The global distribution of oral and maxillofacial surgeons: a mixed-methods study

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.

Effects of obesity and weight loss on mitochondrial structure and function and implications for colorectal cancer risk

Colorectal cancer (CRC) is the third most common cancer globally. CRC risk is increased by obesity, and by its lifestyle determinants notably physical inactivity and poor nutrition. Obesity results in increased inflammation and oxidative stress which cause genomic damage and contribute to mitochondrial dysregulation and CRC risk. The mitochondrial dysfunction associated with obesity includes abnormal mitochondrial size, morphology and reduced autophagy, mitochondrial biogenesis and expression of key mitochondrial regulators. Although there is strong evidence that increased adiposity increases CRC risk, evidence for the effects of intentional weight loss on CRC risk is much more limited. In model systems, energy depletion leads to enhanced mitochondrial integrity, capacity, function and biogenesis but the effects of obesity and weight loss on mitochondria in the human colon are not known. We are using weight loss following bariatric surgery to investigate the effects of altered adiposity on mitochondrial structure and function in human colonocytes. In summary, there is strong and consistent evidence in model systems and more limited evidence in human subjects that over-feeding and/or obesity result in mitochondrial dysfunction and that weight loss might mitigate or reverse some of these effects.

Intellectual and academic outcomes after pediatric liver transplantation: Relationship with transplant-related factors

As survival rates for pediatric liver transplant continue to increase, research attention is turning toward long-term functional consequences, with particular interest in whether medical and transplant-related factors are implicated in neurocognitive outcomes. The relative importance of different factors is unclear, due to a lack of methodological uniformity, inclusion of differing primary diagnoses, varying transplant policies, and organ availability in different jurisdictions. This cross-sectional, single-site study sought to address various methodological limitations in the literature and the paucity of studies conducted outside of North America and Western Europe by examining the intellectual and academic outcomes of Australian pediatric liver transplant recipients (N = 40). Participants displayed significantly poorer intellectual and mathematical abilities compared with the normative population. Greater time on the transplant waitlist was a significant predictor of poorer verbal intelligence, working memory, mathematical abilities, and reading but only when considering the subgroup of children with biliary atresia. These findings support reducing the time children wait for a transplant as a priority.

Prevalence of and factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa

BACKGROUND

The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries.

METHODS

Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa.

RESULTS

This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa.

CONCLUSIONS

Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.

An easy method to modify PEDOT:PSS/perovskite interfaces for solar cells with efficiency exceeding 15%

Surface treatment of PEDOT:PSS films using propionic acid (PA) leads to better device performance for the resulting CH₃NH₃PbI₃ perovskite solar cells (PCE > 15%).

Flexible Coding of Task Rules in Frontoparietal Cortex: An Adaptive System for Flexible Cognitive Control

How do our brains achieve the cognitive control that is required for flexible behavior? Several models of cognitive control propose a role for frontoparietal cortex in the structure and representation of task sets or rules. For behavior to be flexible, however, the system must also rapidly reorganize as mental focus changes. Here we used multivoxel pattern analysis of fMRI data to demonstrate adaptive reorganization of frontoparietal activity patterns following a change in the complexity of the task rules. When task rules were relatively simple, frontoparietal cortex did not hold detectable information about these rules. In contrast, when the rules were more complex, frontoparietal cortex showed clear and decodable rule discrimination. Our data demonstrate that frontoparietal activity adjusts to task complexity, with better discrimination of rules that are behaviorally more confusable. The change in coding was specific to the rule element of the task and was not mirrored in more specialized cortex (early visual cortex) where coding was independent of difficulty. In line with an adaptive view of frontoparietal function, the data suggest a system that rapidly reconfigures in accordance with the difficulty of a behavioral task. This system may provide a neural basis for the flexible control of human behavior.

Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis

AIM

Currently in the UK the standard surgical practice for the management of perforated sigmoid diverticulitis is a Hartmann's procedure. There have been a number of recent publications on the use of laparoscopic peritoneal lavage for perforated sigmoid diverticulitis, as an alternative to the emergency Hartmann's procedure, with its associated morbidity and mortality. We aim to review the current literature on this topic.

METHOD

A search was made on the electronic database MEDLINE from PubMed, EMBASE and the Cochrane library. The keywords 'diverticulitis', 'perforated' and 'laparoscopy' were searched for in the titles and abstracts without language restrictions. Further studies were identified from searches on Google Scholar, as well as manual searches through reference lists of the relevant studies found. All included studies were quality assessed.

RESULTS

Twelve relevant studies were included. A total of 301 patients were reported, with a mean age of 57 years. All were non-randomized studies. The majority of patients were of Hinchey classification III. All were treated with intravenous antibiotics followed by laparoscopic lavage and insertion of intra-abdominal/pelvic drains. The mean conversion rate was 4.9% and mean length of hospital stay was 9.3 days. The mean complication rate was 18.9% and the overall mortality rate was 0.25%. Subsequent elective resections with primary anastamosis were performed in 51% of patients and the majority were completed laparoscopically.

CONCLUSION

Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis appears to be a potentially effective and more conservative alternative to a Hartmann's procedure. Randomized control trials are needed to better evaluate its role.

Depression and anxiety in perinatal period: prevalence and risk factors in an Italian sample

Accumulating evidence suggests that pregnancy does not protect women from mental illness. The aim of this study was to assess the prevalence, sociodemographic correlates, and the risks factors for perinatal depression and anxiety. Five hundred ninety women between 28th and the 32nd gestational weeks were recruited and submitted to a sociodemographic, obstetric, and psychological interview. The Edinburgh Postnatal Depression Scale (EPDS) and the state-trait anxiety inventory (STAI-Y) were also administered in antenatal period and 3 months postnatally. The Structured Clinical Interview for DSM-IV (SCID-I) was used to diagnose mood and anxiety disorders. Three months after delivery, EPDS was administered by telephone interview. Women with an EPDS score ≥10 were 129 in antenatal period (21.9%) and 78 in postnatal period (13.2%). During pregnancy 121 women (20.5%) were positive for STAI-Y state and 149 women (25.3%) for STAI-Y trait. The most important risk factors for antenatal depression are: foreign nationality, conflictual relationship with family and partner, and lifetime psychiatric disorders. The principal risk factors for postnatal depression are: psychiatric disorders during pregnancy and artificial reproductive techniques. Psychiatric disorders, during and preceding pregnancy, are the strongest risk factors for antenatal state and trait anxiety. Antenatal depressive and anxiety symptoms appear to be as common as postnatal symptoms. These results provide clinical direction suggesting that early identification and treatment of perinatal affective disorders is particularly relevant to avoid more serious consequences for mothers and child.

Histopathological changes in the liver and kidney tissues of Wistar albino rat exposed to fenitrothion

The aim of this study was to investigate the dose-related effects of fenitrothion (FNT) on the liver and kidney. The study was conducted on 8-week-old male Wistar rats that were divided into four groups (three experimental groups and one control group) and were treated orally with different doses (25, 50, 100 mg/kg) of FNT for 28 consecutive days. After treatment, the rats were anesthetized with ether and liver and kidney samples were taken for histological studies. The results showed that the histopathological changes in the liver were mainly represented by parenchymatous degeneration of hepatocytes with mild necrosis, leukocytic infiltration in the portal area, severe congestion, and hemorrhage. These changes were dose dependent. Marked tubular dilation, hydropic degeneration in tubular epithelium, moderate congestion, and hemorrhage in the cortical and medulla part of the kidney were recorded. Histopathologic examination of the liver and kidney indicated a significant injury only in rats receiving 100 mg/kg FNT.

Theoretical study of liquid-immersed exposed-core microstructured optical fibers for sensing

The absorption and fluorescence sensing properties of liquid-immersed exposed-core microstructured optical fibers are explored for the regime where these structures act as supported nanowires with direct access to the sensing environment. For absorption-based sensing we demonstrate that the amount of power propagating in the sensing region of the exposed-core fiber can compete with that of traditional MOFs. For fluorescence-based sensing, we see that in addition to the enhanced fluorescence capture efficiency already predicted for small-core, high refractive index contrast fibers, an improvement of up to 29% can be gained by using liquid-immersed exposed-core fibers. Additionally, calculation of the losses associated with interfaces between filled and unfilled sections predict significant benefit in using high refractive index substrate glasses for liquid-immersed exposed-core fiber sensing. This work demonstrates that, for fiber dimensions of interest, the exposed-core fiber is an attractive new sensor technology.

[Use of a screening device for sleep apnea in clinical practice]

About 2-4% of adults suffer from obstructive sleep apnea (OSA), which is the most common sleep-related breathing disorder (SRBD). Repetitive obstructions of the upper airway mean that it is associated with hypertension and an elevated cardio- and cerebrovascular morbidity, which can be lowered by means of effective therapy. These patients cannot be treated correctly unless they are identified early in the course of the condition. Therefore, this study evaluated the use of the microMESAM screening device (known up to December 2005 as the "ApneaLink") in 61 patients in whom SRBD was suspected. The device proved reliable and practical in application.

Properties of a thermostable nitrate reductase from the hyperthermophilic archaeon Pyrobaculum aerophilum

The nitrate reductase of the hyperthermophilic archaeon Pyrobaculum aerophilum was purified 137-fold from the cytoplasmic membrane. Based on sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, the enzyme complex consists of three subunits with apparent molecular weights of 130,000, 52,000, and 32,000. The enzyme contained molybdenum (0.8-mol/mol complex), iron (15.4-mol/mol complex) and cytochrome b (0.49-mol/mol complex) as cofactors. The P. aerophilum nitrate reductase distinguishes itself from nitrate reductases of mesophilic bacteria and archaea by its very high specific activity using reduced benzyl viologen as the electron donor (V(max) with nitrate, 1,162 s(-1) (326 U/mg); V(max) with chlorate, 1,348 s(-1) (378 U/mg) [assayed at 75 degrees C]). The K(m) values for nitrate and chlorate were 58 and 140 microM, respectively. Azide was a competitive inhibitor and cyanide was a noncompetitive inhibitor of the nitrate reductase activity. The temperature optimum for activity was > 95 degrees C. When incubated at 100 degrees C, the purified nitrate reductase had a half-life of 1.5 h. This study constitutes the first description of a nitrate reductase from a hyperthermophilic archaeon.

Effects of chronic estrogen-receptor blockade on ovine perinatal pulmonary circulation

Prolonged infusions of 17beta-estradiol reduce fetal pulmonary vascular resistance (PVR), but the effects of endogenous estrogens in the fetal pulmonary circulation are unknown. To test the hypothesis that endogenous estrogen promotes pulmonary vasodilation at birth, we studied the hemodynamic effects of prolonged estrogen-receptor blockade during late gestation and at birth in fetal lambs. We treated chronically prepared fetal lambs with ICI-182,780 (ICI, a specific estrogen-receptor blocker, n = 5) or 1% DMSO (CTRL, n = 5) for 7 days and then measured pulmonary hemodynamic responses to ventilation with low- and high-fraction inspired oxygen (FI(O(2))). Treatment with ICI did not change basal fetal PVR or arterial blood gas tensions. However, treatment with ICI abolished the vasodilator response to ventilation with low FI(O(2)) [change in PVR -30 +/- 6% (CTRL) vs. +10 +/- 13%, (ICI), P < 0.05] without reducing the vasodilator response to ventilation with high FI(O(2)) [change in PVR, -73 +/- 3% (CTRL) vs. -77 +/- 4%, (ICI); P = not significant]. ICI treatment reduced prostacyclin synthase (PGIS) expression by 33% (P < 0.05) without altering expression of endothelial nitric oxide synthase or cyclooxygenase-1 and -2. In situ hybridization and immunohistochemistry revealed that PGIS is predominantly expressed in the airway epithelium of late gestation fetal lambs. We conclude that prolonged estrogen-receptor blockade inhibits the pulmonary vasodilator response at birth and that this effect may be mediated by downregulation of PGIS. We speculate that estrogen exposure during late gestation prepares the pulmonary circulation for postnatal adaptation.