Epithelium is the periodontal first line of defense against microbes. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed in epithelium. Ddr1 knockout (Ddr1-/-) mice develop periodontitis-like defects, including junctional epithelium (JE) downgrowth, bacterial invasion, and alveolar bone loss. The objective of this study was to investigate epithelial responses in the absence of DDR1. We hypothesized that Ddr1-/- mice exhibit increased JE permeability and delayed epithelial wound healing. Epithelium was analyzed in Ddr1-/- and wild-type (Ddr1+/+) mice. JE permeability was studied in vivo by applying a fluorescent dye and measuring dye penetration. Immunohistochemistry (IHC) was used to identify the localization of E-cadherin and collagens IV, VIII, and XVII in oral epithelium. DDR1 expression in wound healing was confirmed by histology. Epithelial wound healing responses were assessed by creating skin and oral wounds and measuring epithelial migration and wound closure. No differences in JE permeability were observed between Ddr1-/- and Ddr1+/+ mice, although a trend in the means was observed toward decreased dye surface area (p = 0.07) and intensity (p = 0.08-0.09) in the periodontium of the former mice. IHC did not reveal differences in the localization of E-cadherin or collagens IV, VIII, and XVII between genotypes. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. Wound healing experiments revealed a higher % wound healing of dorsal skin in Ddr1-/- than Ddr1+/+ mice at 5 days post-wounding (dpw) (p = 0.01). DDR1 does not affect JE permeability but may play a role in effective epithelial cell migration during cutaneous wound healing. Epithelium is the periodontal first line of defense against microbial attacks. Discoidin domain receptor 1 (DDR1) is a collagen receptor expressed at the epithelium. Mice not expressing the receptor (Ddr1-/- mice) develop defects consistent with periodontitis, including epithelium downgrowth and bone loss. In this study, we investigated periodontal epithelial permeability by applying a fluorescent dye in the mouth of Ddr1+/+ and Ddr1-/- mice. Additionally, we used histological methods to reveal differences in the localization of gingival proteins between Ddr1+/+ and Ddr1-/-. Finally, we investigated the role of DDR1 in wound healing in human sections and in a live animal model. No differences in junctional epithelium (JE) permeability were observed between Ddr1+/+ and Ddr1-/- mice, as expressed by the comparable presence of dye in the periodontal tissues of both types of mice. There were no differences in the localization of E-cadherin or collagens IV, VIII, and XVII between Ddr1+/+ and Ddr1-/-. In human gingiva, DDR1 was expressed at the epithelial front, migrating to cover palatal wounds. The animal wound healing study revealed higher healing of skin wounds in Ddr1-/- than Ddr1+/+ mice at 5 dpw. In conclusion, this study has elucidated a role for DDR1 in epithelial cell migration during skin wound healing.
Oral squamous cell carcinoma (OSCC) is the most common cancer in the oral and maxillofacial region. While the 5-year survival rate ranges from 75% to 94% when detected early, the majority of cases are diagnosed at an advanced stage, where survival drops to 20%-40%, underscoring the critical need for improved early detection strategies. This study aimed to non-invasively detect OSCC by measuring the thermal difference between carcinogenic tissue and healthy mucosa using an infrared sensor and to assess the accuracy of this diagnostic modality. A novel intraoral infrared device was designed and manufactured to non-invasively measure intraoral tissue temperature. Twenty participants (13 males and 7 females) were examined, including 10 patients and 10 healthy individuals. The temperature of the lesion and contralateral healthy mucosa in the patients' group as well as both sides of the tongue in the control group were measured. The temperature differences were analyzed using the t-test. The accuracy of the device was evaluated using the receiver operating characteristic (ROC) curve. A significant difference was observed in the temperature of the tumoral tissue and healthy mucosa in the patients' group (p < 0.001). The assessment of the device's accuracy in detecting OSCC revealed that a temperature differential greater than 0.97°C between the measured sides indicates the potential presence of a lesion on the higher temperature side (sensitivity = 1, specificity = 1). Regions exhibiting temperatures higher than 38.42°C were identified as potentially indicating the presence of malignant lesions (sensitivity = 1, specificity = 0.9). Thermography can serve as an effective non-invasive diagnostic modality for detecting suspicious oral lesions by leveraging temperature differences. The designed device facilitates early detection of these lesions based on thermal variations, offering a promising tool for timely and accurate diagnosis. IRCT20181130041806N1.
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease, is one of the most prevalent liver diseases globally, contributing to both economic and health-related challenges. We aimed to evaluate the global, regional, and national burden of MASLD from 1990 to 2023, quantify the contribution of identified modifiable risk factors, and project future prevalence up to the year 2050. Estimates of MASLD prevalence and disability-adjusted life-years (DALYs) were produced by age, sex, region, Socio-demographic Index (SDI), and Healthcare Access and Quality (HAQ) index across 204 countries and territories from 1990 to 2023 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The MASLD burden attributable to three risk factors (smoking, high BMI, and high fasting plasma glucose) was assessed as part of the GBD comparative risk assessment. As a secondary analysis, we used these estimates to forecast MASLD prevalence up to 2050 using fasting plasma glucose and mean BMI as predictors. Furthermore, to examine the relative contributions of population ageing, population growth, and changes in MASLD prevalence rate to the forecasted changes in case counts from 2023 to 2050, we conducted a decomposition analysis. In 2023, approximately 1·3 billion (95% uncertainty interval [UI] 1·2 to 1·4) individuals were estimated to be living with MASLD (ie, 16·1% of the global population), with an age-standardised prevalence rate of 14 429·3 (95% UI 13 268·3 to 15 990·6) per 100 000 population, representing a percentage increase of 142·7% (95% UI 139·2 to 146·7) in crude numbers from 1990 (0·5 billion [0·5 to 0·6]) and of 28·6% (27·8 to 29·5) in the rate (11 217·2 [10 276·8 to 12 467·0] per 100 000 in 1990). An estimated 3·6 million (2·8 to 4·5) total DALYs were attributable to MASLD worldwide in 2023, corresponding to an age-standardised DALY rate of 39·6 (31·2 to 49·9) per 100 000 population. Despite a 116·3% (93·3 to 139·4) increase in crude DALYs (from 1·7 million [1·3 to 2·1] in 1990), its age-standardised estimate remained consistent (1·8% [-8·6 to 12·8]) from 1990 (38·9 [30·1 to 49·8] per 100 000) to 2023. There was substantial variation in age-standardised estimates across regions. North Africa and the Middle East had the highest prevalence rate (29 246·1 [26 848·3 to 32 048·7] per 100 000) and Andean Latin America showed the highest DALY rate (152·3 [114·1 to 194·7] per 100 000). By contrast, the high-income Asia Pacific region had the lowest prevalence rate (8653·5 [7923·7 to 9592·8] per 100 000) and east Asia had the lowest DALY rate (16·3 [13·5 to 19·9] per 100 000) among all GBD regions. North Africa and the Middle East showed disproportionately higher prevalence rates relative to other regions with similar SDIs. Lower SDIs and HAQs were associated with higher age-standardised DALY rates. The age-standardised prevalence rate was consistently higher in males (15 616·4 [14 349·2 to 17 263·3] per 100 000 people in 2023) than in females (13 245·2 [12 132·0 to 14 692·6] per 100 000 people), and peaked at age 80-84 years in both sexes. The number of MASLD prevalent cases was the highest in younger adults, peaking at age 35-39 years for males and age 55-59 years for females. Among the risk factors for MASLD, high fasting plasma glucose presented the largest contribution to the age-standardised DALY rate of total MASLD in 2023 (2·2 [95% UI 1·6 to 3·1] per 100 000 people), followed by high BMI (1·4 [0·6 to 2·4] per 100 000 people) and smoking (1·0 [0·3 to 1·8] per 100 000 people). Our forecasting model estimates that 1·8 billion (95% UI 1·6 to 2·0) individuals are likely to have MASLD by 2050, representing a 42·0% increase from 2023. The age-standardised prevalence rate is expected to increase to 15 774·9 (95% UI 14 613·9 to 17 336·2) per 100 000 people in 2050, representing an average annual percentage change of 0·3% (95% UI 0·3-0·3). According to our decomposition analysis, this change will be primarily due to population growth, particularly in sub-Saharan Africa and North Africa and Middle East, and less by population ageing or epidemiological change. With a global prevalence of 16·1% and approximately 1·3 billion people already living with MASLD in 2023, the condition has and will continue to have substantial health and economic impacts worldwide. An inverse association between the HAQ Index and age-standardised DALY rates suggests that countries with lower health-care access and quality might be less well positioned to manage the growing MASLD burden, underscoring the need for strengthened health-system capacity in these settings. Gates Foundation.
Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.
Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.
Surgeons in the United Kingdom and the United States often perform identical oral and maxillofacial operations with strikingly different instrument sets. The extent and practical significance of this divergence have not, to our knowledge, been previously reported. We conducted a descriptive comparative review of contemporary UK and US practice (2023-2024), cataloguing instruments through clinical observation and discussions with peers and scrub teams, then verifying nomenclature, design, and provenance against reference texts and manufacturers' catalogues. Functionally equivalent but non-identical instruments were paired and profiled for origin, form, and typical use. Findings show a small common core (Freer elevator, Minnesota retractor, Austin retractor, DeBakey forceps, Adson forceps, Metzenbaum scissors, and Mayo scissors) with nearly all other instruments differing, illustrating parallel solutions to the same operative tasks. British instruments and their American counterparts (for example, Molt #9, Woodson #1, Seldin elevator, Molt #4, Dean scissors, Army-Navy retractor, Sweetheart retractor, Sistrunk retractor, Hargis retractor, 301 elevator, and Cogswell elevators) were assembled into a practical compendium, with the aim of encouraging cross-pollination of surgical practice. Awareness of transatlantic instrument choices presents an opportunity to refine one's armamentarium. Through selective adoption of unfamiliar but potentially advantageous instruments, the open-minded surgeon can discover new ways to enhance operative precision, efficiency, or ergonomics.
The bidirectional association between Alzheimer's disease (AD) and periodontitis (PD) has been recently demonstrated, indicating how the oral-brain axis connects the two conditions. Chronic oral inflammation caused by PD is accompanied by biological immunological responses, unchecked inflammation, and the spread of periodontal bacteria, all contributing to nervous system inflammation and AD pathogenesis. There are two primary pathways: (a) Inflammatory cascades, in which pro-inflammatory cytokines, such as IL-1β and TNF-α, originating from periodontal lesions, cause inflammation in the brain region of the head, resulting in tau hyperphosphorylation, amyloid beta (Aβ) accumulation, and disruption of the blood-brain barrier; (b) Microbial involvement, in which oral pathogens, such as Porphyromonas gingivalis (P. gingivalis), can enter the bloodstream, enter the trigeminal nerve, and activate microglia. The fact that AD patients are known to experience greater periodontal disease than others, together with additional research maintaining the connection between oral dysbiosis and neurodegeneration, further supports these pathways. In older patients, the collapse of the blood-brain barrier exacerbates inhibitor breaches, allowing poisons and microorganisms to enter, increasing the formation of Aβ and neurotoxicity. Conversely, periodontal infections may exacerbate AD over time by causing a loss in peri-oral neglect (cognitive decline) and self-oral care (hygiene). To clarify the directed causative links that therapeutic approaches seek to resolve, rather than an attributable association, systematic reviews help interdisciplinary approaches focus on the integral integration of oral healthcare into AD preventive policies built around proactive AD management systems and longitudinal research studies. This evidence synthesis sets the oral-brain interaction as an axis of critically heightened focus for investigating AD pathogenesis, maximally shifting the paradigm for proactive intervention and tailored care models.
Advancements in three-dimensional (3D) printing have introduced innovative tools for medical and dental education. In dental surgery, 3D-printed simulation models offer valuable presurgical training. This review explores the scope, study types, key findings, limitations, and future research needs to enhance their application in dental education. A comprehensive literature search was conducted across seven major health and education databases for studies published up to June 2025. A structured search strategy was developed using a combination of MeSH terms and keywords related to dental and oral surgical procedures, educational interventions, and 3D printing. Two reviewers independently screened and evaluated the retrieved articles. Studies were included if they investigated the use of 3D-printed models as hands-on simulation tools for intraoral surgery education. Only peer-reviewed articles published in English were considered. A total of 3686 studies were identified, 34 of which met the inclusion criteria after screening. These studies, largely published within the past decade, evaluated the use of 3D-printed models as training tools across five core areas of intraoral surgery, with the greatest focus on minor oral surgery (32%) and maxillofacial related procedures: orthognathic procedures (26%), followed by cleft palate surgery (15%), implant surgery (15%), and periodontal interventions (12%). Various printers and materials were employed, with an emphasis on model fabrication and evaluation through trainee feedback. The models were widely accepted by trainees, who reported improved technical skills, increased confidence, and reduced procedure time. However, challenges remain, particularly the need for advanced soft tissue-replicating material to enhance anatomical realism. 3D-printed models are effective tools for pre-operative planning and hands-on training in oral surgery. Future research should focus on developing cost-efficient printing technologies and advanced materials to better replicate hard and soft tissues in these models. Furthermore, well-designed studies are needed to support changes to implementation into current curricula and enhance the delivery of surgical education.
To date no study has looked at the cost-effectiveness of melatonin for anxiety prior to general anaesthetic in children or young people. The aim of the health economic analysis was to evaluate the within trial cost-effectiveness of melatonin for anxiety in children compared to usual care (midazolam) prior to general anaesthesia in children from an NHS and Personal Social Services perspective. The economic evaluation was undertaken alongside a multicentre randomised controlled trial (MAGIC). Children were individually randomised to receive either melatonin or midazolam for anxiety prior to general anaesthesia. Resource use was collected from case-record forms. Children were followed up at 14 days post-surgery. The main outcome was the incremental cost per successful procedure. The trial was closed early due to recruitment futility, which limited the studies statistical power. A total of 100 children received the Investigational Medicinal Product (IMP) treatment, 50 receiving melatonin and 50 receiving midazolam, these were the focus of the health economic analysis. On average, costs over 14 days were lower for those who received melatonin (-£46.20, 95% CI: -£166.14 to £66.74) with a mean incremental difference in procedure success of -0.02 (95% CI –0.08 to 0.004), though there was uncertainty around the results. There was no evidence of either treatment being cost-effective in a cost per QALY analysis using the CHU-9D (-£46.20, 95% CI: -£166.142 to £66.74) with a mean incremental QALY -0.0001 (95% CI –0.0008 to 0.0008). Subgroup analysis was limited to those who underwent head and neck procedures owing to small numbers by subgroup for other procedure types and age group and results were similar to the main analysis. This is the first study to examine the cost-effectiveness of melatonin in comparison with midazolam in children. The results were inconclusive showing no evidence that melatonin was more cost-effective than midazolam. The study closed early owing to issues with recruitment, which reduced the studies statistical power, and this has limited the economic analysis. Registered with the UK Clinical Study Registry ISRCTN18296119 on 10/01/2019. The online version contains supplementary material available at 10.1186/s12871-025-03489-x.
While many studies have explored the drivers of health-worker emigration, there is limited understanding of the factors that potentially encourage them to remain or return after migration. We explored three interrelated questions: what factors encouraged some members of the study population to remain in Nigeria?; what circumstances might encourage those intending to migrate to reconsider their plans?; and what conditions could encourage those who have already emigrated to consider returning? We conducted a sequential explanatory mixed-methods study among a cohort of Nigerian-trained doctors and dentists. In the quantitative phase, 274 cohort members completed a structured survey assessing drivers of migration. In the qualitative phase, 50 participants across three migration status groups (emigrated, intending to migrate, and not intending to migrate) were interviewed. Thematic analysis was conducted. Overall, 49.3% (135/274) of the cohort had already migrated within 15 years of qualifying, while 63.6% (82/139) of those still in Nigeria expressed an intention to migrate. Qualitative findings reinforced the quantitative results, highlighting shared potential enablers of staying (among those intending to migrate) or returning (among already migrated), including improved security, economic stability, better remuneration, stronger healthcare infrastructure, and enhanced training opportunities. Most of those who had already migrated expressed a willingness to return, though often as a long-term plan. Those with no intention to migrate cited a sense of duty and patriotism, family responsibilities, thriving businesses, and professional or age-related factors as reasons for staying back. This study offers actionable insights to inform policies on health-worker migration. Main findings: Despite the dearth of digital data capture and clinical decision support systems for newborn care outside of tertiary settings, we found healthcare professionals in lower-level facilities were highly motivated to use an adapted digital quality improvement system to support the delivery of newborn care.Added knowledge: In our intervention adaptation process, we found that lower-level facilities providing basic essential newborn care in Malawi are falling short of global standards, with respect to training, routine data collection and basic equipment.Global health impact for policy and action: International guidance for the provision of newborn care across all levels of the health system need to be adopted within national contexts, thereby ensuring implementers have contextually relevant benchmarks to achieve quality improvements across the care continuum.
Use of patient-specific models as a surgical planning and training tool can support novice practitioners' surgical skill development. This study aimed to introduce a novel workflow for fabricating 3D-printed, patient-specific simulation models and evaluate their accuracy and transferability for use in periodontal and oral surgery training. Patient-specific anatomical models of the maxilla were fabricated using the CBCT and intraoral scan data. The proposed workflow outlines a novel process for creating a patient-specific model that accurately replicates both the hard and soft tissues of the patient. The accuracy of the printed models was evaluated by scanning five models and comparing them to the patient's intraoral scan using cloud-to-cloud distance analysis. Then, in an exploratory study design, a simulated gingival flap surgery exercise was completed by 18 periodontists and 50 students. The face and content validity of the model were assessed using an 8-item online questionnaire with a VAS of 0-100 and a free comment question. The data were analyzed using descriptive statistics, Mann-Whitney U tests and independent t-test. The printed model demonstrated high dimensional accuracy. The overall VAS score of the model was significantly higher for students than for periodontists (83.7 ± 9.7 vs. 72.1 ± 15.8, p < 0.006). The face and content validity scores reported by students were also higher (P < 0.01), with mean differences of 8.86% and 12.62%, respectively. Periodontists rated the models lower for soft-tissue tactile feedback, particularly during incision. The proposed 3D-printed simulation workflow produced an accurate and educationally valuable model with the potential to enhance surgical training. Experienced surgeons suggested that refining the soft-tissue realism could further improve its overall educational value.
To analyse the facial proportions of the Indian population belonging to the Tibeto-Burman population from Northeast India. An anthropometric cross-sectional cohort study was conducted on Indian population enrolling subjects belonging to the Tibeto-Burman population from Northeast India with same racial descent and residing in India. This study evaluated 90 subjects for facial anthropometric data. Subjects belonging to the age group of 18 to 25 years, healthy subjects with normal body mass index, subjects with the well-balanced face and subjects with Class I occlusal relationship with near normal dental arches based on the British Standards Institute's incisor classification were included. Subjects with known developmental or acquired facial abnormalities and subjects with either Class II or Class III occlusal relationship or with dental crowding or spacing were excluded. Both linear and angular measurements were taken to determine the morphologic characteristics of the maxillofacial complex. Sexual dimorphism was noted with the men exhibiting a greater and wider dimension than their counterparts. The populace revealed a flatter facial profile with reduced nasal projection and increased malar prominence. The intercanthal distance, width of the palpebral fissure and the frontonasal angle were lesser than the Caucasian race. When compared to Caucasian race, they showed smaller lower facial height, width of mouth, nasal bridge inclination, Naso-labial angle, length of nose, columella length, intercanthal distance, and chin throat angle. The facial proportions of the Tibeto-Burman population from Northeast India exhibited significant variances in certain parameters from that of the Caucasian race.
Professor Roy Duckworth was Professor of Oral Pathology at the London Hospital. He became Dean of Dentistry and then of the whole medical school. Roy was also Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of England. His major early research was on fluorides. Professor Stephen Duckworth was the youngest principal researcher to publish a paper in the British Dental Journal at the age of 18 years and then to give an oral presentation on his research project relating to fluoride in tea. He was paralysed from rugby while a medical student. He did qualify but the General Medical Council refused to register him as a doctor. Nevertheless, Stephen went on to gain postgraduate degrees and became an Adjunct Professor of Bioengineering. He presented a Bradlaw Oration at the Royal College of Surgeons and was awarded an honorary FDS.
Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world's population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors. The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100 000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included. In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044·18 [95% UI 2748·67-3303·04] per 100 000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870·24 [4046·70-5962·78] per 100 000 population) and southeast Asia (4778·18 [3970·25-5735·61] per 100 000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508·67 [95% UI 394·89-669·92] per 100 000 population) compared with the high-income Asia Pacific region (204·40 [129·23-290·41] per 100 000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1·37 [95% CI 1·26-1·48]) and Kazakhstan (0·73 [0·55-0·93]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657·58 [95% UI 485·04-880·45] per 100 000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females. Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation. Gates Foundation.
This multicentre randomized controlled clinical trial aims to investigate the regenerative effects of various thicknesses and types of barrier materials with and without bone grafting in a rabbit calvaria model. One hundred male rabbits were partitioned into two groups: one without bone graft (NB) and one with bone grafting (BG). The groups were further divided into five subgroups, n = 10 each: C (control); SC (0.3 mm single-layered collagen); DC (0.6 mm double-layered collagen); L1 (0.5 mm cortical collagenated bone barrier); and L2 (1.0 mm cortical collagenated bone barrier). In all experimental groups, each distinct type of barrier was applied following the creation of a 10 mm circular defect in the calvaria of each rabbit. After 24 weeks, the calvariae were examined by histologic and histomorphometric analyses. The utilization of cortical bone barriers increased bone formation in all experimental groups. For Group NB, the histological score significantly differed among subgroups (p < 0.001). L1 and L2 subgroups had more favorable histological scores than the control groups (p < 0.001). Furthermore, the L2 subgroup had a higher histological score than the SC subgroup (p < 0.001). In Group BG, histological score significantly differed among subgroups (p < 0.001). DC, L1, and L2 subgroups had higher histological scores than the controls (p < 0.02), (p < 0.001), and (p < 0.001), respectively. The L2 subgroup had a higher histological score than the SC subgroup (p < 0.01). The BG group had significantly higher histological scores overall compared to the NB group based on barriers (p < 0.05). Within the limits of this model, the 1.0 mm cortical lamina barrier demonstrated the most favorable regenerative performance, consistently achieving higher histologic scores and more advanced tissue maturation than thinner cortical lamina or collagen membranes. These findings indicate that barrier architecture, particularly thickness and mechanical stability, plays an important role in promoting predictable bone regeneration.
The subacromial-subdeltoid bursa block (SBB) has been reported to provide postoperative pain relief following arthroscopic shoulder surgery, although evidence of its efficacy remains unclear. This meta-analysis evaluates the analgesia efficacy of adding SBB to systemic analgesia compared to systemic analgesia alone. Literature was searched for randomized controlled trials comparing SBB and systemic analgesia to systemic analgesia alone (Control). Post-operative analgesic consumption, measured in oral morphine equivalents over the first 24 h post-operatively, was the primary outcome. Secondary outcomes included pain scores up to 48 h post-operatively, patient satisfaction, functional outcomes, opioid-related side effects, and block-related complications. Fifteen trials (679 patients) were included. Compared to systemic analgesia alone, the addition of single injection SBB reduced 24-h post-operative morphine consumption by 58.98 mg [-100.14, -17.81] (p = 0.005) over the first 24 h. SBB also reduced pain scores up to 18 h post-operatively. In contrast, continuous SBB did not reduce opioid consumption, with a mean difference of -40.36 mg [-81.77, 1.06] (p = 0.06). Additionally, continuous SBB did not improve pain control at any time point. The addition of SBB did not yield any differences in patient satisfaction, functional scores, or adverse events compared to systemic analgesia alone. Compared to systemic analgesia alone, this meta-analysis suggests that for arthroscopic shoulder surgery, the addition of single-injection SBB can reduce postoperative pain and opioid consumption for up to 18 and 24 h, respectively. In contrast, continuous SBB does not seem to improve any of the analgesic outcomes. Single-injection SBB may be considered an effective analgesic technique for arthroscopic shoulder surgery when proximal brachial plexus blockade is contraindicated or otherwise undesirable.
AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews, version 2) and ROBIS are tools used to assess the methodological quality and the risk of bias in a systematic review (SR). We applied AMSTAR-2 and ROBIS to a sample of 200 published SRs. We investigated the overlap in their methodological constructs, responses by item, and overall, percentage agreement, direction of effect, and timing of assessments. AMSTAR-2 contains 16 items and ROBIS 24 items. Three items in AMSTAR-2 and nine in ROBIS did not overlap in construct. Of the 200 SRs, 73% were low or critically low quality using AMSTAR-2, and 81% had a high risk of bias using ROBIS. The median time to complete AMSTAR-2 and ROBIS was 51 and 64 minutes, respectively. When assessment times were calibrated to the number of items in each tool, each item took an average of 3.2 minutes per item for AMSTAR-2 compared to 2.7 minutes for ROBIS. Nine percent of SRs had opposing ratings (i.e., AMSTAR-2 was high quality while ROBIS was high risk). In both tools, three-quarters of items showed more than 70% agreement between raters after extensive training and piloting. AMSTAR-2 and ROBIS provide complementary rather than interchangeable assessments of systematic reviews. AMSTAR-2 may be preferable when efficiency is prioritized and methodological rigour is the focus, whereas ROBIS offers a deeper examination of potential biases and external validity. Given the widespread reliance on systematic reviews for policy and practice, selecting the appropriate appraisal tool remains crucial. Future research should explore strategies to integrate the strengths of both instruments while minimizing the burden on assessors.
Information on childhood cancer burden is crucial for effective cancer policy planning. Unfortunately, observed paediatric cancer data are not available in every country, and previous global burden estimates have not discretely reported several common cancers of childhood. We aimed to inform efforts to address childhood cancer burden globally by analysing results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, which now include nine additional cancer causes compared with previous GBD analyses. GBD 2023 data sources for cancer estimation included population-based cancer registries, vital registration systems, and verbal autopsies. For childhood cancers (defined as those occurring at ages 0-19 years), mortality was estimated using cancer-specific ensemble models and incidence was estimated using mortality estimates and modelled mortality-to-incidence ratios (MIRs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the standard life expectancy at the age of death. Prevalence was estimated using survival estimates modelled from MIRs and multiplied by sequelae-specific disability weights to estimate years lived with disability (YLDs). Disability-adjusted life-years (DALYs) were estimated as the sum of YLLs and YLDs. Estimates are presented globally and by geographical and resource groupings, and all estimates are presented with 95% uncertainty intervals (UIs). Globally, in 2023, there were an estimated 377 000 incident childhood cancer cases (95% UI 288 000-489 000), 144 000 deaths (131 000-162 000), and 11·7 million (10·7-13·2) DALYs due to childhood cancer. Deaths due to childhood cancer decreased by 27·0% (15·5-36·1) globally, from 197 000 (173 000-218 000) in 1990, but increased in the WHO African region by 55·6% (25·5-92·4), from 31 500 (24 900-38 500) to 49 000 (42 600-58 200) between 1990 and 2023. In 2023, age-standardised YLLs due to childhood cancer were inversely correlated with country-level Socio-demographic Index. Childhood cancer was the eighth-leading cause of childhood deaths and the ninth-leading cause of DALYs among all cancers in 2023. The percentage of DALYs due to uncategorised childhood cancers was reduced from 26·5% (26·5-26·5) in GBD 2017 to 10·5% (8·1-13·1) with the addition of the nine new cancer causes. Target cancers for the WHO Global Initiative for Childhood Cancer (GICC) comprised 47·3% (42·2-52·0) of global childhood cancer deaths in 2023. Global childhood cancer burden remains a substantial contributor to global childhood disease and cancer burden and is disproportionately weighted towards resource-limited settings. The estimation of additional cancer types relevant in childhood provides a step towards alignment with WHO GICC targets. Efforts to decrease global childhood cancer burden should focus on addressing the inequities in burden worldwide and support comprehensive improvements along the childhood cancer diagnosis and care continuum. St Jude Children's Research Hospital, Gates Foundation, and St Baldrick's Foundation.
The global prevalence of obesity and diabetes continues to rise, with metabolic-bariatric surgery recognised as an effective intervention for obesity and type 2 diabetes, offering potential for type 2 diabetes remission and improved glycaemic control. This guideline, developed by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP), provides recommendations for the management of diabetes in individuals undergoing metabolic-bariatric surgery. It emphasises the importance of multidisciplinary care and individualised treatment plans to optimise outcomes. Key recommendations include pre-operative glycaemic optimisation, targeting HbA1c <69 mmol/mol (<8.5%) where safe to do so, prevention of hypoglycaemia throughout all phases of care and providing a framework for medication adjustments during the liver reduction diet (LRD), peri-operative and post-operative phases. For type 2 diabetes, oral and non-insulin therapies such as metformin, DPP4 inhibitors and GLP-1 based therapies may be continued during LRD, while sulfonylureas, meglitinides and SGLT2 inhibitors should be discontinued to reduce the risk of hypoglycaemia. For those with type 2 diabetes on insulin, doses should be reduced by 35%-50% during LRD and adjusted post-operatively based on individual glycaemic control. To prevent diabetic ketoacidosis (DKA) in those with type 1 diabetes, insulin must never be stopped and careful planning with diabetes teams is essential. Post-operatively, regular glucose monitoring, hypoglycaemia surveillance, medication adjustments, and follow-up with diabetes specialists are recommended. This document serves as a guide for clinicians and service commissioners, aiming to improve inpatient diabetes care and outcomes for individuals undergoing metabolic-bariatric surgery.
The management of drug-use associated endocarditis (DUA-IE) has historically been piece-meal with variable involvement of multiple specialties - cardiology, addictions medicine, infectious disease, surgery and others. The literature was reviewed and combined with the writing group's insights from years of clinical experience to come up with recommendations for care. In this review, the potential benefits of providing holistic, person-centered, multidisciplinary care to these patients are discussed. The diagnosis of a patient with DUA-IE provides an opportunity to not only treat their presenting condition, but to screen for co-infections, address socioeconomic barriers, and connect with longitudinal care. Moreover, there is an ongoing paradigm shift towards the use of partial-oral antibiotic regimens which may reduce barriers to access and adherence for this population. Variability in whether surgery is offered for persons who inject drugs exists, especially in relation to first expecting abstinence, however this is a non-evidence-based criterion to determine operative candidacy. Decisions around timing and type of surgical intervention should be made systematically with the support of a multi-disciplinary team to avoid bias and achieve the best possible clinical outcome. Regarding management of substance use, data exists to support harm reduction strategies including provision of sterile substance use equipment, opioid agonist therapy, overdose prevention, take-home naloxone programs, drug checking services, and supportive housing programs. The mobilization of a multi-disciplinary endocarditis team is fundamental for providing the best possible care, which should be individualized.