fines content of the pellets, agglutinated with wheat starch and kraft lignin (both at 4%), was 125 higher and 75% lower than in the control, respectively  to produce bonding between the particles. Temperatures above 90 °C improve pellet characteristics, and require lower compaction pressure at increasing compaction matrix temperatures41. The lower density values of wheat starch pellets may be due to the high moisture content of the steam generated during the high temperatures in the compaction process (120 °C), causing micro-cracks in the pellet structure and reducing its density35. Starch acts as a lubricating agent in the pelletizing process, facilitating the flow of raw material through the pelletizing matrix36. The bulk density of the pellets was greater than the minimum required by the European Marketing Standard EN 14961-232, equal to or greater than 0.60 g cm−3 in all treatments. This highlights the potential use of additives in pelletizing, which should be at most 2% relative to the dry mass of primary raw material.The higher bulk density values for 3% kraft lignin pellets may be associated with a higher amount of lignin in the mixture (wood + additive), which plasticizes more efficiently, generating a smooth and uniform texture in the pellets and improving their density. The pelletizing matrix temperature influences the durability and bulk density of pelletsThe apparent density of pellets varied in a fashion similar to that of bulk density Table , with no−3 (3% wheat) and 1.23 g m−3 (3% lignin), is possibly due to the wheat starch gelatinization process starting at lower temperatures (± 70 °C) than that of corn starch (± 85 °C)42. This leads to the starch adhering to the pellet feeder system wall, reducing the proportion of additive that reaches the pelletizing matrix and consequently diminishing the unit density of the pellet. The higher apparent density of pellets produced with 1 and 2% corn starch and 1, 3, 4 and 5% kraft lignin is due to the lower rate of return of the pelletizing process and the higher molecular weight of the additives, influencing the pellet density36. Bulk density and apparent density determine pellet storage and transport conditions, and are directly related to energy density in those with 1 and 2% corn starch and 1, 3, 4 and 5% lignin, with higher density and a higher amount of energy per volume unit43.The variation in the apparent density of the pellets, similar to that of bulk density between 1.15 g m−3 in their longitudinal axis , directly related to the susceptibility to rupturePellet density varied in longitudinal density profiles, with one uniform and one irregular pattern Fig. . The app48. Cracks are common in compacted material during pelletizing6, and can be attributed to inadequate pellet moisture content or particle sizes. The density of biomass varies with the moisture content44 and with the temperature strengthening the adhesion between the particles. Density profiles can explain the performance of pellets, whose cracks and high density variability affect their durability and final quality, since reductions in density are associated with cracks and, consequently, pellet breakage or rupture points, which can generate fines5. The apparent density of the pellets by gravimetric and X-ray densitometry, similar between treatments with additives, confirm that this technique, commonly used to evaluate the apparent density of materials and easier to apply than other methodologies, can be used to evaluate the quality of the pellets. Variations in the apparent density and longitudinal density profile obtained with the gravimetric and X-ray densitometry demonstrate that factors such as moisture, binder type, pressure and particle size interfere with the pelletizing process, causing variations in the material’s internal structure47. In addition, this technique accesses different parts of the pellet and therefore identifies point variations in the product density as reported for the 2% wheat starch pellet.Uniform or irregular density patterns according to longitudinal pellet density profiles are due to variations in pellet internal density, which can be attributed to factors such as additive molecular weight, particle size, and temperature and pressure during pelletizationIn conclusion, the additives reduced the fines content and increased the hardness and density of the pellets. Therefore, they have the potential to produce pellets with greater resistance to the transport, storage and handling processes. Apparent density along the longitudinal axis of the pellets without starch was higher. The apparent density of pellets containing starch increased the cohesion between the particles and reduced the density variation as shown by their densitometric profiles.The experiment was installed in the municipality of Viçosa, Minas Gerais state, Brazil (20°45′14″S and 42°52′54″W).Pinus sp. were air-dried to a moisture content of approximately 20% (dry basis). The particles of these residues were classified using overlapping sieves, with the fraction that went through the 3.0 mm sieve and was then retained in the 1.0 mm sieve being used in the experiment , with a production capacity of 30 kg h−1 Fig. A. The av2.The pelletizing machine had a system with a motor reducer, a speed controller and a continuous screw. Four nozzles installed along the continuous screw injected water vapor produced by autoclaving at a pressure of 0.8 kgf/cmPinus sp. dry mass  was determined using the Holmen Ligno-Tester (United Kingdom), in accordance with EN 15210-1The hardness of the pellets was determined in a diametric compression test in a manual hardness tester with a scale of 0–100 kgf, manufactured by Amandus Kahl (Germany). One pellet at a time was inserted into the hardness tester, receiving an increasing load until the sample was fractured. The maximum load was defined as what a pellet could withstand before breaking.49, with the samples conditioned at 65% relative humidity and 20 °C temperature.The pellet bulk density was obtained according to EN 1510350.The apparent relative density was obtained by immersing the pellet in mercuryThe apparent density profile of the pellets was obtained in a Faxitron model LX-60 (United States of America) cabinet X-ray system Fig. A. The peTen pellets with 19 mm of length per treatment were analyzed and conditioned in an acclimatized chamber at 20 °C and 65% relative humidity, with 12–15% equilibrium moisture content, for 24 h.Pinus sp. without additives). The averages were grouped using the Tukey test (p ≤ 0.05). The results considered the values of the control and were submitted to the Dunnett test (p ≤ 0.05).The apparent density, bulk density, fines content and hardness data were analyzed in a completely randomized design in a factorial arrangement with three additives  in five percentages , besides the control (pellets of pure


The Letter to the Editor by Riggare et alThe Editorial Office apologizes for these errors and has revised the process for dealing with letters to the Journal.


Crime, Law and Social Change (CL&SC) depends on a large work group including Springer’s team, reviewers, and managing editors. Additionally, we acknowledge and appreciate the significant contributions made by our editorial board members. Because individually thanking each member who has served the journal would be a Promethean task, this special introduction attempts to acknowledge the past and present dedication of our editorial board. Our recent efforts to invite new scholars to serve on the board have resulted in commentary that I would like to share.The success of Corruption and Reform, published by Martinus Nijhoff, with two close UK colleagues. We operated on a virtual shoestring for seven years, producing a journal that reflected a continuing rise in quality, and that was out ahead of the curve in terms of interest in corruption issues. "Ahead of the curve" isn't always a good place to be, however; in early 1993 (!) Nijhoff, claiming there was insufficient interest in corruption research, told us they were folding our journal into CL&SC, then edited by Alan Block. Eventually my good friend Nikos Passas invited me to join the board.I have been a board member since godknowswhen, have enjoyed the work, and look forward to continuing to contribute. In fact, I have a deeper history with CL&SC: back in the mid-1980s I co-founded the journal Also, Peter Yeager will remain on the board, despite his gracious gesture to step aside: “I am happy to continue in this role. But I am also happy to relinquish it to another qualified person… whom membership on the board would constitute valuable experience and exposure as well as a helpful achievement in a rising career arc.” My belief is that we can accommodate current members and add new scholars as suggested by Peter. John Braithwaite, now Emeritus, has agreed to continue participating and responded in a lovely personal message that needs no further explanation for those who know the brilliance of this celebrated scholar.Many board members have agreed to continue in their current role. Michael Johnston, for example, who brings years of historical experience to our collective work commented:Looking back, I was just about the only person who was nominally an economist working with your journal or even in criminology. [T]hat was a good thing since most of what economists have to say today is best ignored since it can be harmful if anyone really takes it seriously. Most of my generation of troublemakers have moved on. I hope CL&SC can continue to stand outside the mainstream of social science—since the mainstream has always looked to me more like a cesspool.Dr. Naylor’s comments remind us that, at times, academic muckrakers are essential to discovering new “truths.” Our hope is that we can apply his message and strive to be innovative. Dr. Naylor will be sorely missed as a member of our editorial board.Professor Thomas Naylor, Department of Economics at McGill University, offered insight into the journal’s history. He mentioned a number of issues--past, present, and future--that serve as reminders of CL&SC’s high quality and trailblazing approach. And he indicated his preference for publishing in our journal. Dr. Naylor also contributed numerous invaluable articles while Alan Block and Nikos Passas were editors. Many of Dr. Naylor’s comments noted the innovative nature of our articles and remind us of a timeless guiding principle:Contemporary Crises). In 1977, Bill (a friend and colleague wholeheartedly missed by our entire community) offered these enduring words:[C]hanging and challenging ideas bespeak the fact that social science is currently experiencing an intellectual revolution of gigantic proportions. Theoretical traditions are being challenged and new paradigms are being explored. The period is both the most exciting and the most frustrating for perhaps the past fifty years. It is exciting, for the prospects are bright for breaking out of the ideological and pseudo-scientific strait-jackets that have hampered rather than pushed forward the quest for knowledge (p. 1).We would be remiss to ignore Bill’s call for further “innovation in the emerging intellectual traditions” that promote critical criminology. Remembering Bill’s contributions and his sociological imagination inspires us to remain the leader in publishing international articles that challenge current paradigms and offer cutting edge research.Michael Lynch, who was appointed to the board in 1994 shared an important message from William J. Chambliss, who founded the original journal (We thank and honor all our current and departing editorial board members who have wisely served the journal for many years. Also, we welcome our new board members: Rita Faria, Universidade do Porto; Rajeev Gundur, Flinders University; Olga Petintseva, Ghent University and Melissa Rorie, Univeristy of Nevada—Las Vegas. Megan J. Parker, University of Colorado Denver, will be serving as our new book review editor and Sari Weichbrodt will continue as managing editor.I find myself writing this introduction during self-imposed isolation, but I remain hopeful that as we weather COVID-19 our world becomes a better place of continued caring and understanding. Best wishes to our staff, editorial board members, contributors, and readers who make us a premier journal. Stay safe and I hope to see many of you at the European Society of Criminology in Romania.Mary Dodge, Co-Editor in Chief.


Providing restorations to anterior teeth in children is a challenging task due to the need for high esthetics, strength, and durability. This study was done to compare prefabricated primary zirconia with resin composite strip crowns on primary maxillary central and lateral incisors with regards to gingival health, plaque accumulation, recurrent caries, restoration failure, and opposing teeth wear over a period of 3, 6 and 12 months.Children attending the King Abdulaziz University, Faculty of Dentistry (KAUFD) clinics who needed restorations were screened for inclusion criteria. A total of 120 teeth were treated; 60 with zirconia and 60 with strip crowns. Randomization was done by simple random allocation using SPSS software version 20.0 . A simple descriptive statistic was used for analysis by Wilcoxon Signed-Rank test and Chi-square test. Level of significance was set at (α = 0.05) and level of confidence at (95%). The presented research was registered retrospectively at ClinicalTrials.gov in 6th of August 2017, under registration number NCT03184012.p < 0.006, p < 0.001; respectively), less plaque accumulation at all follow up visits (p < 0.001), no restoration failure (p < 0.001), but more wear to opposing teeth (p < 0.02). No significant difference was found between the two crowns with regards to recurrent caries (p < 0.135).Zirconia crowns showed significantly less gingival bleeding at the 3- and 6-months follow up periods (Based on our data we conclude that overtime teeth covered with zirconia crowns show better gingival health and less bleeding, plaque accumulation as well as less loss of material. On the other hand, zirconia can cause more loss of opposing tooth structure. Early childhood caries (ECC) is a chronic multifactorial disorder which continues to be dominant in children, especially in families of low socioeconomic status –7. EarlyProviding care to children who are considered to be at risk from ECC, can be achieved by a specialist who received adequate training and has experience in treating children as well as disease process . To perfDespite their poor esthetics stainless steel crowns (SSC) are often the treatment of choice for multi-surface carious teeth and lesions with widespread white spots. Primary incisors with large or multi-surface caries can be restored with resin composite strip crowns if there is sufficient tooth structure after removing all carious tissues . When reMore recently, zirconia aesthetic crowns for pediatric patients appeared in the market. Zirconia is a crystal-like dioxide of zirconium that possess a metal like mechanical properties and a tooth like color, and the ready to use zirconia crowns are available for primary teeth. Although there is high acceptance of zirconia crowns, the literature lacks solid proof for their pediatric clinical performance . There aThis study was aimed at comparing prefabricated primary zirconia with resin composite strip crowns on primary maxillary central and lateral incisors with regards to gingival health, plaque accumulation, recurrent caries, restoration failure, and opposing teeth wear over a period of 3, 6 and 12 months.G*Power 3.1.9.2 software  performed for power analysis, indicated that we needed a total 120 teeth , at Jeddah, Saudi Arabia. . All children visiting the clinics between November 1, 2015 to January 31, 2016 with the following criteria were included in the study:Written consents were obtained from the parents/guardians after explaining the full details of the treatment procedure and its possible outcomes, discomfort, risks, and benefits.No patient was excluded based on gender, race, social or economic background. Oral hygiene instructions were given and reinforced in each follow up visit.Teeth with proximity to exfoliation and resorption of the root passed its half.Presence of single surface caries not involving the proximal surfaces.Teeth that have been subjected to trauma.Anxiety and lack of cooperation which required treatment under general anesthesia.Bruxism.Special health needs.Presences of teeth wear on the opposing teeth, or absence of opposing. (See Flow Chart)Children having the following criteria were excluded from this research:The present study was a randomized controlled clinical trial that followed the guidelines published by Consolidated Standards of Reporting Trials (CONSORT) . This reConcealment was applied for randomization of children in each group to either resin composite strip crown or zirconia crowns. Randomization was done using SPSS software version 20.0  Allocation concealment was assured by handling sequentially numbered opaque sealed envelopes to the attending candidate. At the time of crown application, an envelope was opened and allocate the child to the written restoration material inside that envelop.The same examiner was responsible of preparation and evaluation. To test the reliability of the examiner and evaluate the restoration performance, sixteen teeth were treated by full coronal restorations then examined. The examiner evaluated those teeth based on the standard evaluation criteria of the study. The results produced by the examiner were analyzed using Cohen’s kappa to test intra-examiner reliability.(A)Zirconia crowns The crowns were selected previously based on the mesio-distal measurement of the tooth. Each tooth was prepared for “passive fit” as the zirconia crowns are not flexible. According to the manufacturer instructions, incisal edge was reduced to obtain a 2 mm clearance. For the labial surface: the 2-plane reduction was made close to natural tooth and for proximal surface the distance to the adjacent teeth was considered and parallel mesial and distal walls were created extending 1–2 mm subgingivally. Enough reduction of cingulum was done on the palatal surface. Feather-edge margins were provided about 1–2 mm subgingivally. After evaluation made for marginal fit, the zirconia crowns were cemented with light cure resin cement (NuSmile BioCem®) and firm consistent pressure at proper position was applied on the tooth till the initial set Strip crowns Prior to treatment appointments, strip crowns were prepared and adjusted. Escape venting holes were prepared by piercing the mesial or distal incisal angles of the crowns, this was achieved using sharp explorers . Strip crowns were seated and fitted after applying a coating of resin-modified glass ionomer base to protect dentinal tissues. Each crown was cured individually after filling with composite resin as the adjacent strip crowns placed (unfilled) on their respective teeth to make sure that appropriate spacing between crowns preserved. A cleoid/discoid carver or scalpel was used to peel off the strip crown shell from the lingual side then ooclusion is checked and adjusted if needed . Simple descriptive statistics were applied to characterize the variables of the study via tally and percentages for the definitive and nominal variables, whereas mean and standard deviations were used to represent the constant variable. In comparing the distributions of two variables, a Proportion distribution of demographic dataFull coronal restorations were placed on 120 primary maxillary anterior teeth  on 32 patients, . The mean age of patients at the base line was 4.43 years, with no drop out until the 12 months follow up. . At the 6-months follow-up also more teeth in the strip crown group were bleeding (p < 0.001). However, at the last follow-up visit at 12 months both groups showed no bleeding.Gingival health as measured by bleeding with probing is depicted in Table Plaque index evaluationp < 0.001). At the 6-months follow-up also more zirconia covered teeth showed less plaque accumulation (p < 0.001). At the end of the study all teeth covered with zirconia were free of plaque while only 80% of those covered with strip crowns were free of plaque and 20% had a film of plaque at the gingival margin (p < 0.001).Both groups were examined for plaque indices and scored according to Silness and Löe criteria. at the beginning of the study dental prophylaxis was provided to all patients and oral hygiene instructions were given to patients and their parents as well. Table Secondary caries evaluationChi-Square Test (p < 0.135)  criteria. The resu p < 0.13 .Crown failure during follow up intervals Table  was clinp < 0.024). Moreover, this loss increased with time to reach 30% small but noticeable area of loss of material and 8.3% large loss of crown by the 12 months follow up (p < 0.001).On the other hand, failure was more in the strip crown group as 11.7% showed small but noticeable area of material marginal loss and 1.7% presented with large loss of crown during the 6 months follow up (p < 0.02), Fig. Tooth wear was evaluated Table  accordinIn evaluation of gingival health, this study shows better gingival response in zirconia crowns which can be explained by the fact that zirconia is biocompatible and possesses a polished and smooth surface leading to less plaque accumulation and hence less gingival irritation –18. ThisA retrospective study done in 2003 by Kupietzky et al.  includedIn agreement with our study, Walia et al.  who asseOur data showed that none of the teeth covered with zirconia crowns showed recurrent caries during the entire follow up. In contrast, teeth restored with composite resin strip crowns showed that 6.7% developed recurrent caries in the 12-months follow up. The lack of adequate preventive measures could have contributed in caries recurrence in our community. Important factors that influence development of caries are poor oral hygiene and high cariogenic diet consumed by the patients included in our study.A recent study by Holsinger et al.  reportedThe greater restoration failure of the composite strip crowns in this study may be explained by the fact that treatment was done under nitrous oxide sedation and physical restrains to manage the children behavior. Eidelman et al.  reportedRegarding the zirconia crowns, the success rate in this study was 98.3% by the end of the 12 months follow up. Only two crowns failed due to trauma. Current research on the clinical success of prefabricated primary zirconia crowns for primary incisors is still limited. Walia et al.  reportedTooth wear in this study was evaluated according to the Smith and Knight Tooth Wear Index , 14. SevAlthough one of the inclusion criteria was selecting patients with positive behaviour, some children occasionally became uncooperative due to prolonged procedure. Another limitation was the high cost of Zirconia crowns.This study adds significant value to the literature with regards to the clinical performance of zirconia crowns in anterior primary molars. Although the zirconia crowns are considered expensive in comparison to strip crowns, we should take into consideration the high failure rate of strip crowns and the need to repeat dental visits and re-treatment of failed strip crowns. This fact may make the zirconia crowns cost effective after all as it has high success rate and minimal need for re-treatment.Although one of the inclusion criteria was choosing patients with positive behaviour, in few cases children became uncooperative due to prolonged procedure. Another limitation was the high cost of Zirconia crowns.We recommend longer follow-up studies on zirconia crowns with inclusion of more evaluation parameters such as patients’ satisfaction especially with high cost of zirconia crowns, ease of handling, as well as other variables.Based on our data we can conclude that overtime teeth covered with zirconia crowns show better gingival health and less bleeding, plaque accumulation as well as less loss of material. On the other hand, zirconia can cause more loss of opposing tooth structure.


This international symposium brings together leading occupational therapy researchers from around the world with a shared focus is on evaluating and improving the driving performance of older adults to decrease their crash risk and facilitate their community participation. In this session, five groups of international scholars will share their collective and individual research outcomes for driving as a means of community mobility. The first presentation will outline their collective international, cross-sectional study of 247 older adults from seven countries where the impact of driving on out-of-home mobility was compared. Each presentation that follows will then present results from innovative studies of ways in which to assess and address fitness to drive in older adulthood. Our discussant will summarize the potential expansion of the current work and engage the audience through interactive questions. Transportation and Aging Interest Group Sponsored Symposium.


PT was diagnosed clinically and confirmed by either grayscale US or power Doppler US, or both. Controls had no history of anterior knee pain and no clinical signs of PT. Patellar tendon stiffness  was assessed using SWE. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Reliability analyses included coefficients-of-variation (CV), coefficients-of-repeatability (CR), intraclass correlation coefficient (ICC) for intraobserver and interobserver reliability, and Bland-Altman analysis.p < .001) and adjusted multivariate analyses  showed that athletes with PT had significantly increased patellar tendon stiffness. ICC for intraobserver reliability was 0.95 (95% CI 0.92–0.97), CR (CV) 12 kPa (10%) and 0.79 (95% CI 0.65–0.88), CR (CV) 18 kPa (21%) for interobserver reliability. Mean differences from Bland-Altman analysis were 5.6 kPa  for intraobserver reliability and 4.6 kPa  for interobserver reliability.In total, 76 participants with PT  and 35 asymptomatic controls  were included. Univariate analyses  is higher in athletes with patellar tendinopathy than in healthy controls, also after adjusting for potential confounders.• Excellent intraobserver reliability and good interobserver reliability were found for the quantitative assessment of patellar tendon stiffness using SWE. Patellar tendinopathy (PT) is an overuse injury of the patellar tendon resulting in pain, decreased exercise tolerance, and impaired function . PT is hShear-wave elastography (SWE) is an ultrasound-based imaging technique which evaluates viscoelastic properties, depicted as color-coded images (elastogram) . AccordiMusculoskeletal applications of SWE constitute a relatively new area which has emerged from well-established applications in breast, liver, thyroid, and prostate imaging –13. AddiThe primary aim of this study was, therefore, to determine the association between patellar tendon stiffness and the presence of PT in jumping athletes. The secondary aim was to evaluate the reliability of the patellar tendon stiffness assessment and image analysis using SWE.ClinicalTrials.gov, ID: NCT02938143).This case-control study in Erasmus MC University Medical Center Rotterdam, The Netherlands, was approved by the institutional review board. Participants provided written informed consent prior to inclusion. We performed cross-sectional analysis of baseline data from a prospective trial investigating two different exercise programs for PT . Activity level was assessed using the Cincinnati Sports Activity Scale (CSAS) [Jumping athletes with suspected PT and asymptomatic athletes were invited to our hospital to confirm eligibility. Clinical evaluation was performed by a sports physician (R.V.) with 10 years’ experience, and athletes were regarded positive for PT if tenderness at the inferior patellar pole or patellar tendon could be reproduced on palpation and a single-leg squat . Provocae (CSAS) .US was performed by one trained examiner (S.B.: radiologist-in-training with 5 years’ experience) using an ultrasound machine equipped with SWE . A linear 5–15-MHz transducer  was used for GSUS and PDUS and a linear 3.1–10-MHz transducer  for SWE. Ultrasound gel (Sonogel Vertriebs GmbH) was used at room temperature (21 °C).Participants were examined in supine position with the back rest of the examination table upright in 60° for patient comfort and improved patellar tendon relaxation. GSUS was performed with both knees in 30° flexion, supported by a foam roll. PDUS and SWE were performed in passive extension of both knees. The standardized US acquisition protocol included longitudinal and transverse GSUS of the patellar tendon and transverse cine-loops for PDUS. The patellar tendon was designated as vascular if it demonstrated one or more blood vessels in the posterior portion of the patellar tendon or within the tendon. SWE was performed with mild pressure, in the longitudinal plane with the inferior patellar pole just in the field-of-view. Elastograms were generated in dual-screen mode, displaying GSUS and the overlaying elastogram. Three elastograms were acquired, of which one was randomly selected for the first analysis directly after the image acquisition. A second analysis of all elastograms in PT athletes was performed by the same examiner (S.B.) after the recruitment of subjects had finished, blinded for the results of the first analysis. The second analysis consisted of stiffness measurements in all three elastograms acquired using the same method as the first analysis. Patellar tendon stiffness was averaged for the three elastograms and the relative variability of these measurements was calculated. The maximum thickness of subcutaneous tissue overlying the proximal patellar tendon was measured on a transverse GSUS image, at a standardized location within 1 cm below the inferior patellar border. A subset of controls was invited consecutively to be re-examined with SWE at the same time point by an independent examiner (A.V.) with 2 years’ experience, who also performed the analyses of these collected images, blinded for the results of the first examiner. Quantitative analysis of patellar tendon stiffness was performed on the ultrasound machine, with maximum transparency of the elastograms to avoid subjective placements of regions-of-interests (ROIs). A reference ruler of 20 mm was set posterior to the patellar tendon, starting 5 mm distal to the inferior patellar pole. This guided placement of circular ROIs and avoided inclusion of artifacts from the patella  and 95% confidence intervals (95% CIs). Univariate (unadjusted) and multivariate models adjusted for potential confounders, including age, sex, body mass index, and thickness of subcutaneous tissue, were applied. Determinants with p value < .10 were used in the multivariable model. Interaction terms for age*stiffness and sex*stiffness were added, based on findings in previous research [P values < .05 were considered statistically significant.SPSS software  was used. Normal distribution was tested using Shapiro-Wilk’s test. Median and interquartile range (IQR) were obtained for non-normally distributed data. Between-group differences were assessed with Student’s research , 24. Mulresearch . An ICC research . P valuen = 76) participated in volleyball (n = 26), soccer (n = 17), basketball (n = 16), korfball (n = 8), track and field (n = 4), field hockey (n = 3), and handball (n = 2) as primary sports. Asymptomatic controls (n = 35) participated in basketball (n = 15), korfball (n = 10), volleyball (n = 9), and track and field (n = 1). No significant differences were found in activity levels between athletes with PT and asymptomatic controls. In PT athletes, the left patellar tendon was the primary site of symptoms in 41 participants (54%) and the right patellar tendon in 35 participants (46%). The diagnosis of PT was unilateral in 44 participants (58%), of which 26 were left-sided. Median duration of symptoms in PT athletes was 104 weeks .Participants were consecutively enrolled between January 2017 and June 2019. A total of 313 applications from potentially eligible PT athletes and asymptomatic controls were initially screened, of which 138 participants were invited to our hospital to verify or exclude the diagnosis of PT. Finally, 111 participants remained eligible for inclusion . Hypoechoic changes were seen in 89% of PT athletes and 26% of asymptomatic controls. Tendon calcifications were observed in 27% of PT athletes and erosions of the inferior patellar border in 29%. Both were absent in asymptomatic controls. Intratendinous Doppler flow was present in 89% of PT athletes and 3% of asymptomatic controls.The proximal patellar tendon was significantly thicker in PT athletes (mean 8.4 ± 2.4 mm) than in asymptomatic controls (mean 4.1 ± 0.9 mm) (p < .001) . Only in ROI 1, patellar tendon stiffness was significantly higher in PT with tendon calcifications than in PT without calcifications (p = .017). In PT athletes without tendon calcifications, symptomatic tendons were still significantly stiffer than asymptomatic tendons in ROI 1, both on the left (p = .043) and right (p = .005) side, but not in other ROIs. This increased stiffness in ROI 1 was not observed in the asymptomatic tendons (left p = .679 and right p = .396).Stiffness of the proximal patellar tendon was significantly higher in PT athletes  than in asymptomatic athletes  (9.9–43.0)For the patellar tendon stiffness assessments in all ROIs, the CV was 5.3% (95% CI 4.0–6.3) and the CR was 6.6 kPa (IQR 3.6–12.1). For analysis in separate ROIs, the CV ranged from 10.8 to 11.8% and the CR ranged from 7.3 to 10.7 kPa.p < .001) and in adjusted multivariate regression analyses . The odds ratios for patellar tendon stiffness are estimated for each kilopascal (kPa). In univariate analysis, 7 determinants were associated with the presence of PT symptoms with a p value < 0.10, and therefore included in the multivariate model  and limits of agreement were −15.8 kPa (lower limit) and 26.9 kPa (upper limit).The intraobserver reliability analysis Table  revealedp < .001) and the limits of agreement were −14.8 kPa (lower limit) and 24.0 kPa (upper limit).For the interobserver reproducibility, 56 paired measurements in 28 healthy athletes were used Table  was 4.6 In this study on the implementation of SWE on the patellar tendon in jumping athletes with patellar tendinopathy and activity-matched controls, we found that patellar tendinopathy was associated with significantly higher patellar tendon stiffness, both in univariate analyses and in adjusted multivariate analyses. The intraobserver reliability of the SWE analysis was excellent and the interobserver reliability for independent SWE acquisitions and analyses was good. This finding of tendon stiffening in PT provides additional information to GSUS/PDUS and could lead to improved understanding of the disease and eventually in altered therapeutic decision-making, for example, by staging the altered viscoelastic properties in PT and by monitoring the response to therapeutic interventions.The trend of increased stiffness was in accordance with experiments on patellar tendon specimens that reproduced the increased state of tissue hydration in PT by using hypotonic solutions . This efInconsistencies in those studies included methods of image analysis, different ultrasound equipment, and different positioning of the knee. These inconsistencies form potential explanations for the discordant SWE results . First, Other differences of our study compared with previous studies were  the exteStrengths of our study are the relatively large sample size and homogeneity of the study population with respect to age and level of sports. Due to our stringent inclusion criteria, the study population represented the predefined target group consisting of athletes performing sports involving frequent jumping and cutting in which PT is most prevalent. We also excluded other causes for anterior knee pain than PT such as patellofemoral pain. Patellofemoral pain is difficult to distinguish from PT without focused physical examination  which haThe main limitation of our study is the known clinical status of the athletes before the SWE acquisition was performed, because GSUS and PDUS were part of our initial eligibility assessment in PT athletes. A second limitation is the difference in baseline characteristics between PT athletes and controls, despite the relative small differences of age and anthropometric characteristics. Therefore, we interpreted the clinical relevance of these differences as minimal. Third, the intraobserver reliability was based on analysis of multiple elastograms from one acquisition in PT athletes and interobserver reliability was based on a subset of healthy controls, where both SWE acquisitions and image analyses were performed by independent examiners.Future research directions would comprise implementation of SWE before any reference standard is performed using standardized acquisition protocols, assessment of the prognostic value of patellar tendon stiffness in longitudinal studies, and its role to monitor therapy response.In conclusion, SWE is able to detect higher stiffness of the proximal patellar tendon in athletes with patellar tendinopathy with a good to excellent reliability, and could provide attractive novel biomarkers to assess therapy response.


Journal of Cachexia, Sarcopenia and Muscle (JCSM) is an open access peer‐reviewed journal that was founded 10 years ago in 2010. It is published by Wiley and in association with the non‐profit organization ‘Society on Sarcopenia, Cachexia, and Wasting Disorders  and 2018 (n = 90). Hence, the 2019 Thomson Scientific journal impact factor for JCSM was 9.802 (1686/172). The number of total citations towards JCSM is increasing each year .et al.TableTablesIn 2019, Web of Science ranked JCSM number 2/51 in the section ‘Geriatrics & Gerontology’ and number 9/165 in the section ‘Medicine, General & Internal’ in 2019.None declared.


In this research, we investigated the influence of bran type—wheat bran (WB) and oat bran (OB), and concentration (0–20% w/w) on the starch digestibility and eGI of magwinya. Rapidly available glucose (RAG) of control fried dough (60.31 g/100 g) was 33% less than fried batter (90.07 g/100 g). There was a significant reduction in RAG and an increase in slowly available (SAG) and unavailable glucose (UG) content of the fried products with OB and WB addition. The highest SAG content was observed in WB fried dough. Control fried batter had the highest eGI value (80.02) and control fried dough had medium eGI value (58.11). WB fried dough, fried batter, and OB fried dough were categorised as medium GI foods at eGI range of 56.46–58.39, 65.93–68.84 and 56.34–57.27, respectively. The eGI values of OB fried batter ranged from 73.57 to 80.03 and were thus classified as high GI foods. UG showed significant correlation with eGI  and fat content  for WB and OB fried products. These results reveal that ingredient modification through bran enrichment is effective for the regulation of starch digestion and reduction of eGI of deep-fried dough/batter foods.A deep-fried dough/batter food ( Starch is the major carbohydrate found in food commodities such as maize, wheat, potato and rice . It is aUnderstanding the relationship between the physicochemical and physiological properties of food is a vital way to explain the value of carbohydrate in human nutrition. The glycaemic glucose fraction of food, excluding lactose, is a summation of glucose in its glycaemic carbohydrate fraction . The gluFactors that affect starch digestibility include starch characteristics, enzyme inhibitors, amylose/amylopectin ratio, particle size of starch granule, processing method, starch gelatinisation, retrogradation and presence of other ingredients such as lipids, proteins and fibre ,6,11,12.Magwinya is a deep-fried product made from wheat flour, sugar, salt and water. It can be categorised as fried dough or batter based on the preferences of the consumers [magwinya has not been reported. Therefore, the objectives of this paper are: (i) to quantify available glucose and digestible starch fractions of magwinya via in vitro assay; (ii) to assess the effect of bran concentration and initial moisture content on available glucose and digestible starch content of magwinya; and (iii) to calculate the estimated glycaemic index of magwinya.onsumers . It is ponsumers  and can onsumers , it is emagwinya production. Guar gum (G4129), amyloglucosidase (A7095–260 U/mL), pepsin (P7000–250 U/mL), invertase (I4504–300 U/mg) and pancreatin (P7545–8 x USP specification), sulfuric acid (25810-5), glucose oxidase peroxidase kit (GAGO 20) for in-vitro digestion assays were sourced from Sigma–Aldrich, . Potassium hydroxide, acetic acid, hydrochloric acid and other chemicals used were of analytical grade.Wheat flour  wheat bran , oat bran , sucrose , salt, instant yeast (Anchor Yeast), sunflower oil (Spar) sourced locally in South Africa were used for the production of fried products. Wheat and oat bran were milled to 200 µm particle size using an ultra-centrifugal mill  and were stored at –20 °C until used for w/w), respectively, of wheat and oat bran. All dry ingredients were weighed as follows: composite flour (100 g), sugar (15 g), salt (1 g), yeast (1 g), into a mixing bowl at ambient temperature (24 °C). Lukewarm water (65 mL and 100 mL) was added gradually until all ingredients were homogenously mixed to form a dough and batter, respectively. The dough was kneaded for 10 min in a mixer  and cut into a 50-g mass and formed into a ball. The dough and batter were proofed at 30 °C in a T7 bread proofer (with temperature control limit of 46 °C and 95% humidity) and fried at 180 °C for 5 min in a deep fryer  with built-in automatic temperature and time control system. Oil was pre-heated for 1 h before frying.Fried products were processed using the method of Onipe et al. . Wheat fmagwinya was minced  was added. Guar gum was added to standardise the viscosity of the solution. To initiate proteolysis, each tube was covered, vortex-mixed, and transferred to a water bath for 30 min at 37 °C. To each tube, 5 mL sodium acetate buffer solution (0.5 M) at pH 5.2 and 15 glass beads of 5 mm diameter were added, shaken gently and equilibrated for 3 min in the water bath.Step 2: Starch hydrolysis of fried productsFresh enzyme cocktail was made from amyloglucosidase (260 U/mL), invertase (300 U/mg) and pancreatin (8 × USP) at 4:6:18 ratio per 100 mL enzyme mixture. Five millilitres of enzyme cocktail was added to each tube and agitated at 137 rpm in a shaking water bath set at 37 °C. Each tube was timed and removed from the water bath at exactly 20 and 120 min after the addition of the enzyme cocktail. Approximately 0.2 mL of the digest was pipetted into 4 mL absolute ethanol and vortex-mixed to end enzymatic hydrolysis. These were G20 and G120 fractions (glucose concentration at 20 min and 120 min).Step 3: Digestion for hydrolysis of starch to glucose The tubes were covered, mixed vigorously on a vortex mixer, and cooled for 5 min in an ice water bath. Subsequently, 7 M KOH solution 10 mL) was added and mixed. The tubes were agitated horizontally for 30 min in an ice water bath. A 0.2-mL portion of the content was pipetted into 1 mL acetic acid 1 M solution after which 40 µl of amyloglucosidase solution was added. The tubes were vortex mixed and transferred to a water bath for 30 min at 70 °C. The tubes were cooled for 15 min in an ice bath and subsequently allowed to reach ambient temperature before adding 12 mL of absolute ethanol. This tube corresponded to the TG  portion. Glucose oxidase and peroxidase assay kit were used to estimate glucose concentration of G20, G120, and TG portions using glucose oxidase and peroxidase assay kit GAGO-20 . The RAG, SAG and UG fractions were estimated using equations 1–3 as described by Contardo et al. [0 mL was magwinya was calculated from Equation (5).The kinetics of starch hydrolysis was described by the non-linear first-order Equation (4) established by Goñi et al. . The estmagwinya sample and AUC of the reference sample (white bread) as presented in the Equations (6) and (7) [∞ is the equilibrium concentration at the final time (120 min) and k is the kinetic constant. tf is final time t0 is the initial time, C is the starch hydrolysed at a chosen time t.The hydrolysis index (HI) was obtained from a division of area under the hydrolysis curve (AUC) of  and (7) ,26.(6)HP < 0.05. Multivariate linear regression was carried out to determine the test of between-subject effect, that is, linear and interaction effect of bran addition, initial moisture content and bran type on dependent variables. The association between independent and dependent variables was tested using Pearson’s correlation. All statistical tests were performed using SPSS software .Results were presented as the mean of triplicate determinations. Analysis of variance was carried out to determine the effect of bran concentration on glucose fractions. Means were separated using Duncan’s multiple range test where the effect of the independent variable was significant at magwinya have their source linked to starch and sugar components of magwinya. The RAG and content of starchy food are significant determinants of its glycaemic response [p < 0.01) implying that the consumption of WB fried batter will likely cause the rapid release of glucose in the bloodstream. The SAG content of WB fried dough ranged from 2.62 to 12.56 g/100 g and 6.88 to 18.76 g/100 g in fried batter  at p < 0.01. Higher RAG values in fried batter may be indicative of a higher degree of gelatinisation of fried batter compared to fried dough. Gelatinised starch is easily hydrolysed because of the loss of amylopectin crystallinity which makes the granules porous and accessible to digestive enzymes [magwinya formulation may delay the release of glucose in the bloodstream within 20 min of digestion. The SAG content of OB fried dough ranged from 2.62 to 10.18 g/100 g and 6.88 to 14.07 g/100 g in fried batter (magwinya (r = 0.557) at p < 0.01.The RAG of OB fried dough ranged from 41.47 to 60.31 g/100 g while that of fried batter ranged from 71.84 to 90.07 g/100 g . A signi enzymes . Controld batter . A signimagwinya are higher than those for WB magwinya. This may be associated with the difference in fibre solubility of WB and OB. The rate of UG increase is like those observed in WB fried dough and batter. An increase in UG in fried batter may be attributed to the interaction of WB fibres with water at a molecular level [magwinya (r = −0.985) and OB magwinya (r = −0.935) at p < 0.01. The UG values of OB fried batter increased significantly (p < 0.05) at higher substitution levels of OB.The UG fraction corresponds to the amount of glucose not released within 120 min of starch digestion and it is mainly from resistant starch content of the food [ar level ; thus, rp < 0.05) on RAG, SAG and UG contents of magwinya except for interaction effect of bran type and initial moisture content which showed no significance (p > 0.05) on SAGHigh UG values in fried dough samples may also be accounted for by incomplete gelatinisation as a result of competition for water by fibre, salt, and sugar molecules causing less water for starch granules to attain full gelatinisation upon heating ,6. Multimagwinya with low initial moisture content (fried dough) are medium GI food. This reduction in eGI of fried dough samples may be attributed to the combined effect of dietary fibre and limited water in the food matrix, which would have caused incomplete starch gelatinisation, and of a consequence resistance to amylolytic enzymes in the digestion time frame [magwinya, which has other components such as sugar (sucrose), salt, protein (gluten) and fibre, coupled with low initial water in the dough, these components compete with the starch granules for water. For complete gelatinisation to occur, heat and water are two crucial factors viz: water must enter the crystalline region (amylopectin) where swelling occurs (upon heating) and the cell ruptures, causing the amylose to leach out. It is easier for digestive enzymes to hydrolyse the exposed amylopectin and amylose into glucose monomers for absorption in the body. When there is incomplete gelatinisation, the foregoing does not occur, and this reduces the GI of the food [The eGI values of WB fried dough were in the range of 56.46–58.39 and were significantly lower than control (58.11) except WB1 . The eGIthe food .p < 0.05) on eGI of OB and WB magwinya. There was a significant reduction in eGI of magwinya with increments to OB and WB concentrations in magwinya formulation. In the control sample, eGI of 80.62 revealed fried batter to be a high GI food, while that of fried dough at 58.11 can be classified as intermediate GI food.Fried batter exhibited high eGI values viz: 65.93–80.62 in WB samples and 73.75–80.62 in OB samples . The linp < 0.05) lower than their OB counterpart. In the glycaemic index table collated by Foster-Powell et al. [Carbohydrate-rich foods can either be labelled low GI (<55), medium (55–70) and/or high GI (> 80) . The eGIl et al. , GI of dmagwinya made from either dough/or batter. Despite the similarity between both types of products, their eGI shows high disparity which was affected by the difference in ingredient (bran type used) and initial moisture content of the products which resulted in different degrees of starch gelatinisation and rates of carbohydrate digestion and their respective eGI values.The GI-lowering effect of bran types used in this study can be linked to their dietary fibre content which is composed mostly of non-starch polysaccharides such as β glucans (soluble fibre) in OB and arabinoxylan in WB ,32. The magwinya was estimated using Pearson’s correlation to observe and report linear trends amongst these properties. The fat content of the fried products in this study was reported in a recent publication [The relationship between GI, glucose, and total oil content of lication .magwinya is presented in p < 0.01) and SAG  of WB magwinya, implying that increase in SAG and RAG may have led to an increase in eGI. The RAG of foods has been established as a potential predictor of in vitro glycaemic response of starchy foods [p < 0.01) correlated positively to RAG  and SAG . This supports the effect of high water in fried batter samples that caused complete gelatinisation for fried batter. For complete gelatinisation during heat treatment, water is essential to hydrate starch molecules and cause a disruption of the crystalline structure of amylopectin. When there is not enough water, gelatinisation becomes incomplete which affects starch digestion [p < 0.05) and positively to SAG . Fat content correlated positively to RAG and SAG of WB magwinya and negatively to UG . Individually in fried dough, a negative correlation was established between FC and UG , while no significant correlation existed in WB fried batter. A positive correlation between fat and eGI  showed that an increase in fat content may increase eGI. This may be accounted for by fried batter samples which had higher eGI values. A possible explanation could be the enzyme used which catalysed fried batter samples thus increasing the eGI content. The fat content of fried products was inversely related to UG and directly proportional to eGI–indicative of amylose–lipid complex formation in the fried dough and starch gelatinisation in fried batter products [The relationship between glucose , fat content and eGI of WB and OB hy foods . Initialproducts .magwinya is presented in magwinya as indicated by positive correlations . Initial moisture content positively correlated to RAG, SAG and eGI of OB magwinya as shown (p < 0.01). In a low-moisture system like fried dough in this study, an increase in UG may be as a result of incomplete starch gelatinisation. Abundant water and heat are two important factors that aid starch gelatinisation and in turn the extent of starch digestion during hydrolysis. Exposure of starch molecules to heat in excess water leads to disruption of the crystalline structure thereby linking the hydroxyl group of starch and water molecules via hydrogen bonding [magwinya. There is a dearth of research on starch digestion of deep-fried dough/batter foods, hence the comparison of the results in this study with other deep-fried starchy foods. Fat content negatively correlated to UG . Opposing results on the effect of deep-frying on RS content of potato products have been reported. Deep-frying significantly increased RS because deep-frying increases fat available for amylose–lipid complex formation in the food [magwinya formulation also contributed to fat reduction and consequential increase in RS [Correlation among independent variables, available glucose , and eGI of OB as shown , and neg bonding . This, ithe food ,35. Starthe food . Conversthe food  observedse in RS .magwinya fried products caused a reduction in RAG values as well as an increase in SAG and UG values. This points to a delay in glucose release due to the presence of bran fibres during enzymatic hydrolysis. OB and WB had a similar effect on the reduction of RAG of fried dough while WB had improved an effect in fried batter products. There was a reduction of eGI of all samples with addition of WB and OB. This reduction effect on the eGI of magwinya can be attributed to the dietary fibre constituents of OB and WB. Overall, this study shows how bran enrichment can be used to control the glucose contents and reduce eGI of magwinya, thereby improving its nutritional properties. The outcomes of this study can serve as baseline information for magwinya (or fried food) processors, nutritionists, and consumers. In vitro studies only cater to an estimation of starch digestion and glycaemic index. To obtain magwinya GI, in vivo study using human or animal subjects is recommended. Extraction and purification of bran dietary fibres and evaluation of their constituents on their molecular mechanism in starch digestion are also suggested for future studies. The results of this study indicated that WB and OB are suitable additives for the reduction of RAG and eGI of magwinya.Incorporation of WB and OB in


Every effort was made to contact the authors in this regard, but without success. The Editor deeply regrets the inconvenience that this retraction has caused to the authors of the previously published articles, and to the readership of the Journal.Following an internal investigation, the Journal was able to confirm that this accusation of plagiarism was well-founded. On those grounds, the Editor of