Licuri Kernel (Syagrus coronata (Martius) Beccari): A Promising Matrix for the Development of Fermented Plant-Based Kefir Beverages.

New licuri-based kefir beverages were obtained using water kefir grains as fermentation inoculum (1, 2.5, and 5%) under different fermentation times (24 and 48 h). Metagenomic sequencing of the kefir grains adapted to the aqueous licuri extract revealed Lactobacillus hilgardii and Brettanomyces bruxellensis to be predominant in this inoculum. The excellent adaptation of the kefir grains to the licuri extract raised the possibility of prebiotic action of these almonds. The beverages showed acidity values between 0.33 ± 0.00 and 0.88 ± 0.00 mg lactic acid/100 mL and pH between 3.52 ± 0.01 and 4.29 ± 0.04. The viability of lactic acid bacteria in the fermented beverages was equal to or greater than 108 CFU/mL, while yeasts were between 104 and 105 CFU/mL. There were significant differences (p < 0.05) in the proximate composition of the formulations, especially in the protein (1.37 ± 0.33-2.16 ± 0.84) and carbohydrate (5.86 ± 0.19-11.51 ± 1.26) contents. In addition, all the samples showed good stability in terms of acidity, pH, and viability for LAB and yeasts during 28 days of storage (4 °C). Overall, the beverages showed a dominant yellow-green color, non-Newtonian pseudoplastic behavior, and high mean scores in the sensory evaluation. This study provided evidence of the emerging potential of licuri in the plant-based beverage industry.

Biological Significance of Probiotic Microorganisms from Kefir and Kombucha: A Review.

(1) Background: The human microbiota is essential for maintaining a healthy body. The gut microbiota plays a protective role against pathogenic bacteria. Probiotics are live microorganisms capable of preventing and controlling gastrointestinal and balancing the immune system. They also aid in better nutrients and vitamins absorption. Examples of natural probiotic cultures are kefir and kombucha. (2) Methods: Therefore, the aim of this review was to address the beneficial properties of probiotic kefir and kombucha using a Boxplot analysis to search for scientific data in the online literature up to January 2024: (Latin American and Caribbean Health Sciences (LILACS), PubMed, Medical Literature Analysis (MED-LINE), Science Direct, Google Scholar/Google Academic, Bioline Inter-national and Springer Link). Boxplots showed the summary of a set of data "Index Terms-Keywords" on kefir and kombucha in three languages (English, Portuguese and Spanish). (3) Results: Google Scholar was the database with the highest number of articles found, when the search for the keywords used in the study (containing ~4 × 106-~4 million articles available). This was Followed by the Science Direct database, containing ~3 × 106-~3 million articles available, and the BVS databases-Biblioteca Virtual de Saúde (Virtual Health Library) e Lilacs, both containing a value of ~2 × 106-~2 million articles available. The databases containing the smallest number of articles found were Nutrients and Medline, both containing a value of ≤0.1 × 106-≤100 thousand articles. (4) Conclusions: Scientific studies indicate that kefir and kombucha certainly contain various functional properties, such as antimicrobial, antitumor, anticarcinogenic and immunomodulatory activity, in addition to having a microbiological composition of probiotic bacteria and yeasts. Kefir and kombucha represent key opportunities in the food and clinic/medical fields.

Melanoma prevention using an augmented reality-based serious game.

OBJECTIVES: The purpose of this study was to field-test a recently developed AR-based serious game designed to promote SSE self-efficacy, called Spot. METHODS: Thirty participants played the game and answered 3 questionnaires: a baseline questionnaire, a second questionnaire immediately after playing the game, and a third questionnaire 1 week later (follow-up). RESULTS: The majority of participants considered that the objective quality of the game was high, and considered that the game could have a real impact in SSE promotion. Participants showed statistically significant increases in SSE self-efficacy and intention at follow-up. Of the 24 participants that had never performed a SSE or had done one more than 3 months ago, 12 (50.0%) reported doing a SSE at follow-up. CONCLUSIONS: This study provides supporting evidence to the use of serious games in combination with AR to educate and motivate users to perform SSE. Spot seems to be an inconspicuous but effective strategy to promote SSE, a cancer prevention behavior, among healthy individuals. PRACTICE IMPLICATIONS: Patient education is essential to tackle skin cancer, particularly melanoma. Serious games, such as Spot, have the ability to effectively educate and motivate patients to perform a cancer prevention behavior.

Effect of drying temperature and storage time on the crispiness of homemade apple snacks.

BACKGROUND: The apple (Malus domestica Borkh.) plays an important role in the trendy market of dried snacks because of its exceptional flavor and texture. In addition to the health benefits, there is also a general disposition to consume organic and do-it-yourself products. RESULTS: Three different drying temperatures, 65, 75, and 85 °C, were tested using a commercial ventilated drying oven in 'Royal Gala' and 'Golden Delicious' cultivars. Physical changes, including texture, color, shrinkage ratio, and microstructure, were evaluated for the temperatures and cultivars considered. Based on the results, particularly in terms of shrinkage, hardness, and crispiness, a drying temperature of 75 °C was selected to perform texture profile analyses throughout the drying period. Storability conditions were evaluated to determine the best moment to maintain the physical properties of the dried snacks during storage. Considered the more important property related to consumer preferences, crispiness was followed with puncture tests. CONCLUSION: The storage of apple chips, dried at the various temperatures, that must be performed in 5-10 min after removing from the drying oven, was assessed over the course of a month. Both the drying process and the subsequent storage proved effective in preserving the desired texture of the apple snacks, regardless of the specific cultivar or drying temperature used. Through this study, with a refined understanding of the changes occurring during the drying process and the optimization of storage conditions, we can confidently offer consumers the best combination of crispy and healthy snacks that meet their expectations. © 2023 Society of Chemical Industry.

Macro and trace element compositions and physicochemical parameters of guajiru fruits (Chrysobalanus icaco l.) from two Brazilian states.

Chrysobalanus icaco L. is a tree found in America and Africa. In Brazil it can be found in the biome along the coast. It has great food potential and its fruits, named guajiru, are consumed by fishing communities in natura and processed as jams and jellies. However, the literature on this tree species is limited. This study aims to describe the element contents and physicochemical characteristics of the C. icaco fruits from two regions in Brazil and investigate if they influence its sensory characteristics. The fruits were collected in the Northeastern region of Brazil in Maracajaú, State of Rio Grande do Norte (RN) and in Salvador, Bahia (BA). The morphometric characteristics, color, texture, and sensory analyses were carried out on the fruits in natura, and the physicochemical analyses and mineral profile on the pulp homogenized with the peel. The mineral profile showed K > Na > Mn > Mg > Ca > Fe > Mn > Cu > Zn > Ni > Cr, varying from 206 mg/100g (K) to 0.87 µg/100 g (Cr). The fruits from RN presented higher levels of trace and macronutrients, which affected the sensory characteristics, mainly the flavor, and led to better acceptance of these samples as compared to those from BA. The results suggest that C. icaco fruits present a good nutritional profile and sensory acceptance and hence their commercialization could be stimulated as a table fruit or mixed with other fruits.

Effects of Substitution and Substrate Strain on the Structure and Properties of Orthorhombic Eu1-xYxMnO3 (0 ≤ x ≤ 0.5) Thin Films.

The effects on the structure and magnetic properties of Eu1-xYxMnO3 (0.0 ≤ x ≤ 0.5) thin films due to lattice strain were investigated and compared with those obtained in equivalent composition ceramics. The films were deposited by spin-coating chemical solution onto Pt\TiO2\SiO2\Si (100) standard substrates. X-ray diffraction and Raman spectroscopy measurements revealed that all films crystallize in orthorhombic structure with space group Pnma, observing an added contraction of the unit cell with increasing Y-substitution ou Eu, corresponding to a broadening of the Mn-O1-Mn angle and a gradual decrease in magnetic order response.

MAX IV Laboratory.

MAX IV Laboratory is a Swedish national synchrotron radiation facility that comprises three accelerators with varying characteristics. One of the accelerators, the 3 GeV storage ring, is the world's first fourth-generation ring and pioneered the use of the multibend achromat lattice to provide access to ultrahigh brightness X-rays. MAX IV aims to stay at the forefront of the current and future research needs of its multidisciplinary user community, principally located in the Nordic and Baltic regions. Our 16 beamlines currently offer and continue to develop modern X-ray spectroscopy, scattering, diffraction, and imaging techniques to address scientific problems of importance to society.

Influence of Cupric (Cu2+) Ions on the Iron Oxidation Mechanism by DNA-Binding Protein from Starved Cells (Dps) from Marinobacter nauticus.

Dps proteins (DNA-binding proteins from starved cells) are multifunctional stress defense proteins from the Ferritin family expressed in Prokarya during starvation and/or acute oxidative stress. Besides shielding bacterial DNA through binding and condensation, Dps proteins protect the cell from reactive oxygen species by oxidizing and storing ferrous ions within their cavity, using either hydrogen peroxide or molecular oxygen as the co-substrate, thus reducing the toxic effects of Fenton reactions. Interestingly, the interaction between Dps and transition metals (other than iron) is a known but relatively uncharacterized phenomenon. The impact of non-iron metals on the structure and function of Dps proteins is a current topic of research. This work focuses on the interaction between the Dps from Marinobacter nauticus (a marine facultative anaerobe bacterium capable of degrading petroleum hydrocarbons) and the cupric ion (Cu2+), one of the transition metals of greater biological relevance. Results obtained using electron paramagnetic resonance (EPR), Mössbauer and UV/Visible spectroscopies revealed that Cu2+ ions bind to specific binding sites in Dps, exerting a rate-enhancing effect on the ferroxidation reaction in the presence of molecular oxygen and directly oxidizing ferrous ions when no other co-substrate is present, in a yet uncharacterized redox reaction. This prompts additional research on the catalytic properties of Dps proteins.

Controlled modulation of the dynamics of the Deinococcus grandis Dps N-terminal tails by divalent metals.

DNA-binding proteins from starved cells (Dps) are small multifunctional nanocages expressed by prokaryotes in acute oxidative stress conditions or during the starvation-induced stationary phase, as a bacterial defense mechanism. Dps proteins protect bacterial DNA from damage by either direct binding or by removing precursors of reactive oxygen species from solution. The DNA-binding properties of most Dps proteins studied so far are related to their unordered, flexible, N- and C-terminal extensions. In a previous work, we revealed that the N-terminal tails of Deinoccocus grandis Dps shift from an extended to a compact conformation depending on the ionic strength of the buffer and detected a novel high-spin ferrous iron center in the proximal ends of those tails. In this work, we further explore the conformational dynamics of the protein by probing the effect of divalent metals binding to the tail by comparing the metal-binding properties of the wild-type protein with a binding site-impaired D34A variant using size exclusion chromatography, dynamic light scattering, synchrotron radiation circular dichroism, and small-angle X-ray scattering. The N-terminal ferrous species was also characterized by Mössbauer spectroscopy. The results herein presented reveal that the conformation of the N-terminal tails is altered upon metal binding in a gradual, reversible, and specific manner. These observations may point towards the existence of a regulatory process for the DNA-binding properties of Dps proteins through metal binding to their N- and/or C-terminal extensions.

Growth and Structural Characterization of h-LuMnO3 Thin Films Deposited by Direct MOCVD.

In this work, we investigated the MOCVD conditions to synthesize thin films with the hexagonal P63cm h-LuMnO3 phase as a potential low-band gap ferroelectric material. The main parameters investigated were the ratio of organometallic starting materials, substrate temperature, and annealing effect. Two different substrates were used in the study: fused silica (SiO2) glass and platinized silicon (Pt\Ti\SiO2\Si(100)). In order to investigate the thermodynamic stability and quality of the developed phases, a detailed analysis of the crystal structure, microstructure, morphology, and roughness of the films was performed by X-ray diffractometer, scanning electron microscopy (SEM), energy dispersive spectrometry (EDS), Raman spectroscopy, and piezoelectric force microscopy (PFM). Molar compositions in the film within 0.93 < |Lu|/|Mn| < 1.33 were found to be suitable for obtaining a single-phase h-LuMnO3. The best films were obtained by depositions at 700 °C, followed by thermal treatments at 800 °C for long periods of up to 12 h. These films exhibited a highly crystalline hexagonal single phase with a relatively narrow direct band gap, around 1.5 eV, which is within the expected values for the h-LuMnO3 system.

Innovation in Alternative Food Sources: A Review of a Technological State-of-the-Art of Insects in Food Products.

Insects present great potential for the food industry due to their easier rearing conditions and high nutritional value, in comparison with traditional livestock. However, there is a lack of evaluation of the technological status of food products developed with edible insects. Therefore, this study aims to analyze the emergent technological and scientific applications of edible insects in the food industry through a prospective study of patent documents and research articles. Espacenet was used as a research tool, applying the terms Insect, Pupa, Larva, or Nymph and the codes A23L33 and A23V2002. A total of 1139 documents were found-341 were related to the study. Orbit® was used to evaluate technological domains and clusters of concepts. Scopus database research was performed to assess the prevalence of insect research, with the term "edible and insect*". The main insects used were silkworms, bees, beetles, mealworms, crickets, and cicadas. Protein isolates were the predominant technology, as they function as an ingredient in food products or supplements. A diverse application possibility for insects was found due to their nutritional composition. The insect market is expected to increase significantly in the next years, representing an opportunity to develop novel high-quality/sustainable products.

Utilization of Agro-Industrial Residues in the Rearing and Nutritional Enrichment of Zophobas atratus Larvae: New Food Raw Materials.

Edible insects are a potential alternative food source of high feed conversion efficiency and protein content. Zophobas atratus is an edible insect that adapts to different diets, enabling sustainable rearing by adding value to by-products and agro-industrial residues. This study aimed to evaluate the performance and nutritional characterization of Zophobas atratus larvae fed with different proportions of grape residue. Physicochemical analysis of the diets and larvae (AOAC procedures), fatty acid profile (chromatographic techniques), metals and non-metals (inductively coupled plasma optical emission spectrometry), larval mass gain, feed conversion efficiency, and mortality rate were assessed. The replacement of 25% of the conventional diet with grape residue increased lipid, ash, and fiber contents and reduced protein, carbohydrates, and energy. It promoted greater mass gain, lower mortality rate, and reduced larval growth time by 51%. Among the replacements, 25% resulted in the second-highest content of calcium, sodium, magnesium, and zinc, and the lowest content of potassium and phosphorus in the larvae. The 100% replacement resulted in the highest amounts of C18:2n6 (27.8%), C18:3n3 (2.2%), and PUFA (30.0%). Replacing 25% of the conventional diet with grape residue is equivalent to the conventional diet in many aspects and improves several larvae performance indices and nutritional values.

Elaboration of wild passion fruit (Passiflora cincinnata Mast.) liqueur: a sensory and physicochemical study.

Liqueur is an alcoholic beverage composed of a mixture of water, alcohol, sugar and substances that add flavour and aroma. Wild passion fruit is a product with good agricultural and nutritional characteristics, and is a low-cost, regional fruit that could be used to elaborate new products. The goal of this study was to develop passion fruit (Passiflora cincinnata Mast.) liqueurs and evaluate their chemical, physical and sensory characteristics. 5 formulations were prepared with defined pulp and syrup concentrations (F1, F2, F3, F4 and F5). The following physicochemical parameters were evaluated: alcohol degree (ºGL), density, pH, total titratable acidity, total soluble solids (TSS), reducing and non-reducing sugars and colour parameters. A sensory acceptance test was applied. The formulations F4 and F5, produced with 640g pulp/70ºBrix syrup and 500g pulp/55ºBrix syrup, respectively, showed the highest acceptance scores, probably due to their acid pH, high acidity and soluble solids values. In general, the beverages developed were considered feasible, aimed at aggregating value to a regional fruit and increasing family incomes. The high sensory acceptance indicated market potential for this aggregated value product.

Analysis and Modeling of Innovations in the Global Microalgae Lipids Market.

Microalgae lipids offer numerous advantages over those of plants and animals, enabling the sustainable commercialization of high value-added products in different markets. Although these markets are in a vertiginous annual expansion, technological life cycle modeling is a tool that has been rarely used for microalgae. Life cycle modeling is capable of assisting with decision-making based on data and is considered as a versatile model, usable in multiple software analyzing and diagnostic tasks. Modeling technological trends makes it possible to categorize the development level of the market and predict phase changes, reducing uncertainties and increasing investments. This study aims to fill this gap by performing a global analysis and modeling of microalgal lipid innovations. The Espacenet and Orbit platforms were used by crossing the keywords "microalgae", "lipid*", and the IPC code C12 (biochemistry and microbiology). Different sigmoid growth models were used in the present study. A successive repetition of the Chlorella genus category was found in the keyword clusters regarding extraction and separation of lipids. The life cycle S curve indicates a market starting at the maturity phase, where the BiDoseResp model stands out. The main countries and institutions at the technological forefront are shown, as well as potential technological domains for opening new markets.

Condensation and Protection of DNA by the Myxococcus xanthus Encapsulin: A Novel Function.

Encapsulins are protein nanocages capable of harboring smaller proteins (cargo proteins) within their cavity. The function of the encapsulin systems is related to the encapsulated cargo proteins. The Myxococcus xanthus encapsulin (EncA) naturally encapsulates ferritin-like proteins EncB and EncC as cargo, resulting in a large iron storage nanocompartment, able to accommodate up to 30,000 iron atoms per shell. In the present manuscript we describe the binding and protection of circular double stranded DNA (pUC19) by EncA using electrophoretic mobility shift assays (EMSA), atomic force microscopy (AFM), and DNase protection assays. EncA binds pUC19 with an apparent dissociation constant of 0.3 ± 0.1 µM and a Hill coefficient of 1.4 ± 0.1, while EncC alone showed no interaction with DNA. Accordingly, the EncAC complex displayed a similar DNA binding capacity as the EncA protein. The data suggest that initially, EncA converts the plasmid DNA from a supercoiled to a more relaxed form with a beads-on-a-string morphology. At higher concentrations, EncA self-aggregates, condensing the DNA. This process physically protects DNA from enzymatic digestion by DNase I. The secondary structure and thermal stability of EncA and the EncA-pUC19 complex were evaluated using synchrotron radiation circular dichroism (SRCD) spectroscopy. The overall secondary structure of EncA is maintained upon interaction with pUC19 while the melting temperature of the protein (Tm) slightly increased from 76 ± 1 °C to 79 ± 1 °C. Our work reports, for the first time, the in vitro capacity of an encapsulin shell to interact and protect plasmid DNA similarly to other protein nanocages that may be relevant in vivo.

Microscopic Identification of Anatomical Elements and Chemical Analysis of Secondary Nests of Vespa velutina nigrithorax du Buyson.

Vespa velutina accidentally arrived in Europe (France) in 2004, and rapidly expanded throughout the entire country. Its presence in mainland Portugal was first noticed in 2011. Being an invasive species with no natural predators in the region to control it, it has caused enormous environmental and economic damage, particularly on Apis mellifera (honeybee) colonies. Although there is already some research on this species' biology, little is known about its adaption to European ecological conditions, specifically in terms of nest building. This type of hornet builds a primary nest in the spring to start a colony. During the summer, they build a secondary nest to develop the main colony. These secondary nests are ovoid-shaped and range in size from 18.7 cm to 45.0 cm in diameter and from 19.2 cm to 65.0 cm in length, attaining their highest development in late summer. The external appearance of these nests is characterized by alternating stripes that are beige and brown in color. The main objective of this study is to identify the composition and the origin of the materials that are used by Vespa velutina nigrithorax to build the outer envelope of these secondary nests. This information could be very interesting and will not only increase our knowledge on the biology of the species in regions far from its original area, but will also be relevant for the future implementation of new policies to control this invasive species by means biological control. Several samples were taken from each nest and were observed under different optical magnifying devices. In the second stage, their chemical composition was analyzed by X-ray diffraction (XRD) and scanning electron microscopy (SEM/EDS). It was noticed that almost all of the materials used in the nests' construction were lignocellulose from woody materials from both softwood (gymnosperm) and hardwood (angiosperm) forest species as well from leaves and small particles of agricultural origin (grasses). The beige strips were formed almost exclusively from woody softwood cells, while the brown strips were composed of hardwood cells, leaf tissues, and grasses. Chemically, it was noticed that this material mainly consisted of cellulose, with more than 99% being composed of C and O and very little mineral material from elements such as Na, Al, Si, K, and Ca. The achieved results allow us to state that in the construction of these secondary nests, these hornets only used organic materials that are then probably agglomerated through their mouths.

The Conformation of the N-Terminal Tails of Deinococcus grandis Dps Is Modulated by the Ionic Strength.

DNA-binding proteins from starved cells (Dps) are homododecameric nanocages, with N- and C-terminal tail extensions of variable length and amino acid composition. They accumulate iron in the form of a ferrihydrite mineral core and are capable of binding to and compacting DNA, forming low- and high-order condensates. This dual activity is designed to protect DNA from oxidative stress, resulting from Fenton chemistry or radiation exposure. In most Dps proteins, the DNA-binding properties stem from the N-terminal tail extensions. We explored the structural characteristics of a Dps from Deinococcus grandis that exhibits an atypically long N-terminal tail composed of 52 residues and probed the impact of the ionic strength on protein conformation using size exclusion chromatography, dynamic light scattering, synchrotron radiation circular dichroism and small-angle X-ray scattering. A novel high-spin ferrous iron-binding site was identified in the N-terminal tails, using Mössbauer spectroscopy. Our data reveals that the N-terminal tails are structurally dynamic and alter between compact and extended conformations, depending on the ionic strength of the buffer. This prompts the search for other physiologically relevant modulators of tail conformation and hints that the DNA-binding properties of Dps proteins may be affected by external factors.

Wiggler radiation at a low-emittance storage ring and its usage for X-ray absorption spectroscopy.

A wiggler is a high-power insertion device that was used in the past to produce a smooth wide-band X-ray spectrum. It is widely believed that on low-emittance synchrotrons this X-ray source loses its spatial and spectral homogeneity and therefore becomes less ideal than a scanning undulator. In this paper, we report on experimental and computational studies of an in-vacuum wiggler installed on the first fourth-generation synchrotron MAX IV. We investigate how several physical parameters affect the wiggler spectrum and propose a combination of a few of them that results in significant spectral smoothing. We also examine EXAFS spectra for possible distortions originating from the source imperfection. For this purpose, we scrutinize samples of various homogeneity. We conclude that wigglers are still an appropriate class of insertion devices, also on low-emittance synchrotrons.

Increase in Hepatitis A Cases Linked to Imported Strains to Rio de Janeiro, Brazil: A Cross-Sectional Study.

This study aims to evaluate the epidemiological and molecular features associated with HAV transmission in adults in Rio de Janeiro during a period of increased registered cases of HAV (2017-2018). Socio-epidemiological data and serum samples from anti-HAV IgM+ individuals were obtained. HAV RNA was RT-PCR amplified and sequenced for further phylogenetic and phylogeographic analyses. From fifty-two HAV IgM+ individuals, most were men (78.85%; p = 0.024), aged 20-30 years old (84.61%; p < 0.001), resided in the Rio de Janeiro north zone (31/52; 59.62%; p = 0.001), and are men who have sex with men (MSM) (57.69%; p = 0.002). Sexual practices were more frequent (96%) than others risk factors (food-borne (44%), water-borne (42.31%), and parenteral (34.62%)). Individuals who traveled to endemic regions had a 7.19-fold (1.93-36.04; p < 0.01) increased risk of HAV. Phylogenetic analysis revealed four distinct clades of subgenotype IA, three of them comprised sequences from European/Asian MSM outbreaks and one from Brazilian endemic strains. Bayesian Inference showed that the imported strains were introduced to Brazil during large mass sportive events. Sexual orientation and sexual practices may play a role in acquiring HAV infection. Public policies targeting key populations must be implemented to prevent further dissemination of HAV and other STIs.

Do We Have a Culprit? An Association of Giant Cell Arteritis with Pulmonary Embolism.

Giant cell arteritis is the most common type of systemic vasculitis. An increased risk of venous thromboembolism has been described in these patients. We report the case of a 79-year-old woman with a history of polymyalgia rheumatica, who presented with left thoracic pain radiating to the neck and scapula plus temporal headache. She had no changes on physical examination, but work-up tests showed increased D-dimer levels and computed tomography pulmonary angiography revealed signs of a chronic/subacute embolism in the right inferior lobe. Anticoagulation with edoxaban was started after 5-day bridging with enoxaparin. Three weeks after the initial diagnosis the headache still persisted and she developed scalp tenderness. Giant cell arteritis was diagnosed and treated with prednisolone, with complete resolution of symptoms. Extensive diagnostic work-up was performed to identify an alternative cause of pulmonary thromboembolism; however, the investigations were negative. This case supports the hypothesis that this type of vasculitis could be related to the occurrence of pulmonary embolism. LEARNING POINTS: An increased risk of thromboembolism has been associated with giant cell arteritis.Early diagnosis is crucial; however, the role of antiplatelets or anticoagulants is not yet established.