This study investigates the environmental and occupational health risks associated with arsenic (As) and mercury (Hg) contamination in a specific industrial site: a mercury mine site that contains a metallurgical plant within its premises. Utilising a comprehensive sampling and analysis approach, As and Hg concentrations in the soil and air across various zones within the site were assessed. The results revealed elevated levels of both contaminants, particularly in areas proximal to industrial processes such as metal smelting and waste disposal. Risk assessment using the Cancer Risk (CR) and Hazard Index (HI) indices demonstrated significant health hazards that exceed regulatory thresholds, indicating potential carcinogenic effects from As exposure and risks of non-cancerous occupational diseases. Three distinct risk areas were identified based on the CR and HI indices, guiding the formulation of tailored risk management strategies. While some zones may permit limited industrial activities under specific conditions, others require stringent safety measures and specialised personal protective equipment (PPE) due to exceptionally high contaminant concentrations. Overall, the findings underscore the critical need for robust safety protocols and regulatory compliance to mitigate the health risks associated with As and Hg exposure in industrial settings, ensuring the protection of worker health, environmental stewardship, and the promotion of sustainable mining practices. Full article

The verification of image integrity has attracted increasing attention. Irreversible algorithms embed fragile watermarks into cover images to verify their integrity, but they are not reversible due to unrecoverable loss. In this paper, a new dual tampering detection scheme for reversible image fragile watermarking is proposed. The insect matrix reversible embedding algorithm is used to embed the watermark into the cover image. The cover image can be fully recovered when the dual-fragile-watermarked images are not tampered with. This study adopts two recovery schemes and adaptively chooses the most appropriate scheme to recover tampered data according to the square errors between the tampered data and the recovered data of two watermarked images. Tampering coincidence may occur when a large region of the fragile-watermarked image is tampered with, and the recovery information corresponding to the tampered pixels may be missing. The tampering coincidence problem is solved using image-rendering techniques. The experimental results show that the PSNR value of the watermarked image obtained using our scheme can reach 46.37 dB, and the SSIM value is 0.9942. In addition, high-accuracy tampering detection is achieved. Full article

The two existing clades of Galloanseres, orders Galliformes (landfowl) and Anseriformes (waterfowl), exhibit dramatically different evolutionary trends. Mitochondria serve as primary sites for energy production in organisms, and numerous studies have revealed their role in biological evolution and ecological adaptation. We assembled the complete mitogenome sequences of two species of the genus Aythya within Anseriformes: Aythya baeri and Aythya marila. A phylogenetic tree was constructed for 142 species within Galloanseres, and their divergence times were inferred. The divergence between Galliformes and Anseriformes occurred ~79.62 million years ago (Mya), followed by rapid evolution and diversification after the Middle Miocene (~13.82 Mya). The analysis of selective pressure indicated that the mitochondrial protein-coding genes (PCGs) of Galloanseres species have predominantly undergone purifying selection. The free-ratio model revealed that the evolutionary rates of COX1 and COX3 were lower than those of the other PCGs, whereas ND2 and ND6 had faster evolutionary rates. The CmC model also indicated that most PCGs in Anseriformes exhibited stronger selective constraints. Our study suggests that the distinct evolutionary trends and energy requirements of Galliformes and Anseriformes drive different evolutionary patterns in the mitogenome. Full article

The purpose of this review is to focus on the diagnostic endoscopic ultrasound of the gastrointestinal tract. In the last decades, EUS has gained a central role in the staging of epithelial and sub-epithelial lesions of the gastrointestinal tract. With the evolution of imaging, the position of EUS in the diagnostic work-up and the staging flow-chart has continuously changed with two extreme positions: some gastroenterologists think that EUS is absolutely indispensable, and some think it is utterly useless. The truth is, as always, somewhere in between the two extremes. Analyzing the most up-to-date and strong evidence, we will try to give EUS the correct position in our daily practice. Full article

Security and privacy concerns pose significant obstacles to the widespread adoption of IoT technology. One potential solution to address these concerns is the implementation of cryptographic protocols on resource-constrained IoT edge nodes. However, the limited resources available on these nodes make it challenging to effectively deploy such protocols. In cryptographic systems, finite-field multiplication plays a pivotal role, with its efficiency directly impacting overall performance. To tackle these challenges, we propose an innovative and compact bit-serial systolic layout specifically designed for Montgomery multiplication in the binary-extended field. This novel multiplier structure boasts regular cell architectures and localized communication connections, making it particularly well suited for VLSI implementation. Through a comprehensive complexity analysis, our suggested design demonstrates significant improvements in both area and area–time complexities when compared to existing competitive bit-serial multiplier structures. This makes it an ideal choice for cryptographic systems operating under strict area utilization constraints, such as resource-constrained IoT nodes and tiny embedded devices. Full article

Due to the extraordinary mechanical properties of ultra-high-performance concrete (UHPC), the shear stirrups in UHPC beams could potentially be eliminated. This study aimed to determine the effect of beam height and steel fiber volume content on the shear behavior of non-stirrup UHPC beams under a larger shear span–depth ratio (up to 2.8). Eight beams were designed and fabricated including six non-stirrup UHPC beams and two comparing stirrup-reinforced normal concrete (NC) beams. The experimental results demonstrated that the steel fiber volume content could be a crucial factor affecting the ductility, cracking strength, and shear capacity of non-stirrup UHPC beams and altering their failure modes. Additionally, the height of the beam had a considerable effect on its shear resistance. French standard formulae were more accurate for the UHPC beams with larger shear span–depth ratios, PCI-2021 formulae greatly overestimated the shear capacity of UHPC beams with larger shear span–depth ratios, and Xu’s formulae were more accurate for the steel fiber-reinforced UHPC beams with larger shear span–depth ratios. In summary, French standard formulae were the most suitable formulae for predicting the shear capacity of UHPC beams in this paper. Full article

In response to a perceived epidemic of coronary heart disease, Ancel Keys introduced the lipid–heart hypothesis in 1953 which asserted that high intakes of total fat, saturated fat, and cholesterol lead to atherosclerosis and that consuming less fat and cholesterol, and replacing saturated fat with polyunsaturated fat, would reduce serum cholesterol and consequently the risk of heart disease. Keys proposed an equation that would predict the concentration of serum cholesterol (ΔChol.) from the consumption of saturated fat (ΔS), polyunsaturated fat (ΔP), and cholesterol (ΔZ): ΔChol. = 1.2(2ΔS − ΔP) + 1.5ΔZ. However, the Keys equation conflated natural saturated fat and industrial trans-fat into a single parameter and considered only linoleic acid as the polyunsaturated fat. This ignored the widespread consumption of trans-fat and its effects on serum cholesterol and promoted an imbalance of omega-6 to omega-3 fatty acids in the diet. Numerous observational, epidemiological, interventional, and autopsy studies have failed to validate the Keys equation and the lipid–heart hypothesis. Nevertheless, these have been the cornerstone of national and international dietary guidelines which have focused disproportionately on heart disease and much less so on cancer and metabolic disorders, which have steadily increased since the adoption of this hypothesis. Full article

This research was undertaken to study the duration effects on the seismic economic risk of steel moment frame (SMF) buildings, a prominent class of buildings in commercial stock. Firstly, a modified version of FEMA P-695 ground motion scaling, tailored for seismic loss estimation purposes and incorporating two sets of spectrally matched bi-directional short- and long-duration ground motions, is proposed to study code-compliant plan-symmetrical SMFs with different heights (i.e., two to 20 stories). It is shown that long-duration ground motions increase the collapse risk of SMFs, on average, by 28.0% at the MCE level. Next, a component-based loss estimation methodology was adopted for evaluating the seismic losses under each set of ground motions. These losses are studied separately for building components (i.e., structural and nonstructural) and contents. Moreover, we propose an approach for calculating average annualized loss (AAL) as a prominent risk meter that segregates contributions of short- and long-duration ground motions to attain hazard consistency. Loss analyses showed the minimal impact of building height on the contribution of these two types of earthquakes. The seismic risk analysis of buildings also revealed that collapse risk is influenced mainly by duration effects followed by building and content losses. Full article

Chitinases are biotechnologically relevant enzymes that can be applied in such different sectors as pharmaceutical, food, environmental management, the biocontrol of pests and in the paper and cellulose industry. Microorganisms as filamentous fungi are the most important source of these biomolecules. The fungus Aspergillus niveus produces extracellular chitinase when cultured under submerged fermentation using shrimp shells, a residue generated by the fish industry, as a carbon source, for 96 h at 30 °C and 100 rpm. The particle size and concentration of the shrimp shells affected enzyme production. The chitinase was purified until electrophoretic homogeneity through the use of a Sephadex G-100 chromatographic column. It is a monomeric glycoprotein with a molecular mass of 47 kDa estimated using SDS-PAGE and 49.3 kDa determined using gel filtration. The carbohydrate content was 22.8%. The best temperature and pH for enzyme activity were 65 °C and 6.0, respectively. Approximately 80% of the enzymatic activity was preserved at pH 4.0 and 5.0 for 48 h, and the half-life (t₅₀) was maintained for 48 h at 40 °C. Salts, EDTA and β-mercaptoethanol did not affect chitinase activity significantly, but organic solvents reduced it. The kinetic parameters determined using p-NPGlycNac were K_m of 2.67 mmol L⁻¹, V_max of 12.58 U mg of protein⁻¹, Kcat of 2.47 s⁻¹ and K cat/K_m of 0.93 s⁻¹ mmol L⁻¹. The A. niveus chitinase inhibited the growth of all fungal strains used, especially Trichoderma harzianum (MIC = 22.4 μg mL⁻¹) and Penicillium purpurogenum (MIC = 11.2 μg mL⁻¹). The chitinase produced by A. niveus presented interesting characteristics that indicate its potential of application in different areas. Full article

Deep learning (DL) networks have shown attractive performance in medical image processing tasks such as brain tumor classification. However, they are often criticized as mysterious “black boxes”. The opaqueness of the model and the reasoning process make it difficult for health workers to decide whether to trust the prediction outcomes. In this study, we develop an interpretable multi-part attention network (IMPA-Net) for brain tumor classification to enhance the interpretability and trustworthiness of classification outcomes. The proposed model not only predicts the tumor grade but also provides a global explanation for the model interpretability and a local explanation as justification for the proffered prediction. Global explanation is represented as a group of feature patterns that the model learns to distinguish high-grade glioma (HGG) and low-grade glioma (LGG) classes. Local explanation interprets the reasoning process of an individual prediction by calculating the similarity between the prototypical parts of the image and a group of pre-learned task-related features. Experiments conducted on the BraTS2017 dataset demonstrate that IMPA-Net is a verifiable model for the classification task. A percentage of 86% of feature patterns were assessed by two radiologists to be valid for representing task-relevant medical features. The model shows a classification accuracy of 92.12%, of which 81.17% were evaluated as trustworthy based on local explanations. Our interpretable model is a trustworthy model that can be used for decision aids for glioma classification. Compared with black-box CNNs, it allows health workers and patients to understand the reasoning process and trust the prediction outcomes. Full article

The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT). Particularly, pelvic bone marrow dose exposure has been identified as a contributing factor to this hematologic toxicity. Chemotherapy further increases bone marrow suppression, often necessitating treatment interruptions or dose reductions. A systematic search for original articles published between 1 January 2006 and 7 January 2024 that reported on chemoradiotherapy for locally advanced cervical cancer and hematologic toxicities was conducted. Twenty-four articles comprising 1539 patients were included in the final analysis. HT of grade 2 and higher was observed across all studies and frequently exceeded 50%. When correlating active pelvic bone marrow and HT, significant correlations were found for volumes between 10 and 45 Gy and HT of grade 3 and higher. Several dose recommendations for pelvic bone and pelvic bone marrow sparing to reduce HT were established, including V10 < 90–95%, V20 < 65–86.6% and V40 < 22.8–40%. Applying dose constraints to the pelvic bone/bone marrow is a promising approach for reducing HT, and thus reliable implementation of therapy. However, prospective randomized controlled trials are needed to define precise dose constraints and optimize clinical strategies. Full article

Background: Breast cancer (BC) incidence increases with age, particularly in HR-positive/HER2-negative subtypes. Cyclin-dependent kinase 4 and 6 inhibitors (CDK 4/6is) alongside endocrine therapy (ET) have emerged as promising treatments for HR-positive/HER2-negative advanced and early BC. However, their efficacy, safety, and impact on quality of life (QoL) in older and frail patients remain underexplored. Methods: This position paper assesses the existing literature from 2015 to 2024, focusing on CDK4/6is use in patients aged 65 years and older with HR-positive/HER2-negative BC. Results: Our analysis methodically addresses critical questions regarding the utilization of CDK4/6is in the elderly BC patient population, organizing findings from the metastatic and adjuvant settings. In the metastatic setting, CDK4/6is significantly improve progression-free survival (PFS), paralleling benefits observed in younger patients, and suggest potential overall survival (OS) benefits, warranting further investigation. Despite an increased incidence of grade ≥ 3 adverse events (AEs), such as neutropenia and asthenia, CDK4/6is present a markedly lower toxicity profile compared to traditional chemotherapy, with manageable side effects. QoL analysis indicates that integrating CDK4/6is into treatment regimens does not significantly impact elderly BC patients’ daily life and symptom management. Special attention is given to frail subgroups, and personalized approaches are recommended to balance efficacy and adverse effects, such as starting with ET alone and introducing CDK4/6is upon progression in patients with a low disease burden. Transitioning to the adjuvant setting, early results, particularly with abemaciclib, indicate positive effects on disease-free survival (DFS), emphasizing the need for continued analysis to validate these findings and assess long-term implications. However, data on older patients are insufficient to conclude whether they truly benefit from this treatment. Conclusion: Overall, CDK4/6is present a favorable benefit-risk profile in older BC patients, at least in advanced BC; however, further research is warranted to optimize treatment strategies and improve outcomes in this population Full article

The latest progress in deep learning approaches has garnered significant attention across a variety of research fields. These techniques have revolutionized the way marine parameters are measured, enabling automated and remote data collection. This work centers on employing a deep learning model for the automated evaluation of tide and surge, aiming to deliver accurate results through the analysis of surveillance camera images. A mode of deep learning based on the Inception v3 structure was applied to predict tide and storm surges from surveillance cameras located in two different coastal areas of Italy. This approach is particularly advantageous in situations where traditional tide sensors are inaccessible or distant from the measurement point, especially during extreme events that require accurate surge measurements. The conducted experiments illustrate that the algorithm efficiently measures tide and surge remotely, achieving an accuracy surpassing 90% and maintaining a loss value below 1, evaluated through Categorical Cross-Entropy Loss functions. The findings highlight its potential to bridge the gap in data collection in challenging coastal environments, providing valuable insights for coastal management and hazard assessments. This research contributes to the emerging field of remote sensing and machine learning applications in environmental monitoring, paving the way for enhanced understanding and decision-making in coastal regions. Full article

It is essential to develop electromagnetic (EM) wave-absorbing materials with exceptional versatility to address a variety of applications, including anti-radar stealth, EM radiation protection, and EM interference shielding. EM wave absorption coatings, mainly composed of matrices and EM absorbers, have excellent practical performance. Researchers have been developing advanced EM absorption coating with properties like thin, light, broadband, and anti-aging. This review summarizes the recent progress in EM absorption coatings, including the design principles, feedstocks, manufacturing techniques, performance evaluation methods, and applications. Finally, the current challenges and future research directions are discussed. Full article

Gel-based materials have garnered significant interest in recent years, primarily due to their remarkable structural flexibility, ease of modulation, and cost-effective synthesis methodologies. Specifically, polymer-based conductive gels, characterized by their unique conjugated structures incorporating both localized sigma and pi bonds, have emerged as materials of choice for a wide range of applications. These gels demonstrate an exceptional integration of solid and liquid phases within a three-dimensional matrix, further enhanced by the incorporation of conductive nanofillers. This unique composition endows them with a versatility that finds application across a diverse array of fields, including wearable energy devices, health monitoring systems, robotics, and devices designed for interactive human-body integration. The multifunctional nature of gel materials is evidenced by their inherent stretchability, self-healing capabilities, and conductivity (both ionic and electrical), alongside their multidimensional properties. However, the integration of these multidimensional properties into a single gel material, tailored to meet specific mechanical and chemical requirements across various applications, presents a significant challenge. This review aims to shed light on the current advancements in gel materials, with a particular focus on their application in various devices. Additionally, it critically assesses the limitations inherent in current material design strategies and proposes potential avenues for future research, particularly in the realm of conductive gels for energy applications. Full article

With the ever-increasing focus on sustainable development, recycling waste and renewable use of waste products has earned immense consideration from academics and policy makers. The serious pollution, complex types, and strong infectivity of medical waste have brought serious challenges to management. Although several researchers have addressed the issue by optimizing medical waste management networks and systems, there is still a significant gap in systematically evaluating the efficiency of medical waste recycling systems. Therefore, this paper proposes a two-stage data envelopment analysis (DEA) approach that combines the virtual frontier and the global bounded adjustment measure (BAM-VF-G), considering both undesirable inputs and outputs. In the first stage, the BAM-G model is used to evaluate the efficiency of medical waste recycling systems, and the BAM-VF-G model is used to further rank super-efficient medical waste recycling systems. In the second stage, two types of efficiency decomposition models are proposed. The first type of models decompose unified efficiency into production efficiency (PE) and environment efficiency (EE). Depending upon the system structure, the second type of models decompose unified efficiency into the efficiency of the medical waste collection and transport subsystem (MWCS) and the efficiency of the medical waste treatment subsystem (MWTS). The novel approach is used to measure the efficiency of the medical waste recycling systems in China’s new first-tier cities, and we find that (1) Foshan ranks the highest in efficiency, followed by Tianjin and Qingdao, with efficiency values of 0.386, 0.180, and 0.130, respectively; (2) the EE lacks resilience and fluctuated the most from 2017 to 2022; and (3) the efficiency of MWCSs has always been lower than that of MWTSs and is a critical factor inhibiting the overall efficiency of medical waste recycling systems. Full article

In 1542, with the promulgation of the New Laws, Spanish authorities made a greater effort to eliminate indigenous slavery in America, after the doubts expressed by various missionaries about the treatment given to the indigenous people by Spanish settlers. However, legally sanctioned slavery among indigenous people continued in the border regions of the Spanish Empire. My interest is to demonstrate that the persistence of this practice did not result in a legal contradiction, but rather was a means of sanctioning rebellious indigenous groups, using arguments of Francisco de Vitoria and other School of Salamanca scholars, especially in places where control of sovereignty was in question. Methodologically, I will use original texts from various sources, such as the minutes of the Cabildo of the Audiencia of Guadalajara, as well as reports on the Chichimeca War by various clerics and jurists who witnessed the conflict, such as Guillermo de Santa María, Jean Focher, and Fulgencia Vique. Temporally, I will focus on the discussion of war and slavery against the nomadic peoples of northern New Spain, known as the Chichimecas. The result was that, for many New Spanish clerics, slavery would serve to punish the supposed crimes of these peoples against peace, and also to change their archaic customs and teach them sedentary and civil life. Finally, I argue that the establishment of indigenous slavery in the northern frontier of New Spain demonstrates the limitations of the Spanish Empire in maintaining its most remote borders, especially when faced with peoples who did not have a civil political life with definable centers and hierarchies. Full article

Inhaled ciprofloxacin (CFX) has been investigated as a treatment for lower respiratory tract infections (LRTIs) associated with cystic fibrosis (CF), chronic obstructive pulmonary disease (COPD), and bronchiectasis. The challenges in CFX effectiveness for LRTI treatment include poor aqueous solubility and therapy resistance. CFX dry powder for inhalation (DPI) formulations were well-tolerated, showing a remarkable decline in overall bacterial burden compared to a placebo in bronchiectasis patients. Recent research using an inhalable powder combining Pseudomonas phage PEV20 with CFX exhibited a substantial reduction in bacterial density in mouse lungs infected with clinical P. aeruginosa strains and reduced inflammation. Currently, studies suggest that elevated biosynthesis of fatty acids could serve as a potential biomarker for detecting CFX resistance in LRTIs. Furthermore, inhaled CFX has successfully addressed various challenges associated with traditional CFX, including the incapacity to eliminate the pathogen, the recurrence of colonization, and the development of resistance. However, further exploration is needed to address three key unresolved issues: identifying the right patient group, determining the optimal treatment duration, and accurately assessing the risk of antibiotic resistance, with additional multicenter randomized controlled trials suggested to tackle these challenges. Importantly, future investigations will focus on the effectiveness of CFX DPI in bronchiectasis and COPD, aiming to differentiate prognoses between these two conditions. This review underscores the importance of CFX inhalable formulations against LRTIs in preclinical and clinical sectors, their challenges, recent advancements, and future perspectives. Full article

Connected and automated vehicles (CAVs), integrated with sensors, cameras, and communication networks, are transforming the transportation industry and providing new opportunities for consumers to enjoy personalized and seamless experiences. The fast proliferation of connected vehicles on the road and the growing trend of autonomous driving create vast amounts of data that need to be analyzed in real time. Anomaly detection in CAVs refers to identifying any unusual or unforeseen behavior in the data generated by vehicles’ various sensors and components. Anomaly detection aims to identify any unusual behavior that might indicate a problem or a malfunction in the vehicle. To identify and detect anomalies efficiently, a method must deal with noisy data, missing data, dynamic frequency data, and low- and high-magnitude data, and it must be accurate enough to detect anomalies in a dynamic sensor streaming environment. Therefore, this paper proposes a fast and efficient hard-voting-based technique named FT-HV, comprising three fine-tuned machine learning algorithms to detect and classify anomaly behavior in CAVs for single and mixed sensory datasets. In experiments, we evaluate our approach on the benchmark Sensor Anomaly dataset that contains data from various vehicle sensors at low and high magnitudes. Further, it contains single and mixed anomaly types that are challenging to detect and identify. The results reveal that the proposed approach outperforms existing solutions for detecting single anomaly types at low magnitudes and detecting mixed anomaly types in all settings. Furthermore, this research is envisioned to help detect and identify anomalies early and efficiently promote safer and more resilient CAVs. Full article

Groundwater-influenced ecosystems (GIEs) are increasingly vulnerable due to groundwater extraction, land-use practices, and climate change. These ecosystems receive groundwater inflow as a portion of their baseflow or water budget, which can maintain water levels, water temperature, and chemistry necessary to sustain the biodiversity that they support. In some systems (e.g., springs, seeps, fens), this connection with groundwater is central to the system’s integrity and persistence. Groundwater management decisions for human use often do not consider the ecological effects of those actions on GIEs. This disparity can be attributed, in part, to a lack of information regarding the physical relationships these systems have with the surrounding landscape and climate, which may influence the environmental conditions and associated biodiversity. We estimate the vulnerability of areas predicted to be highly suitable for the presence of GIEs based on watershed (U.S. Geological Survey Hydrologic Unit Code 12 watersheds: 24–100 km²) and pixel (30 m × 30 m pixels) resolution in the Atlantic Highlands and Mixed Wood Plains EPA Level II Ecoregions in the northeastern United States. We represent vulnerability with variables describing adaptive capacity (topographic wetness index, hydric soil, physiographic diversity), exposure (climatic niche), and sensitivity (aquatic barriers, proportion urbanized or agriculture). Vulnerability scores indicate that ~26% of GIEs were within 30 m of areas with moderate vulnerability. Within these GIEs, climate exposure is an important contributor to vulnerability of 40% of the areas, followed by land use (19%, agriculture or urbanized). There are few areas predicted to be suitable for GIEs that are also predicted to be highly vulnerable, and of those, climate exposure is the most important contributor to their vulnerability. Persistence of GIEs in the northeastern United States may be challenged as changes in the amount and timing of precipitation and increasing air temperatures attributed to climate change affect the groundwater that sustains these systems. Full article

This systematic review examines studies focusing on tooth bleaching and its effects on healthy enamel or incipient caries and bacterial adhesion. The aim is to explore the impact of different bleaching agents on incipient caries lesions and healthy enamel. Clinical studies, in vitro studies, and observational studies that compared at least two groups were included. A search strategy was used to select studies from the MEDLINE via Pubmed and Scopus databases. Two evaluators performed data extraction, screening, and quality assessment independently. Only studies written in English were included. From 968 initial records, 28 studies were selected for a full-text evaluation. Of these, 7 studies were classified as cluster 1 (bacterial adherence on teeth), 12 studies as cluster 2 (no bacteria involved), 4 studies as cluster 3 (no teeth deployment), and 5 clinical studies were cluster 4. Of the selected studies, 6 (21.4%) supported increased bacterial attachment capacity and cariogenic dynamics, 4 (14.3%) decreased adhesion and cariogenic activity, 7 (25%) showed no difference, and 11 (39.3%) followed a different methodological approach and could not be categorized. The risk of bias appeared to be high, mainly because of the different methodologies in the studies, so we cannot reach a confident conclusion. Nevertheless, as far as carbamide peroxide bleaching is concerned, there does not seem to be a clinically significant alteration, neither in microorganism counts nor in enamel microstructure. Full article