Live and Heat-Inactivated Streptococcus thermophilus MN-ZLW-002 Mediate the Gut-Brain Axis, Alleviating Cognitive Dysfunction in APP/PS1 Mice.

Research on regulating brain functions with probiotics and postbiotics through the gut-brain axis is attracting attention, offering the possibility of adjuvant therapy for Alzheimer's disease (AD). Three-month-old male APP/PS1 mice were gavaged with live and heat-inactivated S. thermophilus MN-002 for three months. This study demonstrated that live and heat-inactivated S. thermophilus MN-002 improved cognitive dysfunctions in APP/PS1 mice, especially in spatial memory. However, the main effects of live S. thermophilus MN-002 directly altered the intestinal microbiota composition and increased serum IL-1ß and IL-6. Heat-inactivated S. thermophilus MN-002 increased colonic propionic acid levels and enhanced the hippocampus's antioxidant capacity. Furthermore, the changes were more obvious in the high-dose group, such as astrogliosis in the hippocampus. These results indicate that different forms and doses of the same strain, S. thermophilus MN-002, can partly improve cognitive functions in AD model mice via the gut-brain axis.

Bifidobacterium infantis and 2'-fucosyllactose supplementation in early life may have potential long-term benefits on gut microbiota, intestinal development, and immune function in mice.

The health benefits of nutritional interventions targeting the gut microbiota in early life are transient, such as probiotics, prebiotics, and synbiotics. This study sought to determine whether supplementation with Bifidobacterium infantis 79 (B79), 2'-fucosyllactose (2'-FL), or both (B79+2'FL) would lead to persistent health benefits in neonatal BALB/c mice. We found that at postnatal day (PND) 21, Ki67 and MUC2 expression increased, while total serum IgE content decreased in the B79, 2'-FL, and B79+2'-FL groups. The gut microbiota structure and composition altered as well. The levels of propionic acid, sIgA, and IL-10 increased in the 2'-FL group. Moreover, butyric acid content increased, while IL-6, IL-12p40, and tumor necrosis factor-α decreased in the B79+2'-FL group. At PND 56, Ki67 and MUC2 expression increased, whereas the gut microbiota remained altered in all 3 groups. The serum total IgG level increased only in the B79+2'-FL group. In conclusion, our study suggests that early-life supplementation with B79, 2'-FL, or their combination persistently alters the gut microbiome and promotes intestinal development; the immunomodulatory capacity of B79 and 2'-FL occurs during weaning, and their combination may persist into adulthood.

Associations between adiposity, diabetes, lifestyle factors and the risk of gliomas.

Background: Despite numerous observational studies linking adiposity, diabetes, and lifestyle factors with gliomas, the causal associations between them remain uncertain. Methods: This study aimed to use two-sample Mendelian randomization (MR) analysis to investigate whether these associations are causal. Specifically, independent genetic variants in body mass index (BMI), waist circumference (WC), type 2 diabetes (T2D), smoking, alcohol, and coffee consumption were extracted from the published genome-wide association studies (GWASs) with genome-wide significance. The corresponding summary-level data for gliomas were available from a GWAS of 1,856 cases and 4,955 controls of European descent from the GliomaScan consortium. Additionally, glioma pathogenesis-related protein 1 data were used for validation, and Radial MR analysis was conducted to examine the potential outlier single-nucleotide polymorphisms (SNPs). Results: One standard deviation (SD) increase in BMI had an odds ratio (OR) of 1.392 (95% confidence interval (CI), 0.935-2.071) for gliomas, while one SD increase in WC had an OR of 0.967 (95% CI, 0.547-1.710). For T2D, a one-unit increase in log-transformed OR had an OR of 0.923 (95% CI, 0.754-1.129). The prevalence of smoking initiation had an OR of 1.703 (95% CI, 0.871-3.326) for gliomas, while the prevalence of alcohol intake frequency had an OR of 0.806 (95% CI, 0.361-1.083), and the prevalence of coffee intake had an OR of 0.268 (95% CI, 0.033-2.140) for gliomas. Conclusion: This study provides evidence that adiposity, T2D, smoking, alcohol drinking, and coffee intake do not play causal roles in the development of gliomas. The findings highlight the importance of reconsidering causal relationships in epidemiological research to better understand the risk factors and prevention strategies for gliomas.

Gut Microbiota Perturbation in Early Life Could Influence Pediatric Blood Pressure Regulation in a Sex-Dependent Manner in Juvenile Rats.

The present study aimed to investigate whether gut dysbiosis induced by ceftriaxone in early life could influence pediatric blood pressure regulation in childhood with or without exposure to a high-fat diet (HFD). Sixty-three newborn pups of Sprague-Dawley rats were administered ceftriaxone sodium or saline solution until weaning at 3 weeks, and the rats were fed a HFD or regular diet from 3 to 6 weeks. Tail-cuff blood pressure, the expression levels of genes of the renin-angiotensin system (RAS), the concentrations of IL-1ß, IL-6, and TNF-α in the colon and prefrontal cortex, and the composition of fecal microbiota were analyzed. Ceftriaxone treatment significantly increased the diastolic blood pressure of male rats at 3 weeks. At 6 weeks, systolic blood pressure (SBP) was significantly increased only in ceftriaxone treated male rats fed with HFD. The RAS showed increased activation in the kidney, heart, hypothalamus, and thoracic and abdominal aorta of male rats, but only in the kidney, heart, and hypothalamus of female rats. HFD-fed female rats showed a decreased level of IL-6 in the colon. α diversity of gut microbiota decreased and the Firmicutes to Bacteroidetes ratio increased in both male and female rats at 3 weeks; however, these parameters recovered to various degrees in female rats at 6 weeks. These results revealed that early-life gut dysbiosis induced by antibiotics combined with a HFD in childhood could be involved in pediatric blood pressure regulation and an increase in SBP in juvenile rats, and these effects occurred in a sex-dependent manner.

[Heat-inactivated Streptococcus thermophilus MN002 alleviate lipid metabolism of high fat diet-fed induced obese mice through modulating gut microbiota structure and bile acids].

OBJECTIVE: To explore the effects of heat-inactivated Streptococcus thermophilus MN-ZLW-002(MN002) on glucose metabolism, lipid metabolism, gut microbiota and bile acids in high-fat diet fed obese mice. METHODS: Sixty 3-week-old male C57BL/6 mice were randomly divided into control group, high-fat group and intervention group(n=20). After 1 week of adaptive feeding, the control group was fed with normal chow and continued intragastric administration of normal saline for 12 weeks, the high-fat group was fed with high-fat diet and continued intragastric administration of normal saline for 12 weeks, and the intervention group was fed with high-fat diet and continued intragastric of MN002 for 12 weeks. During the experiment, the body weight, food intake, fasting blood glucose content of mice were measured and feces were collected. At the end of the experiment, the oral glucose tolerance of mice was measured and blood, periintestinal fat, peritestosterone fat and perirenal fat samples were collected. The histopathological changes of liver were observed by hematoxylin-eosin staining. Triglyceride, low density lipoprotein, high density lipoprotein and total cholesterol were detected by automatic biochemical analyzer, bile acids content in feces was detected by liquid chromatography-mass spectrometry, gut microbiota structure of mice was analyzed by 16S rDNA sequencing. RESULTS: Compared with high fat group, serum triglyceride, total cholesterol and perirenal fat in intervention group were significantly decreased(P<0.05), the content of fossil cholic acid sulfate in feces was significantly increased, while the content of ursodeoxycholic acid, porcine deoxycholic acid and deoxycholic acid were significantly decreased(P<0.01). Heat inactivation of MN002 could significantly increase the relative abundance of Ruminiclostridium and Alistipes and reduce the relative abundance of Lactobacillus(P<0.01). CONCLUSION: Heat-inactivated Streptococcus thermophilus MN002 can regulate the gut microbiota structure and bile acid composition and content of high-fat diet fed mice, thereby alleviating the lipid metabolic disorders caused by high-fat diet.

Direct Observation and Real-Time Tracking of an Extraordinarily Stable Folding Intermediate in Mitotic Arrest Deficient Protein 2 Folding by Single-Molecule Fluorescence Resonance Energy Transfer.

Although ensemble experiments have suggested that mitotic arrest deficient protein 2 (Mad2), a metamorphic protein, has folding intermediates, direct evidence and characterization are not available. It remains an outstanding challenge to capture the folding intermediates in real time, which is crucial to elucidate the folding mechanism, but the folding intermediates are normally unstable and only exist transiently. By combining confocal-microscopy-based and total internal reflection fluorescence (TIRF)-microscopy-based single-molecule Förster resonance energy transfer (sm-FRET) techniques, we have investigated the folding/unfolding process of Mad2 and captured its folding intermediate at the single-molecule level. This provides direct evidence for the existence of an intermediate along the folding pathway of Mad2. The folding intermediate proved to be extraordinarily stable, with an extremely long average dwell time of 2.3 s under the conditions of 3 M GdmCl at ambient temperature. The folding trajectories obtained from TIRF experiments further suggest that the intermediate is on-pathway to native Mad2.

Study on Extraction Valuable Metal Elements by Co-Roasting Coal Gangue with Coal Gasification Coarse Slag.

Coal gangue (CG) and coal gasification coarse slag (CGCS) possess both hazardous and resourceful attributes. The present study employed co-roasting followed by H2SO4 leaching to extract Al and Fe from CG and CGCS. The activation behavior and phase transformation mechanism during the co-roasting process were investigated through TG, XRD, FTIR, and XPS characterization analysis as well as Gibbs free energy calculation. The results demonstrate that the leaching rate of total iron (TFe) reached 79.93%, and Al3+ achieved 43.78% under the optimized experimental conditions (co-roasting process: CG/CGCS mass ratio of 8/2, 600 °C, 1 h; H2SO4 leaching process: 30 wt% H2SO4, 90 °C, 5 h, liquid to solid ratio of 5:1 mL/g). Co-roasting induced the conversion of inert kaolinite to active metakaolinite, subsequently leading to the formation of sillimanite (Al2SiO5) and hercynite (FeAl2O4). The iron phases underwent a selective transformation in the following sequence: hematite (Fe2O3) → magnetite (Fe3O4) → wustite (FeO) → ferrosilite (FeSiO3), hercynite (FeAl2O4), and fayalite (Fe2SiO4). Furthermore, we found that acid solution and leached residue both have broad application prospects. This study highlights the significant potential of co-roasting CG and CGCS for high-value utilization.

Numerical Study of Thermal Enhancement in a Single- and Double-Layer Microchannel Heat Sink with Different Ribs.

In this paper, a microchannel heat sink model was proposed to realize single- and double- layer flow through built-in ribs. The finite element volume method was used to analyze the influence of the length, thickness and angle of the inner rib on the flow and heat transfer characteristics of the microchannel heat sink. The pressure drop, temperature field, flow field, and thermal characteristics are given. The numerical simulation results show that the rectangular rib plate makes the fluid in the microchannel heat sink flow alternately in the upper and lower layers, which can effectively enhance heat transfer. However, with the increase in rib length, the comprehensive evaluation factor decreases. The change of the angle of the rectangular rib plate has little influence on the Nusselt number. The change rate of the comprehensive evaluation factor of the thickness of the rectangular rib plate is the largest. When the Reynolds number is 1724, the comprehensive evaluation factor of Case 9 is 4.7% higher than that of Case 2. According to the parameter study of the built-in rib plate, the optimal parameter combination is given, in which the angle is 0°, the length is 7.5 mm, and the thickness is 0.2-0.3 mm.

Acute hypoxia induced dysregulation of clock-controlled ovary functions.

High altitudes or exposure to hypoxia leads to female reproductive disorders. Circadian clocks are intrinsic time-tracking systems that enable organisms to adapt to the Earth's 24-h light/dark cycle, which can be entrained by other environmental stimuli to regulate physiological and pathological responses. In this study, we focused on whether ovarian circadian clock proteins were involved in regulating female reproductive dysfunction under hypoxic conditions. Hypobaric hypoxia was found to induce a significantly prolonged estrous cycle in female mice, accompanied by follicular atresia, pituitary/ovarian hormone synthesis disorder, and decreased LHCGR expression in the ovaries. Under the same conditions, the levels of the ovarian circadian clock proteins, CLOCK and BMAL1, were suppressed, whereas E4BP4 levels were upregulated. Results from granulosa cells (GCs) further demonstrated that CLOCK: BMAL1 and E4BP4 function as transcriptional activators and repressors of LHCGR in ovarian GCs, respectively, whose responses were mediated by HIF1ɑ-dependent (E4BP4 upregulation) and ɑ-independent (CLOCK and BMAL1 downregulation) manners. The LHCGR agonist was shown to efficiently recover the impairment of ovulation-related gene (EREG and PGR) expression in GCs induced by hypoxia. We conclude that hypoxia exposure causes dysregulation of ovarian circadian clock protein (CLOCK, BMAL1, and E4BP4) expression, which mediates female reproductive dysfunction by impairing LHCGR-dependent signaling events. Adjusting the timing system or recovering the LHCGR level in the ovaries may be helpful in overcoming female reproductive disorders occurring in the highlands.

B(C6F5)3-catalyzed O-H insertion reactions of diazoalkanes with phosphinic acids.

A highly efficient base-, metal-, and oxidant-free catalytic O-H insertion reaction of diazoalkanes and phosphinic acids in the presence of B(C6F5)3 has been developed. This powerful methodology provides a green approach towards the synthesis of a broad spectrum of α-phosphoryloxy carbonyl compounds with good to excellent yields (up to 99% yield). The protocol features the advantages of operational simplicity, high atom economy, practicality, easy scalability and environmental friendliness.

Fabrication of Oil-in-Water Emulsions with Whey Protein Isolate-Puerarin Composites: Environmental Stability and Interfacial Behavior.

Protein-polyphenol interactions influence emulsifying properties in both directions. Puerarin (PUE) is an isoflavone that can promote the formation of heat-set gels with whey protein isolate (WPI) through hydrogen bonding. We examined whether PUE improves the emulsifying properties of WPI and the stabilities of the emulsions. We found that forming composites with PUE improves the emulsifying properties of WPI in a concentration-dependent manner. The optimal concentration is 0.5%, which is the highest PUE concentration that can be solubilized in water. The PUE not only decreased the droplet size of the emulsions, but also increased the surface charge by forming composites with the WPI. A 21 day storage test also showed that the maximum PUE concentration improved the emulsion stability the most. A PUE concentration of 0.5% improved the stability of the WPI emulsions against environmental stress, especially thermal treatment. Surface protein loads indicated more protein was adsorbed to the oil droplets, resulting in less interfacial WPI concentration due to an increase in specific surface areas. The use of PUE also decreased the interfacial tension of WPI at the oil-water interface. To conclude, PUE improves the emulsifying activity, storage, and environmental stability of WPI emulsions. This result might be related to the decreased interfacial tension of WPI-PUE composites.

[Balloon Eustachian tuboplasty for treatment of Eustachian tube dysfunction: A systematic review and Meta-analysis].

Objective:To sysetematically evaluate the efficacy, compliance and collaborative operation of Balloon Eustachian tuboplasty（BET） for treatment of Eustachian tube dysfunction via Meta-analysis. Method:The PubMed, OVID, Embase, Cochrane Library, ProQuest, Web of Science, Chinese biomedical literature database, VIP database, WanFang database, CNKI were searched for papers on autoinflation for treatment of chronic otitis media with effusion in children（up to March 2020）. Statistical analysis was performed by using Cochrane tools and RevMan5.2. Result:A total of 14 articles were included. The results of Meta-analysis showed that the effective rate of the BET was 86%（95%CI: 0.79-0.94）, and had statistical significance. The tubomanometry, ETS, ETDQ-7 of postoperative BET was better than that of the control group, and had statistical significance. Heterogeneity of tubomanometry,ETS was relatively small, which is I²=51%（OR 3.57, 95%CI ：1.95 - 6.55） and I²=59%（SMD 1.33, 95%CI ：0.98-1.67） respectively. There was no statistical significance between BET plus tympanic paracentesis compared with those treated with BET alone. The recurrence rate of the included literature was 5.37% and the complication rate was only 0.33%. Conclusion:Balloon Eustachian tuboplastycan be a safe and effective treatment for adult Eustachian tube dysfunction. However, in terms of collaborative surgery and evaluation methods, we still need more homogeneous, multi-center randomized controlled studies to obtain more accurate conclusions to guide clinical practice.

Microwave pretreatment promotes the annealing modification of rice starch.

Early indica rice starch can only be modified to a small extent by annealing treatment (ANN), which limits its application. Microwave pretreatment (MW) with different intensity was used to enhance the effectiveness of ANN, and single ANN or MW treatments were used as controls. MW pretreatments per se exhibited insignificant or minor effect on the starch. However, MW pretreatment with appropriate intensity could significantly promote the structural and physicochemical modification of the starch in subsequent ANN, including the enhancement of long- and short-range crystalline structures, the increases in gelatinization enthalpy, particle size, peak viscosity, breakdown and G' value, and the decreases in tan δ value. The MW pretreatment could untangle the entanglements between starch chains by inducing violent movement of the chains, which facilitated the molecular rearrangement and interaction during subsequent ANN, thereby promoting the structural and physicochemical changes. This study provided new insights into the annealing mechanism of starch.

An Artificial Cadaveric Leg Blood Flow System for Endoscopic Vein Harvesting Simulation.

Despite being the most common training model for endoscopic vein harvesting, cadaveric legs are limited by their absence of blood flow, resulting in a faded vascular appearance. Because the saphenous vein and the surrounding tissue seem less distinguishable, dissection of the saphenous vein and bipolar coagulation of its branches becomes increasingly inefficient and difficult. An inexpensive artificial blood flow system was developed to overcome this limitation. A cadaveric leg was thawed to a soft and yielding degree, and the saphenous vein was dissected medial and proximal to the medial malleolus. An artificial blood solution was prepared by dissolving 4% protein powder, red dye, and a contrast agent-for x-ray visualization-in saline. The solution was perfused through the saphenous vein and artery. The open ends of the vessels were temporarily clamped after the perfusion had been completed. Blood flow within the vessels was confirmed via angiography and endoscopic visualization of the leg's vessels. A bleeding effect was observed when the saphenous vein was perforated or when a vascular branch was transected. Conversely, a tight seal indicated successful bipolar coagulation of a branch, providing an objective, quantifiable assessment parameter. The artificial blood flow system helps overcome the limitations of the cadaveric leg, creating a more realistic and inexpensive model for endoscopic vein harvesting simulation training.

Head Injury as a Risk Factor for Dementia and Alzheimer's Disease: A Systematic Review and Meta-Analysis of 32 Observational Studies.

BACKGROUND: Head injury is reported to be associated with increased risks of dementia and Alzheimer's disease (AD) in many but not all the epidemiological studies. We conducted a systematic review and meta-analysis to estimate the relative effect of head injury on dementia and AD risks. METHODS: Relevant cohort and case-control studies published between Jan 1, 1990, and Mar 31, 2015 were searched in PubMed, Web of Science, Scopus, and ScienceDirect. We used the random-effect model in this meta-analysis to take into account heterogeneity among studies. RESULTS: Data from 32 studies, representing 2,013,197 individuals, 13,866 dementia events and 8,166 AD events, were included in the analysis. Overall, the pooled relative risk (RR) estimates showed that head injury significantly increased the risks of any dementia (RR = 1.63, 95% CI 1.34-1.99) and AD (RR = 1.51, 95% CI 1.26-1.80), with no evidence of publication bias. However, when considering the status of unconsciousness, head injury with loss of consciousness did not show significant association with dementia (RR = 0.92, 95% CI 0.67-1.27) and AD (RR = 1.49, 95% CI 0.91-2.43). Additionally, this positive association did not reach statistical significance in female participants. CONCLUSIONS: The findings from this meta-analysis indicate that head injury is associated with increased risks of dementia and AD.

Preparation of an aptamer based organic-inorganic hybrid monolithic column with gold nanoparticles as an intermediary for the enrichment of proteins.

A novel strategy for the preparation of an aptamer based organic-inorganic hybrid affinity monolithic column was developed successfully using gold nanoparticles (GNPs) as an intermediary for a sandwich structure to realize the functional modification of the surface of the monolithic matrix. This monolithic matrix was facilely pre-synthesized via one-step co-condensation. Due to the high surface-to-volume ratio of GNPs and the large specific surface area of the hybrid matrix, the average coverage density of aptamers on the hybrid monolith reached 342 pmol µL(-1). With the combination of an aptamer based hybrid affinity monolithic column and enzymatic chromogenic assay, the quantitation and detection limits of thrombin were as low as 5 nM and 2 nM, respectively. These results indicated that the GNPs attached monolith provided a novel technique to immobilize aptamers on an organic-inorganic hybrid monolith and it could be used to achieve highly selective recognition and determination of trace proteins.

Effect of fluvoxamine on the pharmacokinetics and pharmacodynamics of clopidogrel in rats.

1. Fluvoxamine, a selective serotonin reuptake inhibitor (SSRI), is often coprescribed with clopidogrel for the treatment of ischemic vascular diseases. The aim of this study was to explore the effect of fluvoxamine on the pharmacokinetics and pharmacodynamics of clopidogrel. 2. Twelve male rats were employed to investigate the effect of fluvoxamine on the pharmacokinetics of clopidogrel in vivo. Clopidogrel carboxylic acid was used for the pharmacokinetic study of clopidogrel. 3. After pretreatment with high dose of fluvoxamine (27 mg/kg), there were significant increases in the AUC0-t (from 9850±4060 to 27,300±6910 µg/l h; p<0.05), AUC0-∞ (from 9850±4060 to 27,600±6800 µg/l h; p<0.05) and t1/2 (from 2.07±0.0942 to 7.49±1.22 h; p<0.05) of clopidogrel carboxylic acid. The pharmacokinetic data for clopidogrel carboxylic acid showed significant decreases in VLz/F (from 0.765±0.299 to 0.256±0.0594 l/kg; p<0.05) after pretreatment with high dose of fluvoxamine. Pharmacodynamic studies that measure platelet aggregation percentage (from 21.63±6.05% to 45.98±5.11%; p<0.01) show that high doses of fluvoxamine significantly inhibit the effect of clopidogrel. 4. In conclusion, the pharmacokinetics and pharmacodynamics of clopidogrel were significantly affected by high doses of fluvoxamine. This study indicated that potential drug-drug interaction between fluvoxamine and clopidogrel should be taken into consideration in clinical use.

Aptamer-based organic-silica hybrid affinity monolith prepared via "thiol-ene" click reaction for extraction of thrombin.

A novel strategy for preparing aptamer-based organic-silica hybrid monolithic column was developed via "thiol-ene" click chemistry. Due to the large specific surface area of the hybrid matrix and the simplicity, rapidness and high efficiency of "thiol-ene" click reaction, the average coverage density of aptamer on the organic-silica hybrid monolith reached 420 pmol µL(-1). Human α-thrombin can be captured on the prepared affinity monolithic column with high specificity and eluted by NaClO4 solution. N-p-tosyl-Gly-Pro-Arg p-nitroanilide acetate was used as the sensitive chromogenic substrate of thrombin. The thrombin enriched by this affinity column was detected with a detection of limit of 0.01 µM by spectrophotometry. Furthermore, the extraction recovery of thrombin at 0.15 µM in human serum was 91.8% with a relative standard deviation of 4.0%. These results indicated that "thiol-ene" click chemistry provided a promising technique to immobilize aptamer on organic-inorganic hybrid monolith and the easily-assembled affinity monolithic material could be used to realize highly selective recognition of trace proteins.

Evaluation of Vessel Sealing Performance Among Ultrasonic Devices in a Porcine Model.

BACKGROUND: As new technologies emerge, it is imperative to define which new devices are most likely to provide a reproducible, effective result for the patient and surgeon. The purpose of our study was to analyze 3 commercially available ultrasonic energy devices; the Sonicision (SC), the Harmonic ACE (HA), and the THUNDERBEAT (TB). MATERIAL AND METHODS: Eight female Yorkshire pigs were used for data collection and vessel harvest. Three devices were evaluated and compared with each other with respect to seal failure and cutting speed in vivo. After vessel harvest, one end of the fragment was sent for histological evaluation, and the other was used for burst pressure measurement testing in a blinded fashion. The coagulation and cut levels of all the generators were set up at a similar and constant level. RESULTS: Eighty-four vessels (47 arteries and 37 veins) were tested. Mean vessel diameter was equal among the groups. Cutting speed was significantly faster with TB (3.4 ± 0.7 seconds) than SC or HA (5.8 ± 2.4 and 6.1 ± 3.1 seconds; P < .0001). Burst pressure trended higher after ligation with TB (505.4 ± 349.4 mm Hg) than SC and HA (435.8 ± 403.0 and 437.6 ± 291.3 mm Hg). There were 2 seal failures in the SC group and HA group and none in the TB group. Histologically, the perpendicular width of tissue seal with TB (1.250 ± 0.55 mm) was significantly longer than that of the SC and the HA (0.772 ± 0.23 and 0.686 ± 0.23 mm; P < .0001). CONCLUSIONS: TB has proven to provide the most rapid and reliable seal. Therefore, TB may be safer and may decrease time during surgical procedures.