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An "intelligent" or smart packaging is able to continuously monitor physicochemical and/or biological variations of packaged food materials, providing real-time information concerning their quality, maturity, and safety. Electrospun nanofiber (ENF) structures, nowadays, reckon as versatile biomaterial platforms in designing intelligent packaging (IP) systems. Natural biopolymer-based ENF traits, for example, surface chemistry, rate of degradation, fiber diameter, and degree of alignment, facilitate the development of unique, tunable IP, enhancing food quality, and safety. In this review, after a brief overview of the electrospinning process, we review food IP systems, which can be utilized to detect variations in food features, for example, those based on alterations in temperature, O

Extensive use of α-pinene in cosmetics, and medicine, especially for its antioxidant/antibacterial, and anti-cancer properties, and also as a flavoring agent, has made it a versatile product. α-Pinene (one of the two pinene isomers) is the most abundant terpene in nature. When extracting α-pinene from plants and, to a lesser extent, fruits, given that its purity is essential, purification methods should also be used as described in this study. Also, an attempt has been made to describe the extraction techniques of α-pinene, carried out by conventional and novel methods. Some disadvantages of conventional methods (such as hydrodistillation or solvent extraction) are being time consuming, low capacity per batch and being labor intensive and the requirement of trained operators. Most novel methods, such as supercritical fluid extraction and microwave-assisted extraction, can reduce the extraction time, cost, and energy compared to conventional methods, and, in fact, the extraction and preservation efficiency of α-pinene in these methods is higher than conventional methods. Although the above-mentioned extraction methods are effective, they still require rather long extraction times. In fact, advanced methods such as green and solvent-free ultrasonic-microwave-assisted extraction are much more efficient than microwave-assisted extraction and ultrasound-assisted extraction because the extraction efficiency and separation of α-pinene in these methods are higher; furthermore, no solvent consumption and maximum extraction efficiency are some crucial advantages of these techniques. However, the application of some novel methods, such as ultrasound-assisted extraction, in industry scale is still problematic because of their intricate design data.

ImportanceBreast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal.ObjectiveTo provide race and ethnicity–adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality.Design, Setting, and ParticipantsThis nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020.ExposuresProxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group–specific mortality data without modeling or adjustment.Main Outcomes and MeasuresDisease-specific mortality due to invasive BC in female patients.ResultsThere were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity–adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years.Conclusions and RelevanceThis study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening.

The rapid progress in modern technologies and paying more attention to food safety has prompted new green technologies superior than chemical methods in the food industry. In this regard, enzymes can decrease the usage of chemical reactions but they are sensitive to environmental effects (pH and temperature). In addition, enzymes are scarcely possible to be reused. Consequently, their application as natural catalysts is restricted. Using nanotechnology and the possibility of enzyme immobilization on nanomaterials has led to nanobiocatalysts, resulting from the integration of nanotechnology and biotechnology. Nanocarriers have individual features like nanoscale size, excellent surface/volume ratio, and diversity in construction to improve the activity, efficiency, stability, and storage stability of enzymes. Nanobiocatolysts have a wide range of applications in purification, extraction, clarification, production, and packaging of various products in the food industry. Furthermore, the application of nanobiocatalysts to identify specific components of food contaminants such as microorganisms or their metabolites, heavy metals, antibiotics, and residual pesticides has been successful due to the high accuracy of detection. This review investigates the integration of nanotechnology and food enzymes, the nanomaterials used to create nanobiocatalysts and their application, along with the possible risks and legal aspects of nanomaterials in food bioprocesses.

Propolis is a natural antioxidant but, its application is limited due to its strong flavor and alcohol-soluble nature. Soluble complexes and coacervates of almond gum (AG) and sodium caseinate (CAS) were produced at pH = 7 and 4.6, respectively for encapsulation of alcoholic extract of propolis. Despite the higher process yield of complexes at pH = 7, the sample at pH = 4.6 indicated higher encapsulation efficiency, antioxidant activity, and total phenolic content. The results of FTIR and XRD supported the interaction of propolis with biopolymeric complexes. Moreover, the thermal stability and antibacterial activity of propolis were improved after encapsulation; propolis showed higher antibacterial activity against Gram-positive than Gram-negative bacteria. Also, encapsulated propolis showed a controlled release in various food simulants and gastrointestinal environments. Apoptosis evaluation and MTT assay confirmed that the encapsulated propolis induces lower cytotoxicity than pure propolis against fibroblast cell line possibly due to the delayed release of propolis.

IntroductionAcute kidney injury (AKI) has been associated with an increased mortality rate among hospitalized patients with Coronavirus disease 2019 (COVID-19). The current review aimed to evaluate the symptoms, complications, and treatments performed to manage AKI in patients with COVID-19.MethodsWe searched PubMed/Medline, Web of Science, and Embase for the relevant scientific literature published up to February 1, 2022. The following keywords were used: “COVID-19”, “SARS-CoV-2”, and “Acute kidney injury”.ResultsForty-four studies with a total number of 114 COVID-19 patients with AKI (Mean age: 53.6 years) were included in our systematic review. The most common comorbidities in patients with COVID-19 suffering from AKI were the history of diabetes, hypertension, and hyperlipidemia. Twelve out of the 44 included studies reported a history of chronic kidney disease (CKD) in this group of patients. Focal segmental glomerulosclerosis (FSGS) and acute tubular necrosis (ATN) were the most common pathological evidence. The average length of hospital stay was 19 days, and the average duration of need for mechanical ventilation was 3 days.ConclusionsThe current systematic review shows that AKI frequently complicates the course of COVID-19 hospitalizations and is associated with increased severity of illness, prolonged duration of hospitalization, and poor prognosis. Given the extent of the adverse impact of AKI, early detection of comorbidities and renal complications is essential to improve the outcomes of COVID-19 patients.

Objectives Obesity and overweight are among the main causes of cardiovascular disease (CVD) mortality. Dyslipidemia, fatty liver index, is strongly related to CVD. Vitamin E as an antioxidant protects the hepatic cells against oxidative stress and prevents fatty liver disease. The aim of the current study is to evaluate the relationship between anthropometric parameters and fasted lipid profile with serum vitamin E levels. Study design A randomized trial was designed based on data from the Mashhad stroke and heart atherosclerotic disorders (MASHAD: 2010–2020). Methods 363 CVD subjects (173 males and 190 females) was selected at random, among 9704 subjects in three regions of Mashhad, northeast of Iran to investigate the specific correlations among their serum vitamin E, lipid profile (TG, HDL-C, LDL-C and TC), and anthropometric features (height, weight, BMI, hip and waist circumferences. Result The results indicated the significant relationships between vitamin E, and fasting serum lipid profile in subjects. Serum vitamin E was negatively correlated to TC, TG, and LDL-C and positively related to HDL-C. Also, statistically negative correlations were found between vitamin E and anthropometric parameters (weight, waist and hip circumference, middle Arm, and Systolic Blood Pressure). Moreover, vitamin E ratios such as vitamin E/(TC + TG) and vitamin E/TC values as standardized vitamin E, had significant negative correlation with BMI, the whole of anthropometric parameters, and dyslipidemia risk factors including TC, TG and LDL-C. Conclusion We found that vitamin E profile was significantly lower in the dyslipidemia subjects. It is generally suggested that vitamin E monitoring might be used as a useful prognostic and therapeutic agent in dyslipidemia disorder.

A new family of lifetime distributions is introduced via distribution of the upper record values, the well-known concept in survival analysis and reliability engineering. Some important properties of the proposed model including quantile function, hazard function, order statistics are obtained in a general setting. A special case of this new family is proposed by considering the exponential and Weibull distribution as the parent distributions. In addition estimating unknown parameters of specialized distribution is examined from the perspective of the traditional statistics. A simulation study is presented to investigate the bias and mean square error of the maximum likelihood estimators. Moreover, one example of real data set is studied; point and interval estimations of all parameters are obtained by maximum likelihood and bootstrap (parametric and non-parametric) procedures. Finally, the superiority of the proposed model in terms of the parent exponential distribution over other known distributions is shown via the example of real observations.

Background Indications and diagnostic yield of small-bowel video capsule endoscopy (SB-VCE) are communicated in recent clinical academic guidelines. However, guidelines are based mainly on relatively few, small, selection-biased studies at experienced centers, and thus we lack information on indications and diagnostic yield of SB-VCE in the real-world community setting. The aim of the study was to evaluate indications and diagnostic yield of SB-VCE in the real-world community setting. Methods Our local VCE clinical database was used to identify patients undergoing SB-VCE procedures over a 7-year period (2011–2018). Patients were broadly referred and underwent SB-VCE using PillCam™ SB 2 and SB 3 capsule systems. Procedures were reviewed by local endoscopists, who had undergone similar formal SB-VCE review training. Medical reports of the procedures were composed as such. We retrospectively reviewed all reports and gathered data regarding indications and findings. Diagnostic yield was considered positive if SB-VCE visualized any type of clinically significant pathological finding. Results 536 SB-VCE procedures in 516 patients were included in final assessment. Patient mean (± SD) age was 50 ± 20 years with approximately even female/male ratio (275:241). The overall proportion of positive findings was 42% (225/536). The two main indications were obscure gastrointestinal bleeding (occult/anemia or overt/active, OGIB) of 46% (246/536) and definite/suspected Crohn’s disease (CD) of 39% (210/536). Positive SB-VCE findings were obtained in 44% (108/246) of procedures with indication of OGIB and in 50% (104/210) of procedures with indication of CD. Conclusions The indications for SB-VCE are largely consistent with guidelines but with an apparently relatively low diagnostic yield in our real-world community setting.

Background: As economic resistance is largely defined as the capacity of an economy to improve or adapt to the effects of unexpected, exterior shocks such as COVID-19 pandemic for health systems, the purpose of this study was to identify the economic resistance components of the Iranian health system during COVID-19 pandemic. Methods: This qualitative study was conducted using the content analysis method from 2020 to 2021. The statistical population of the study consisted of health system experts who are familiar with the subject of resistance economy. Using the snowball sampling method, semi-structured interviews with 30 selected participants were done. The reliability and transparency were determined by Guba and Linkon criteria such as credibility, transferability, confirmability, and consistency, or dependability. Data were analyzed using the Clarke and Braun thematic six-step method. Results: It was found that economic growth, economic stability, justice, and economic resilience, as four main components, affected the economic resistance of the health system in COVID-19 pandemic. Each of these components encompasses a number of sub-components that can help reinforce the health system in two restorative and resilient categories. Conclusions: To the best of our knowledge, a comprehensive study with an exploratory approach was not retrieved to find the main determinants of economic resistance components in COVID-19 pandemic. The present study can greatly contribute to the available knowledge to guide the policymakers for better understanding of the system during unexpected situations and applying the most applied solutions as well. It may help the health systems particularly those who encounter unpleasant macro-trends and unplanned crises, to keep their preparedness and readiness and improve their resilience.

Objective Health insurance is based on people’s significant risks in receiving health services that they cannot afford alone. Since the outbreak of the corona epidemic, the health insurance system has suffered many economic problems. Designing a model of a health insurance system based on the requirements of a resilient economy can improve the functions of this system in the corona crisis. Results In this research 12, structural components were obtained in the form of 4 conceptual components. The 4 main conceptual components are Knowledge-based economy, Economic stability, Economic resilience, and justice. The knowledge-based economy is the basis for the formation of economic resilience in the health insurance systems. Health insurance systems will achieve two crucial intermediate results, namely economic resilience, and economic stability, by building the basic infrastructure of a knowledge-based economy. In the long run, maintaining such intermediate results is the foundation of justice in the health insurance system.

Fractional models and their parameters are sensitive to intrinsic microstructural changes in anomalous materials. We investigate how such physics-informed models propagate the evolving anomalous rheology to the nonlinear dynamics of mechanical systems. In particular, we study the vibration of a fractional, geometrically nonlinear viscoelastic cantilever beam, under base excitation and free vibration, where the viscoelasticity is described by a distributed-order fractional model. We employ Hamilton's principle to obtain the equation of motion with the choice of specific material distribution functions that recover a fractional Kelvin–Voigt viscoelastic model of order α. Through spectral decomposition in space, the resulting time-fractional partial differential equation reduces to a nonlinear time-fractional ordinary differential equation, where the linear counterpart is numerically integrated through a direct L1-difference scheme. We further develop a semi-analytical scheme to solve the nonlinear system through a method of multiple scales, yielding a cubic algebraic equation in terms of the frequency. Our numerical results suggest a set of α-dependent anomalous dynamic qualities, such as far-from-equilibrium power-law decay rates, amplitude super-sensitivity at free vibration, and bifurcation in steady-state amplitude at primary resonance.

The present study was designed to investigate the possible role of Mg2+ in suppression of phosphoenolpyruvate carboxy kinase (PEPCK) enzyme via inhibition of FOXO1gene expression in liver and we also examined whether Mg contributes to decrease blood glucose in muscle via inhibiting FOXO1 gene and protein expression. Fifty rats in five groups of experiment were considered as; non-diabetic control (NDC), Mg2+-treated non-diabetic control (Mg2+-NDC), chronic diabetic (CD), Mg2+-treated chronic diabetic (Mg2+-CD), and insulin-treated chronic diabetic (Ins-CD). Streptozotocin (STZ) was used for diabetes induction. The Mg2+-CD and Mg2+-NDC groups received 10 g/l of magnesium sulfate (MgSO4) added to drinking water, and Ins-CD group received 2.5 U/kg of insulin. The blood glucose level and body weight were measured weekly. After 16 weeks, intraperitoneal glucose tolerance test (IPGTT) was done and blood samples were taken to determine the plasma levels of Mg and gastrocnemius muscle legs, and liver were isolated for both Forkhead transcription factor (FOXO1) and PEPCK enzyme genes and proteins expression. Administration of MgSO4 improved IPGTT, lowered blood glucose levels and decreased FOXO1 and PEPCK genes and proteins expression in muscle and liver, while insulin just could decrease FOXO1 gene and protein expression in the muscle. These findings illustrated that MgSO4 improved hyperglycemia via inhibition of FOXO1 gene and protein level in the muscle and liver, and it also decreased blood glucose level by prohibition of gluconeogenesis pathway in the liver. However, long time administration of insulin did not have any effect on liver.

Background Evidence-based guidance for starting ages of screening for first-degree relatives (FDRs) of patients with prostate cancer (PCa) to prevent stage III/IV or fatal PCa is lacking in current PCa screening guidelines. We aimed to provide evidence for risk-adapted starting age of screening for relatives of patients with PCa. Methods and findings In this register-based nationwide cohort study, all men (aged 0 to 96 years at baseline) residing in Sweden who were born after 1931 along with their fathers were included. During the follow-up (1958 to 2015) of 6,343,727 men, 88,999 were diagnosed with stage III/IV PCa or died of PCa. The outcomes were defined as the diagnosis of stage III/IV PCa or death due to PCa, stratified by age at diagnosis. Using 10-year cumulative risk curves, we calculated risk-adapted starting ages of screening for men with different constellations of family history of PCa. The 10-year cumulative risk of stage III/IV or fatal PCa in men at age 50 in the general population (a common recommended starting age of screening) was 0.2%. Men with ≥2 FDRs diagnosed with PCa reached this screening level at age 41 (95% confidence interval (CI): 39 to 44), i.e., 9 years earlier, when the youngest one was diagnosed before age 60; at age 43 (41 to 47), i.e., 7 years earlier, when ≥2 FDRs were diagnosed after age 59, which was similar to that of men with 1 FDR diagnosed before age 60 (41 to 45); and at age 45 (44 to 46), when 1 FDR was diagnosed at age 60 to 69 and 47 (46 to 47), when 1 FDR was diagnosed after age 69. We also calculated risk-adapted starting ages for other benchmark screening ages, such as 45, 55, and 60 years, and compared our findings with those in the guidelines. Study limitations include the lack of genetic data, information on lifestyle, and external validation. Conclusions Our study provides practical information for risk-tailored starting ages of PCa screening based on nationwide cancer data with valid genealogical information. Our clinically relevant findings could be used for evidence-based personalized PCa screening guidance and supplement current PCa screening guidelines for relatives of patients with PCa., Xing Xu and co-workers assess prostate cancer risk in relatives of men with prostate cancer., Author summary Why was this study done? Family history is the strongest known risk factor for prostate cancer (PCa), and current guidelines concur that an earlier screening for men with a family history of PCa is necessary. However, limited evidence-based guidance is available on at what age actually this early screening should start. This study was conducted to provide precise recommendations about at what age should relatives of PCa patients start screening based on the number of affected relatives and the age at onset of PCa in the family. What did the researchers do and find? In this nationwide study on 6,343,727 men, the risk of stage III/IV or fatal PCa in close family members of patients with PCa was estimated. It was observed that men with family history of PCa reach the screening risk threshold up to 12 years earlier than the general population. This study found that age, age at diagnosis of PCa in relative/s, and number of affected first-degree relatives (FDRs) are important elements in increased risk of stage III/IV or fatal PCa, and these factors accordingly resulted in different risk-adapted starting ages of PCa screening. Comparison between our evidence-based risk-adapted starting age of screening and recommended age of PCa screening by different guidelines showed a difference ranging from −2 to 11 years. What do these findings mean? This study made use of the largest dataset available, to our knowledge, to identify the optimal age for starting PCa screening in relatives of patients with PCa. This study took into account not only the number of relatives but also age at onset of PCa in the family members, which is an additional important piece of information for the guidelines. The results may contribute to a more evidence-based personalized PCa screening guidance in real-world settings, and clinicians could inform patients with PCa about this possibility and encourage individualized counseling for their relatives.

Background Wide implementation of mammography screening has resulted in increased numbers of women diagnosed with breast carcinoma in situ. We aimed to determine the risk of invasive breast cancer in relatives of patients with breast carcinoma in situ in comparison to the risk in relatives of patients with invasive breast cancer. Methods We analyzed the occurrence of cancer in a nationwide cohort including all 5,099,172 Swedish women born after 1931 with at least one known first-degree relative. This was a record linkage study of Swedish family cancer datasets, including cancer registry data collected from January 1, 1958, to December 31, 2015. We calculated standardized incidence ratios (SIRs) and 10-year cumulative risk of breast cancer diagnosis for women with a family history of in situ and invasive breast cancer. Results Having one first-degree relative with breast carcinoma in situ was associated with 50% increased risk of invasive breast cancer (SIR = 1.5, 95% CI 1.4–1.7) when compared to those who had no family history of invasive breast cancer or breast carcinoma in situ in either first- or second-degree relatives. Similarly, having one first-degree relative with invasive breast cancer was associated with 70% (1.7, 1.7–1.8) increased risk. The 10-year cumulative risk for women at age 50 with a relative with breast carcinoma in situ was 3.5% (2.9–3.9%) and was not significantly different from 3.7% (3.6–3.8%) risk for 50-year-old women with a relative with invasive breast cancer (95% confidence intervals overlapped). Conclusions The risk of invasive breast cancer for women with a family history of breast carcinoma in situ was comparable to that for women with a family history of invasive breast cancer. Therefore, family history of breast carcinoma in situ should not be overlooked in recommendations for breast cancer prevention for women with a family history of breast cancer.

OBJECTIVES: Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes. METHODS: In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported. RESULTS: Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p

The demand for food and beverage markets has increased as a result of population increase and in view of health awareness. The quality of products from food processing industry has to be improved economically by incorporating greener methodologies that enhances the safety and shelf life via the enzymes application while maintaining the essential nutritional qualities. The utilization of enzymes is rendered more favorable in industrial practices via the modification of their characteristics as attested by studies on enzyme immobilization pertaining to different stages of food and beverage processing; these studies have enhanced the catalytic activity, stability of enzymes and lowered the overall cost. However, the harsh conditions of industrial processes continue to increase the propensity of enzyme destabilization thus shortening their industrial lifespan namely enzyme leaching, recoverability, uncontrollable orientation and the lack of a general procedure. Innovative studies have strived to provide new tools and materials for the development of systems offering new possibilities for industrial applications of enzymes. Herein, an effort has been made to present up-to-date developments on enzyme immobilization and current challenges in the food and beverage industries in terms of enhancing the enzyme stability.

The covalent immobilization of xylanase onto the trichlorotriazine-functionalized polyethylene glycol grafted magnetic nanoparticles was exploited to generate a stabilized xylanase with improved catalytic activity and stability. Several tools were deployed to monitor the synthesis and immobilization processes, the loading capacity of nanocarrier, and the structural/chemical characteristics of the nanobiocatalyst. The optimum immobilization yield of xylanase was 260 mg xylanase/g nanocarrier in 20 mM phosphate buffer, pH 6.5 at 25 °C. A forward shift in optimum pH (6.5 to 7.5) and temperature (60 to 70 °C) of xylanase was observed after immobilization and the performance of immobilized enzyme was improved at high temperatures and pHs as affirmed by enhancement of vmax (2.69 to 6.01 U/mL) and decreases of Ea (14.61 to 13.41 kJ/mol). An increase in Km from 25.51 to 40.42 mg/mL was recorded after immobilization. The obtained results indicated augmented thermal stability of the immobilized xylanase. Notably, it showed good reusability as validated by retention of 50% of its initial activity after nine recycles in enrichment of the pineapple juice clarification after 120 min incubation at 50 °C, pH 4.5. The structural analysis revealed some partial changes in the α-helix and β-sheet content of the enzyme after several recycles.

Heavy-tailed distributions play an important role in modeling data in actuarial and financial sciences. In this article, a new method is suggested to define new distributions suitable for modeling data with a heavy right tail. The proposed method may be named as the Z-family of distributions. For illustrative purposes, a special submodel of the proposed family, called the Z-Weibull distribution, is considered in detail to model data with a heavy right tail. The method of maximum likelihood estimation is adopted to estimate the model parameters. A brief Monte Carlo simulation study for evaluating the maximum likelihood estimators is done. Furthermore, some actuarial measures such as value at risk and tail value at risk are calculated. A simulation study based on these actuarial measures is also done. An application of the Z-Weibull model to the earthquake insurance data is presented. Based on the analyses, we observed that the proposed distribution can be used quite effectively in modeling heavy-tailed data in insurance sciences and other related fields. Finally, Bayesian analysis and performance of Gibbs sampling for the earthquake data have also been carried out.

Obesity is an important feature of the metabolic syndrome and is associated with an increased risk of type 2 diabetes mellitus, cardiovascular disease, and some cancers. The aim of this study was to determine the relationship between body fat percentage and an imbalance of the prooxidant/antioxidant balance (PAB), serum superoxide dismutase (SOD1) and inflammation (serum hs-CRP) and increase risk of metabolic syndrome and diabetes mellitus. In this study, 9154 individuals were recruited as part of the Mashhad Stroke and Heart Association Disorder (MASHAD) study. Subjects were categorized into two groups according to body fat percentage as defined >25% in male and > 30% in female, according to gender. Biochemical factors, including serum PAB, SOD1, and hs-CRP were measured in all subjects. SPSS version 18 was used for statistical analyses for all. GraphPad Prism 6 for figures was used. Of total number of subjects (9154), 6748 (73.7%) were found to have a high body fat (BF) percentage. Serum hs-CRP and PAB were significantly higher in individuals with a high BF percentage (P 0.05). BF percentage, serum PAB and serum hs-CRP were significantly higher in individuals with metabolic syndrome and diabetes versus those without metabolic syndrome and diabetes mellitus (P < 0.05), however serum SOD1 was significantly lower in individuals with metabolic syndrome (P < 0.005). Oxidative stress and inflammation are two factors that may link the presence of high BF percentage with the development of metabolic syndrome, diabetes, and cardiovascular disease. © 2018 BioFactors, 45(1):35-42, 2019.

The effects of long-term oral administration of magnesium sulfate and insulin on hyperglycemia were investigated using Akt2 and IRS1 gene expression methods in streptozotocin-induced diabetic rats. Fifty rats were randomly divided into five experimental groups: 1, non-diabetic control (NDC); 2, Mg2+-treated non-diabetic control (Mg-NDC); 3, chronic diabetic (CD); 4, Mg2+-treated chronic diabetic (Mg-CD); and 5, insulin-treated chronic diabetic (Ins-CD). Streptozotocin was used to induce diabetes. The Mg-CD and Mg-NDC groups received 10 g/l of MgSO4 added to drinking water. The Ins-CD group received 2.5 U/kg of insulin twice a day. Blood glucose level and body weight were measured every week. The intraperitoneal glucose tolerance test (IPGTT) was performed after 16 weeks. MgSO4 administration improved the blood glucose level and IPGTT. It also increased Akt2 and IRS1 genes as well as protein expression. Insulin lowered the blood glucose level and increased IRS1 gene and protein expression, but did not affect Akt2 gene and protein expression. Glucose reduction after Mg therapy may be mediated, at least partially, via IRS1 and Akt2 genes and protein stimulation. In insulin-treated rats, insulin resistance was not significant due to the absence of Akt2 gene expression.

AIMS/INTRODUCTION: The purpose of the present study was to investigate the possible effect of oral magnesium sulfate (MgSO4 ) in the reduction of atherosclerosis plaques through inhibition of lectin-like low-density lipoprotein receptor-1 (LOX-1) gene expression in diabetic vessels. MATERIALS AND METHODS: A total of 50 rats were divided into five groups, including non-diabetic control, Mg-treated non-diabetic control, chronic diabetic, Mg-treated chronic diabetic and insulin-treated chronic diabetic. The induction of diabetes was carried out by streptozotocin. The Mg-treated chronic diabetic and Mg-treated non-diabetic control groups were treated with 10 g/L of MgSO4 added to their drinking water. The insulin-treated chronic diabetic group received 2.5 U/kg of insulin twice per day. The fasting blood glucose level and bodyweight were determined weekly. Blood pressure measurement and the intraperitoneal glucose tolerance test were carried out after 16 weeks, and the plasma levels of Mg, lipid profile and oxidized low-density lipoprotein cholesterol (oxLDL) were determined. The mesenteric bed was isolated and perfused according to the McGregor method. The aorta was isolated for LOX-1 genes and proteins expression, and pathological investigation. RESULTS: MgSO4 administration improved blood pressure, sensitivity to phenylephrine, intraperitoneal glucose tolerance test, lipid profile and plasma ox-LDL level, and also lowered the blood glucose level to the normal range, and decreased LOX-1 gene and protein expressions. Insulin decreased blood pressure, sensitivity to phenylephrine, blood glucose, lipid profiles and plasma oxLDL level, but it did not decrease LOX-1 gene and protein expressions. CONCLUSIONS: The present findings suggested that MgSO4 improves blood pressure and vessel structure through decreasing oxLDL, and LOX-1 gene and protein expressions; however, insulin did not repair vessel structure, and LOX-1 gene and protein expressions. © 2018 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Background: Outsourcing is considered as one of the tools for organizational development and promotion of productivity by managers. In recent years, outsourcing of healthcare services has become significant. The aim of this study was to identify the most important factors influencing the decision making of outsourcing healthcare services. Methods: This study is a combined study. First, the literature was examined to identify the factors influencing decision making for outsourcing. Then, with the aim of consensus on the most important factors affecting the decision making of outsourcing in health services, the panel of experts and Delphi technique were used. Sampling was purposeful. Results: In the selected articles, a total of 180 factors were extracted. The members of the panel of experts from these 180 factors selected 29 sub-factors in the form of six main factors: strategy, quality, management, technology, performance feature, and economy, as the most important factors affecting the outsourcing of services. Finally, the results of Delphi showed that 22 sub-factors were more important in outsourcing decision making at healthcare services. Conclusion: The study showed that the decision making to outsource health services is a complex and multi-criteria decision. Therefore, when deciding to outsource healthcare services, attention should be paid to various factors, such as strategy, quality, management, technology, and economics.

The vitamin D receptor (VDR) gene polymorphisms have been reported to be related to the development of Behcet's disease (BD). However, the results have been inconsistent among diverse populations. Therefore, this comprehensive meta-analysis has been designed to assess a more accurate association between VDR polymorphisms and BD susceptibility.An electronic literature search was conducted to identify eligible studies. Pooled odds ratios (OR) with corresponding 95% confidence interval (CI) were calculated in different genetic models to assess this association.A total of six separate comparisons comprised of 468 cases and 516 controls were included in the meta-analysis model. The meta-result demonstrated that A allele of ApaI (A vs. a: 1.54 95% CI = 1.04-2.26, P = 0.029), and F allele of FokI (F vs. f: OR = 0.58, 95% CI = 0.45-0.76, P = 0.007) polymorphisms were associated with the risk of BD in total and African populations, respectively. This significant association was also found in recessive and homozygotes models. Subgroup analysis indicated that FokI variant among Africans and ApaI variant among Caucasian were significantly associated with the risk of BD. No relationship was found between Bsmi and TaqI polymorphisms and BD risk.This meta-analysis demonstrated the association between FokI and ApaI polymorphisms in VDR gene with the risk of BD, providing insights into the potential role of vitamin D receptor in the pathogenesis of BD.

Introduction: Outsourcing of health information technology services (OHITS) is an important process for healthcare organizations due to the lack of expert staff to respond rapid advance in IT and the security of patient�s information. This study aimed at presenting a model to evaluate factors affecting OHITS. Method: This is a descriptive-analytic study, conducted in 2017. Participants were experts of IT and accounting field. This research was performed in four general steps: identifying the factors affecting OHITS through literature review; determining suitable indicators by Delphi technique; prioritizing the factors using Analytical Hierarchical Process (AHP), measuring the accuracy of research hypotheses by Partial Least Square (PLS) and calculating the Goodness Of Fit (GOF) criteria for the model. Findings: the most and the least important factors affecting OHITS were �motivation� and �selection of a provider� respectively. GOF criteria was 0.697, suggesting powerful model fitting. Conclusion: Using the model presented in this research, the healthcare managers and chief officers of IT will be able to decide consciously about outsourcing projects, and also manage the project better. © 2018 Mohammad Shirdeli, Sahar Zare, Erfan Kharazmi, Rita Rezaee, Mohammad Hadi Maher

BackgroundThe diagnostic role of cardiac MRI in myocarditis is evolving, however with extremely limited data in paediatrics. The goal of this study was to assess the utility of cardiac MRI in paediatric myocarditis and present a new prognostic score for risk stratification.MethodThe present study is a retrospective investigation of children with a clinical diagnosis of myocarditis, including analysis of demographics, clinical presentation, diagnostic studies, including cardiac MRI, and outcomes.ResultsA total of 44 patients met the inclusion criteria, of whom 20 had undergone cardiac MRI. Patients who underwent cardiac MRI were older (median 15.6 versus 11.1 years, p=0.004), had a shorter length of hospital stay (median 4.0 versus 12.5 days, p=0.004), had overall less-severe illness at presentation as evidenced by a higher left-ventricular ejection fraction on echocardiography, had lower peak brain-type natriuretic peptide, were less likely to require advanced mechanical support, and were less likely to experience cardiac death or transplant. In patients who had undergone cardiac MRI, the most common findings were increased early gadolinium enhancement (n=9) or late gadolinium enhancement (n=9). Cardiac MRI findings did not predict a worse outcome. Independent predictors of the need for heart-failure medications at 1-year follow-up included inotrope requirement, extracorporeal membrane oxygenator requirement, and antiarrhythmic requirement at presentation (pConclusionIn paediatric myocarditis, cardiac MRI is not used uniformly, has a low yield, and does not predict worse outcomes. Future research should evaluate clinical decision-making and the cost–benefit analysis of cardiac MRI in the diagnosis of paediatric myocarditis.

Developing an effective strategy to economically exploitation of pectinase, as one of the most widely used enzymes in food industry, is of utmost importance. Herein, pectinase was covalently immobilized onto polyethylene glycol grafted magnetic nanoparticles via trichlorotriazine with high loading efficiency. The generated immobilized pectinase showed enhanced catalytic activity, improved operational stability, and easily reusability. Thermal and pH stabilities studies showed improved performance of immobilized pectinase especially at extreme points. Compared to free enzyme, the noticeably lower Km and higher vmax values of immobilized pectinase demonstrated the enhanced catalytic activity of this enzyme after immobilization. Besides, the immobilized enzyme exhibited excellent reusability and stability by retaining up to 55 and 94% of its initial activity after 10 recycles and 125 days storage at 25 °C, respectively. Moreover, turbidity reduction occurred up to 59% in treated pineapple juice with immobilized pectinase, suggesting applicability of this system in juice and food-processing industries.

Due to high prevalence of diabetes in our region (16.3%) and no data on the frequency of gastrointestinal (GI) symptoms in this population, we performed a cross-sectional study to evaluate the frequency of GIsymptoms in diabetic patients and its association between microvascular complications (retinopathy and nephropathy) and gastrointestinal symptoms in diabetic subjects.This analytical crosssectional study was conducted from 2014 to 2016 on 233 patients with type 2 diabetes mellitus (T2DM), 3065-year, referred to Yazd diabetic research center. They were selected by convenient sample method. A questionnaire according to Rome III Criteria was used to collect digestive information related to diabetes. Last HbA1c (Since 2-3 months ago) was available in the patient's medical folder. Diabetic nephropathy defines to increased excretion rate of albumin in the urine in the range of above 30 mg/g creatinine. Diabetic retinopathy was examined by an expert ophthalmologist (retinal specialist). For the current study, 233 patients (age 30-65 years with mean age of 57.43±10.49 years, 102 (43.8%) males and 131 (56.2%) females) were included. Among 233 patients, 91 cases (39.1%) had nephropathy,and 111(47.6%) subjects had different degrees of retinopathy. Bloating and early satiety and upper GI symptoms were higher in the subjects with retinopathy than another group. In summary, this study provides evidence that GI symptoms in diabetic subjects are independently linked to diabetic complications, particularly to retinopathy.

ObjectiveTo explore the risk of colorectal cancer in family members of patients with colorectal cancer, with an emphasis on subtypes of second degree relatives, especially half siblings, which were lacking in the literature.DesignAmbidirectional cohort study.SettingNationwide Swedish Family Cancer Data (record linkage).ParticipantsAll people residing in Sweden and born after 1931, with their biological parents, totalling >16 million individuals (follow-up: 1958-2015); of those with clear genealogy, 173 796 developed colorectal cancer.Main outcome measuresLifetime (0-79 years) cumulative risk and standardised incidence ratio of colorectal cancer among first degree relatives and second degree relatives.ResultsThe overall lifetime cumulative risk of colorectal cancer in siblings of patients was 7%, which represents a 1.7-fold (95% confidence interval 1.6 to 1.7; n=2089) increase over the risk in those without any family history of colorectal cancer. A similarly increased lifetime cumulative risk (6%) was found among half siblings (standardised incidence ratio 1.5, 95% confidence interval 1.3 to 1.8; n=140). The risk in people with colorectal cancer in both a parent and a half sibling (standardised incidence ratio 3.6, 2.4 to 5.0; n=32) was close to the risk in those with both an affected parent and an affected sibling (2.7, 2.4 to 3.0; n=396). Family history of colorectal cancer in only one second degree relative other than a half sibling (without any affected first degree relatives), such as a grandparent, uncle, or aunt, showed minor association with the risk of colorectal cancer.ConclusionFamily history of colorectal cancer in half siblings is similarly associated with colorectal cancer risk to that in siblings. The increase in risk of colorectal cancer among people with one affected second degree relative was negligible, except for half siblings, but the risk was substantially increased for a combination of family history in one affected second degree relative and an affected first degree relative (or even another second degree relative). These evidence based findings provide novel information to help to identify people at high risk with a family history of colorectal cancer that can potentially be used for risk adapted screening.

This research was conducted to investigate the biochemical effects of thymosin alpha-1 using human lung cancer cells (A549). The A549 cells were treated with different concentrations of Thα1 for 24 h and the growth, inhibition of cells was determined. Thα1 revealed anti-proliferative effect at 24 and 48 μg/ml after 24 h. Furthermore, it indicated antioxidant properties by significantly enhancing the activity of catalase (12 μg/ml), superoxide dismutase (6 and 12 μg/ml), and glutathione peroxidase (3, 6 and 12 μg/ml) and reducing the production of cellular ROS. Our results showed that Thα1 inhibits the migration of A549 cells in a concentration-dependent manner after 24 and 48 h. Moreover, the effect of Thα1 on apoptosis was investigated by Hoechst 33342 staining and cell cycle analysis. Results demonstrated no significant effect on the induction of apoptosis in A549 cells. In conclusion, our results showed the antioxidant properties of Thα1 on A549 cancer cells.

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Background: Main health challenge of the 21st century is improving quality of life (QoL). This study aimed to investigate the mediating role of health locus of control (HLC) between health literacy and QoL among Iranian pregnant women. Methods: In this cross sectional survey, 400 pregnant women referred to the community health centers of Gonabad, Iran, and completed the demographic, health literacy, QoL, and multidimensional HLC questionnaires during 2015-2016. Descriptive statistics and structural equation modeling were conducted using SPSS 22.0 version and AMOS 24.0 software. Results: The findings showed that health literacy has a significant positive effect on the physical (β= 0.54, p< 0.001) and mental (β= 0.57, p< 0.001) health. Also, it has a significant positive effect on internal subscale (β= 0.42, p< 0.001) and a significant negative effect on the chance (β= -0.51, p< 0.001) and powerful others (β= -0.33, p< 0.001) subscale of HLC. From HLC subscales, internal HLC had a significant positive effect on physical (β= 0.26, p< 0.001) and mental (β= 0.12, p= 0.010) health, while the effects of chance and powerful others on QoL dimensions were not significant. The findings indicated that internal HLC is a partial mediator between health literacy and physical dimension of QoL. Conclusion: The results indicate that health literacy can be considered as an effective factor in HLC orientations and can improve QoL. This reflects the need for more attention on health literacy and the recognition of the type of HLC beliefs, especially the internal belief in health promotion programs for pregnant women.

Background Colorectal cancer (CRC) incidence is increasing among young adults below screening age, despite the effectiveness of screening in older populations. Individuals with diabetes mellitus are at increased risk of early-onset CRC. We aimed to determine how many years earlier than the general population patients with diabetes with/without family history of CRC reach the threshold risk at which CRC screening is recommended to the general population. Methods and findings A nationwide cohort study (follow-up:1964–2015) involving all Swedish residents born after 1931 and their parents was carried out using record linkage of Swedish Population Register, Cancer Registry, National Patient Register, and Multi-Generation Register. Of 12,614,256 individuals who were followed between 1964 and 2015 (51% men; age range at baseline 0–107 years), 162,226 developed CRC, and 559,375 developed diabetes. Age-specific 10-year cumulative risk curves were used to draw conclusions about how many years earlier patients with diabetes reach the 10-year cumulative risks of CRC in 50-year-old men and women (most common age of first screening), which were 0.44% and 0.41%, respectively. Diabetic patients attained the screening level of CRC risk earlier than the general Swedish population. Men with diabetes reached 0.44% risk at age 45 (5 years earlier than the recommended age of screening). In women with diabetes, the risk advancement was 4 years. Risk was more pronounced for those with additional family history of CRC (12–21 years earlier depending on sex and benchmark starting age of screening). The study limitations include lack of detailed information on diabetes type, lifestyle factors, and colonoscopy data. Conclusions Using high-quality registers, this study is, to our knowledge, the first one that provides novel evidence-based information for risk-adapted starting ages of CRC screening for patients with diabetes, who are at higher risk of early-onset CRC than the general population., Uzair Ali Khan and colleagues describe the risk of colorectal cancer in patients with diabetes., Author summary Why was this study done? Diabetes is associated with increased risk of colorectal cancer (CRC), especially in young adults before age 50. CRC incidence is increasing among young adults who are not targeted for screening. Diabetes has not been considered as a risk factor in any CRC screening guideline. What did the researchers do and find? For each single age, we calculated the risk of developing CRC in the next 10 years; for example, at age 50, which is the most common age for starting CRC screening, the risk of developing CRC during next 10 years (age 50 to 59) in the Swedish population was 0.44% in men and 0.41% in women. Men and women with diabetes reached the risk levels for 50-year-old individuals (0.44% and 0.41%, respectively) at about age 45 instead of age 50, i.e., nearly 5 years earlier than the general population, whereas patients with an additional family history of CRC reach these screening risk thresholds, 12 to 21 years earlier than the general population. What do these findings mean? These findings for the first time provide evidence-based information about the best starting age of screening for CRC in patients with diabetes. A major strength of this study would relate to the extremely large and comprehensive national (Swedish) datasets available and the duration involved (all Swedish residents born after 1931 and their parents, followed up to 2015). Clinicians could inform patients with diabetes (with or without family history of CRC) about this possibility and encourage individualized counseling for CRC screening.

Background: Oral mucosal lesions are more prevalent in diabetic patients compared to healthy individuals. Periodontal disorders have been known as the sixth complication of diabetes mellitus after microvascular and cardiovascular complications. The aim of this research was to assess the relationship between oral mucosal lesions and retinopathy and nephropathy in type 2 diabetic subjects in the Yazd province. Methods: This analytical cross-sectional study was conducted in diabetes research center during 2014 - 2016 in Yazd. Individuals with glomerular filtration rate (GFR) less than 60, oropharyngeal cancer, pregnancy, lactation, type one diabetes, or newly diagnosed diabetes (< 2 years) are excluded from study. The subjects’ demographic data and oral examination was performed by an oral medicine specialist. Soft tissues oral cavity findings consist of any form of candidiasis, periodontitis, gingivitis, xerostomia, geographic tongue, lichen planus, gingival hyperplasia, delay oral wound healing, fissured tongue, and burning mouth sensation. Fasting blood sugar (FBS), HbA1c, and micro-albuminuria were checked. Diabetic nephropathy defined to the urinary excretion rate of albumin above 30 mg/g creatinine. The retinal specialist evaluated diabetic retinopathy. Finally, frequency of soft tissue oral lesions in individuals with and without retinopathy and nephropathy were compared. We analyzed data using the SPSS version 20. Statistical significance less than 0.05 were accepted. Results: Totally, 274 patients (48% male) participated in this study. Most of the patients (70.8%) suffer from at least one of the diabetic microvascular complications (retinopathy, nephropathy or both) and 80 diabetic patients (29.2%) had no complications. Gingivitis (P = 0.049) and fissured tongue (P = 0.047) were more prevalent in retinopathic individuals compared to subjects without retinopathy. Fissured tongue and delayed wound healing were high in nephropathic persons compared to other groups (P = 0.047 and 0.039, respectively). Presence of at least one of the oral lesions are higher than in patients with retinopathy and nephropathy compared to individuals without complications (P = 0.047 and 0.049 respectively). Conclusions: High frequency of oral problems in subjects with micro-vascular complications were found. Our findings showed that closer cooperation between the endocrinologist and the oral medicine specialist is required. In addition, diagnosis of oral problems in diabetics, especially with micro-vascular complications, is necessary to improve the oral health of them.

In the present paper, a new family of lifetime distributions is introduced according to cumulative hazard rate function, the well-known concept in survival analysis and reliability engineering. Some important properties of proposed model including survival function, quantile function, hazard function, order statistic and some results of stochastic ordering are obtained in general setting. An especial case of this new family is introduced by considering Weibull distribution as the parent distribution; in addition estimating unknown parameters of specialized model will be examined from the perspective of Bayesian and classic statistics. Moreover, three examples of real data sets: complete, right-censored and progressively type-I interval-censored data are studied; point and interval estimations of all parameters are obtained. Finally, the superiority of proposed model in terms of parent Weibull distribution over other fundamental statistical distributions is shown via complete real observations.

The prevalence of hypertension (HTN) is increasing globally. It has been shown that there is an association between micronutrient deficiency and HTN. In the current study, we aimed to assess the association between HTN with serum copper and zinc concentrations in a large representative Iranian population. The participants were enrolled into the Mashhad stroke and heart atherosclerotic disorders study (MASHAD study), a cohort study that was initiated in 2010. Anthropometric indices were assessed using standard procedures. Systolic (SBP) and diastolic (DBP) blood pressures were measured using a standard mercury sphygmomanometer. Fasting blood glucose (FBG), lipid profile, uric acid and blood urea nitrogen (BUN), and hs-CRP were measured using routine methods. HTN defined as persons who had SBP ≥ 130 mmHg and/or DBP ≥ 85 mmHg and/or medication use. Flame atomic absorption (Varian AA240FS) was used to measure serum Zn and Cu concentrations. SPSS software was used for all statistical analyses. A total of 9588 participants were recruited into the MASHAD study project. Participants were divided into two groups; 5695 healthy (non-hypertensive) (mean age 45.85 ± 7.5 years) and 3893 hypertensive participants (mean age 51.18 ± 7.67 years). Systolic (p 0.001) and diastolic blood pressure (p 0.001) were significantly different for different serum copper quartiles. The participants with serum copper levels 80 μg/dl had 1.33 times greater risk of an increased blood pressure than other participants. Participants with serum copper levels 130 μg/dl had a 1.94-fold higher risk of raised blood pressure. Serum zinc was not associated with systolic blood pressure, but individuals in the first quartile level of serum zinc had a diastolic blood pressure that was significantly higher than other quartiles (p = 0.035). Serum copper is associated with blood pressure status in adults in a U-shaped relationship, with a range of serum copper between 80 and 130 μg/dl being associated with normal blood pressure.

The availability of Landsat data allows improving the monitoring and assessment of large-scale areas with land cover changes in rapid developing regions. Thus, we pretend to show a combined methodology to assess land cover changes (LCCs) in the Hamoun Wetland region (Iran) over a period of 30-year (1987–2016) and to quantify seasonal and decadal landscape and land use variabilities. Using the pixel-based change detection (PBCD) and the post-classification comparison (PCC), four land cover classes were compared among spring, summer, and fall seasons. Our findings showed for the water class a higher correlation between spring and summer (R2 = 0.94) than fall and spring (R2 = 0.58) seasons. Before 2000, ~ 50% of the total area was covered by bare soil and 40% by water. However, after 2000, more than 70% of wetland was transformed into bare soils. The results of the long-term monitoring period showed that fall season was the most representative time to show the inter-annual variability of LCCs monitoring and the least affected by seasonal-scale climatic variations. In the Hamoun Wetland region, land cover was highly controlled by changes in surface water, which in turn responded to both climatic and anthropogenic impacts. We were able to divide the water budget monitoring into three different ecological regimes: (1) a period of high water level, which sustained healthy extensive plant life, and approximately 40% of the total surface water was retained until the end of the hydrological year; (2) a period of drought during high evaporation rates was observed, and a mean wetland surface of about 85% was characterized by bare land; and (3) a recovery period in which water levels were overall rising, but they are not maintained from year to year. After a spring flood, in 2006 and 2013, grassland reached the highest extensions, covering till more than 20% of the region, and the dynamics of the ecosystem were affected by the differences in moisture. The Hamoun wetland region served as an important example and demonstration of the feedbacks between land cover and land uses, particularly as pertaining to water resources available to a rapidly expanding population.

A minimum subantral bone height in the posterior maxilla may require a bone augmentation where a sinus lift procedure is the most commonly used technique, either preceding or simultaneously with the implant installation. While elevating the Schneiderian membrane ruptures are common, possibly resulting in less bone formation. In this paper, we propose the surgical pneumatization of the Schneiderian membrane as a new technique to minimize the risk of such complications. This can be achieved mainly by creating a hole for the immediate and increased passage of air through the Schneiderian membrane and the maxillary sinus wall above the region of augmentation.