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Objective: To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA). Design: A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents. Participants: Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions. Methods: An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped. Results: Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important. Conclusions: A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations. Design: Cross-sectional survey study. Participants: Participants in an international webinar that focused on palatal fistula treatment were included. Intervention: Participants were presented with a survey pre- and post-webinar. Main outcomes: Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system. Results: A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system. Conclusions: This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas. [ABSTRACT FROM AUTHOR]

Objective: Palatal fistulas after palatoplasty could pose difficulties for both patients and surgeons. Numerous surgical approaches are available to treat palatal fistulas. In this manuscript, we investigate surgical treatment options for palatal fistula repair looking at the different anatomical locations, and we create a summary of surgical approaches to facilitate the decision-making process for palatal fistulae repair., Design: In this cross-sectional survey, nine anonymized patient cases with palatal fistulae that differed in severity and anatomical location were presented to participants from the International Cleft Master Course in Amsterdam about "Palatal Fistulas". Participants were invited to participate in this survey. A total of 141 participants reported their preferred surgical treatment options for fistula repair at different anatomical locations., Results: We created different options for fistula treatment, catalogued by fistula location. This overview gives the surgeon possible approaches for each location. If the soft palate is involved, this overview underscores the importance of including velopharyngeal insufficiency management into the fistula repair. For hard palate involvement, our overview lists techniques available for nasal lining repair and for oral lining repair in each region., Conclusions: We provide a comprehensive overview of potential surgical approaches to repair palatal fistulae. This inventory of techniques is grouped per location to support surgeons in their decision-making process when confronted with a palatal fistula., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The Oberg-Manske-Tonkin (OMT) classification established excellent reliability scores in several validation studies. However, one study published in 2022 found much lower scores in a subanalysis of their sample when very simple anomalies were excluded. Our study assessed the reliability of the OMT among physicians with a different background, all involved in congenital hand anomaly care, and analyzed codes with less agreement. Time required for classification was recorded to give an indication on its usability., Methods: One hundred digital cases were classified twice with a minimal 1-month time interval, with the use of the 2020 version of the OMT. Two pediatric hand surgeons, 2 rehabilitation specialists, and 2 plastic surgery residents participated in this reliability analysis. The use of multiple codes was allowed. The intra- and interrater reliability was assessed for all 15 possible rater couples by calculating percentage of agreement. Cohen's kappa was calculated along with a 95% confidence interval. For the analysis of individual codes with less agreement, we calculated positive agreement with the use of a summed agreement table. Time necessary for classification was documented in seconds., Results: The inter- and intrarater agreement was moderate with a mean Cohen's kappa of 0.45 and 0.60 retrospectively. On average, 39 seconds per case were necessary for the first and 24 seconds for the second rating. Background did not influence the level of agreement. Lowest agreement levels (ie, lowest positive agreement) were observed with all the arthrogryposis multiplex congenita subgroups, the "other" subgroups of isolated congenital contractures, syndromic syndactyly, and synpolydactyly. Codes commonly used interchangeably were symbrachydactyly and transverse deficiency and the distinction between these anomalies of only the hand or the entire upper limb; symbrachydactyly and brachydactyly; and camptodactyly and distal arthrogryposis., Conclusions: Our study showed a moderate reliability, emphasizing the complexity of this heterogeneous patient population. Despite its imperfections, the OMT remains the best and most versatile classification tool at hand. Its main purpose may lie in contributing to a universal language for research., Level of Evidence: I., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Although the maxillary nerve block (MNB) provides adequate pain relief in cleft palate surgery, it is not routinely used globally, and reported techniques are heterogeneous. This study aims to describe relevant anatomy and to present the preferred technique of MNB administration based on the current literature and the expert opinion of the authors., Method and Materials: First, a survey was sent to 432 registrants of the International Cleft Palate Master Course Amsterdam 2023. Second, MEDLINE (PubMed interface) was searched for relevant literature on maxillary artery (MA) anatomy and MNB administration in pediatric patients., Results: Survey response rate was 18% (n=78). Thirty-five respondents (44.9%) used MNB for cleft palate surgery before the course. A suprazygomatic approach with needle reorientation towards the ipsilateral commissure before incision was most frequently reported, mostly without the use of ultrasound. Ten and 20 articles were included on, respectively, MA anatomy and MNB administration. A 47.5% to 69.4% of the MA's run superficial to the lateral pterygoid muscle and 32% to 52.5% medially. The most frequently described technique for MNB administration is the suprazygomatic approach. Reorientation of the needle towards the anterior aspect of the contralateral tragus appears optimal. Needle reorientation angles do not have to be adjusted for age, unlike needle depth. The preferred anesthetics are either ropivacaine or (levo)bupivacaine, with dexmedetomidine as an adjuvant., Conclusion: Described MNB techniques are heterogeneous throughout the literature and among survey respondents and not routinely used. Further research is required comparing different techniques regarding efficacy and safety., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Mutaz B. Habal, MD.)

Measurement of auricle parameters for planning and post-operative evaluation presents substantial challenges due to the complex 3D structure of the human auricle. Traditional measurement methods rely on manual techniques, resulting in limited precision. This study introduces a novel automated surface-based three-dimensional measurement method for quantifying human auricle parameters. The method was applied to virtual auricles reconstructed from Computed Tomography (CT) scans of a cadaver head and subsequent measurement of important clinically relevant aesthetical auricular parameters (length, width, protrusion, position, auriculocephalic angle, and inclination angle). Reference measurements were done manually (using a caliper and using a 3D landmarking method) and measurement precision was compared to the automated method. The CT scans were performed using both a contemporary high-end and a low-end CT scanner. Scans were conducted at a standard scanning dose, and at half the dose. The automatic method demonstrated significantly higher precision in measuring auricle parameters compared to manual methods. Compared to traditional manual measurements, precision improved for auricle length (9×), width (5×), protrusion (5×), Auriculocephalic Angle (5-54×) and posteroanterior position (23×). Concerning parameters without comparison with a manual method, the precision level of supero-inferior position was 0.489 mm; and the precisions of the inclination angle measurements were 1.365 mm and 0.237 mm for the two automated methods investigated. Improved precision of measuring auricle parameters was associated with using the high-end scanner. A higher dose was only associated with a higher precision for the left auricle length. The findings of this study emphasize the advantage of automated surface-based auricle measurements, showcasing improved precision compared to traditional methods. This novel algorithm has the potential to enhance auricle reconstruction and other applications in plastic surgery, offering a promising avenue for future research and clinical application., (© 2024. The Author(s).)

Objective: To assess which information about microtia and the possible reconstructive options health care providers (HCPs), patients and parents believe should be included in a patient decision aid (PtDA)., Design: A mixed-methods study comprised of an online survey of HCPs and focus group discussions with patients and parents., Participants: Survey respondents were members of the International Society for Auricular Reconstruction (ISAR). Focus group participants were patients with microtia and their parents, recruited through the microtia outpatient clinic at Amsterdam UMC, and through a Dutch patient organization for cleft and craniofacial conditions., Methods: An online, investigator-made survey was sent to ISAR members in December 2021. Semi-structured focus group discussions were held in February 2022. Quantitative results were summarized, and qualitative results were thematically grouped., Results: Thirty-two HCPs responded to the survey (response rate 41%). Most respondents (n = 24) were plastic surgeons, who had a median of 15 years of experience (IQR: 7-23 years). Two focus groups were held with a total of five patients and two parents. HCPs, patients and parents generally agreed on the information needed in a PtDA, emphasizing the importance of realistic expectation management. Patients and parents also considered psychosocial and functional outcomes, patient experiences, as well as patients' involvement in decision-making important., Conclusions: A PtDA for microtia reconstruction should target all patients with microtia, and include information on at least technique-related information, expected esthetic results, possible adverse effects, psychosocial and functional outcomes and patient experiences. Preference eliciting questions should be developed for both pediatric patients and their parents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: There is a paucity of information about the possible risk factors that could identify patients with Robin sequence (RS) who are more prone to developing obstructive airway complications after palate closure. This study aimed to compare the respiratory complication rates in patients with RS and isolated cleft palate (ICP)., Materials and Methods: In this retrospective study, we reviewed the medical records of 243 consecutive patients with RS and ICP who were treated at Amsterdam University Medical Centers over the past 25 years. We collected preoperative data on previous treatment, diagnostic findings, surgical technique, weight, and presence of congenital anomalies., Results: During cleft palate closure, patients with RS were older (11.9 versus 10.1 months; p = 0.001) and had a lower gestational age than those with ICP (37.7 versus 38.5 weeks; p = 0.002). Patients with RS had more respiratory complications (17 versus 5%; p = 0.005), were more often non-electively admitted to the pediatric intensive care unit (PICU) (13 versus 4.1%; p = 0.022), and had a longer hospital stay duration (3.7 versus 2.7 days; p = 0.011) than those with ICP. The identified risk factors for respiratory problems were a history of tongue-lip-adhesion (TLA) (p = 0.007) and a preoperative weight of < 8 kg (p = 0.015). Similar risk factors were identified for PICU admission (p = 0.015 and 0.004, respectively)., Conclusions: The possible risk factors for these outcomes were a low preoperative weight and history of TLA. Closer postoperative surveillance should be considered for patients with these risk factors., Clinical Relevance: Identifying risk factors for respiratory complications could provide clinicians better insight into their patients and allows them to provide optimal care for their patients., (© 2024. The Author(s).)

Objective: The objective of this study was to investigate how cleft surgeons classify palatal fistulas. We focused on three different anatomical locations (ie, hard palate, soft palate, junction hard/soft palate) to analyze agreement/disagreement at various anatomical locations., Design: Cross-sectional survey study., Participants: Participants in an international webinar that focused on palatal fistula treatment were included., Intervention: Participants were presented with a survey pre- and post-webinar., Main Outcomes: Frequency of used classification systems for classifying oronasal fistulas and the inter-rater reliability of the Pittsburgh classification system., Results: A total of 141 participants completed the questionnaires prior to the webinar and 109 participants completed the survey after the webinar. In total, four classification systems were used (ie, Pittsburgh, Pakistan Comprehensive Fistula Classification [PCFC], anatomical and 'other'). The Pittsburgh classification was the most commonly used system in all cases. However, Pittsburgh inter-rater reliability was low (κ = 0.136 pre-webinar, and κ = 0.174 post-webinar). Surprisingly, a substantial shift was observed from the anatomical to Pittsburgh classification after the webinar, indicating increased awareness of the usability of the Pittsburgh classification system., Conclusions: This study demonstrates a large heterogeneity with regards to the classification of cleft palate fistulas. Interestingly, a shift was observed from the anatomical to Pittsburgh classification after the webinar. However, the inter-rater reliability for using the Pittsburgh classification was low. Classifying palatal fistulas in a homogenous fashion could enhance comparison of primary palate repair and could improve treatment of palatal fistulas., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Traditional on-site missions of plastic surgeons from "high-income countries" in "low- and middle-income countries" are often limited in time and lack proper follow-up. Regular digital collaboration could lead to a more impactful and durable exchange of knowledge for plastic surgeons and residents in both settings., Aims: The aim of this study was to evaluate the satisfaction of the first twelve months of weekly digital meetings, explore advantages/disadvantages, and to provide tools for similar initiatives., Methods: Weekly meetings started from August 2021. An encrypted digital connection allowed residents and plastic surgeons from Uganda and the Netherlands to discuss cases for educational purposes, where treatment options were considered. After twelve months, a survey was sent to participants from both countries to indicate the meetings' strengths, weaknesses, and possible improvements., Results: A total of 18 participants responded to the questionnaire (ten plastic surgeons, six residents, and two researchers). The strengths of the meetings were the accessibility of the meetings, knowledge exchange and practice for residents' final exams. Possible improvements included having a clear format for patient discussion, a session moderator and better internet connectivity. Moreover, a database to assess the impact of the given intervention on the patient cases by evaluating postoperatively (e.g. three months), could further improve clinical care., Conclusions: Virtual patient discussions subjectively contributed to medical education at both locations. Improved digital infrastructure and a collaborative database could further maximize learning capacity. Furthermore, digital proctoring is a promising way to establish sustainable collaborations between high- and low-resource countries., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Commonly used methods to evaluate auricles are subjective and are therefore not specific, comprehensive, and precise nor effective in the assessment of microtia reconstruction outcomes. This scoping review aimed to summarize the objective methods for the accurate evaluation of microtia reconstruction., Methods: We performed a scoping review of publications that used objective measurement methods to evaluate outcomes of microtia reconstruction according to the PRISMA-ScR guidelines. A systematic literature search was conducted in the Embase, PubMed, Cochrane, CNKI, and VIP databases, and literature references were screened for additional records. Studies that evaluated auricles after microtia reconstruction using quantitative anthropometric methods were included, and data on these methods were collected., Results: Twenty-five publications reported on quantitative objective outcome measurements. Thirteen studies evaluated auricular protrusion, three articles assessed the position or symmetry, and twelve studies reported on auricle size. The quantitative measurements of fine structures, such as the tragus and concha, were described in three studies. All described measurements used manual landmarking, where fifteen studies described well-defined landmarks, fifteen studies described poorly defined landmarks, and four studies used a combination of well and poorly defined landmarks., Conclusion: The objective evaluation of microtia reconstruction outcomes is hindered by significant heterogeneity of measurement methods. The measurement methods used for general auricular measurements (auricular protrusion, auriculocephalic angle, and size) used in microtia reconstruction were abundant, while measurements of auricular position and the fine structures of the auricle were limited. Three-dimensional imaging combined with computer analyses poses promising future alternatives., Competing Interests: None., (© 2023 The Author(s).)

The goal of this study was to explore the availability of diagnostic and treatment options for managing upper airway obstruction (UAO) in infants with Robin Sequence (RS) in Europe. Countries were divided in lower- (LHECs, i.e., PPP per capita < $4000) and higher-health expenditure countries (HHECs, i.e., PPP per capita ≥ $4000). An online survey was sent to European healthcare professionals who treat RS. The survey was designed to determine the availability of diagnostic tools such as arterial blood gas analysis (ABG), pulse oximetry, CO2 analysis, polysomnography (PSG), and sleep questionnaires, as well as to identify the used treatment options in a specific center. Responses were received from professionals of 85 centers, originating from 31 different countries. It was equally challenging to provide care for infants with RS in both LHECs and HHECs (3.67/10 versus 2.65/10, p = 0.45). Furthermore, in the LHECs, there was less access to ABG (85% versus 98%, p = 0.03), CO2 analysis (45% versus 70%, p = 0.03), and PSG (54% versus 93%, p < 0.01). There were no significant differences in the accessibility concerning pulse oximetry, sleep questionnaires, home saturation monitoring, nasopharyngeal tubes, Tuebingen plates, and mandibular distraction.    Conclusion: This study demonstrates a large difference in available care for infants with RS throughout Europe. LHECs have less access to diagnostic tools in RS when compared to HHECs. There is, however, no difference in the availability of treatment modalities between LHECs and HHECs. What is Known: • Patients with Robin sequence (RS) require complex and multidisciplinary care. They can present with moderate to severe upper airway obstruction (UAO). There exists a large variety in the use of diagnostics for both UAO treatment indications and evaluations. In most cases, conservative management of UAO in RS is sufficient. Patients with UAO that persist despite conservative management ultimately need surgical intervention. To determine which intervention is best suitable for the individual RS patient, the level of UAO needs to be determined through diagnostic testing. • There is a substantial variation among institutions across Europe for both diagnostics and treatment options in UAO. A standardized, internationally accepted protocol for the assessment and management of UAO in RS could guide healthcare professionals in the timing of assessment and indications to prevent escalation of UAO. Creating such a protocol might be a challenge, as there are large financial differences between countries in Europe (e.g., health expenditure per capita in purchasing power parity in international dollars ranges from $600 to over $8500). What is New: • There is a substantial variation in the availability of objective diagnostic tools between European countries. Arterial blood gas analysis, CO2 analysis and polysomnography are not equally accessible for lower-healthcare expenditure countries (LHECs) compared to higher-healthcare expenditure countries (HHECs). These differences are not only limited to availability; there is also a difference in quality of these diagnostic tools. Surprisingly, there is no difference in access to treatment tools between LHECs and HHECs. • There is national heterogeneity in access to tools for diagnosis and treatment of RS, which suggests centralization of health care, showing that specialized care is only available in tertiary centers. By centralization of care for RS infants, diagnostics and treatment can be optimized in the best possible way to create a uniform European protocol and ultimately equal care across Europe. Learning what is necessary for adequate monitoring could lead to better allocation of resources, which is especially important in a low-resource setting., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Ceratonia siliqua L. (Carob tree) is a Mediterranean evergreen, well known for its medicinal properties. The different parts of Carob were proven to exert antidiabetic, antibacterial, antifungal, and antiproliferative effects. Hence, the present paper aims to validate the positive correlation between the high antioxidant activity of carob seed peels and the improvement of negative symptoms of schizophrenia. Materials & Methods: The antioxidant activity was carried out using the β-carotene test. Methionine and carob seed peels (CSP) extracts (50 and 100 mg/kg) were orally administrated to mice for a week. After administration, behavioral tests were assessed using the Y-maze, elevated plus maze, and forced swimming tests, as well as the novel object recognition task. Furthermore, the oxidative stress status was evaluated by analyzing the levels of the antioxidant enzymes: Superoxide dismutase (SOD), glutathione peroxidase (GPx), and malondialdehyde levels (MDA). Results: Both extracts exhibited remarkable antioxidant activity and showed antibacterial effect against Gram-positive bacteria tested ( Bacillus subtilis and Staphylococcus aureus ) and against Pseudomonas aeruginosa (Gram-negative). Therefore, Escherichia coli was very resistant. The behavioral tests proved the efficacy of CSP in enhancing the cognitive impairment of animal models of schizophrenia. Hence, the stated correlation between oxidative stress and schizophrenia was confirmed by the increased SOD and GPx activities and the decreased MDA level. Conclusions: The present study gave further confirmation of the potential correlation between oxidative stress and the development of psychiatric disorders and highlighted the use of natural antioxidants, especially Ceratonia siliqua L. in the improvement of cognitive impairment in the dementia of schizophrenia.

Background. Chamaerops humilis L. var. argentea Andre is a plant widely spread in the region of Taza (North-East of Morocco); it is used in traditional phytotherapy against cancer, diabetes, inflammations, cardiovascular and respiratory diseases, and for the treatment of digestive disorders. Objective and Methods. The objective of our work is to contribute firstly, to the study of the in vitro antimitotic potential by the phytotest of Lepidium sativum and the evaluation of the in vitro antidiabetic activity of three enzymes ( α -amylase, α -glucosidase, and β -galactosidase) on nine aqueous and organic extracts prepared from the leaves of Chamaerops humilis . In addition, a correlation study was carried out on the chemical composition and the antimitotic and antidiabetic activities of Chamaerops humilis leaves. Then, we tested the acute toxicity of the decocted extract and the ethanolic extract. Results. The results of the antimitotic activity showed that the decocted extract showed a higher inhibitory activity than the other aqueous extracts (IC 50 = 9.624 × 10 3 ± 95.97  μ g/mL); for the organic extracts, the ethanolic extract and ethanolic macerated expressed the highest values for the cell growth inhibition test with an IC 50 of 5.638 × 10 3 ± 22.61 and 5.599 × 10 3 ± 45.51  μ g/mL with statistically nonsignificant difference. Regarding the antidiabetic activity, the decocted showed a higher inhibitory activity than the other aqueous extracts for α -amylase (IC 50 = 1.781 · 10 5 ± 358.30  μ g/mL), α -glucosidase (2.540 × 10 2 ± 3.14  μ g/mL), and β -galactosidase (7.118 × 10 2 ± 16.13  μ g/mL); the ethanolic extract also revealed the highest inhibitory activity for α -amylase (IC 50 = 8.902 × 10 3 ± 57.81  μ g/mL), α -glucosidase (2.216 × 10 2 ± 1.39  μ g/mL), and β -galactosidase (2.003 × 10 2 ± 7.41  μ g/mL). A strong correlation was recorded between the antimitic activity and the inhibitory capacity of β -galactosidase and between these two activities and the chemical composition of Chamaerops humilis leaves. The acute toxicity study showed that the decocted and the ethanolic extract are weakly toxic with an LD 50 greater than or equal to 5000 mg/kg. Conclusion . Chamaerops humilis could become a good source in traditional herbal medicine., Competing Interests: The authors declare no conflict of interest associated with this publication., (Copyright © 2022 Nacima Lachkar et al.)

Introduction: The present study is carried out for the first time on Chamaerops humilis L. var. argentea Andre from the region of Taza using an ethnopharmacological survey, an experimental study of the mineralogical and chemical compositions, and evaluations of the antioxidant and antibacterial activities., Methods: After conducting the ethnopharmacological survey, a mineralogical and phytochemical study involving the preparation of aqueous and organic extracts was done. Essential oils were also extracted by hydrodistillation. Subsequently, qualitative and quantitative chemical analyses were performed. In vitro evaluation of antioxidant activities was performed by five tests (H 2 O 2 , DPPH, ABTS, FRAP, and RP) and antibacterial activities by the disc method and determination of MIC and MBC. A principal component analysis (PCA) was performed to visualize the different correlations., Results: The different parts of the plant are used for the treatment of digestive disorders, cardiovascular diseases, and diabetes. In addition, the leaves are rich in mineral compounds, catechic tannins, flavonoids, and sterols. However, they have some traces of essential oils. The quantitative analysis revealed that the ethanolic macerated had a higher content of total polyphenols (100.27 ± 1.95 mg EAG/g E) and catechic tannins (52.11 ± 1.02 mg EC/g E). This extract had a strong antioxidant capacity (H 2 O 2 (37.34 ± 0.55%), DPPH (IC 50 = 31.18 ± 0.66  μ g/ml), ABTS (108.28 ± 1.29 mg E AA/g E), FRAP (148.85 ± 0.43 mg E T/g E), and RP (10.86 ± 0.01 mg E AA/g E). The same extract had a bactericidal effect against Staphylococcus aureus . Principal component analysis (PCA) showed that antioxidant activity was highly correlated with the chemical composition of C. humilis leaves; a high correlation was recorded between the total polyphenol content and ABTS ( r = 0.9779), FRAP ( r = 0.9644), DPPH ( r = 0.9418), and PR ( r = 0.9271) tests. In addition, cathectic tannins were highly correlated with the tests of DPPH ( r = 0.9753) and ABTS ( r = 0.8843). Flavonoids were similarly correlated with DPPH ( r = 0.8897) and ABTS ( r = 0.7599) tests., Conclusion: These results could justify the traditional use of the leaves of Chamaerops humilis in the region of Taza for the treatment of some diseases., Competing Interests: The authors declare no conflict of interest associated with this publication, and there has been no financial support for this work that could have influenced its outcome., (Copyright © 2022 Nacima Lachkar et al.)

Haloxylon scoparium is a plant widely used in traditional medicine for the treatment of diabetes. Hence, this study focuses on the mineralogical and chemical composition and evaluation of the antidiabetic and antioxidant activities of the aerial part of this species. The mineralogical analysis was done by inductively coupled plasma atomic emission spectrometry (ICP-AES). The phytochemical study consisted in the preparation of different extracts from the aerial part by aqueous and organic extraction using Soxhlet and cold maceration. Then, phytochemical screening was performed on the plant powder and on the extracts, which is completed by spectrophotometric quantification of total polyphenols, flavonoids, and catechic tannins. The evaluation of antidiabetic activity was done by three enzymes: a -amylase, a -glucosidase, and ß -galactosidase, and that of antioxidant activity was done by five methods: H 2 O 2 , DPPH, ABTS, FRAP, and reducing power (RP). Mineralogical analysis revealed the presence of iron, potassium, magnesium, phosphorus, sodium, copper, calcium, strontium, selenium, and zinc. The studied part is rich in alkaloids, flavonoids, catechic tannins, and saponins. The methanolic extract is rich in total polyphenols (161.65 ± 1.52 Ug EAG/mg E), and the ethyl acetate extract has high levels of catechic tannins (23.69 ± 0.6 Ug EC/mg E). In addition, the decoctate expresses a high flavonoid content of 306.59 ± 4.35 Ug EQ/mg E. The in vitro evaluation of the antidiabetic activity showed that the decoctate has a higher inhibitory capacity on a -glucosidase (IC50 = 181.7 ± 21.15 ug/mL) than acarbose (IC50 = 195 ± 6.12 ug/mL). The results of the antioxidant activity showed that the methanolic extract and the decoctate present a percentage of hydrogen peroxide (H 2 O 2 ) scavenging (20.91 ± 0.27 and 16.21 ± 0.39%) higher than that of ascorbic acid (14.35 ± 0.002%). Positive correlations obtained between the total polyphenol content and the antioxidant activity of the extracts were studied. A positive correlation of a -amylase inhibitory activity was also recorded with the antioxidant activity tests., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2021 Nacima Lachkar et al.)

Medicinal plants are a rich source of bioactive phytochemicals or bionutrients. Studies carried out during the past few decades have shown that these phytochemicals play an important role in preventing metabolic diseases such as cancer and diabetes. The present study was dedicated to the analysis of mineral and chemical composition and evaluation of antidiabetic, antioxidant, and antibacterial properties of aqueous and organic extracts of Leopoldia comosa , a plant with a long history of therapeutic and food use. Mineral content was determined using inductively coupled plasma atomic emission spectroscopy. Chemical composition was carried out by extraction of essential oils, preparation of aqueous and organic extracts, and qualitative and quantitative analysis. The biological study consisted of the evaluation of antidiabetic activity by inhibition of three enzymes, antioxidant activity by five tests, and antibacterial activity by the disc diffusion method. The correlation between chemical composition and antidiabetic and antioxidant properties was explored by PCA. The results showed that L. comosa contains high levels of Fe, K, P, Na, Cu, Mg, and Ca with values, respectively, in the order of 33552, 1843.14, 756.36, 439.65, 303.9, 272.37, and 20.55 mg/kg. Quantitative analysis showed that the diethyl ether extract had the highest content of polyphenols (129.75 ± 0.29  µ g GAE/mg E), flavonoids (988.26 ± 0.18  µ g QE/mg E), and tannins (30.22 ± 0.15  µ g CE/mg E). All extracts of L. comosa possess inhibitory activity of alpha-amylase, alpha-glucosidase, and beta-galactosidase enzymes, mainly the decocted and the acetone extract. The antioxidant results showed that organic extracts are more active than aqueous extracts especially diethyl ether extract which was similarly found to have an antibacterial effect on Listeria innocua and Proteus mirabilis. PCA allowed us to deduce that phenolic compounds, flavonoids, and tannins are strongly correlated with antioxidant and antidiabetic activity. L. comosa may have potential remedy in the prevention of metabolic disease., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Mohamed Boulfia et al.)

Background and Purpose- We developed a rat model of silent brain infarcts based on microsphere infusion and investigated their impact on perfusion and tissue damage. Second, we studied the extent and mechanisms of perfusion recovery. Methods- At day 0, 15 µm fluorescent microspheres were injected into the right common carotid artery of F344 rats. At days 1, 7, or 28, the brain was removed, cut in 100-µm cryosections, and processed for immunofluorescent staining and analysis. Results- Injection of microspheres caused mild and transient damage to the treated hemisphere, with a decrease in perfused capillary volume at day 1, as compared with the untreated hemisphere. At day 1 but not at days 7 and 28, we observed IgG staining outside of the vessels, indicating vessel leakage. All microspheres were located inside the lumen of the vessels at day 1, whereas the vast majority (≈80%) of the microspheres were extravascular at day 7, and 100% at day 28. This was accompanied by restoration of perfused capillary volume. Conclusions- Microspheres cause mild and transient damage, and effective extravasation mechanisms exist in the brain to clear microsized emboli from the vessels.

Carob tree (Ceratonia siliqua L.) is one of the most widespread medicinal plants in the Mediterranean area. Traditionally, it was cultivated for its ethnopharmacological benefits and, more especially, for the seeds, which served as unit of measurement of jewelers "carat." Hence, in the last half-century, numerous studies reported a wide range of phytoconstituents contained in all parts of Ceratonia siliqua such as phenolic compounds, flavonoids, tannins, anthocyanins, alkaloids, glycosides, proteins and minerals. This review article unveils the phytochemical constituents, bioactivity and pharmacological studies of Ceratonia siliqua. Recent studies have shown that the extracts of this plant exhibit an antioxidant, antidiarrheal, antibacterial, antifungal, anti-inflammatory, antidiabetic activities and also hepatoprotective and antiproliferative effects. In this review, we provide a summary of the most interesting data related to bioactivity and therapeutic potential of Ceratonia siliqua in a way to suggest possible future studies that may use Ceratonia siliqua as an undeniable natural alternative for neurodegenerative diseases treatment.

Vasospasm is known to contribute to delayed cerebral ischemia following subarachnoid hemorrhage (SAH). We hypothesized that vasospasm initiates structural changes within the vessel wall, possibly aggravating ischemia and leading to resistance to vasodilator treatment. We therefore investigated the effect of blood on cerebral arteries with respect to contractile activation and vascular remodeling. In vitro experiments on rodent basilar and middle cerebral arteries showed a gradual contraction in response to overnight exposure to blood. After incubation with blood, a clear inward remodeling was found, reducing the caliber of the passive vessel. The transglutaminase inhibitor L682.777 fully prevented this remodeling. Translation of the in vitro findings to an in vivo SAH model was attempted in rats, using both a single prechiasmatic blood injection model and a double cisterna magna injection model, and in mice, using a single prechiasmatic blood injection. However, we found no substantial changes in active or passive biomechanical properties in vivo. We conclude that extravascular blood can induce matrix remodeling in cerebral arteries, which reduces vascular caliber. This remodeling depends on transglutaminase activity. However, the current rodent SAH models do not permit in vivo confirmation of this mechanism., (© 2015 S. Karger AG, Basel.)

A major challenge for a wearable dialysis device is removal of urea, as urea is difficult to adsorb while daily production is very high. Electro-oxidation (EO) seems attractive because electrodes are durable, small, and inexpensive. We studied the efficacy of urea oxidation, generation of chlorine by-products, and their removal by activated carbon (AC). EO units were designed. Three electrode materials (platinum, ruthenium oxide, and graphite) were compared in single pass experiments using urea in saline solution. Chlorine removal by AC in series with EO by graphite electrodes was tested. Finally, urea-spiked bovine blood was dialyzed and dialysate was recirculated in a dialysate circuit with AC in series with an EO unit containing graphite electrodes. Platinum electrodes degraded more urea (21 ± 2 mmol/h) than ruthenium oxide (13 ± 2 mmol/h) or graphite electrodes (13 ± 1 mmol/h). Chlorine generation was much lower with graphite (13 ± 4 mg/h) than with platinum (231 ± 22 mg/h) or ruthenium oxide electrodes (129 ± 12 mg/h). Platinum and ruthenium oxide electrodes released platinum (4.1 [3.9-8.1] umol/h) and ruthenium (83 [77-107] nmol/h), respectively. AC potently reduced dialysate chlorine levels to < 0.10 mg/L. Urea was removed from blood by EO at constant rate (9.5 ± 1.0 mmol/h). EO by graphite electrodes combined with AC shows promising urea removal and chlorine release complying with Association for the Advancement of Medical Instrumentation standards, and may be worth further exploring for dialysate regeneration in a wearable system., (Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Ethnopharmacological Relevance: Centaurium erytrea is used in traditional medicine for treat urine retention, abdominal colic and diabetes mellitus. The aim of the present study was to evaluate the possible protective effects of Centaurium erythrea leaf extract (CE) against pancreas β-cells' damage and antioxidant defense systems in streptozotocin induced diabetes rats., Materials and Methods: Experimental diabetes was induced by a single dose of STZ (65 mg/kg) administered by intraperitoneal way. The oxidative stress was measured by tissue MDA levels, protein carbonyl (PCO) content, reduced glutathione (GSH) content and by enzymatic activities of superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) in pancreas. Biochemical observations were further substantiated with histological examination of pancreas., Results: The increase in blood glucose and MDA levels with the decrease in GSH content and in enzymatic activities were the salient features observed in diabetic rats. Administration of CE (200mg/kg bw/day, i.p) for 30 days caused a significant reduction in blood glucose and MDA levels in STZ treated rats when compared with diabetic rats. Furthermore, diabetic rats treated with CE leaf extract showed a significant increase in the activities of both enzymatic and non-enzymatic antioxidants when compared to those of diabetic rats. Degenerative changes of pancreatic β-cells in STZ treated rats were minimized to near normal morphology by administration of CE leaf extract as evidenced by histopathological examination., Conclusion: Results clearly indicate that Centaurium erythrea treatment exerts a therapeutic protective nature in diabetes by decreasing oxidative stress and pancreatic β-cells' damage which may be attributed to its antioxidative potential., (Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.)