Xerostomia is a common oral manifestation of type 2 diabetes mellitus (T2DM) and may reflect alterations in salivary gland function associated with chronic metabolic dysregulation. Oral dryness can negatively affect mastication, speech, oral comfort, and quality of life, highlighting the need for reliable patient-reported assessment tools. This study aimed to assess xerostomia in adults with T2DM and to translate, culturally adapt, and validate the Romanian version of the Summated Xerostomia Inventory (SXI). A cross-sectional study was conducted in 132 adults with T2DM recruited from a tertiary diabetes outpatient center in Romania. Translation and cross-cultural adaptation followed COSMIN recommendations. Participants completed the Romanian SXI, a global xerostomia question, and a Visual Analog Scale (VAS) for oral dryness. Unstimulated whole salivary flow rate (UWSFR) was additionally measured. Internal consistency, test-retest reliability, concurrent validity, convergent validity, and feasibility were evaluated. The mean SXI score was 9.58 ± 3.82. Xerogenic medication use was reported by 87.1% of participants, while hyposalivation was identified in 9.1%. Xerostomia-related manifestations included oral burning sensation (21.2%), speech difficulties associated with oral dryness (20.5%), and suspected sleep apnea or habitual snoring (26.5%). The Romanian SXI demonstrated excellent psychometric performance, with high internal consistency (Cronbach's α = 0.90), corrected item-total correlations ranging from 0.56 to 0.86, and excellent test-retest reliability (ICC = 0.975). Mean SXI scores increased significantly across xerostomia severity categories (p < 0.001), and a very strong positive correlation was observed between SXI and VAS scores (Spearman's r = 0.93, p < 0.001). No significant floor or ceiling effects were detected. Xerostomia-related symptoms were common among adults with T2DM, supporting the importance of routine assessment of oral dryness in diabetes care. The Romanian version of the SXI demonstrated excellent validity, reliability, and feasibility and provides a practical instrument for the evaluation and monitoring of xerostomia in Romanian-speaking adults with T2DM. Beyond its application in diabetes care, the Romanian SXI may facilitate the assessment of xerostomia in other populations affected by salivary gland dysfunction, supporting future clinical practice, epidemiological research, and cross-cultural studies in Romanian-speaking populations.
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Individual and relational factors have been found to facilitate infidelity, yet the psychological dynamics linking personality traits and relationship quality to extradyadic infatuation - the cognitive, affective, and motivational preoccupation with someone other than the romantic partner - remain largely unexplored. The aim of our cross-sectional study was to explore the predictive roles of different individual factors (i.e., Dark and Light Triad traits and sociosexuality) and one relationship characteristic (i.e., relationship satisfaction) on extradyadic infatuation. A sample of 303 Romanians in a current committed relationship, aged between 19 and 64 (M = 37.82, SD = 11.41), filled in measures of Dark and Light Triad traits, sociosexuality, relationship satisfaction, extradyadic infatuation, and personal and relationship demographics. Multiple regression analyses indicated that higher levels of humanism, psychopathy, and sociosexuality, along with lower levels of faith in humanity, Machiavellianism, and relationship satisfaction, significantly predicted extradyadic infatuation, controlling for gender, age, Kantianism, and narcissism. These findings indicate that extradyadic infatuation arises from a complex interplay of various traits and relationship dynamics. It is not solely attributed to socially undesirable characteristics; instead, it also involves traits that are generally considered positive.
Hereditary angioedema is a rare but potentially life-threatening disorder in which outcomes depend not only on correct diagnosis and effective medicines, but also on how health systems organize referral, laboratory confirmation, emergency pathways, reimbursement, home treatment, and long-term follow-up. Selected health systems in the Balkan Peninsula area provide a particularly informative setting for health-system comparison because neighboring countries with active hereditary angioedema expertise differ substantially in rare-disease governance, registry maturity, diagnostic infrastructure, treatment coverage, and patient-organization capacity. This Policy and Practice Review synthesizes international guidance, published regional literature, comparative country information from the Balkan Experts in Angioedema: Consensus and Ongoing Navigation (BEACON) initiative, and advocacy-informed implementation insights to assess current care delivery in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Romania, Serbia, Slovenia, and Türkiye. Across the region, the most consistent problems are prolonged diagnostic delay, unequal access to complement and genetic testing, approved-but-not-reimbursed modern therapies, hospital-only access to rescue medication, uneven use of home treatment and self-administration, incomplete emergency preparedness, and variable registry and advocacy infrastructure. Countries with stronger alignment between policy frameworks, specialist centers, registries, reimbursement pathways, and patient organizations appear better positioned to deliver guideline-concordant care, whereas fragmentation at any point in the care pathway reduces the practical value of therapeutic advances. The review argues that the main barriers to equitable hereditary angioedema care across the included health systems are now predominantly regulatory, financing, organizational, and educational rather than scientific. We therefore propose actionable recommendations for ministries and payers, specialist centers and professional societies, emergency-care systems, registry stakeholders, and patient organizations, with the goal of converting regional heterogeneity into a structured quality-improvement agenda.
This work is a result of a pilot study integrated in an international project of collaboration and consists in the developing a comprehensive methodological framework to investigate the multifactorial nature of corrosion in hospitals across Spain, Romania and Turkey. By integrating multidisciplinary perspectives from engineering, materials science and law, the program prepares participants to address corrosion challenges through both technical competence and regulatory awareness. This pilot study conducted at Dr. Negrin Hospital (Spain) validated the methodology, involving 3 hospital professionals and 11 students with 3 academic staff from the University of Las Palmas de Gran Canaria. The study included environmental monitoring, laboratory experiments on electrochemical behavior and protective strategies against corrosion. Representative functional zones (including operating rooms, sterilization units, HVAC systems, intensive care units and patient wards) were instrumented with environmental monitoring devices to record pollutants, temperature, humidity and particulate matter. Metal coupons made of stainless steel, carbon steel, aluminum and zinc were exposed under simulated hospital conditions to assess corrosion rates. Data analysis combined quantitative and qualitative approaches to ensure methodological feasibility and reliability. The results emphasize that corrosion in healthcare settings has significant technical, economic and legal implications. Preventive strategies and continuous monitoring can reduce maintenance costs, enhance patient safety and ensure regulatory compliance. Ultimately, this work underscores the importance of multidisciplinary education and international collaboration in developing sustainable corrosion management practices for modern healthcare infrastructure.
Enterococci are commensal bacteria of the digestive and genitourinary flora of humans and animals. In humans, enterococci can cause sepsis of urinary or abdominal origin. Compared to Enterococcus faecium and Enteroccocus faecalis, Enterococcus thailandicus is one of the least characterized members of the genus Enterococcus. E. thailandicus has been rarely associated with human pathology. We describe the first report of E. thailandicus in respiratory samples, and the third one in an intra-abdominal infected collection. Clinical isolates of E. thailandicus were cultured on Luria-Bertani medium at 37°C for 24 h. A review of the current literature regarding E. thailandicus in humans was performed. All published contributions on PubMed were found using the term ''Enterococcus thailandicus''. We describe a 73-year-old patient with acute abdomen due to duodenal perforation. After surgical and endoscopic treatment, the patient developed pneumonia. Bronchoscopy showed diffuse purulent secretions and raised, cream-coloured pseudomembranes. Microbiological analysis from a subhepatic collection and respiratory samples identified E. thailandicus. Following adequate antibiotic treatment, the patient recovered. After six reports from Belgium, Romania, Spain, Germany and Japan, this is the seventh case of E. thailandicus in humans. The current case describes the first report of E. thailandicus in respiratory samples in a critically ill patient and adds further evidence on the possible pathological impact of this bacterium in humans. Although E. thailandicus has a low clinical virulence today, continuous reporting of new potential pathogens could increase our understanding and improve interpretation of the role of rare enterococci in human pathology.
Cytauxzoon banethi is one of the least characterized members of the genus Cytauxzoon and has so far been reported only from two European wildcats (Felis silvestris) in Romania. Consequently, its host range and geographic distribution remain poorly understood. In the present study, we molecularly characterized a Cytauxzoon isolate detected in a free-ranging striped hyena (Hyaena hyaena) from western Iran. Genomic DNA extracted from blood was analyzed by PCR amplification and sequencing of partial 18S rRNA and mitochondrial cytochrome b (cytb) genes. The 18S rRNA sequence was identical to published C. manul sequences and highly similar to several other Cytauxzoon species, confirming the limited species-level resolution of this conserved marker. In contrast, direct comparison of the cytb sequence with the available C. banethi reference sequence revealed only five synonymous nucleotide substitutions across 1,089 aligned positions (99.5% identity). Phylogenetic analysis of the cytb dataset placed the obtained isolate within the C. banethi lineage as the sister taxon to C. manul, supporting its identification as C. banethi. To the best of our knowledge, this represents the first molecular detection of C. banethi in a member of the family Hyaenidae, the first record in a non-felid feliform host, the first report from Iran and Asia, and the first detection of this species outside Europe. These findings expand the currently recognized host range and geographic distribution of C. banethi and emphasize the importance of multilocus molecular approaches and broader wildlife surveillance for improving our understanding of the diversity and evolution of Cytauxzoon species in general, and for better assessing the genetic diversity and taxonomic boundaries of C. banethi.
The measurement of cytokines in serum, milk, and saliva is advancing rapidly, especially for non-invasive health monitoring, stress evaluation, and disease diagnosis in bitches. This study aimed to evaluate the potential of a cytokine panel in serum, milk, and saliva in bitches with pseudopregnancy (PSG; n = 11) and compare their values to those observed in bitches with subclinical mastitis (SM; n = 7) and healthy lactating bitches (n = 6). Results showed that, in serum, only keratinocyte-derived chemokine (KC)-like protein levels differed significantly between groups (P < 0.05), being lower in pseudopregnancy and subclinical mastitis compared to healthy dogs (P < 0.05). Conversely, in milk, bitches with pseudopregnancy had higher levels of GM-CSF, IFNg, IL2, IL7, IL10, IL15, IL18, IP10, and TNFalpha than those with SM or healthy controls. These findings indicate that pseudopregnancy, a common clinical condition, involves a significant localized inflammatory response and should be actively managed rather than regarded as purely physiological.
Hypersaline environments constitute ideal systems for studying evolutionary processes and microbial diversification due to their relatively low (and thus tractable) diversity and geographically isolated nature. Based on metagenomic sequencing of samples from 25 hypersaline sites in 11 countries taken within a single year, we explored the relationships between environmental factors, geographic distance, and microbial community structure and diversification. Our results revealed that microbial communities of coastal sites were more similar to each other than those of the inland sites, reflecting higher connectivity due to ocean currents and nearly unrestricted dispersal. Conversely, inland hypersaline environments showed less connectivity and higher genetic and taxonomic dissimilarities that did not correlate with the distance between the sampled sites. The latter results reflect reduced species migration characterizing inland sites as well as site-specific environmental factors selecting for divergent taxa. The 484 MAGs recovered, representing 284 distinct species, revealed a striking global ubiquity, with 62.5% of the species showing cosmopolitanism, defined as being present at both coastal and inland sites. Most cosmopolitan species showed allopatric differentiation, reflected by an increased frequency of non-synonymous substitutions between MAGs of the same species recovered from more distant sites. However, a few cases of truly cosmopolitan genomovars (average nucleotide identity, or ANI > 99.8%), were also observed. Our results suggest that extreme halophiles have nearly unrestricted global dispersal among ocean-connected sites, and to a lesser extent, among geographically isolated inland sites, although cases of allopatric diversification were also observed.
Fermentation is among the oldest biotechnological processes and a modern platform for precision metabolic engineering, enabling the targeted production of health-promoting metabolites. The human gut microbiota, with its complex enzymatic potential, converts dietary substrates into a wide range of bioactive molecules, including short-chain fatty acids, vitamins, neuroactive compounds, and polyphenol-derived metabolites that influence host metabolism, immunity, and neurological functions. Advances in microbial genomics, systems biology, and synthetic biology now allow the design of fermentation processes and engineered microbial strains capable of producing specific metabolites with improved bioavailability and tailored health effects. Precision fermentation integrates traditional microbial fermentation with genome editing, metabolic flux optimisation, and AI-assisted pathway design to achieve predictable yields of vitamins, polyphenols, bioactive peptides, and long-chain polyunsaturated fatty acids. These innovations create opportunities to develop functional foods, nutraceuticals, and personalized nutrition strategies that match metabolite profiles to an individual's microbiome composition. This chapter explores the mechanistic links between microbial metabolism and host health, reviews emerging fermentation technologies for targeted metabolite production, and highlights industrial case studies demonstrating the transition of precision fermentation from research to commercial applications.
Bispecific antibodies(BsAbs) are a novel class of therapy for relapsed/refractory multiple myeloma (RRMM), leading to deep and durable responses in heavily pretreated patients. Their use is associated with a high burden of infections, particularly with anti-BCMA-targeting agents. This retrospective, single-center study included 50 RRMM patients treated with anti-BCMA or anti-GPRC5D BsAbs, of whom 13 received both agents because of disease progression. Standard prophylactic strategies included vaccination, antimicrobial prophylaxis, and, in selected patients, subcutaneous immunoglobulin (SCIg). Overall, 78% of patients received prior vaccinations and those with ≥3-4 vaccines exhibited the lowest infection-related mortality (23.4%, respectively 6.7%). We analyzed 121 infectious episodes recorded during the study period, of which 45.5% were severe (grade ≥3). The respiratory tract was the most affected site (65%), by viral (43%) and bacterial (45%) etiologies. Anti-BCMA BsAb were associated with a higher incidence and severity of infections, as well as a shorter median time to first infection compared with anti-GPRC5D therapy (2.3 vs 3.8 months). Infectious complications occurred throughout the course of therapy, with the highest risk observed early after treatment initiation, while remaining clinically relevant during prolonged follow-up. Infection-related mortality was the second leading cause of death (34%), after disease progression. Multivariable analyses showed that male sex and patients with high-risk disease were associated with increased infection risk.
Wilson disease (WD) is an autosomal recessive disorder caused by mutations in the ATP7B gene, resulting in impaired biliary copper excretion and progressive copper accumulation in multiple tissues. Ocular manifestations represent some of the most characteristic and clinically valuable features of the disease, contributing to diagnosis, monitoring, and assessment of neurological involvement. This narrative review summarizes current knowledge regarding the pathophysiology, clinical presentation, and imaging characteristics of ocular involvement in WD. Copper deposition within the eye occurs primarily through the aqueous humor, leading to accumulation in the corneal Descemet membrane and lens capsule. Kayser-Fleischer rings remain the most prevalent ocular sign being strongly associated with neurological disease, while sunflower cataracts represent a less common but highly characteristic manifestation. Anterior segment optical coherence tomography and in vivo confocal microscopy have recently improved the detection and monitoring of these lesions. Beyond copper deposition, growing evidence indicates that WD is associated with retinal and optic nerve neurodegeneration. Optical coherence tomography studies consistently demonstrate thinning of the retinal nerve fiber layer, ganglion cell complex, and macular structures, particularly in patients with neurological involvement. Electrophysiological investigations, including visual evoked potentials and electroretinography, reveal delayed neural conduction and retinal dysfunction, supporting the concept of widespread neuro-ophthalmological impairment. Optical coherence tomography angiography further identifies microvascular alterations affecting retinal and peripapillary capillary networks. Importantly, several ocular abnormalities correlate with neurological severity and may serve as non-invasive biomarkers of disease progression. Current treatments, including copper chelators and zinc therapy, can induce regression of Kayser-Fleischer rings and sunflower cataracts. Ocular assessment therefore provides a valuable window into systemic and neurological disease activity, highlighting the importance of multidisciplinary management and the potential role of emerging imaging biomarkers in Wilson disease.
Although psychosocial interventions delivered by non-specialist providers effectively treat common mental disorders such as depression and anxiety, the treatment-specific elements driving their efficacy remain largely unknown. Our aim was to compare and rank the efficacy of the individual active components of task-shared psychosocial interventions and to predict efficacy using individual participant characteristics. We performed a systematic review and Bayesian individual participant data component network meta-analysis of RCTs comparing different task-shared psychosocial interventions with control conditions for the treatment of adults with common mental disorders. We searched MEDLINE, Embase, PsycINFO, and CENTRAL from database inception to March 15, 2023. We included additional datasets published up to May 29, 2026 and unpublished RCTs. We sought individual participant data from the trial authors. A purpose-built taxonomy of treatment-specific elements was used to dismantle interventions into their constituent components. The primary outcome was efficacy in reducing symptoms of common mental disorders, as measured at study endpoint. We used incremental mean difference to indicate the added benefit (or detrimental effect) of adding a component to a treatment. We assessed the risk of bias of the included studies with the revised Cochrane Risk of Bias tool. The protocol was published in a peer-reviewed journal. We included 34 RCTs, from which 30 trials (89%) contributed individual participant data from 10 612 participants. Of these participants, 7662 were women (72·2%) and 2950 were men (27·8%). The mean age of participants was 36·7 years (SD 5·5). Findings identified strengthening social support (incremental mean difference -9·48; 95% credible interval [CrI] -13·29 to -6·60), behavioural activation (-4·15; -7·48 to -0·05), and problem management (-4·08; -5·37 to -2·83) as the most beneficial components. Relaxation (7·97; 3·35 to 12·11) and, less clearly, cognitive reframing (5·17; 0·78 to 9·15) were identified as detrimental components. Interaction analyses revealed that component effects vary systematically by baseline severity and other sociodemographic characteristics. Ethnicity data were not available. Individuals with lived experience contributed to the interpretation of results. Personalised effect estimates can be computed via a freely accessible web application. Strengthening social support, problem management, and behavioural activation were associated with the greatest incremental benefit within task-shared psychosocial interventions for adults with depression or anxiety. European Commission.
Chronic venous disease (CVD) and varicose veins (VV) are highly prevalent yet remain inconsistently managed despite existing guidelines, with variability in treatment selection, patient stratification, and use of conservative therapies. This multinational initiative sought to establish expert consensus on key clinical questions in venous disease management. A Delphi-like process involved 38 phlebologists from 15 countries across Europe, North Africa, and Central Asia. Four thematic workshops addressed interventional and conservative approaches for both CVD and VV. Twenty predefined questions were discussed, and resulting statements were rated on a 5-point Likert scale, with consensus defined as ≥75% agreement. Of 34 proposed statements, 30 (88%) achieved consensus. The panel emphasized that treatment decisions should be driven primarily by symptoms and quality of life rather than anatomy alone. Endovenous procedures were supported for symptomatic disease, with endovenous laser ablation and radiofrequency ablation considered equivalent for VV. Diosmin-based venoactive drugs, often combined with compression, were endorsed across CEAP classes for symptom relief, although adherence to conservative therapy remains limited. This consensus provides practical guidance for individualized care and highlights unmet needs in risk stratification, adherence, and long-term comparative outcomes.
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This study aimed to evaluate the effects of a personalized integrative training program on ideomotor representation, motor control estimated through whole-routine performance, and body aesthetics in juvenile rhythmic gymnasts, as well as to examine short-term transfer to competitive performance. The study used a pre-post intervention design and included 9 competitive rhythmic gymnasts aged 8-11 years who followed, for 14 weeks, a program integrated into their regular training. The assessment included whole-routine performance, used as an operational expression of motor control, computerized video analysis, the Movement Imagery Questionnaire-3 (MIQ-3), and the Evaluation of Body Aesthetics in Sports (EBAS). All athletes showed increases in total whole-routine score, with the group mean rising from 16.06 ± 1.10 to 17.26 ± 1.00 points, while the mean difficulty realization rate increased from 64.66% to 72.82%. At the inferential level, ideomotor representation was the only variable that showed a statistically significant change between T0 and T2 (Z = -2.25, p = 0.024). Indicators of whole-routine performance and body aesthetics showed favorable directional improvements, but these were not statistically significant at group level. At the individual level, the response to the intervention was differentiated, and short-term transfer to competitive performance remained variable. Ideomotor representation was the dimension most responsive to the intervention and may provide a useful reference point for optimizing performance organization in juvenile rhythmic gymnasts, even though the relationships among ideomotor representation, motor control, and body aesthetics remain unevenly consolidated in the short term and transfer to competitive performance is expressed differentially.
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Revisional one-anastomosis gastric bypass (OAGB) is an available intervention after failed sleeve gastrectomy (SG), but the optimal biliopancreatic limb (BPL) length remains uncertain. This study compared tailored versus fixed BPL length in revisional OAGB after SG, with emphasis on weight loss, nutritional outcomes, gastrointestinal symptoms. This retrospective cohort study included 200 patients who underwent revisional OAGB after SG for inadequate weight loss or weight regain. Patients were assigned according to operative strategy into a tailored BPL group (n = 100) and a fixed BPL group (n = 100). In the fixed group, BPL length was 200cm. In the tailored group, BPL length was set at 30% of total measured small bowel length, with a mean length of 276.66 ± 34.12cm. Patients were followed at 6, 12, and 24 months. Outcomes included percentage excess weight loss (%EWL), percentage total weight loss (%TWL), body mass index (BMI), micronutrient deficiency, one-year biochemical markers, gastrointestinal symptoms, complications, and quality of life. Weight loss outcomes significantly favored the tailored group at all follow-up points. Mean %EWL at 6, 12, and 24 months was 38% ± 10%, 71% ± 23%, and 92% ± 30% in the tailored group versus 31% ± 10%, 55% ± 20%, and 66% ± 22% in the fixed group (all p < 0.001). Mean %TWL was also greater in the tailored group: 18% ± 5% versus 14% ± 3% at 6 months, 33% ± 5% versus 25% ± 6% at 12 months, and 45% ± 5% versus 33% ± 7% at 24 months (all p < 0.001). Micronutrient deficiency was less frequent in the tailored group (4% vs. 26%, p < 0.001), with significantly better hemoglobin, serum iron, vitamin D, calcium, and albumin levels at one year. Quality-of-life outcomes also favored the tailored approach, although mild bile reflux was reported more often in this group. Our findings suggest that in revisional OAGB after sleeve gastrectomy, tailoring the biliopancreatic limb to 30% of total small bowel length is associated with greater weight loss, better nutritional preservation, and improved quality of life compared with a fixed 200cm limb.
Demand for aesthetic surgery has risen rapidly, and the parallel growth in cross-border medical travel is increasingly burdening European health systems with imported complications. The perspective of board-certified plastic surgeons themselves-as both providers of cross-border care and managers of its complications-has not been systematically captured at a European level. An anonymous online questionnaire (43 items across three thematic sections) was distributed by the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) to its member national societies between December 2025 and February 2026. The instrument addressed (A) the practice of surgeons treating international patients, (B) the management of complications from procedures performed abroad, and (C) safeguards and policy reform. Quantitative data were summarised descriptively; free-text responses were analysed thematically. Two hundred and fifty board-certified plastic surgeons from 36 countries responded; 230/250 (92.0%) held national or international board certification. The most common procedures performed for international patients were breast augmentation (n=86), breast reduction/mastopexy (n=82), and abdominoplasty (n=80). Eighty-nine per cent of respondents had managed complications of procedures performed abroad in the preceding five years; abdominoplasty (n=144), breast augmentation (n=106), and liposuction (n=76) predominated, with wound dehiscence/necrosis (n=156) and infection (n=131) the most frequent patterns. Cost was the most often cited primary motivation for patients (49.8%); 79.2% of respondents identified board certification as the single most important verification criterion, and 77.2% identified profit prioritisation over patient safety as the principal facilitator-related risk. Mandatory international qualification standards (35.6%) and stricter facilitator regulation (23.6%) were the most frequently endorsed policy priorities. European plastic surgeons describe a fragmented landscape in which a regulated core coexists with an unregulated commercial periphery. ESPRAS proposes a four-pillar framework-public surgeon registries, facility and facilitator accreditation, mandatory complication insurance, and harmonised European patient- and surgeon-facing guidelines-as the basis of a coordinated European response.
Cardiac computed tomography (CCT) plays an established role in the assessment of cardiac patients. In this document, the aim is to demonstrate and clarify the role of CCT in the clinical management of heart disease. This document will cover the clinical indications, prognostic values, and limitations of CCT in the diagnosis and follow-up of heart disease, including ischaemic heart disease, valvular heart disease, cardiomyopathies, cardiac masses, large vessel disease, and adult congenital heart disease. It will provide a basic knowledge of CCT technology and scan protocols. Continuous improvements in CCT technology and reduced radiation exposure will further enhance its clinical utility. Therefore, this document outlines the technical principles of CCT and its use in everyday clinical practice for cardiologists who are not experts in CCT.