Influence of lip position on esthetics perception with respect to profile divergence using silhouette images.

BACKGROUND: The aim of the study was to determine the facial divergence and lip position combinations that are most and least preferred, and to investigate whether age or gender has an impact on these preferences. METHODS: The current investigation was carried out on a sample of 1077 individuals who were not experts in the field (253 men and 824 females). The research employed black silhouette photographs of profiles featuring different lip locations and profile divergences. The recruitment of participants was conducted in order to assess the attractiveness of the profiles, employing a Likert scale. The various positions of the lips and variations in facial profiles were thoroughly categorized. Results were analyzed using the Chi-square test. RESULTS: The findings of the research demonstrated that aesthetic perceptions displayed diversity when considering different lip locations and profile divergences. It was shown that neutral lip positions were predominantly favored, accounting for approximately 40.2% of the total frequencies in the anterior diverging group. It is noteworthy to highlight the aesthetically pleasing features exhibited by those with the most prominent lip position, occurring at a frequency of 10.9% in straight-diverging group. In the posterior divergent group, the most protruded lip position, showed very attractive aesthetics with frequency (7.1%). Gender, age, region, and level of education had significant influence on aesthetic perception. CONCLUSIONS: The variety of aesthetic preferences is influenced by the location of the lips and the divergence of the facial profile, resulting in different outcomes within the categories of anterior, straight, and posterior divergence. Clinicians are advised to customize the treatment regimen in order to correspond with the unique desires and preferences of the patient.

A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone.

BACKGROUND: Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. No direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs in patients commencing T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. PATIENTS AND METHODS: Patients with human epidermal growth factor receptor 2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinicopathological information, prior treatment, the presence or absence of central nervous system (CNS) disease, outcomes and treatment-emergent adverse events (TEAEs) were recorded. RESULTS: Twenty-nine female patients, with a median age of 52 years (interquartile range 44-62 years), were identified; the prevalence of BM was 41%. Median number of lines of prior therapy was 2 (range 2-6). At a median follow-up of 13.8 months, median progression-free survival (PFS) for the overall population was 13.9 months [95% confidence interval (CI) 12.4 months-not estimable (NE)], 16.1 months (95% CI 15.1 months-NE) for active BMs and 12.4 months (95% CI 8.3 months-NE) for progressive extracranial disease alone. The 12-month overall survival (OS) rate was 74% (95% CI 59% to 95%) in the overall population, and 83% (95% CI 58% to 100%) and 66% (95% CI 45% to 96%) for active BMs and extracranial disease only, respectively. Most common TEAEs were fatigue, alopecia, and constipation. In nine patients (31%, including two deaths), pneumonitis occurred. CONCLUSION: In this real-world population, we demonstrate T-DXd to be effective in patients with active BMs and those with progressive extracranial disease alone. PFS and OS were numerically longer in those with active BMs. These data demonstrate that patients with active BM treated with T-DXd have at least comparable outcomes to those with extracranial disease alone. The high rate of pneumonitis warrants further consideration.

Tweaking the Small Non-Coding RNAs to Improve Desirable Traits in Plant.

Plant transcriptome contains an enormous amount of non-coding RNAs (ncRNAs) that do not code for proteins but take part in regulating gene expression. Since their discovery in the early 1990s, much research has been conducted to elucidate their function in the gene regulatory network and their involvement in plants' response to biotic/abiotic stresses. Typically, 20-30 nucleotide-long small ncRNAs are a potential target for plant molecular breeders because of their agricultural importance. This review summarizes the current understanding of three major classes of small ncRNAs: short-interfering RNAs (siRNAs), microRNA (miRNA), and transacting siRNAs (tasiRNAs). Furthermore, their biogenesis, mode of action, and how they have been utilized to improve crop productivity and disease resistance are discussed here.

Abiotic Stress Tolerance in Plants: Brassinosteroids Navigate Competently.

Brassinosteroid hormones (BRs) multitask to smoothly regulate a broad spectrum of vital physiological processes in plants, such as cell division, cell expansion, differentiation, seed germination, xylem differentiation, reproductive development and light responses (photomorphogenesis and skotomorphogenesis). Their importance is inferred when visible abnormalities arise in plant phenotypes due to suboptimal or supraoptimal hormone levels. This group of steroidal hormones are major growth regulators, having pleiotropic effects and conferring abiotic stress resistance to plants. Numerous abiotic stresses are the cause of significant loss in agricultural yield globally. However, plants are well equipped with efficient stress combat machinery. Scavenging reactive oxygen species (ROS) is a unique mechanism to combat the deleterious effects of abiotic stresses. In light of numerous reports in the past two decades, the complex BR signaling under different stress conditions (drought, salinity, extreme temperatures and heavy metals/metalloids) that drastically hinders the normal metabolism of plants is gradually being untangled and revealed. Thus, crop improvement has substantial potential by tailoring either the brassinosteroid signaling, biosynthesis pathway or perception. This review aims to explore and dissect the actual mission of BRs in signaling cascades and summarize their positive role with respect to abiotic stress tolerance.

The EDN1 Missense Variant rs5370G > T Regulates Adaptation and Maladaptation under Hypobaric Hypoxia.

Endothelin 1 (EDN1) encodes a potent endogenous vasoconstrictor, ET1, to maintain vascular homeostasis and redistribution of tissue blood flow during exercise. One of the EDN1 missense polymorphisms, rs5370 G/T, has strongly been associated with cardiopulmonary diseases. This study investigated the impact of rs5370 polymorphism in high-altitude pulmonary oedema (HAPE) disorder or maladaptation and adaptation physiology in a well-characterized case-control study of high-altitude and low-altitude populations comprising 310 samples each of HAPE-patients, HAPE-free controls and native highlanders. The rs5370 polymorphism was genotyped, and the gene expression and plasma level of EDN1 were evaluated. The functional relevance of each allele was investigated in the human embryonic kidney 293 cell line after exposure to hypoxia and computationally. The T allele was significantly more prevalent in HAPE-p compared to HAPE-f and HLs. The EDN1 gene expression and ET1 bio-level were significantly elevated in HAPE-p compared to controls. Compared to the G allele, the T allele was significantly associated with elevated levels of ET-1 in all three study groups and cells exposed to hypoxia. The in silico studies further confirmed the stabilizing effect of the T allele on the structural integrity and function of ET1 protein. The ET1 rs5370 T allele is associated with an increased concentration of ET-1 in vivo and in vitro, establishing it as a potent marker in the adaptation/maladaptation physiology under the high-altitude environment. This could also be pertinent in endurance exercises at high altitudes.

Automatic Plane of Minimal Hiatal Dimensions Extraction From 3D Female Pelvic Floor Ultrasound.

There is an increasing interest in the applications of 3D ultrasound imaging of the pelvic floor to improve the diagnosis, treatment, and surgical planning of female pelvic floor dysfunction (PFD). Pelvic floor biometrics are obtained on an oblique image plane known as the plane of minimal hiatal dimensions (PMHD). Identifying this plane requires the detection of two anatomical landmarks, the pubic symphysis and anorectal angle. The manual detection of the anatomical landmarks and the PMHD in 3D pelvic ultrasound requires expert knowledge of the pelvic floor anatomy, and is challenging, time-consuming, and subject to human error. These challenges have hindered the adoption of such quantitative analysis in the clinic. This work presents an automatic approach to identify the anatomical landmarks and extract the PMHD from 3D pelvic ultrasound volumes. To demonstrate clinical utility and a complete automated clinical task, an automatic segmentation of the levator-ani muscle on the extracted PMHD images was also performed. Experiments using 73 test images of patients during a pelvic muscle resting state showed that this algorithm has the capability to accurately identify the PMHD with an average Dice of 0.89 and an average mean boundary distance of 2.25mm. Further evaluation of the PMHD detection algorithm using 35 images of patients performing pelvic muscle contraction resulted in an average Dice of 0.88 and an average mean boundary distance of 2.75mm. This work had the potential to pave the way towards the adoption of ultrasound in the clinic and development of personalized treatment for PFD.

Survival analysis for estimating lamb survival up to weaning in Harnali sheep.

The present study was carried out to estimate lamb survival (in days) from birth to weaning under survival analysis using data records from 2057 Harnali lambs born to 134 sires and 623 dams between the period from 2001 to 2020. The weaning age in resourced population was 90 days from birth. The hazard ratio in terms of risk of death up to weaning was determined using Cox proportional hazards model by subjecting some fixed factors such as year of birth, sex of lamb, birth weight (kg), dam's weight at lambing (kg) and dam's age at lambing (years). The overall survivability up to weaning among lambs was 91.59% and Kaplan-Meier estimates of mean survival time up to weaning was 85.77 days. Cox proportional hazard modelling revealed that the hazards of death up to weaning was higher in male lambs [1.66, 95% confidence interval (CI): 1.22-2.26] compared with female lambs [hazard ratio (HR) = 1.00]. It was also observed that the hazards of death (HR = 0.91, 95% CI: 0.88-0.94) had decreasing trends over years. For birth weight (kg), hazard rate was 0.34 (95% CI: 0.25-0.46), which indicated that the risk of pre-weaning mortality was lower as birth weight increases. The weight and age of dams at lambing did not influence the survival time of studied population. The present findings indicated that survival time increased in studied lambs over the years and it could be increased more by giving more emphasis on better litter weight and general health aspects at farm level.

Investigation of cause-specific pre-weaning mortality in Harnali sheep.

Lamb mortality is an important aspect in sheep production system which affects farm profitability worldwide. The aim of the present study was to investigate the causes of pre-weaning mortality (PWM) in Harnali lambs with respect to various associated factors. The data records of 173 lambs which died before 90 days of age (weaning age) out of 2057 lambs born during 2001-2020 year were collected from various registers, and the respective causes of mortality were taken from the post-mortem reports. The association of various factors such as age, sex, period of birth, birth weight of lamb and causes of death with PWM was assessed using chi-square test and log-linear modelling. The results showed that respiratory and digestive diseases were major causes of PWM. The log-linear modelling showed significant (P < 0.05) association of age, sex and period of birth with PWM. In the first month of age, digestive disease was the predominant cause of death; however, with age of lamb advances, respiratory disease was more prevalent. It was also revealed that male lambs (odds ratio (OR) = 0.48, 95% confidence interval (CI) = 0.24, 0.97) had lesser deaths due to respiratory diseases as compared to digestive disease. The reverse scenario was observed in female lambs. The findings of the present study might be helpful for understanding the risks and common causes of PWM in lambs to implement appropriate management practices in order to reduce economic losses to sheep farmers.

Chromatin-Based Transcriptional Reprogramming in Plants under Abiotic Stresses.

Plants' stress response machinery is characterized by an intricate network of signaling cascades that receive and transmit environmental cues and ultimately trigger transcriptional reprogramming. The family of epigenetic regulators that are the key players in the stress-induced signaling cascade comprise of chromatin remodelers, histone modifiers, DNA modifiers and regulatory non-coding RNAs. Changes in the histone modification and DNA methylation lead to major alterations in the expression level and pattern of stress-responsive genes to adjust with abiotic stress conditions namely heat, cold, drought and salinity. The spotlight of this review falls primarily on the chromatin restructuring under severe abiotic stresses, crosstalk between epigenetic regulators along with a brief discussion on stress priming in plants.

RNA Interference for Improving Disease Resistance in Plants and Its Relevance in This Clustered Regularly Interspaced Short Palindromic Repeats-Dominated Era in Terms of dsRNA-Based Biopesticides.

RNA interference (RNAi) has been exploited by scientists worldwide to make a significant contribution in the arena of sustainable agriculture and integrated pest management. These strategies are of an imperative need to guarantee food security for the teeming millions globally. The already established deleterious effects of chemical pesticides on human and livestock health have led researchers to exploit RNAi as a potential agri-biotechnology tool to solve the burning issue of agricultural wastage caused by pests and pathogens. On the other hand, CRISPR/Cas9, the latest genome-editing tool, also has a notable potential in this domain of biotic stress resistance, and a constant endeavor by various laboratories is in progress for making pathogen-resistant plants using this technique. Considerable outcry regarding the ill effects of genetically modified (GM) crops on the environment paved the way for the research of RNAi-induced double-stranded RNAs (dsRNA) and their application to biotic stresses. Here, we mainly focus on the application of RNAi technology to improve disease resistance in plants and its relevance in today's CRISPR-dominated world in terms of exogenous application of dsRNAs. We also focused on the ongoing research, public awareness, and subsequent commercialization of dsRNA-based biocontrol products.

Genetic and non-genetic effects associated with ewe productivity in Harnali sheep.

The objective of the current study was to estimate the genetic parameters for ewe productivity traits of Harnali sheep by examining non-genetic effects. The data records of 440 animals born to 85 sires and 259 dams were collected with respect to various traits such as litter size at birth (LSB), litter weight at birth (LWB), litter size at weaning (LSW), litter weight at weaning (LWW) and age at first lambing (AFL) for the period of 2001 to 2020. Genetic parameters were estimated by fitting a series of animal models using an average information restricted maximum likelihood (REML) algorithm in WOMBAT software. Least-squares analysis revealed significant (P < 0.05) influences of period of lambing, age and weight of ewe at lambing on the studied traits. These results indicated that heavier ewes had significantly higher (P < 0.05) values of litter weight traits than their counterparts. On the basis of likelihood ratio test, the estimates of direct heritability under best model for AFL, LSB, LWB, LSW and LWW were 0.06, 0.18, 0.09, 0.07 and 0.16, respectively. Maternal permanent environment effect made a significant contribution to the LSB trait (0.20). The genetic correlation between litter size and LWW was negative, while the remaining correlations were positive. The present results suggest that selection based on ewe productivity traits will result in low genetic progress and therefore the management role is more important for better gains.

NDK/NME proteins: a host-pathogen interface perspective towards therapeutics.

No effective vaccine is available for any parasitic disease. The treatment to those is solely dependent on chemotherapy, which is always threatened due to development of drug resistance in bugs. This warrants identification of new drug targets. Here, we discuss Nucleoside diphosphate kinases (NDKs) of pathogens that alter host's intra and extracellular environment, as novel drug targets to simultaneously tackle multiple pathogens. NDKs having diverse functions, are highly conserved among prokaryotes and eukaryotes (the mammal NDKs are called NMEs [non-metastatic enzymes]). However, NDKs and NMEs have been separately analysed in the past for their structure and functions. The role of NDKs of pathogen in modulation of inflammation, phagocytosis, apoptosis, and ROS generation in host is known. Conversely, its combined contribution in host-pathogen interaction has not been studied yet. Through the sequence and domain analysis, we found that NDKs can be classified in two groups. One group comprised NMEs 1-4 and few NDKs of select essential protozoan parasites and the bacterium Mycobacterium tuberculosis. The other group included NME7 and the other NDKs of those parasites, posing challenges in the development of drugs specifically targeting pathogen NDKs, without affecting NME7. However, common drugs targeting group 2 NDKs of pathogens can be designed, as NME7 of group 2 is expressed only in ciliated host cells. This review thus analyses comparatively for the first time the structures and functions of human NMEs and pathogen NDKs and predicts the possibilities of NDKs as drug targets. In addition, pathogen NDKs have been now provided a nomenclature in alignment with the NMEs of humans.

Evaluating advanced computing techniques for predicting breeding values in Harnali sheep.

Advanced computing techniques have been used by animal researchers to understand the intricate data structures for deriving the most reliable allusions of populations in order to conserve genetically superior animals. The present attempt was made to evaluate the potential of two advanced techniques, artificial neural networks (ANN) and Bayesian technique (BT), for predicting breeding values (BV) of weaning weight (WWT) using data of 498 lambs born to 41 sires and 173 dams in Harnali sheep for the period from 2014 to 2019. The estimated BV for WWT was initially obtained using univariate animal model under restricted maximum likelihood procedure. ANN using multilayer perceptron with two hidden layers was fitted to training set (75%) of estimated BV to predict BV for test set (25%). Similarly, BT using Markov chain Monte Carlo (MCMC) method was also fitted to similar datasets. The high accuracy of prediction, i.e., correlation between BV and predicted BV, was observed as 0.89 and 0.90 under ANN and BT, respectively. Further, similar ranges of goodness of fit criteria, viz., R2, root mean square error (RMSE), mean absolute error (MAE), and bias, indicated that both ANN and BT had similar prediction ability, which was also confirmed by 10-fold cross-validation. The present study indicated high capability and analogous model adequacy for both techniques that can be exploited in selection programs.

Influence of maternal and additive genetic effects on offspring growth traits in Beetal goat.

The purpose of the present study was to obtain estimates of variance components and genetic parameters for direct and maternal effects on various growth traits in Beetal goat by fitting four animal models, attempting to separate direct genetic, maternal genetic and maternal permanent environmental effects under restricted maximum likelihood procedure. The data of 3,308 growth trait records of Beetal kids born during the period from 2004 to 2019 were used in the present study. Based on best fitted models, the direct additive h2 estimates were 0.06, 0.27, 0.37, 0.17 and 0.10 for birth weight (BWT), weight at 3 (WT3), 6 (WT6), 9 (WT9) and 12 (WT12) months of age, respectively. Maternal permanent environmental effects significantly contributed for 10% and 7% of total variance for BWT and WWT, respectively, which reduced direct heritability by 40 and 10% for respective traits from the models without these effects. For average daily gain (ADG1) and Kleiber ratios (KR1) up to weaning period (3 months) traits, maternal permanent environmental effects accounted for 7% and 8% of phenotypic variance, respectively, and resulted in a reduction of 6.6% and 5.4% in direct h2 of respective traits. For post-weaning traits, the maternal effects were non-significant (p > .05) which indicates diminishing influence of mothering ability for these traits. High and positive genetic correlations were obtained among WT3-WT6, WT6-WT9 and WT9-WT12 with correlations of 0.96 ± 0.25, 0.84 ± 0.23 and 0.90 ± 0.13, respectively. Thus, early selection at weaning age can be practised taking into consideration maternal variation for effective response to selection in Beetal goat.

Caputo SIR model for COVID-19 under optimized fractional order.

Everyone is talking about coronavirus from the last couple of months due to its exponential spread throughout the globe. Lives have become paralyzed, and as many as 180 countries have been so far affected with 928,287 (14 September 2020) deaths within a couple of months. Ironically, 29,185,779 are still active cases. Having seen such a drastic situation, a relatively simple epidemiological SIR model with Caputo derivative is suggested unlike more sophisticated models being proposed nowadays in the current literature. The major aim of the present research study is to look for possibilities and extents to which the SIR model fits the real data for the cases chosen from 1 April to 15 March 2020, Pakistan. To further analyze qualitative behavior of the Caputo SIR model, uniqueness conditions under the Banach contraction principle are discussed and stability analysis with basic reproduction number is investigated using Ulam-Hyers and its generalized version. The best parameters have been obtained via the nonlinear least-squares curve fitting technique. The infectious compartment of the Caputo SIR model fits the real data better than the classical version of the SIR model (Brauer et al. in Mathematical Models in Epidemiology 2019). Average absolute relative error under the Caputo operator is about 48% smaller than the one obtained in the classical case ( ν = 1 ). Time series and 3D contour plots offer social distancing to be the most effective measure to control the epidemic.

A high-throughput RNA-Seq approach to elucidate the transcriptional response of Piriformospora indica to high salt stress.

Piriformospora indica, a root endophytic fungus, augments plant nutrition and productivity as well as protects plants against pathogens and abiotic stresses. High salinity is a major problem faced by plants as well as by microbes. Until now, the precise mechanism of salt stress tolerance in P. indica has remained elusive. In this study, the transcriptomes of control and salt-treated (0.5 M NaCl) P. indica were sequenced via the RNA-seq approach. A total of 30,567 transcripts and 15,410 unigenes for P. indica were obtained from 7.3 Gb clean reads. Overall 661 differentially expressed genes (DEGs) between control and treated samples were retrieved. Gene ontology (GO) and EuKaryotic Orthologous Groups (KOG) enrichments revealed that DEGs were specifically involved in metabolic and molecular processes, such as "response to salt stress", "oxidoreductase activity", "ADP binding", "translation, ribosomal structure and biogenesis", "cytoskeleton", and others. The unigenes involved in "cell wall integrity", "sterol biosynthesis", and "oxidative stress" such as Rho-type GTPase, hydroxymethylglutaryl-CoA synthase, and thioredoxin peroxidase were up-regulated in P. indica subjected to salt stress. The salt-responsive DEGs have shown that they might have a potential role in salt stress regulation. Our study on the salt-responsive DEGs established a foundation for the elucidation of molecular mechanisms related to P. indica stress adaptation and a future reference for comparative functional genomics studies of biotechnologically important fungal species.

Chemical Profiling of Chlorophytum comosum (Thunb.) Jaques by GC-MS/LC-ESIMS and its Antiproliferative Effects on Human Carcinoma Cell Lines.

BACKGROUND: Chlorophytum comosum, popularly known as Spider Ivy, is used as a medicinal plant in traditional Chinese medicine, however, its detailed chemical composition and biological activity are yet unexplored. OBJECTIVE: To carry out the phytochemical investigation on different parts of Chlorophytum comosum using GCMS/ LC-ESI-MS and evaluation of its antioxidant, hemolytic and antiproliferative potential on breast cancer (MCF-7), lung cancer (A549, H1299) and normal lung (L-132) cell lines. METHODS: Chemical constituents from aqueous roots and leaves extracts were identified using LC-ESI-MS/GCMS. The identified compounds were annotated based on the match of mass spectra with the literature using NIST 14 and METLIN databases. Antioxidant activity was studied using DPPH, FRAP and TPC assays. The antiproliferative effects of ethanolic roots and leaves extracts of Chlorophytum comosum were measured by MTT assay on breast cancer (MCF-7), lung cancer (A549 & H1299) and normal lung (L-132) cell lines. The toxicity studies of the extracts were carried out using Hemolysis assay. RESULTS: GC-MS analysis identified 34 metabolites in roots and 17 from leaves, while 17 compounds from roots and 7 from leaves were detected by LC-ESI-MS. Significant antiproliferative effects were observed on the A549 and MCF-7 cancer cell lines with IC50 values ranging from 56.86 µg/ml to 68.68 µg/ml while no marked response was observed against normal cell line L-132. CONCLUSION: Our study represents the first report on the detailed chemical composition and antiproliferative potential of Chlorophytum comosum against lung and breast cancer cell lines.

Comparative transcriptome profiling of rice colonized with beneficial endophyte, Piriformospora indica, under high salinity environment.

The salinity stress tolerance in plants has been studied enormously, reflecting its agronomic relevance. Despite the extensive research, limited success has been achieved in relation to the plant tolerance mechanism. The beneficial interaction between Piriformospora indica and rice could essentially improve the performance of the plant during salt stress. In this study, the transcriptomic data between P. indica treated and untreated rice roots were compared under control and salt stress conditions. Overall, 661 salt-responsive differentially expressed genes (DEGs) were detected with 161 up- and 500 down-regulated genes in all comparison groups. Gene ontology analyses indicated the DEGs were mainly enriched in "auxin-activated signaling pathway", "water channel activity", "integral component of plasma membrane", "stress responses", and "metabolic processes". Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that the DEGs were primarily related to "Zeatin biosynthesis", "Fatty acid elongation", "Carotenoid biosynthesis", and "Biosynthesis of secondary metabolites". Particularly, genes related to cell wall modifying enzymes (e.g. invertase/pectin methylesterase inhibitor protein and arabinogalactans), phytohormones (e.g. Auxin-responsive Aux/IAA gene family, ent-kaurene synthase, and 12-oxophytodienoate reductase) and receptor-like kinases (e.g. AGC kinase and receptor protein kinase) were induced in P. indica colonized rice under salt stress condition. The differential expression of these genes implies that the coordination between hormonal crosstalk, signaling, and cell wall dynamics contributes to the higher growth and tolerance in P. indica-inoculated rice. Our results offer a valuable resource for future functional studies on salt-responsive genes that should improve the resilience and adaptation of rice against salt stress.

The state of bariatric dental care in Australia: a silent disability crisis?

In the absence of dental related guidelines available in Australia specific to obesity and minimal awareness of the clinical implications on local dental practice, bariatric dental care can be perceived as a 'silent disability crisis'. This opinion piece and brief clinical note aims to question and raise awareness amongst dental professionals surrounding the current limited availability of bariatric dental chairs, difficulties in access, the safety of dental care delivery and ethical considerations for the dental management of people with obesity.