The endothelium solves problems that endothelial cells do not know exist

The endothelium is the single layer of cells that lines the entire cardiovascular system and that regulates vascular tone and blood-tissue exchange, recruits blood cells, modulates blood clotting and determines the formation of new blood vessels. To control each function, the endothelium uses a remarkable sensory capability to continuously monitor vanishingly small changes in the concentration of many simultaneously arriving extracellular activators that each provide cues to physiological state. Here, we suggest that the extraordinary sensory capabilities of the endothelium does not come from single cells but from the combined activity of a large number of endothelial cells. Each cell has a limited, but distinctive, sensory capacity and shares information with neighbours so that sensing is distributed among cells. Communication of information among connected cells provides a system-level sensing substantially greater than the capabilities of any single cell and, as a collective, the endothelium solves sensory problems too complex for any single cell

Bariatric surgery tourism in the COVID-19 era

Background: Since the start of the Covid-19 pandemic primary and secondary health care services in Northern Ireland have observed an increase in the number of patients who have had bariatric surgery outside of the UK. This study sought to estimate the frequency of bariatric surgery tourism and to audit indications, blood monitoring and medical complications.Methods: All primary care centres within the Western Health Social Care Trust (WHSCT) were invited to document the number of patients undergoing bariatric surgery between January 1, 2017 and December 31, 2022. For one primary care centre, patients who underwent bariatric surgery were assessed against the National Institute of Health and Clinical Excellence (NICE) guideline indications for bariatric surgery. In addition, the blood monitoring of these patients was audited against the British Obesity and Metabolic Surgery Society (BOMSS) guidelines for up to two years following surgery. Medical contacts for surgical complications of bariatric surgery were recorded.Results: Thirty-five of 47 (74.5%) GP surgeries replied to the survey, representing 239,961 patients among 325,126 registrations (73.8%). In the six year study period 463 patients had reported having bariatric surgery to their GP. Women were more likely to have had bariatric surgery than men (85.1% versus 14.9%). There was a marked increase in the number of patients undergoing bariatric surgery with each year of the study (p&lt;0.0001 chi square for trend). Twenty-one of 47 patients (44.7%) evaluated in one primary care centre fulfilled NICE criteria for bariatric surgery. The level of three-month monitoring ranged from 23% (for vitamin D) to 89% (electrolytes), but decreased at two years to 9% (vitamin D) and 64% (electrolytes and liver function tests). Surgical complication prevalence from wound infections was 19% (9 of 44). Antidepressant medications were prescribed for 23 of 47 patients (48.9%).Conclusions: The WHSCT has experienced a growing population of patients availing of bariatric surgery outside of the National Health Service. In view of this and the projected increase in obesity prevalence, a specialist obesity management service is urgently required in Northern Ireland.</p

Overcoming restoration barriers in a degraded coastal environment

Restoration techniques that naturally accelerate regeneration by removing ecological barriers, such as limited seed dispersal, could reduce the need for expensive and labour-intensive methods. One potential method to overcome this barrier is the strategic placement of artificial perches in degraded areas. These perches encourage frugivorous birds to fly out from remnant areas to rest and defaecate seed in degraded areas, thereby increasing seed dispersal. This technique has been extensively tested in tropical systems but is yet to be explored in coastal systems. We aimed to determine the success of artificial perches in a degraded coastal environment by investigating: (1) their ability to attract fruit-consuming birds from nearby remnant vegetation; (2) their potential to increase seed rain in comparison to the open landscape, and (3) the seasons in which they are most effective. In this study, nine bird species that consume fruit as part of their diet visited the perches. The most frequent of these visitors were Gymnorhina tibicen (Australian magpie), Acanthagenys rufogularis (spiny-cheeked honeyeater), Sturnus vulgaris (common starling) and Corvus coronoides (Australian raven), which are all greater than 20 cm in size. Smaller fruitconsumers may be less inclined to rest in open areas and risk predation. Artificial perches effectively increased the seed rain of several native fleshy-fruited species in degraded paddocks and were most effective in summer–autumn, when the majority of native species were fruiting. The restoration ability of perches was reduced in some months owing to the abundant defaecation of invasive species. Potential modifications to the restoration technique may overcome this limitation.Victoria E. A. McCarron, David C. Pato