Indications and Coverage of Metabolic and Bariatric Surgery: A Worldwide IFSO Survey Comparing Different National Guidelines.

INTRODUCTION: Knowing how metabolic and bariatric surgery (MBS) is indicated in different countries is essential information for the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). AIM: To analyze the indications for MBS recommended by each of the national societies that comprise the IFSO and how MBS is financed in their countries. METHODS: All IFSO societies were asked to fill out a survey asking whether they have, and which are their national guidelines, and if MBS is covered by their public health service. RESULTS: Sixty-three out of the 72 IFSO national societies answered the form (87.5%). Among them, 74.6% have some kind of guidelines regarding indications for MBS. Twenty-two percent are still based on the US National Institute of Health (NIH) 1991 recommendations, 43.5% possess guidelines midway the 1991s and ASMBS/IFSO 2022 ones, and 34% have already adopted the latest ASMBS/IFSO 2022 guidelines. MBS was financially covered in 65% of the countries. CONCLUSIONS: Most of the IFSO member societies have MBS guidelines. While more than a third of them have already shifted to the most updated ASMBS/IFSO 2022 ones, another significant number of countries are still following the NIH 1991 guidelines or even do not have any at all. Besides, there is a significant number of countries in which surgical treatment is not yet financially covered. More effort is needed to standardize indications worldwide and to influence insurers and health policymakers to increase the coverage of MBS.

Curcumin protects against testis-specific side effects of irinotecan.

OBJECTIVE: Irinotecan (IR/CPT-11) is a semisynthetic, water-soluble derivative of the alkaloid camptothecin. It is a topoisomerase I group antineoplastic drug commonly used for the treatment of many cancer types, although it has side effects in tissues such as the testis. Curcumin (CRC) is a polyphenol compound produced from the Indian saffron root; it is used as food colouring and food flavouring. This study examined the testis-specific side effects of IR and the ability of CRC to protect against these side effects. MATERIALS AND METHODS: Forty male Sprague-Dawley rats were used in our study (n = 10). The rats were randomly divided into the following four groups: control, IR, IR + CRC, and CRC. IR 10 mg/kg/day was administered intraperitoneally and CRC 100 mg/kg was administered orally. Blood and testicular samples were collected from rats in all four groups on day 30 after drug administration. Histological, biochemical, and spermatological analyses were conducted. RESULTS: Testis tissue and blood samples were collected from the four groups. Tissue samples from the control and CRC groups demonstrated normal histological appearance on light microscopy. The IR group exhibited the following findings: vascular congestion in the tunica albuginea layer; tubular degeneration and vascular congestion in the interstitial area; oedema, vacuolisation, and luminised cells in the seminiferous tubule; and cells that temporarily stopped dividing at any stage of division in the seminiferous tubule epithelium. In the IR+CRC group, histopathological damage was significantly reduced by CRC treatment. Biochemical analysis showed that the level of thiobarbituric acid reactive substance (TBARS) was significantly increased in the IR group, compared with the other groups. CRC treatment significantly decreased this IR-mediated increase in TBARS level, and the TBARS level in the IR + CRC group approached the level observed in the control group. IR treatment caused significant decreases in glutathione (GSH), superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT) levels. However, CRC administration tended to ameliorate the decreases in GSH, SOD, CAT, and GPx levels. CONCLUSIONS: In this study, IR had some toxic effects in rat testis tissue; these effects were ameliorated by CRC treatment. Further studies are warranted to confirm our results.

Management of mole gun injuries: Review of 19 cases with proposed treatment algorithm.

Injuries caused by mole guns are mostly localized in the hands and characterized by contaminated and necrotic tissues due to the blast effect and a large number of residual foreign bodies in the wound. This study analyzed the medical records of patients' who had hand injuries caused by mole guns and presents our approach through a reconstruction algorithm. Data from 19 consecutive patients who sustained mole gun injuries between March 2015 and May 2019 were reviewed in this retrospective study. Demographics, affected tissues at the injury site, surgical treatment, presence of foreign bodies, and postoperative complications were recorded. A treatment algorithm was created based on the results of this study. Six patients underwent one operation, while the remaining 13 underwent more than one operation. A bone defect was found in four patients, skin and soft tissue defects in six patients, and a neurovascular defect in six patients. Two or less foreign bodies were seen in seven patients. Foreign body removal and debridement procedures are important in the first surgical session. The repair of defectless structures during the same session is also essential. Preparation of the structures with defects that will be repaired 5-7 days later simplifies the secondary surgery.

Influence of static and dynamic cyclic fatigue tests on the lifespan of four reciprocating systems at different temperatures.

AIM: To compare the cyclic fatigue resistance of four reciprocating single-file systems within artificial stainless-steel canals at two temperatures using different kinematics. METHODOLOGY: A total of 240 instruments, Reciproc Blue, Reciproc, WaveOne Gold and WaveOne, (60 of each), were tested at room and intracanal temperature using both a static and a dynamic model (n = 15) in a stainless-steel artificial canal with an inner diameter of 1.5 mm, 60° angle of curvature and 5 mm radius of curvature until fracture occurred. The time to fracture was measured in seconds using a digital chronometer, and data were analysed using one-way analysis of variance and Bonferroni tests. RESULTS: WaveOne instruments had significantly less fatigue resistance compared to that of other systems in all conditions (P < 0.05). Comparison of the results from the static and dynamic models at both temperatures revealed that fatigue resistance was significantly increased in the dynamic model for all the instrument systems (P < 0.05). Temperature did not influence the cyclic fatigue resistance results (P > 0.05). There were no significant differences in the mean length of the fractured fragments of the various instruments tested (P > 0.05). CONCLUSION: WaveOne files had a shorter cyclic fatigue life. The dynamic axial movement extended the cyclic fatigue life, but it did not have any influence on the comparison among the instruments tested in respect of the static test. Temperature did not significantly affect the cyclic fatigue of these nickel-titanium files.

Effect of Various Bleaching Agents on the Surface Composition and Bond Strength of a Calcium Silicate-based Cement.

This study aimed to evaluate the morphological and elemental changes that occur on the surface of calcium silicate-based cement (CSC) and to analyze the bond strength of composite resin to CSC after application of various bleaching agents. One hundred twenty-five CSC blocks (Biodentine) were prepared and randomly divided into five groups according to the bleaching agent applied over the material surface (n=25): SP-DW (sodium perborate-distilled water mixture), SP-HP (sodium perborate-3% hydrogen peroxide [H2O2] mixture), CP (37% carbamide peroxide gel), HP (35% H2O2 gel), and a control group (no bleaching agent). After 1 week, scanning electron microscopy provided an analysis of the surface morphology and elemental composition for 10 specimens from each group. Composite resin was placed at the center of each cement surface in the remaining specimens (n=15). A universal testing machine determined shear bond strength (SBS) and fracture patterns were identified with a dental operating microscope. Data were analyzed using one-way analysis of variance and Tukey HSD tests. The cement surface in the CP and HP groups presented changes in structure and elemental distribution compared with the remaining groups. The former groups exhibited a decrease in the calcium level and an increase in the silicon level and presented significantly fewer SBS values than the remaining groups ( p<0.05). Most failures were adhesive in the CP and HP groups, while they were predominantly cohesive in the remaining groups. The bleaching agents with higher concentration induced deterioration of the cement surface and negatively affected the bond strength of the composite resin to CSC. The use of CSC is recommended as a cervical barrier when intracoronal bleaching is performed with a mixture of sodium perborate with water or 3% H2O2.

Effect of plunger diameter on the push-out bond values of different root filling materials.

AIMS: To evaluate the effect of plunger diameter on the push-out bond strength of different root filling materials to root canal dentine. METHODOLOGY: Freshly extracted human incisors (n=90) were decoronated, and the root canals were enlarged with post drills. Prepared roots were placed into a custom alignment apparatus to embed the roots vertically within self-curing acrylic resin. The specimens were randomly assigned into three groups according to the root filling system used: gutta-percha/AH Plus; Resilon/Epiphany; and fibre-reinforced composite (FRC)/Duolink resin cement. After filling, the specimens were further subdivided according to the diameter of the plunger used to employ the debonding force: 0.75, 1 and 1.25 mm. Intra-radicular bond strength was measured using the push-out test at a cross-head speed of 1 mm min(-1) . The data were analysed statistically using Kruskal-Wallis test with Bonferroni correction at P = 0.05. RESULTS: Regardless of the plunger diameter, FRC yielded the highest bond strength, followed by gutta-percha and Resilon, respectively (P<0.001). In all groups, greater plunger diameter resulted in an apparent increased bond strength, but the differences were only significant in the FRC group, with the 1.25-mm plunger generating higher debonding values compared with that of its 0.75- and 1-mm versions (P<0.001). In the gutta-percha and Resilon groups, the majority of specimens had adhesive failures. Roots filled with FRC exhibited more cohesive failures than those of the other test groups. CONCLUSIONS: Different plunger diameters are associated with significantly different intra-radicular push-out bond strengths of root filling systems.

Fatigue and sleep disturbance in multiple sclerosis.

Considering the association of sleep disturbance and fatigue in multiple sclerosis (MS), we investigated the presence of sleep disturbances that may be related to fatigue by using objective and subjective measures. We included 27 MS patients with fatigue, 10 MS patients without fatigue and 13 controls. The Pittsburgh sleep quality index score showed significant differences between patient groups and controls. Beck depression inventory scores were significantly higher in fatigued than non-fatigued patients. Comparison of patient groups and controls revealed significant differences for time in bed, sleep efficiency index, sleep continuity index, wake time after sleep onset, total arousal index and periodic limb movement arousal index. Our study confirms that MS causes sleep fragmentation in terms of both macro and microstructure. Fatigue in MS could be partially explained by disruption of sleep microstructure, poor subjective sleep quality and depression.