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While the physiological and transcriptional response of the host to biotic and abiotic stresses have been intensely studied, little is known about the resilience of associated microbiomes and their contribution towards tolerance to these stresses. We evaluated the impact of one such abiotic stress, elevated tropospheric ozone (O3), under open-top chamber field conditions on host susceptibility and phyllosphere microbiome associated with pepper cultivars resistant and susceptible toXanthomonas. Pathogen challenge resulted in distinct microbial community structures in both cultivars under an ambient environment. Elevated O3alone affected microbial community structure associated with resistant cultivar but not the susceptible cultivar, indicating the role of host genotypic background in response to abiotic stress. Elevated O3did not influence overall host susceptibility but did increase disease severity on the resistant cultivar, indicating a possible compromise in the resistance. Interestingly, combined stress resulted in a shift in microbial composition and structure like that observed with pathogen challenge alone. It indicates the possible prioritization of community response towards the most significant stress and pathogen being most influential regardless of the cultivar. Despite community composition differences, overall functional redundancy was observed in the phyllosphere community. To gain insights into community-level interactions, network topology assessment indicated a stable network with enhanced taxon connectedness upon pathogen challenge. However, an observation of destabilized random network with a shift in hub taxa in the presence of combined stress warrants future studies on the consequences of such unstable microbial communities on host response to pathogens in the face of climate change.

Globally the SARS-CoV-2 pandemic has posed significant challenges in the delivery of clinical care, in part owing to the lack of an evidence base for treatment and formalised patient care pathways. Guidelines have been published on the technical protocol for surgical tracheostomy in SARS-CoV-2 patients [2], however it is important to also focus on the pre-operative referral process. In order to make assertions on whether tracheostomy may have aided weaning, it would be necessary to implement formal, standardised methods of patient selection and record variables that may allow eventual patient prognostication. With a view to address this issue we have established a COVID-19 tracheostomy referral pathway based on work by The British Laryngological Association (BLA) and multidisciplinary stakeholders at Barts Health NHS Trust (see online Appendix 1) [3].

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time.

With services continuing to dominate the gross domestic product, the marketing and advertising of services remain a core issue in the discipline. Because of their generally intangible nature, however, services often face unique challenges in developing effective and appropriate advertising strategies. Given the importance of promotional decisions to service practitioners, an assessment of the current literature guiding services-advertising decisions is important. In 1997, Carolyn Tripp published an overview of the services-advertising literature covering a 15-year period corresponding to services-marketing9s emergence and early development. Her overall conclusion was that the services-advertising literature lagged behind the services-marketing field in general. As a result, she proposed several specific areas that needed attention and suggestions for enhancing the quality of research on services advertising. In this paper, we provide an update to this research by identifying, classifying, and analyzing articles on services advertising that have been published since 1997. Although a number of services-advertising articles seem to have heeded Tripp9s various concerns, there is still much to be done on the topic. Hence, we provide additional direction for needed areas of research in the area of services advertising.

Department of Radiology, University College London Hospital, London, UKIntroduction:Interstitialphotodynamictherapyremainsan attractive remedial option in minimally invasivesurgery. Our aim in this prospective study was to evaluatethe outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients’ reports on quality of life withclinicalandradiologicalevaluationwerethemainendpointparameters used to assess the outcome.Materials and Methods: Sixty-eight patients werereferredtotheUCLHHeadandNeckCentre fortreatmentof various deep-seated pathologies involving the head andneckregion,upperandlowerlimbs.Allpatientsunderwentinterstitial photodynamic therapy under general anaes-thesia, using 0.15mg/kg mTHPC as the photosensitisingagent.Followingtreatment,patientswerefollowed-upforamean of 7 months.Results: All three patients who presented with visualproblemsreportedimprovementaftertreatment.Also,14/17patients reported improvement of breathing. Improvementof swallowing was reported by 25/30 patients; while speak-ing improvement was evident in 16/22 patients and 33/40reported reduction in the disfigurement caused by theirpathology. All five patients with impeded limb functionreported some degree of improvement. Clinical assessmentshowed that half of the patients had ‘good response’ to thetreatmentandathirdreported‘moderateresponse’withtwopatients being free of disease. Radiological assessmentcomparingimaging6-weekpost-PDTtothebaselineshowedstable pathology with no change in size in 13 patients,minimal response in 18 patients, moderate response in23 patients and significant response in 11 patients.Conclusion: This study on 68 patients with deep-seatedpathologies undergoing interstitial photodynamic therapyprovided evidence that PDT can be the fourth modalityin the management of tissue disease. Lasers Surg. Med.41:612–621, 2009. 2009 Wiley-Liss, Inc.Key words: photodynamic therapy; ultrasound; headand neck; cancer treatment; tumour; vascular malforma-tion; hamartoma; interstitialINTRODUCTIONPhotodynamic therapy (PDT) remains an attractiveremedial option in oncology. In principle, light applicationto the target tissue leads to a non-thermal photochemicalreaction; this is usually initiated some hours following theadministrationofthephotosensitiser andleadstoselectivedamage to the target tissue. The efficacy of the treatmentdepends on the type and the concentration of the photo-sensitiser, light dose, fluence rate, the availability ofoxygen and cellular localisation. Several photosensitisersare currently being tested for better specificity of targettissue [1–3].Two generations of photosensitisers are currently beingused in oncological practice. Profimer sodium (Photofrin-first generation) is commonly used in Barrett’s high-gradedysplasia, cervical, gastric, oesophageal, endobronchialandpapillarybladdercancers.While5-aminolevulinicacid(5-ALA), a natural heme precursor, has been successfullyapplied in basal cell carcinoma, actinic keratosis and oraldysplasia. mTHPC (Foscan) a much more potent secondgeneration photosensitiser for cancer treatment, whencompared to Photofrin and ALA, is commonly used in headand neck cancer. Third generation photosensitisers (tinethyl etiopurpurin, mono

Photodynamic therapy, the fourth oncological intervention modality has proved its successfulness in the management of variety of pathologies involving the human body. Our aim in this prospective clinical study was to evaluate the outcome following ultrasound-guided iPDT of pathologies involving the head and neck region as well as the upper and lower limbs. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.

Interstitial photodynamic therapy remains an attractive remedial option in minimally invasive surgery. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided iPDT of deep-seated pathologies. Patients' reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.Sixty-eight patients were referred to the UCLH Head and Neck Centre for treatment of various deep-seated pathologies involving the head and neck region, upper and lower limbs. All patients underwent interstitial photodynamic therapy under general anaesthesia, using 0.15 mg/kg mTHPC as the photosensitising agent. Following treatment, patients were followed-up for a mean of 7 months.All three patients who presented with visual problems reported improvement after treatment. Also, 14/17 patients reported improvement of breathing. Improvement of swallowing was reported by 25/30 patients; while speaking improvement was evident in 16/22 patients and 33/40 reported reduction in the disfigurement caused by their pathology. All five patients with impeded limb function reported some degree of improvement. Clinical assessment showed that half of the patients had 'good response' to the treatment and a third reported 'moderate response' with two patients being free of disease. Radiological assessment comparing imaging 6-week post-PDT to the baseline showed stable pathology with no change in size in 13 patients, minimal response in 18 patients, moderate response in 23 patients and significant response in 11 patients.This study on 68 patients with deep-seated pathologies undergoing interstitial photodynamic therapy provided evidence that PDT can be the fourth modality in the management of tissue disease.

This unusual case of a facial injury caused by being shot with a diver's harpoon gun highlights the importance of good radiological assessment and careful planning before removal of the harpoon, and emphasises the need to control the barb.

s / British Journal of Oral and Maxillofacial Surgery 52 (2014) e43–e74 e61 bone from a previous project. Multidirectional mechanical tests were performed on the various designs of titanium cell structures (n=80). The predictability and quality of manufacturing was assessed statistically and also with scanning electron microscope (SEM). The results demonstrated structures matching the mechanical properties of bone and even anisotropy as our results suggest 3 GPa elasticity. This allows the possibility to build regenerating bone with predictable properties. In addition, predictable patterning unlike etching and sandblasting of microscopic (nano) features found to be significant and non homogenous simple repetitive patterns provide better cellular response. The benefit that tissue engineering techniques offer is decreased morbidity, relative independence from donor site, with a highly specific and customized shape. Titanium based reconstruction constructs seems to offer an alternative future for bony reconstruction. http://dx.doi.org/10.1016/j.bjoms.2014.07.059

The management of base of tongue carcinoma continue to be a major challenge in head and neck oncology. Our aim in this prospective study was to evaluate the outcome following ultrasound-guided interstitial photodynamic therapy (US-iPDT) of stage IV tongue base carcinoma. Patients’ reports on quality of life with clinical and radiological evaluation were the main end point parameters used to assess the outcome.