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Bone tissue regeneration is a critical aspect of dental surgery, given the common occurrence of bone resorption leading to alveolar bone defects. The aim of this paper was to conduct a systematic review to provide a comprehensive summary of the evidence regarding the regenerative properties of dentin biomaterial. This systematic review was conducted through comprehensive searches in the PubMed, Scopus, and Web of Science databases, as well as an extensive exploration of the gray literature sources, including WorldCat, The New York Academy of Medicine Library, and Trip Database, following the established PRISMA protocol. Keywords such as tooth, dentin, grinder, and autograft guided the search, with a focus on a standardized procedure involving dentin grinders within laboratory, experimental, and clinical settings. Initially, a pool of 1942 articles was identified with 452 duplicates removed. An additional 1474 articles were excluded for not aligning with the predefined topics, and three more were excluded due to the unavailability of the full text. Ultimately, 13 articles met the strict inclusion criteria and were included in the review. The chemical composition of the dentin particles was similar to natural bone in terms of oxygen, carbon, calcium, phosphorus, sodium, and magnesium content, as well as in terms of the Ca/P ratio. In addition, the dentin also contained amide I and amide II structures, as well as aliphatic and hydroxyl functional groups. The chemically treated dentin was free of microorganisms. The dentin had characteristic tubules that opened after chemical treatment. At the cellular level, dentin released bone morphogenetic protein 2, induced significant cell growth, and stimulated the reorganization of the fibroblast cytoskeleton. Most clinical studies have focused on alveolar bone regeneration. After the transplantation of demineralized dentin particles, studies have observed new bone formation, a reduction in residual bone, and an increase in connective tissue. Clinical reports consistently indicate uncomplicated healing and recovery post-transplantation. However, there is a notable gap in the evidence concerning complication rates, patient-reported outcomes, and the presence of pro-inflammatory factors. In conclusion, dentin biomaterial emerges as a versatile bone substitute, demonstrating high biocompatibility and ease of acquisition. The preservation of its internal structure containing organic matter and growth factors enhances its potential for effective bone regeneration. Particularly, in dental surgery, dentin-derived materials present a promising alternative to traditional autologous bone autografts, offering the potential to reduce patient morbidity and treatment costs.

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Biomaterials and biopharmaceuticals for correcting large bone defects are a potential area of translational science. A new bioproduct, purified from snake venom and fibrinogen from buffalo blood, aroused interest in the repair of venous ulcers. Expanding potential uses, it has also been used to form biocomplexes in combination with bone grafts, associated with physical therapies or used alone. The aim of this preclinical study was to evaluate low-level laser photobiomodulation (PBM) in critical defects in the calvaria of rats filled with nanohydroxyapatite (NH) associated with the heterologous fibrin biopolymer (HFB). Sixty animals were used, divided into six groups (n = 10 each): G1 (NH); G2 (HFB); G3 (NH + HFB); G4 (NH + PBM); G5 (HFB + PBM); G6 (NH + HFB + PBM). PBM simultaneously used red (R) and infrared (IR) light emission, applied intraoperatively and twice a week, until the end of the experiment at 42 days. Microtomography, bone formation can be seen initially at the margins of the defect, more evident in G5. Microscopically, bone formation demonstrated immature and disorganized trabeculation at 14 days, with remnants of grafting materials. At 42 days, the percentage of new bone formed was higher in all groups, especially in G5 (HFB, 45.4 ± 3.82), with collagen fibers at a higher degree of maturation and yellowish-green color in the birefringence analysis with Picrosirius-red. Therefore, it is concluded that the HFB + PBM combination showed greater effectiveness in the repair process and presents potential for future clinical studies.

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PURPOSE: As the number of instrumented fusions increases, so does the utilization of bone substitutes. However, controversies persist regarding the effectiveness of ceramics in promoting solid fusion. Few histological studies have been conducted on patients to address this issue. To contribute insights into this topic, we assessed bony fusion both intraoperatively and histologically in patients who underwent posterolateral instrumented fusions enhanced with a biphasic ceramic compound. METHODS: We analyzed a series of 13 patients who underwent revision surgery due to adjacent segment disease following the initial use of ceramics as bone extenders in the index surgery. In each case, patients exhibited apparent radiological fusion in the instrumented posterolateral fusions. Follow-up exceeded 18 months. Bone fusion was assessed intraoperatively, and biopsies of the bone mass at the intertransverse area were examined under an optical microscope. RESULTS: Surgical exploration of the fusion block at the intertransverse space did not indicate solid fusion. Moreover, histological analysis of the 13 biopsies revealed a lack of proper integration of the bone substitutes, incomplete resorption of hydroxyapatite granules, and substitution of ceramic particles by immature fibrous tissue lacking the structural competence to bear loads or add stability to spinal fusion. CONCLUSION: The utilization of biphasic ceramics proved ineffective in attaining a proper fusion mass between the intertransverse space. Both surgical inspection and histological studies confirmed the absence of integration. Prudence should be exercised regarding the use of ceramics. While no clear instability was observed, neither was there any integration.

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INTRODUCTION: Dry eye disease (DED) is one of the most prevalent eye conditions worldwide, with artificial tears serving as a primary treatment option. Despite their wide availability on the European market, there is a lack of established classifications based on their physicochemical properties. The aim of our study was therefore (i) to develop an analytical method that measures the concentration and the molecular weight (MW) of the hyaluronic acid (HA) in commercialized products, and (ii) to propose an overview based on their various physicochemical parameters. METHODS: The intrinsic viscosity and MW of the HA, as well as osmolarity, pH, rheological profile, and viscosity, were measured or determined. A specific method was developed to measure the average intrinsic viscosity and HA content using a liquid size-exclusion chromatography system. The MW was determined using the Mark-Houwink equation. RESULTS: Thirty-seven products commercialized in Europe were analyzed, with 21 of them containing HA. The HA MW was lowest (300 kDa) for Thealose®, Thealoz Duo® Gel, and Hyabak®, and highest (1300 kDa) for Vismed® Multi, Vismed® Gel, and Neovis® Gel. The pH values varied between 5.94 for Treovis® and 8.06 for Systane® Ultra. Osmolarity ranged between 148 mOsm/L and 325 mOsm/L for Neovis® and Treovis®, respectively. Viscosity was highly variable, ranging from 0.38 mPas·s for Hylolipid® to 337.47 mPas·s for Thealoz® Duo Gel. Finally, rheological profile analysis revealed different shear-thinning behaviors. CONCLUSION: While the perfect eye drop does not exist, a multitude of options are available to choose from. This study improves our understanding of the major tear substitutes available on the European market based on several physicochemical properties. A better understanding and awareness of these parameters is crucial in order to offer the best treatment for patients with DED.

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Self-assembled fibrinogen nanofibers are promising candidates for skin tissue engineering due to their biocompatibility and ability to mimic the native blood clot architecture. Here, we studied the structure-property relationship and degradation of rehydrated fibrinogen nanofibers prepared by salt-induced self-assembly, focusing on the effect of scaffold layering, cross-linking time and freeze-drying. Optimal fiber stability was achieved with cross-linking by formaldehyde (FA) vapor, while treatment with liquid aldehydes, genipin, EDC, and transglutaminase failed to preserve the nanofibrous architecture upon rehydration. Scaffold layering did not significantly influence the mechanical properties but changed the scaffold architecture, with bulk fiber scaffolds being more compact than layered scaffolds. Freeze-drying maintained the mechanical properties and interconnected pore network with average pore diameters around 20 µm, which will enhance the storage stability of self-assembled fibrinogen scaffolds. Varying cross-linking times altered the scaffold mechanics without affecting the swelling behavior, indicating that scaffold hydration can be controlled independently of the mechanical characteristics. Cross-linking times of 240 min increased scaffold stiffness and decreased elongation, while 30 min resulted in mechanical properties similar to native skin. Cross-linking for 120 min was found to reduce scaffold degradation by various enzymes in comparison to 60 min. Overall, after 35 days of incubation, plasmin and a combination of urokinase and plasminogen exhibited the strongest degradative effect, with nanofibers being more susceptible to enzymatic degradation than planar fibrinogen due to their higher specific surface area. Based on these results, self-assembled fibrinogen fiber scaffolds show great potential for future applications in soft tissue engineering that require controlled structure-function relationships and degradation characteristics.

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Introduction: Globally, there is rising concern over the growing reliance on breast milk substitutes (BMSs). However, limited studies have been conducted to explore this issue in Ethiopia. Objective: To assess infant formula feeding and associated factors among mothers of infants aged 0-6 months in Debre Berhan City, 2023. Methods and materials: This cross-sectional study used a multistage sampling technique to select 656 mothers residing in Debre Berhan city. The data was collected through face-to-face interviews using a semi-structured questionnaire. Bivariable and multivariable logistic regression models were employed to identify the factors associated with infant formula feeding. The findings are then presented as frequencies, percentages, and odds ratios. Results: The prevalence of infant formula feeding in Debre Berhan city was 39.7 %. In addition, having a female child [AOR = 1.75, 95 % CI: 1.08-2.86], receiving a college education or higher [AOR = 5.79, 95 % CI: 2.38-14.08], being in the age category of 25-34 [AOR = 2.38, 95 % CI: 1.10-5.15] or 35-45 [AOR = 3.43, 95 % CI: 1.35-8.69], being a prime mother [AOR = 1.81, 95 % CI: 1.12-2.94], receiving breastfeeding advice [AOR = 4.64, 95 % CI: 2.78-7.75], delivering via a C-section [AOR = 5.39, 95 % CI: 2.54-11.42], initiating breastfeeding late [AOR = 2.26, (95 % CI: 1.41-3.64)], or being unaware of the risks associated with infant formula feeding [AOR = 5.48, 95 % CI: 3.20-9.39] were the factors that drove mothers towards infant formula feeding. Conclusion: In Debre Berhan city, the prevalence of infant formula feeding was high. Fortunately, with appropriate interventions, most of the factors that led to infant formula feeding could be effectively addressed.

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Arterial hypertension remains the most important modifiable cardiovascular risk factor for morbidity and mortality worldwide. This review summarizes and discusses major clinical trials published in 2023 and early 2024 in hypertension research. These trials include new epidemiological data, studies investigating the impact of blood pressure cuff size on blood pressure measurements, benefits of salt substitutes, and novel antihypertensive treatment options, including pharmacotherapy and bariatric surgery in patients with obesity. This summary reviews the major clinical trials published in 2023 and early 2024. AHT arterial hypertension, BP blood pressure, HR hazard ratio, OBP office blood pressure, PRA plasma renin activity, SBP systolic blood pressure.

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Background: This article informs about the state of breastfeeding in Ukraine after more than 2 years of war. The article presents important information on breastfeeding data, the widespread implementation of the baby-friendly hospital initiative, human milk banks working in difficult situations, the first overestimation of breast milk substitute needs, the International Code, and the presence of donations reaching an overburdened health system. It covers the training of health care professionals as well as counseling in wartime. Conclusion: It is a testimony of important work done on different levels of the Ukrainian population as well as among the aid agencies present and the health system to protect and support breastfeeding for infants and mothers' health in a war situation. The acquired breastfeeding knowledge through BFHI training of health care professionals and the whole package of BFHI measures is important for ensuring the health and survival of children.

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The synergistic effects between xanthan gum (XG) and ß-cyclodextrin (ß-CD) on the properties and stability of vegetable oil-based whipped cream stabilized by kidney bean protein aggregates was investigated. The visual appearance, SEM, TEM, CLSM, FT-IR and LF-NMR results showed that when the ratio of XG to ß-CD in the XG-ß-CD complex was appropriate, the hydrogen bonding effect between ß-CD and XG was significant enhanced, the three-dimensional network structure has the highest density, the emulsion droplets were the smallest and evenly distributed. The unique tapered microstructure of ß-CD acted as a bridge between the hydrophilic and hydrophobic components, effectively preventing the aggregation of oil droplets and establishing a flexible support system between oil droplets; while the flexible molecular structure of XG could support Pickering emulsion system. The XG-ß-CD complex had a synergistic effect with protein aggregates, making it ideal for use in whipped cream products. This study explored the stability mechanism of ß-CD in the Pickering emulsion-based whipped cream system, providing valuable insights into producing whole plant-based whipped cream by texturizing highly unsaturated oils. This effectively solves the problem of inadequate intake of unsaturated oil for individuals who consume excessive amounts of animal-derived fats.

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This research evaluated the occurrence and bioaccessibility of acrylamide and HMF in commercial instant coffees (IC) and coffee substitutes (CS), considering both isolated consumption and combination with milk. There were no significant differences in acrylamide content between IC and CS samples (median: 589 vs. 671 µg/kg), but higher variability was reported for CS, probably due to their varied composition (roasted cereals, nuts, honey, dehydrated fruits, and/or chicory). Acrylamide level were always below the EU benchmark for each category. HMF contents were similar between both groups (1354-5127 mg/kg for IC and 735-7134 mg/kg for CS; median: 2890 vs. 2960 mg/kg), with no clear ingredient relationship. Since IC consumption by the Spanish population is ten times higher than that of CS, exposure to acrylamide and HMF was higher from IC (6.8 vs. 1.07 ng/kg body weight/day for acrylamide; 39.1 vs. 4.2 µg/kg body weight/day for HMF). The standardized in vitro gastrointestinal digestion protocol (INFOGEST) was used. The gastrointestinal process reduced the bioaccessibility of acrylamide up to 27.2 % in IC and to 22.4 % in CS, regardless of the presence of milk. HMF bioaccessibility from IC significantly dropped after the gastrointestinal digestion, whereas it greatly increased for CS. The presence of milk did not affect HMF bioaccessibility. These results highlight the importance of assessing food bioaccessibility in typical consumption scenarios, providing a holistic view and a realistic evaluation of the potential risks associated with acrylamide and HMF exposure in the diet.

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AIM: The aim of this systematic review and meta-analysis was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when hyaluronic acid (HA) was added and mixed with graft materials in bone regeneration. MATERIALS AND METHODS: This review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) of the National Institute of Health Research (registration number CRD42024530030). Electronic research was performed, and involved studies published up to 29 February 2024 using a specific word combination. The primary outcome was to assess possible histomorphometric differences in new bone formation and in remaining graft particles when HA was added and mixed with graft materials in bone regeneration. The search resulted in 138 potential studies. Meta-analyses were performed using the fixed and random effects model to identify significant changes in new bone formation and in the remaining graft particles. RESULTS: After screening procedures, only three randomized controlled trials fulfilled the inclusion criteria and were selected for qualitative and quantitative analysis. The effect size of HA in the new bone formation was not statistically significant at 95% CI (Z = 1.734, p-value = 0.083, 95 % CI -,399; 6516). The effect size of HA in the remaining graft particles was not statistically significant at 95% CI (Z = -1.042, p-value = 0.297, CI -,835; 255). CONCLUSIONS: Within the limitations of the present systematic review and meta-analysis, the addition of HA to bone graft did not result in significant changes in bone regeneration procedures in terms of new bone formation and residues, even if the included studies showed encouraging and promising results.

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The use of dermal substitutes with subsequent skin graft application constitutes an alternative treatment option in situations that limit the use of other conventional approaches.

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BPA and its analogues are facing increasingly stringent regulations restricting their use due to the increasing knowledge of their harmful effects. It is therefore expected that novel BPA analogues and alternatives will replace them in plastic products, cans and thermal paper to circumvent restrictions imposed by legislation. This raises concerns about the safety of "BPA-free" products, as they contain BPA substitutes whose safety has not been sufficiently assessed prior to their market introduction. The regulatory agencies have recognised BPAP, BPBP, BPC2, BPE, BPFL, BPG, BPP, BPPH, BPS-MAE, BPS-MPE, BP-TMC, BPZ and the alternatives BTUM, D-90, UU and PF201 as compound with insufficient data regarding their safety. We demonstrate that the mentioned compounds are present in consumer products, food and the environment, thus exhibiting toxicological risk not only to humans, but also to other species where their toxic effects have already been described. Results of in silico, in vitro and in vivo studies examining the endocrine disruption and other effects of BPA analogues show that they disrupt the endocrine system by targeting various nuclear receptors, impairing reproductive function and causing toxic effects such as hepatotoxicity, altered behaviour and impaired reproductive function. In vitro and in vivo data on BPA alternatives are literally non-existent, although these compounds are already present in commonly used thermal papers. However, in silico studies predicted that they might cause adverse effects as well. The aim of this article is to comprehensively collate the information on selected BPA substitutes to illustrate their potential toxicity and identify safety gaps.

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OBJECTIVE: The use of extracted teeth has been introduced as an option for bone grafting. However, the current method requires special machines and solutions, posing significant time and cost. The aim of this study was to evaluate the clinical performance of autogenous raw tooth particles (RTP), a grafting material made from a ground tooth using basic equipment, for alveolar ridge preservation. MATERIALS AND METHODS: Twenty-three patients (12 study/11 control), having 14 and 13 sites were included for the study and control groups (commercially available xenograft), respectively. Radiographic measurements were taken at the baseline and the 4-month follow-up appointment. Furthermore, a questionnaire survey concerning the general preference of the type of graft to receive (if needed), before and after knowing the price, was distributed at the completion of the procedure for patients to answer. RESULTS: Alveolar ridge width change was -1.03 ± 0.64 and -0.84 ± 0.35 for the study and the control groups, respectively. Regarding the height, the study group showed a buccal and lingual change of -0.66 ± 0.48 and -0.78 ± 0.81, respectively, while this was -0.78 ± 0.56 and -0.9 ± 0.41 for the xenograft group. There was no statistically significant difference between the groups. Patients preferred the raw tooth particles over other grafting materials (p = .01). CONCLUSION: No core biopsies were taken to evaluate bone formation, which should be done in future studies. Within its limitations, the current study demonstrated that RTP graft could be an alternative graft for bone augmentation, offering a new cost-effective option for clinicians when available.

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Spina bifida is a congenital neural tube closure defect, with myelomeningocele being the most clinically significant open neural tube defect occurring in one in 1000 births worldwide as reported by Phillips LA et al. (Curr Probl Pediatr Adolesc Health Care 47(7):173-177, 2017) and Zerah M and Kulkarni AV (Handb Clin Neurol 112:975-991, 2013). With advances in fetal surgery, this condition can be corrected in utero. Despite such precision surgery, many complications may still arise, with consequent spinal cord tethering being a major one. When the roots of the spinal cord adhere to the spinal canal instead of floating freely within the dural sleeve within the canal, it is termed as "tethering" as discussed by Martínez-Lage JF et al. (Neurocirugia (Astur) 18(4):312-319, 2007). Tethering has a variety of complications, which are best avoided by analyzing the outcomes of the different dural substitutes and improving surgical techniques. This literature review evaluates the use of different dural substitutes in fetal and postnatal surgery, with their effects on spinal cord tethering. Finding a significant difference in spinal cord adherence outcomes between these two groups can help one introspect on the impact of ideal surgical techniques to be implemented, thus reducing subsequent tethering and other future surgical interventions.

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BACKGROUND: A prebiotic is defined as an indigestible feed substance that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the large intestine, thereby improving host health and products. OBJECTIVES: This study was conducted to determine the effects of supplementing prebiotic fructooligosaccharide (FOS) to the diets of Hy-Line W-36 laying hens. METHODS: A total of 168 Hy-Line W-36 laying hens were allocated to four dietary levels of FOS (0, 1.0, 2.0, 3.0 g/kg diet), 6 replicates of 7 birds each during 63-74. The experiment was performed using a completely randomized design. RESULTS: Productive performance was not significantly affected by the FOS supplementation. Body weight gain was linearly decreased with increasing FOS levels in the diet (p < 0.01). However, eggshell strength, shell thickness and Ca and p percentages were not significantly affected, as were anti-sheep red blood cell titres, blood parameters and blood metabolites. In the first period of the experiment (63-65 weeks), shape index and Haugh unit at the dose of 3.0 g/kg FOS were significantly increased and decreased in comparison with control, respectively (p < 0.05). In the third and fourth periods (69-71 and 72-74 weeks of age), the FOS had no significant effect on the internal egg quality traits. Furthermore, FOS had a linear decrease in the most saturated fatty acids (SFAs), including myristic, palmitic, margaric and stearic fatty acids; some of the mono-un-SFA (MUFA; palmitoleic and ginkgolic acids), and poly-unsaturated fatty acids (γ-linolenic and eicosatrienoic). CONCLUSIONS: Supplementing different levels of FOS to the diet of commercial laying hens had no significant effect on the layers' performance, immune response and blood parameters, whereas there was a significant effect on some of the internal egg quality traits and egg yolk fatty acid contents.

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Hexafluoropropylene oxide (GenX) is a kind of substitute to PFOA, which has been listed in the Stockholm Convention. In this study, GenX was attempted to be degraded using a boron-doped diamond anode in the electrochemical oxidation system. The effects of operating parameters, including current density (0.5-10 mA/cm2), initial pH (3.0-11.49), initial concentration of GenX (20-150 mg/L), electrode distances (0.5-2 cm), electrolyte types (Na2SO4, NaCl, NaNO3 and NaHCO3) and Na2SO4 electrolyte concentration (40-80 mm), on GenX were studied. GenX can almost completely be degraded under the optimal operating parameters after 180 min of electrolysis. Free radical quenching experiments were carried out to investigate the effects of hydroxyl radicals and sulphate radicals on the degradation of GenX. The degradation intermediates were identified based on the ultra-high performance liquid chromatography equipped with a tandem mass spectrometer, and the degradation mechanisms were also proposed. Finally, the toxicities of GenX and its degradation products were evaluated using the QSAR models. The novelty is that the degradation mechanisms of the high concentration GenX (100 mg/L) were elucidated based on the free radical quenching experiments and the intermediates detected, when the degradation ratio reached 100%.

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Owning to the increasing body of evidence about the ubiquitous exposure to endocrine disruptors (EDCs), particularly bisphenol A (BPA), and associated health effects, BPA has been gradually substituted with insufficiently tested structural analogs. The unmanaged excessive use of antimicrobial agents such as triclosan (TCS) during the COVID-19 outbreak has also raised concerns about its possible interferences with hormonal functions. The similarity of BPA and estradiol, as well as TCS and non-steroidal estrogens, imply that endocrine-disrupting properties of their analogs could be predicted based on the chemical structure. Hence, this study aimed to evaluate the endocrine-disrupting potential of BPA substitutes as well as TCS derivatives and degradation/biotransformation metabolites, in comparison to BPA and TCS based on their molecular properties, computational predictions of pharmacokinetics and binding affinities to nuclear receptors. Based on the obtained results several under-researched BPA analogs exhibited higher binding affinities for nuclear receptors than BPA. Notable analogs included compounds detected in receipts (DD-70, BTUM-70, TGSA, and BisOPP-A), along with a flame retardant, BDP. The possible health hazards linked to exposure to TCS and its mono-hydroxylated metabolites were also found. Further research is needed in order to elucidate the health impacts of these compounds and promote better regulation practices.

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Introduction Small compounds like L-leucine can boost bone regrowth by blocking certain effects, sparking cell reactions through signaling sequences. This research explored how combining L-leucine with hyaluronic acid on the developed novel graft material affects the bone's ability to conduct bone-building processes. Material and methods This study was designed as an in-vitro experiment, where a novel bone graft was formulated by integrating L-leucine with hyaluronic acid and incorporated into a hydroxyapatite-based ovine bone graft material. The sintering procedure was modified to include the amino acid L-arginine. Comprehensive examinations were executed using methodologies such as scanning electron microscopy, X-ray diffractometry, Fourier-transform infrared spectroscopy (FTIR), MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, and bone formation assay. These analyses were juxtaposed with the characteristics of the commercially accessible unaltered Bio-Oss, focusing on their physicochemical properties. The properties were compared with a commercially available bone graft material. Results The sintered hydroxyapatite/L-leucine graft displayed an interconnected pore structure, indicating that higher sintering and consolidation affected hydroxyapatite, as observed through scanning electron microscopy. X-ray diffraction (XRD) analysis confirmed hydroxyapatite in the sintered ovine bone samples, affirming their suitability for various biomedical applications. In the bone formation assay, optical density (OD) values were 61% for the hydroxyapatite/L-arginine graft, 58% for the Bio-Oss group, and 51% for the control group. The MTT assay, which assesses cell viability and metabolic activity, demonstrated biocompatibility and cell growth for all samples at 24 hours. Conclusion The research noted beneficial outcomes by incorporating L-leucine into the novel bone graft material with hyaluronic acid for bone grafting, demonstrating enhanced compatibility with existing bone tissue. However, the specific advantages of this combined approach are not fully known. It is essential to conduct more studies to uncover how this synergy works, assess its prolonged impacts, carry out clinical tests, and enhance the effectiveness of this blend for practical applications in bone graft surgeries.

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Breastfeeding rates in Vietnam, and globally, remain suboptimal. A major contributor to this is the aggressive marketing of commercial milk formulas (CMF), mainly through online media. The Vietnamese Government has implemented legal measures to limit CMF marketing, but these have been difficult to enforce, because of complex online environments. We aimed to quantify the extent and nature of online violations and contradictions in various Vietnamese laws related CMF marketing over 12 months in 2022. Using a cross-sectional study design, we used an artificial intelligence-enabled virtual violations detector (VIVID) to monitor official websites and social media pages of 25 breastmilk substitute (BMS) merchandise and distributors, every day for 12 months in 2022. Data were summarised descriptively. We detected more than 3000 online advertisements that violated or contradicted the intent of Vietnamese laws, involving almost 7000 violations of various articles within these laws (average 9.5 violations per day). More than 700 detections were related to CMF products being registered as "supplementary foods" or similar, thereby circumventing Vietnamese CMF marketing laws, because they are not registered as "BMS products. We demonstrate the need to strengthen the design, monitoring and enforcement of existing Vietnamese laws to eliminate mothers" exposure to the exploitative digital marketing of CMF. By turning a highly resource-intensive task into one that is, automated requiring substantially less resources, our study represents the most comprehensive in Vietnam and internationally on the extent and nature of the online marketing of BMS. VIVID can be applied worldwide to hold industry accountable for the inappropriate marketing of CMF.