Elevated NF‐kB levels have been identified in primitive bone marrow cells from patients with MDS/AML, suggesting NF‐kB as a therapeutic target in MDS/AML. We herein describe an MDS patient ineligible for SCT who, following treatment with azacitidine and bortezomib, transformed to leukemia, but maintained complete remission after monotherapy with ixazomib. Elevated NF‐kB levels have been identified in primitive bone marrow cells from patients with MDS/AML, suggesting NF‐kB as a therapeutic target in MDS/AML. We herein describe an MDS patient ineligible for SCT who, following treatment with azacitidine and bortezomib, transformed to leukemia, but maintained complete remission after monotherapy with ixazomib. We herein describe an MDS patient ineligible for SCT who, following treatment with azacitidine and bortezomib, transformed to leukemia, but maintained complete remission after monotherapy with ixazomib.Myelodysplastic syndrome (MDS) is a hematopoietic stem cell disorder that is characterized by ineffective hematopoiesis and often transforms into acute myeloid leukemia (AML). Although treatments for MDS/AML have advanced, the treatment for elderly patients who are not eligible for SCT remains inadequate. Thus, novel pharmacologic therapies capable of preventing or delaying disease progression are in critical need. Elevated nuclear NF‐kB levels have been identified in primitive bone marrow cells from patients with MDS, suggesting NF‐kB as a therapeutic target in MDS.We herein a report of successful treatment with ixazomib in a patient with MDS transformed to AML who previously failed to respond to azacytidine (AZA) and bortezomib treatment.29/L with 3% of peripheral blast cells), anemia (hemoglobin 64 g/L), and hyperproteinemia . Her renal function and levels of calcium, serum albumin, and lactate dehydrogenase were normal. The serum β2‐microglobulin level was 4.0 mg/dL, and the concentrations of IgG and κ‐light chain were 28.8 g/L  and 147 mg/dL , respectively. The serum free light chain ratio was 4.9 . Serum protein electrophoresis disclosed a monoclonal spike in the γ‐globulin region, and urine electrophoresis also revealed a monoclonal spike. Serum immunofixation electrophoresis confirmed the presence of an IgG‐κ chain monoclonal M component. Bone marrow examination showed that 18% were blasts with dysplasia of erythropoiesis, granulopoiesis, and megakaryopoiesis and flow cytometric analysis was positive for CD13, CD33, CD34, and HLA‐DR. Moreover, bone marrow aspiration showed 13% plasma cells and flow cytometric analysis was positive for CD38, CD138 and kappa, and negative for CD19, CD20, and lambda. Strong nuclear CD34 and p53 immunostaining was detected in 8% and 10% of hematopoietic cells, respectively, and CD138 immunostaining was noted in 5% of plasma cells. Karyotype analysis indicated a 46, XX karyotype (20/20 cells). Interphase fluorescence chromosomal in situ hybridization of the bone marrow cells revealed no gene abnormalities in 1q21, RB1, P53, D13S319, and IgH. She had no evidence of myeloma‐defining events or amyloidosis. A diagnosis of the simultaneous occurrence of MDS with excess blast‐2  and monoclonal gammopathy of undetermined significance (MGUS) was made, and 5‐azacytidine (AZA)  treatment was initiated. After 2 cycles of this treatment, she had normal peripheral blood counts, and serum IgG paraprotein and β2‐microglobulin (β2‐MG) levels decreased to 16 g/L and 1.8 mg/L, respectively. A repeat marrow examination showed slightly hypercellular marrow, with a significant decrease in myeloblasts to 1% blasts and 5% plasma cells. Strong nuclear CD34 and p53 immunostaining decreased in hematopoietic cells and CD138 immunostaining was detected in a few plasma cells. She achieved hematological CR and continued AZA treatment.In 2016, a 78‐year‐old female was referred to our hospital with leukopenia , anemia (hemoglobin 56 g/L), and hyperproteinemia . Serum IgG paraprotein and β2‐microglobulin (β2‐MG) levels increased to 42 g/L and 4.0 mg/L, respectively. The serum free light chain ratio was 7.7. Marrow examination showed slightly hypercellular marrow, with 7% blasts and 8% plasma cells. Strong nuclear CD34 and p53 immunostaining was detected in 5% and 10% of hematopoietic cells, respectively, and CD138 immunostaining was noted in 20% of plasma cells. Karyotypic analyses indicated a 46, XX karyotype (20/20 cells). She was administered bortezomib and dexamethasone (VD) . After 3 cycles of the treatment, she achieved hematological CR, and her serum and urine M protein were negative by immunofixation, and bone marrow examination showed a decrease in plasma cells (4%). She continued the VD treatment.In September 2018, after 30 cycles of AZA, the patient exhibited evidence of disease progression, with leukopenia (white blood count 2.1 × 109/L and 5% of blast cells) and anemia (hemoglobin 70 g/L). Serum IgG paraprotein and β2‐microglobulin (β2‐MG) levels increased to 38 g/L and 5.8 mg/L, respectively. The serum free light chain ratio was 5.7. The bone marrow was hypercellular marrow and showed that blasts were 20% and plasma cells were 7% with dysplasia of erythropoiesis, granulopoiesis, and megakaryopoiesis , a master transcription factor involved in cell growth and proliferation. Elevated nuclear NF‐kB levels have been identified in primitive bone marrow cells from patients with MDS/AML, suggesting NF‐kB as a therapeutic target in MDS/AML.Ixazomib, the biologically active boronic acid form of ixazomib citrate that forms immediately upon exposure to aqueous solution or plasma, has a proteasome dissociation half‐life that is sixfold faster than that of bortezomib.The frequencies of TP53 mutations in MDS and MM were 7‐19 and 8%‐15%, respectively, and TP53 mutant clones may drive disease progression.To the best our knowledge, this is the first case report to document successful treatment with ixazomib alone as salvage therapy in an elderly relapse/refractory MDS patient. Although treatments for MDS/AML have advanced, the treatment for elderly patients who are not eligible for SCT remains inadequate. The mechanism of ixazomib action in AML/MDS is still unclear and further investigation is needed.None declared.SO: was involved in patient care and writing the manuscript. KO: has reviewed and arranged the pathology images.Informed consent was obtained from the patient for publication of this case report and the accompanying images.Bone marrow biopsies showed hypercellular marrow with myelodysplasia‐related changes and numerous blasts (A) and strong nuclear CD34 and p53 immunostaining was detected in 10% and 30% of hematopoietic cells (B and C). After ixazomib treatment, repeat marrow examination showed slightly hypercellular marrow, with a significant decrease in myeloblasts to 1% blasts and 2% plasma cells . Strong nuclear CD34 and p53 immunostaining decreased in hematopoietic cells .


Total viable counts (TVC), yeast, and molds in bread ranged from 2.82–3.64 log10 cfu/g and 1.48–2.16 log10 cfu/g, respectively, on the last day of storage. Water activity, TVC, and fungal counts were low in sweet potato composite bread as compared to white bread. Total β-carotene in OFSP bread ranged from 1.9–5.4 mg/100 g (on dry weight). One hundred grams of bread portion enriched with 40% and 50% OFSP purée provides more than 50% of vitamin A dietary requirements to children aged 4–8 years. Incorporation of up to 50% OFSP purée in wheat flour produces a relatively shelf-stable, nutritious, and health-promoting functional bread.Partial substitution of wheat flour with orange-fleshed sweet potato (OFSP) purée in bread can increase vitamin A intake among consumers. The study investigated the influence of wheat flour substitution with 20–50% of OFSP purée on proximate composition, color, β-carotene, water activity, and microbial keeping quality. The moisture content, crude protein, crude fat, total ash, crude fiber, and carbohydrate in bread ranged from 28.6–32.7%, 9.9–10.6%, 5.0–5.5%, 1.9–3.2%, 1.4–1.8%, and 79.1–80.9%, respectively. β-carotene, total ash, and crude fiber contents in bread, and Hunter color values  Bread is a global staple food that plays a vital role in food security . Over thVitamin A is an essential micronutrient for human health. It is primarily involved in vision, reproduction, growth, and cellular communication ,8. VitamStrategies, such as dietary diversification, vitamin A supplementation, and food fortification, are being explored to address vitamin A deficiency. These approaches are however not feasible and sustainable . FurtherBiofortified orange-fleshed sweet potato (OFSP) is being grown and promoted as a food-based strategy to address the problem of VAD in SSA ,14. OFSPOFSP is bulky, highly perishable, and mainly consumed as boiled or steamed in SSA. However, the majority of the urban population has a low preference towards boiled sweet potato . EffortsBakeries in SSA are currently substituting wheat flour with up to 30% of OFSP purée in the production of sweet potato bread . HoweverBacillus subtilis, yeast, and molds. There has also been an attempt to assess the shelf-life of bread substituted with 30% OFSP purée [The shelf-life of bread is relatively short. It is limited mainly by staling and spoilage by microorganisms, such as SP purée  but moreSP purée , hence tThe objectives of this study, therefore, were: (1) to develop sweet potato composite bread from different proportions of wheat flour and OFSP purée, and (2) to investigate the effects of wheat flour substitution with 20–50% of OFSP purée on proximate composition, β-carotene, color, water activity and microbial shelf-life of the composite bread.Sweet potato purée was prepared from fresh OFSP roots of the “VITA” variety at the purée processing company in Homa Bay County, Kenya. It was prepared following methods described by ,34. The All the ingredients: commercial baker’s flour ; bread improver , formulated with corn starch, ascorbic acid, calcium carbonate, and baking enzymes (α-amylase and hemicellulase); salt , sugar , baker’s yeast , and cooking fat  were purchased from a retail outlet in Nairobi. All the ingredients were purchased from a retail chain store in Nairobi and formulated as shown in The bread was produced by straight dough according to ,35 with The bread was sliced manually using sterilized kitchen knives. Nine slices were selected from each bread for analysis. They were equally selected from the center, and both ends of each bread. The crust was manually cut and separated from the crumb and grinded separately for beta-carotene analysis. The crust (20 mm × 20 mm × ~4 mm) and the crumb (20 mm × 20 mm × 20 mm) were also prepared manually for color measurement. Samples for proximate composition and water activity analyses were milled without the separation of the crumb and the crust. Bread samples for the analysis of water activity and microbial profile were analyzed immediately while the rest of the samples were kept in a clean and sanitized oven space at 25 °C to mimic the normal shelf storage conditions for bread.Sample preparation, extraction, and analysis were performed under golden-yellow lights to prevent the degradation of beta-carotene. All the samples were analyzed for moisture content, protein, fat, fiber, ash, β-carotene, color, water activity, total viable counts, and fungal counts. All the analyses were performed in triplicate.Moisture content, crude fat, crude protein, crude fiber, and total ash were determined according to the Official Methods of Analysis of AOAC International .W1 is the weight of the dish and fresh sample, W2 is the weight of the dish and dried sample, and wS is the sample weight.The moisture content was determined by the method of AOAC 934.01 . Two graW1 is the weight of the ash and crucible after incineration, W2 is the weight of the empty crucible, and wS is the initial weight of the sample.The ash content was determined according to the methods of AOAC 942.05 . Two grafW is the weight of the receiver flask and extracted fat, W is the weight of the empty receiver flask, and wS is the weight of the sample used.The fat content was performed by acid hydrolysis and Solvent extraction method as described by AOAC 920.39 . Five gr2SO4 for 30 min. The volume was maintained at 200 mL with hot distilled water while stirring the sample during the digestion process. It was then filtered through the glass wool on a Buchner funnel. The second digestion step was conducted using 2.5 M NaOH. The sample was filtered again through the same glass wool. The residue on the glass wool was rinsed with 3 mL of ethanol. The glass wool together with the residue were dried in an oven at 105 °C for 30 min until a constant weight (W1) was achieved. The oven-dried samples were then incinerated in a muffle furnace at 600 °C for 3 h. The incinerated sample was cooled in a desiccator at room temperature and reweighed:W1 is the weight of the crucible and sample before incineration, W2 is the weight of the crucible containing ash, and wS is the weight of the sample.The crude fiber content in bread was established according to the AOAC 978.10 methods . Two gra2SO4 was added with 2 g of Kjeldahl tablet . Samples were digested until a pure colorless solution was obtained. Kjeldahl distiller was used for distillation with 35% NaOH (w/w) to release ammonia from the sample. The distilled ammonia was collected in a flask with 50 mL of 4% boric acid mixed with bromocresol green and methyl red indicators. The distilled sample was titrated against 0.1 HCl. The protein content was calculated by multiplying the value of nitrogen by a factor of 5.7 [a is the normality of the acid, b is the volume of the standard acid used (mL), W is the weight of the sample (g), and 5.7 is the conversion factor for protein from % nitrogen.Protein content was performed by the Kjeldahl method as described by AOAC . Exactlyr of 5.7 :(5)CrudeThe percentage of available carbohydrates was calculated by subtracting the total contents of moisture, total ash, crude protein, crude fat, and crude fiber content from 100%:AC is the available carbohydrate, TF is total fat, and CP is the crude protein.The gross energy content of bread was estimated by Atwater’s conversion equation :(7)Food All the proximate composition analyses were performed in triplicate. Cereal-based food  from LGC Standards Proficiency Testing UK, previously used for proficiency testing in the lab, and an in-house quality control food material (wheat bran), were used as reference materials for quality control.w/v) to each tube, mixing, and further incubation at 85 °C for 5 min. The tubes with the samples were removed from the water bath and immediately cooled in a bucket full of ice. Distilled water (5 mL) was added to each tube while still immersed in ice and vortexed for 1 min. This was followed by the addition of 3 mL hexane  and mixing on the vortex mixer for 1 min. The tubes were then centrifuged  at 3000 rpm for 10 min. The upper phase of hexane was extracted using a Pasteur pipette into separate clean 25 mL Pyrex glass test tubes. The extraction and separation processes were repeated thrice by adding 3 mL hexane to each sample pellet in the tubes. β-carotene extraction was confirmed to be complete after obtaining a white residue and a clear upper liquid phase. The extract was washed by addition of 5 mL of distilled water, vortexing, and centrifugation at 3000 rpm for 5 min. The upper hexane phase was separated into 15 mL clean test tubes and evaporated under a stream of nitrogen using a nitrogen evaporating machine  with a water bath at 40 °C. Dried tubes with carotenoids were then reconstituted with 5 mL of methanol and tetrahydrofuran (HPLC grade) (85:15 v/v) and filtered through a 0.2 µm PFTE syringe filter into amber vials for HPLC analysis.β-carotene extraction in bread was conducted by saponification and extraction with hexane as described by  with modv/v) and filtered through a 0.2 µm PFTE syringe filter into 2 mL-amber vials for HPLC analysis.β-carotene extraction in OFSP purée was performed according to  with somv/v/v, with 1.5% ammonium acetate in the water-mobile phase A) and methanol/tert-butyl methyl ether/water . A linear gradient elution was employed and set as follows: 0–1 min, 100% A; 1–10 min, 90% A; 10–22 min, 45% A; 22–33 min, 5% A; 33–37 min, 5% A; 37–39 min, 100% A; 39–40 min, 100% A. The flow rate was maintained at 0.4 mL per minute and a run time of 40 min [Ten microliters (10 µL) of each sample were injected into the HPLC  with an auto-sampler and a UV-Vis photodiode array detector (PDA-2996). Empower software controlled the entire system and data acquisition. The extracts were resolved on a 150 mm × 4.6 mm, YMC C30, 3 µm particle size HPLC column  utilizing a reverse-phase gradient HPLC method. The mobile phases were methanol/tert-butyl methyl ether/water  were calculated according to the conversion factor of 12 µg of β-carotene to 1 µg of retinol . Vitamincarotene ,43. The L* (a measure of lightness), a* (a measure of greenness to redness), and b* (a measure of blueness to yellowness) values. The color of bread was determined using a Hunter color meter  with standard illuminant D65, observation angle of 10°, and an aperture of 30 mm [L* = 98.63, a* = 0, and b* = 0. Three readings were recorded from different positions of the petri dish with the sample. All the samples were analyzed in three replicates. The psychometric color terms chroma, hue angle, and delta E were calculated according to the methods of [L0, a0, and b0 are Hunter color values of white bread and L1, a1, and b1, are experimental color values of different sweet potato composite breads.Color measurement was based on Hunter of 30 mm ,36,44. Tthods of ,46, as fWater activity (aw) was determined by a water activity meter  . The ins−3/mL. Precisely 0.1 mL of each serial dilution was spread evenly and separately on Petri dishes with solidified plate count agar (PCA) for total counts and potato dextrose agar (PDA) for enumeration of yeasts and molds. All the analyses were performed in triplicate. Cultured PCA plates were incubated at 30 °C for 48 h, while PDA plates were incubated at 25 °C for five days. The colonies were enumerated and recorded after incubation. Microbial quality evaluation was conducted on day 0, day 3, and day 6 of storage. The analyses were performed in triplicate.Total mesophilic  and fungi were carried out to determine the microbial load of the bread samples by pour plate method according to ,48 with p < 0.05). Principal Component Analysis (PCA) was performed using The Unscrambler X  to distinguish the bread samples based on their attributes.The experimental data were subjected to statistical evaluation using analysis of variance (ANOVA) followed by Tukey’s test to determine the significant differences between bread quality characteristics of the various formulations. Pearson correlation was also performed to establish the relationship between the variables. The analyses were conducted using the statistical software for social sciences . The statistical significance was defined as (p < 0.05), with the lowest value in white bread (28.6 g/100 g) and the highest in 50% OFSP purée bread (32.7 g/100 g). The range of moisture content in the current study is similar to the findings by [Moisture content is an essential food quality attribute that largely contributes to the physical, sensory, and microbial properties of bread. The moisture content of bread in this study varied significantly . Our findings report a similar range of crude fat content as [p > 0.05) on the fat content of bread.Lipids from wheat flour, shortenings, and dough strengtheners, influence dough development, fermentation, proofing, baking, and bread storage . On the ntent as ), but hintent as , which rp > 0.05).The protein content in the bread ranged from 9.9 g/100 g in 20% OFSP bread to 10.6 g/100 g in white bread. Similar findings in sweet potato flour composite bread have been reported by . On the p < 0.05) higher in OFSP bread as compared to the white bread. The fiber content of sweet potato composite bread in the current study ranged from 1.2 to 1.8%. This range was higher in comparison to bread formulated by wheat, maize, and sweet potato flours in a study by [The crude fiber content was significantly  increased with an increase in the proportion of OFSP purée.trans- and cis-isomers of β-carotene were detected in OFSP purée bread. More than 70% of the total β-carotene in bread was in trans form, which has more vitamin A activity compared to the cis-isomers. The trans- and cis-β-carotene in bread significantly (p < 0.05) increased with an increase in the percentage of OFSP purée. The concentration of the 13-cis, all-trans and 9-cis β-carotene in sweet potato composite bread ranged from 1410–3950 µg/100 g, 430–1200 µg/100 g, and 70–240 µg/100 g, respectively.A typical HPLC chromatogram of the carotenoids in bread from OFSP variety “VITA” obtained with the YMC C30, 3 µm particle size HPLC column is presented in trans-β-carotene, hence a good source of vitamin A. As expected, OFSP bread contained more of the cis-β-carotene and less of the trans-β-carotene in comparison to fresh OFSP purée. This is in agreement with [trans-β-carotene, thereby increasing the concentration of the cis-form in bread.As a rule of thumb, processed foods containing at least 15 µg/g can be considered a good source of vitamin A . In the ent with . The bakRetinol Activity Equivalents (RAEs)  providedp < 0.05) increased with an increase in the ratio OFSP purée and wheat flour. Consumption of 100 g of 30% sweet potato bread could provide about 47% and 32% of vitamin A daily body requirement to adolescents and children below five years, respectively. A similar amount could provide about 25% and 15% of vitamin A RDA to pregnant and lactating women, respectively. OFSP bread (50%) can provide up to 97% of vitamin A daily body requirement to children below the age of five, 65% to adolescents, 51% to pregnant women, and 30% to lactating mothers.OFSP bread in this study could provide 138.5–389.1 µg/100 g of RAEs. RAE significantly (L*), redness (a)*, yellowness (b*), chroma, hue angle, and ∆E values of the crumb significantly (p < 0.05) varied from 65.3–77.8, 1.0–11.4, 17.8–40.7, 17.9–42.2, 74.3–86.6, and 11.0–28.1, respectively. L*, a*, b*, chroma, h°, and delta E values for the crust varied from 57.3–69.2, 7.7–13.4, 25.4–35.7, 26.6–38.1, 66.3–73.1, and 9.8–16.7, respectively and were significantly different (p < 0.05). L* and hue angle values for both the crust and crumb significantly decreased with the addition of the purée in bread, while a*, b*, chroma, and ∆E values increased significantly (p < 0.05). A recent study by [E values. The high ∆E values of sweet potato bread were high, indicating the color changes could easily be perceived without a closer visual inspection in comparison to wheat flour bread. The color change is contributed by β-carotene from the OFSP purée, Maillard browning, and caramelization, which are influenced by the distribution of water and the reaction between reducing sugars and amino acids [Bread color is an important attribute that influences consumer acceptability. Wheat flour and sweet potato purée blend ratio influenced the color of bread . The ligp < 0.05) lower as compared to white bread. Water activity in bread from the current study ranged from 0.92–0.93 , the decline in water activity in sweet potato bread can be attributed to the concentration of natural sugars in the purée due to loss of moisture during storage.Our study findings were in agreement with water activity range values in bread from previous studies by ,36. Watep < 0.05) in comparison to the control sample. TVC, yeast, and molds were absent in freshly baked bread. This shows that the bread was of good quality and safe for consumption. Total counts ranged between 2.17–2.35 log10 cfu/g and 2.82–3.64 log10 cfu/g after 3 and 6 days of storage, respectively.The microbial quality profiles of bread in the study are shown in 10 cfu/g and 1.48–2.16 log10 cfu/g after three and six days of storage, respectively. These counts are low compared to a study by [Aspergillus, Penicillium, Rhizopus, and Mucor species. There was a significant (p < 0.01) positive correlation between water activity and microbial counts in bread. The high microbial counts and fast growth of molds on white bread are attributed to the high water activity. Besides the low water activity, OFSP purée bread has a relatively long shelf life due to the increased moisture retention, hence reducing the rate of staling.Yeast and molds cause surface growth, discoloration, and off-flavors in bread . From thstudy by  but highstudy by ,63. Moldp < 0.01) positive correlation existed between moisture content and ash (r = 0.885), beta-carotene (r = 0.910) and Hunter color values a* (r = 0.886), b* (0.876), chroma (0.881), and ∆E (0.904). On the contrary, a significant (p < 0.01) moderate negative correlation existed between moisture content and carbohydrate (r = −0.75) and water activity (r = −0.630). Sweet potato composite bread higher in moisture content/low dry matter will tend to be high in ash and β-carotene. It is a challenge to simultaneously improve dry matter and beta-carotene among the sweet potato germplasm during biofortification. The positive correlation between β-carotene and total ash suggests an indirect improvement of the latter through selection for higher β-carotene in the variety used for the study [The correlation matrix in he study .p < 0.01) negative correlation between L* (a measure of lightness) and a*, b*, c*, ∆E, and β-carotene content in bread . The findings illustrate that bread with a high proportion of wheat flour would be expected to be lighter in color due to low amounts of β-carotene. The amount of β-carotene in bread, positively correlated (p < 0.05) with Hunter color values a* (r = 0.979), b* (r = 0.940), c* (r = 0.946) and ∆E (r = 0.924). Similar findings have been reported in a previous study by [a* and b* can be useful in predicting the amount of β-carotene in processed products with OFSP as a natural colorant.There was a significant  of wheat–OFSP composite bread are shown in a*, b*, chroma, and ∆E, β-carotene, and moisture content of bread. These components were highly correlated to each other as indicated by their location on the outer ellipse of the correlation loadings. Water activity (aw), total ash, crude fiber also contributed to the variation in PC1. These attributes were prominent in sweet potato purée breads. On the other hand, crude protein and crude fiber were located in the inner circle of the correlation loadings. They, therefore, do not contain enough structured variation to distinguish different bread formulations in the study. The variation in PC2 was contributed by color parameters L* and hue angle (h°). They positively correlated to each other (r = 0.848) and contributed to the PC2 variation that separated white bread from sweet potato purée composite bread.As indicated by the correlation plot b, the vaThe current study reports the effect of partially substituting wheat flour with OFSP purée on the nutritional, selected physical and microbial quality of sweet potato purée composite bread. An increase in the proportion of OFSP purée as a substitute for wheat flour significantly increased the β-carotene, total ash, and fiber contents of bread. Sweet potato purée also enhanced the color and microbial keeping quality of bread. Consumption of a 100 g portion of 40% and 50% OFSP bread can provide 76% and 97% of vitamin A daily requirement in children below five years. A similar portion of bread formulated with 50% OFSP purée provides half (51%) and 30% of vitamin A daily requirement in pregnant women and lactating mothers, respectively. However, further studies should be considered to determine the dough characteristics, texture properties, and sensory attributes of sweet potato bread.


Giardia lamblia, with prevalence of 41.0% [95% CI: 25.0‐59.0%], Blastosystis hominis with 28.0% [95% CI: 15.0‐44.0%] and Entamoeba coli with 22.0% [95% CI: 16.0‐29.0%] had the highest prevalence while, Dientamoeba fragilis 5.0% [95% CI: 4.0‐7.0%], Iodamoeba bütschlii 5.0% [95% CI: 2.0‐8.0%], Chilomastix mesnili 5.0% [95% CI: 2.0‐9.0%] and Endolimax nana with 3.0% [95% CI: 1.0‐7.0%], were less prevalent. Infection with Ascaris lumbricoides7.0% [95% CI: 0.0‐29.0%] was more prevalent helminth followed with Enterobius vermicularis 3.0% [95% CI: 1.0‐5.0%], Hymenolepis nana 2.0% [95% CI: 1.0‐3.0%], Taenia spp. 2.0% [95% CI: 0.0‐7.0%] and Trichuris trichiura 1.0% [95% CI: 0.0‐1.0%]. The high prevalence of commensal parasites, such as Entamoeba coli, which does not need cure is indicating the importance of personal hygiene in food handlers.Food handlers regardless of whether preparing or serving food, play key roles in the transmission of food‐borne infections. This study aimed to evaluate the prevalence of intestinal parasitic infections in food handlers in Iran. In the present study, a comprehensive literature search was carried out in electronic databases, including PubMed, Scopus, Google Scholar, Science Direct, Magiran, Scientific Information Database (SID), Iran Medex and Iran Doc, to identify all the published studies from 2000 to 31st April 2019. A total of 25 articles from different regions of Iran were identified and fulfilled our eligibility criteria. Totally, 140,447 cases were examined and 1163 cases were infected with intestinal parasites. Of all cases, 19,516 were male and 5901 were female with 1163 and 652 infected cases, respectively. The overall prevalence of intestinal parasitic infections was evaluated 14.0% [95% CI: 11.0‐17.0%]. It is revealed that protozoan, such as Our results revealed the high prevalence of intestinal parasitic infection in food handlers in Iran. Monitoring programs to prevent and controlling of transmission to individuals are needed. Food handlers regardless of whether preparing or serving food, play key roles in transmission of food‐borne infections. This study aimed to evaluate the prevalence of intestinal parasitic infections in food handlers. Among all mentioned zoonotic parasites, some are more important and cause more morbidities, including E. histolytica, C. parvum, T. saginata and G. lamblia and need more attention from both humans and animals. Although, there was a doubt about the pathogenic nature of some protozoan, such as Blastocystis hominis (B. hominis), in humans at present it is proven that they are associated with diarrhoea . Several studies have been conducted in different parts of the world regarding the prevalence of intestinal parasites in food handlers  statement. The PROSPERO registration number is: CRD420191236622.1In this meta‐analysis, a comprehensive literature search was carried out in electronic databases, including PubMed, Scopus, Google Scholar, Science Direct, Magiran, Scientific Information Database (SID), Iran Medex, and Iran Doc, to identify all the published studies from 2000 to 31st April 2019. Duplicates and studies out of Iran were excluded. All original descriptive studies  about intestinal parasites in food handlers were concerned. The process is shown in Figure 2.2In the initial search of collected bibliographic references, 433 articles were found. After removing duplicated, irrelevant studies and studies out of Iran, finally, 25 articles with epidemiological parameters of interest fulfilled the inclusion criteria. Those articles reporting the prevalence of intestinal parasitic infections in food handlers in Iran were included to our study Table .2.3Two authors screened the titles, abstracts and full text of literatures, independently. Any disagreements between two reviewers were resolved by discussion among researchers. Extracted data included first author name, the year of publication, prevalence rate, demographic information (age and gender), geographical region of study, diagnostic test, sample size (number of examined people), and the number of infected cases Table .2.4To assess the quality of observational studies included in this meta‐analysis using a checklist as in Table 2.5Q‐test which is suggested by the Cochrane Handbook  and I‐square index I2 < 50%, as substantial heterogeneity). If we found substantial heterogeneity, sub‐group meta‐analysis (fixed or random effect model) was performed to compute the pooled prevalence of infection based on a characteristic such as sex, country, education, pathogenicity and parasite species. In addition to meta‐regression examined to find the source of heterogeneity. To detect sources of heterogeneity, we performed meta‐regression on publish year and sample size of studies.After extracting the sample size and the number of positive infections for each study, the proportion of infection and standard error (SE) were computed. Before estimating pooled effect size, sensitivity analysis was used to explore the effect of each study on pooled effect size. Heterogeneity among studies assessed using both p < 0.1 as significant). If we detected a substantial publication bias, the trim and fill method was applied to estimate and adjust for the number of missing studies (due to publication bias) in a meta‐analysis   and unpublished data from 2000 to 2019 (19 years), 25 articles were eligible to include in this systematic review and meta‐analysis. The literature searches and selection process are shown in Figure To evaluate the effect of each study on the pooled estimate of prevalence, by repeating the meta‐analysis after omitting each study, the sensitivity of studies was depicted in Figure p > 0.1). Also, there were not enough studies for assessing publication bias for D. fragilis and T. trichiura , B. hominis with 28.0% (95% CI: 15.0‐44.0%) and E. coli with 22.0% (95% CI: 16.0‐29.0%), had the highest prevalence, respectively. Also, other species had the prevalence between 1.0% (T. trichiura) to 9.0% (E. histolytica/dispar) . According to the results of sub‐group analysis, ) Figure .D. fragilis 5.0% [95% CI: 4.0‐7.0%], I. bütschlii 5.0% [95% CI: 2.0%‐8.0%], C. mesnili 5.0% (95% CI: 2.0‐9.0%) and E. nana 3.0% (95% CI: 1.0‐7.0%). The results for intestinal helminthic infections showed that A. lumbricoides with prevalence of 7.0% (95% CI: 0.0‐29.0%) had the highest prevalence and then E. vermicularis with infection rate of 3.0% (95% CI: 1.0‐5.0%), H. nana with 2.0% (95% CI:1.0‐3.0%), Taenia spp. with 2.0% . Also, our analysis revealed that sample size did not affect the prevalence of intestinal parasitic infection in food handlers (p = 0.68). To evaluate the effect of each study on the pooled prevalence, by meta‐analysis, the sensitivity of studies is shown in Figure Iˆ2 = 99.40%, p < 0.001). In sub‐group analysis, a random effect model was performed on parasite species  was achieved in owners of school snack bars, where children took cooked food and snacks. The results may have a bias for a small sample size, but the important point in this regard is that 5 of 18 different school cafeteria owners were infected with intestinal parasites which are significant. This may have resulted from weak health controlling programs in schools. In a study carried out by Costa‐ Cruz et al. in Brazil, the researchers studied 20 schools for the evaluation of intestinal parasitic infections in school food handlers. They found that 49 of 104 (47.10%) of school food handlers were infected . Comparing their findings with ours indicates the higher rate of infection in their studied subjects. The meta‐analysis revealed the high prevalence of intestinal parasitic infection in butchers (11.50%) and backers (10.20%). These two groups play an important role in public food health. Interestingly, the lowest prevalence of intestinal parasitic infection rate was observed among confectioners (1.70%). Although the sample size comprised 978 cases and relatively big, the results indicate appropriate personal hygiene in this group which is regularly monitored by the health‐care system.H. nana worms . Their results revealed insufficient hygiene in food preparation and our results indicated inappropriate personal hygiene. Our meta‐analysis showed that the highest intestinal infection in food handlers was caused by protozoan parasites and the most frequent parasite (41.0%) was G. lamblia  and T. saginata (10.0%). Also, 13.30% of them were infected with both Staphylococcus aureus and intestinal parasites. Unlike our results, the infection rate with G. lamblia in their study was higher.Also, our meta‐analysis revealed the infection rate in males 13%) was significantly higher than females (8%) which may be resulted from a smaller sample size in females and less involvement of females in food‐handling processes than males in Iran. In some countries, the ratio of male to female was different from ours. In a study in Thailand in 2011, Kusolsuk et al., studied 219 females and 47 males. This has resulted from the great role of females in food preparing and handling in Thailand. The result of their study revealed that the infection rate in 273 food handlers was 10.30% which is higher than our results when compared with the infection rate of 14.0% in 1,40,447 subjects in our study. In contrast with our results, the most infecting cases were found with hookworms (70%) while our most prevalent helminthic infection was with % was siga Figure  which caa Figure . In a stZ = 0.41, p = 0.82)  Figure .5Our results revealed the high prevalence of intestinal parasitic infection in food handlers in Iran. This high prevalence is largely due to poor personal hygiene practice, poverty, lack of knowledge, insufficient environmental sanitation and inadequate health controlling services. Although the food industry workers, food handlers, and anyone who is connected with the production, handling, storage, transportation, preparation, or else, is obliged to undergo routine medical examinations including stool microscopy for intestinal parasitic infections (once every 6 months) but, it seems that they are not sufficient. It is advised that some strict rules such as obligation in filling the stool container in the lab should be added. Also, if infected food handler cases are identified, immediate decisions for the exclusion of the career up the resolving all symptoms or completion of further investigations should be made. Additional programs, including education for changing attitude about infectious diseases requires more consideration.The authors declare that they do not have any conflict of interest.No ethical approval was required as this is a review article with no original research data.K. S.S. and M. H.H. were involved in data gathering. A. S. was Project administration and Supervisor; involved in writing‐review & editing data and critical revise. S. H. T. was involved in methodology; data validation; formal data analysis and critical revise.https://publons.com/publon/10.1002/vms3.590The peer review history for this article is available at


Staphylococcus aureus is a major cause of skin and soft tissue infections as well as bloodstream infections worldwide. Here, we report the draft genome sequences of 18 deidentified S. aureus clinical strains collected from positive blood cultures. Staphylococcus aureus is a human skin and mucosa commensal. S. aureus is a leading cause of endocarditis, osteomyelitis, hospital-acquired infections, and bacteremia  and grown aerobically overnight at 37°C with shaking at 250 rpm. Genomic DNA was prepared for sequencing using the Nextera XT DNA library prep kit  according to the manufacturer’s instructions. The libraries were validated by running 5 μl of PCR cleanup on a 1% agarose gel, bead-normalized using the Nextera XT library normalization beads according to the manufacturer’s instructions, and pooled in equal volumes. The pooled normalized libraries  and PhiX were diluted and denatured according to the MiSeq system user’s guide, with a final concentration of 80 pM. The final pool was heated at 96°C for 3 min to ensure denaturation before sequencing on a MiSeq instrument using a read length of 2 × 300 bp, onboard fastq file generation, and sample demultiplexing, generating 0.6 to 1.4 million paired-end reads per sample. FastQC 0.10, Trimmomatic 0.33, SPAdes 3.12, BBMap 38.06, and QUAST 4.1 were used for examining the quality of sequence reads, trimming the reads, de novo assembly, exclusion of contigs smaller than 200 bp, and determining the quality of the de novo assembled genomes, respectively (5https://github.com/). Default parameters were used for all software unless otherwise specified. The NCBI Prokaryotic Genome Annotation Pipeline (PGAP 5.2) (https://www.ncbi.nlm.nih.gov/genome/annotation_prok/) was used for annotation  accession numbers, numbers of contigs, and N50 values are provided in The BioProject accession number for these sequences is


Banana is a significant source of nutrients, and it has been found to contain carbohydrates and other nutritional components. The present study was conducted to evaluate the proximate composition, antioxidant composition, and physicochemical properties of flour obtained from two different banana varieties (Musa acuminata cv. Pisang awak and Musa acuminata cv. Red dacca) and to evaluate the proximate composition and antioxidant composition of cookies prepared by incorporating both banana flours. Several sets of cookie samples were prepared separately by incorporating each banana flour where wheat flour and banana flour combinations were 85%-15%, 75%-25%, 70%-30%, and 0-100%. These samples were evaluated for sensory attributes, and two best cookie formulations were selected (70% wheat flour and 30% banana flour) for the analysis. Both Awak and Dacca had obtained similar amount of carbohydrates p < 0.05 while Dacca had recorded a higher amount of moisture, fat, protein, ash, and phytonutrients such as polyphenols, antioxidants, and flavonoids. Dacca flour had obtained higher values for physicochemical properties like water holding capacity (WHC) and oil holding capacity (OHC). L∗, a∗, and b∗ values were evaluated for banana flour incorporated cookies. Lightness and the redness of cookies were prominent while yellowness was not prominent. There was no significant difference in texture parameters but hardness was higher in banana cookies as they contained a higher content of protein and fiber.Banana  Musa acuminata (Musa sp.), a very popular fruit in the world market. It can be eaten as raw or processed as well as flour is used as a functional ingredient in various food products  wit wit20] wμL of NaNO2 (5%), 150.0 μL of AlCl3 (10%), and 1.0 mL of sodium hydroxide (NaOH) (1 M) were pipetted into tubes, respectively. After that, the solution volume was increased up to 5.0 mL by adding distilled water. The content of the mixture was vortexed properly, and the absorbance of each sample was measured at 510 nm using a UV-Vis spectrophotometer. The results were expressed as quercetin equivalent (QE) in milligram per g of the dried sample using a calibration curve of quercetin .The total tlavonoid content was determined by the method as outlined in  with sliL∗ ), a∗ (green (−60) to red (+60)), and b∗ (blue (−60) to yellow (+60)). L∗, a∗, and b∗ color values for cookies were measured by using chromameter (CR-400). Color values were taken as replicate (n = 3) in different areas of the biscuit surface  ex exAwak-DBanana being abundant in antioxidants has contained bioactive compounds such as phenolics, carotenoids, dopamine, dopa, carotenes, norepinephrine, and ascorbic acid (vitamin C) which have the ability to protect the body against oxidative stress.  expresseAwak-Dacca flour, respectively, while significantly different (p < 0.05). Effect of extracting solvent which dissolved the sample has contributed to the behavior of the obtained results of flours. DPPH increases when the concentration of phenolic compounds and their hydroxylation increase. The DPPH ranged from 0.04 to 0.15 mg TE/g in Awak-Dacca cookies. The highest DPPH was obtained in Dacca flour and Dacca cookies. [DPPH ranged from 0.15 to 0.68 mg GE/g in cookies.  stated tAwak and Dacca flours, respectively, and there was a significant difference (p < 0.05). FRAP values of the cookies ranged from 3.39 to 7.32 mg TE/g in Awak and Dacca cookies. Dacca still had significantly higher (p < 0.05) antioxidant activity than Awak. ABTS values of Awak and Dacca flours ranged from 59.65 to 68.06 mg TE/g, and results for Awak and Dacca flour cookies were 37.92-56.80 mg TE/g. Both Awak flour and Awak cookies had recorded the lower values for ABTS. The incorporation of banana flour into wheat flour significantly improved the antioxidant capacity of composite flours compared to wheat flour.FRAP values ranged from 25.35 to 28.75 mg TE/g in d ± 0.01 while the FRAP value of 4P% banana flour : 96% wheat flour-incorporated cookies was recorded as 0.64b ± 0.01. According to (adedayo), the ABTS value of Cavendish banana 5.03 ± 0.08a mmol TEAC/g was recorded and Red dacca was recorded as 4.98 ± 0.11a mmol TEAC/g.According to , the FRAAwak and Dacca flours ranged from 0.20 to 0.27 mg QE/g while Awak cookies and Dacca cookies ranged from 0.45 to 0.68 mg QE/g. Baking contributed to a significant increase (p < 0.05) in TFC of cookies compared with the flours.Banana flour is high in TFC compared to wheat flour, and the main classes of flavonoids detected in bananas are quercetin, myricetin, and kaempferol. According to , flavonob ± 0.05 to 23.19e ± 0.11 and TFC of 4% banana flour : 96% wheat flour-incorporated cookies was 33.74d ± 0.17. Baking contributed to a significant increase in TFC of cookies compared to banana flour. This difference can occur due to the development of meladoins. Meladoins, brown color pigments, are the products of Maillard browning reaction which occur during the baking process. Meladoins are produced as a result of high temperatures due to reactions between amino acids and reducing sugars, and they give different flavors and brown color in baked food. Based on the literature [According to , the resterature , formulaAwak flour-incorporated cookies  and Dacca flour-incorporated cookies . The sensory scores for the sensory attributes of cookie samples varied significantly (p < 0.05).Mean sensory scores for sensory attributes of the cookies produced by wheat-banana flour and banana flour blends at different proportions are shown in T3 (70 : 30) was better accepted by panel members as the best Awak flour-incorporated cookie. However, T3 was compared favorably well with treatments T1, T2, and T0 (control) in texture, appearance, odor, taste, aftertaste, and overall acceptability. Treatment T2 had the highest rating for appearance. The lower ratings for appearance in treatment T3 may be due to the initial dark color in banana flour compared to the wheat flour that is lighter in color. The color or appearance of cookies becomes darker in the baking process as the chemical reactions take place due to higher sugar content. Treatments T1, T2, and T0 (control) had almost similar scores for overall acceptability while sample T3 has recorded the highest.Cookie, treatment T3− (70 : 30) was better accepted by panel members as the best Dacca flour-incorporated cookie from the sensory evaluation results T3− has obtained the higher mean score for all the attributes. Treatment T0− (control) had the lowest scores for all the attributes. Treatments T1− and T2− had obtained almost similar scores. Treatment T3− has recorded the highest score for appearance due to low sugar content (less darkness) [Treatment T3− 70 :  was bettHylocereus undatus) peel flour blends. According to [b ± 1.31 while the value of 15% pitiya peel flour : 75% wheat flour cookies was 4.93ab ± 1.48. The value for overall acceptability of 100% wheat flour cookies was 4.97a ± 1.45, and the value for overall acceptability of 15% pitaya flour : 75% wheat flour cookies was 5.23a ± 1.54, respectively.A similar study has been done to evaluate the sensory attributes of cookies prepared from wheat flour and pitaya , redness (a∗), and yellowness (b∗).L∗, a∗, and b∗ values of Awak and Dacca flour-incorporated biscuits ranged from 59.18 to 60.29, 6.82 to 9.20, and 28.94 to 31.12, respectively. The color changes occurred due to the extent of Maillard reaction as banana contains glucose, fructose, and protein. The least L∗ value was observed in Awak flour-incorporated cookies because caramelization or Maillard reaction caused browning during baking of banana flour at high temperature as Awak contains more sugar. As a∗ values indicate the redness of cookies both banana flour-incorporated cookies had obtained positive a∗ values which were significantly different (p < 0.05). The redness of the crust was higher in Dacca flour-incorporated cookies due to the highest antioxidant and phenolic content. The b∗ color value represents the yellowness of biscuits, and the yellowness of both biscuits was more prominent than redness [L∗, a∗, and b∗ values of 100% wheat flour-incorporated biscuits were recorded as 66.00, 4.06, and 27.53, respectively.The  redness . Accordi redness , L∗, a∗,L∗, a∗, and b∗ values as 51.767c ± 0.945, 5.433b ± 0.473, and 20.467c ± 0.378, respectively, while 100% wheat flour cookies has recorded L∗, a∗, and b∗ values as 65.000d ± 0.529, 4.067a ± 0.058, and 27.533d ± 0.757. L∗, a∗, and b∗ values of cookies have been decreased with the substitution of banana peel flour.According to , 4% banaTextural quality is one of the most important quality attributes for cookies. The texture of the two best banana cookie formulations was tested against the texture of 100% wheat flour cookie which was considered a commercial type cookie. The primary TPA parameters, hardness, springiness, and cohesiveness, and secondary parameters of gumminess and chewiness are shown in p < 0.05) differences in the texture parameters of the cookies. Hardness can be defined as the peak force required to break the cookie, increased as incorporating banana flour. Baking conditions, the type and quantity of ingredients, and protein content and fiber content of the flour influence its hardness and other textural attributes. The mechanical changes attributed to the replacement of wheat flour by banana flour in cookies are related to the increases of fibers, liquid oil, proteins, and reduction in carbohydrates. Cookies are made out of a continuous glass-like sugar structure in which ungelatinized starch granules and fat are embedded in the structure. Due to starch gelatinization recrystallization, protein denaturation has occurred and the structure and texture are developed. Though protein content is higher in cookies, the gluten content is reduced in the dough. And also, in baking, moisture migrates from the wet area to the drier surface and the product is turning in dry.There were no significant (There was no significant difference in texture parameters but hardness is higher in banana cookies as they contained a higher content of protein and fiber. Protein and fiber are more important for texture than the lowering of carbohydrates (starch). Previous studies  also disa ± 1.17 while the hardness of 4% banana peel flour : 96% wheat flour-incorporated cookies was recorded as 3572.83d ± 1.14.According to , hardnesa and 31.01 ± 6.0c,b. It states that increasing of okara flour is affected by the fracture force and the fracture force is increased as the okara flour content is increased. Because the dough structure is compacted by proteins and fiber.According to , 100% whPisang awak and Red dacca) were higher than banana cookies except for protein and fat as they are added in the cookie preparation process. OHC in Red dacca was higher and WHC in Pisang awak was less than Red dacca as they contain more sugars and reduce the hydration properties by limiting the availability of water to hydrate the starch. Cookies enriched with banana flour reduce the postharvest loss of banana while improving the nutritional quality of cookies. Textural attributes of cookies are increased with the incorporation of banana flour instead of using 100% wheat flour in cookies. L∗, a∗, and b∗ values of cookies have been decreased with the substitution of banana flour. Among the three formulations, 70% wheat flour : 30% banana flour cookies achieved the highest value for the overall performance.The results clearly revealed the proximate composition and antioxidant composition of banana flour (


Haemaphysalis longicornis (Neumann) is a well-known vector of numerous pathogens of veterinary and medical importance. Various control strategies, including the use of synthetic pesticides, have been developed to control this tick species. However, demand for effective and safe alternative pesticides is increasing due to the adverse effects associated with the intensive and injudicious use of synthetic pesticides, which include undesirable effects on non-target species and environmental pollution. Hence, the acaricidal activity of the extract and the essential oil of Cinnamomum cassia (Chinese cinnamon) and their major components, and the underlying mechanisms of this activity, were evaluated against unfed larvae and nymphs of H. longicornis.The tick C. cassia were determined by gas chromatography-mass spectrometry, and their larvicidal and nymphicidal activity were evaluated using the larval and nymphal packet test. The underlying detoxification mechanism was elucidated by targeting in vivo esterase and monooxygenase activity, and the toxicological effect was assessed on non-target Tenebrio molitor and Harmonia axyridis by topical application in open Petri dishes.The components of the extract and essential oil of E)-cinnamaldehyde was the predominant component of the extract (50.79%) and essential oil (89.95%). The 50% lethal concentration (LC50) for larvae and nymphs treated with the extract was 11.56 and 49.18 mg/mL, respectively. The essential oil, (E)-cinnamaldehyde and fenvalerate exhibited acaricidal activity, with LC50 values of 3.81, 3.15, and 0.14 mg/mL, respectively, against the larvae, and 21.31, 16.93, and 1.89 mg/mL, respectively, against the nymphs. (E)-cinnamaldehyde significantly increased esterase and monooxygenase activity in both larvae and nymphs. Unlike fenvalerate, C. cassia essential oil and (E)-cinnamaldehyde did not cause mortality of T. molitor or H. axyridis adults.-cinnamaldehyde have the potential to be developed into botanical-based larvicidal and nymphicidal agents for tick control.This study demonstrates that  Haemaphysalis longicornis Neumann (Acari: Ixodidae) is an obligate hematophagous ectoparasite native to East Asian countries, and was recently found to be established in several states of the USA  on the biochemical parameters of larvae and nymphs of H. longicornis were tested by targeting in vivo esterase and monooxygenase activity. In ticks, esterase and monooxygenase are common detoxification enzymes against xenobiotic compounds  was obtained from a local supplier (Yu Cheng product workshop) in Chaozhou, Guangdong, China. This supplier extracts essential oils on a small scale by hydrodistillation.The bark of C. cassia extract and essential oil were determined on a gas chromatography-mass spectrometer . Chromatographic separation was achieved using a DB-5MS capillary column (30 m × 0.25 mm × 0.25 µm). The carrier gas was helium at 1 mL/min flow rate, and the spilt ratio 10:1. The temperature conditions were 60 °C for 2 min, increased to 150 °C for 1 min, and finally to 280 °C for 5 min. The mass spectrometer was bombarded with an electron impact ionization source, and the electron energy was 70 eV. The inlet temperature was 280 °C and the ion source temperature was 230 °C. The mass scanning range was 40–550 m/z. Compounds were identified using the Standard Reference Database of the National Institute of Standards and Technology.Components of E)-cinnamaldehyde , a clear yellow liquid, was purchased from Aladdin Biochemical . Fenvalerate , used as a sample synthetic  acaricide, was purchased from a local market. Esterase, monooxygenase, and protein assay kits were purchased from Shanghai Enzyme-linked Biotechnology .Analytical grade methanol was purchased from Baishi Chemicals . , Zhangjiakou, Hebei Province, China. Unfed adult ticks were placed on the ears of New Zealand white rabbits and the resulting engorged females were maintained in an incubator  for oviposition. The larvae that hatched during a period of 14 days and the nymphs that molted during a period of 14 days were used for subsequent tests.Unfed adult ticks of T. molitor larvae were collected from a commercial breeder in Zhengzhou, Henan, China. They were first reared to the pupal and then to the adult stage on a diet of wheat bran and potato slices in plastic containers (18 × 11 × 11 cm), as described by George et al. , and the resulting adults (3–7 days old) were used in this study.e et al. , under le et al. . H. axyrH. longicornis was determined using larval and nymphal packet tests. First, the bark extract of C. cassia, essential oil of C. cassia, and (E)-cinnamaldehyde were diluted with 70% methanol. There is little or no toxicity of 70% methanol when it is used as a solvent in the packet test in vitro  [see details of the larval packet test (LPT) below]. In addition, previous studies have shown that analytical grade methanol (undiluted) has little or no toxicity against tick species, and it has been suggested as a suitable solvent for dissolving plant extracts when testing acaricidal activity . The numbers of dead larvae and adults of T. molitor were determined 48 h after treatment. T. molitor that did not respond to the probe were considered dead. Each treatment and control group was replicated five times.The essential oil and  and (E)-cinnamaldehyde  on adult H. axyridis were assessed by using a minor modification of the method described by Youn et al. . The number of dead H. axyridis was determined 48 h after treatment  and H. axyridis  when compared with the control  during the 48-h observation period, thus these data were omitted from all calculations and comparisons. Pedersen et al.  and nymphs of H. longicornis  exposed to (E)-cinnamaldehyde  when compared with the control. Likewise, esterase activity significantly increased when the nymphs were exposed to C. cassia essential oil (tested concentration: LC50 21.31 mg/mL)  = 22.346, p = 0.000] and nymphs  after treatment with LC50 of C. cassia essential oil and (E)-cinnamaldehyde. Esterase and monooxygenase are involved in the metabolic detoxification of pesticides [Rhipicephalus microplus [R. microplus [C. cassia essential oil and (E)-cinnamaldehyde. However, additional studies are needed to test different times of exposure, since esterase and monooxygenase activities may decrease with time [H. longicornis after treatment with C. cassia essential oil, (E)-cinnamaldehyde and fenvalerate ranged from 0.98 to 1.05 mg/mL for the larvae and 0.96–1.13 mg/mL for the nymphs, and treatment with the essential oil, (E)-cinnamaldehyde and fenvalerate did not induce significant changes in the total protein of either.Elucidating the underlying detoxification mechanism can provide important clues for the development of botanical-based acaricides. In the present study, both the essential oil of  [Fig.  F,10 = 17. [Fig.  F,10 = 17. [Fig.  F,10 = 17. [Fig.  F,10 = 17.icroplus . The incC. cassia essential oil in terms of LC50 values, i.e. lower concentrations compared with those of the extract -cinnamaldehyde. (E)-cinnamaldehyde is the key component of C. cassia bark responsible for its insecticidal and acaricidal activity [E)-cinnamaldehyde was effective against the larvae and nymphs of Rhipicephalus sanguineus, with 100% mortality at 2.55 and 10 μL/mL, respectively [Amblyomma cajennense at a (E)-cinnamaldehyde concentration of 5.0 μL/mL [E)-cinnamaldehyde was effective with 100% mortality at a concentration of 5 μL/mL against R. microplus and Dermacentor nitens larvae [E)-cinnamaldehyde was also observed against the larvae of Amblyomma sculptum (LC50 1.40 mg/mL) and D. nitens (LC50 1.68 mg/mL) [E)-cinnamaldehyde was found to be an efficient mosquito larvicidal against Aedes albopictus, Culex quinquefasciatus and Armigeres subalbatus, with LC50 values below 50 µg/mL [In addition, based on the present results, the efficacy of ct Figs. , 2, may activity . When teectively . A simil.0 μL/mL . Likewiss larvae . Acarici8 mg/mL) . Besidesm LC50 1. mg/mL anCymbopogon citratus  [C. cassia bark essential oil tested in this study showed greater acaricidal activity against the larvae and nymphs of H. longicornis. The insecticidal activity of C. cassia essential oil has also been reported for other target species, e.g. against the nymphs of Ricania sp., with an LC50 value of 37.66 mg/mL after exposure for 72 h [C. cassia extract has been reported for pests of stored products including Tribolium castaneum and Lasioderma serricorne, with LD50 values of 3.96 and 23.89 μg/adult, respectively [C. cassia extract and essential oil against vector ticks. The essential oils obtained from other species of Cinnamomum have also been studied against tick species. For example, the larvicidal activity of Cinnamomumzeylanicum essential oil was evaluated against R. microplus larvae, with an LC50 of 0.086% [Cinnamomumverum essential oil was found to exhibit larvicidal activity against fourth-instar Cx. quinquefasciatus (LC50 40.7 μL/L) and adulticidal (LC50 42 μg/adult) activity against Musca domestica [Compared with other essential oils, for example, essential oil of ctively) , C. cassfor 72 h . In addiectively . To our f 0.086% . Apart f in vivo and/or field trials of C. cassia products, concentration–response curves should be determined. These can be used to identify lethal and non-lethal concentrations for ticks and mammalian hosts. Additionally, application of C. cassia products directly to the host may provide better protection from tick infestation, since hosts can be kept in enclosures to protect them against environmental factors including weather conditions that could interfere with the efficacy of the applied products [Cinnamon oil is considered safe by the US Food and Drug Administration and is exempted from toxicity data requirements by the US Environmental Protection Agency , 42. Howproducts . Naturalproducts .C. cassia products tested in the present study, especially the essential oil and (E)-cinnamaldehyde, exhibited good acaricidal activity against larvae and nymphs of Haemaphysalislongicornis, whereas no toxic effect was found against the terrestrial invertebrates T. molitor and Harmoniaaxyridis, which suggests that they may not be harmful to non-target terrestrial invertebrates when used as acaricides. The defense response of the larvae and nymphs of H. longicornis to C. cassia essential oil and (E)-cinnamaldehyde may be partly related to the increased synthesis of esterase and monooxygenase. In addition, the acaricidal activity of C. cassia essential oil or extract is likely related to the biochemical activity of (E)-cinnamaldehyde, i.e. the increased expression of esterase and monooxygenase activity. However, the molecular mechanism underlying the acaricidal activity of C. cassia warrants further exploration, and future studies on its effects on other non-target species such as soil-dwelling (earthworms) and aquatic organisms are imperative.The


TM Multiaxial-Warp-Knitting–Needle (MWK–N) C/SiC composite and pin were designed and fabricated using the isothermal chemical vapor infiltration (ICVI) method. The composite’s microstructure and mechanical properties were examined by subjection to tensile and interlaminar shear tests. Three types of double-shear tests were conducted for C/SiC pins, including shear loading perpendicularly, along, and at 45° off-axial to the lamination. The fracture surface of the tensile and shear failure specimens was observed under scanning electronic microscope (SEM). The relationships between the composite’s microstructure, mechanical properties, and damage mechanisms were established. The composite’s average tensile strength was σuts = 68.3 MPa and the average interlaminar shear strength was τu = 38.7 MPa. For MWK–N–C/SiC pins, the double-shear strength was τu = 76.5 MPa, 99.7 MPa, and 79.6 MPa for test types I, II, and III, respectively. Compared with MWK–C/SiC pins, the double-shear strength of MWK–N–C/SiC pins all decreased, i.e., 26.7%, 50.8%, and 8% for test types I, II, and III, respectively. The MWK–N–C/SiC composite and pins possessed high interlaminar shear strength and double-shear strength, due to the needled fiber in the thickness direction, low porosity (10–15%), and high composite density (2.0 g/cm3).In this paper, the 12k T-700 The C/SiC ceramic-matrix composites (CMCs) have excellent properties such as high-temperature resistance, thermal shock resistance, high strength, toughness, hardness, wear resistance, chemical stability, design tolerance, and low density and thermal expansion coefficients ,2,3,4,5.u = 157.7 MPa and the main failure mechanisms involved debonding of the lap interface and fiber shear-off within the pin. Around the hole, intact morphology, matrix crushing, and pin/hole debonding appeared. Liu et al. [Three different techniques are currently used in an industrial scale for the production of C/SiC and C/C–SiC composites, i.e., chemical vapor infiltration (CVI), liquid polymer infiltration (LPI) or polymer infiltration and pyrolysis (PIP), and liquid silicon infiltration (LSI). Fiber orientation, dimensionality of the preform, and thermal treatment conditions are important parameters of influence on the performance of the final CMC product . Due to u et al.  performeu et al. ,27,28. Tu et al. . To imprTM MWK–N–C/SiC composite and pin using the isothermal chemical vapor infiltration (ICVI) method and perform microstructure and mechanical properties experiments  on the composite and pin. Three types of double-shear tests are conducted for C/SiC pins, including shear loading perpendicularly, along, and at 45o off-axial to the lamination. The fracture surface of the tensile and shear failure specimens is observed under a scanning electronic microscope (SEM). The relationships between the composite microstructure, mechanical properties, and damage mechanisms are established. In TM MWK–N–C/SiC composite and pin and the mechanical test procures for the tensile, interlaminar shear, and double-shear are introduced. In The objective of this paper is to fabricate the 12k T-700TM MWK–N–C/SiC composite and pin is illustrated and the mechanical test procedures for determining the tensile, interlaminar, and double-shear properties for the composite and pins are also provided.In this section, the fabrication method for the 12k T-700TM MWK–N–C/SiC composite and pins are fabricated using the isothermal chemical vapor infiltration (ICVI) method. The carbon fiber’s preform is multiaxial warp-knitted in 0°/±45°/90° with needled fibers in the Z direction. The fiber’s preform volume is 40–45%. The pyrolytic carbon (PyC) interphase is deposited on the surface of the T-700TM carbon fibers through the chemical reaction in Equation (1), and the PyC thickness is 0.1–0.2 μm. The deposition temperature is 1000 °C with a pressure of 5 kPa, a flow rate of Ar of 500 mL/min, C3H6 of 30 mL/min, and a deposition duration of 20 h.The 12k T-700After the deposition of the PyC interphase, the SiC matrix is deposited on the fiber’s preform with the PyC interphase through the chemical reaction in Equation (2):2 is 100 mL/min; the mole mixture ratio between H2 and MTS is 10; and the deposition duration is 120 h. To increase the density of the SiC matrix, multiple CVI processes are conducted until the density of the C/SiC composite is above 2.0 g/cm3, and the porosity volume is 10–15%.For the deposition of the SiC matrix, the fabrication temperature is 1000 °C; the pressure is 5 kPa; the flow rate of HAfter the deposition of the SiC matrix, the surface of the C/SiC composite is coated with SiC to seal the open porosity, and the thickness of the SiC coating is 50–100 μm.Type I, the shear loading is perpendicular to the lamination.Type II, the shear loading is along the lamination.Type III, 45° off-axial shear loading.TM MWK–N–C/SiC composite are conducted. The tensile damage behavior and tensile and interlaminar shear fracture strength are analyzed. For the 12k T-700TM MWK–N–C/SiC pin, three double-shear tests are conducted. The double-shear fracture strength and related damage mechanisms are also discussed.In this section, the tensile and interlaminar shear tests of the 12k T-700TM MWK–N–C/SiC composite is investigated by subjection to tensile loading. After tensile fracture, the fracture surface of the sample is observed under a scanning electron microscope  to show the tensile damage mechanisms. TM MWK–N–C/SiC composites at room temperature. TM MWK–N–C/SiC composites. Six samples were used to conduct the tensile experiments. The black and red curves in uts = 68.3 MPa and the average composite tensile modulus is E = 195.3 GPa.Tensile behavior of the 12k T-700After the tensile fracture, the failure specimens were observed under the SEM, as shown in TM MWK–N–C/SiC composite is investigated under the interlaminar shear test. After shear failure, the fracture surface of the samples is observed under the SEM. TM MWK–N–C/SiC composite at room temperature. Five specimens were conducted for the interlaminar shear mechanical tests. The average interlaminar shear strength is τu = 38.7 MPa.Interlaminar shear behavior of the 12k T-700After interlaminar shear failure, the fracture specimens were observed under the SEM, as shown in Under interlaminar shear loading, the needled fibers increased the energy dissipation along the crack path and improved the interlaminar shear strength. Needled fibers along the thickness direction can improve the resistance for the crack propagation between the laminar.TM MWK–N–C/SiC pins is investigated for test types I, II, and III. Comparison analysis of the double-shear strength among the three test types is also conducted. F-δ) curves of the 12k T-700TM MWK–N–C/SiC pins under double-shear loading for test types I, II, and III.The double-shear mechanical behavior of 12k T-700TM MWK–N–C/SiC pins subjected to test types I, II, and III.u = 76.5 MPa.For test type I, five samples  were conducted for the double-shear test. The average double-shear strength is τu = 99.7 MPa.For test type II, five samples  were conducted for the double-shear test. The average double-shear strength is τu = 79.6 MPa.For test type III, five samples  were conducted for the double-shear test. The average double-shear strength is τTM MWK–C/SiC pins without needled fibers in the Z direction, the shear strength is τu = 104.3 MPa, 202.8 MPa, and 86.5 MPa for test types I, II, and III, respectively. Compared with the 12k T-700TM MWK–C/SiC pins without needled fibers in the Z direction, the double-shear strength of the MWK–N–C/SiC pins all decreases in test types I, II, and III. By introducing the needled fibers in the C/SiC pins, the interlaminar fracture toughness can increase, however, the double-shear strength decreases 26.7%, 50.8%, and 8% for test types I, II, and III, respectively.For the 12k T-700TM MWK–N–C/SiC pins for the double-shear test types I, II, and III. On the fracture surface, there exists obvious fiber pullout in the 0° and ±45° fibers, which increases the fracture toughness before shear failure. However, compared with the MWK–C/SiC pins, there is porosity and holes in the MWK–N–C/SiC pins. The needled fiber destroys the continuity of the in-plane fiber bundle and reduces the bearing capacity of the in-plane fiber. The shear strength of the pin in all directions is similar, which shows the significant effect of reducing the anisotropy of pins with needled fibers.3). In fact, the needled fibers do not show high shear strength. On the other side, the decrease in the ceramic matrix porosity should have an exponential impact on the shear strength leading to a significant increase in its strength. For example, SICARBON™ materials produced by Airbus have a porosity higher than 20% and their interlaminar shear strength decreases from 15 MPa to 4 MPa when the porosity increases from 22 to 27% [The mechanical properties of the C/SiC composites in the present analysis are compared with material data from other manufacturers. 2 to 27% .TM MWK–N–C/SiC composites and pins using the ICVI method and performed microstructure and mechanical properties experiments on the composites and pin. Three types of double-shear tests were conducted for the C/SiC pins, including the shear loading perpendicularly, along, and at 45° off-axial to the lamination. The fracture surface of the tensile and shear failure specimens was observed under SEM. Relationships between the composite microstructure, mechanical properties, and damage mechanisms were established.This paper fabricated 12k T-700uts = 68.3 MPa and the average composite tensile modulus was E = 195.3 GPa. At the fracture surface, long fiber pullout existed in the 0° and ±45° plies, and the needled fibers along the Z direction appeared in the pullout fibers in the 0° and ±45° fibers.The average composite tensile strength was σu = 38.7 MPa. Compared with the MWK–C/SiC composite, needled fiber fracture and pullout appeared in the Z direction.The average interlaminar shear strength was τu = 76.5 MPa, 99.7 MPa, and 79.6 MPa for test types I, II, and III, respectively. Compared with the MWK–C/SiC pins, the double-shear strength of the MWK–N–C/SiC pins all decreased, i.e., 26.7%, 50.8%, and 8% for test types I, II, and III, respectively.For the MWK–N–C/SiC pins, the double-shear strength was τ3).The tensile strength of the MWK–N–C/SiC composite possessed low tensile strength compared with those C/SiC composites with (0°/90°) plain-woven (PW) fiber preform, due to the low fiber volume content along the tensile loading direction. The Young’s modulus and interlaminar shear strength of the MWK–N–C/SiC composite were higher than those of the PW–C/SiC composite, due to the needled fiber in the thickness direction, low porosity (10–15%), and high composite density (2.0 g/cmTemperature affects the mechanical behavior of the material ,36. In f


Background: Bevacizumab was demonstrated to have efficacy in patients with NSCLC. However, application of different doses of bevacizumab in different clinical trials was overlooked. This study aims to investigate the effects and safety of different doses of bevacizumab in the treatment.Methods: From January 2016 to March 2020, 79 patients with NSCLC received first-line combination treatment with chemotherapy (pemetrexed + platinum) and bevacizumab for four cycles; patients without progression after four cycles were randomly assigned to maintenance therapy with bevacizumab combined with pemetrexed, of which 57 patients received bevacizumab at a dose of 7.5 mg/kg and 22 patients at a dose of 15 mg/kg. The primary endpoint was progression-free survival, and secondary endpoints were overall response rate, disease control rate, and adverse events.Results: There was no significant difference between two groups in effectiveness; Median PFS in 7.5 mg/kg group and in 15 mg/kg group were 8.0 and 8.7 months, respectively (p = 0.663), reaching the primary endpoint. The ORR and DCR in the bevacizumab 7.5 and 15 mg/kg group were 45.46 and 86.0% vs. 50 and 90.9% showing no statistical significance (p = 0.804 and 0.717). Most of side effects were tolerable. The incidences of overall toxicities were higher in 15 mg/kg group (p = 0.001). No new safety signals were observed.Conclusion: We did not detect significant difference of efficacy and safety between 7.5 mg/kg group and 15 mg/kg group for bevacizumab administration, the cost-effectiveness of the 7.5 mg/kg group was significantly better than that of the 15 mg/kg group. Lung cancer is the most common cancer with leading cause of cancer deaths in China and worldwide , 2019. ISeveral clinical trials have confirmed that the combination of bevacizumab and chemotherapy (BC) significantly prolonged progression free survival (PFS) and overall survival (OS) in NSCLC patients as compared with chemo-monotherapy . BC has There are few comparative studies of bevacizumab in NSCLC. Most treatment guidelines did not make a recommendation of the optimal dose to physicians. In AVAIL, bevacizumab was used by 7.5 or 15 mg/kg in BC regimen. The treatment efficacy of both bevacizumab groups seemed to be similar when compared to the placebo group. However, further analysis of 105 Asian patients in the study showed that there was OS benefit in the low-dose bevacizumab group, but not in the high-dose bevacizumab group. In terms of safety, the incidence of grade 3 or above adverse reactions in high-dose bevacizumab group was 44%, which was higher than that in low-dose bevacizumab group (33%) and chemotherapy group (33%) . TherefoIn this study, all patients received first-line bevacizumab plus pemetrexed-platinum (PC). In the JMDB study, PC was the preferred chemotherapy regimen for non-small cell lung cancer . MoreoveA total of 1,205 treatment-naïve patients were diagnosed with advanced NSCLC from January 2016 to March 2020 at Hunan Cancer Hospital. After screening, all patients were ≥18 years old and histologically diagnosed of non-squamous NSCLC with stage IV. They were all with an Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0–1. Their driver gene mutations were negative and first line treatments were BC. The characteristics of the patients including sex, age, smoking history, brain metastasis, and status of HER-2, BRAF, KRAS, TP53, M861 mutations are summarized in Patients received induction therapy on day 1 of each 21-day period by the regimen of cisplatin (75 mg/m2)/carboplatin , pemetrexed (500 mg/m2), and bevacizumab. Induction therapy was repeated every 3 weeks for a maximum of four cycles. After completion of at least three cycles of induction therapy, patients received maintenance therapy on day 1 of the 21-days cycle comprising pemetrexed (500 mg/m2) and bevacizumab. The dose of bevacizumab in maintenance therapy was the same as induction therapy. Maintenance therapy was repeated every 3 weeks until disease progression or intolerance.Chemotherapy response was evaluated after every two treatment cycles by computed tomography. They were evaluated as complete response (CR), partial response (PR), stable disease (SD), progression disease (PD), or not evaluable according to the Response Evaluation Criteria in Solid Tumor criteria 1.1.9. The ORR was defined as the sum of CR and PR. The disease control rate (DCR) was defined as the sum of CR, PR, and SD. Toxicities were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. The primary endpoint was progression-free survival (PFS). Secondary endpoints were ORR, DCR, and adverse effect.p values were two-tailed. Kaplan–Meier curves were generated for progression free survival and overall survival. Log-rank tests were used to compare the survival between groups. All statistical analyses were performed using the SPSS 22.0 software for Windows ; p < 0.05 was considered to indicate a statistically significant difference.Descriptive summaries were created for demographic and clinical variables. The Chi-squared test was used to compare subset variables and toxicities. All Among 1,205 NSCLC patients, 111 patients who received first-line PC combined with bevacizumab were enrolled in this study. Thirty-two patients with EGFR mutations, ALK fusions, or ROS-1 fusions were excluded . A retrop = 0.804; DCR, p = 0.717).The treatment responses are listed in p = 0.766). Moreover, we conducted subgroup analysis according to the clinical variables, and the results showed no significant differences between bevacizumab 7.5 mg/kg group and bevacizumab 15 mg/kg groups (This study met the primary endpoint. The median PFS (mPFS) were 8.0 months  in the bevacizumab 7.5 mg/kg group and 8.7 months  in the bevacizumab 15 mg/kg group, respectively . There wg groups .p = 0.001) (Most side effects were tolerable (grade 1–2); nine patients (11.4%) had severe adverse events (grade 3–4). As summarized in = 0.001) . MeanwhiBevacizumab has been widely used in anti-tumor therapy in the form of monotherapy and combination therapy. However, there is no standard dosage for bevacizumab. Fatih Kose et al. reported the half-dose bevacizumab experience in relapsed ovarian cancer patients, following showed the lower dose group has similar effectiveness with lower rate of hypertension . In NSCLn = 48, ABCP 7%, n = 28, BCP 6%, n = 24) (The immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Bevacizumab has been investigated in combination with immunotherapy and chemotherapy. Based on IMPOWER 150 study, combination therapy with atezolizumab, bevacizumab, and chemo [carboplatin + paclitaxel (CP)] has been approved for first line treatment in advanced non-squamous NSCLC. In exploratory analysis of IMPOWER 150, the arms containing bevacizumab (ABCP and BCP) had lower rate of new brain lesions comparing with ACP arm ACP  . On the  n = 24) . HoweverThe results of this study revealed that there was barely noticeable difference of mPFS between 7.5 mg/kg group and 15 mg/kg group. The ORR and DCR were 45.46 and 86.0% in bevacizumab 7.5 mg/kg group and were 50 and 90.9% in bevacizumab 15 mg/kg group, which was consistent with historical research data . In AVAPn = 44) and high dose group patients (n = 22) who share a similar value of the propensity score of age was analyzed. We did not find any significant difference (p = 0.864); the result is consistent with that in overall sample.The baseline characteristics are mostly identical in both groups, but for the age of ≥60 years old, the percentage in high dose group was much lower, and we did propensity score matching (PSM 1:2 match on the nearest neighbor) to balance the covariate. Matched sets of low-dose group patients (There are some limitations in this study. Firstly, the sample size is small and may increases the likelihood of a Type II error, which decreases the power of the study. Secondly, several patients crossed over from high dose group to low dose group in maintenance therapy, and that may affect the results of side-effects analysis. It is necessary to research whether the dose of maintenance therapy is consistent with that of induction therapy. Lastly, we conducted subgroup analyses of PFS in the two groups according to the clinical variables, but no significant differences were observed in all the subgroups. It might be because the sample size was too small, and a larger sample size is needed in further investigations.In conclusion, chemotherapy combined with bevacizumab 7.5 and 15 mg/kg reach the similar PFS, ORR, and DCR in advanced non-driver gene mutation NSCLC patients. No significant difference of efficacy was observed between the two groups. However, the incidences of overall toxicities were higher in the 15 mg/kg group. Meanwhile, the medical fees of half-dose bevacizumab administration were significantly lower than that of 15 mg/kg; as a result, considering the cost-effectiveness, the 7.5 mg/kg administration was logically preferred.


The average depth of perineal trauma was (9.63 ± 7.22) cm and (16.23 ± 10.13) cm, respectively. The larger the area of perineal injury and the deeper the depth of perineal trauma, the worse their prognosis. Cox multivariate analysis showed that complications, MOTS-RTS score, ISS score, GCS score, perineal trauma area, and perineal trauma depth were independent risk factors affecting the prognosis of patients with pelvic fracture with perineal injury. Most of the patients with pelvic fracture complicated with perineal injury are 20–29 years old and 50–59 years old. The more serious the perineal injury is, the higher the mortality is. The main causes of death are refractory hemorrhagic shock and infection.This study is aimed at summarizing and analyzing the epidemiological characteristics and prognostic risk factors of patients with a pelvic fracture with perineal injury. The clinical data of 153 patients with pelvic fracture with perineal injury treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The data of sex, age, injury mechanism, pelvic fracture type, shock index (SI), perineal wound depth, concomitant injury, total hospital stay, and death were collected by the electronic medical record system. Among the 153 patients, there were 94 males and 59 females, with an average age of (43.2 ± 16.8) years. The cases were mainly concentrated into two age groups: 20–29 years old and 50–59 years old. In a year, pelvic fractures were mainly concentrated in 1–2 months and 11–12 months. In terms of injury time, there were mainly two periods of time in a day: 10 : 00～12 : 00 and 15 : 00～18 : 00. The MOTS-RTS scores of the patients in the undead group and the dead group were (7.12 ± 1.52), (2.69 ± 0.96), ISS scores were (27.36 ± 15.84), (61.32 ± 7.08), GCS scores were (12.84 ± 3.69), (4.13 ± 1.25), APACH II scores were (12.87 ± 8.84), (32.41 ± 6.98), and SOFA scores were (6.68 ± 5.87), (17.12 ± 3.12). The MOTS-RTS and GCS scores of the nondeath group were significantly higher, while the ISS score, APACH II score, SOFA score, and shock index were significantly lower. The overall mortality rate of 153 patients was 13.7%. The average area of perineal trauma in undead and dead patients was (54.5 ± 113.52) cm About 10% of pelvic fractures are unstable pelvic fractures, which are often caused by high-energy injuries such as car accidents, fall injuries, and crush injuries . Pelvic The clinical data of 153 patients with a pelvic fracture with perineal injury treated in our hospital from January 2012 to June 2021 were analyzed retrospectively. The data of sex, age, injury mechanism, pelvic fracture type, shock index (SI), major trauma outcome study-revised trauma score (MOTS-RTS), injury severity score (ISS), Glasgow coma scale (GCS), acute physiology and chronic health score (APACH II), sepsis-related organ failure score (SOFA), perineal injury wound area (length × width/2), perineal wound depth, concomitant injury, total hospital stay, and death were collected by the electronic medical record system.The fracture types of the patients were classified according to the Tile's/AO standard, which was mainly divided into A, B, and C types. Type A (stable): type A pelvic fracture mainly involves the pubic bone and iliac crest of the pelvis and has no structural damage to the whole pelvic ring. Type A1 fracture refers to unilateral iliac crest fracture; type A2 refers to unilateral or bilateral pubic branch fracture or iliac fracture; type A3 refers to the transverse fracture of sacrum and coccyx. Type B : type B1 fracture is mainly caused by the anterior ligament of the sacroiliac joint leading to the anterior injury of the sacroiliac joint. Type B2 is a unilateral compression injury that can lead to the ipsilateral injury of the posterior ligament of the iliac joint and anterior pubic and ischial injuries. The injury of type B3 fracture comes from the pressure on the opposite side. Type C (unstable): the injury degree of this type of pelvic fracture is more serious; it not only has rotational instability but also vertical instability. Type C1 digital sacral iliac joint was injured or dislocated. Type C2 refers to bilateral sacroiliac joint injury and even sacroiliac joint dislocation in severe cases, accompanied by the injury of the anterior pubic symphysis. Type C3 refers to sacral fractures.(1) GCS score: GCS score can be effectively used to judge the condition of craniocerebral injury and estimate the prognosis. The responses of eyes opening, language, and transportation were evaluated. The total score of the three items was 3–15, including mild coma (13–14 scores), moderate coma (9–12 scores), and severe coma (3–8 scores). (2) MOTS-RTS score: the score mainly includes respiratory rate, systolic blood pressure, and GCS score. Because the respiratory rate, systolic blood pressure, and the GCS score of patients can be obtained quickly in clinics, MOTS-RTS score is very operable in the treatment of acute trauma. (3) APACH II score: APACH II score is commonly used to dynamically monitor the condition of critically ill patients at present, and dynamic monitoring can more effectively predict the mortality of critically ill patients. APACH II score includes three parts: acute physiology score, age score, and chronic health score. (4) Shock index: it is used to determine whether there is shock or not or to reflect the severity of shock. Shock index = pulse rate/systolic blood pressure is calculated according to the formula to help determine the shock and the severity of shock. Shock index>1.0–1.5 indicates shock, > 2.0 indicates severe shock.P < 0.05, it was considered that the difference was statistically significant.SPSS20.0 and GraphPadPrism5.0 software were used for data processing. The counting data are expressed by the number of cases, and the measurement data are expressed by mean ± standard deviation. Kaplan–Meier curve was used for survival. The logarithmic rank test was used to calculate the significance of differences among subgroups. Stepwise multivariate Cox regression analysis was used to find out the independent prognostic factors related to survival. When Among the 153 patients, 94 (61.44%) were males and 59 (38.56%) were females. The average age was (43.2 ± 16.8) years, ranging from 1 to 87 years old. The cases were mainly concentrated in the two age groups of 20 to 29 years old and 50 to 59 years old, accounting for 35.29% (54/153) of all patients, as shown in Among the 153 cases of pelvic fracture, there were 36 cases of type A fracture (23.53%), 60 cases of type B fracture (39.22%), and 57 cases of type C fracture (37.25%). The causes of injury in the whole group included traffic accident in 79 cases, fall from height in 41 cases, flat ground fall in 15 cases, accident in factory and mine in 4 cases, crush injury in 3 cases, firearm injury in 2 cases, puncture injury in 3 cases, and other 2 cases. The main cause of injury was fall injury in patients under 20 years old, traffic injury in patients aged 20 to 69 years old, and falling on the ground in people over 70 years old. Among the 153 patients, 129 cases had combined injuries, accounting for 84.31% of the total. 37 cases (19.47%) were complicated with limb fracture or ligament injury, 30 cases (15.79%) with subcutaneous hematoma, 28 cases (14.74%) with a rib fracture, 22 cases (11.58%) with hemopneumothorax, 17 cases (8.95%) with abdominal organ injury, 16 cases (8.42%) with spinal fracture, 14 cases (7.37%) with craniocerebral trauma, and 12 cases (6.32%) with urinary system injury. Extensive skin avulsion was found in 8 cases (4.21%) and sacral plexus injury or rectal injury in 6 cases (3.16%).The MOTS-RTS scores of the patients in the undead group and the dead group were (7.12 ± 1.52), (2.69 ± 0.96), ISS scores were (27.36 ± 15.84), (61.32 ± 7.08), GCS scores were (12.84 ± 3.69), (4.13 ± 1.25), APACH II scores were (12.87 ± 8.84), (32.41 ± 6.98), and SOFA scores were (6.68 ± 5.87), (17.12 ± 3.12). Compared with the death group, the MOTS-RTS and GCS scores of the nondeath group were significantly higher, while the ISS score, APACH II score, SOFA score, and shock index were significantly lower. n = 32), shock (n = 10), ARDS (n = 7), respiratory failure (n = 5), heart failure (n = 4), multiple organ failure (n = 3), stress ulcer (n = 1), diffuse intravascular coagulation (n = 1), and pulmonary embolism (n = 1).Among the 153 patients with pelvic fractures, 93 patients (60.78%) received nonoperative treatment and 60 patients received surgical treatment (39.22%). Of the 60 patients, 45 patients (75.00%) received open reduction and internal fixation, 10 patients (16.67%) received closed reduction and external fixator fixation, and 5 patients (8.33%) chose bone traction. There were 10 types of complications in 48 patients, including infection  cm2, respectively. The perineal trauma area of dead patients was significantly larger than that of undead patients. The average depth of perineal trauma in undead patients and dead patients was (9.63 ± 7.22) cm and (16.23 ± 10.13) cm, respectively. The survival curve showed that the larger the area of perineal injury  and the deeper the depth of perineal trauma , the lower the survival rate of patients. The average perineal trauma area of undead patients and dead patients was (54.5 ± 113.52) cmCox multivariate analysis showed that complications, MOTS-RTS score, ISS score, GCS score, perineal trauma area, and depth of perineal trauma were independent risk factors affecting the prognosis of patients with pelvic fracture with perineal injury. In the past, most of the literature studies were reported on pelvic fracture or open pelvic fracture, but there were a few reports on pelvic fracture with perineal injury. With the development of social economy, the incidence of such injuries in China is increasing year by year . AlthougIn this paper, a retrospective analysis of 153 patients with a pelvic fracture with perineal injury showed that most of the 21 dead patients had a hemorrhagic shock on admission, and 5 patients had an uncontrollable massive hemorrhage. This kind of injury is extensive, complex, and serious. It is often accompanied by abdominal, craniocerebral, and thoracic and abdominal multiple trauma, and there is a large amount of active bleeding . HemostaFor patients with a pelvic fracture with hemodynamic instability, the first priority is to quickly open venous channels and restrict fluid resuscitation against shock, and, if necessary, multichannel rapid fluid replacement and selective use of pressurized infusion device can be evaluated according to the antishock effect of fluid replacement . The priThis paper investigated a total of 8 causes of injury, mainly focused on traffic accidents, high fall and flat fall, and other three causes. The height fall injury of male patients is higher than that of female patients, which is related to male work and occupation, and on the one hand, high-altitude workers are mainly male patients . On the In conclusion, the main causes of death of perineal trauma patients with pelvic fractures were a refractory hemorrhagic shock in the early stage and infection, septic shock, and multiple organ failure in the middle and late stages. Hemorrhagic shock in perineal trauma patients with type C pelvic fractures is difficult to control, and repeated infections and septic shock may indicate an increased risk of death. Close monitoring of bleeding, infection and shock, effective control of active bleeding, and active prevention and treatment of infection will help to reduce mortality.